Dermatology

Question 1

What is the difference between mild, moderate and severe acne?

Answer 1

Mild - <30 lesions on face
Moderate - total lesions 30-125
Severe - >125 with >5 pseudocysts

Question 2

What is the topical treatment for acne?
Which antibiotics are used first-line? How long should they be used for before changing?
If there is an adequate resonse to treatment, how long should it be continued for?
What is the maintenance treatment for acne?

Answer 2

Topical benzoyl peroxide + retinoid or clindamycin OR azelaic acid
Lymecycline or doxycycline; trial for 3 months
12 weeks
Topical retinoid or azelaic acid

Question 3

If antibiotics and topical treatments are unaffective in acne, what other treatments are available?

Answer 3

Oral isotretinoin

Question 4

What is the differential diagnosis for acne? (3)

Answer 4

Rosacea
Seborrhoeic dermatitis
SLE

Question 5

What symptoms are associated with rosacea? (3)
What is the thickening of the nose called?
How do you differentiate between acne and rosacea?

Answer 5

Blepharitis, conjunctivitis, eyelid oedema
Rhinophyma
Only have comedones in acne (i.e. blackheads)

Question 6

What is the treatment pathway for eczema?

Answer 6

Emollients
Topical steroids
Topicla calcineurin inhibitors e.g. tacrolimus
Phototherapy
Systemic therapy and biologics

Question 7

What are the signs of eczema herpeticum?

Answer 7

Rapidly worsening, grouped vesicles, punched-out lesions

Question 8

What is it called when psoriasis appears at sites of minor trauma?

Answer 8

Koebner’s phenomenon

Question 9

What are the nail abnormalities associsted with psoriasis? (6)

Answer 9

Nail pitting
Onycholysis
Subungal hyperkeratosis
Splinter haemorrhages
Beau's lines
Periungal erythema

Question 10

How long does it take guttate psoriasis to resolve?

Answer 10

3-4 months

Question 11

What is the differential diagnosis for psoriasis?

Answer 11

Sebhorrhoeic dermatitis
Eczema
Lichen planus

Question 12

What scales are used to determine the severity of psoriasis?

Answer 12

PASI

DLQI

Question 13

What is the management pathway for psoriasis?
What systemic therapies are used for psoriasis?

Which potency of steroids should you use for:

1. Scalp, trunk, limbs
2. Face, flexures, genitals

Answer 13

Emollients
Topical steroids + vitamin D analogues
Tar based shampoo for scalp psoriasis
Phototherapy 
Systemics - methotrexate, ciclosporin

1. Potent
2. Weak to moderate

Question 14

How do the following typically present?

1. Squamous cell carcinoma
2. Basal cell carcinoma

Answer 14

1. Rapidly growing, tender and painful nodules which may be ulcerated
2. Slow growing papules which may have a “pearly”, transclucent quality with rolled edges

Question 15

What risk factors can increase the likelihood of developing squamous cell carcinoma? (6)

Answer 15

Immunosuppresion, smoking, sun exposure, HPV, chronic ulcer, genetics

Question 16

What is the topical treatment for pre-malignant forms of squamous cell carcinoma?

Answer 16

5-FU cream

Question 17

How do you evaluate a lesion for melanoma?

Answer 17

Asymemtry
Border (irregular)
Colour (more than one colour)
Diameter (>5mm)
Evolving

Question 18

What is the most common type of melanoma?

Answer 18

Superficial spreading

Question 19

How do you determine the prognosis of melanoma?

Answer 19

Breslow thickness

Question 20

What are the major features suggestive of melanoma in the NICE criteria? (3)
What are the minor features suggestive of melanoma in the NICE criteria? (4)
What score warrants a referral?

Answer 20

Change in shape, irregular shape, irregular colour

7mm or more, oozing, change in sensation, inflammation

3 or more

Question 21

What are systemic causes of itch? (7 categories)

Answer 21

Metabolic - hyperthyroidism, CKD, diabetes
GI - cholestasis
Malignancy
Inflammatory - scleroderma 
Neurological - MS, peripheral neuropathy
Infection - HIV, hepatitis
Medication