RTS - Dermatology

Question 1

The skin is the largest organ in the body, list its functions.

Answer 1

1) barrier
2) acting as a sensory organ
3) protects tissues
4) homoeostatic balance

Question 2

Describe what emollients are and what they are used for.

Answer 2

1) Emollients are moisturising treatments applied directly to the skin to reduce the amount of water loss
2) they cover the skin and form a protective film
3) they help to manage dry or scaly skin conditions
4) they soften cracks in the skin
5) ease itching of the skin

Question 3

outline the four different types of emollients

Answer 3

emollients are available as - creams, ointments, lotions or sprays, both oils and shower products

1) occlusive emollients- create a film over the skin to prevent water evaporating (diprobase)
2) Humectant-containing emollients- contain additives such as urea, propylene glycol and lactic acid to attract and hold water in the top layer of the skin (doublebase)
3) Antipruritic emollients- contain ingredients to prevent/combat itching (Eurax)
4) Antiseptic emollients- contain ingredients to combat/prevent infection (dermol)

Question 4

Explain what topical corticosteroids are and what they are used for.

Answer 4

1) topical steroids are used to treat inflammatory skin conditions.
2) they reduce skin inflammation and skin irritation
3) they help induce remission during a flare up

hydrocortisone acetate 1% cream HC45, clobetasone butyrate 0.05% cream Eumovate.

Question 5

describe how topical corticosteroids are classified and their side effects.

Answer 5

1) Mild, Moderate, Potent, Very potent (last 2 are prescription only). you want to use the least potient one to treat the condition.

side effects

1) skin thinning
2) skin more vulnerable to infection
3) skin changing colour

Question 6

The skin is the largest organ in the body, list its functions.

Answer 6

1) barrier
2) acting as a sensory organ
3) protects tissues
4) homoeostatic balance

Question 7

outline the restrictions to corticosteroid sale

Answer 7

patient factors

1) patient must be over 10 years (hydrocortisone), over 12 years (clobetasone)
2) not allowed in pregnancy/ breastfeeding

Treatment duration
3) applied TWICE a day, MAX 7 days use.

Pack size
4) can only sell 15g max at any one time.

site
5) cannot be used on face, anogenital, broken or infected skin.

Question 8

Describe the application of a corticosteroid cream.

Answer 8

The finger tip unit

1) one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adults fingertip.
2) a finger tip is from the very end of the finger to the first crease in the finger.
3) one FTU is enough to treat an area of skin twice the size of the flat of an adults hand.

Question 9

Describe what Antifungals are and how they work.

Answer 9

1) killing the fungal cells: affecting the cell walls, causing the cells to leak out
2) prevent growth: prevent the fungal cells from reproducing.

available: cream, sprays, gels, powders
clotrimazole 1% canesten - athletes foot

Question 10

Describe what emollients are and what they are used for.

Answer 10

1) Emollients are moisturising treatments applied directly to the skin to reduce the amount of water loss
2) they cover the skin and form a protective film
3) they help to manage dry or scaly skin conditions
4) they soften cracks in the skin
5) ease itching of the skin

Question 11

outline the four different types of emollients

Answer 11

emollients are available as - creams, ointments, lotions or sprays, both oils and shower products

1) occlusive emollients- create a film over the skin to prevent water evaporating (diprobase)
2) Humectant-containing emollients- contain additives such as urea, propylene glycol and lactic acid to attract and hold water in the top layer of the skin (doublebase)
3) Antipruritic emollients- contain ingredients to prevent/combat itching (Eurax)
4) Antiseptic emollients- contain ingredients to combat/prevent infection (dermol)

Question 12

list the possible causative reasons for a rash.

Answer 12

a rash is a symptom- it is not a disease

1) eczema
2) psoriasis
3) bacterial, viral or fungal infections
4) allergies
5) infestations

Question 13

explain what Atopic eczema is and list some aggravating factors.

Answer 13

1) an allergic condition normally affecting infants and children. patients often have other sensitivities e.g asthma, hay fever. sensitisation occurs leading to an inflammatory response.

aggravating factors:
1) pollen, sweat, detergents/soaps, cosmetics, rubber and latex, dyes and colouring.

Question 14

outline the presenting features of Atopic eczema

Answer 14

1) itching
2) redness
3) inflammation
4) papules
5) rash
6) dry skin
7) scaly skin
8) cracked skin
9) pruritus- itching sensation.

