Dermatology

Question 1

What % of children are affected by atopic eczema?

Answer 1

20%

Question 2

Lifetime risk subsequent malignant melanoma from congenital pigmented naevi >9cm

Answer 2

4-6%

Question 3

Itchy rashes

Answer 3

Eczema 
Chickenpox 
Urticaria/allergy
Contact dermatitis 
Insect bites 
Scabies 
Pityriasis rosea

Question 4

Characteristic distribution of nappy rash

Answer 4

Buttocks, perineal region, lower abdo, upper thighs

Sparing flexures

Question 5

Mx nappy rash

Answer 5

• Advise highly absorbent, disposable nappies,
• Regularly changing, careful drying
• Nappy off for as much as possible
• Avoid soaps, lotions, etc.
• Barrier protection e.g. sudocreme
• If inflamed - hydrocortisone 1% for 7 days
• If candida (satellite lesions) - clotrimazole
• If bacterial - fluclox

Question 6

Presentation of seborrhoeic dermatitis

Answer 6

Cradle cap - thick, yellow, adherent layer
Then break out in erythematous rash similar to nappy rash distribution + flexures

NOT ITCHY (unlike eczema)

Question 7

What do children with seborrhoeic dermatitis have an increase risk of developing?

Answer 7

Atopic eczema

Question 8

Mx seborrhoeic dermatitis

Answer 8

Emollients
Sulphur/salycylic acid ointment
Topic steroids

Question 9

Differences between atopic eczema and serborrhoeic dermatitis

Answer 9

AE - ITCHY, generally not common before 2 mos

SD - not itchy, common before 2 mos. Yellow, scaly cap

Question 10

When does atopic eczema usually present?

Answer 10

First year of life

Question 11

What % atopic eczema resolved by 16 years

Answer 11

75%

Question 12

Proportion of children with atopic eczema going on to develop asthma

Answer 12

1/3

Question 13

Presentation atopic eczema

Answer 13

Itchy rash -
Face and trunk in inftants
Flexures in children

Question 14

Causes of exacerbations of eczema

Answer 14

Bacterial infection (e.g. staph)
Viral infection (e.g. HSV)
Allergens 
Heat/humidity 
Stress

Question 15

Mx of eczema

Answer 15

• Avoidance of triggers
• Cut nails short, loose cotton clothing
• Emollients (E45, cetraben, dermol500, diprobase) - use liberally and frequently
• Mild steroids e.g. hydrocortisone
• Moderate steroids e.g.

Question 16

Mx of eczema

Answer 16

• Avoidance of triggers
• Cut nails short, loose cotton clothing
• Psychosocial support
• Emollients (E45, cetraben, dermol500, diprobase) - use liberally and frequently
• Mild steroids e.g. hydrocortisone
• Moderate steroids e.g. eumovate
• Calcineurin inhibitors
• Occlusive bandages (lichenification) w/ zinc and tar
• Potent steroids e.g. betnovate
• Very potent steroids e.g. dermovate
• PO steroids
• Anti-histamines e.g. cetirizine

Question 17

Eczema steroid ladder

Answer 17

Hydrocortisone
Eumovate
Betnovate
Dermovate

Question 18

Indications for referral eczema

Answer 18

Suspected eczema herpeticum
Severe atopic eczema not responded within 1 week
Failure of bacterial infected treatment
Severe recurrent infections

Question 19

Eczema treatment w/ lichenifcation

Answer 19

Occlusive bandages with zinc and tar

Question 20

Cause of viral warts

Answer 20

HPV

Question 21

Mx viral warts

Answer 21

Daily application salicylic acid paint

Cryotherapy

Question 22

Which virus causes molluscum contagiosum

Answer 22

Pox

Question 23

Mx molluscum contagiosum

Answer 23

Watch and wait (resolves spontaneously after 6-12 months)

Cryotherapy for chronic lesions

Question 24

Molluscum contagiosum time course

Answer 24

6-12 months

Question 25

Skin coloured pearly papules with central umbilication

Answer 25

Molluscum contagiosum

Question 26

Annular lesions with crusted egde. Circular

Answer 26

Ringworm

Question 27

Which fungi cause ringworm

Answer 27

Dematophytes invade dead keratinous structures

Question 28

Mx ringworm

Answer 28

Topical antifungals e.g. terbinafine cream/clotrimazole | Systemic antifungals for severe infection (e.g. terbinafine, itraconazole)

Question 29

Diagnosis ringworm

Answer 29

Fungal hyphae on skin scrapings

Question 30

Common cause (source of fungi) ringworm

Answer 30

Pets

Question 31

Burrows, vesicles, papules on palms, soles, between fingers and toes. Severe itching

Answer 31

Scabies

Question 32

Mx scabies

Answer 32

5% permethrin for WHOLE FAMILY Washed off after 8-12 hours then reapplied 2 weeks later Chlorphenamine (drowsy anti-H) for sleep/itchy.

