Week 2 Dermatology Formative Questions

Question 1

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Answer 1

Dermatophyte infections - typically caused by trichophyton (also caused by microsporum and epidermophyton) * Tinea corporis - body * Tinea capitis - scalp * Tinea pedis - foot * Tinea unguuium - nails * Tinea manuum - hand * Tinea barbae - beard * Tinea cruris - groin

Question 2

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Answer 2

Head lice - parasitic infection due to lice Shingles - viral infection due to varicella zoster (HHV3) Ring worm - dermatophyte infection affecting keratinised tissues due to Trichophyton, Microsporum, and Epidermophyton genera Necrositising fasciitis - bacterial infection typically due to strep pyogenes (Group A beta-haemolytic strep) and sometimes staph aureus

Question 3

State what the base/vehicle is based on the description given * Semisolid emulsion of oil in water - non greasy, preservative, cosmetically acceptable * Semisolid grease/oil, no preservative, greasy * Liquid formulation * Thickened aqueous solution * Semisolid, stiff, diffiulct to apply

Answer 3

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Question 4

Which investigation would you choose for the following diseases. * Shingles * Scabies * Ring worm * Impetigo

Answer 4

* Shingles -viral infection- lesion should be swabbed and the sample sent in a viral container for PCR * Scabies - parasitic infestation - skin scrapings should be taken and then examined under a microscope for signs of the mites. * Ringworm - fungal infection - better seen under a ‘woods lamp’ which can allow for more accurate skin scrapings * Impetigo - bacterial infection - lesion should be swabbed and the sample sent in a bacterial container for microscopy and culture

Question 5

A 58 year old man presents in July with blisters on the dorsal aspect of his hands which have been appearing over the last few months, crust over and heal leaving scarring. He works as a joiner and is aware that his skin has also been more fragile than usual. You notice that he has a lot of hair growing on his cheeks. He is generally well and on no medication What is the most likely diagnosis?

Answer 5

Porphyria cutanea tarda Blistering, fragility, hypertrichosis, hyperpigmentation

Question 6

Regarding the inherited condition Neurofibromatosis type 1, which ONE of the following is TRUE? Select one: * There is always a family history of the condition * Adenoma sebaceum are commonly seen * Inheritance is autosomal recessive * It affects around 1 in 500 individuals * ‘Cafe au lait’ macules are present in around 90% of cases

Answer 6

Cafe au lait’ macules are present in around 90% of cases >5 NF1 - autosomal dominant Cafe au lait macules, axillary/inguinal freckling, lisch nodules, neurofibromas, optic nerve glioma, family history

Question 7

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Answer 7

Autosomal recessive X-linked recessive Multifactorial

Question 8

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Answer 8

Shows autosomal inheritance - Tuberous sclerosis Red hair and xeroderma pigmentosum are autosomal recessive Atopic dermatitis and psoriasis are mutlifactorial

Question 9

Which of the following are true about rosacea? (Must select ALL correct answers to gain marks) Select one or more: * Most commonly affects teenagers * Sebum excretion is abnormal * The Female to male ratio of incidence is 3:1 * May present with papules * May present with pustules * Presents with Erythema

Answer 9

In rosacea there is sebaceous gland hyperplasia however sebum excretion is normal. It is commoner in females but often more severe in men. rosacea presents with erythema, signs and symptoms can also include telangiectasia, papules, pustules and sometimes lymphoedema. The most commonly affected age group is the middle-aged however it does still occur in young adults and the elderly. The correct answers are: Presents with Erythema, May present with papules, May present with pustules

Question 10

Which of the following systems are important in maintaining good circulation in the lower limb? (Must select ALL correct answers) Select one or more: * The ‘muscle pump’ * Diabetes * Pulse pressure * Venous valves * High diastolic blood pressure * Heart rate * Gravity

Answer 10

The correct answers are: The ‘muscle pump’, Venous valves, Pulse pressure

Question 11

Which ONE of the following is NOT an appropriate topical therapy for localised chronic plaque psoriasis of trunk and limbs? Select one: * Vitamin D analogue * Very potent topical steroid * Coal tar solution * Dithranol * Emollient

Answer 11

Very potent topical steroid - should not be used on large areas of the body

Question 12

Which strains of the Human Papilloma Virus (HPV) are most common in warts/verruca’s? Select one: Types 1-4 Types 16 and 18 Types 6 and 11

Answer 12

HPV types 1-4

Question 13

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Answer 13

Pulmonary vein Left side of the Heart Aorta Abdominal Aorta Common iliac artery External iliac artery Femoral artery Popliteal artery Anterior tibial Dorsalis pedis

Question 14

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Answer 14

Deep Plantar Vein Great saphenous vein Femoral vein External iliac vein Common iliac vein Abdominal vena cava Inferior vena cava Right atrium

Question 15

Which ONE of the following is true regarding topical therapies? Select one: * Ointments are more cosmetically acceptable to patients than creams * Creams are more likely than ointments to cause contact sensitisation * A typical adult body requires 10g of ointment for one all over application * Occluding a treated area with clingfilm will reduce topical therapy penetration * Lotions are useful for very dry and hyperkeratotic eczema

Answer 15

The correct answer is ‘creams are more likely than ointments to cause contact sensitisation’ - this is because they contain preservatives. Generally patients find creams more acceptable, but greasier ointments are better for very dry or hyperkeratotic areas. Lotions are good for less severe dryness and wide areas, especially if hairy. Around 20-30g is needed for one all over application in an adult and occlusion increases penetration.

