1
Q
How long are you infectious with shingles until?
A
They are infectious until the vesicles have crusted over, usually 5-7 days following onset
2
Q
well-defined erythematous and pruritic rash of extensor surfaces following the use of a beta-blocker
Likely dx?
A
Flexural psoriasis
BBs can trigger psoriasis flares
3
Q
skin biopsy shows immunoglobulin A (IgA) deposition in a granular pattern within the upper dermis
Dx and mx?
A
Dx: Dermatitis herpetiformis
Mx: Dapsone + Gluten free diet (Often seen in Coeliacs)
4
Q
Causes of livedo reticularis?
A
Idiopathic
Polyarteritis nodosa
SLE
Cyroglobulinaemia
ALPS
EDS
Homocystinuria
5
Q
What vasculitic syndrome is Hep B associated with?
A
Hep B is associated with Polyarteritis Nodosa and can present with livedo reticularis
6
Q
Management of venous ulceration ? ABPI in these patients?
A
Compression bandaging
Oral pentoxiphylline can improve heading rates
Normal ABPI as arterial supply is still good
7
Q
- 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
Are features of what condition?
A
Erythema multiforme
8
Q
Itchy rash that usually starts on the abdomen, particularly around stretch marks, and can spread to the rest of the body except for the face + Pregnant - when does it occurr, what is it?
A
This is polymorphic eruption of pregnancy
It
9
Q
Painful, inflamed nodule on the helix or antihelix of the ear.
It most commonly affects middle-aged or elderly individuals and is thought to be related to pressure and sun exposure
Suggestive of ?
A
Chondrodermatitis nodularis helicis
10
Q
What causes guttate psoriasis and how would you describe the rash? mx?
A
tear drop papules on the trunk and limbs
Occurs 2-4 weeks post-strep infection
mx is supportive however if symptomatic leisons can use topical treatment (same as psoriasis)
11
Q
painful, necrotic ulcers often found on the lower extremities in someone with IBD history is suggestive of what?
A
Pyoderma gangrenosum
12
Q
Rash in SLE?
A
Butterfly rash sparing naso-labial folds
13
Q
Smoking skin cancer RF?
A
Smoking is a significant RF for SCC
14
Q
deep ulcer and surrounding violaceous pigmentation -> Dx?
A
Pyoderma gangrenosum
15
Q
Organism causing pityriasis rosea?
A
HHV 7
16
Q
well-circumscribed pigmented lesion on his shin that appears flat on the skin surface. It also has the appearance of a wart-like texture
Dx?
A
Solar keratosis will have stuck on appearance
17
Q
Bullous pemphigoid skin biopsy result?
A
immunofluorescence shows IgG and C3 at the dermoepidermal junction
18
Q
dermatitis, diarrhoea and dementia is the triad of which condition?
A
Pellagra - Niacin B3 deficiency commonly seen in alcoholics / anorexics
Also in corn rich diets as corn is low in niacin
19
Q
Scabies mx?
A
Permethrin 5% - Apply once to whole body and repeat in one week and advise household contacts to do same
20
Q
What blood test is required in someone with Dapsone and why?
A
FBC - risk of haemolytic anaemia
Also risks of peripheral neuropathy + agranulocytosis in rare cases
21
Q
Drugs that can cause erythema nodosum?
A
penicillins
sulphonamides
combined oral contraceptive pill
22
Q
Most common triggers for erythema multiforme?
A
Mycoplasma pneumoniae + HSV
23
Q
Drug causes of erythema multiforme?
A
penicillin,
sulphonamides,
carbamazepine,
allopurinol,
NSAIDs,
oral contraceptive pill,
nevirapine
24
Q
Most common malignant association of acanthosis nigricans?
A
Gastrointestinal adenocarcinoma
25
rolled, pearly edges with telangiectasia surrounding a central crater
Dx?
BCC
26
ysesthesic erythematous rash with desquamation of the palms and soles is a classic description ???
