Week 3 Dermatology Formative Questions

Question 1

Match the cause of ulcer to the part of the body most likely to be affected. * Pressure Ulcer * Arterial Ulcer * Venous Ulcer * Medial or lateral malleolus * Over the foot or mid shin * Over the sacrum, heels, ischia & greater trochanters

Answer 1

Pressure Ulcer - over the sacrum, heels, ischia and greater trochanters Arterial Ulcer - over the foot or mid shin Venous Ulcer - medial or lateral malleolus

Question 2

Match the size of the lesion with the most appropriate surgical technique. * Medium sized lesion on the patients nose * Large lesion on the patients calf * Small lesion on the patients cheek * Excision with a skin flap * Excision with a skin graft * Small elipitcal excision

Answer 2

A skin flap will provide the best healing and less visible scarring on the medium lesion on the patients nose.- medium sized lesion on the patients nose A small elliptical excision is suitable for small lesions. - small lesion on patients cheek For large lesions skin grafts may be needed to replace lost skin. - excision with a skin graft

Question 3

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Answer 3

Anchoring is “the tendency to perceptually lock onto salient features in the patient’s initial presentation too early in the diagnostic process, and failing to adjust this initial impression in the light of later information”.

Question 4

Which one of the terms in the list below best matches the following definition? “The disposition to judge things as being more likely, or frequently occurring, if they readily come to mind”. * Availability * Framing effect * Anchoring * Search satisfying * Fundamental Attribution Error * Aggregate bias * Ascertainment bias * Overconfidence bias

Answer 4

Availability is “the disposition to judge things as being more likely, or frequently occurring, if they readily come to mind”.

Question 5

Which of the following factors is linked with an increased risk of developing squamous cell carcinoma of the skin. (You must select ALL that apply to gain marks) * Select one or more: * Lifelong outdoor occupation * Chronic actinic dermatitis (photosensitivity) * Skin type 1 * Weekly commercial sunbed use for 5 years * Long term topical steroid use in atopic dermatitis * Renal transplantation

Answer 5

TRUE Lifelong outdoor occupation Skin type 1 Weekly commercial sunbed use for 5 years Renal transplantation FALSE Chronic actinic dermatitis (photosensitivity) Long term topical steroid use in atopic dermatitis

Question 6

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Answer 6

Ankle exercises are vital to prevent skin fibrosis causing the joint to stiffen. Rarely squamous cell carcinomas can develop in ulcers. Contact sensitivity does frequently develop. Compression bandages should NOT be used in ulcers where the cause is arterial. Systemic antibiotics are only needed for overt infection.

Question 7

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Answer 7

Dermatofibroma - typically presents on the limbs as a firm lump with some pigmentation and may itch

Question 8

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Answer 8

Melanocytic naevus - probabaly an intradermal naevus is softly pigmented and adult age

Question 9

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Answer 9

Superficial spreading melanoma Asymmetrical in shape and colour Border is irregular Colour is variable Diameter is >6mm Evolving

Question 10

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Answer 10

Superficial basal cell carcinoma - can see the erythematous scaly plaque with slightly pearliness at the edges

Question 11

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Answer 11

Squamous cell carcinoma - nodular, painful, and history of longstanding precursor

Question 12

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Answer 12

The correct answer is: Bowen’s disease (intraepidermal squamous cell carcinoma)

Question 13

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Answer 13

Nodular basal cell carcinoma

Question 14

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Answer 14

Breslow thickness is The depth from the granular layer of the epidermis to the deepest melanoma cell and is a prognostic indicator This patient has a thickness of 0.5mm 4mm 50% 5 year survival

Question 15

Recommended methods of skin cancer prevention include. (Multiple responses) Select one or more: * Short sleeve clothing with a loose weave * Sunscreens * Seeking shade * Only sunbathing from 11am until 3pm * Hats with a brim * Long sleeve clothing with a tight weave * Avoid burning

Answer 15

Sunscreens Seeking shade Hats with a brim Long sleeve clothing with a tight weave Avoid burning

Question 16

When excising skin, which of the following methods provides the best aesthetic result. Select one: * An elliptical excision with the scalpel cutting at 45 degrees to the surface of the skin * An elliptical excision with the scalpel cutting at 90 degrees to the surface of the skin * A circular excision with the scalpel cutting at 90 degrees to the surface of the skin * A circular excision with the scalpel cutting at 45 degrees to the surface of the skin

Answer 16

Cutting at 90 degrees reduces the chance of the wound dehiscing and an elliptical excision provides the neatest scar afterwards The correct answer is: An elliptical excision with the scalpel cutting at 90 degrees to the surface of the skin

Question 17

Which of the following prognostic indicators worsen the prognosis, in a diagnosis of malignant melanoma (more than one may apply) Select one or more: * Female * Ulceration * Vascular invasion * Nodular subtype

Answer 17

Ulceration Vascular invasion Nodular subtype

Question 18

Organise the layers of the scalp in order from inside to outside of the body. (drag the options to the order you think is correct) * Skin * Periosteum * Connective tissue * Loose connective tissue * Aponeurosis

Answer 18

Mnemonic - SCALP for the layers of the scalp Skin Connective tissue Aponeurosis Loose connective tissue Periosteum

Question 19

Rank the following cancers in terms of how potentially life threatening they are, with the most potentially life threatening at the top (drag the items to form the order) * Basal cell carcinoma * Malignant melanoma * Squamous cell carcinoma

Answer 19

Malignant melanoma Squamous cell carcinoma Basal cell carcinoma

Question 20

Malignant melanomas can usually be effectively treated with combined therapy of chemotherapy and radiotherapy Select one: True False

Answer 20

FALSE Due to their embryological origins and the high amount of melanin within them, malignant melanomas do not respond well to chemotherapy or radiotherapy even when used in combination. The most effective treatment is early radical surgery