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MISCELLANEOUS FACTS FROM PASSMED Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the aetiology of vitiligo?

A

Vitiligo is an autoimmune condition which results in the loss of melanocytes and consequent depigmentation of the skin. It is thought to affect around 1% of the population and symptoms typically develop by the age of 20-30 years.

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2
Q

What are the features of vitiligo?

A

Well demarcated patches of depigmented skin

Peripheries tend to be most affected

Trauma may precipitate new lesions (Koebner phenomenon)

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3
Q

What conditions are associated with vitiligo?

A

Type 1 diabetes mellitus

Addison’s disease

Autoimmune thyroid disorders

Pernicious anaemia

Alopecia areata

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4
Q

How do we treat vitiligo?

A

Sun block for affected areas of skin

Camouflage make-up

Topical corticosteroids may reverse the changes if applied early

There may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients

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5
Q

A 41-year-old man develops itchy, polygonal, violaceous papules on the flexor aspect of his forearms. Some of these papules have coalesced to form plaques. What is the most likely diagnosis?

Lichen planus

Scabies

Lichen sclerosus

Morphea

Psoriasis

A

Lichen planus

Lichen planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common

Lichen sclerosus: itchy white spots typically seen on the vulva of elderly women

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6
Q

A 19-year-old man comes for review after burning himself with an iron. On examination he has a 4 by 3 cm area of pale pink skin the left forearm. In the middle of the area there are two small, fluid filled blisters. What is the most accurate description for this type of injury?

Partial thickness (deep dermal) burn

Partial thickness (superficial dermal) burn

Superficial epidermal burn

Major scald

Minor scald

A

Partial thickness (superficial dermal) burn

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7
Q

A 34-year-old man with a long history of back pain asks you to have a look at his back. He has had a bad back over the last few days which has been helped by analgesia and warmth. His wife has noticed a rash. What is the most likely type of rash?

Pityriasis rosea

Erythema multiforme

Erythema ab igne

Pityriasis versicolor

Cold urticaria

A

Erythema ab igne

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8
Q

A 40-year-old man complains of widespread pruritus for the past two weeks. The itching is particularly bad at night. He has no history of note and works in the local car factory. On examination he has noted to have a number of linear erythematous lesions in between his fingers. What is the most likely diagnosis?

Polyurethane dermatitis

Fiberglass exposure

Cimex lectularius infestation (Bed-bugs)

Scabies

Langerhans cell histiocytosis

A

Scabies

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9
Q

A 34-year-old man with a history of polyarthralgia, back pain and diarrhoea is found to have a 3 cm red lesion on his shin which is starting to ulcerate. What is the most likely diagnosis?

Systemic Shigella infection

Syphilis

Metastatic colon cancer

Erythema nodosum

Pyoderma gangrenosum

A

Pyoderma gangrenosum

This patient is likely to have ulcerative colitis, which has a known association with large-joint arthritis, sacroilitis and pyoderma gangrenosum

Erythema nodosum is also associated with ulcerative colitis but does not tend to ulcerate.

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10
Q

A 22-year-old woman presents due to hypopigmented skin lesions on her chest and back. She has recently returned from holiday in Spain and has tanned skin. On examination the lesions are slightly scaly. What is the most likely diagnosis?

Tinea corporis

Pityriasis versicolor

Porphyria cutanea tarda

Lyme disease

Psoriasis

A

Pityriasis versicolor

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11
Q

A 67-year-old man with a history of Parkinson’s disease presents due to the development of an itchy, red rash on his neck, behind his ears and around the nasolabial folds. He had a similar flare up last winter but did not seek medical attention. What is the most likely diagnosis?

Levodopa associated dermatitis

Seborrhoeic dermatitis

Flexural psoriasis

Acne rosacea

Fixed drug reaction to ropinirole

A

Seborrhoeic dermatitis

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12
Q

A 52-year-old man asks you to look at the side of his tongue. The white patches have been present for the past few months and are asymptomatic. He is a smoker who is known to have type 2 diabetes mellitus. What is the most likely diagnosis?

Candidiasis

Squamous cell carcinoma

Lichen sclerosus

Oral leukoplakia

Geographic tongue

A

Oral leukoplakia

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13
Q

What is a cherry haemangioma?