This is a classic description of palmar-plantar erythrodyesthesia which can occurr with chemotherapy
27
sore throat, macular erythematous rash and mucous involvement is suggestive of?
Stevens-Johnson/ toxic epidermal necrolysis spectrum disorder
28
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop
Features of what condition?
Features of seborrhoeic dermatitis can be seen in HIV and PD
29
Mx of rosacea?
Rosacea treatment:
- mild/moderate: topical ivermectin
- severe/resistant: combination of topical ivermectin + oral doxycycline
30
rhinophyma is a complication of which derm disorder?
Acne rosacea
31
Chronic Plaque Psoriasis mx?
1. Regular emollients
2. Potent corticosteroid + Vit D analogue OD - 4 weeks
3. Vit D analogue BD if no improvement on 2. after 8 weeks
4. Potent corticoteroid BD 4 weeks or coal tar prep OD / BD if no improvement on above with 8-12 weeks
32
What causes seborrhoeic dermatitis?
an inflammatory reaction to Malassezia furfur
33
How to distinguish acne rosacea from seborrhoeic dermatitis?
Seborrhoeic dermatitis involves nasolabial folds!
34
An itchy rash affecting the face and scalp distribution
Common cause? What else can develop?
Seborrhoeic dermatitis
Can also develop otitis externa + blepharitis
35
Scabies mx?
Permethrin treatment: all skin including scalp + leave for 12 hours + retreat in 7 days
36
small violaceous polygonal papules, mainly clustered around the wrist flexors
Likely Dx?
Lichen planus
37
What is Koebners phenomenon and which conditions display it?
Koebners phenomenon - minor trauma causes new leisons
Seen in Warts And ALL (warts, autoimmune, AIDS, lichen planus & lichen sclerosis) + molluscum contagiosum
38
Mx of eczema when topical corticosteroids have failed?
Topical calcineurin inhibitors eg tacrolimus
Oral / IV only used for organ rejection
39
Which deficinency causes deficiency causes a characteristic skin rash (mainly at the intertriginous - where two opposing skin surfaces rub or touch and perioral areas), alopecia, taste impairment, glucose intolerance, and diarrhoea?
Zinc
40
Mx of SCC?
Surgical excision:
4mm margin if <20mm diameter
6mm margin if >20mm diameter
Mohs micrographic surgery if high risk or cosmetically important sites
41
widespread, intensely pruritic rash with erythematous, urticated plaques and annular lesions affecting the abdomen
During pregnancy, dx? how to distinguish from other pregnancy related rashes?
Pemphigoid gestationis
- lesions are most prominent around the umbilical region, which is a classic early feature of pemphigoid gestationis and helps distinguish it from other pregnancy-related dermatoses such as polymorphic eruption of pregnancy, which typically spares the umbilicus
42
Which meds can trigger psoriasis?
Lithium
BB
Antimalarials
NSAIDs
ACEi
Abx tetracyclines and penicillins
+ Withdrawal of systemic steroids
43
Features of Keratoacanthoma?
Keratoacanthoma are fast-growing skin lesions which may appear in areas of sun damaged skin. They may also develop after a minor skin injury
Start as a small, round fleshy nodule before developing a keratinised central core - Look like a volcano
44
Mx of acintic keratoses?
Topical flurouracil cream - reduce risk of malignant transformation
Can give steroids after this if skin is inflammed
45
What are the features of yellow nail syndrome?
Congenita lymphoedema
Pleural effusions - Exudative
Bronchiectasis
Chronic sinus infection
46
What is Dariers sign?
Localised erythema and urticaria on scratching, rubbing or stroking of the skin
Seen in mastocytosis
47
Infective causes of erythema nodosum?
streptococci
tuberculosis
brucellosis
48
Most common malignancy associated with Acanthosis nigricans?
GI adenocarinoma
49
whitish scarred meatus with a white plaque on phimotic foreskin.
