DUMS

Question 1

Where are melanocytes derived from?

Answer 1

Neural crest

Question 2

What are the three layers of Keratin (corneocytes)?

Answer 2

Granular
Prickle
Basal

Question 3

What are the two types of sweat gland and what are their function?

Answer 3

Apocrine = armpit + groin (androgen dependent)
Eccrine = normal (everywhere else)

Question 4

What do melanocytes do?

Answer 4

Convert tyrosine to melanin (for light absorption)

Question 5

What are the mechanoreceptors in the skin?

Answer 5

Merkel cells

Question 6

What in the skin senses pressure and vibration?

Answer 6

Pressure = Pacinian corpuscules
Vibration = Meissners corpuscules

Question 7

What type of light is needed for VitD to stimulate Ca absorption from the bowel and mineralisation of bone?

Answer 7

UVB (290-320nm)

Question 8

What is a porphyria?

Answer 8

Inherited genetic condition that causes accumulation of porphyrins in the body (necessary for RBC function)  
Either acute (nervous system) or cutaneous (skin)

Question 9

What are the symptoms of porphyria cutanea tarda?

Answer 9

Burning pain on sun exposure
Blistering on exposed surfaces
Red or brown pee

Question 10

What is Ramsay Hunt syndrome?

Answer 10

Reactivation of Herpes zoster virus (chickenpox/shingles)
Affects facial nerve (facial palsy)
Vesicles and pain in auditory canal and throat (deafness, vertigo, tinnitus)

Question 11

What is used to treat herpes?

Answer 11

Aciclovir

Question 12

What type of herpes causes oral lesions?

Answer 12

HSV type 1

Question 13

What is erythema multiforme?

Answer 13

Target lesions, usually a drug reaction

Question 14

How does molluscs contagiosum present?

Answer 14

Raised pink lesions with a dimple, usually in children, self-limiting

Question 15

What strains of HPV (human papilloma virus) cause genital warts or cervical cancer?

Answer 15

Genital warts: HPV type 6 and 11

Cervical cancer: HPV types 16 and 18

Question 16

What is erythema infectiosum?

Answer 16

Slapped cheek disease (in kids)
From human parvovirus infection
Rash on face followed by lacy macular rash on body

Question 17

How does syphillis present and what is the infecting organism?

Answer 17

T. palladium (sexually transmitted)

Genital, mouth or skin ulcer (small and painless open sore)

Question 18

What are the phases of synphillis infection?

Answer 18

1. Primary infection: small painless ulcer at site of entry (mouth/genital)
2. Secondary phase: red rash all over body, snail track ulcers on mucous membranes
3. Tertiary phase: CNS, CVS involvement

Question 19

What contagious skin condition is associated with care homes and how is it treated?

Answer 19

Scabies

Malathion lotion

Question 20

What drug is used to treat staph aureus infection?

Answer 20

Flucloxacillin

Question 21

What drug is used to treat tinea infections?

Answer 21

Clotrimazole

Question 22

What are the 2 types of necrotising fasciitis?

Answer 22

Type I: mixed anaerobes/coliforms (post abdominal surgery)

Type II: group A strep infection (strep pyogenes)

Question 23

What is the order of treatment of psoriasis?

Answer 23

Emollients,
VitD analogues (calcitriol)
Phototherapy
Systemic therapy (methotrexate)
Biologics (...numab)

(not steroids due to rebound flares)

Question 24

What are black and whiteheads called?

Answer 24

Blackhead: open comedone
Whitehead: closed comedone

Question 25

What is the order of treatment of acne?

Answer 25

Benzoyl peroxide (antibacterial) Retinoid (adapalene - drying effect) Isotretin (may cause an initial flare up)

Question 26

What is the treatment of rosacea?

Answer 26

Topical metronidazole Long term: oral tetracycline (avoid steroids)

Question 27

How do vesicles/bullae appear in pemphigus vs pemphigoid?

Answer 27

Pemphigus vulgaris: flaccid, thin roofed (Superficial) | Bullous pemphigoid: large, tense (deep)

Question 28

What is Nikolsys signs and what type of bullous disease expresses it? What occurs in the other?

Answer 28

Slight rubbing of the skin causes shedding of the outer layer = Pemphigus Pemphigoid = erosions (from bursting of blisters)

Question 29

What disease is an ash leaf macule diagnostic of?

Answer 29

Tuberous sclerosis

Question 30

What is tuberous sclerosis and how may it present?

Answer 30

Genetic mutation causing non-cancerous tumours across many organ systems Presents with facial angiofibromas or infantile seizures

Question 31

What disease presents with cafe au lait spots? What are the more severe manifestations of this disease?

Answer 31

Neurofibromatosis type 1 | Learning difficulties, blindness, skeletal disfigurement, may progress to malignancies

Question 32

How does neurofibromatosis type 2 present?

Answer 32

Bilateral vestibular schwannomas

Question 33

How does a BCC present?

Answer 33

Slow growing lump or non-healing ulcer

Question 34

How does an SCC present?

Answer 34

Crusted lump or ulcer on sun damaged skin | Fast growing and may be painful/bleed

Question 35

What are the precursor lesions to SCC?

Answer 35

Actinic keratoses | Bowen's disease (red/brown plaques on lower legs of elderly males)

Question 36

What scale is used to measure the severity of a melanoma? What is the risk <1mm, >4mm?

Answer 36

Breslow thickness <1mm = 95-100% survival >4mm = 50% survival (mets = 5% survival)

Question 37

What are the growth phases of a melanoma?

Answer 37

Radial growth phase: less invasive | Vertical growth phase: very invasive (risk of mets)

Question 38

What are the different strengths of topical steroid and give an example of each?

Answer 38

Mild: Hydrocortisone Moderate: clobestasone butyrate Potent: betamethasone valerate Very potent: clobetasol propionate

Question 39

How does erythema nodosum commonly present?

Answer 39

Red tender lumps or nodules on both shins, usually young people (12-20) Often have flu-like symptoms and aching joints first Self-resolving within 30 days

Question 40

How does pyoderma gangrenosum commonly present and who gets it?

Answer 40

Deep ulcers usually on the legs that become necrotic (after initial small red papule) Seen with IBD (UC/crohns) and connective tissue disorders

Question 41

What disease is associated with a non-blanching rash?

Answer 41

Henoch-Schönlein purpura