A

Cherry haemangiomas (Campbell de Morgan spots) are benign skin lesions which contain an abnormal proliferation of capillaries.

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14
Q

In which group of patients are cherry haemangiomas most commonly found in?

A

They are more common with advancing age but affect men and women equally.

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15
Q

What are the features of cherry haemangiomas?

A

Erythematous, papular lesions

Typically 1-3 mm in size

Non-blanching

Not found on the mucous membranes

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16
Q

How do we treat cherry haemangiomas?

A

As they are benign no treatment is usually required.

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17
Q

A 72 year old man attends to discuss laboratory results for nail clippings taken 6 weeks ago. He initially presented with extensive thickening and discolouration of all the nails on his left foot. His past medical history includes type 2 diabetes and hypertension. He is currently well and his repeat medications include metformin, simvastatin and ramipril. The laboratory report confirms onychomycosis. What treatment should you offer him?

Oral terbinafine

Topical itraconazole

Oral fluconazole

Topical amorolofine

Footcare advice

A

Oral terbinafine

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18
Q

What is onychomycosis?

A

Fungal infection of the nail

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19
Q

What are the three main types of fungus that cause onychomycosis?

A

Dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases

Yeasts - such as Candida

Non-dermatophyte moulds

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20
Q

What are the features of onychomycosis?

A

‘Unsightly’ nails are a common reason for presentation

Thickened, rough, opaque nails are the most common finding

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21
Q

What investigations would you do for someone in whom you suspected onychomycosis?

A

Nail clippings sent off to lab

Scrapings of the affected nail sent off to lab

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22
Q

How do we manage someone with onychomycosis caused by dermatophyte infection?

A

Diagnosis should be confirmed by microbiology before starting treatment:

Oral terbinafine is currently recommended first-line with oral itraconazole as an alternative.

6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months

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23
Q

How do we manage someone with onychomycosis caused by candida infection?

A

Diagnosis should be confirmed by microbiology before starting treatment:

Mild disease should be treated with topical antifungals (e.g. Amorolfine)

More severe infections should be treated with oral itraconazole for a period of 12 weeks

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24
Q

A 25-year-old man presents with a pruritic skin rash. This has been present for the past few weeks and has responded poorly to an emollient cream. The pruritus is described as ‘intense’ and has resulted in him having trouble sleeping. On inspecting the skin you notice a combination of papules and vesicles on his buttocks and the extensor aspect of the knees and elbows. What is the most likely diagnosis?

Lichen planus

Chronic plaque psoriasis

Henoch-Schonlein purpura

Dermatitis herpetiformis

Scabies

A

Dermatitis herpetiformis

25
Q

A 62-year-old male is referred to dermatology by his GP due to a lesion over his shin. On examination shiny, painless areas of yellow skin over the shin are found with abundant telangiectasia. What is the most likely diagnosis?

Pretibial myxoedema

Necrobiosis lipoidica diabeticorum

Erythema nodosum

Pyoderma gangrenosum

Syphilis

A

Necrobiosis lipoidica diabeticorum

26
Q

What is the differential diagnosis for skin lesions over the skin?

A

Erythema nodosum

Pretibial myxoedema

Pyoderma gangrenosum

Necrobiosis lipoidica diabeticorum

27
Q

What are the characteristic features of erythema nodosum and what are the conditions with which it is associated?

A

Symmetrical, erythematous, tender, nodules which heal without scarring

Causes:

Infection: streptococci, TB, brucellosis

Systemic disease: sarcoidosis, inflammatory bowel disease, Behcet’s

Malignancy/lymphoma

Drugs: penicillins, sulphonamides, combined oral contraceptive pill

Pregnancy

28
Q

What are the characteristic features of pretibial myxoedema and what are the conditions with which it is associated?

A

symmetrical, erythematous lesions

Shiny, orange peel skin

Seen in Graves’ disease

29
Q

What are the characteristic features of pyoderma gangrenosum and what are the conditions with which it is associated?