Question 16

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Answer 16

Atopic eczema - itch, flexural rash, onset before 2 years, Itching plus 3 or more: Visible flexural rash* History of flexural rash* Personal history of atopy (or first degree relative if under 4 yo) Generally dry skin Onset before age 2 years *cheeks and extensor surfaces in infants

Question 17

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Answer 17

You selected the correct response. psoriasis vulgaris - the commonest form of psoriasis, forming chronic plaques commonly on the extensors and posterior scalp.

Question 18

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Answer 18

Sounds like it could be a contact dermatitis - unsure if allergy or irritant Patch testing will confirm if allergic contact dermatitis Provide emollients / steroids to treat flare

Question 19

A 66 year old man presented with a 2 week history of a blistering rash. Which of the following clinical features would be typical of diagnosis of Bullous Pemphigoid? Select one: * Widespread involvement of the oral mucosa * Small thin roofed blisters which rupture easily * Associated bowel symptoms/loose stools * A history of itch in the months preceding the onset of blistering * Improvement on sun exposure

Answer 19

Bullous pemphigoid causes full epidermal thickness blisters which rarely affects mucosal surfaces (unlike pemphigus). Bowel symptoms area feature of dermatitis herpetiformis / coeliac disease. The correct answer is: A history of itch in the months preceding the onset of blistering

Question 20

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Answer 20

Looks like impetigo - is contagious

Question 21

Along with atopic eczema, what are the other two diseases which form the Atopic Triad? (TWO answers) Select one or more: * Emphysema * Psoraisis * Acne Vulgaris * Hayfever * Bronchiatis * Asthma * Peanut Allergy

Answer 21

Hayfever and asthma

Question 22

Dermatitis herpetiformis is managed through adherence to a gluten free diet. Which of the following foods must be excluded from a gluten free diet? Select one or more: * Wheat * Barley * Potatoes * Rye * Sweetcorn * Rice

Answer 22

Wheat, barley and rye

Question 23

Regarding topical steroids, which ONE of the following is TRUE? Select one: * They have a vaso-dilatory effect * They cross the plasma membrane by endocytosis * They increase cell proliferation * They are lipophilic * Absorption is greater across hyperkeratotic than atrophic skin

Answer 23

The correct answer is ‘they are lipophilic’ - this allows passive diffusion across the plasma membrane where they combine with cell receptors and bind to steroid responsive elements in the DNA. They are anti-proliferatives, anti-inflammatory and vasoconstrictive. Absorption is affected by skin thickness, skin state, occlusion, the vehicle used and drug concentration.

Question 24

The woman is a 20 year old waitress. She is already very conscious of her skin at work and does not want to have to put any greasy or smelly treatment on as it may show on her shirt. Which of the following therapies would be best suited for her? Select one: * Coal tar solution * Topical antibiotic gel * Very potent steroid ointment * Dithranol cream * Vitamin D analogue cream

Answer 24

Vitamin D analogue cream would be the 1st line treatment in her case as it is effective, easy to apply, non greasy and non-smelly. * Coal tar solution smells and can stain. * Topical antibiotics are not indicated as her condition is not caused by bacteria. * Very potent steroid ointment is not recommended due to the long term affects of steroid use. * Dithranol cream is a short contact therapy, time consuming to use and can stain.

Question 25

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Answer 25

Rosacea Treatment options usually begin with topical metronidazole If not responding then try oral antibiotics usually a tetracycline (oxytetracecyline) (use erythromycin - macrolide- if pregnant) Isotretinoin can be given if severe Demodex mites may respond to topical ivermectin

Question 26

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Answer 26

Lichenification Fluid filled blisters Excoriations Fissuring

Question 27

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Answer 27

Atopic dermatitis - emollients and steroids

Question 28

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Answer 28

Contact dermatitis - patch testing Emollients/steroids

Question 29

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Answer 29

Seborrheic dermatitis Due to overgrowth of skin yeasts (Malassezia) - Give anti fungal/steroid eg daktacort (hydrocortisone +miconazole) or ketaoconazole cream

Question 30

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Answer 30

Venous dermatitis - varicose eczema

Question 31

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Answer 31

Soap substitute eg dermol 500 Regular emollient - provides barrier and reduces dryness Moderate potency steroids as required for flares

Question 32

What hypersensitivity is allergic dermatitis caused by? The majority of patients with contact dermatitis have allergic contact dermatitis? - true or false

Answer 32

Type 4 hypersensitivity - allergic contact dermatitis False - the majority of patients with contact dermatitis actually have irritant contact dermatitis

Question 33

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Answer 33

B - 3 visits are required over the course of 1 week for patch testing D - single patches may be removed at home if causing severe discomfort patient must avoid showering and keep the patches dry

Question 34

Where are the patches applied in patch testing and when are they checked?

Answer 34

Patching is applied to the back 1 visit to apply the patch, one to remove the patches and assess at the 48 hour mark and re-asses at 96 hours