PASSMED

Question 1

what is erythema multiforme

Answer 1

hypersensitivity reaction which is most commonly triggered by infections. It may be divided into minor and major forms.

Question 2

features of erythema multiforme

Answer 2

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

Question 3

causes of erythema multiforme

Answer 3

viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy

Question 4

what is alopeica areata

Answer 4

autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs

Question 5

management of alopecia areata

Answer 5

Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients. Other treatment options include:
topical or intralesional corticosteroids
topical minoxidil
phototherapy
dithranol
contact immunotherapy
wigs

Question 6

small rubbery mass

Answer 6

lipoma

Question 7

what is a lipoma

Answer 7

benign tumour of adipocytes

Question 8

pathophysiology of lipomas

Answer 8

• they are generally found in subcutaneous tissues
• rarely, they may also occur in deeper adipose tissues
• malignant transformation to liposarcoma is very rare

Question 9

features of lipoma

Answer 9

lump characteristics:
smooth
mobile
painless

Question 10

if lipoma more than 5cm what do u do

Answer 10

US to rule out liposarcoma

Question 11

management of lipoma

Answer 11

• may be observed

- if diagnosis uncertain, or compressing on surrounding structures then may be removed

Question 12

features of liposarcoma

Answer 12

Size >5cm
Increasing size
Pain
Deep anatomical location

Question 13

derm drug that causes gynaecomastia

Answer 13

ketoconazole

Question 14

how to differentiate between spider naevi and telangectasia

Answer 14

press on lesion

fill from the centre - spider naevi

fill from the edge - telangiectasia

Question 15

what is spider naevi

Answer 15

describe a central red papule with surrounding capillaries. The lesions blanch upon pressure. Spider naevi are almost always found on the upper part of the body.

Question 16

associations of spider naevi

Answer 16

liver disease
pregnancy
combined oral contraceptive pill

Question 17

1 day following skin grafts he becomes tachycardic and hypotensive. He vomits twice and this shows evidence of haematemesis

Answer 17

Curlings Ulcer

Question 18

urine analysis he has + blood. His U+E’s show mild hyperkalaemia and a CK of 3000

Answer 18

rhabdomyolysis

aggressive IV fluids

Question 19

increasing pain in lower leg and on examination there is parasthesia and severe pain in the lower leg. Foot pulses are normal

Answer 19

compartment syndrome

Eshcarotomy is required, and compartmental decompression

Question 20

features of lichen planus

Answer 20

• itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
• rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
• Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
• oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
• nails: thinning of nail plate, longitudinal ridging

Question 21

causes of lichenoid drug eruptions

Answer 21

gold
quinine
thiazides

Question 22

management for lichen planus

Answer 22

• potent topical steroids are the mainstay of treatment
• benzydamine mouthwash or spray is recommended for oral lichen planus
• extensive lichen planus may require oral steroids or immunosuppression

Question 23

venous ulceration commonly seen

Answer 23

above the medial malleolus

Question 24

Ix for venous ulceration

Answer 24

ankle-brachial pressure index (ABPI) is important in non-healing ulcers to assess for poor arterial flow which could impair healing

a ‘normal’ ABPI may be regarded as between 0.9 - 1.2. Values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)

Question 25

management for venous ulceration

Answer 25

compression bandaging, usually four layer (only treatment shown to be of real benefit) oral pentoxifylline, a peripheral vasodilator, improves healing rate small evidence base supporting use of flavinoids little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression

Question 26

melasma ass with

Answer 26

sun exposure NSAIDs oral contraceptives

Question 27

DD for shin lesions

Answer 27

- erythema nodosum - pretibial myxoedema - pyoderma gangrenosum - necrobiosis lipoidica diabeticorum

Question 28

features of pretibial myxoedema

Answer 28

symmetrical, erythematous lesions seen in Graves' disease | shiny, orange peel skin

Question 29

features of Necrobiosis lipoidica diabeticorum

Answer 29

shiny, painless areas of yellow/red skin typically on the shin of diabetics often associated with telangiectasia

Question 30

what is Necrobiosis lipoidica diabeticorum

Answer 30

rare granulomatous skin disorder which can affect the shin of insulin-dependent diabetics, although it may occur in non-diabetic subjects as well.

