Pre-Block Formative

Question 1

What is a pyogenic granuloma?

Answer 1

An exaggerated healing response

Question 2

A history of a lesion arising at the site of injury suggests what?

Answer 2

A pyogenic granuloma

Question 3

What is a myxoid cyst?

Answer 3

A digitial myxoid cyst (sometimes called a mucous cyst) is a non-cancerous swelling that occurs on the fingers or sometimes toes.

The cyst is often connected to the lining of the finger or toenail joint, and is usually located between the joint and the nail.

Question 4

What is this lesion?

Answer 4

Myxoid cyst

Question 5

What is this lesion?

Answer 5

Myxoid cyst

Question 6

What is a strawberry naevus?

Answer 6

The infantile superficial haemangioma is commonly known as a strawberry naevus (capillary haemangioma).

Clinically, they appear as red, relatively soft, and somewhat irregular in outline.

Question 7

This lesion was on a sun-exposed site of an older person. What is the diagnosis?

Answer 7

Amelanotic melanoma

(melanoma where the malignant cells have little or no pigment)

Question 8

What is a melanocytic naevus?

Answer 8

a.k.a a mole

A common, benign skin lesion due to a local proliferation of melanocytes.

Can get congenital or aquired melanocytic naevi.

Question 9

What are the pathological classifications of melanocytic naevi?

Answer 9

Pathological classification of melanocytic naevi relates to where naevus cells are found in the skin.

1. Junctional naevus
2. Dermal naevus
3. Compound naevus
4. Combined naevus

Question 10

Describe a junctional naevus

Answer 10

A flat mole.

• groups of naevus cells at the junction of the epidermis and the dermis

Question 11

Describe a dermal naevus

Answer 11

A papule, plaque or nodule with a pedunculated, papillomatous or smooth surface.

• groups of naevus cells in the dermis

Question 12

Describe a compound naevus

Answer 12

A central raised area surrounded by a flat patch

• groups of naevus cells at the epidermal-dermal junction as well as within the dermis

Question 13

Describe a combined naevus

Answer 13

Usually a blue naevus and a compound naevus.

• Has two distinct types of mole within the same lesion

Question 14

List some histological features of plaque psoriasis

Answer 14

• epidermal thickening
• absence of granular layer
• presence of parakeratosis
• Munro microabscesses

Question 15

What is pityriasis rosea?

Answer 15

Pityriasis rosea is a viral rash which lasts aprox. 6-12 weeks.

Characterised by a herald patch followed by similar, smaller oval red patches that are located mainly on the chest and back.

Question 16

Who gets pityriasis rosea?

Answer 16

Most often affects teenagers and young adults but can affect males and females of any age

Question 17

How long does pityriasis rosea last?

Answer 17

Clears up in about 6-12 weeks

Pale marks or brown discolouration may persist for a few months in darker-skinned people.

Question 18

How should pityriasis rosea be managed?

Answer 18

Treatment is with emollients and milt to moderate potency topical steroids if required but it will likely resolves in 6-12 weeks

Question 19

What is isotretinoin?

Answer 19

Sold under the brand name: Accutane or Roaccutane

Used in treatment of severe acne

Question 20

What are some important side-effects of oral isotretinoin? (Roaccutane)

Answer 20

• Dry skin
• Photosensitivity
• Altered lipids
• Teratogenicity (most important)

Question 21

List some of the different presentations of psoriasis

Answer 21

• Chronic plaque psoriasis (most common)
• Flexural
• Palmoplantar
• Guttate
• Unstable plaque psoriasis (Koebner phenomeno seen)
• Scalp
• Sebopsoriasis
• Nail
• Erythrodermic

Question 22

What are ash leaf macules associated with?

Answer 22

Tuberous sclerosis

Question 23

What features are used in diagnosis neurofibromatosis?

Answer 23

• Axillary freckling
• Lisch nodules
• Multiple cafe au lait macules
• Sphenoid bone dysplasia

Question 24

What type of hypersensitivity reaction is tested for with IgE tests and prick testing?

Answer 24

Type I

Question 25

What are the clinical features of necrobiosis lipoidica diabeticoru?

Answer 25

Occurs in diabetics.

