Dermatology Medicine incorrects

Question 1

actinic keratosis learn to identify vs sebhorreic keratosis

Answer 1

sebhorreic keratosis are coloured - brown

Question 2

multiple red brown papules on the back after immunosupression and organ transplantation 3 months ago is most likely?

Answer 2

kaposi sarcoma!!!

scc = sun exposed area and unlikley for multiple in short space of time

Question 3

first line treatment for non inflammatory acne?

treatment for inflammatory acne?

treatment for nodular cystic acne?

Answer 3

topical retinoid = salicylic, azelaic or glycolic acid

mild = topical retinoid + benzoyl peroxide
moderate = add topical antibiotics eg clindamycin, erythromycin
severe = add oral antibioitcs

as inflammatory acne. if severe = oral isotretinoin

Question 4

cold sore last week
patient now has painful blisters and bullae in and around mouth (can also be genital) and on hands

most likely diagnosis?
investigations?

Answer 4

erythema multiforme
clinical diagnosis

Question 5

how does necrobiosis lipoidica present?

Answer 5

pretibial plaque with erythematous border

typically affects diabetics

Question 6

a recurrent puritic, VESICULAR rash affecting the palms and soles and sides of digits that can desquamate

no occupational exposures

most likely diagnosis?

Answer 6

dishydrotic eczema = acute palmoplantar eczema

treatment= emollients, corticosteroids

Question 7

89 YO with purpural lesions, all blood tests platelets clotting normal.

most likley diagnosis?

Answer 7

senile purpura -> perivacular connective tissue atrophy

Question 8

which covers more body surface area? SJS or TEN?

Answer 8

TEN (Ten is 10/10)

(in reality TEN is if >30% of body area involved)

Question 9

pityriasis versicolor treatment?

Answer 9

topical selenium sulfide!!!!!

(or topical terbenafine or topical ketoconazole)

Question 10

which medications can induce lichen planus?

Answer 10

ace inhibitors
thiazide diuretics

(hypertensive meds)

Question 11

28 year old patient with history of lupus. on oral prednisolone, hydroxychloroquine and nsaids

reports 1-3mm erythematous papules on back shoulders and upper arms

what is the most likely cause?

Answer 11

medication adverse effect!!!

drug induced acne!!!! -> common side effect of systemic glucocorticoids!!!!

only resolves when you stop the agent

Question 12

papule with indented centre on the thigh of a 26 YO sexually active woman is most likely molluscum contagiosum

first line treatment?

Answer 12

liquid nitrogen!!! -> cryotherapy

or curettage

or topical cantharidin or podophyllotoxin

Question 13

Erysipelas has sharp RAISED borders vs cellulitis = flat

Question 14

tinea corporis treatment?

Answer 14

TOPICAL antifungal eg terbinafine, fluconazole, miconazole

Question 15

fatigue, elevated LFTS, arthralgias, porphyria cutanea tarda

further evaluation will reveal what underlying condition?

what else could be seen as a result of the condition?

Answer 15

chronic hepatitis C infection

lichen planus, mixed cryoglobulinemia (palpable purpura, glomerulonephritis, low complement levels)

Question 16

sudden severe onset psoriasis may mean what underlying diagnosis?

Answer 16

HIV

Question 17

nummular eczema presentation

Answer 17

roundish plaque - red, puritic, scaly

Question 18

are mucocutaneous blisters present in pemphigus vulgaris or bullous vulgaris

diagnostic investigation?

Answer 18

pemphigus vulgaris!!! -> rupture and form erosions in mouth (pemfeedus)

mucosal involvement is rare in bullous. in addition bullous typically affects patients > 60

skin biopsy

Question 19

both allergic contact dermatitis and sporotrichosis can develop after exposure to plants. describe the difference in symptoms

Answer 19

sporotrichosis = ulcerating NODULES. vesicles and bullae are not characteristic. direct inoculation eg thorn of a plant asymptomatic so not puritic!!!

allergic contact dermatitis - intensely puritic, erythematous, vesicular rash

Question 20

nickle in belts watches and jewelry is a common trigger for allergic contact dermatitis -> region affected mid lower abdomen, earlobes, wrists

in the acute stage bullae, veiscles, but in the chronic stage Lichenification!!! fissuring!!

treatment?

Answer 20

topical corticosteroids and allergen avoidance

Question 21

tinea pedis diagnostic test?

Answer 21

potassium hydroxide microscopy of skin scraping

Question 22

patient out on the beach, an hour in the sun, burning sensation, erythema and vesicles of face, anterior neck, upper chest, dorsal surface of hands and forearms

recently started a treatment for facial acne

most likely cause?

Answer 22

doxcycline induced photosensitivity!!!

other drugs with photosensitive reactions:
-> antibiotics = tetracyclines eg doxy
-> antipsychotics = chlorpromazine, prochlorperazine
-> Diuretics = furosemide, hydroxchlorothiazide
others: amiodarone, promethazine, piroxicam

patients with SJS/TEN typicall y have fever and different causative drugs

Question 23

there are two types of contact dermatitis: allergic contact dermatitis as described previously and irritant contact dermatitis

how does irritant contact dermatitis present? triggers?

Answer 23

fissures, scaly skin on hands, lichenification

soap, detergent, chemicals, acid/alkali
so a job as a janitor is a risk

Question 24

tingling following sun exposure, erythema of face and small papules and pustules are signs of papulopustular rosacea. how do you manage this?

Answer 24

topical metronidazole!!!!!

or azelaic acid or ivermectin

Question 25

seborrheic dermatitis in adults management?

Answer 25

topical LOW potency corticosteroids
topical antifungals

Question 26

ichthyosis vulgaris
second line if emollients dont work?

Answer 26

topical alpha hydroxy acid!!!!
topical urea
topical salicylic acid

Question 27

how does small plaque psoriasis present?

Answer 27

small pustules with overlying silvery scales

seen on the scalp and bilateral dorsal hands

Question 28

bullous pemphigoid 1st line treatment?

Answer 28

high potency topical corticosteroid eg topical clobetasol

Question 29

post pregnancy hair loss

widespread thinning of hair but shafts and scalp appear normal

most likely cause?

Answer 29

Telogen effluvium!!! - diffuse non inflammatory hair loss

stressful events are triggers -> weight loss, pregnancy, major illness or surgery or psychiatric trauma

Question 30

first step in management of a recurrent tinea cruris infection?

Answer 30

examine other parts of the body for autioinfection eg skin between the toes

Question 31

21 YO. painful blisters of palms after golf lessons, foot blisters after hiking

history of oral ulcers as an infant

bullae and erosions on both palms on examination

most likely diagnosis?

Answer 31

epidermollysis bullosa - inherited, triggered by minor trauma

not bullous or pemphigus vulgaris as they do not affect palms and soles and do not manifest in infancy

Question 32

dermatitis herpetiformis management?

Answer 32

dapsone immediate term + gluten free diet

Question 33

white lesions in mouth for last several MONTHS. burning sensation, worse when eating hot or spicy foods. most likely diagnosis?

Answer 33

lichen planus

apthous stomatitis/canker sores. in contrast are acute, lasting only a few days

Question 34

what blood test should be taken in patients with vitiligo?

Answer 34

serum TSH level

risk of autoimmune thyroid disease!!!