A

Initially small red papule

Later deep, red, necrotic ulcers with a violaceous border

Idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

30
Q

What are the characteristic features of necrobiosis lipoidica diabeticorum and what are the conditions with which it is associated?

A

Shiny, painless areas of yellow/red skin

Often associated with telangiectasia

Typically on the shin of diabetics

31
Q

Which one of the following conditions is most associated with vitiligo?

Addison’s disease

Asthma

Iron-deficiency anaemia

Toxic multinodular goitre

Type 2 diabetes mellitus

A

Addison’s disease - autoimmune conditions

32
Q

A 32 year old lady presents with hair-loss which she thinks started after the birth of her second child 7 months ago. She is normally fit and well and is not on any regular or over the counter medication. On examination you notice patches of hair loss around her occiput. The skin looks normal and a few short broken hairs are obvious at the edges of two of the patches. What condition is most likely?

Trichotillomania

Alopecia areata

Tinea capitis

Early scarring alopecia

Telogen effluvium

A

Alopecia areata

33
Q

How do we subdivide alopecia?

A

Scarring and non-scarring

34
Q

What are the causes of scarring alopecia?

A

Trauma, burns

Radiotherapy

Lichen planus

Discoid lupus

Tinea capitis - scarring may develop in untreated tinea capitis if a kerion develops

35
Q

What are the causes of non-scarring alopecia?

A

Male-pattern baldness

Drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine

Nutritional: iron and zinc deficiency

Autoimmune: alopecia areata

Telogen effluvium (hair loss following stressful period e.g. surgery)

Trichotillomania

36
Q

What is alopecia areata?

A

Alopecia areata is a presumed autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs

37
Q

How do we manage someone with alopecia areata?

A

Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients.

Other treatment options include:

Topical or intralesional corticosteroids

Topical minoxidil

Phototherapy

Dithranol

Contact immunotherapy

Wigs

38
Q

What are the skin disorders associated with SLE?

A

Photosensitive ‘butterfly’ rash

Discoid lupus

Alopecia

Livedo reticularis: net-like rash

39
Q

Which one of the following best describes the typical distribution of atopic eczema in a 10-month-old child?

Nappy area and flexor surfaces of arms and legs

Face and trunk

Nappy area and trunk

Flexor surfaces of arms and legs

Scalp and arms

A

Face and trunk

40
Q

A 54-year-old man is referred by his GP to the dermatology outpatient department due to a facial rash which has persisted for the past 12 months. On examination there is a symmetrical rash consisting of extensive pustules and papules which affects his nose, cheeks and forehead. What is the most appropriate treatment?

Ciprofloxacin

Isotretinoin

Oxytetracycline

Hydroxychloroquine

Prednisolone

A

Oxytetracycline

Acne rosacea treatment:

Mild/moderate: topical metronidazole

Severe/resistant: oral tetracycline

41
Q

You review a 24-year-old man who has recently presented with large psoriatic plaques on his elbows and knees. You recommend that he uses an emollient to help control the scaling. What is the most appropriate further prescription to use as a first-line treatment on his plaques?

Topical steroid

Topical steroid + topical calcipotriol

Topical coal tar

Topical calcipotriol

Topical dithranol

A

Topical steroid + topical calcipotriol

42
Q

A 54-year-old man presents with a two month history of a rapidly growing lesion on his right forearm. The lesion initially appeared as a red papule but in the last two weeks has become a crater filled centrally with yellow/brown material. On examination the man has skin type II, the lesion is 4 mm in diameter and is morphologically as described above. What is the most likely diagnosis?

Seborrhoeic keratosis

Keratoacanthoma

Pyoderma gangrenosum

Basal cell carcinoma

Malignant melanoma

A

Keratoacanthoma

43
Q

What are the features of a keratocanthoma?

A

Features - said to look like a volcano or crater

Initially a smooth dome-shaped papule

Rapidly grows to become a crater centrally-filled with keratin

44
Q

How do we treat a keratocanthoma?

A

Spontaneous regression of keratoacanthoma within 3 months is common, often resulting in a scar. Such lesions should however be urgently excised as it is difficult clinically to exclude squamous cell carcinoma. Removal also may prevent scarring.