• occur in both shins (rarely found in other sites)
• symptomatic/tender
• shiny, pale, thinned with telangiectasia
• can ulcerate (ulcers at risk of bacterial infection and delayed healing)

Question 26

What is Auspitz sign?

Answer 26

when adherent psoriatic scales are scraped or picked off pinpoint bleeding occurs

Question 27

What is the Koebnar phenomenon?

Answer 27

describes the appearance of new skin lesions of a pre-existing dermatosis on areas of cuteanous injury in otherwise healthy skin

(psoriasis, vitiligo and lichen planus)

Question 28

What is telogen effluvium?

Answer 28

Telogen effluvium is due to altered hair cycle and mass shedding

Is a common transient problem after childbirth

Question 29

A 63 year old man presents to Dermatology as an urgen referral with a new and changing pigmented lesion on his chest, which you suspect to be a melanoma. What is the most appropriate initial mangement?

Answer 29

The lesion should initially be excised with 2mm margins. Further treatment and size of wider excision depends on initial pathology report.

Question 30

A 60 year old lady with recurrent episodes of rash on the lower legs for 1-2 years. She is overweight with type 2 diabetes, hypothyroidism and hypertension and has recently started a new anti-hypertensive. The rash is itchy and never clears completely.

What are your differential diagnoses for red rash on legs?

What diagnosis best fits this presentation? How would you manage it?

Answer 30

Gravitational/stasis eczema

Prescribe topical agents and fit for compression stockings

Other differenitals to rule out for red rash on legs:

• Cellulitis (bilateral cellulitis is very unusual, and tender rather than itchy)
• Tinea corporis (tends to be unilateral)
• Erythema nodosum (manifests as more discrete tender subcutaneous swellings)
• Vasculitis (purpuric lesions rather than confluent erythema)

Question 31

What is erythema nodosum?

Answer 31

Erythema nodosum is a type of panniculitis, an inflammatory disorder affecting subcutaenous fat.

Question 32

How does erythema nodosum present?

Answer 32

Tender red nodules bilaterally on anterior shins.

(less commonly can affect thighs and forearms)

Accompanied by fever and joint pain.

Question 33

What is pompholyx eczema?

Answer 33

Eczema characterised by an itchy vesicular eruption of the hands, fingers and soles of the feet.

It can be acute, recurrent or chronic.

Question 34

What is the treatment for scabies?

Answer 34

Permethrin cream

Question 35

A 26 year old man presents with a recurrent rash as shown, which tends to follow episodes of herpes simplex labialis.

What is the most likely diagnosis?

a) Eczema herpeticum
b) Bullous pemphigoid
c) Erythema multiforme
d) Bullous impetigo
e) Erythema nodosum

Answer 35

c) Erythema multiforme

Targetoid lesions in association with herpes simplex is consistent with a diagnosis of erythema multiforme, which can be bullous

Question 36

List some risk factors for developing melanoma

Answer 36

• Systemic immunosuppression
• Personal history of melanoma
• Blistering sunburns in childhood
• Giant congenital naevus
• Skin type 1

Question 37

A 28 year old female attends her GP following a holiday to Portugal. After a few days away, she developed an itchy spotty rash which is just starting to settle now after being home for 4 days. She’s otherwise well, with no associated systemic symptoms. She’s going away agan later in the year and is worried the same might happen again.

What is her most likely diagnosis?

Answer 37

Polymorphic light eruption

• Fairly common in females of this age
• Often helped with desensitisation phototherapy

Question 38

Describe the Fitzpatrick skin types in re. to tanning ability

Answer 38

Type I: Always burns, does not easily tan

Type II: Burns easily, tans poorly

Type III: Tans after initial burn

Type IV: Burns minimally, tans easily

Type V: Rarely burns, tans darkly easily

Type VI: Never burns, always tans darkly

Question 39

A 17 year old man with a history of asthma and atopic eczema attended the out of hours GPP as he developed a rash on face which has now extended down to his torso and arms. On examination, you see multiple monomorphic ersosions, however, the patient states that the rash began as small blisters. You notes a small cold sore on his bottom lip. He has a temperature of 38 degrees, feels generally unwell and has flu-like symptoms.

What is the most likely diagnosis?

Answer 39

Diffuse herpes simplex infection (eczema herpecticum) is a recognised complication of atopic eczema and requires emergency management