Dermatology

Question 1

What endocrine diseases are associated with acanthosis nigricans?

Answer 1

Diabetes and GI cancer

Question 2

What condition is dermatitis herpetiformis associated with?

Answer 2

Coeliac

Question 3

What are the key characteristics of the rash associated with lupus?

Answer 3

Rash is associated with photosensitivity, alopecia, livedo reticularis, and Raynaud’s phenomenon.

Question 4

SLE investigations

Answer 4

Diagnosis involves testing for antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA).

Question 4

SLE management

Answer 4

prednisolone for systemic lupus erythematosus (SLE) and betamethasone 0.1% cream for discoid lupus erythematosus (DLE).

Question 5

What is a common cause of erythema multiforme, and how is it treated?

Answer 5

Erythema multiforme is often caused by herpes simplex infection. Treatment options include clobetasol 0.05% cream or prednisolone.

Question 6

Which body parts are affected by erythema multiforme?

Answer 6

Minor cases involve the hands/feet, while major cases present with systemic symptoms and mucosal involvement.

Question 7

What conditions are associated with pyoderma gangrenosum?

Answer 7

ulcerative colitis (p-ANCA) and Crohn’s disease

Question 8

How does pyoderma gangrenosum present and how is it managed?

Answer 8

Enlarging painful ulcers - prednisolone

Question 9

What are the key features of dermatomyositis?

Answer 9

Myositis (muscle weakness), a photosensitive rash (shawl sign), Gottron papules, and nail fold erythema

Question 10

How is dermatomyositis diagnosesd?

Answer 10

creatine kinase (CK), antinuclear antibodies (ANA), anti-Jo-1

Question 11

What are the common causes of erythroderma?

Answer 11

Erythroderma can be idiopathic or result from psoriasis, dermatitis, or drugs.

Question 12

How does erythroderma present?

Answer 12

Generalized erythema affecting more than 90% of the skin, and patients may feel cold despite the skin feeling hot.

Question 13

What drugs commonly cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Answer 13

Allopurinol, sulphonamides, NSAIDs, and anticonvulsants

Question 14

What is the causative organism of necrotizing fasciitis?

Answer 14

Streptococcus pyogenes

Question 15

Clinical features of necrotising fascitis

Answer 15

Pain out of proportion, dusky purple rash and oedema progressing to blisters and necrosis

Question 16

How is localised impetigo treated?

Answer 16

Fusidic acid cream

Question 17

What is the causative organism of impetigo?

Answer 17

Staphylococcus aureus

Question 18

How is widespread impetigo treated?

Answer 18

Oral flucloxacillin

Question 19

How is dermatophytosis (tinea) treated?

Answer 19

Terbinafine 1% cream

Question 19

What is the clinical presentation of varicella zoster?

Answer 19

Pyrexia followed by a macular-papular-vesicular pruritic rash

Question 19

What are the common areas affected by dermatophytosis (tinea)

Answer 19

Feet (athlete’s), hands, groin

Question 20

How is Varicella zoster treated

Answer 20

Calamine lotion

Question 20

What are the treatment options for head lice infestation?

Answer 20

Dimeticone 4% lotion or malathion 0.5% liquid

Question 21

Where is plaque psoriasis commonly found on the body?

Answer 21

Extensor surfaces, sacrum, scalp

Question 22

What is seen in psoriasis?

Answer 22

Red scaly plaque

Question 23

What is the associated risk with leukoplakia?

Answer 23

Squamous cell carcinoma

Question 24

What are the key features of acne rosacea?

Answer 24

Flushing, telangiectasia, photosensitive erythema, papules, and pustules

Question 25

What virus is associated with Kaposi's sarcoma, and in which context is it commonly seen?

Answer 25

Kaposi's sarcoma is associated with Human Herpesvirus 8 (HHV-8). It is commonly seen in immunocompromised individuals, especially those with HIV/AIDS.

Question 26

What is the most common type of skin cancer?

Answer 26

Basal cell carcinoma

Question 27

How does basal cell carcinoma present?

Answer 27

Grows slowly over time

Question 28

How is Bowen's disease related to actinic keratoses?

Answer 28

Bowen's disease is considered squamous cell carcinoma in situ

Question 29

What are the characteristics of squamous cell carcinoma (SCC), and how does it typically grow?

Answer 29

It grows quickly and often presents as a raised lesion with crusting and ulceration. Surgical excision is the primary treatment.

Question 30

Scoring system used to calculate quantity of fluid required in first 24 hours after a burn

Answer 30

Parkland criteria

Question 31

What advice should be given to someone with a herpetic cold sore?

Answer 31

Avoid kissing babies while you have the lesion

Question 32

How does psoriasis appear on black skin vs white

Answer 32

Purple rather than silver scales

Question 33

Which medications may exacerbate psoriasis

Answer 33

Beta blockers and aspirin

Question 34

Management plan for severe urticaria

Answer 34

Non-sedating antihistamine e.g. citirazine + short course of oral steroids

Question 35

Most aggressive type of melanoma

Answer 35

Nodular

Question 36

Wallace's rule of 9s in burns

Answer 36

9% for each arm; 18% for anterior torso

Question 37

What is the Parkland formula - used to calculate the fluid requirement in burns

Answer 37

4ml x body weight (kg) x total body surface area affected (%) - Give 50% of this in first 8 hours and rest in the remaining 16

Question 38

Name 2 features you would assess for in your history and examination that would be suspicious for potential smoke inhalation

Answer 38

- Burning sensation in the nose / throat - Productive cough - Stridor - Dyspnoea - Rhonchi - Wheezing - Hoarse voice - Accessory muscle usage - Tachypnoea - Cyanosis - Odynophagia - Headache - Delirium - Hallucinations - Decreasing consciousness / comatose - Convulsions / seizures - Hypertonia - Facial burns / loss of facial or intranasal hair - Soot in mouth or sputum

Question 39

How carbon monoxide affects the oxyhaemoglobin dissociation curve

Answer 39

Carbon monoxide has a greater affinity for haemoglobin than oxygen (so readily binds to Hb) Causing the curve to shift to the left Left shift → increased affinity of haemoglobin for oxygen / so haemoglobin holds onto oxygen more tightly Reducing the release of oxygen to tissues, causing hypoxia and the associated symptoms

Question 40

Which gene is associated with IBD, psoriasis, ankylosing spondylitis

Answer 40

HLA B27

Question 41

Define the appearance of chronique plaque psoriasis

Answer 41

- Found on extensor surfaces / elbows + knees / trunk / scalp - Symmetrically distributed - Raised - Clearly defined plaques / clear delineation - Pink or red / erythematous/ violet or grey in pigmented skin - Silvery scales - Itch - May become fissured / painful (in certain sites) - 1cm - a few cm in diameter - Auspitz sign / pinpoint bleeding points if scale is removed