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31.10.07 Dermatology Quiz Answers WATKIN

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31.10.07 Dermatology Quiz Answers WATKIN Powered By Docstoc
					                                 Dermatology Quiz Answers

Question 1
   a. What is this?                                                        Acne vulgaris
   b. If your patient asked what causes this what would you say?
   Some people have skin that is more sensitive to testosterone than others. This leads to
   increased sebum production fro the sebaceous glands which lie at base of hair follicles.
   This leads to blocking of pores causing white heads and black heads. This leads to a
   breading ground for bacteria, esp proprionibacterium acnes which normally lives
   harmlessly on skin surface but in acne invades blocked follicles breaking sebum into Fatty
   acids stimulating inflammation causing pustules and inflamed papules to develop leads to
   white heads, black heads and inflammation
   c. Describe this rash using medical terminology?
   inflammed papules
   d. What other clinical signs may be visible in this condition?
   comedones, whiteheads (open), blackheads (closed), pustules, papules nodules, keloid
   scarring, inflammation

Question 2
   a. Describe this skin rash
       eczematous, erythematous, lichenified, weeping in flexures
   b. What is the diagnosis                                                      Atopic Eczema
   c. When is it most likely to occur                                            <5 years
   d. What proportion of children will grow out of this rash before adulthood.   2/3


Question 3
  a. What is the diagnosis                                             Seborrhoeic dermatitis
  b. Which groups does it most commonly effect?                        Adult males, also common
      in HIV infection and in infants
  c. Which areas does it most affect (name at least 3)                 scalp (95%), eyebrows,
      forehead, nasolabial folds, checks, retro auricular, presternal, interscapular,
      intertriginous
  d. What organism is commonly associated with this condition          pityrosporum yeast skin
      commensals
  e. What is the treatment?                                            Topical imidazoles with
      steroid e.g. daktacort. Scalp shampoos containing Ketoconazole or tar shampoos.

Question 4
   a. What is the diagnosis                                              Psoriasis
   b. What is the presumed aetiology?                                    Precise cause unknown.
       hyper proliferation of keratinocytes with an inflammatory cell infiltrate.
   c. Describe the natural history.                                      Recurring – life long. Can
       treat but not cure
   d. How could you treat associated scalp problems?                     Tar and salicylic ointment
       e.g seb co to remove scales. Apply bedtime. Wash out with tar shampoo in morning.
       Plus topical steroid e.g betnovate scalp application or synalar gel.
   e. Name the topical treatments available. Are their any complications of treatment to warn
       patients about?
       Vit D analogues (irritant) e.g calcipotriol, vit D plus topical steroid e.g dovanex (ST
       useage) coal tar preparations (stain) short contact dithranol (erythema)

Question 5
   a. What is the diagnosis                                              Guttate psoriasis
   b. What investigation should be performed?                            ASOT (assoc with
       streptococcal sore throat)
Question 6
Emollient usage
   a. The whole skin area should be treated not just the effected area                             T
   b. Should be applied in the opposite direction of hair growth to avoid blocking hair follicles. F
        (same direction)
   c. Emollients can be used as a substitute for soap                                              T
   d. A 100g tube of emollient (i.e. standard size) should last a patient with dermatitis of the trunk
        2 weeks if used twice daily                                                                F
        (this would last less than 3 days if used properly and according to BNF guidelines)
   e. It is possible to be allergic to emollients                                                  T

Question 7
In relation to acne please describe the following statements as true or false/
     a. For mild acne it is reasonable to advice the patient that “Its’ just teenage spots and they will
          grow out of it”                                                                            F
     b. Topical treatment should be applied to all areas predisposed to acne and not just individual
          lesions                                                                                    T
     c. An oral antibiotic should be given for at least 1 months before considering a change in
          treatment                                                                                  F
          ( 3 months)
                               st
     d. Flucloxacillin is the 1 line oral antibiotic used in acne                                    F
          (flucloxacillin dose not play a role; drugs of choice are oxytetracycline, lymecycline,
          doxycycline, erythromycin and trimethoprim. Doxycycline and lymecycline can be
          given once daily increasing compliance)
     e. The OCP Dianette can only be prescribed for moderate to severe acne and not for
          contraception alone or mild acne                                                           T
     f. The NHS could save millions if doctors stopped prescribing doxycycline for acne              F
          (minocycline)
     g. Eating greasy foods makes acne worse                                                         F
     h. The progesterone only pill can be used as treatment for acne                                 F
     i. Isotretinoin is a vitamin D analogue used to treat sever acne(Roaccutane)                    F
          (vitamin A analogue; treatment can only be prescribed by the hospital. Roaccutane is
          teratogenic and female patients are required to have monthly pregnancy tests and to
          use contraception)


Question 8
Topical steroids are described as mild, moderate, potent and very potent.
Put the following common topical steroids into the appropriate groups

Betnovate
Betnovate RD
Dermovate
Elocon
Eumovate
1% hydrocortisone
Synalar


Mild                     Moderate                 Potent           Very potent
1% hydrocortisone        Betnovate RD             Betnovate        Dermovate
                         Eumovate                 Elocon
                                                  Synalar
Question 9
    In relation to topical steroid use describe the following statements as true or false
    Cream rather than ointment should be used for dry, lichenified skin.                       T
    Occlusive polythene dressings can be used to increase topical steroid absorption           T
    Patients should be advised to only treat the worse affected areas with topical steroids    F
    (this is contrary to what it says in many of the manufacturers instructions)
    Should be applied immediately following emulsifying ointment                               F
       (patients should wait at least 30 mins after applying emulsifying ointment
    OTC 1% hydrocortisone cream can be purchased for mild facial eczema in adults              F
       (Not for use under age of 10 without medical advice or for application to face,
       anogenital region, broken or infected skin)

Question 10
In childhood atopic eczema
    a. Maintenance treatment below the neck may need to be with a moderately potent steroid T
         (e.g. eumovate – see derby GP guidelines available on hospital intranet or via vts
         office))
    b. Topical calcineurin inhibitors e.g. Pimecrolimus and Tacrolimus should only be initiated by a
         dermatology specialist                                                                   T
         (see GP dermatology guidelines)
    c. In flare ups potent steroids can be used on the trunk for a maximum of 5 days              F
         (potent steroids e.g. betamethasone and Elocon are required in flare ups including
         infected eczema but can be given for up to 14 days)
    d. Infected eczema is usually due to streptococcus pyrogens                                   F
         (Staph aureus is most common although can be due to Strept pyrogens. Treat with
         flucloxaillin or erythromycin and a potent steroid)
    e. Concern due to social problems e.g. school absenteeism would be an indication for referral T
    f. Patients with widespread disease benefit from wet wrap or icothopaste bandaging. GPs can
         refer parents directly for training in this via the paediatric dermatology nurse.        T
    g. Allergy testing is often required in severe eczema                                         F
         (Allergy testing is not considered useful except very occasionally in severe disease. In
         general dietary manipulation should be avoided unless disease very poorly controlled
         and done under hospital/dietician supervision)