Derm Spot Test

Question 1

List the skin changes that may be seen in cases of viral hepatitis

Answer 1

1. Erythema multiforme
2. Uriticaria
3. Polyarteritis nodusa
4. Lichen planus

Question 2

Topical treatment for actinic keratosis

Answer 2

Efudix cream

Question 3

Histology of psoriasis

Answer 3

Epidermal hyperplasia
Parakeratosis
Neutrophils within the dermis
Elongated epidermal ridges

Question 4

Features of a lipoma

Answer 4

Deep to the skin 
Skin moves freely over them 
Soft and doughy 
Mobile on palpitation 
Must ultrasound to rule out sarcoma and liposaroma

Question 5

Treatment for head lice

Answer 5

Dimeticone 4% gel

Question 6

Features of Bechets disease

Answer 6

Syndrome of recurrent painful oral ulceration
+ 2 of recurrent painful genital ulcers
opthalamic lesions
skin lesions (erythema nods)

May also present with systemic features such as arthritis and IBD

Question 7

Treatment of Bechet disease

Answer 7

Colchine
Glucocorticoids
Immunosupressive agents

Question 8

List the conditions that are associated with pyoderma gangrenosum

Answer 8

Inflammatory bowel disease 
Hepatitis 
Rheumatoid arthritis 
Hairy cell leukaemia 
Granulomatous with polyangitis (Wegner's)

Question 9

Pathology of bullous pemphigoid

Answer 9

autoantibodies to components of hemidesmosomes

Question 10

Pathology of pemphigus vulgaris

Answer 10

Autoimmune disease with IgG antibodies to the desmoglein 3

Question 11

List the different steroids in order of increasing potency

Answer 11

Hydrocortisone
Eumovate
Betnovate
Dermovate

Question 12

Side effects of topical steroids

Answer 12

Atrophy 
Striae 
Bruising 
Bleeding 
Telengectasia 
Hypertrichosis

Question 13

Name the scoring systems used in psoriasis

Answer 13

PASI
Psoriasis area and severity index

DLQI
Dermatology life and quality index

Question 14

List the side effects associated with iostrenion

Answer 14

Dry eyes, lips, skin 
Easy to sunburn 
Headache 
Myalgia 
Abnormal lipids 
Abnormal mood and depression 
Tetratogenic (double contraceptions)

Question 15

List the clinical features of neurofibromatosis type I and II

Answer 15

NFI

• 6+ cafe au last spots
• axillary freckling
• Lisch nodules
• Neurofibromas
• Optic glioma
• Hearing and learning difficulties

NFII
- Bilateral vestibular schwanoma

Question 16

List the features associated with tubersclerosis

Answer 16

• angiofibromas
• ash leaf maples
• peringual fibroma
• shagreen patches
• seizures
• behavouiral abnormalties
• heart, lung, kidney tumours

Question 17

Name the scoring system for neck fas

Answer 17

SCORETEN

Question 18

List the complications of erythroderma

Answer 18

1. Fluid status
2. Hypothermia
3. Infection
4. HF , pneumonia
5. Low albumin
6. Pigement changes

Question 19

List the disease that are associated with vitiligo

Answer 19

Graves disease 
Pernicious disease 
Addison disease 
Uveitis 
Alopecia areta 
Polyglandular autoimmune syndrome 1 and 2

Question 20

Name three skin conditions that have associations with cancers (not skin cancers)

Answer 20

Acanthosis nigrans: adenocarcinoma
Acquired ichthyosis: Lymphoma
Dermatomyositis: Lung cancer, Genital cancer
Thromboplebitis migrans: Carcinoma of the pancreas

Question 21

Primary prevention of skin cancer

Answer 21

Sun cream
Avoid the sun
Avoid tan
Cover up

Question 22

Risk factors for developing sun cancer

Answer 22

Fair skinned 
High number of moles 
\+ve family history 
Older 
Immunosuppressed

Question 23

Treatment of SCC according to the type

Answer 23

INSITU

• cyrotherapy
• topical chemo

INVASIVE

• wide surgical excision
• > 2cm MOH’s surgery

METASTATIC
- excision and radiotherapy

Question 24

Types of basal cell carcinoma and list their features

Answer 24

1. Nodular
   - seen at the head and neck
   - papule, nodule pearly rolled edge
2. Superficial
   - demarcated
   - threadlike border
   - poorly defined border
3. Cystic
   - Mid facial
   - yellowish plaque
4. Scleorosing
   - blue brown melanoma