Question 15

describe the treatment for Atopic eczema

Answer 15

1) emollient therapy- apply liberally
2) topical corticosteroid
- not for under 10 years
- not during pregnancy
- not for treatment on face

Question 16

outline the referral criteria for Atopic eczema

Answer 16

1) treatment failure
2) presenting on the face
3) child
4) broken skin
5) pregnant or breastfeeding

red flag symptoms:

6) bleeding
7) weeping
8) infection (yellow crusts)
9) non-blanching rash.

Question 17

describe the additional advice you would give to a patient suffering from Atopic eczema

Answer 17

1) avoid triggers
2) certain fabrics can irritate the skin , avoid these. wear : soft, fine-weave clothing or natural materials such as cotton
3) heat can aggravate eczema- keep rooms cool
4) avoid using soaps or detergents that affect your skin. use soap substitutes instead

Question 18

describe what contact dermatitis is and list the parameters affecting the response.

Answer 18

1) inflammatory response of the skin after exposure to an irritant
2) an “agent” must penetrate the outer layer of skin - the stratum corneum

parameters affecting the response: ( All affect the severity of reaction)
1) type of irritant- acid
2) the concentration
3) quantity involved
4) length of exposure
this can occur with a single exposure , more commonly frequent exposures, the irritant accumulates on the skin.

Question 19

list the aggravating factors for contact dermatitis

Answer 19

1) detergents/ soaps
2) cosmetics
3) rubber and latex
4) dyes and colouring
5) acid/ alkali - cement
6) jewellery - nickel

Question 20

list the presenting features of contact dermatitis

Answer 20

1) itching
2) redness
3) Inflammation
4) papules
5) rash
6) dry skin
7) scaly skin
8) cracked skin
9) pruritis

Question 21

Explain what topical corticosteroids are and what they are used for.

Answer 21

1) topical steroids are used to treat inflammatory skin conditions.
2) they reduce skin inflammation and skin irritation
3) they help induce remission during a flare up

hydrocortisone acetate 1% cream HC45, clobetasone butyrate 0.05% cream Eumovate.

Question 22

outline the treatment options for contact dermatitis

Answer 22

1) emollient therapy
2) topical corticosteroid - not under 10 years, pregnant or breastfeeding, not for face.
3) remove the causative agent

Question 23

describe the referral criteria for contact dermatitis

Answer 23

1) treatment failure
2) lesions on the face
3) child
4) pregnant/breastfeeding
5) broken / bleeding/ weeping skin
6) widespread
7) infection
8) red flag symptom - non blanching rash

Question 24

outline the additional advice you would give to patients suffering from contact dermatitis

Answer 24

1) remove trigger
2) avoid scented/fragranced products
3) clean your skin
4) use protective clothing
5) change products
6) regular use of emollients

Question 25

explain what psoriasis is, and where it commonly develops.

Answer 25

1) relapsing inflammatory disorder 2) lesions are present 3) can present at any time in life 4) rare in infants and uncommon in children psoriasis develops: 5) at sites of skin trauma 6) at sunburnt areas 7) round cuts 8) during periods of stress. symmetrical distribution - usually scalp, knees, elbows

Question 26

outline the presenting features of psoriasis

Answer 26

1) characteristic "salmon pink" lesions 2) silvery-white scales 3) well defined boundaries 4) raised 5) large 6) redness 7) scaling 8) patches 9) plaques 10) history 11) long term 12) symmetry

Question 27

outline the treatment options for psoriasis

Answer 27

pharmacist can be involved in diagnosis, suitably placed to refer patients, involved in treatment options. however treatment is likely to be initiated by doctor/dermatologist 1) emollients- alone or in conjunction with active therapy 2) coal tar based preparations- efficacious in management of psoriasis. e.g capasal- messy to use, can stain skin/clothing 3) keratolytics- incorporated into emollients. aid in clearing scale. Evidence vs practice , e.g. urea or salicylic acid.

Question 28

explain the additional advice you would give to a patient with psoriasis

Answer 28

1) keep up with the treatment , if it feels better do not stop treatment 2) regular review with dermatology team 3) eating a healthy, balanced diet and exercising regularly can also relieve stress, which may help improve the psoriasis.

Question 29

describe how topical corticosteroids are classified and their side effects.

Answer 29

1) Mild, Moderate, Potent, Very potent (last 2 are prescription only). you want to use the least potient one to treat the condition. side effects 1) skin thinning 2) skin more vulnerable to infection 3) skin changing colour

Question 30

The skin is the largest organ in the body, list its functions.

