Dermatology

Question 1

What type of ulcer is deep, red, necrotic with undermined violaceous oedematous border and leaves a cribriform pattern of scarring? What disease is it associated with?

Answer 1

Pyoderma gangrenosum
Associated with Myeloproliferative disorders, IBD, RA, Granulomatosis with polyangitis and lymphoma

Question 2

What are the skin manifestations associated with sarcoidosis? (4)

Answer 2

Eythema nodosum- painful eythematous lumps on shins
lupus pernio - large dark patches on nose and extremities
skin plaques - dark red / brown
S/C nodules

Question 3

What skin lesion is associated with mycoplasma pneumoniae?

Answer 3

Erythema multiforme- targetoid patches on trunk and limbs (non-specific)

Question 4

Apart from sarcoidosis, which disease has erythema nodosum? What is the other most common skin manifestation in this disease?

Answer 4

TB
lupus vulgaris

Question 5

What is melanoma in-situ? What is the cause and how do you treat?

Answer 5

Lentigo maligna
Lesion- macule
chronic sun damage- so presents in elderly
Mx: excision

Question 6

What is bowen’s disease?

Answer 6

Squamous cell cancer in situ, presents as red, scaly plaque

Question 7

What disease has rolled, pearly edges and telangiectasia with focal/global pigmentation?

Answer 7

Pigmented BCC

Question 8

Which lesion has a stuck-on, sharply demarcated appearance?

Answer 8

Seborrheic keratosis

Question 9

What can be given in chronic spontaenous urticaria besides combination of second-generation antihistamines?

Answer 9

Leukotriene receptor antagonist - Montelukast

Question 10

What can be added if second gen antihistamines and montelukast fail to control chronic spontaneous urticaria?

Answer 10

Cyclosporin (immunosuppressive)

Question 11

What can be tried if 4 weeks of antihistamines/montelukast don’t work and immunosuppressive therapy fails for chronic spontaneous urticaria?

Answer 11

Omalizumab (monoclonal antibody against IgE)

Question 12

In which disease do you get a herald patch followed by widespread, similar red patches with a fine collaret of scale? What is the treatment?

Answer 12

pityriasis rosea
Often truncal rash in christmas tree configuration
Conservative- resolves after 6 weeks - up to 12 weeks later

Question 13

Which disease has a photosensitive rash, hypertension and hyponatraemia?

Answer 13

Porphyria

Question 14

What antibodies are associated with autoimmune hepatitis?

Answer 14

Anti-smooth muscle Ab

Question 15

Which disease affects bronchial carcinoma patients and presents as painful mouth ulcers, generalised tense blistering in skin and mucosa and an itchy skin rash?

Answer 15

Paraneoplastic pemphigus

Question 16

What antibody is found in paraneoplastic pemphigus?

Answer 16

Anti-envloplakin

Others: periplakin, bullous pemphigoid antigen 1, desmoplakin, desmoplakin II, plectin, alpha 2 macroglobulin like 1 , also: desmoglein 3 (a/w pemphigus vulgaris), desmoglein 1 (a/w pemphigus foliaceus)

Question 17

Which Ab is a/w granulomatosis with polyangitis?

Answer 17

cANCA

Question 18

What Ab is a/w paraneoplastic cerebellar degeneration?

Answer 18

Anti-Hu

Question 19

What Ab is a/w development of SLE and also development of neonatal heart block when present during pregnancy?

Answer 19

Anti-Ro

Question 20

What Ab is a/w coeliac disease?

Answer 20

Anti TTG

Question 21

Which disease presents as polymorphic rash affecting the palms and soles of the feet after a typical painless initial ulcer on the penis? How to manage?

Answer 21

Secondary syphilis
Penicillin 2.4 million units (MU) intramuscularly (IM) as a single dose

Question 22

In case of penicillin allergy or unwillingness to take penicillin IM, what is the treatment available?

Answer 22

Macrolides - azithromycin 2g oral stat
(not recommended in early pregnancy- as high rate of treatment failure)

Question 23

If penicillin and macrolides are not suitable for treatment of primary / secondary syphilis, what is the drug of choice? what is the dose for neuro syphilis?

Answer 23

Doxycyline 100mg BD for 14 days
For neuro-syphilis doxy 200mg BD for 28 days

Question 24

Why is doxycyline not suitable for use in pregnancy?

Answer 24

Tooth staining in fetus

Question 25

What disease affects NH residents, causes severe pruritus at night, burrows in web spaces, penile papules? What is the treatment?

Answer 25

Scabies Topical permethrin- retreat one week later

Question 26

what diseases can be s/w lichen planus?

Answer 26

hepatitis C, primary biliary cirrhosis, chronic active hepatitis

Question 27

what is wickham's striae?

Answer 27

a fine, white, lacy pattern in mouth (seen in lichen planus)

Question 28

purplish, polygonal, flat topped papules are characteristic of ?

Answer 28

lichen planus

Question 29

when do drug eruptions happen?

Answer 29

1-8 weeks of initiation of a drug

Question 30

What treatments are available for alopecia areata?

Answer 30

topical /intralesional steroids Topical minoxidil contact allergen therapy Janus kinase inhibitors Wig/hairpiece, false eyelashes, eyebrow tattooing

Question 31

What causes scarring alopecia with well defined erythematous plaques with scaling, atrophy and follicular plugging in light exposed areas of the body and is exacerbated by sunlight?

Answer 31

Discoid lupus erythematosus

Question 32

What is hair loss after high fever, stress, malnutrition, surgery or childbirth?

Answer 32

Telogen effluvium

Question 33

What condition presents with upper GI haemorrhage, plucked chicken skin, loose skin folds around the axilla and angioid streaks on retina?

Answer 33

Pseudoxanthoma

Question 34

How will you diagnose Pseudoxanthoma?

Answer 34

Skin biopsy- short, fragmented elastic fibres, basophilic staining, granuloma formation. Van Kossa stain - calcium deposits