Derm

Question 1

ABPI > what for compression bandaging?

Answer 1

>0.8

Question 2

Management of venous ulceration?

Answer 2

Emollients, and compression bandaging if abpi adequate

Question 3

Pain management in venous ulcers, what not to use?

Answer 3

Do not use nsaid as impairs healing! Paracetamol and codein helpful and leg elevation

Question 4

What is this?

Answer 4

Lipodermatosclerosis

inflammation of the subcutaneous fat causing fibrosis, and hard, tight skin which may be red or brown.

Champagne bottle legs

Question 5

What is this?

Risk factors?

Treatment?

Answer 5

Venous eczema

Standing for long periods, past DVT, varicose veins

Emollients ABX if needed steroids for flares and compression stocking if ABPI above 0.8

Question 6

Diagnosis of eczema, most likely symptoms/history?

Answer 6

The presence of itching

Starts in infancy

History of Atopy

In adults often hands, longstanding disease affects flexures usually

Chronic causes thickened skin

Question 7

Diagnosis?

Answer 7

Eczema probably adult due to hands

Question 8

Diagnosis?

Answer 8

Eczema- flexural

Question 9

Moderately potent steroid cream?

Answer 9

betamethasone valerate 0.025%

Question 10

Eczema treatment in general?

Answer 10

Stepwise approahc always emollients even when skin is clear

Steroids depending on the severity calcineurin inhibitors on specialsit advice

Question 11

Trauma to the skin and then development of itchy scaly area?

Answer 11

Psoriasis can occur in 20% of people with psoriasis trauma or insect bites

Question 12

Drugs causing or exacerbating psoriasis?

Answer 12

lithium, antimalarial drugs such as chloroquine, beta-blockers, nonsteroidal anti-inflammatory drugs

Question 13

URTI and then droplet scaly lesions appear?

Answer 13

Guttate psoriasis can also be an exacerbation of chronic plaques

Question 14

Nail symptoms with psoriasis?

Answer 14

Common with psoriatic arhtritis

Pitting

discoloured-oil drop

nail bed hyperproliferation

onycholysis-nail bed away from the nail

Question 15

Diagnosis? Treatment?

Answer 15

Eczema herpeticum

Aciclovir and referall to hospital especially in young kids

Question 16

Important things to consider when using accutane?

Answer 16

teratogenic, mood disorders, very dry skin(esp lips)

Measure LFTYs and cholesterol/triglycerides

Try and avoid ETOH

Question 17

Systemic treatments for psoriasis?

Answer 17

Methoterexate, acetritin ciclosporin

UVB/PUVA light therapy

Then biologics

Question 18

Risks for BCC?

Answer 18

–Sun

–Age

–Prev BCC

–Type 1 skin

Question 19

Features of BCC?

Answer 19

• Pearly
• Papular
• Bleeds regularly
• Peripheral telangectasia

Question 20

What margin size for BCC excision?

Answer 20

4mm also for SCC too

Question 21

Risks for SCC and what is a precursor?

Answer 21

Age, Sun, Type 1 skin, Previous Ak, Smoking

Actinic keratosis is a precursor

Question 22

SCC features/presentation?

Answer 22

indurated nodular keratinising or crusted tumour that may ulcerate

often present on head and neck

Question 23

7 points for checklist of skin cancer?

Answer 23

Major

Change in size

Irregular shape

Irregular colour.

Minor

Largest diameter 7 mm or more

Inflammation

Oozing

Change in sensation

Question 24

BCC referall urgency?

Answer 24

Usually routine unless a good reason not to be

Question 25

Primary treatment of actinic keratosis?

Answer 25

cryotheraoy, but can use imiquimod or 5FU

Question 26

What is this? Complications?

Answer 26

Actinic keratosis, possible transformation in to scc

Question 27

Diagnosis?

Answer 27

SCC

Question 28

Diagnosis?

Answer 28

SCC

Question 29

Solar (actinic) keratosis? Stages of development? Where found?

Answer 29

Usually single spot feels like sandpaper initially then multiple plaques red and scaly eventually thick and hyperkarotic Usually found on head, face, ears scalp back of hands

Question 30

Treatments of keloid scar?

Answer 30

Local steroids and rarely excision

Question 31

Risk for keloid?

Answer 31

Hx trauma, Fhx of scarring, darker skinned

Question 32

Spot diagnosis? Features?

Answer 32

kaposis sarcoma- maligancy AIDS defining Can affect mucosa, Usually painless unless inflamed Lesions can ulkcerate- respirastory involment common

Question 33

Excoriations between fingers? ++Itchy Treatment?

Answer 33

Scabies permethrin 5% or malathion 0.5% Keep on for 8-12hrs repeat after 7 days pruritis may continue for a while

Question 34

Diagnosis why?

Answer 34

Nodular BCC, pearly and rolled edges

Question 35

Where would you use MOHS surgery?

Answer 35

Sensitive areas such as face eyes and ears

Question 36

A-E of melanoma?

Answer 36

A Asymmetry B Border irregularity C Colour variation D Diameter over 6 mm E Evolving (enlarging, changing)

Question 37

Diagnosis? How common?

Answer 37

Superficial spreading melanoma most common

Question 38

What is used to assess severity of melanoma?

Answer 38

Breslow thickness

Question 39

Initial treatment of melanoma?

Answer 39

Wide local excision- Margins depend on thickness and size of melanoma

Question 40

Biopsy of kaposi shows?

Answer 40

Spindle cells

Question 41

What is this? Associations?

Answer 41

Pyoderma ganrenosum assoc with IBD and RA

Question 42

Pyoderma gangrenosum treatment?

Answer 42

Steroids topicalfor small ulcer and systemic for big

Question 43

later deep, red, necrotic ulcers with a **_violaceous border_** buzz word for?

Answer 43

Pyoderma- may have immunosupression/immune condition not usually caused by diabetes

Question 44

What is this what may be an underlying condition?

Answer 44

Erythemaq nodosum IBD, SLE, sarcoid, strep infection

Question 45

Venous ulcer features? Where?

Answer 45

features of venous insufficiency (previous DVT/Veins) Usually above medial malleoulus, painless, illdefined border mange with compression bandages and emollient if ABPI \>0.8

Question 46

**_Multiple_** target lesions? Causes?

Answer 46

Erythema multiforme infection- mycoplasma, EBV, Anti tnf/NSAIDS

Question 47

1st line for bowens disease treatment?

Answer 47

Cryotherapy or curretage or 5FU or imiquimod

Question 48

Risk of what increased in psoriasis?

Answer 48

CVD