RTS- Dermatology 1

Question 1

The skin is the largest organ in the body, list its functions. (4)

Answer 1

1) barrier
2) acting as a sensory organ
3) protects tissues
4) homoeostatic balance

Question 2

Describe what emollients are and what they are used for. (5)

Answer 2

1) Emollients are moisturising treatments applied directly to the skin to reduce the amount of water loss
2) they cover the skin and form a protective film
3) they help to manage dry or scaly skin conditions
4) they soften cracks in the skin
5) ease itching of the skin

Question 3

outline the four different types of emollients (4)

Answer 3

emollients are available as - creams, ointments, lotions or sprays, both oils and shower products

1) occlusive emollients- create a film over the skin to prevent water evaporating (diprobase)
2) Humectant-containing emollients- contain additives such as urea, propylene glycol and lactic acid to attract and hold water in the top layer of the skin (doublebase)
3) Antipruritic emollients- contain ingredients to prevent/combat itching (Eurax)
4) Antiseptic emollients- contain ingredients to combat/prevent infection (dermol)

Question 4

Explain what topical corticosteroids are and what they are used for. (3)

Answer 4

1) topical steroids are used to treat inflammatory skin conditions.
2) they reduce skin inflammation and skin irritation
3) they help induce remission during a flare up

hydrocortisone acetate 1% cream HC45, clobetasone butyrate 0.05% cream Eumovate.

Question 5

describe how topical corticosteroids are classified and their side effects. (1, 3)

Answer 5

1) Mild, Moderate, Potent, Very potent (last 2 are prescription only). you want to use the least potient one to treat the condition.

side effects

1) skin thinning
2) skin more vulnerable to infection
3) skin changing colour

Question 6

outline the restrictions to corticosteroid sale (5)

Answer 6

patient factors

1) patient must be over 10 years (hydrocortisone), over 12 years (clobetasone)
2) not allowed in pregnancy/ breastfeeding

Treatment duration
3) applied TWICE a day, MAX 7 days use.

Pack size
4) can only sell 15g max at any one time.

site
5) cannot be used on face, anogenital, broken or infected skin.

Question 7

Describe the application of a corticosteroid cream. (3)

Answer 7

The finger tip unit

1) one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adults fingertip.
2) a finger tip is from the very end of the finger to the first crease in the finger.
3) one FTU is enough to treat an area of skin twice the size of the flat of an adults hand.

Question 8

Describe what Antifungals are and how they work. (2)

Answer 8

1) killing the fungal cells: affecting the cell walls, causing the cells to leak out
2) prevent growth: prevent the fungal cells from reproducing.

available: cream, sprays, gels, powders
clotrimazole 1% canesten - athletes foot

Question 9

list the possible causative reasons for a rash. (5)

Answer 9

a rash is a symptom- it is not a disease

1) eczema
2) psoriasis
3) bacterial, viral or fungal infections
4) allergies
5) infestations

Question 10

explain what Atopic eczema is and list some aggravating factors. (1, 8)

Answer 10

1) an allergic condition normally affecting infants and children. patients often have other sensitivities e.g asthma, hay fever. sensitisation occurs leading to an inflammatory response.

aggravating factors:
1) pollen, sweat, detergents/soaps, cosmetics, rubber and latex, dyes and colouring.

Question 11

outline the presenting features of Atopic eczema (9)

Answer 11

1) itching
2) redness
3) inflammation
4) papules
5) rash
6) dry skin
7) scaly skin
8) cracked skin
9) pruritus- itching sensation.

Question 12

describe the treatment for Atopic eczema (2)

Answer 12

1) emollient therapy- apply liberally
2) topical corticosteroid
- not for under 10 years
- not during pregnancy
- not for treatment on face

Question 13

outline the referral criteria and red flag symptoms for Atopic eczema (5, 4)

Answer 13

1) treatment failure
2) presenting on the face
3) child
4) broken skin
5) pregnant or breastfeeding

red flag symptoms:

6) bleeding
7) weeping
8) infection (yellow crusts)
9) non-blanching rash.

