Monday [27/9/22]

Question 1

What is folliculitis? [2]

Answer 1

Folliculitis means an inflamed hair follicle due to any cause. The result is a tender red spot, often with a surface pustule.

Folliculitis may be superficial or deep. It can affect anywhere there are hairs, including chest, back, buttocks, arms, and legs. Acne and its variants are also types of folliculitis

Question 1

What is folliculitis due to? [2]

Answer 1

Folliculitis can be due to infection, occlusion (blockage), irritation and various skin diseases.

Question 2

Which medications can cause folliculitis? [3]

Answer 2

Folliculitis may be due to drugs, particularly corticosteroids (steroid acne), androgens (male hormones), adrenocorticotrophic hormone (ACTH), lithium, isoniazid (INH), phenytoin and B-complex vitamins. Treatment with protein kinase inhibitors (epidermal growth factor receptor inhibitors) and targeted therapy for metastatic melanoma (vemurafenib, dabrafenib) nearly always results in folliculitis

Question 3

Conditions that may cause deep seated inflammatory conditions and hair loss? [4]

Answer 3

Certain uncommon inflammatory skin diseases may cause permanent hair loss and scarring because of deep-seated sterile folliculitis. These include:

Lichen planus
Discoid lupus erythematosus
Folliculitis decalvans
Folliculitis keloidalis.

Question 3

Conditions that may cause deep seated inflammatory conditions and hair loss? [4]

Answer 3

Certain uncommon inflammatory skin diseases may cause permanent hair loss and scarring because of deep-seated sterile folliculitis. These include:

Lichen planus
Discoid lupus erythematosus
Folliculitis decalvans
Folliculitis keloidalis.

Question 3

Conditions that may cause deep seated inflammatory conditions and hair loss? [4]

Answer 3

Certain uncommon inflammatory skin diseases may cause permanent hair loss and scarring because of deep-seated sterile folliculitis. These include:

Lichen planus
Discoid lupus erythematosus
Folliculitis decalvans
Folliculitis keloidalis.

Question 3

Conditions that may cause deep seated inflammatory conditions and hair loss? [4]

Answer 3

Certain uncommon inflammatory skin diseases may cause permanent hair loss and scarring because of deep-seated sterile folliculitis. These include:

Lichen planus
Discoid lupus erythematosus
Folliculitis decalvans
Folliculitis keloidalis.

Question 4

Dx for deep-seated folliculitis [1]

Answer 4

Treatment depends on the underlying condition and its severity. A skin biopsy is often necessary to establish the diagnosis.

Question 5

Ix to consider for folliculitis [4]

Answer 5

bacterial skin swab
viral skin swab
skin scraping for mycology
tissue culture

Question 6

Folliculitis treatment [3]

Answer 6

Using antibacterial cleansers to clean the skin. This will limit the amount of bacteria on your skin.
Applying warm towels to your irritated skin to sooth the discomfort.
Using anti-itch creams.

Question 7

What are cavernomas? [2]

Answer 7

Cavernoma are abnormal clusters of vessels with small bubbles (sometimes known as caverns) filled with blood that make them look like a raspberry or blackberry. Cavernomas are also known as cavernous angioma, cavernous haemangioma or cerebral cavernous malformation (CCM).

Question 8

How often do cavernomas occur? [2]

Answer 8

Cavernoma occur in approximately 1 in 200 of the general population.

Many are present at birth but some develop later in life

Question 9

Are cavernomas genetic? [2]

Answer 9

Most cavernoma are not familial, which means they don’t occur in families. A minority, however, (less than 50%) are thought to be the genetic type which means there may be a family history.

If you have more than one cavernoma it is reasonable to suspect a genetic component. If you do have more than one or someone else in your family has been diagnosed with one, then you may be offered or request genetic counselling to evaluate your family’s risk of cavernoma.

Question 10

How often do patients with cavernomas develop Sx? [2]

Answer 10

Some people with cavernomas may have no symptoms and this is a completely incidental finding found when investigating or performing scans for another reason.

Unfortunately, one in three people with cavernomas eventually develop symptoms. These can occur at any age but most often between the ages 20 and 40.

Question 11

What Sx will the patient usually complain of with cavernomas? [4]

Answer 11

Cavernoma are often diagnosed after a person has experienced symptoms including:

A haemorrhage (may be small, but sometimes bigger leading to stroke like symptoms or a new or sudden severe headache)
Seizures (most common first symptom in around 50% of people)
Headaches
Problems such as dizziness, balance problems, slurred speech, double vision and tremors
Limb weakness, numbness, tiredness, visual changes, memory and concentration difficulties.

Question 12

Mx of cavernomas [5]

Answer 12

Each person with a cavernoma is unique.

Symptoms of cavernoma can vary from person to person depending on size, location and the number of cavernomas.

A neurologist or a neurosurgeon can give specific medical advice.

Conservative Management: (this is often recommended) Watch and wait and observe changes, recent haemorrhage or worsening symptoms. A ‘watch and wait’ approach may be recommended; this can include periodic MRI scans to monitor the cavernoma(s).
If this is your management then you should let us know if you develop new symptoms.