Answer 30

1) barrier 2) acting as a sensory organ 3) protects tissues 4) homoeostatic balance

Question 31

describe what chicken pox is and its duration

Answer 31

1) classed as a childhood illness, caused by varicella- zoster virus 2) must prevent spread of infection- isolate patient, protect vulnerable patient groups 3) presents on the trunk 4) duration is 14 days , scabs from after 5 days

Question 32

list the presenting features of chicken pox

Answer 32

1) rash 2) itchy spots 3) fluid filled blisters 4) fever 5) loss of appetite 6) aching body 7) trunk

Question 33

outline the treatment options for chicken pox

Answer 33

1) pain - analgesic paracetamol 2) fever - antipyretic paracetamol 3) itching- antihistamines chlorphenamine, emollients aqueous cream, cooling gels poxclin

Question 34

describe the referral criteria for chicken pox

Answer 34

1) infected blisters 2) pregnant/breastfeeding 3) immuno-suppressed patients 4) red flag symptoms- non blanching rash

Question 35

outline the additional advice given to patients suffering from chicken pox

Answer 35

1) hydration- drink plenty of fluid to avoid dehydration 2) cool clothing- loose fitting, smooth, cotton fabrics are best and will help stop the skin from becoming sore and irritated. 3) wiping any objects or surfaces with a sterillising solution and making sure that any infected clothing and bedding is washed.

Question 36

describe what shingles is

Answer 36

1) the same virus as chicken pox 2) infection of the nerves and skin 3) unilateral condition- one side of the body 4) painful rash 5) duration 2-4 weeks

Question 37

explain the treatment options for shingles

Answer 37

1) pain- analgesics paracetamol, NSAIDs 2) fever- analgesic : paracetamol 3) rash - keep it clean , wear loose fitting clothing, use non-adherent dressing

Question 38

outline the restrictions to corticosteroid sale

Answer 38

patient factors 1) patient must be over 10 years (hydrocortisone), over 12 years (clobetasone) 2) not allowed in pregnancy/ breastfeeding Treatment duration 3) applied TWICE a day, MAX 7 days use. Pack size 4) can only sell 15g max at any one time. site 5) cannot be used on face, anogenital, broken or infected skin.

Question 39

list the presenting features for shingles

Answer 39

1) burning 2) itching 3) fever 4) malaise 5) nerve pain 6) red blotches 7) blistering rash

Question 40

outline the referral criteria fro shingles

Answer 40

early referral reduces; 1) antiviral treatment 2) neuropathic pain relief ( if required) 3) severity of symptoms 4) risk of complications 5) red flag symptoms- non blanching rash

Question 41

Describe the application of a corticosteroid cream.

Answer 41

The finger tip unit 1) one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adults fingertip. 2) a finger tip is from the very end of the finger to the first crease in the finger. 3) one FTU is enough to treat an area of skin twice the size of the flat of an adults hand.

Question 42

describe the additional advice you would give to a patient suffering from shingles

Answer 42

1) hydration - drink plenty of water 2) cool clothing- loose fitting, smooth, cotton fabrics are best and will help stop the skin fro becoming sore and irritated 3) wipe any objects and surfaces with a sterilising solution and making sure that any infected clothing or bedding is washed regularly.

Question 43

describe what ring worm is and the presenting features.

Answer 43

fungal infection- Tinea corporis 1) itchy 2) pink or red 3) scaly 4) raised 5) patches 6) inflamed 7) defined border 8) central clearing

Question 44

outline the treatment options for ring worm

Answer 44

1) anti fungal topical preparations - clotrimazole 1% cream canesten. apply TWO or THREE times a day - max 14 days

Question 45

explain the referral criteria fro ring worm

Answer 45

1) large areas of body 2) treatment failure 3) facial involvement 4) scalp and anogenital involvement 5) pregnant/ breastfeeding 6) red flag symptoms - non blanching rash

Question 46

describe the additional advice given to patients suffering from ring worm

Answer 46

1) avoid sharing items - combs , towels, bedding 2) wash bed linen, pillow cases and towels on hot cycles 3) wash different peoples clothing separately 4) ensure every member washes hands 5) avoid scratching the affected area of your skin as it could spread infection to other parts of your body

Question 47

describe what bites and stings are

Answer 47

initiation of an inflammatory response upon injection of the venom from animals, insects or plants. more common in warmer climates , produce a localised reaction on the body.

