Clinical Cases

Question 1

What are some causes of psoriasis

Answer 1

Genetic 
Environmental 
Stress
Drugs (B blockers and lithium)
Infection

Question 2

What is the commonest form of psoriasis

Answer 2

Chronic plaque psoriasis (psoriasis vulgaris)

Question 3

What sites of the body are commonly affected by psoriasis

Answer 3

Extensors 
scalp
sacrum
hands
feet
trunk
nails

Question 4

Describe the appearance of psoriasis

Answer 4

Sharply demarcated, scaly, erythematous plaques

Question 5

What type of psoriasis can be life threatening

Answer 5

Erythrodermic

Question 6

What 4 things can happen to nails in psoriasis (psoriatic nail disease)

Answer 6

Oncholysis (lifting of nail from nailed)
Nail pitting
Dystrophy
Subungal hyperkeratosis

Question 7

What are the main treatments of psoriasis

Answer 7

TOPICAL 
vitamin D ointments
Coal tar
Steroid ointments 
OTHERS
phototherapy (UVB and PUVA) 
Immunosuppresion

Question 8

Psoriasis has an association with some other medical problems. What are these

Answer 8

Obesity - losing weight may help to revers the condition

Joints - rheumatology

Question 9

Describe what acne vulgarise is

Answer 9

chronic inflammatory disease of the pilosebaceous unit

Question 10

What are the gradings of acne

Answer 10

Mild
Moderate
Severe

Question 11

What is the treatment for acne

Answer 11

To control/ prevent scarring 
Topical treatments (antibacterial, topical vitamin A derivatives, topical antibiotics
systemic treatment (antibiotics, isotretinoin)

Question 12

What is a disadvantage of isotretinoin

Answer 12

You need to have contraceptive cover if female and of child bearing age

Question 13

What can be used to treat an isotretinoin flare

Answer 13

Oral steroids

Question 14

What areas of the body are affected by rosacea

Answer 14

Nose, chin, cheeks and forehead

Question 15

What are some of the features of rosacea

Answer 15

Papules

Pustules and erythema with no comedones

Question 16

What is the management of rosacea

Answer 16

Reduce aggravating factors 
Antibiotics 
Isotretinoin low dose if severe
Telangiectasia
Rhinophyma

Question 17

What are some aggravating factors of rosacea

Answer 17

Dietary triggers
Sun exposure
Avoid topical steroids

Question 18

What is the difference between Bullous disorders

Answer 18

Bullous pemphogoiD - split is Deeper, through DEJ

PemphiguS split more Superficial, intra-epidermal

Question 19

What age group of patients get Bullous pemphigoid

Answer 19

Elderly patients

Question 20

What is often the presenting feature of Bullous Pemphigoid

Answer 20

Itchy erythematous plaques and papillose

Question 21

What is a negative nikolsky sign

Answer 21

When a blister will not rupture if gently pressed.

Question 22

Where is affected in pemphigus vulgaris

Answer 22

scalp
face
axillae
groins

Question 23

What happens when the lesions burst

Answer 23

they leave raw areas which cause an increased infection

Question 24

Where else might be affected in pemphigus vulgaris

Answer 24

eyes

genitals

Question 25

Most patients achieve remission on treatment within 3-6 months. True or False

Answer 25

True

Question 26

What happens if pemphigus is left untreated

Answer 26

very high chance of mortality

Question 27

What 2 investigations can be carried out for pemphigus

Answer 27

Skin biopsy with direct immunofluorescence

Indirect immunofluorescence

Question 28

What is used to treat pemphigoid and pemphigus

Answer 28

Systemic steroids
Other immunosuppressive agents
Topicals (emollients, topical steroids)