Pictures

Question 1

Answer 1

Pityriasis rosea herald patch

Question 2

Answer 2

SJS/TEN

Question 3

Answer 3

Scabies

Question 4

Answer 4

Rosacea

Question 5

Answer 5

Acne vulgaris

Question 6

Answer 6

Seborrheic keratoses

Question 7

Answer 7

Impetigo

Question 8

Answer 8

Lichen planus

Question 10

Answer 10

Pyogenic granuloma

Question 11

Answer 11

Molluscum contagiosum

Question 12

Answer 12

Actinic keratoses

Question 13

Answer 13

Lichen sclerosis

Question 14

Answer 14

Sebhorreic keratoses

Question 15

Answer 15

Dermatitis herpetiformis

Pruritic, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

Skin biopsy shows deposition of IgA

Associated with Coeliac’s

Gluten free diet

Dapsone

Question 16

Answer 16

Actinic keratoses

Question 17

Answer 17

Pemphigoid gestationis

Question 18

Answer 18

Lichen sclerosus

Question 19

Answer 19

Pityriasis rosea secondary rash

Question 20

Answer 20

Polymorphic eruption of pregnancy

Pruritic condiction associated with last trimester

Pruritic Urticarial Papules and Plaques of Pregnancy

Question 21

Answer 21

Bullous pemphigoid

Question 22

Answer 22

Guttate psoriasis

Question 23

Answer 23

Pityriasis Versicolor

Question 24

Answer 24

Well demaracated roughly symmetrical oval darkly pigmented lesion

Rough scaly surface

Stuck on appearance

Sebhorrheic keratoses

DDx - malignant melanoma - excision biopsy

Mx:

Benign nature

Cryotherapy

Curretage

Shave biopsy

Question 25

Answer 25

Well defined erythematous areas on forehead. Yellow white rough hyperkeratotic crumbly scaly lesion UV exposure area - forehead of balding man Actinic keratoses: partial thickness dysplasia of epidermis DDx - Bowen's disease: full thickness dysplasoia of epidermis Pre-malignant Mx: Excision/punch biopsy any suspicious lesions 5-FU cream- inflammatory reaction (use with hydrocortiosne) Topical imiquimod Topical deiclofenac Surgical excision Cryotherapy - liquid nitrogen Further risk reudction - sun avoidance, sunscreen use

Question 26

Answer 26

Well defined pearly nodule with rolled telangiectasia edges Central ulceration Shiny - arborising blood vessel Dx: Nodular basal cell carcinoma Mx: Excision biopsy with 4mm margin for complete clearance

Question 27

Answer 27

Well defined erythematous lesion with rolled edges Potential arborising vessels Dx: superficial BCC Mx: Excision biopsy with 4mm margin Curretage Cryotherapy

Question 28

Answer 28

Poorly defined erythematous lesion, pearly rolled edge, central ulceration Dx: Morphoeic BCC Mx: Full excision biopsy with 4mm Mohs micrographic surgery - cut lesion out and ensure each section is BCC free - ensures BCC is completely removed

Question 29

Answer 29

Well defined translucent nodule on the patients nasal alar Arborising vessels Dx: BCC Mx: Mohs micrographic surgery Excision biopsy with 4mm margin

Question 30

Answer 30

Well defined pigemented lesion Central ulceration Dx: Malignant melanoma, pigmented BCC Mx: Urgent excision biopsy

Question 31

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Question 33

Question 34

30y/o male Lower leg lesion

Answer 34

Well-defined erythematous plaque with silvery scale DDx: psoriasis, discoid eczema, pityriasis rosea, sebhorreic dermatitis Mx: General: information leaflet and ELMS advice Topical emollient, soap substitute Betnovate (betamethasone) Vitamin D analogue (Donovex) Phototherapy (UVB narrowband) Systemic - methotrexate, ciclosporin Anti-TNF alpha Measure surface area of psoriasis Check psycho social function Cx: Psychosocial impact Psoriatic arthritis - rheumatology referral Anterior uveitis CVS screen - increased risk of CVS disease - lipid profile

