dermatology

Question 1

define eczema (dermatitis)

Answer 1

itchy, dry, inflammatory skin condition

Question 2

what happens in atopic eczema

Answer 2

genetic barrier dysfunction

Question 3

atopic march

Answer 3

tendancy to 3 commonly linked conditions; eczema, asthma and hayfever

Question 4

atopy

Answer 4

overactive immune response to environmental stimuli

Question 5

distribution of eczema in infancy

Answer 5

typically starts on the face/ neck, can spread more generally

Question 6

distribution of eczema in older children

Answer 6

flexural pattern predominated (antecubital fosse, popliteal fosse, wrists, hands, ankles)

Question 7

describe the loss of barrier function in atopic eczema

Answer 7

• loss of water
• irritants may penetrate
• allergens may penetrate

Question 8

what are childhood eczema flares associated with

Answer 8

• infections/ viral illness
• central heating/ cold air
• pets
• teething
• stress

Question 9

where does seborrheoic dermatitis usually affect

Answer 9

scalp and face

Question 10

management of seborrheoic dermatitis

Answer 10

emollients
antifungal creams
anti fungal shampoos
mild topical steroids

Question 11

presentation discoid eczema

Answer 11

scattered annular/ circular patches itchy eczema

Question 12

describe pomphylx eczema

Answer 12

• hand and foot eczema
• characterised by vesicles
• can be intensely itchy

Question 13

cause of irritant eczema

Answer 13

repeated contact with irritant (repeated contact/ water and soaps/ touching irritant foods/ chemical irritants)

Question 14

eczema treatments

Answer 14

• emollients
• topical steroids
• calcineurin inhibitors
• UVB light therapy
• immunosuppressive medication

Question 15

example of mild corticosteroid

Answer 15

hydrocortisone

Question 16

example moderate corticosteroid

Answer 16

eumovate

Question 17

example potent corticosteroid

Answer 17

betnovate

Question 18

example very potent corticosteroid

Answer 18

dermovate

Question 19

how to use topical steroids

Answer 19

• once daily for 1-2 weeks
• if improvement then use alternate days for longer
• if stubborn use twice weekly in these areas

Question 20

unit for steroid cream

Answer 20

finger tip

Question 21

presentation impetigo

Answer 21

• superficial bacterial skin infection

- pustules and honey coloured crust erosions

Question 22

management of impetigo

Answer 22

topical antibiotic - fucidin

oral antibiotic. - flucloxacillin

Question 23

describe molluscum contagiosum

Answer 23

• common benign self limiting infection
• molluscipox virus
• transmission to close direct contacts
• pearly papule, umbilrbated centre
• can take up to 24 months to clear

Question 24

management molluscum contagiosum

Answer 24

5% potassium hydroxide

Question 25

describe viral warts

Answer 25

- often skin coloured - common non-cancerous growths of skin caused by HPV infection - transmitted via skin contact

Question 26

management viral warts

Answer 26

- salicylic acid and paring | - cryotherapy

Question 27

define viral exanthems

Answer 27

ruptive skin rash that is often related to a viral infection

Question 28

conditions that result in viral exanthems

Answer 28

- chicken pox - measles - rubella - roseola - erythema infectiosum

Question 29

virus responsible for chicken pox

Answer 29

varicella-zoster

Question 30

presentation chick pox

Answer 30

- red papules progressing to vesicles often starting on trunk - itchy - associated viral symptoms

Question 31

when is chicken pox contagious

Answer 31

from 1-2 days before rash appears until lesions have crusted

Question 32

presentation parvovirus (slapped cheek)

Answer 32

- erythematous rash cheeks initially then lace like network rash over trunk and limbs - usually self-limiting - virus targets red cells in bone marrow

Question 33

rare complications parvovirus

Answer 33

- aplastic crisis | - risk to pregnant women (spontaneous miscarriage/ intrauterine death)

Question 34

virus causing hand foot and mouth disease

Answer 34

coxsackie virus A16

Question 35

presentation hand foot and mouth disease

Answer 35

blisters on the .... brace yourself.... this is a shocker are you ready.... HANDS FEET and MOUTH also viral symptoms

Question 36

management hand foot and mouth

Answer 36

treatment supportive

Question 37

presentation of eczema herpeticum

Answer 37

- unwell child - eczema history - monomorphic punched out lesions

Question 38

management of eczema herpeticum

Answer 38

- withheld steroids for 24hrs - aciclovir oral or IV - ophthalmology review if near eye

Question 39

presentation of orofacial granulomatosis

Answer 39

- lip swelling and fissuring - oral mucosal lesions - ulcers and tags - cobblestone appearance

Question 40

clinical features erythema nodosum

Answer 40

- painful, erythematous subcutaneous nodules - normally over shins - slow resolution, like bruise

Question 41

causes erythema nodosum

Answer 41

- infections (step, URTI) - IBD - sarcoidosis - drugs (OCP, penicillin) - mycobacterial infections - idiopathic

Question 42

define dermatitis herpetiformis

Answer 42

rare but persistent immunobullous disease that has been linked to coeliac disease

Question 43

clinical presentation dermatitis herpetiformis

Answer 43

- itchy blisters that can appear as clusters - often symmetry - scalp, shoulders, buttocks, elbows, knees

Question 44

management of suspected dermatitis herpetiformis

Answer 44

- coeliac screening | - skin biopsy

Question 45

management dermatitis herpetiformis

Answer 45

- gluten free diet - emollients - topical steroids - dapsone

Question 46

presentation urticaria

Answer 46

- wheals/ hives - associated angioedema (10%) - areas of rash can last few minutes --> 24 hours

Question 47

define acute urticaria

Answer 47

<6weeks

Question 48

causes urticaria

Answer 48

- viral/ bacterial infection - food/ drug allergy - NSAIDs - opiates - vaccinations

Question 49

treatment urticaria

Answer 49

- treat cause | - antihistamines