Question 14

describe the additional advice you would give to a patient suffering from Atopic eczema (4)

Answer 14

1) avoid triggers
2) certain fabrics can irritate the skin , avoid these. wear : soft, fine-weave clothing or natural materials such as cotton
3) heat can aggravate eczema- keep rooms cool
4) avoid using soaps or detergents that affect your skin. use soap substitutes instead

Question 15

describe what contact dermatitis is and list the parameters affecting the response. (2, 4)

Answer 15

1) inflammatory response of the skin after exposure to an irritant
2) an “agent” must penetrate the outer layer of skin - the stratum corneum

parameters affecting the response: ( All affect the severity of reaction)
1) type of irritant- acid
2) the concentration
3) quantity involved
4) length of exposure
this can occur with a single exposure , more commonly frequent exposures, the irritant accumulates on the skin.

Question 16

list the aggravating factors for contact dermatitis (6)

Answer 16

1) detergents/ soaps
2) cosmetics
3) rubber and latex
4) dyes and colouring
5) acid/ alkali - cement
6) jewellery - nickel

Question 17

list the presenting features of contact dermatitis (9)

Answer 17

1) itching
2) redness
3) Inflammation
4) papules
5) rash
6) dry skin
7) scaly skin
8) cracked skin
9) pruritis

Question 18

outline the treatment options for contact dermatitis (3)

Answer 18

1) emollient therapy
2) topical corticosteroid - not under 10 years, pregnant or breastfeeding, not for face.
3) remove the causative agent

Question 19

describe the referral criteria for contact dermatitis (8)

Answer 19

1) treatment failure
2) lesions on the face
3) child
4) pregnant/breastfeeding
5) broken / bleeding/ weeping skin
6) widespread
7) infection
8) red flag symptom - non blanching rash

Question 20

outline the additional advice you would give to patients suffering from contact dermatitis (6)

Answer 20

1) remove trigger
2) avoid scented/fragranced products
3) clean your skin
4) use protective clothing
5) change products
6) regular use of emollients

Question 21

explain what psoriasis is, and where it commonly develops. (8)

Answer 21

1) relapsing inflammatory disorder
2) lesions are present
3) can present at any time in life
4) rare in infants and uncommon in children
psoriasis develops:
5) at sites of skin trauma
6) at sunburnt areas
7) round cuts
8) during periods of stress.
symmetrical distribution - usually scalp, knees, elbows

Question 22

outline the presenting features of psoriasis (12)

Answer 22

1) characteristic “salmon pink” lesions
2) silvery-white scales
3) well defined boundaries
4) raised
5) large
6) redness
7) scaling
8) patches
9) plaques
10) history
11) long term
12) symmetry

Question 23

outline the treatment options for psoriasis (3)

Answer 23

pharmacist can be involved in diagnosis, suitably placed to refer patients, involved in treatment options. however treatment is likely to be initiated by doctor/dermatologist

1) emollients- alone or in conjunction with active therapy
2) coal tar based preparations- efficacious in management of psoriasis. e.g capasal- messy to use, can stain skin/clothing
3) keratolytics- incorporated into emollients. aid in clearing scale. Evidence vs practice , e.g. urea or salicylic acid.

Question 24

describe the referral criteria for psoriasis (7)

Answer 24

1) lesions that are extensive
2) lesions that are infected
3) lesions that are presenting for the 1st time
4) hair loss
5) abnormal lumps
6) pregnant/ breastfeeding
red flag symptoms:
7) non-blanching rash, bleeding, lesions accompanies with- malaise, fever, swollen glands.

Question 25

explain the additional advice you would give to a patient with psoriasis (3)

Answer 25

1) keep up with the treatment , if it feels better do not stop treatment
2) regular review with dermatology team
3) eating a healthy, balanced diet and exercising regularly can also relieve stress, which may help improve the psoriasis.

