Derm

Question 1

Diabetic skin changes

Answer 1

Flexural candidiasis
Yellow patches of skin
Thickened axillary, groin and neck skin

Question 2

Coeliac disease skin changes

Answer 2

Dermatitis herpetiforms - Very itchy burning blisters on elbow, scalp, shoulders and ankles

Question 3

IBD skin changes

Answer 3

Erythema nodosum - Tender subcutaneous lumps

Pyoderma gangrenosum - Rapidly growing very painful pustular blisters.

Question 4

SLE skin changes

Answer 4

Facial butterfly rash

Photo sensitivity

Question 5

HSV changes

Answer 5

Erythema multiforme - Well defined round lesions on extensor surfaces

Question 6

Lyme disease chanages & treatment

Answer 6

Erythema migrans - Target like lesion.

Doxycycline

Question 7

Systemic scleroderma features

Answer 7

CREST
Calcinosis
Raynauds
oEsophageal and gut dysfunction
Sclerodactially
Telangictasia

Question 8

Sarcoidosis changes

Answer 8

Yellow firm nodules in skin
Scarring alopecia
Lupus pernio - Diagnostic
Firm subcutaneous nodules.

Question 9

Actinic keratoses

Answer 9

Pre malignant yellow/white scaly crusts on sun exposed skin. May develop into a SSC

Question 10

Bowens disease & treatment

Answer 10

SSC in situ. Well defined, slowly growing red scaly plaque with full thickness dysplasia. May progress to SSC

Cryotherapy/Flurouracil

Question 11

SSC

Answer 11

Ulcerated or crusted firm irregular lesion on sun exposed skin.

Increased risk of metastasis if on lip, ear, non exposed skin, immunosupression.

Need excision

Question 12

BCC

Answer 12

Commonest skin cancer.
Nodular - Pearl with telangectasic edges
Superficial - Red scaly plaque with raised smooth edge.

Flurouracil/excision

Question 13

Common metastases to skin (5)

Answer 13

Breast.
Stomach and colon
Lung
GU
Lymphoma

Question 14

ABCDEF of melanoma

Answer 14

Asymmetry 
Border irregular 
Colour variation 
Diameter over 6mm
Evolution - changing  
Funny looking mole

Question 15

Psoriasis

Answer 15

Hyperproliferation epidermis with proliferation and dilation of vessels in the dermis & t cell and neutrophills

Question 16

Types of psoriasis (4)

Answer 16

Plaque - Symmetrical well defined red plaque with silver scales on extensor surfaces
Flexural - Plaques in mosts skin folds. Often less scaley and misdiagnosed as fungal.
Guttate - Large numbers of small plaques over trunk and limbs in young. Usually following strep infection
Generalised erythrodermic - May cause systemic upset (fever, increase in WCC and dehydration) - Requires hospital admission.

Question 17

Nail changes in psoriasis

Answer 17

Pitting
Onycholysis
Thickening

Question 18

Treatment for psoriasis (5)

Answer 18

Topical corticosteroid (Betnovate) & topical Vit D
Stronger corticosteriod cream (Dermovate) (not more than 8 weeks)
Phototherapy
Methotrexate/isotretinoin
Infliximab/entancerpt

Question 19

Diagnosing atopic eczema (1+4)

Answer 19

Itchy skin with 3 or more of
Onset before 2 years
Flexural involvement
History of generally dry skin 
Personal or family history of atopy.

Nb typically spares the nappy area

Question 20

Eczema herpeticum

Answer 20

HSV infection of eczema causing systemic illness and wheeping blister rash especially round the mouth. Medical emergency

Question 21

Treatment of eczema

Answer 21

Topical emollients (Diprobase)
Topical corticosteroids
Oral steroids
Azothioprine/methotraxate in severe disease

Question 22

Mild/Moderate-Potent/Very potent topical steroid

Side effects

Answer 22

Hydrocortisone

Betnovate

Dermovate

Skin thinning, telangectasia, irriversable striae.

Question 23

Ringworm treatment

Answer 23

Clotrimazole

Question 24

Candia albicans treatment
Mouth
Skin
Vagina

Answer 24

Nystatin
Clotrimazole
Clotrimazole + pessary (Canistan combi)

Question 25

Bacteria infections of the skin

Answer 25

Impetigo - S.aureus/pyogenes - Honeycoloured crusts - Fusidic acid cream Cellulitis - B haemolytic staph and strep - RCDT - Ben Pen

Question 26

Wart treatment

Answer 26

Cryotherapy/Salicylic acid

Question 27

Koebner phenomenon

Answer 27

Psorisis developing from a scratch/incision

Question 28

Auspitz's sign

Answer 28

Bleeding from psoriasis scales upon removal.

Question 29

When to seek specialist advice in shingles (3)

Answer 29

Immunocompromised Pregnant Ophthalmic involvement

Question 30

Treatment for acne Mild Moderate Severe

Answer 30

Facial comedomes only Benzoyl peroxide or isotretinoin Papules and pustules dominat face and torso Topical antibiotic + Benzoyl peroxide/istretinoin or Doxycycline/tetrocyclin or combined oral contraceptive. Nodules, cysts, scars and inflamation Refer - Best is high does isotretinoin.

Question 31

Rosacea S&S Treatment

Answer 31

Central facial rash with erythema telenagiectasia, papules pustules (without comedomes), lymphoedema. Brought on by stress, alcohol, and spices Mild Topical metronidazole or azelaic acid ``` Moderate Oral tetracycline (Erythro if pregnant) ``` Nb if occular invlovement give ciprofloxacin

Question 32

Drug reactions presentation

Answer 32

``` Morbilliform Urticaria Erythroderma Steven Johnsons syndrome Toxic epidermal necrolysis ```

Question 33

Morbilliform

Answer 33

Generalised erythematous maclues and papules on the trunk + Mild fever within 1-3 weeks of drug. Common drugs Amoxicillin Cephalosporins

Question 34

Steven Johnsons syndrome

Answer 34

URTI symptoms 2-3 weeks after starting a drug. Then Painful erythematous paupular rash evolving to form target like lesions. Affects <10% and severe mucous ulceration in >1 spot. Causative drugs Sulfonamides, anti epileptics, penicillins Management IV Ig, ICU, supportive

Question 35

Toxic epidermal necrolysis

Answer 35

Flu like sysmptoms evloving to widespead painful rash and necrosis of large areas of the epidermis. >30% Causative drugs Sulfonamides, anti epileptics, penicillins, allopurinol Management IV Ig, ICU, supportive

Question 36

Drugs inducing photo sensitivity

Answer 36

Thiazides Tetracyclines Amiodarone

Question 37

Lichen planus 5ps

Answer 37

``` Purple Puritic Poly angular Planar Papules ``` Common on wrists, forearms ankles and legs Treatment steroid

Question 38

HIV infections

Answer 38

``` EBV HSV Candidiasis Scabies Syphilis ```

Question 39

HIV skin problems

Answer 39

``` Seborrhoeic dermatits Psoriasis Drug reactions more common Alopecia Fat loss from face and gain on truck Onychomycosis (fugal infection of nail) ```

Question 40

Pressure ulcer staging

Answer 40

Non blanching erythema Partial thickness skin loss Full thickness skin loss extending into fat Destruction of muscle/bone/fat

Question 41

Pressure ulcer treatment

Answer 41

``` Pressure relieving mattress Regular turning Debride Dressings Optimise nutrition ```

Question 42

Scabies

Answer 42

Very itchy rash affecting finger webs. Highly contagious Treatment - Perimethrin

Question 43

Scoring system for melanoma

Answer 43

Breslows