Dermatology

Question 1

Mechanism of bullous pemphigoid?

Answer 1

Antibody against hemidesmosomes

Question 2

Mechanism of pemphigus vulgaris?

Answer 2

Antibody against desmoglein 3

Question 3

Mechanism of bullous impetigo?

Answer 3

Staph aureus toxin cleaves desmoglein 1

Question 4

Treatment of bullous pemphigoid?

Answer 4

Corticosteroids

Question 5

Treatment of pemphigus vulgaris?

Answer 5

Corticosteroids

Question 6

Difference between SJS and TEN?

Answer 6

SJS: <10% body surface area affected
TEN: >30% body surface area affected

Question 7

What are the 2 types of alopecia and what are their differences?

Answer 7

Androgenic alopecia: hypersensitivity to androgens associated with family history

Alopecia areata: autoimmune disease of hair follicles. Has exclamation mark hairs

Question 8

Features of basal cell carcinoma?

Answer 8

• Slow growing, raised lesion
• Pearly, flesh-coloured papule with a central crater and telangiectasia
• Bleeds with minor trauma

Question 9

Management of a BCC?

Answer 9

Wide excision with 4mm margin

Question 10

What is the most common skin cancer?

Answer 10

BCC

Question 11

What is the second most common skin cancer?

Answer 11

SCC

Question 12

Risk factors of BCC?

Answer 12

• UV exposure
• Skin types 1&2
• Age

Question 13

Risk factors of SCC?

Answer 13

• Excessive exposure to sunlight
• Actinic keratoses and Bowen’s disease
• Immunosuppression
• Smoking

Question 14

Management of SCC?

Answer 14

• Urgent 2ww referral

- Wide excision. 4mm margin if <20mm diameter, 6mm margin if >20mm diameter

Question 15

Which is the most reliable prognostic factor of a skin cancer?

Answer 15

Depth as measured using the Breslow thickness scale

Question 16

Risk factors of melanoma?

Answer 16

• Type 1&2 skin
• Gingers & blondes
• Family history
• Atypical melanocytic naevi
• Giant congenital melanocytic naevi

Question 17

Most common type of melanoma?

Answer 17

Superficial spreading

Question 18

Which melanoma is seen in chronically sun-exposed elderly people?

Answer 18

Lentigo maligna

Question 19

Which melanoma is seen on the palms/soles, African American/Asian patients?

Answer 19

Acral lentiginous

Question 20

Which melanoma is most aggressive and generally bleeds/oozes?

Answer 20

Nodular

Question 21

Management of melanomas?

Answer 21

• Urgent 2ww referral

- Wide excision with 2mm margin and send for histology

Question 22

Treatment for impetigo? How does this differ if they have extensive disease?

Answer 22

Topical hydrogen peroxide

Oral flucloxacillin in extensive disease

Question 23

Treatment of pityriasis versicolour?

Answer 23

-Ketoconazole shampoo

Question 24

Management of pityriasis rosea?

Answer 24

-No treatment as it is self limiting. Give emollients or mild steroid if there is itchiness

Question 25

Difference between guttate psoriasis and pityriasis rosea?

Answer 25

Guttate psoriasis is usually preceded by streptococcal sore throat

Question 26

Which group of patients are particularly susceptible to shingles/herpes zoster infection?

Answer 26

HIV positive patients

Question 27

Most common complication of shingles?

Answer 27

Post-herpetic neuralgia (severe, persistent pain). Herpes zoster ophthalmicus

Question 28

Which immune cells mediate the eczema reactions?

Answer 28

Th2 immune response - IgE, eosinophils, TNFalpha

Question 29

Treatment of seborrheic eczema?

Answer 29

Topical azole anti-fungal creams

Question 30

What investigations should be done in someone with suspected allergic contact eczema?

Answer 30

Patch testing

Question 31

What drugs can exacerbate psoriasis?

Answer 31

- Beta blockers - Lithium - Hydroxychloroquine - NSAIDs - ACEi - Infliximab

Question 32

What features of psoriatic arthropathy are there?

Answer 32

- Pencil in cup appearance on X-ray | - Dactylitis (sausage fingers)

Question 33

Nail changes in psoriasis?

Answer 33

- Pitting - Onycholysis - Longitudinal ridges - Sub-ungual hyperkeratosis

Question 34

1st line treatment for psoriasis?

Answer 34

- Topical Vitamin D analogue (calcitriol) and emollients | - Moderate-potent steroids can be used

Question 35

2nd line treatment for psoriasis?

Answer 35

Phototherapy (UVB or PVA). Guttate psoriasis usually treated this way

Question 36

What is used 3rd and 4th line for psoriasis?

Answer 36

3rd: systemic therapy with methotrexate if resistant to topical therapy 4th: biologic therapy with infliximab, adalimumab

Question 37

Features of lichen planus?

Answer 37

- Intensely itchy rash of wrists, ankles and lumbar region - Shiny, polygonal papules - Koebner phenomenon - Involvement of mucosal surfaces (buccal, vulva)

Question 38

Treatment of lichen planus?

Answer 38

Potent topical steroids

Question 39

Features of lichen sclerosus?

Answer 39

- Intensely sore lesions that are shiny, white, fissured seen in genital regions - Can cause atrophy and fusion of vulva, labia

Question 40

What cancer is associated with lichen sclerosus?

Answer 40

SCC

Question 41

Treatment of lichen sclerosus?

Answer 41

Potent/super potent topical steroids

Question 42

What is the 1st, 2nd, 3rd, 4th line treatment of acne?

Answer 42

1st: Topical monotherapy (retinoid, benzoyl peroxide) 2nd: Topical combination therapy (antibiotic, benzoyl peroxide, retinoid) 3rd: Oral antibiotics (doxycycline or erythromycin if pregnant) 4th line: Oral isotreinoin

Question 43

What side effects must be warned before taking isotretinoin?

Answer 43

- Teratogenicity - Depression - Hair thinning - Hyperlipidaemia, hepatotoxicity - Dryness

Question 44

What tests must be done before starting isotretinoin?

Answer 44

- Pregnancy test - Depression screen - Bloods (lipids, LFTs)

Question 45

Treatment for mild rosacea?

Answer 45

Topical metronidazole

Question 46

Treatment for moderate-severe rosacea?

Answer 46

Oral doxycycline

Question 47

Give examples of: mild, moderate, potent, very potent steroids?

Answer 47

Mild: hydrocortisone 0.1-2.5% Moderate: eumovate Potent: betnovate Very potent: dermovate

Question 48

Features of hereditary haemorrhagic telangiectasia?

Answer 48

- Family history - Epistaxis - Visceral lesions: pulmonary, hepatic, GI, cerebral, spinal AVM - Telangiectasia

Question 49

Which malignancy is associated with acanthosis nigricans?

Answer 49

Gastric adenocarcinoma

Question 50

Which drugs can cause erythema nodosum?

Answer 50

- COCP - Penicillins - Sulfasalazine

Question 51

Treatment for erythema nodosum?

Answer 51

Self limiting and resolves within 6 weeks

Question 52

First line treatment of impetigo?

Answer 52

Topical hydrogen peroxide