Dx?
Lichen sclerosus
50
immune-mediated skin condition that typically presents with target-like lesions on the skin and mucous membranes
Dx?Typical hx?
Erythema multiforme major
sore throat followed by fever, myalgia, and lethargy along with the appearance of a widespread erythematous rash with target lesions and mucosal involvement (conjunctivitis and oral ulceration)
51
Skin biopsy: demonstrating linear IgG and C3 deposition at the dermoepidermal junction.
Dx? Mx?
Dx = Bullous pemphigoid
Mx = Oral steroids
52
Mx of Urticaria?
Non-sedating 1st line = Loratadine, Fexofenadine, Cetirizine
Sedating = Chlorphenamine (night time use in addition to daytime) if sleep sx
Pred for severe / resistance cases
53
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What does this show?
Granuloma annulare is a papular rash often with slightly hyperpigmented lesions which have depressed centres
4x more prevalent in females and is thought to be linked to diabetes
54
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What does this show?
Flexural psoriasis
Eg Eumovate (clobetasone butyrate) OD
55
Most common complications of psoriasis?
PA
Metabolic syndrome
CVD
VTE
Psychological distress
56
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What does this show?
BCC
57
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What does this show? mx?
Tinea corporis
Mx = Topical ketoconazole
58
Systemic mx of psoriasis?
oral methotrexate is used first-line. It is particularly useful if there is associated joint disease
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab
ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials
59
How long after drug exposure does SJS develop?
1-4 weeks avg 14d
60
Mx of Leukoplakia?
Mx = ART often occurs with HIV patients
61
Mx of scalp psoriasis?
Scalp psoriasis - first-line treatment is topical potent corticosteroids
62
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What does this show?
Mx?
Toxic epidermal necrolysis (TEN)
Mx = Supportive, stop precipitating factor, IVIg
63
How to distinguish between Chondrodermatitis nodularis helicis v actinic keratosis on ear?
Chondrodermatitis nodularis helicis is painful
64
how to distinguish between BCC and Keratoacanthoma?
Karatoacanthoma - Although it can appear similar to basal cell carcinoma, Keratoacanthomas tend to grow rapidly over weeks to months and then involute, leaving a scar. They also often have a central keratin-filled crater
65
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What does this show? What viral infection can be associated with this?
Seborrhoeic dermatitis
Associated with HIV
66
In scabies treatment failure, if application was applied appropriately - next step?
treat with difference insecticide, e.g. malathion 0.5% or permethrin 5%
67
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What is this? What drugs can cause this?
Erythema nodosum
Drug causes: Penicillins, sulphonamides, COCP
68
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What is this?
SCC
69
Vemurafenib and dabrafenib - what class of medication and what is it used for? What can this lead to?
These are selective BRAF inhibitors
Increase survival in metastatic melanoma
Increased risk of SCC particularly in older patients and occur in sun exposed areas
70
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What does this show?
What is it associated with?
Pyoderma gangrenosum
Associated with:
- Idiopathic (50%)
- IBD
- Rheum - RA + SLE
- Haem - Myeloproliferative disorders, lymphoma, myeloid leukaemia + monoclonal gammopathy
- GPA
- PBC
71
How does pompholyx present? what is it associated with?
typically affects the hands (80% of the time) or the feet (12%), or both and presents with small vesicles along the digits and palms/soles
Can cause de-roofing + itching + drying of skin
Associated with nickel allergy
72
Mx of SCC?
Low risk - cutterage (+ RT if inadequate margins)
High risk (prev SCC + immunosuppression) - Surgery + sytemic retinoids eg acitretin (+ RT if invasion present at surgery)
73
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What does this show and mx?
Shows multiple oval shaped plaques with fine peripheral scale
Dx = Pityriasis rosea -> Reassurance and discharge (self limiting)
74
severe eczema flare which has not been controlled despite the use of emollients twice each day, strong topical corticosteroids for five days and non-sedating antihistamines
Next step?