Question 35

Answer 35

Psoriasis

Question 36

Answer 36

Crusty erythematous rash antecubital fossa and cheeks and forehead Papular Excoriations Hx/FHx: atopy Past treatment, compliance with treatment Feeding? Exacerbated by staph aureus infection Dx: Eczema Mx: General measures - information leaflet ELMS Refer to specialist nurse Large quantities of emollients 500g/week Soap substitute - no fragrance/lather Topical steroids - hydrocortisone, eumovate on body Topical calcineurin inhibitors - can cause burning rash Antihistamines for itch Cx: Eczema herpeticum - infection Staph infection

Question 37

Answer 37

Crusty erythematous rash antecubital fossa and cheeks and forehead Papular Excoriations Hx/FHx: atopy Past treatment, compliance with treatment Feeding? Exacerbated by staph aureus infection Dx: Eczema Mx: General measures - information leaflet ELMS Refer to specialist nurse Large quantities of emollients 500g/week Soap substitute - no fragrance/lather Topical steroids - hydrocortisone, eumovate on body Topical calcineurin inhibitors - can cause burning rash Antihistamines for itch Cx: Eczema herpeticum - infection Staph infection

Question 38

Answer 38

Diffuse widepread ulcerated erythematous vesicular rash lesions on the face with central golen crusted ulceration Vesicles have superadded infection Dx: Eczema herpeticum - with superadded bacterial infection Contact with cold sore recently? HSV transmission Visual changes? Mx: Swab for viral PCR and MC&S Antibiotics Admission Aciclovir Ophthalmology referral

Question 39

Answer 39

Well defined target lesions Ceoncentric rings of erythema Palms and mucosal membranes affected Dx: Erythema multiforme Caused by HSV, bacteria, orf virus, drugs Mx: Aciclovir Admit Haemodynamic support Nutritional/fluid support

Question 40

Answer 40

Well defined target lesions Ceoncentric rings of erythema Palms and mucosal membranes affected Dx: Erythema multiforme Caused by HSV, bacteria, orf virus, drugs Mx: Aciclovir Admit Haemodynamic support Nutritional/fluid support

Question 41

Answer 41

Desquamation of mucosal membranes Ddx: SJS TEN - full thickness epidermal necrosis Mx: STOP causative factor ITU Intensive skin support - dressing and emollient Haemodynamic support Burns unit

Question 42

Answer 42

Asymmetric irregular erythematous discrete patch on the ankle Lichenification Excoriation Darker erythematous papules within Venous varicosity Dx: Venous stasis eczema Mx: Liberal emollient application Topical corticosteroids - dermovate/betnovate Compression/support Refer to TVN for monitoring of skin for venous ulceration

Question 43

Answer 43

Asymmetric erythematous raised lesion on the chin with a golden/brown crust Dx: Impetigo - stpah aureus or strep pyogenes Mx: Topical fuscidic acid Topical retampulin Topical murpilocin Oral flucloxacillin/erythromycin

Question 44

Answer 44

Bullae with erythematous base Dx: Bullous impetigo Mx: Topical fuscidic acid

Question 45

Answer 45

Erythematous rash of the face with papules and pustules on an erythematous base Flushing Telangiectasia Nasolabial folds are sparded Degree of rhinophyma Can be belpharitis Dx: Rosacea Mx: Topical metronidazole Oxytetracycline High factor sun screen Camoflauge cream Laser treatment for prominent telangiectasia (fill from the outside)

Question 46

Answer 46

Discrete scaly patch of alopecia on the scalp Dx: Tinea capitis Caused by trichophyton or microsporum canis from cats/dogs Mx: Oral Terbinafine Oral grisefulvin for microsporum Topical ketoconazole shampoo

Question 47

Answer 47

Pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter. Dx: Molluscum contagiosum Molluscum contagiosum virus (poxviridae) Mx: Not usually recommended - spont resolution in 18m Contagious - don't share towels, beds No exclusion Treat itchiness with emollient and topical steroid Treat infection (oedema crusting) with fuscidic acid

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Question 55

Phemigus vulgaris vs bullous pemphigoid

Answer 55