Dermatology

Question 1

what is the most common malignant skin tumour?

Answer 1

basal cell carcinoma

Question 2

how would you treat a baby with eczema?

Answer 2

emollient

very careful w/ topical steroids if severe [can stunt growth]

Question 3

what causes scabies? and what lesion is characteristic

Answer 3

mite under skin

linear track lesion

Question 4

what is an unusual feature that characterises an urticaria rash?

Answer 4

rapidly changing/moves round body

Question 5

treatment for urticaria?

Answer 5

oral antihistamine [non-sedating, then sedating if needed]

Question 6

management of and treatment for urticaria with angio-oedema involving mouth/throat?

Answer 6

secure airway

IM adrenaline & IV hydrocortisone

Question 7

topical treatment for mild acne

Answer 7

benzoyl peroxide
azelaic acid
topical antibiotics
keratolytics
retinoids
vit B3 derivative nicotinamide

Question 8

oral treatment for moderate-severe inflammatory acne?

Answer 8

oral antibiotics [3-4 MONTHS]

hormonal treatment [co-cyprindiol] in women

Question 9

3rd line treatment of acne if topical agents and antibiotics fail?

Answer 9

oral retinoid [isotretinoin]

Question 10

contraindication for oral retinoids for acne?

Answer 10

teratogenic!

Question 11

1st line/mild management of eczema

Answer 11

avoid known irritants
emollients
TOPICAL CORTICOSTEROIDS [hydrocortisone]
topical calcineurin inhibitors

Question 12

treatment of moderate/severe eczema when topical therapies unsuccessful?

Answer 12

sedative antihistamines
UV treatment
oral prednisolone/ azathioprine/ ciclosporin

Question 13

treatment for bacterial superinfection in eczema

Answer 13

antibiotics

Question 14

topical treatment for psoriasis?

Answer 14

emollients
vitamin D3 analogues
coal tar
tazarotene [vit A antagonist/retinoid]
corticosteroids
dithranol

Question 15

systemic treatment for psoriasis

Answer 15

oral retinoic acid derivatives
methotrexate
ciclosporin
biological agents [TNF-a blockers]
phototherapy

Question 16

contraindication for retinoic acid derivatives in psoriasis?

Answer 16

teratogenic

Question 17

what recurrent infection may be common in adults with eczema?

Answer 17

staphylococcus aureus

Question 18

side effects of corticosteroids for atopic dermatitis [eczema]

Answer 18

skin atrophy
suppression of skin barrier homestasis
telangiectasia
striae [stretch marks]
acne
hypopigmentation
hypertrichosis

Question 19

side effects of calcineurin inhibitors for eczema?

Answer 19

burning/stinging

theoretical cancer risk

Question 20

downsides of UV therapy for eczema

Answer 20

cancer risk

increased photoaging of skin

Question 21

how does azathioprine work?

Answer 21

blocks DNA synthesis & therefore cell proliferation

Question 22

what is myelotoxicity?

Answer 22

bone marrow suppression

Question 23

why is close follow-up required when using ciclosporin for eczema?

Answer 23

narrow therapeutic window

renal impairment

Question 24

what type of drug is ciclosporin?

Answer 24

calcineurin inhibitor

immunosuppressive

Question 25

seborrhoeic dermatitis is associated with proliferation of which commensal yeast colonization?

Answer 25

malassezia

Question 26

what is seborrhoea?

Answer 26

oily skin

Question 27

common uninflamed form of seborrhoeic dermatitis?

Answer 27

dandruff

Question 28

treatment of scalp seborrhoeic dermatitis

Answer 28

anti-fungal treatment | keratolytic

Question 29

treatment of seborrhoeic dermatitis on flexures, trunk and face

Answer 29

anti-fungal | steroid [for itch]

Question 30

how do topical vitamin D analogues work?

Answer 30

inhibit cell proliferation | stimulate keratinocyte differentiation

Question 31

reason to not use dithranol for psoriasis?

Answer 31

stains bath, skin, clothes etc

Question 32

what type of drug is methotrexate?

Answer 32

DMARD | immunosuppressive [anti-proliferative, anti-inflamm]

Question 33

methotrexate inhibits metabolism of which nutrient/vitamin?

Answer 33

folic acid

Question 34

guttate psoriasis is classically triggered by what bacterial infections?

Answer 34

streptococcal | [upper resp tract]

Question 35

retinoids are derivatives of which vitamin?

Answer 35

A

Question 36

the anti-proliferative action of retinoids reduces which feature of psoriasis?

Answer 36

hyperkeratosis

Question 37

when would you consider biologics in psoriasis?

Answer 37

unresponsive to standard therapies intolerance/contraindication to standard therapies severity meets NICE criteria for biologic

Question 38

how do TNF-alpha antagonists work?

Answer 38

bind to TNK-a, blocking receptor mediated events [inflamm]

Question 39

4 key factors associated w/ acne

Answer 39

1. seborrhoea 2. comedo formation [black/white heads] 3. colonisation 4. inflammation

Question 40

what is rosacea?

Answer 40

chronic inflammatory facial dermatosis | flushing, erythema, papules, pustules

Question 41

treatment of rosacea

Answer 41

topical antibiotic [metronidazole] | topical azelaic acid

Question 42

2 main clinical features of urticaria

Answer 42

wheals [hives] | angio-oedema

Question 43

examples of pigmented skin lesions

Answer 43

mole [melanocytic naevus] seborrhoeic wart freckle [lentigo, ephelis] basal cell carcinoma

Question 44

risk factors for melanoma

Answer 44

``` UV exposure high density freckles red hair >100 moles >5 atypical moles family history ```

Question 45

early signs of melanoma

Answer 45

enlargement | colour change [usually darkening]

Question 46

ABCDE of melanoma

Answer 46

``` Asymmetry Border irregularity Colour variability Diameter >5mm elevation irregularity ```

Question 47

4 types of melanoma

Answer 47

superficial spreading nodular lentigo maligna [face] acral lentiginous [palms/soles]

Question 48

differential diagnosis of melanoma

Answer 48

``` benign pigmented naevus seborrhoeic wart freckle pigmented BCC pyogenic granuloma ```

Question 49

Tx of melanoma

Answer 49

surgical excision B-RAF inhibitors [vemurafenib] immunotherapy - PD-1 inhibitors [nivolumab]

Question 50

mortality rate for melanoma

Answer 50

20%

Question 51

what is toxic epidermal necrolysis

Answer 51

life threatening drug reaction causing widespread blistering and skin peeling

Question 52

which types of drugs can cause toxic epidermal necrolysis

Answer 52

Abx anti-epileptics NSAIDs (+ others)

Question 53

what other types of conditions may a vitiligo Pt have

Answer 53

autoimmune e.g. pernicious anaemia, hypothyroid

Question 54

what type of dermatological condition typically causes annular lesions?

Answer 54

fungi e.g. ringworm

Question 55

local S.E.s of topical corticosteroids

Answer 55

``` skin thinning > atrophy/ stretch marks bruising tearing of the skin telangiectasia worsening of condition: acne/roseacea allergy ```

Question 56

what are retinoids, what effect do they have + what diseases are they useful in treating?

Answer 56

components of vitamin A reduce hyperkeratosis [skin thickening/epithelial overgrowth] for acne, psoriasis, keratoderma