Published on January 5, 2008
DERMATOLOGY QUIZ ANSWERS: DERMATOLOGY QUIZ ANSWERS N.Jakeman. January 2005 Question 1: Question 1 What is a vesicle? Circumscribed, thin walled, elevated blister <5mm in diameter. What is a papule? Elevated solid palpable lesion <1cm in diameter. What is a plaque? Flat-topped elevation formed by confluence of papules >0.5cm in diameter. What is a macule? Flat circumscribed discolouration <1cm in diameter; colour varies. What is a pustule? Vesicle containing purulent fluid. Question 2: Question 2 An 86yr old lady presents to the Emergency Department. She is from a nursing home and has suffered a stroke. You decide to admit the lady and you notice this rash. Slide4: What is the diagnosis? Scabies. What treatments are available and should they be applied? Permethrin (Lyclear) and malathion ( Derbac M of Quellada M.) Apply a thin layer of cream/lotion to the whole of the body except the face. Leave the medication on for at least 8hrs (Permethrin) or 24hrs ( Malathion) If you wash your hands during this period the cream will need to be reapplied. Most people require a single application, but some may need to repeat the treatment. What advice will you give the nursing home? All clothing, towels and bed linen that has been in contact with the patients should be washed in hot soapy water. All those in close contact with the patient should be treated. ( Remember symptoms do not appear for 6 weeks following infection) What advice will you give the ward.? Once the patient has been treated, they are not infective, despite the persistence of itch. How long will the itching last? Up to 6 weeks following treatment. Question 3: Question 3 This middle aged woman had suffered from psoriasis since the age of 19. This time the soles of her feet and palms of her hands were effected by the rash, which was painful, and at times caused a burning sensation. She was having difficulty wearing shoes and walking. Slide6: Describe the appearance of the rash on the feet. There is a symmetrical eruption of numerous small pustules on an erythematous base. What is the likely diagnosis? Pustular psoriasis affecting the palms and soles. What is the differential diagnosis? Fungal infection. ( skin scrapings and culture can aid diagnosis) Pomphylox exzema, contact dermatitis, and idiopathic pustular eruptions. List 4 potential treatments. Tar pastes/dithranol, topical steroids, PUVA, retinoids, methotrexate or cyclosporin A. What concerns would you have if this condition were effecting large areas of the body? Generalised pustular psoriasis is a rare but serious problem with an apprciable mortality. The patient suddenly develops widespread erythema and areas of pustulation and is systemically unwell. May be precipitated by by suddenly stopping high dose oral steroids or very potent topical steroids. Question 4: Question 4 This 4yr old boy presented on a Saturday evening with a 24hr history of a painful swelling of the R sde of his face and the start of tenderness on the other side. He was mildly febrile and was having some discomfort on swallowing. Slide8: What is shown in the picture? Swelling of the R parotid gland. What is the likely diagnosis? Mumps. Similar symptoms may occur after the MMR vaccine. What is the cause of the condition? A paramyxovirus. For what length of time should the child be excluded from nursery or other contacts? Infectivity is for up to 7 days after parotid swelling, which usually subsides within 2 weeks of onset. What are the possible complications and which specific problems effect adults only? Aspetic meningitis/encephalitis. Transient deafness which can occasionally be permenent. In adults the pancreas and gonads may be effected. 15% of postpubertal males may develop a uni or bilateral orchitis. What treatments may be recommended? Symptomatic. Question 5: Question 5 This photograph shows the foot of a 7yr old who has just returned from holiday in Florida. The diagnosis was cutaneous larvae migrans. Slide10: In which areas of the world is this endemic? Tropical and subtropical climes especially Mexico, South America, South Africa and Asia. In addition to the rash, what other symptom is the patient likely to complain of? Intense itching around rash. Name any of the species of nematode that cause this condition? Ancylostoma and strongyloides. Where do the infecting larvae live? Sand and moist soil. Describe 2 