Dermatology & Plastics

Question 1

Describe acne

Answer 1

Caused by glands under the skin producing too much oil. This can block the pores and cause acne. Unrelated to diet or being unclean - in fact over-washing exacerbates acne.

Question 2

Mx of acne

Answer 2

Conservative: wash BD with mild soap, no picking/ scratching

Medical: benzoyl peroxide, retinoid creams, topical abc, oral abx (lymecycline, oxytetracycline)
COCP
3-6 months treatment

Question 3

Advice for order of applying creams

Answer 3

Emollients - then wait few mins before applying steroids

Question 4

How can eczema differ in Asian/ Black communities?

Answer 4

Extensor surfaces/ discoid

Question 5

Mx infected eczema

Answer 5

Fusidic acid cream (short doses - avoid resistance)

Consider oral fluclox

Question 6

Eczema emergency

Answer 6

Herpeticum - aciclovir and same-day referral

Question 7

Psorasis consideration when taking hx

Answer 7

Cardiovascular/ DM risks

Question 8

First-line psoriasis medical mx

Answer 8

Topical vit D analogue OD +/- potent steroid for 4-8 weeks

Advise that stopping suddenly can cause relapse

Question 9

Names for flat lesions

Answer 9

Macule - patch - telangiectasia

Question 10

Names for raised lesions

Answer 10

Plaque - papule - nodule

Question 11

Names for fluid-filled lesions

Answer 11

Vesicle - bulla - pustule - wheal

Question 12

Triggers for eczema

Answer 12

Endogenous: genetic, stress, female hormones

Exogenous: topical irritants, contact allergens, extremes of temp/ humidity, S.aureus, diet, inhaled allergens

Question 13

What % psoriasis have joint disease?

Answer 13

14%

Question 14

Describe rash of psoriasis

Answer 14

Well-demarcated circular and oval bright red elevated plaques, distributed….

Question 15

Questionnaire for patients with dermatological disease

Answer 15

Dermatology Life Quality Index

Question 16

In whom is guttate psoriasis more common

Answer 16

Young adults 1 month after a strep sore throat

Question 17

What is the name of most common rash that is caused by drugs (or infection)?

Answer 17

Toxic erythema

Question 18

What are the dangerous drug eruptions? Why are they life-threatening?

Answer 18

Toxic epidermal necrolysis
Stevens-Johnson Syndrome

Fragile bullae form revealing red, raw underlying dermis
If mouth involved, hard to ingest anything - treat as burns

Question 19

Which drug can pigment skin grey?

Answer 19

Amiodarone (can take 1 year to go)

Question 20

What are Campbell de Morgan spots?

Answer 20

Cherry angiomas

Question 21

What are dermatofibroma?

Answer 21

Raised papules or nodules that dimple on pushing.
Caused by minor trauma.
Multiple in immunocompromised or SLE

Question 22

What does solar keratosis look like?

Answer 22

Stuck on red/ white
aka acitinic keratosis (can metasisise to SCC)
can be treated with topical treatments

Question 23

What does seberrhoec keratosis look like?

Answer 23

Stuck on black

Question 24

What is the pre-malignant form of SCC

Answer 24

Bowen’s disease (CIS)

Question 25

What does SCC look like?

Answer 25

Non-healing ulcer on sun-exposed skin

Question 26

Mx SCC

Answer 26

excise under LA with clear margins

advanced disease can spread to lymph nodes - FNA if enlarged

Question 27

Most common skin cancer

Answer 27

BCC (80% NMSC) - pearly edges, rarely metastasise

Question 28

What is melanoma in situ?

Answer 28

When all cells are in epidermis

Question 29

ABCDE of melanoma

Answer 29

asymmetry
border irregularity
colour irregularity
diameter (7 mm)
evolving

Question 30

What determines survival in melanoma?

Answer 30

Breslow thickness

Question 31

Ix for melanoma

Answer 31

Excise with 2mm border
SNLB
Bloods
CXR + liver US/ or CT chest, abdo, pelvis

Question 32

What virus is responsible for Kaposi’s sarcoma?

Answer 32

HPV8

Question 33

Which tissue is Kaposi’s a proliferation of?

Answer 33

Connective tissue

Question 34

Location of pemphigus vs pemphigoid

Answer 34

Pemphigus mosly mucous membranes (but can be elsewhere)

Pemphigoid on trunk + limb

Question 35

Lupus pernio vs lupus vulgaris

Answer 35

Pernio: nose - sarcoid
Vulgaris: brownish tubercles - TB

Question 36

Why is SCC common post-renal transplant?

Answer 36

immunosuppression

Question 37

Name of leg ulcer that can transform to SCC

Answer 37

Marjolin

Question 38

Graft vs flap

Answer 38

Graft is skin only

Question 39

Signs of smoke inhalatation

Answer 39

singed nasal hairs, carbon particles in the sputum, hoarseness and elevated carbon monoxide levels in the blood

If there is concern about significant airway injury, anaesthetic input should be sought early, as an endotracheal tube may be required. Swelling of the airway worsens over the first 24-48hrs after acute injury, making intubation much more difficult.

Question 40

which type of tissue most affected by electtrical burns

Answer 40

muscle
(damage less apparent on surface)

may be compartment syndrome

Question 41

Features of second degree burns (partial thickness)

Answer 41

Blisters, severe pain, hypersensitivity and weeping skin

Dermis involved

Question 42

What is Parkland formula?

Answer 42

First 24 hrs = 2-4mL kg of crystalloid (Ringer’s Lactate) × patient weight (kg) × % BSA (area of burn)

Half of this amount should be given in the first 8 hours and the rest over the next 16 hours, but urine output should also guide fluid prescribing.

Monitor urine output and test for myoglobinuria, which can cause acute renal failure.

Question 43

Dressings for burns

Answer 43

Paraffin gauze dressings are a good option in superficial burns and silver nitrate dressings are preferred for deeper ones

Question 44

Parkland Formula

Answer 44

4% x TBSA x kg
50% in first 8 hrs
following 50% in next 16h