Questions Flashcards
A 55-year-old male patient presents with several rough, scaly patches on his scalp, forehead, and ears, which are non-tender and non-itchy. He has a history of significant sun exposure over his lifetime.
What is the most likely diagnosis? [1]
What is the most appropriate management for the likely diagnosis? [1]
Actinic keratosis
Tx: Imiquimod
Describe the difference between Eron Class II & III [2]
Class II — the person is either systemically unwell or systemically well but with a comorbidity (for example peripheral arterial disease, chronic venous insufficiency, or morbid obesity) which may complicate or delay resolution of infection.
Class III — the person has significant systemic upset, such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable comorbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromize.
The presentation of a rapidly growing, dome-shaped nodule with a central crust that is tender when palpated is consistent with the diagnosis of []
The presentation of a rapidly growing, dome-shaped nodule with a central crust that is tender when palpated is consistent with the diagnosis of keratoacanthoma
What is the treatment for headlice? [1]
Wet combing or application of dimethicone 4% gel twice, at least 7 days apart
Describe what syndesmophytes are [1]
Syndesmophytes are bony growths originating inside a ligament, commonly seen in ankylosing spondylitis. These develop between vertebrae and contribute to the fusion of the spine (ankylosis), which can lead to the “bamboo spine” appearance on X-ray.
What differentiates a nodule from a papule? [1]
Both raised lesions
Nodule is found in the deeper layers of the skin
Which sign would help indicate a patient has a dermatofibroma? [1]
Positive dimple sign
Describe what is meant by Chondrodermatitis nodularis chronica helicis [1]
a benign inflammatory condition that affects the skin and cartilage of the pinna
What is the treatment for hidradenitis suppurativa? [2]
Tetracycline antibiotics such as lymecycline and doxycycline are often tried initially.
The combination of clindamycin and rifampicin is another option for a 10-week course
Female x spots on jawline
What should you suspect? [1]
PCOS
If you suspected a patient to have pityriasis versicolor, describe how you would quickly investigate? [1]
Can scrape off the fungal Malassezia (mica)
First line treatment for acitinic keratosis? [1]
Cryotherapy or 5-fluorouracil cream
Why should you be concerned if you see a presentation of pemphis vulgaris? [1]
Paraneoplastic disease
BP typically presents in older, frail patients.
Potent topical steroids work well but consideration needs to be given because of the effect of the steroids.
What is an alternative treatment? [1]
doxycycline OD x 3months
Rosacea: a combination of [] + [] is first-line for patients with severe papules and/or pustules
Rosacea: a combination of topical ivermectin + oral doxycycline is first-line for patients with severe papules and/or pustules
[] is the treatment of choice for facial hirsutism
Topical eflornithine is the treatment of choice for facial hirsutism
What is the only method for treating rhinophyma? [1]
CO2 and Erbium YAG lasers
Acitretin is really useful for treating psoriasis.
Which populations can you not give it to? [1]
Females of childbearing age - extremely teratogenic and stays in blood for 3 years
Macular rash that starts on face, that spreads to trunk and limbs. Spares the palms of hands and feet.
Dx? [1]
What other features would indicate this dx? [2]
Measles
- Koplik spots
- Onset of rash coincides with highest fever 40C
Which type of melonoma is most common in pigmented skins? [1]
Acral lentiginous
Which manifestations of psoriasis would indicate a dermatologist referral? [2]
Ocular involvement
Rhinophyma
A diagnosis of actinic keratoses is made. What is the most appropriate first line management?
Topical fluorouracil cream
A man is dx with Basal Cell Carcinoma (BCC).
Which of the following is the most appropriate management?
Radiotherapy
Laser therapy
Mohs micrographic surgery
Sun Cream
Immunosuppressants
A man is dx with Basal Cell Carcinoma (BCC).
Which of the following is the most appropriate management?
Mohs micrographic surgery
- Mohs micrographic surgery involves examining excised tissue under the microscope as it is removed. This ensures all the tumour is removed whilst preserving the maximum amount of healthy tissue possible. It is used in cosmetically sensitive areas, for example near the eye as in this case, and for ill-defined BCCs.
Seborrhoeic dermatitis - first-line treatment is []
Seborrhoeic dermatitis - first-line treatment is topical ketoconazole
- It is thought to be related to an overgrowth of yeast-like fungi from the genus Malassezia, which are part of the normal skin flora.
Difference between lichen planus and lichen sclerosus?