possible treatments. Application of liquid nitrogen or an antihelminth such as thiabendazole. Question 6: Question 6 This 20yr old woman presented to the ED with a 6 week history of a painful discharging area. She had had 3 courses of antibiotics from her GP temporarily improving her symptoms, but the area has become painful again. Slide12: What is the diagnosis? Hidradenitis Suppurativa. What treatment does this patient need? The majority of patients will ultimately require surgery, although the early management is medical and a minority of patients may be treated for long periods with oral antibiotics. What are the characteristic features of this condition? Sinus formation, abscesses and scarring of the deep tissue. How might treatment with the oral contraceptive pill help this condition? Oestrogen appears to reduce both sebaceous and apocrine gland activity. Question 7: Question 7 Match the history with the picture. Slide14: This 24yr old man presented with an itchy rash on his penis, which was so intense it was preventing him from sleeping. He was diagnosed as having scabies, which is often found in association with other STDs Slide15: This 41yr old business man had psoriatic plaques on his elbows and a couple of pits on his fingernails. He was pleased to hear that the area of redness and small plaques on his penis were also psoriasis and not caused by an STD. Slide16: This young man presented with white patches on his penis. He had been treated by his GP with topical steroids, and the rash had disappeared. Unfortunately on stopping the steroids it reoccurred. You diagnose lichen sclerosis et atrophicus. Match the picture and suggest a possible complication. Slide17: This 36yr old man with ulcerative colitis presented with,’Boils,’ on his penis which broke down to form ulcers. This picture shows a typical example of pyoderma gangrenosum. Match the picture and suggest a possible treatment. Slide18: This 22yr old man developed a large punched out lesion on the shaft of his penis 3 weeks after having sex with a prostitute in South America. The ulcer was painless and indurated. He also had non-tender inguinal lymphadenopathy. Initially the ulcer was thought to be caused by lymphogranuloma venereum, although this is characterised by painful lymphadenopathy. He was subsequently diagnosed with syphilis. How is syphilis diagnosed? Suggest a possible treatment. What other action needs to be taken? Question 8: Question 8 This 75yr old man presented with pain in his lower limb. Slide20: What is the diagnosis? Shingles in effecting S2. List 3 potential complications. Bacterial infection, urinary retention and constipation secondary to parasympathetic paralysis. List 4 potentials treatments. Early aciclovir 800mg 5xdaily for 7 days, famciclovir, amitriptyline, carbamezipine, simple analgesics, urinary catheter. Question 9: Question 9 This 25yr old woman presented on a bank holiday after noticing pale patches on her trunk following a holiday in Spain. She has no other symptoms. A fine superficial scale was seen when the surface was lightly scraped with a fingernail. Slide22: What is the diagnosis? Pityriasis versicolor. What is the cause? A commensal yeast Pityrosporum orbiculare, which is known in hyphal form as Malassezi furfur. What is its characteristic appearance? Slightly scaly light brown or pink patches on light coloured skin. In contrast tanned people exhibit reduced pigmentation in affected skin. What test could help? Scrapings of skin collected on black paper or scales lifted off using sellotape will reveal spores and hyphae of the yeast. What is the treatment? Selenium sulphide 2.5% shampoo or topical imadazole cream/ointment. Resistant or recurrent cases require oral itraconazole. Question 10: Question 10 Match the diagnosis with the picture. Slide24: Molluscum contagiosum. Untreated can last for months. If treatment required then curretage or simply squeezing the papules may help. Generally benign. Slide25: Infectious Mononucleosis Slide26: Herpes Simplex Slide27: Koplick’s spots. Generally appear 2 days before the generalised eruption of measles. Slide28: Orf, or cutaneous pustular dermatitis. Caused by the pox virus and is transmitted from the mouths of sheep. A nodule appears, which becomes pustular before the lesion resolves. This normally takes about 6 weeks. There is no effective treatment except for secondary infection.