Dermatology

Question 1

Single most appropriate diagnostic test for allergic contact dermatitis?

Answer 1

Skin patch testing

Question 2

With what is acanthosis nigricans most commonly associated with?

Answer 2

obesity

Question 3

With which malignancy is thrombophlebitis migrans associated with?

Answer 3

pancreatic cancer

Question 4

With which condition is a “herald patch” associated?

Answer 4

Pityriasis rosea-self limiting rash (up to 2 months)

Question 5

Initial management of lichen sclerosus?

Answer 5

if confident in diagnosis in GP can start 3 month trial of topical dermovate (clobetasol proprionate 0.05%) along with soap substitute and barrier preparation

if not confident in dx/tx failure/considering surgery then r/f to special vulval clinic

Question 6

With which condition might the generalised form of granuloma annulare (often a ring of small firm bumps over back of forearms/hands/feet, may burn/itchy) be associated?

Answer 6

diabetes

Question 7

How is the weighted 7 point checklist used in 2ww referral criteria for suspected melanoma?

Answer 7

For suspicious pigmented skin lesion, score 3 or more-refer.
Major criteria (each score 2):-change in size
-irregular shape
-irregular colour
Minor criteria (each score 1): -oozing
-inflammation
-largest diameter 7mm or more
-change in sensation

Question 8

Drugs that can trigger bullous pemphigoid?

Answer 8

gliptins
diuretics
neuroleptics/antipsychotics

Question 9

1st line tx of bullous pemphigoid?

Answer 9

potent topical corticosteroid e.g. dermovate

oral pred often needed if topical application not feasible
if steroids not tolerated/CI or disease relapsing can give high dose doxycycline (100mg BD)
severe cases may require other immunosuppressants or even IV Ig, rituximab or omilizumab

Question 10

Maximum duration that a potent corticosteroid should be applied to 1 site continuously for in the management of chronic plaque psoriasis?

Answer 10

8 weeks

4 weeks for a very potent corticosteroid

Question 11

How long must pregnancy be avoided for when a patient stops taking acitretin?

Answer 11

2 years

Question 12

Initial tx of hidradenitis suppurativa?

Answer 12

tetracycline Abx e.g. lymecycline or doxycycline

Question 13

1st line tx of comedonal acne?

Answer 13

topical retinoid e.g. adapalene

2nd line-azelaic acid

Question 14

1st line PO Abx for mild to moderate pustular/papular acne not responding to topical tx or widespread?

Answer 14

lymecycline or doxycycline
lymecycline 408mg OD-if not responding after 6/52 switch to doxycycline 100mg OD

combine with topical tx ideally BPO, if not then topical retinoid

if pt does not respond to two types of PO Abx, especially if acne starting to scar, should r/f for consideration of isotretinoin

Question 15

Why should macrolides generally be avoided in acne management?

Answer 15

high levels of P.acnes resistance

but are 1st line in pregnancy and children under 12

Question 16

In which medical condition is isotretinoin contraindicatied?

Answer 16

hyperlipidaemia

Question 17

Key points of Pregnancy Prevention Programme for women on PO isotretinoin or other PO retinoids?

Answer 17

• regular pregnancy tests-exclude pregnancy a few days before treatment, every month during tx and 4 weeks after stopping tx.
• practice effective contraception-for at least 1 month before tx, during tx and for at least 1 month after stopping tx. Advised at least 1 method, ideally 2. POPs not effective.

Question 18

Blood monitoring of patients on isotretinoin?

Answer 18

LFTs and serum lipids before starting tx, at 1 month and then every 3 months

Question 19

1st line tx for chronic plaque psoraisis?

Answer 19

potent topical corticosteroid and Vitamin D analogue, both applied once daily (one in the morning and one in the evening)
for up to 4 weeks as initial tx

if no improvement after 8/52 offer Vit D analogue twice daily, if still no improvement after 8-12/52 offer potent corticosteroid twice daily or coal tar preparation applied once or twice daily

Question 20

Management of scalp psoriasis?

Answer 20

-POTENT topical corticosteroid applied once daily for 4/52, if no improvement then use different formulation of steroid and/or a topical agent to remove scale before applying the steroid e.g. salicylic acid

Question 21

Management of face, flexural and genital psoriasis?

Answer 21

• mild or moderate potency topical corticosteroid applied once or twice daily for maximum of 2 weeks
• if unsatisfactory response or requiring continuous treatment, offer a calcineurin inhibitor BD for up to 4 weeks as 2nd line treatment-only to be prescribed if specialist in managing psoriasis. NICE recommend referral to dermatology if there is treatment failure with steroids.

Question 22

Types of phototherapy used in managing psoriasis?

Answer 22

UVB for guttate and plaque psoriasis

PUVA for plaque or palmo-pustular psoriasis

Question 23

1st line tx for vitiligo?

Answer 23

face-topical tacrolimus ointment (protopic) 0.1% BD for 6 months
extra facial sites-potent topical corticosteroid e.g. mometasone 0.1% cream for 3 months

Question 24

What proportion of children develop atopic eczema if both parents are affected?

Answer 24

80%

60% if 1 parent affected

Question 25

When should a patient with guttate psoriasis be urgently referred to dermatology?

Answer 25

if covers more than 10% of body surface area

Question 26

How long should topical corticosteroids be continued for after flare of eczema has been brought under control?

Answer 26

for a further 48 hours

Question 27

2 different options for maintenance tx of chronic eczema (not involving face, flexural or genital areas?

Answer 27

• step down treatment-topical corticosteroid at lowest potency that controls the eczema, usually step down from potency used in acute flare
• intermittent treatment-weekend therapy or twice weekly therapy-using usual topical corticosteroid

mild topical corticosteroid for face, flexural or genital eczema

Question 28

Ratio of quantity of emollients to steroids in management of eczema?

Answer 28

10:1

Question 29

What investigations are required for all patients presenting with a diffuse alopecia?

Answer 29

FBC, ferritin and TFT

Question 30

Risk if isotretinoin is combined with tetracyclines?

Answer 30

benign intracranial hypertension