Trial of steroids whilst awaiting derm review
75
1st line ix of systemic mastocytosis?
Serum tryptase
76
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Dx?
Scabies
77
Thromboangiitis obliterans features?
disorder of the small to medium-sized arteries and superficial veins in the distal extremities
Corkscrew vessels on angio + skin changes indicative of arterial insufficiency (smooth and hairless, PPPPP)
78
Long term mx of uncontrolled non-responsive eczema?
Ciclosporin 1st line - quickest response (2-6w)
2nd line = Azathioprine or Methotrexate (slower response 4-8 or 8-12w)
79
Ix for systemic mastocytosis?
1st line serum tryptase
urinary histaminee assesses disease activity
BM biopsy with KIT D816V mutation is definitive
80
Bullous pemphigoid - scarring?
The blisters usually heal without scarring
81
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What is this?
SCC
82
83
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What is this ? RF?
SCC
RF = Systemic immunosupression eg ciclosporin in renal transplant
84
Drug causes of bullous pemphigoid?
Furosemide
Pencillamine
Catopril
Penicillins
85
Possible complication of erythema ab igne?
SCC
86
help control itching in eczema to prevent further scratching - mx?
Bandaging leisons
87
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What does this show?
Erythema myltiforme
88
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What does this show?
onycholysis (lifting of the nail bed) and pitting (indentations to the surface of the nails) which are suggestive of nail psoriasis
NB this is a RF for PA
89
Mx of pain in shingles?
paracetamol and NSAIDs are first-line
Non-responsive consider neuropathic agents
Oral steroids may be considered in the first 2 weeks in immunocompetent adults with localized shingles if the pain is severe and not responding to above
90
Topical steroid potency?
Mild - Hydrocortisone
Moderate - Betamethasone valerate, colbetasone butyrate
Potent - Betamethasone valerate, Fluticasone propionate
V Potent - Clobetasone propionate
91
well-demarcated, waxy, brown papules with a 'stuck-on'
Dx? What if multiple appear over a short period of time?
Seborrhoeic keratosis
multiple seborrhoeic keratoses in an older adult raises suspicion for Leser-Trélat sign—a paraneoplastic phenomenon often associated with underlying internal malignancy, especially gastrointestinal adenocarcinomas but also lung or breast cancer -> Would need CT TAP
92
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Dx?
Seborrhoeic keratosis with keratotic plugs on surface
93
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Dx?
Venous ulcer
Dry, skin = varicose eczema
NB arterial ulcers = punched out appearance
94
painful burning rash one week after starting chemotherapy. She describes a tingling sensation that started three days previously, which then progressed to swelling and redness of both her hands
Dx? Mx?
Dx = palmar-plantar erythrodysthesia
Mx = Dose reduction of chemo
95
Describe necrobiosis lipoidica diabeticorum rash?
shiny, painless areas of yellow/red skin typically on the shin of diabetics
Often associated w telangiectasia
Mx = Topical corticosteroids + camoflague creams
96
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What does this show?
erythematous plaques covered with a silvery-white scale with clear delineation between the plaques and the surrounding normal skin
Chronic plaque psoriasis
97
The yellow-green fluorescence under Woods lamp
Dx?
Pityriasis versicolor
98
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What is this?
Bowen's disease is a type of precancerous dermatosis that is a precursor to SCC
99
Who is offered shingles vaccine?
all adults turning 65
those aged 70 to 79
those aged 18 and over with a severely weakened immune system
100
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What does this show?
Lichen planus - Multiple round, well-circumscribed, raised purple lesions. On closer inspection, subtle white markings can be visualised on top of the lesions, otherwise known as Wickham striae
101
slowly growing, red, scaly lesion on a sun-exposed area
Dx? mx?
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Bowens disease -> surgical excision
MRCP - Part 2
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