Dermatology

Question 1

Types of psoariasis?

Answer 1

Chronic non infectious inflammatory disease of skin
Type 1- early onset - peak 2nd decade,family history,frequent association with HLA
TYPE 2 - LATE ONSET - peak in 5th decade, relatively mild, less HLA association

Question 2

Causes of psoriasis?

Answer 2

Genetic factors 
Environmental factors
-trauma
-infection 
-hypokalemia
-sunlight
-alcohol 
-smoking
-drugs ( Li,bb,ccb)
-emotions 

Epidermal keratinocyte hyper proliferation

Question 3

Common forms of psoriasis?

Answer 3

1. Chronic plaque psoriasis 4
2. guttate psoriasis 3
3. Flexural psoriasis 4
4. Palmo plantar psoriasis
5. Pustular psoriasis 3
6. Erythemodermic/ exfoliative psoriasis 4
7. Psoriatic athritis
8. Psoriatic nail - pitting, subungual hyperkeratosis, onycholysis

Question 4

Medical co morbidities of psoriasis?

Answer 4

7

1. cardiovascular disease
2. metabolic syndrome
3. lymphoma and non melanoma skin cancers
4. depression
5. alcohol
6. smoking
7. obesity

Question 5

Tx of psoriasis?

Answer 5

Topicaal tx (stable, <30% of the surface area involved) 5
-coal tar, dithranol,steroid,calcipotrid (vit D), salicylic acid

Systemic tx 6
-uv phototherapy, methotrexate, retinoids, cyclosporine, hydroxyurea, systemic steroids are contraindicated.

Question 6

Causative prganism of leprosy and the detecting agents?

Answer 6

Mycobacterium leprae

Detected in tissue be ziehl neelson stain or immunocytochemical test

Question 7

Clinical features and types of leprosy?

Answer 7

Clinical features- 6
IP 2-6 yrs 
Insidious onset 
M>F 
Anaesthetic skin lesions
Thickened peripheral nerves
Pattern depends on immune status

Types

• tuberculoid leprosy
• borderline leprosy
• lepromatous leprosy

Question 8

Featues of tuberculoid leprosy?

Answer 8

Good immunity - localized disease
Main presentation- 5
-few hypopigmented patches 
-usually single skin lesion
-thickened demarcated edges
-central healing and atropy
-face,gluteal region,extremities affected
Thickened and tender nerves
Muscle atropy
Good prognosis
Microscopic features- 
-granuloma formation
-activated macrophages Surrounded by T lymphocytes

Claw fingers
Foot drops

Question 9

Features of lepromatous leprosy?

Answer 9

16
Low immunity
Generalized disease
Many nodules,hypo pigmented patches and plaques with raised poorly demarcated edges
Every organ can be involved
Skin changes earliest and most obvious
Skin lesions predominant in face,gluteal region,extremities
Macules,papules,nodules or plaques
Mucous membrane involvement- nasal stuffiness,laryngitis,hoarseness of voice
Saddle nose,leonine facies,gynecomastia,testicular atropy, nerve palsy
No granuloma formation
Paresthesia (glove and stocking)
Hair loss
Finger and toe necrosis
Chronic uveitis
Facual nerve palsy
Microscopy- lipid Laden macrophages called foam cells and many acid fast bacilli (sheets of foamy macrophages)

Temp lost before pain and touch

Question 10

WHO classification of leprosy?

Answer 10

Paucibacillary leprosy -<5 skin lesions with no bacilli

Multibacillary leprosy- 6 or > lesiond which may have bacilli

Question 11

Lepra reactions and its types?

Answer 11

Immune mediated reactions with borderline or lepromatous spectrum of disease usually during treatment

Type 1 lepra reaction- type 4 hypersensitive (4)
Type 2 lepra reaction- erythema nodosum leprosum ,type 3 hypersensitive (10)

Question 12

Ix of leprosy?

Answer 12

4

1. biopsy of skin or sensory nerve
2. skin or nasal smear
3. lepromin test
4. PCR

Question 13

Tx of leprosy?

Answer 13

Multibacillary (12 months) 3 drugs
Paucibacillary (6 months) 2 drugs
Single lesion paucibacillary (single dose) 3 drugs