11. Skin Disease in Aboriginal and Torres Strait Islander Peoples

Question 1

Which of the following statements is true?

Answer 1

Question 2

Which of the following statements is true?

Answer 2

Question 3

Which of the following statements is true?

Answer 3

Question 4

Definition of:
- Indigenous people?
- Aboriginal?

Answer 4

Question 5

Definition of:
- Torres Strait Islander people?

Answer 5

Question 6

Systemic Lupus Erythematosus in Aboriginal and Torres Strait Islander Peoples.
- Prevalance?
- Causes of higher prevalence?
- Clinical features?
- Main differential?

Answer 6

Main differential diagnosis = tinea faciei - very common in Aboriginals in remote communities.

Question 7

Systemic Lupus Erythematosus in Aboriginal and Torres Strait Islander Peoples.
- Management?

Answer 7

Question 8

What is Neonatal Lupus Erythematosus?

Answer 8

Question 9

Diabetes in Aboriginal and Torres Strait Islander Peoples.
- Background?
- Clinical features?
- Management?

Answer 9

Management - The dermatologist mainly helps in diagnosis. Management is usually carried out by the general practitioner in consultation with cardiology, endocrinology, other specialists, and allied health.

Question 10

Streoptococcal Pyoderma, Rheumatic Fever, and Glomerulonephritis
- Background: 4 Risk factors for Pyoderma?
- Clinical features?

Answer 10

Question 11

Streoptococcal Pyoderma, Rheumatic Fever, and Glomerulonephritis
- Background: 4 Risk factors for Pyoderma?
- Clinical features?

Answer 11

Question 12

Community Acquired MRSA
- Background?
- Clinical features?

Answer 12

Question 13

Tinea
- Background?
- Tinea Corporis: Clinical features?

Answer 13

Question 14

Tinea
- Tinea Capitis: Clinical features?
- Differentials?
- Diagnosis?

Answer 14

Question 15

Management of:
- Tinea corporis?
- Tinea capitis?
- Tinea unguium?

Answer 15

Question 16

Which investigations will you order?
4 Differentials?

Answer 16

Differential Diagnoses
1. Tinea Corporis
2. Subacute SLE
3. Psoriasis
4. Paraneoplastic Erythema Gyratum Repens

Question 17

Management?

Answer 17

Question 18

Pityriasis Versicolor
- Background?
- Clinical features?

Answer 18

Question 19

Pityriasis Versicolor
- Diagnosis?
- Management: Topical treatments?
- Management: Oral treatments?

Answer 19

Question 20

What investigations should be performed?

Answer 20

A skin scraping for direct microscopy to look for the “spaghetti and meatballs” pattern of yeasts and mycelium of pityriasis versicolor.

However, due to the remote location, you do not have access to a microscope to conduct a KOH examination. The scrapings will have to be sent to a laboratory in a major centre.

Question 21

Scabies in Aboriginal and Torres Strait Islander Peoples
- Background: Prevalence? Transmission?
- Clinical features?

Answer 21

Question 22

Scabies in Aboriginal and Torres Strait Islander Peoples
- What is crusted scabies?

Answer 22

Question 23

Scabies in Aboriginal and Torres Strait Islander Peoples
- Diagnosis: Which test?
- Management: Topical treatment?

Answer 23

Question 24

Scabies in Aboriginal and Torres Strait Islander Peoples
- Management: Preventing recurrence?
- Management: Crusted scabies?

Answer 24

Question 25

Which investigations would you perform for this man and how would you manage him?

Answer 25

Question 26

**Give a clinical summary of Leprosy in Australia.** - Where is it found? - Lesions? - Treatments? - Transmission? - Organism? - Classification?

Answer 26

Question 27

**Leprosy in Australia.** - History? (8) - Examination: Skin? Nerves? Eyes?

Answer 27

Question 28

**Leprosy - Clinical Features** - Tuberculoid leprosy? - Lepromatous leprosy?

Answer 28

Question 29

**Leprosy** - Diagnosis? - 7 Pre-treatment investigations? - Management?

Answer 29

**Pre-treatment investigations should include:** 1. CBE 2. EUC 3. LFT 4. HIV Ab 5. Glucose-6-phosphate dehydrogenase levels 6. CXR 7. Mantoux or QuantiFERON gold

Question 30

**Melioidosis** - Organism? - Transmission? - Epidemiology?

Answer 30

**Transmission of Melioidosis** - Infection is commonly acquired through the skin, usually via an abraison, cut or ulcer which comes into contact with contaminated vegetable material, soil or water. - The other common route of infection is via inhalation. - Rarely the transmission may be human-to-human, nosocomial (from bronchoscopes and surgical equipment), animal-to-human, sexual, vertical, and laboratory-associated infection in microbiology staff.

Question 31

**Melioidosis** - Risk Factors?

Answer 31

Question 32

**Melioidosis** - Clinical Manifestations? - Skin? - Systemic?

Answer 32

**Clinical Manifestations** 1. Disease may be acute, subacute, or chronic. Incubation time may range from a few days to over 20 years. 2. Subclinical infection is relatively common. In Northern Australia, 10% of Aboriginal people are seropositive for past exposure. Of Vietnamese refugees, 29% are seropositive. In Thailand, 15% of the population is seropositive. 3. The organism can remain latent in the body and later reactivate. It may be found in the lungs of people with chronic lung disease and may possible be found in the bowel. 4. Disease may involve one or more organ systems.

Question 33

**Melioidosis** - History? (2) - Examination? (4) - Investigations? (6)

Answer 33

Question 34

**Melioidosis - Diagnosis & Treatment** - What will it show in staining? - Which medium should be used? - 2 Patterns of histology? - Antibiotic Susceptibility? - Treatment? (6 points)

Answer 34

The organism of often susceptible to: 1. Ceftazidime 2. Piperacillan/Tazobactam 3. Ticarcillin/Clavulanate 4. Amoxicillin/Clavulanate 5. Meropenem 6. Trimethoprim/Sulfamethoxazole 7. Doxycycline 8. Chloramphenicol

Question 35

What further information would you like to know on history?

Answer 35

- Where has he been? - What has he been doing? - Detailed history of what has happened to his leg?

Question 36

What examination assessment should you perform?

Answer 36

Question 37

- What is the clinical differential diagnosis for the clinical findings at the right leg? (This question is NOT asking for a microbiological diagnosis). (2) - What specimens do you wish to collect for microbiology prior to commencing antibiotics? (6)

Answer 37

**Differentials for right leg**: 1. Bullous cellulitis 2. Necrotizing fasciitis/myonecrosis **Micro Specimens:** 1. Blood cultures 2. Aspirate of the bulla 3. Sputum sample 4. Urine sample 5. A skin biopsy in an area of cellulitis 6. A swab of inoculation site on the lower leg.

Question 38

Answer 38

= Aboriginal lupus patients in the Northern Territory can develop disseminated strongyloidiasis.

Question 39

Answer 39

= Aboriginal patients with diabetes die at a significantly younger age than Causasian patients.

Question 40

Answer 40

= Scabies can predispose to pyoderma.

Question 41

Answer 41

= Scabies in babies involved the head and neck in tropical areas.