Question 26

describe what chicken pox is and its duration (4)

Answer 26

1) classed as a childhood illness, caused by varicella- zoster virus
2) must prevent spread of infection- isolate patient, protect vulnerable patient groups
3) presents on the trunk
4) duration is 14 days , scabs from after 5 days

Question 27

list the presenting features of chicken pox (7)

Answer 27

1) rash
2) itchy spots
3) fluid filled blisters
4) fever
5) loss of appetite
6) aching body
7) trunk

Question 28

outline the treatment options for chicken pox (3)

Answer 28

1) pain - analgesic paracetamol
2) fever - antipyretic paracetamol
3) itching- antihistamines chlorphenamine, emollients aqueous cream, cooling gels poxclin

Question 29

describe the referral criteria for chicken pox (4)

Answer 29

1) infected blisters
2) pregnant/breastfeeding
3) immuno-suppressed patients
4) red flag symptoms- non blanching rash

Question 30

outline the additional advice given to patients suffering from chicken pox (3)

Answer 30

1) hydration- drink plenty of fluid to avoid dehydration
2) cool clothing- loose fitting, smooth, cotton fabrics are best and will help stop the skin from becoming sore and irritated.
3) wiping any objects or surfaces with a sterillising solution and making sure that any infected clothing and bedding is washed.

Question 31

describe what shingles is (5)

Answer 31

1) the same virus as chicken pox
2) infection of the nerves and skin
3) unilateral condition- one side of the body
4) painful rash
5) duration 2-4 weeks

Question 32

explain the treatment options for shingles (3)

Answer 32

1) pain- analgesics paracetamol, NSAIDs
2) fever- analgesic : paracetamol
3) rash - keep it clean , wear loose fitting clothing, use non-adherent dressing

Question 33

list the presenting features for shingles (7)

Answer 33

1) burning
2) itching
3) fever
4) malaise
5) nerve pain
6) red blotches
7) blistering rash

Question 34

outline the referral criteria fro shingles (5)

Answer 34

early referral reduces;

1) antiviral treatment
2) neuropathic pain relief ( if required)
3) severity of symptoms
4) risk of complications
5) red flag symptoms- non blanching rash

Question 35

describe the additional advice you would give to a patient suffering from shingles (3)

Answer 35

1) hydration - drink plenty of water
2) cool clothing- loose fitting, smooth, cotton fabrics are best and will help stop the skin fro becoming sore and irritated
3) wipe any objects and surfaces with a sterilising solution and making sure that any infected clothing or bedding is washed regularly.

Question 36

describe what ring worm is and the presenting features. (8)

Answer 36

fungal infection- Tinea corporis

1) itchy
2) pink or red
3) scaly
4) raised
5) patches
6) inflamed
7) defined border
8) central clearing

Question 37

outline the treatment options for ring worm

Answer 37

1) anti fungal topical preparations - clotrimazole 1% cream canesten. apply TWO or THREE times a day - max 14 days

Question 38

explain the referral criteria fro ring worm (6)

Answer 38

1) large areas of body
2) treatment failure
3) facial involvement
4) scalp and anogenital involvement
5) pregnant/ breastfeeding
6) red flag symptoms - non blanching rash

Question 39

describe the additional advice given to patients suffering from ring worm (5)

Answer 39

1) avoid sharing items - combs , towels, bedding
2) wash bed linen, pillow cases and towels on hot cycles
3) wash different peoples clothing separately
4) ensure every member washes hands
5) avoid scratching the affected area of your skin as it could spread infection to other parts of your body

Question 40

describe what bites and stings are (2)

Answer 40

initiation of an inflammatory response upon injection of the venom from animals, insects or plants.

more common in warmer climates, produce a localised reaction on the body.