On biopsy there will be basophilic cells in nests
High number of mitotic bodies

Question 25

Management of BBC

Answer 25

1. Surgical excision 2. MOH's micrographic surgery to establish extent 3. Radiotherapy

Question 26

Name the types of malignant melanoma

Answer 26

1. Superfacial spreading - lower limb - large flat irregularly pigmented 2. Nodular melanoma - trunk - pigmented lesion - bleeds and ulcerates 3. Lentigo - on face 4. Acral lentiginous melanoma - palms, soles, nails

Question 27

Management of melanoma

Answer 27

1. in situ - wide local excision 2. Melanoma - surgical excision - sentinel lymph node biopsy 3. Metastatic - lymphadenectomy - radiotherapy - chemotherapy

Question 28

Clinical features of lichen sclerosis

Answer 28

itchy painful constipation usually involved labia or cliteosis

Question 29

Management of lichen sclerosis

Answer 29

Reducing course of clobetasol proponent over a month

Question 30

Histological findings of lichen planus

Answer 30

``` Reduced melanocytes Sawtooth pattern Epidermal hyperplasia Upper dermal band like lymph infiltration Globular deposits of IgM ```

Question 31

Describe the skin changes seen in lichen planus

Answer 31

Red violet flat topped papules Wickham's striae Mucusal membranes may also be involved lacy webbed like appearance on the inside of the cheeks

Question 32

Management of lichen planus

Answer 32

``` Treatment is not always needed Symptomatic treatment - moderate potent steroids - calcinurin inhibitors - retinoids ``` Potent steroids for persistent lesions Immunosupression - Acitretin - Hydroxychloroquine - Methotrexate - Azathioprine

Question 33

Clinical features of SJS/TEN

Answer 33

Prodromal illness - Fever >39 - Sore throat - Runny nose - Sore eyes - Aches and pains Rash - Sheets of skin detachment - red oozing dermis Mucosal involvement - red sore photosensitive eyes - painful mouth ulcers - GI tract hard to eat

Question 34

List the diagnostic features associated with both SJS/TEN

Answer 34

SJS - >10% of body surface area - mucutaneous necrosis @ 2 mucosal sites TEN - >30% of the body surface area - mucutaneous necrosis - systemic toxicity

Question 35

Investigations for SJS/TEN

Answer 35

``` Increased levels of serum granulising Skin biopsy Histopathology - keratinocyte death - full thickness epidermal necrosis - minimal inflammation - no ab deposits ```

Question 36

List the criteria involved in SCORETEN and what it is used for

Answer 36

Grade illness severity and predict mortality 1. age >40 2. +ve of malignancy 3. HR >120 4. initial dermal detachment >10% 5. Serum urea >10mmol 6. serum glucose >14mmol 7. Serum bicarbonate >20mmol

Question 37

Management of SJS/TEN

Answer 37

``` Stop cause ITU admission Nutrition and fluid replacement Pain relief Sterile handling Skin, dressing, bacterial swabs, rx bacterial infection Other organ specific care ```

Question 38

List the causes of erythroderma

Answer 38

``` Drugs (penicillins, carbamazepine, NSAIDs) Dermatitis Skin conditions Lymphoma Graft vs host ```

Question 39

Clinical features of erythroderma

Answer 39

``` Warm skin very itchy eyelid swelling scaly skin hair loss lymphadenopathy ```

Question 40

Management of erythroderma

Answer 40

``` Discontinue all unnecessary meds Monitor fluid balance and body temp Skin moisturise - wet wipes - emollients - topical steroids Bacterial abx if infected ```

Question 41

Causes of erythema multiforme

Answer 41

``` Bacteria (strep, mycoplasma) Virus (HSV) IBD RA Radio/chemo ```

Question 42

List the diseases that are associated with Vitiligo

Answer 42

``` Graves Disease Pernicious anaemia Addison's disease Uveitis Alopecia areta Polyglandular autoimmune syndrome 1 &2 ```

Question 43

List the complications of dermatomyositis

Answer 43

Aspiration pneumonia Pulmonary fibrosis Cardiomyopathy Muscle atrophy

Question 44

Treatment of dermatomyositis

Answer 44

Steriods | Methotrexate, azathioprine, cyclophosphamide

Question 45

List the pathological differences between pemiphugus vulgarise and bullous pemphigoid

Answer 45

Pemiphygus vulgaris - abs vs desmosomes - Desmogleins 1/3 - intra-epidermal circular deposits Bullous pemphegoif - abs vs hemidesmosomes - IgG and C3 deposits along basement membrane

Question 46

List the diseases that are associated with pyoderma gangrenosum

Answer 46

``` Inflammatory bowel disease Acute leukaemia Polycthemia ruba vera Autoimmune heptatisis Myeloma ```

Question 47

List the rashes which present on the palms and the soles

Answer 47

``` Reactive arthritis Syphillis Psoriasis Eczema Erythema multiforme ```