45
Q

A 34-year-old man presents with an itchy rash on his genitals and palms. He has also noticed the rash around the site of a recent scar on his forearm. Examination reveals papules with a white-lace pattern on the surface. What is the diagnosis?

Lichen planus

Scabies

Lichen sclerosus

Morphea

Pityriasis rosea

A

Lichen planus

46
Q

Venous ulceration is most characteristically seen above the:

Lateral malleolus

Greater trochanter

Sacrum

Medial malleolus

Pre-tibial area

A

Medial malleolus

47
Q

What investigations should be done for someone with a suspected venous ulcer?

A

Ankle-brachial pressure index (ABPI) is important in non-healing ulcers to assess for poor arterial flow which could impair healing

48
Q

How do we manage venous ulceration?

A

Compression bandaging, usually four layer (only treatment shown to be of real benefit)

Oral pentoxifylline, a peripheral vasodilator, improves healing rate

Small evidence base supporting use of flavinoids

Little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression

49
Q

What are the cutaneous features of tuberous sclerosis?

A

Depigmented ‘ash-leaf’ spots which fluoresce under UV light

Roughened patches of skin over lumbar spine (Shagreen patches)

Adenoma sebaceum (angiofibromas): butterfly distribution over nose

Fibromata beneath nails (subungual fibromata)
café-au-lait spots* may be seen

50
Q

A 57-year-old woman presents with pruritus. She states she has been gaining weight despite eating less and complains of constant nausea. On examination she is pale. What is the most likely diagnosis?

Liver disease

Hypothyroidism

Diabetes mellitus

Pregnancy

Chronic kidney disease

A

Chronic kidney disease

Pregnancy is unlikely given her age

51
Q

What is lentigo maligna?

A

Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.

52
Q

What is the scientific name for athlete’s foot?

A

Tinea pedis. It is usually caused by fungi in the genus Trichophyton.

53
Q

What are the features of tinea pedis (athlete’s foot)?

A

Typically scaling, flaking, and itching between the toes

54
Q

What are the first line treatments for tinea pedis (athlete’s foot)?

A

Topical imidazole, undecenoate, or terbinafine

55
Q

A 23-year-old female presents with red, thickened skin on the soles. On closer inspection a crop of raised lesions are seen. What is the most likely diagnosis?

Palmoplantar pustulosis

Callus

Idiopathic plantar hidradenitis

Exfoliative keratolysis

Contact dermatitis

A

Palmoplantar pustulosis

56
Q

A 22-year-old man presents with a 3 cm area of hyperkeratotic skin on the heel of his right foot. A number of pinpoint petechiae are seen in the lesion. What is the most likely diagnosis?

Pitted keratolysis

Mosaic wart

Acquired keratoderma

Juvenile plantar dermatosis

Palmoplantar pustulosis

A

Mosaic wart

57
Q

A 15-year-old complains of excessively smelly feet. On examination he has white skin over the sole of the forefoot bilaterally. Small holes can be seen on the surface of the affected skin. What is the most likely diagnosis?

Pitted keratolysis

Mosaic wart

Acquired keratoderma

Juvenile plantar dermatosis

Palmoplantar pustulosis

A

Pitted keratolysis

58
Q

A 72 year-old woman presents to the GP with a large itchy, sore white plaque on her vulva. Upon examination, a diagnosis of lichen sclerosus is made. What is the first line management plan?

Topical tacrolimus

Topical clobetasol propionate

Symptom management with topical imiquimod cream

Surgical excision with access to reconstruction

Symptom management with analgesia

A

Topical clobetasol propionate

Lichen sclerosis is a dermatological condition that affects the vulva. The first line treatment is a strong topical steroid thus the answer is topical clobetasol propionate. In around 4-10% of women with lichen sclerosus, the disease will be resistant to steroids and in this case topical tacrolimus is the next line of treatment however this is only initiated in specialist clinics. Surgical excision with access to reconstruction is the first line treatment in vulval intraepithelial neoplasia but is not appropriate in treatment of lichen sclerosus. Topical imiquimod cream, a treatment for genital warts, has been described as inducing florid lichen sclerosus and as such is not a correct answer. Analgesia would not be sufficient treatment in this patient.

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