Question 31

features of HHT

Answer 31

- epistaxis : spontaneous, recurrent nosebleeds telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose) visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM family history: a first-degree relative with HHT

Question 32

features of Von Hippel Lindau disease

Answer 32

faulty tumour suppressor gene resulting in the development of multiple unusual tumours 1) haemangioblastoma, 2)phaeochromocytoma 3) renal cell carcinoma.

Question 33

peutz jegher syndrome

Answer 33

large numbers of polyps in the intestine which become cancerous in a majority of patients.

Question 34

features of Granulomatosis with polyangiitis

Answer 34

Sinus dysfunction is the most common initial symptom causing nasal congestion or epistaxis. If a rash is present, it is usually made up of palpable purpura from small vessel inflammation.

Question 35

what is HHT

Answer 35

autosomal dominant condition

Question 36

features of strawberry naeuvs

Answer 36

erythematous, raised and multilobed tumours.

Question 37

duration of strawberry naevus

Answer 37

until around 6-9 months before regressing over the next few years

Question 38

common sites of strawberry naevus

Answer 38

face, scalp and back

Question 39

potential complications of strawberry naevus

Answer 39

- mechanical e.g. Obstructing visual fields or airway - bleeding - ulceration - thrombocytopaenia

Question 40

treatment of strawberry naevus if required

Answer 40

propranolol is increasingly replacing systemic steroids

Question 41

features of iron deficiency anaemia

Answer 41

Pallor | Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis

Question 42

features of polycythaemia

Answer 42

Pruritus particularly after warm bath 'Ruddy complexion' Gout Peptic ulcer disease

Question 43

features of CKD

Answer 43

Lethargy & pallor Oedema & weight gain Hypertension

Question 44

features of lymphoma

Answer 44

Night sweats Lymphadenopathy Splenomegaly, hepatomegaly §

Question 45

what are salmon patches

Answer 45

pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck. birthmark

Question 46

A 35-year-old woman presents with a 6 week history of a worsening facial rash. She says she has a history of ‘intermittent eczema’‛ on the face for which she self medicates with a topical agent.

Answer 46

perioral dermatitis

Question 47

management for perioral dermatits

Answer 47

oral ABx like acne | stop steroids

Question 48

what is eryhtema ab igne

Answer 48

skin reaction caused by chronic exposure to infrared radiation in the form of heat

Question 49

what is erythema gyratum repens

Answer 49

rare paraneoplastic type of annular erythema w a distinctive figurative 'wood grain' appearance strong ass w malignancy

Question 50

predisposing factors of keloid scars

Answer 50

ethnicity: more common in pp with dark skin - more common in young adults - common site -> sternum, shoulder, neck. face, extensor surface of limbs, trunk

Question 51

Mx of keloid scars

Answer 51

early ones may be treated with intra-lesional steroids ie. triamcinolone

Question 52

causes of itch eruption (pruritus)

Answer 52

``` eczema scabies urticaria lichen planus iron deficiency anaemia parasitic infestation ```

Question 53

Mx of pruritus

Answer 53

``` keep the pt cool keep skin well oiled with emoillients avoid excessive bathing - drying antihistamines sedatives low dose amitryptilline short nails ```

Question 54

CKD features

Answer 54

Lethargy & pallor Oedema & weight gain Hypertension pruritus

Question 55

advise about emollients

Answer 55

Initially applying emollients 2-3 times per day (including immediately after washing) When skin worsens emollients can be applied hourly Wash hands before applying emollient to prevent infection of damaged skin Either dispense emollient using a pump or spoon from a tub to avoid contamination of the tub. Apply emollient generously to all areas of the body onto the skin in a downward motion in direction of hair Do not rub in emollients, but rather leave them to soak in.