BAD booklet stuff

Question 1

What is erythema nodosum & which diseases is it associated with

Answer 1

Blue/red painful lesions on shins, associated with sarcoid, strep infection and sulphonamides

Question 2

What is erythema multiforme & what causes it

Answer 2

Symmetrical target lesions on palms soles and limbs. Caused by infections (HSV, mycoplasma) and drugs (SNAPP - sulphonamides, NSAIDs, allopurinol, penicillin, phenytoin)

Question 3

What is Stevens Johnson syndrome?

Answer 3

More severe form of EM with mucosal involvement

Question 4

What is Toxic Epidermal Necrolysis and how do you treat it?

Answer 4

Extreme form of SJS usually from a drug reaction, extensive mucosal ulceration and epidermal loss. Increased risk in HIV, treat with dexamethasone and IVIG

Question 5

What is dermatitis herpetiformis and how do you treat it?

Answer 5

Itchy vesicles on extensor surfaces, associated with coeliac disease. IgA deposition. treat with dapsone.

Question 6

What is pyoderma gangrenosum?

Answer 6

Wide, deep ulceration on legs associated with IBD, RA, wegeners. Treat with high dose steroids.

Question 7

What is livedo reticularis?

Answer 7

Persistent red/blue mottled lesions that don’t blanch, usually on legs, triggered by cold. Associated with vasculitis, antiphospholipid syndrome

Question 8

5 features of malignant melanoma

Answer 8

Asymmetry, Border irregular, Multiple colours, Diameter >6mm, Evolving/elevated

Question 9

5 risk factors for malignant melanoma

Answer 9

Family history, fair skin, lots of moles, sun exposure, increasing age, immunosupression

Question 10

5 classifications of malignant melanoma?

Answer 10

Superficial spreading, lentigo melanoma maligna, acral lentiginous, nodular melanoma, amelanotic

Question 11

2 staging criteria for malignant melanoma?

Answer 11

Breslows depth and Clarks staging

Question 12

Treatment of malignant melanoma

Answer 12

Depending on staging - excision, +/- lymphadenectomy +/- chemotherapy

Question 13

What does SCC look like?

Answer 13

Ulcerated lesion with hard raised everted edges, on sun exposed areas. can bleed, itch and be painful.

Question 14

7 risk factors for SCC

Answer 14

Sun exposure, smoking, fair skin, moles, outdoor occupation, pre malignant lesions, skin trauma, asbestos, arsenic

Question 15

What are actinic keratotoses?

Answer 15

Pre malignant, irregular, crusty warty lesions. Treat with 5-fluouracil/diclofenac/imiquimod

Question 16

What is the evolution of SCC?

Answer 16

Actinic keratoses -> Bowens -> SCC

Question 17

Treatment of SCC?

Answer 17

Topical 5 fluouracil or salicylic acid, cryotherapy, excision

Question 18

2 risk factors for BCC

Answer 18

Fair skin and sun exposure

Question 19

What does BCC look like?

Answer 19

Typically a pearly nodule with a red, raised, rolled edge, telangiectasia,

Question 20

Treatment of BCC?

Answer 20

Topical 5-fluouracil or salicylic acid, cryotherapy, excision

Question 21

What are seborrhoeic keratoses?

Answer 21

Crusty, pigmented, wart like benign lesions

Question 22

8 risk factors for cellulitis

Answer 22

Diabetes, skin breaks, insect bites, chronic venous insufficiency, IVDU, immunosuppression, varicose veins, lymphedema, age, fungal infections, obesity

Question 23

2 common bacterial causes of cellulitis

Answer 23

Group a beta haemolytic strep - pyogenes and staph aureus

Question 24

Presentation of cellulitis

Answer 24

Typically unilateral leg, erythema (rubor) warmth (calor) pain (dolor) swelling (tumor) - quick spreading.

Question 25

Treatment of cellulitis?

Answer 25

General - analgesia, raise legs, ?tetanus booster Admit if systemically unwell, unstable comorbidities, sepsis, immunocompromised etc etc. Fluclox/erythromycin oral in 1ry care, IV in hospital

Question 26

6 acute and 2 chronic complications of cellulitis

Answer 26

Acute - nec fasc, osteomyelitis, abscess, sepsis, meningitis, post strep glomerulonephritis. Chronic - persistent ulceration, lymphedema

Question 27

Pathology of psoriasis

Answer 27

Chronic inflammatory skin condition. Hyperproliferation of keratinocytes and T cell driven inflammatory infiltration of dermis and epidermis

Question 28

5 histopathological findings in psoriasis

Answer 28

Parakeratosis, acanthosis, T cells in upper dermis, lengthened retes ridges, absent granular layer, munro microabscesses, capillary loop dilatation

Question 29

Presentation of psoriasis

Answer 29

Well circumscribed erythematous plaques with silver scaling. Kobner phenomenon. Extensor surfaces, scalp. Arthropathy. Nail changes.

Question 30

4 nail changes in psoriasis

Answer 30

Beaus lines, pitting, onycholysis, subungual hyperkeratosis

Question 31

4 other types of psoriasis

Answer 31

Guttate - follows strep infection Palmo-planar pustular Flexural Erythrodermic - emergency - rx with methotrexate

Question 32

Management of psoriasis

Answer 32

``` Emollients Vit D analogues Topical corticosteroids Salicylic acid Coal tar Dithranol Retinoids UVB ```

Question 33

Epidemiology of psoriasis

Answer 33

Peaks in 20s and 50s

Question 34

5 pillars of acne

Answer 34

``` Basal keratinocyte proliferation in pilosebaceous follicles Increased sebum production Propionibacterium acnes colonisation Inflammation Comedones blocking secretions ```

Question 35

Treatment pathway of acne

Answer 35

Mild - topical benzoyl peroxide, azelaic acid, topical clindamycin Moderate - topical benzoyl peroxide and retinoids, doxycycline/minocycline Severe - isotretinoin

Question 36

What is bullous pemphigoid?

Answer 36

Autoimmune subepidermal blistering due to IgG autoantibodies BP1 and BP2

Question 37

How does bullous pemphigoid present?

Answer 37

Acute or insidious onset, thick tense blisters on flexural surfaces, self limiting

Question 38

Treatment for bullous pemphigoid

Answer 38

Steroids & immunosuppresants, topical if localised systemic if severe

Question 39

What is pemphigus vulgaris?

Answer 39

Autoimmune epidermal blistering due to IgG autoantibodies - keratinocyte surfaces (desmoglien)

Question 40

How does pemphigus vulgaris present?

Answer 40

Age 40-60, mucosal, oral lesions, flaccid blisters. Nikolsky sign - slight rubbing exfoliates outer layer of skin

Question 41

Causes of erythema nodosum

Answer 41

Idiopathic, Drugs, OCP, Sarcoid, UC/crohns/behcets, Microbiology - EBV/strep/mycoplasma

Question 42

Presentation of lichen planus

Answer 42

Planus - Purple Pruritic Papular Polygonal rash on flexure surfaces, Wickhams striae on surface - white lace like