Dermatology

Question 1

When taking a dermatological history, what aspects should be explored?

Answer 1

Presenting complaint History of presenting complaint Past medical history Family history Social history Drug history Quality of life impact and ICE

Question 2

What aspects of the presenting complaint should be explored?

Answer 2

Nature (rash/lesion) Site Duration and changes

Question 3

What aspects of the history of the presenting complaint should be explored?

Answer 3

Initial appearance and evolution Symptoms (particularly itch/pain) Aggravating and relieving factors Previous and current treatments

Question 4

What aspects of the past medical history should be explored?

Answer 4

Systemic diseases History of atopy Skin cancer Sunburn/sun-bed use Skin type

Question 5

What are the atopic conditions?

Answer 5

Asthma Eczema Hay-fever

Question 6

What system can be used to analyse skin type?

Answer 6

Fitzpatrick skin types

Question 7

What aspects of family history should be explored?

Answer 7

Family history of skin disease (e.g. psoriasis) Family history of atopy Family history of autoimmune disease (e.g. alopecia, vitiligo)

Question 8

What aspects of social history should be explored?

Answer 8

Occupation Sun exposure Exposure to chemicals Improvement of symptoms when away from work

Question 9

What aspects of a drug history should be explored?

Answer 9

Regular and recent drugs Systemic and topical treatments used

Question 10

How should the use of topical treatments be explored?

Answer 10

Where applied? How much? How long for?

Question 11

How should quality of life impact and ICE be explored?

Answer 11

Impact of skin on life Ideas Concerns Expectations

Question 12

When examining the skin what parts should be examined?

Answer 12

All sites, including: Nails Mucosa Hair

Question 13

How should a dermatological examination be conducted?

Answer 13

Inspect Palpate Describe

Question 14

When palpating the skin, what should be assessed?

Answer 14

Flat/raised Warmth

Question 15

What mnemonic can be used to describe the skin?

Answer 15

S - site and distribution/size and shape C - colour A - associated changes M - morphology

Question 16

How can colour be described?

Answer 16

Erythema (blanching redness) Purpura (red or purple non-blanching) Pigmented/hyperpigmented (brown/black) Hypopigmented

Question 17

How can a lesion/rash’s morphology be described?

Answer 17

Macule Papule Patch Plaque Nodule Vesicle Pustule Bulla Annular Wheal Discoid Comedone

Question 18

How does a macule feel on palpation?

Answer 18

Flat

Question 19

How does a papule feel on palpation?

Answer 19

Raised but in a small area

Question 20

How does a patch feel on palpation?

Answer 20

Flat but in a large area

Question 21

How does a plaque feel on palpation?

Answer 21

Raised, but broader than it is high

Question 22

How does a nodule feel?

Answer 22

Like a papule but >1cm

Question 23

What is a vesicle?

Answer 23

A clear fluid filled lesion

Question 24

What is a pustule?

Answer 24

A pus filled lesion

Question 25

What is a bulla?

Answer 25

A large fluid filled lesion

Question 26

What shape is an annualar lesion?

Answer 26

Ring shaped

Question 27

What presents with a wheal?

Answer 27

Urticaria

Question 28

What shape is a discoid lesion?

Answer 28

Coin shaped

Question 29

What forms can a comedone come in?

Answer 29

Open (black head) Closed

Question 30

How can pigmented lesions be assessed?

Answer 30

A - asymmetry B - border C - colour D - diameter E - evolution

Question 31

What surface features can be described?

Answer 31

Scale Crust Excoriation Erosion/ulceration Fissures

Question 32

What is scale?

Answer 32

Built up keratin

Question 33

What is crust?

Answer 33

Dried exudate

Question 34

What is excoriation?

Answer 34

Erosion from scratching

Question 35

What is erosion/ulceration?

Answer 35

Partial/full thickness loss of skin

Question 36

What are fissures?