Question 48

list the presenting features of bites and stings

Answer 48

Bites 1) itchy , papules, weals, pain stings 2) intense burning pain , erythema, oedema, systemic response- breathing difficulties

Question 49

outline the treatment options for stings and bites

Answer 49

1) pain - analgesics paracetamol 2) itchiness- antihistamines oral tablet chlorphenamine (piriton), topical cream mepyramine (anthisan) 3) Wheals, swelling, erythema- topical corticosteroid hydrocortisone 1% cream

Question 50

describe the referral criteria for stings and bites

Answer 50

1) intense swelling 2) bleeding 3) restriction to blood flow 4) insect or sting still present red flag symptoms: 5) anaphylaxis- difficulty breathing, swelling lips 6) flu like symptoms- temperature, malaise

Question 51

outline the additional advice given to patients suffering from bites and stings

Answer 51

1) move away slowly and don't panic 2) cover exposed skin 3) wear shoes when outdoors 4) apply insect repellent to exposed areas of skin 5) avoid using products with strong perfumes 6) avoid camping near water 7) keep food and drink covered and windows closed.

Question 52

Describe what Antifungals are and how they work.

Answer 52

1) killing the fungal cells: affecting the cell walls, causing the cells to leak out 2) prevent growth: prevent the fungal cells from reproducing. available: cream, sprays, gels, powders clotrimazole 1% canesten - athletes foot

Question 53

describe what meningitis is

Answer 53

1) there are two types- bacterial meningitis and viral meningitis. bacterial is very serious and should be treated as a medical emergency 2) anyone can develop meningitis, however, babies and the young are at greater risk

Question 54

list the presenting features of meningitis

Answer 54

1) have a high fever 2) vomit 3) feel agitated 4) become drowsy 5) grunt or breathe rapidly 6) unusual high pitched or moaning cry 7) have a stiff neck 8) dislike bright lights 9) have convulsions or seizures 10) have pale blotchy skin, and a red rash that doesn't fade when a glass is rolled over it 11) have a tense, bulging soft spot on the head

Question 55

describe the treatment options for meningitis

Answer 55

ACCIDENT AND EMERGENCY NOW!

Question 56

describe what a melanoma is

Answer 56

1) type of cancer that begins in the skin 2) cells in the skin begin to develop abnormally 3) exposure to UV light fro natural or artificial sources may be responsible

Question 57

explain what can increase your risk of developing melanoma

Answer 57

1) lots of moles or freckles 2) pale skin that burns easily 3) red and blonde hair 4) family member who has it 5) radiotherapy treatment 6) a condition that suppresses your immune system 7) medicines that suppress your immune system 8) a previous diagnosis of skin cancer

Question 58

describe where melanomas commonly appear on the body

Answer 58

1) back , face , legs , arms - in the sun exposed areas

Question 59

list the presenting features of melanomas

Answer 59

1) getting bigger 2) changing shape 3) changing colour 4) itchy or painful 5) bleeding or becoming crusty

Question 60

when referring to melanomas explain what the acronym ABCDE stands for

Answer 60

Asymmetrical- melanomas have two very different halves and are an irregular shape Border - notched or ragged border Colours- mix of two or more colours Diameter- larger than 6mm in diameter Enlargement or elevation - a mole that changes size over time is more likely to be a melanoma

Question 61

describe the treatment for melanomas

Answer 61

See the doctor

Question 62

explain what cellulitis is

Answer 62

1) an infection of the deeper layers of the skin and the underlying tissue 2) the main symptoms are the skin suddenly turning red, painful swollen and hot 3) it affects the legs, but can occur anywhere

Question 63

explain how cellulitis develops

Answer 63

1) cellulitis develops when bacteria or fungi move down through the skins surface through a damaged or broken area of skin. e.g cuts, burns, bites, eczema, athletes foot 2) having a skin condition can cause small breaks and cracks to develop in the surface of the skin, this makes a person more vulnerable to cellulitis.

Question 64

list the presenting features of cellulitis

Answer 64

1) nausea and vomiting 2) shivering and chills 3) a general sense of feeling unwell 4) high temperature 5) rapid spreading of the area of redness 6) confusion 7) rapid heartbeat 8) rapid breathing 9) dizziness particularly when standing

Question 65

describe the treatment options for cellulitis

Answer 65

depending on severity, see doctor today or A&E