UKMLA passmed(Derm)

Question 1

Erythema Multiforme

Answer 1

• Hypersensitivity reaction
  Features: (think red targets)
• Target lesions (NB: eryThema=Target lesions): red, circles(look like target shop sign0
• Affects upper limbs more, seen on back of hands/feet before spreading to torso
  Causes: virus, bacteria, idiopathic, malignancy
• If have mucosal involvement= severe form: Erythema multiforme major

Question 2

Erythema Nodosum

Answer 2

Features: Nodular lesions(that are tender and red) (think Red Nodes: name)
- Resolves within 6 weeks and lesions heal without scarring
Causes:
- Infection= TB, Strep, systemic disease (sarcoidosis), malignancy, drugs, pregnancy

Question 3

Guttate Psoriasis

Answer 3

• Precipitated by Strep. infection 2-4 weeks before lesions appear.
• Features: tear drop pattern, is more common in children and adolescents.
• lots of small pink spots all over body
• Management: resolve spontaneously within 2-3 months, topical agents (similar to psoriasis), phototherapy

Differences to Pityriasis Rosea (PR)(similar condition):
- PR: Acute,self-limiting rash, fir tree, herald patch erythematous appearance, self-limiting and resolves after around 6 weeks, affects young adults

Question 4

Acne Vulgaris*:

Answer 4

Types:
1. Comedones: closed top=whitehead, open top= blackheads
2. Inflammatory: Papules and Pustules
3. Excessive inflammatory: Nodules and Cyst

Classified into mild, moderate, severe: Mx=

• Mild: 12 wk of topical Adapalene+benzoyl peroxide, topical tretinoin with clindamycin, topical benzoyl peroxide+clindamycin
• Moderate: 12 wk course: add either oral lymecycline or doxycycline (NB: Tetracyclines- avoid in pregnant and breastfeeding women and in children less than 12 years of age, can use Erythromycin)
  -Severe:

Severe Acne: Acne Fulminans: associated with fever; hospital admission and needs oral steroids.

Question 5

Animal and Human Bites

Answer 5

ANIMAL: Most often dogs/cats.
- Most common organism= Pasteurella Multocida
Mx: Cleanse wound (except puncture wound)
Mx: Co-Amoxiclav (if allergic to penicillin=Doxycycline+Metronidazole)

HUMAN: Cause can be aerobic/anaerobic
- Organisms: Strep, Staph
Mx: Co-Amoxiclav (same as animal bites)

Can be a risk of viral infections (HIV, Hep C)

Question 6

Bed bugs (Cimex Hemipteru):

Answer 6

Presents:
- Itchy skin rashes
- Bites
- Allergic symptoms (secondary to infestation of bed bugs)
-are found in mattresses of fabrics and difficult to get rid of.
Mx: Topical Hydrocortisone: Suitable to control itch, definitive mx= pest management+fumigation of the house
- Can be controlled: by hot-washing bed linen+using mattress covers

Question 7

Lyme disease: (Spirochaete Borrelia Burgdorferi) and spread by ticks:

Answer 7

EARLY features (within 30 days):
= Bull’s eye at site of tick bite (Erythema Migrans- is indication to start abx. immediately)
- Usually painless, Systemic: headache, lethargy, fever
LATE features (after 30 days):
= Cardiovascular (heart block, peri/myocarditis)
=Neurological (facial nerve palsy, radicular pain, meningitis)

Investigations: 1st line) ELISA antibodies to Borrelia burgdorferi
Mx: Doxycycline (unless pregnant=Amoxicillin)
- if disseminated(spread out) disease= Ceftriaxone

Question 8

Burns: (Mx)

Answer 8

• Immediate first aid: ABC (Airway, Breathing, Circulation)
• Assessing depth of burns: first, second, third degree=
  1st: Superficial Epidermal: Red and painful, dry, no blisters
  2nd: Superficial dermal: Pale pink, painful, blistered, slow cap refill
  2nd: Deep dermal: typically white (patches of non-blanching erythema)
  3rd: Full thickness (white/brown/leathery/black in colour, no blisters, no pain)

Question 9

Acanthosis Nigricans:

Answer 9

• Symmetrical, brown velvety plaques= found on neck, axilla, groin
• Causes: T2DM, GI cancer, Obesity, Cushing’s Disease

Pathophysiology: Insulin resistance= Hyperinsulinaemia= stimulation of keratinocytes (IGFR1)

Question 10

Lichen Planus: (Skin disease of unknown cause, immune-mediated)

Answer 10

Features:
- Itchy papular rash most common on palms, soles
- Rash: Polygonal in shape with ‘white lanes’
- Koebner phenomenon: New skin lesions appearing at site of trauma.
- Oral involvement: in around 50% of patients, nails: thinning of nail plate, longitudinal ridging
Mx: Potent topical steroids=main treatment, Benzydamine mouthwash= Oral lichen planus

Question 11

Rosacea: (chronic disease of unknown cause)

Answer 11

Features:
- Typically affects nose, cheeks, forehead
- Flushing: is often first symptom
Telangiectasia is common
- Sunlight: may exacerbate symptoms
- Later develops into erythema+papules+pustules
- Ocular movements: Blepharitis (Swollen, itchy eyelids)
MX: sunscreen, flushing= topical Brimonidine gel, mild-moderate pustules: Topical Ivermectin=1st line
Moderae-severe: Topical ivermectin+ oral Doxycycline

Question 12

Seborrhoeic Dermatitis (adults and children)

Answer 12

ADULTS:
- is chronic, thought to be caused by fungus= Malassezia furfur (P.ovale)
- is common
MX: 1st line treatment= Ketoconazole 2% shampoo/ shampoo with zinc
Can also use: Topical steroids= best used for short periods.
- Is hard to treat as recurrences are common.

CHILDREN:
- Common in children, affects the scalp (CRADLE CAP), nappy area, face and limb flexures.
Cradle Cap: early sign that may develop in first few weeks of life, erythematous rash+coarse yellow scales
- Mx: resolves within a few weeks, can try a topical emollient onto scalp, severe= topical imidazole cream.
Tends to resolve spontaneously by around 8 months of age.

Question 13

Eczema Herpeticum

Answer 13

Very severe infection of skin caused by:
- Herpes Simplex Virus 1/2
- More commonly seen in children with atopic eczema= rapidly progressing painful rash
- O/e: Monomorphic punched out lesions (circular, depressed ulcerated lesions)
- Mx: Life-threatening, children should be admitted: IV Aciclovir

Question 14

Eczema in children+topical steroids

Question 15

Basal cell Carcinoma

Question 16

Cellulitis

Question 17

Head lice

Question 18

Fungal nail infections

Question 19

Nail signs:

Question 20

Onycholysis:

Question 21

Psoriasis and psoriatic arthropathy: nail changes

Question 22

Pruritus

Question 23

Impetigo

Question 24

Malignant Melanoma

Question 25

Pressure Ulcers: also on slide 42*

Question 26

Keloid Scars

Question 27

Chronic plaque psoriasis

Question 28

Guttate psoriasis

Question 29

Psoriasis* (big condition)

Question 30

Lower leg ulcers

Question 31

Venous Ulceration

Question 32

Lipoma

Question 33

Scabies

Question 34

SCC (Squamous cell carcinoma of the skin)

Question 35

Tinea

Question 36

Urticaria

Question 37

Atrophic Vaginitis

Question 38

Pruritus vulvae

Question 39

Most modifiable risk factor to reduce chances of developing thyroid eye disease? (in patients with Graves disease)

Answer 39

Smoking