Medication: Medicines may be given to help with symptoms for example, control of seizures and headaches. There is no known medication that can treat the cavernoma directly.
All cavernoma present a risk of bleeding. This is known as intracranial haemorrhage (ICH). Some bleeds occur and are not noticed whereas others cause symptoms. If a cavernoma has bled severely or a number of times causing symptoms then your neurosurgeon may offer surgical treatment to remove it. Some cavernoma, however, are in parts of the brain that make removal unfeasible because the risk of surgery is too high.

Treatment of Cavernoma

The decision to treat is made with your neurosurgeon who takes into account your wellbeing and personal wishes.

Surgery: The most common reason for surgery is to reduce the risk and frequency of seizures or if you are having progressive symptoms of stroke.
Surgery is sometimes considered following a bleed. Some cavernoma bleed slowly enough that the body can reabsorb the blood and symptoms resolve with time. Others bleed more profusely and need urgent surgery to remove the blood and the cavernoma. Once a decision is made and discussed with you by your medical team; with your agreement you will be placed on the waiting list for treatment.
A less common treatment options includes ‘Stereotactic radiosurgery’ which is a single concentrated dose of radiation therapy which zaps the cavernoma. Gamma Knife and CyberKnife are a non-invasive type of stereotactic radiosurgery. It is unknown how well either single or multiple cavernomas respond to this form of treatment.
Genetic counselling may be available for some individuals and their families to determine if there is a genetic cause.

Question 13

Mx of cavernomas [5]

Answer 13

Each person with a cavernoma is unique.

Symptoms of cavernoma can vary from person to person depending on size, location and the number of cavernomas.

A neurologist or a neurosurgeon can give specific medical advice.

Conservative Management: (this is often recommended) Watch and wait and observe changes, recent haemorrhage or worsening symptoms. A ‘watch and wait’ approach may be recommended; this can include periodic MRI scans to monitor the cavernoma(s).
If this is your management then you should let us know if you develop new symptoms.

Medication: Medicines may be given to help with symptoms for example, control of seizures and headaches. There is no known medication that can treat the cavernoma directly.
All cavernoma present a risk of bleeding. This is known as intracranial haemorrhage (ICH). Some bleeds occur and are not noticed whereas others cause symptoms. If a cavernoma has bled severely or a number of times causing symptoms then your neurosurgeon may offer surgical treatment to remove it. Some cavernoma, however, are in parts of the brain that make removal unfeasible because the risk of surgery is too high.

Treatment of Cavernoma

The decision to treat is made with your neurosurgeon who takes into account your wellbeing and personal wishes.

Surgery: The most common reason for surgery is to reduce the risk and frequency of seizures or if you are having progressive symptoms of stroke.
Surgery is sometimes considered following a bleed. Some cavernoma bleed slowly enough that the body can reabsorb the blood and symptoms resolve with time. Others bleed more profusely and need urgent surgery to remove the blood and the cavernoma. Once a decision is made and discussed with you by your medical team; with your agreement you will be placed on the waiting list for treatment.
A less common treatment options includes ‘Stereotactic radiosurgery’ which is a single concentrated dose of radiation therapy which zaps the cavernoma. Gamma Knife and CyberKnife are a non-invasive type of stereotactic radiosurgery. It is unknown how well either single or multiple cavernomas respond to this form of treatment.
Genetic counselling may be available for some individuals and their families to determine if there is a genetic cause.

Question 14

What is AFP used for? [2]

Answer 14

Help confirm or rule out a diagnosis of liver cancer or cancer of the ovaries or testicles.
Monitor cancer treatment. AFP levels often go up if cancer is spreading and go down when treatment is working.
See if cancer has returned after treatment.
Monitor the health of people with cirrhosis or hepatitis.

Question 15

Sensitivity and specificity of AFP [2]

Answer 15

Four studies with AFP threshold of 200 ng/mL showed the summary sensitivity and specificity of 0.49 (95%CI 0.47–0.50) and 0.98 (95%CI 0.97–0.99), respectively. Forty-six studies with AFP threshold of 20–100 ng/mL showed the summary sensitivity and specificity of 0.61 (95%CI 0.60–0.62) and 0.86 (95%CI 0.86–0.87),

Question 16

Faecal calprotectin test [1]

Answer 16

Used for IBD

Question 17

Specificity and sensitivity for faecal calprotectin [2]

Answer 17

The faecal calprotectin test has a relatively high specificity and sensitivity (approximately 90%) for distinguishing between non-inflammatory bowel disorders (e.g. irritable bowel syndrome) and inflammatory bowel disease (e.g. ulcerative colitis and Crohn’s disease)

Question 18

Limitations of faecal calprotectin [5]

Answer 18

While there is no doubt that faecal calprotectin can be used to separate those with irritable bowel syndrome and inflammatory bowel disease it cannot be relied on as the sole investigation. It helps to fast track those who need urgent endoscopic investigation but it is essential to remember that its use in diagnosing the following causes of diarrhoea has yet to be established:
 Coeliac disease
 Pancreatic exocrine insufficiency
 Microscopic colitis
 Colonic adenomas and colorectal cancers
 Bile salt malabsorption