Lichen sclerosus
- usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming
Lichen planus:
- Planus = all the Ps
purple (violaceous), papular, polygonal plaques; have white striae on them (Wickham’s stria)
The most common dermatosis in pregnancy is []
The most common dermatosis in pregnancy is atopic eruption of pregnancy
Describe the ulcers seen in squamous cell carcinoma [4]
typically on sun-exposed sites such as the head and neck or dorsum of the hands and arms
rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding
Pneumonic for drugs that can cause TEN/SJS?
Never Press Skin As It Can Peel
NSAIDs, Phenytoin, Sulphonamides, Allopurinol, IV Ig, Carbamazepine, Penicillins
NB: IV Ig is a treatment not cause
The dermatologist diagnoses scalp psoriasis.
What is the most appropriate management for her new diagnosis?
Oral methotrexate
Phototherapy
Topical betamethasone valerate
Topical vitamin D
GP review in 2 weeks
Topical betamethasone valerate
Scalp psoriasis - first-line treatment is topical potent corticosteroids
Which score is used to assess level of hirsutism? [1]
What scores would indicate a moderate to severe level? [1]
Ferriman-Gallwey scoring system:
- 9 body areas assigned a score from 0-4
- Score > 15 is indicates a moderate to severe level
[Infection] is associated with seborrhoeic dermatitis
HIV is associated with seborrhoeic dermatitis
[Neurological condition] is associated with seborrhoeic dermatitis
Parkinsons Disease
A non-healing painless ulcer associated with a chronic scar is indicative of []
A non-healing painless ulcer associated with a chronic scar is indicative of squamous cell carcinoma (SCC)
Scar x SSC
Which sides (lateral/medial) are venous and arterial ulcers more likely to present on? [2]
vEnous - mEdial
Arterial - lAteral
What is this? [1]
This is a common presentation of a dermatofibroma - they are usually asymptomatic and are often precipitated by an injury to the site, such as an insect bite.
Pityriasis rosea often follows a [] infection
Pityriasis rosea often follows a viral infection
[] is often the most effective treatment for prominent telangiectasia in rosacea
Laser therapy is often the most effective treatment for prominent telangiectasia in rosacea
Oral [] are the first-line treatment for pyoderma gangrenosum
Oral steroids are the first-line treatment for pyoderma gangrenosum
Acne vulgaris in pregnancy - use oral [] if treatment needed
Acne vulgaris in pregnancy - use oral erythromycin if treatment needed
tetracyclines have a risk of teratogenicity
A man has presented with a rash consistent with seborrhoeic dermatitis, which is a particular risk given a past medical history of []. The first-line treatment for this condition is topical ketoconazole.
A man has presented with a rash consistent with seborrhoeic dermatitis, which is a particular risk given a past medical history of [HIV]. The first-line treatment for this condition is topical ketoconazole.
In acute urticaria a sedating antihistamine (e.g. []) may be considered for night-time use for troublesome sleep symptoms
In acute urticaria a sedating antihistamine (e.g. chlorphenamine) may be considered for night-time use for troublesome sleep symptoms
Severe urticaria - A short course of an oral [] may required in addition to a non-sedating antihistamine
Severe urticaria - A short course of an oral corticosteroid may required in addition to a non-sedating antihistamine
Solitary firm papule/nodule that dimples on pinching → []
Solitary firm papule/nodule that dimples on pinching → dermatofibroma
This man has a rhinophyma, a complication of acne rosacea.
Dx? [1]
Usual pattern of disease? [1]
Pemphigoid gestationis
- pruritic blistering lesions
- peri-umbilical region, later spreading to the trunk, back, buttocks and arms
- usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
Dx? [1]
Tx? [1]
Atopic eruption of pregnancy:
it typically presents as an eczematous, itchy red rash.
- no specific treatment is needed
What is a dermoid cyst? [1]
Where are they usually found? [1]
Dermoid cysts are embryological remnants and may be lined by hair and squamous epithelium (like teratomas).
- located in the midline and may be linked to deeper structures resulting in a dumbbell shape to the lesion.
rash worsens after eating spicy food indicates which pathology? [1]
1st line Tx? [1]
Rosacea:
- Topical ivermectin is an appropriate first-line treatment for papulopustular rosacea
The well-defined erythematous plaque with fine scaling is indicative of psoriasis.
How would you treat this patient (Figure 1)?
Ciclosporin is a clear first choice here. The patient is young and healthy, and therefore likely to tolerate the drug well. It has the fastest onset of action of all the options and usually works well for acute guttate psoriasis.
