DERMATOLOGY

1. Below is true regarding skin lesions terminologyA. macule is a flat lesion < 0.5 mm with colour changes B. vesicle is large blister > 0.5 mm consisting of clear fluid C. erythema is defined as redness of the skin due to vascular dilatation D. lichenification is superficial abrasion often linear due to scratching E. scale is an accumulation of thickened horny layer keratin in the form of readily detached

fragments

2. All are true regarding side effect of topical steroids on the skinA. atrophy of the skinB. easy bruisingC. allergic contact dermatitisD. moon faceE. growth retardation

3. All are true regarding psoriasisA. can be inheritedB. peak age are in 2nd and 6th decadesC. nail involvement is common which are pitting and onycholysisD. most common site is on flexors areasE. methotrexate can be used in severe condition

4. Investigation of the contact dermatitis includes A. photo testB. patch testC. prick testD. tuberculin test

5. Patient education for contact dermatitis patient areA. avoid shampoo, solvents and hair lotionsB. wear gloves when to wash dishes or dusty workC. put on moisturizers to avoid drynessD. use any lotion or ointments

6. Causes of non scarring hair loss/alopeciaA. alopecia areataB. lupus erythematosusC. cytotoxic drugs inducedD. hypothyroidismE. trauma

7. Causes of hypopigmentationA. albinismB. post inflammatory i.e. psoriasis and eczemaC. pityriasis versicolorD. leprosy

E. vitiligo

8. Among drugs can caused drug eruption are A. ACE inhibitorsB. Beta blockers C. Sulphonamides D. Aspirin

9. Regarding scabies, all are true exceptA. Caused by Sarcoptes scabieB. Most common in children and young adultC. All close contact should be treated at the same time only if they are

symptomaticD. Treated with EBB in all age group ex cept in children less than 1 year oldE. Common sites are between web toes, umbilicus and axillae

10. This statement are true about patch test exceptA. Is a test to identify the agent of the dermatitisB. It will take 3 to 5 daysC. Patient should stop taking piriton and prednisolone onlyD. Complication of the test are irritation and anaphylactoid reactionE. Patient can continue their daily activities include strenuous activities

11. PsoriasisA. Is infectiousB. Nothing to do with foodsC. Can be worse by antihypertensive drugs and antipsychiatry drugsD. Can be treated with ultraviolet therapyE. It can affect sexual activity

12. It is true regarding acne vulgarisA. Is a self limited disease affect primarily teenagers and young peopleB. Hallmark is comedoneC. It can be whitehead or blackheadD. Common site is at the backE. Topical agents can be use are benzoyl peroxide, salicylic acid and

retinoid acid

All are true regarding psoriasisA) This is quite straightforward. In most sufferers, the tendency to get psoriasis is inherited. It is

not passed on in a simple, direct way like hair color, but involves multiple genes. For this reason, it is not always clear from whom one inherited it. Inherited psoriasis usually starts in older childhood or as a young adult. Sometimes, especially in children, a virus or strep throat triggers brief attacks of tiny spots of psoriasis. Tapi die boleh jugak non-inherited. So xsemestinya die inherited.

There may be a family history—if one parent has psoriasis. 16% of the children will have it, if both parents, the figure is 50%.

Maka, A- true

Additional info on psoriasis.Psoriasis is an inflammatory disorder of the skin in which activation of T lymphocytes results in release of cytokines that leads to proliferation of keratinocytes. In normal skin, the cells of the epidermis are regenerated every 28 days, while in psoriatic skin epidermis is regenerated every two to four days.

http://www.aad.org, http://www.aocd.org, buku ABC of dermatology page 9

B) This disorder may affect people of any age, though most commonly begins between ages 15 and 40. About 10% develop psoriasis during childhood; it can begin in infancy too. The earlier the psoriasis appears, the more likely it is to be widespread and recurrent.

B- false

http://psoriasis-cure.info

C) True.

Nail changes dlm psoriasis sgt laa common. Contohnya, yellow discoloration, thickening, surface pitting, and lifting of the nail plate off of the distal nail bed (onycholysis).

www.aad.org

D) False

ABC of dermatology, page 9

E) True

Oral retinoids, cyclosporine, and methotrexate have also been used for treatment of severe generalized psoriasis, erythrodermic psoriasis, and pustular psoriasiswww.aad.org info on psoriasis treatment

Mild or limited psoriasis can be treated with topical therapy, including topical corticosteroids, tars, anthralin, calcipotriene (a vitamin D3 analog), or tazarotene (a retinoid). In more generalized cases phototherapy with ultraviolet B iseffective.