Answer 36

Cracks

Question 37

What hair findings can be found on examination?

Answer 37

Alopecia Hypertrichosis Hirsuitism

Question 38

What is alopecia?

Answer 38

Alopecia describes hair loss, can be patchy or diffuse

Question 39

What is hypertrichosis?

Answer 39

Excess of hair

Question 40

What is hirsuitism?

Answer 40

Excess androgenic pattern of hair in women

Question 41

What nail findings can be found on examination?

Answer 41

Koilonychia Pitting Onycholysis

Question 42

What is koilonychia?

Answer 42

Spooning of the nails

Question 43

What can koilonychia indicate?

Answer 43

Iron deficiency

Question 44

What disease is pitting of the nails associated with?

Answer 44

Psoriasis

Question 45

What is onycholysis?

Answer 45

Separation of the nail from the nail bed

Question 46

What diseases is onycholysis associated with?

Answer 46

Psoriasis Thyroid disease

Question 47

How common is acne?

Answer 47

Very common

Question 48

When can acne occur?

Answer 48

Infantile (due to maternal hormones in breast milk) Adolescent Adult (12% of women and 5% of men, 5% of both genders will have it for life)

Question 49

What are the risks associated with acne?

Answer 49

Painful Scarring Can have severe psychological affects

Question 50

Where on the body is acne most common?

Answer 50

T-zone of the face Shoulders Chest

Question 51

Describe the pathophysiology of acne

Answer 51

Follicular plugging occurs, causing increased sebum Then become infected by propionobacterium acnes

Question 52

What can cause acne?

Answer 52

Hormones Cosmetics Medication (especially the POCP)

Question 53

When should acne be referred early?

Answer 53

In patients with darker skin types who are more prone to scarring

Question 54

What is another name for eczema?

Answer 54

Atopic dermatitis

Question 55

What symptom is required for an eczema diagnosis?

Answer 55

Itchy

Question 56

Where does eczema typically affect in children?

Answer 56

Face

Question 57

Where does eczema typically affect in adults?

Answer 57

Flexures e.g. cubical fossa and popliteal fossa

Question 58

What do eczema lesions most commonly become infected with?

Answer 58

Staph aureus

Question 59

What can indicate a staph aureus infection in eczema?

Answer 59

One side looks different to the other

Question 60

What is a serious complication of eczema?

Answer 60

Infections with herpes zoster/herpes simplex

Question 61

What does eczema management consist of?

Answer 61

Education and advice Moisturiser Steroids Antibiotics to treat infection

Question 62

What education and advice should be given to eczema patients?

Answer 62

Keep nails short Regular bath/shower (no soaps) Avoid aqueous creams

Question 63

How should eczema patients use moisturisers?

Answer 63

Apply as often as possible, at least 3-4 times/day Use ointments or creams

Question 64

What is another name for moisturisers?

Answer 64

Emollients

Question 65

When are creams more suitable then ointments?

Answer 65

For use in the day as they are less oily

Question 66

What should be done in the case of resistant eczema?

Answer 66

Investigate compliance Consider inadequate steroid treatment Consider infection Consider incorrect diagnosis

Question 67

What is the most common form of psoriasis?

Answer 67

Plaque psoriasis

Question 68

What is the average age of onset for psoriasis?

Answer 68

28

Question 69

Describe the pathophysiology of plaque psoriasis

Answer 69

Increased rate of skin turnover leading to keratin excess

Question 70

What is the normal turnover rate of skin?

Answer 70

23 days

Question 71

What is the turnover rate of skin in plaque psoriasis?

Answer 71

5 days

Question 72

Where does plaque psoriasis typically affect?

Answer 72

Elbows Knees Trunk

Question 73

When can psoriasis look less scaly?

Answer 73

In flexural or genital psoriasis where the sweat makes it look more red and moist

Question 74

What can flexural/genital psoriasis often be confused for?

Answer 74

Fungal infection