Question 33

Complications of scabies

Answer 33

Secondary bacterial infection | Slowly resolving nodular lesions

Question 34

Commonest lice infestation in children

Answer 34

Headlice (pediculosis)

Question 35

Itchy scalp/nape | Suboccipital lymphadenopathy

Answer 35

Headlice (pediculosis)

Question 36

Mx of headlice

Answer 36

Wet combing with fine tooth comb | Dimeticone 4% lotion left in overnight and repeated 1 week later

Question 37

Mx periorbital cellulitis

Answer 37

High dose IV abx - Ceftriaxone Incision, drainage and culture of peri-ocular abscess

Question 38

Mx tinea capitis

Answer 38

Systemic antifungal therapy - PO terbinafine

Question 39

Advice for ringworm infection

Answer 39

Loose fitting clothing Wash affected areas daily and dry thoroughly Avoid scratching Do not share towels Wash clothes and bed linen frequently

Question 40

Commonest psoriasis in childhood

Answer 40

Guttate

Question 41

Presentation of guttate psoriasis

Answer 41

Raindrop erythematous scaly patches of trunk and upper limbs Typically follows streptococcal/viral throat or ear infection

Question 42

Mx guttate psoriasis

Answer 42

Phototherapy (narrow band UVB) Emollients Potent steroids Vitamin D analogues on plaques

Question 43

Single round scaly macule (Herald's patch)

Answer 43

Pityriasis rosea

Question 44

Origin of pityriasis rosea

Answer 44

Viral

Question 45

Mx of pityriasis rosea

Answer 45

None - self resolving in 4-6 weeks

Question 46

Pathophysiology of acne

Answer 46

Around puberty, increased production of sebum, androgenic stimulation of sebaceous glands. Obstruction of sebaceous follicles = acne

Question 47

Features of acne

Answer 47

Open comedones - blackheads Closed comedones - whiteheads Nodules, pustules, cysts

Question 48

Advice for acne

Answer 48

Gentle cleansing 2x/day - do not overclean Avoid squeezing Healthy diet Non-comedogenic make up/emollients (Treatments are effective but may take up to 8 weeks to have desire effect)

Question 49

Mx of acne

Answer 49

Conservative advice - Topical retinoids or antibiotics (clindamycin) - Benzoyl peroxide - PO abx (lymecyclin/doxycycline) - change to different abx after 3 months if no improvement - Roaccutance (dermatology r/f) - COCP (NOT progesterone only)

Question 50

Which contraception should be avoided in girls with acne

Answer 50

Prosterone only - with androgenic activity can worsen acne

Question 51

What must be checked for patients on roaccutane

Answer 51

Must be on contraception (teratogenic) Regular LFT checks

Question 52

Mx hand foot and mouth disease

Answer 52

``` Symptomatic support (hydration, analgesia) Does not need school exclusion ```

Question 53

Pathophysiology of milia

Answer 53

Keratin trapped under surface of skin

Question 54

Mx milia

Answer 54

Most cases clear by themselves Cosmesis - fine needle, cryotherapy, laser, dermabrasion, chemical peeling

Question 55

Causes erythema nodosum

Answer 55

IBD TB Drug reaction Idiopathic

Question 56

Causes erythema multiforme

Answer 56

HSV Mycoplasma pneumonia Drug reaction

Question 57

Is HSP more common in girls or boys?

Answer 57

Boys

Question 58

Erythema nodosum

Answer 58

Tender, discrete nodules on the shins

Question 59

Erythema infectiosum

Answer 59

Slapped cheeck - parvovirus B19 Erythematous cheek progresses to maculopapular lace-like rash over trunj and limbs Fever, malaise, headache, myalgia

Question 60

How does PVB19 cause an aplastic crisis?

Answer 60

Infects erythroblastoid red cell precursors in the BM | - Paritcularly common in sickle cell