Dermatology

Question 1

Drug causes of Steven Johnson syndrome (5)

Answer 1

penicillin
sulphonamides
anti epileptics - lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

Question 2

Renal transplant associated cancer (1)

Answer 2

skin cancer (particularly squamous cell) is the most common malignancy secondary to immunosuppression

Question 3

Contact Dermatitis (2) types and examples

Answer 3

1 - Irritant - non allergy, usually hands, eg detergents

2 - allergic - type IV hypersensitivity, weeping eczema eg hair dyes

Question 4

Lichen planus (autoimmune condition against keratinocytes) rash

• description and site
• Mx

Answer 4

Itchy, raised - ankles/ soles, wrists/ palms, lower back

Mx - topical steroid, Benzydamine (if oral involvement)

Question 5

Blisters/ bullae differentiation (whether mucosal involvement) (2)

Answer 5

no mucosal involvement: bullous pemphigoid

mucosal involvement: pemphigus vulgaris

Question 6

Dermatitis herpetiformis (IgA)
rash description
association (1)
Mx

Answer 6

itchy, vesicular lesions on extensor surfaces
associated with coeliacs
Mx - dapsone, gluten free diet

Question 7

Lichen sclerosis
Rash description
Mx

Answer 7

elderly, genitalia, white patches, itch
Mx - topical steroid + emollients
Increased risk vulva cancer

Question 8

Fungal nail infections

Mx - Dermatophyte, Candida

Answer 8

Dermatophyte - oral terbinafine/ oral itraconazole alternative
Candida - topical antifungal (eg Amorolfine)

Question 9

Pompholyx eczema

location of rash

Answer 9

effects hands and feet

Question 10

Pityriasis Vesicolour
fungal cause
rash description
Mx

Answer 10

Malassezia furfur
trunk, hypopigmented, scales
Mx - topical antifungal (ketoconazole shampoo)

Question 11

Pellagra features (3)

Answer 11

dementia
diarrhoea
dermatitis

Question 12

facial hirsutism Mx (1)

Answer 12

Topical eflornithine

Question 13

Scabies Mx

Answer 13

1st - Permethrin: all skin including scalp + leave for 12 hours + retreat in 7 days
2nd - Malathion

Question 14

Rosacea Mx
mild
severe

Answer 14

mild/moderate: topical metronidazole

severe/resistant: oral tetracycline

Question 15

Psoriasis (primary care) Mx (3 steps)

Answer 15

1st - topical corticosteroid + topical vit D analogue OD 4 weeks
2nd (>8weeks no improvement): vit D analogue BD
3rd - topical corticosteroid BD OR a coal tar preparation OR dithranol

Question 16

Psoriasis (secondary care) Mx

Answer 16

Phototherapy - UVB

Oral methotrexate/ Ciclosporin

Question 17

Causes of erythema nodosum (4)

Answer 17

infection - streptococci, Tb
disease - sarcoidosis, Crohns, Behcet’s, malignancy/lymphoma
drugs - penicillin, sulphonamides, COCP
pregnancy

Question 18

Actinic keratoses Mx

Answer 18

Topical Flurouricil

Question 19

Acanthosis Nigricans Cancer association

Answer 19

Gastric cancer

Question 20

Impetigo Mx

Answer 20

1 - Hydrogen peroxide cream 1%
2 - Topical Fusidic acid
3 - Topical Mupirocin
4 - Oral flucloxacillin

Question 21

Eczema Herpeticum (HSV 1+2)
Features
Mx

Answer 21

bg of eczema, rapidly progressive painful rash

Mx - IV Aciclovir

Question 22

Bullous pemphigoid Ix

Answer 22

skin biopsy