Physical Agents

Question 1

Second degree deep burns destroy deep follicular structures

Answer 1

True

Question 2

Frostbite needs rapid rewarming

Answer 2

True

Question 3

Phases of frostbite

Answer 3

1 - cooling
2. -thawing and rewarming
3 - extension of injury
4 - resolution

Question 4

Pernio (chilblains) —> usually women and elderly, children in homes lacking central healing

Answer 4

True

Question 5

Perniosis in children have a longer course

Answer 5

False - older individuals, younger pt improve spontaneously

Question 6

Pernio - erythrocyanotic macules, papules, plaques in which distribution ?

Answer 6

Toes, fingers, ears, nose, heels

Question 7

Histo of perniosis

Answer 7

Dermal oedema
Fluffy perivascular oedema
Superficial and deep lymphohistiocytic infiltrate with peri eccrine accentuation
Infiltrate is predominantly T lymphocytes

Question 8

Associations of perniosis

Answer 8

Poor nutrition
Eating disorders
Haem malignancy
Autoimmune systemic disease (LE)

Question 9

How does actinic prurigo differ from PMLE

Answer 9

Typically early age of onset with involvement of the dorsal nose , lips and conjunctivae

Question 10

PMLE is immediate type hypersensitivity

Answer 10

False, delayed type

Question 11

PMLE is mediated by T helper cells early then T suppressor cells at 72h

Answer 11

True

Question 12

PMLE occurs in as little as 1 minute

Answer 12

False 10 min

Question 13

Priming phenomenon also exists in chronic actinic dermatitis

Answer 13

False, PMLE with delay after exposure usually 6hr or more

Question 14

Action spectrum of PMLE is UVA, UVB and rarely visible light

Answer 14

True

Question 15

DDx PMLE

Answer 15

cutaneous lupus including tumid lupus 
Porphyria (when vesicles involved)
Solar urticaria
Photoexacerbated dermatoses
Photo drug eruption 
Jessner’s lymphocytic infiltrate

Question 16

Provocation testing not usually possible with PMLE

Answer 16

False - can be provoked by irradiating very small areas of skin monochromator

Question 17

PMLE histo

Answer 17

Variable epidermal spongiosis
Superficial and deep perivascular and periappendegeal lymphohistiocytic dermal infiltrate, often with scattered eos and neuts
Significant dermal oedema

Question 18

Actinic prurigo Perennial itchy papules and vesicles during acute flares

Answer 18

True

Question 19

Actinic prurigo most commonly commences in childhood

Answer 19

True

Question 20

Gene involved in actinic prurigo

Answer 20

HLA DRB1*0407

Question 21

Actinic prurigo action spectrum

Answer 21

Usually both UVA and UVB (rarely UVA only)

Question 22

Chronic actinic dermatitis broad spectrum but predominantly UVA

Answer 22

False,UVB

Question 23

Chronic actinic dermatitis occurs seasonally

Answer 23

True

Question 24

Chronic actinic dermatitis is less common in temperate climates

Answer 24

False - more common

Question 25

Pseudolymphomatous changes occur in the setting of chronic actinic dermatitis

Answer 25

True

Question 26

Actinic reticulohistiocytoma has pseudolymphomatous and nodular prurigo-like changes

Answer 26

True

Question 27

Solar urticaria is induced by UVA, visible light and rarely UVB

Answer 27

True

Question 28

10% of CAD resolve spontaneously in 6-7years

Answer 28

False 1-2 years

Question 29

Solar urticaria usually exhibits hardening

Answer 29

False -= does not typically

Question 30

Monochromator testing is particularly useful in solar urticaria

Answer 30

True as get urticarial reaction

Question 31

Hydroa vacciniforme more common in males

Answer 31

True

Question 32

Areas most commonly affected by hydroa vacciniforme

Answer 32

Cheeks, nose, ears, back of hands most commonly affected

Question 33

Hydroa vacciniforme scars painlessly

Answer 33

False- painful

Question 34

UVA wavelengths are implicated in hydroa vacciniforme

Answer 34

True

Question 35

Need to assess immediate and delayed response with monochromator testing

Answer 35

True

Question 36

Hydroa vacciniforme DDx

Answer 36

Hart up disease, EPP, Bullous LE, CTCL (HV-like CTCL reported in children)

Question 37

Hydroa vacciniforme natural course

Answer 37

Usually improves and resolves by later teen years , spontaneous resolution in 60%, mean duration of 9 years

Question 38

Hardening does not help hydroa vacciniforme

Answer 38

False - can do NBUVB in springtime

Question 39

Complications of hydroa vacciniforme

Answer 39

Scarring, ocular complications, cartilage destruction

Question 40

Hydroa vacciniforme aetiology unknown but relates to which virus?

Answer 40

EBV - virus can be found in inflammatory infiltrate in pt with HV in Asia.

Question 41

HV like presentation of T cell lymphoma has been reported in children

Answer 41

True

Question 42

Drugs causing photo onycholysis

Answer 42

Psoralens Tetracyclines PDT Ciprofloxacin

Question 43

What are the types of xanthomas

Answer 43

TV TED (PXP) ``` Tendinous Tuberous Eruptive Dyslipidaemic (includes plane, palmar and xanthelasma) Verruciform xanthoma ```

Question 44

Eruptive xanthoma seen in setting of primary or secondary hypertriglyceridaemia

Answer 44

True