Question 41

list the presenting features of bites and stings (4, 4)

Answer 41

Bites
1) itchy , papules, weals, pain

stings
2) intense burning pain , erythema, oedema, systemic response- breathing difficulties

Question 42

outline the treatment options for stings and bites (3)

Answer 42

1) pain - analgesics paracetamol
2) itchiness- antihistamines oral tablet chlorphenamine (piriton), topical cream mepyramine (anthisan)
3) Wheals, swelling, erythema- topical corticosteroid hydrocortisone 1% cream

Question 43

describe the referral criteria for stings and bites (6)

Answer 43

1) intense swelling
2) bleeding
3) restriction to blood flow
4) insect or sting still present
red flag symptoms:
5) anaphylaxis- difficulty breathing, swelling lips
6) flu like symptoms- temperature, malaise

Question 44

outline the additional advice given to patients suffering from bites and stings (7)

Answer 44

1) move away slowly and don’t panic
2) cover exposed skin
3) wear shoes when outdoors
4) apply insect repellent to exposed areas of skin
5) avoid using products with strong perfumes
6) avoid camping near water
7) keep food and drink covered and windows closed.

Question 45

describe what meningitis is (2)

Answer 45

1) there are two types- bacterial meningitis and viral meningitis. bacterial is very serious and should be treated as a medical emergency
2) anyone can develop meningitis, however, babies and the young are at greater risk

Question 46

list the presenting features of meningitis (11)

Answer 46

1) have a high fever
2) vomit
3) feel agitated
4) become drowsy
5) grunt or breathe rapidly
6) unusual high pitched or moaning cry
7) have a stiff neck
8) dislike bright lights
9) have convulsions or seizures
10) have pale blotchy skin, and a red rash that doesn’t fade when a glass is rolled over it
11) have a tense, bulging soft spot on the head

Question 47

describe the treatment options for meningitis

Answer 47

ACCIDENT AND EMERGENCY NOW!

Question 48

describe what a melanoma is (3)

Answer 48

1) type of cancer that begins in the skin
2) cells in the skin begin to develop abnormally
3) exposure to UV light fro natural or artificial sources may be responsible

Question 49

explain what can increase your risk of developing melanoma (8)

Answer 49

1) lots of moles or freckles
2) pale skin that burns easily
3) red and blonde hair
4) family member who has it
5) radiotherapy treatment
6) a condition that suppresses your immune system
7) medicines that suppress your immune system
8) a previous diagnosis of skin cancer

Question 50

describe where melanomas commonly appear on the body (4)

Answer 50

1) back , face , legs , arms - in the sun exposed areas

Question 51

list the presenting features of melanomas (5)

Answer 51

1) getting bigger
2) changing shape
3) changing colour
4) itchy or painful
5) bleeding or becoming crusty

Question 52

when referring to melanomas explain what the acronym ABCDE stands for

Answer 52

Asymmetrical- melanomas have two very different halves and are an irregular shape
Border - notched or ragged border
Colours- mix of two or more colours
Diameter- larger than 6mm in diameter
Enlargement or elevation - a mole that changes size over time is more likely to be a melanoma

Question 53

describe the treatment for melanomas

Answer 53

See the doctor

Question 54

explain what cellulitis is (3)

Answer 54

1) an infection of the deeper layers of the skin and the underlying tissue
2) the main symptoms are the skin suddenly turning red, painful swollen and hot
3) it affects the legs, but can occur anywhere

Question 55

explain how cellulitis develops (2)

Answer 55

1) cellulitis develops when bacteria or fungi move down through the skins surface through a damaged or broken area of skin. e.g cuts, burns, bites, eczema, athletes foot
2) having a skin condition can cause small breaks and cracks to develop in the surface of the skin, this makes a person more vulnerable to cellulitis.

Question 56

list the presenting features of cellulitis (9)

Answer 56

1) nausea and vomiting
2) shivering and chills
3) a general sense of feeling unwell
4) high temperature
5) rapid spreading of the area of redness
6) confusion
7) rapid heartbeat
8) rapid breathing
9) dizziness particularly when standing

Question 57

describe the treatment options for cellulitis

Answer 57

depending on severity, see doctor today or A&E