Sun exposure can also be helpful. Treatment with oral psoralens plus ultraviolet A exposure, called PUVA, is effective in most patients, but has been associated with an increased risk of skin cancers after many treatments over several years. Recently, narrowband UVB has been introduced for the treatment of psoriasis

Three agents that block TNFa have also been used to treat psoriasis. Etanercept, a fusion protein directed against soluble TNFa , has been approved for the treatment of psoriatic arthritis and is also effective for psoriasis of the skin. Infliximab, a chimeric monoclonal antibody against soluble and cell bound TNFa , is dramatically effective against psoriasis. Adlimumab, a human monoclonal antibody to TNFa , has begun trials for psoriasis and initial results are promising.

13. Investigation of the contact dermatitis includes A. T – photodermatitis is a typr of contact dermatitisB. T- untuk mengetahui apakah allergen or irritant penyebab

C. F- kerana ia utk test hypersensitivity 1 iaitu utk igE. Contact dermatitis adlh hypersensitivity type 4.

D. F- kerna ia adlh untuk sahkan TB.

14. Patient education for contact dermatitis patient areSemua soalan2 ni straight forward,tak perlu di ulas lanjut taw.a) TRUE

Patients are advised to avoid contact with allergen and it cross reactants that irritate the skin(Ref: Dermatology.pdf USMLE Review Notes)

b) TRUEFor irritant contact dermatitis, patients are advised to wear cotton gloves under rubber gloves for all wet work(Ref: Dermatology.pdf USMLE Review Notes)

c) TRUEThis statement is quite confusing. However, this is my answer and reasoning.Allergy type of contact dermatitis can cause symptom of intermittent dry, scaly patches of skin and irritant type of contact dermatitis can cause dry, cracking skin. Thus, it is advisable for patients to put on moisturizers to avoid dryness. Use hand creams and lotions frequently.(Ref:http://my.clevelandclinic.org/disorders/dermatitis_contact/hic_contact_dermatitis.aspx)

d) TRUESame as C.

15. Causes of non scarring hair loss/alopecia A) T – alopecia areata is an autoimmune disease. It is a localized alopecia with normal skin on the scalp, eyebrows, beard or elsewhere. The pathognomonic feature is ‘exclamation mark hairs’ (short hairs which taper towards their bases.)From lecture notes on dermatology page 116

B) F- lupus erythematous will present as scarring alopecia with erythema, scaling and follicular changesFrom dermatology illustrated colour text page 63

C) T- drug induced alopecia will present as diffuse non scarring alopecia. Examples of drug induced are cytotoxic (esp cyclophosphamide), heparin, warfarin, carbimazole, colchicine and vitamin A.From dermatology illustrated colour text page 62

D) T- endocrine disorder will cause diffuse non scarring alopecia. Androgen-secreting tumours in women produce male-pattern baldness with virilization. Malnutrition induces dry brittle hair that becomes pale or red in kwashiorkor (protein deficiency).From dermatology illustrated colour text page 62

E) T- in case of trauma, there will be constantly rubbing or pulling the hair. This will result in loss of hair. However, the surrounding skin is normal.From dermatology illustrated colour text page 62

16. Causes of hypopigmentationF. Albinism

Ans = TrueReference = harrison’s volume I, page 324-325 table 54-9Example in oculocutaneous albinism (OCA)

G. post inflammatory i.e. psoriasis and eczemaAns = TrueReference = Harrison 325 table 54-9 & page 326 table 54-10In inflammatory process, edema present. Edema can block the transfer of melanin from melanocyte to keratinocytes.

H. pityriasis versicolorAns = TrueReference = Harrison page 326 table 54-10 & page 318Can present with hypopigmentation on dark skinCan present with hyperpigmentation on light skin

I. leprosyAns =TrueReference = Harrison volume I page 1022 & figure 159-2 page 1023Skin lesion in tuberculoid leprosy – hypopigmented macules/plaque

J. vitiligoAns = TrueReference = Harrison volume I, table 54-10 page 326In vitiligo – there is destruction of melanocytes due to autoimmune. That’s can lead to hypopigmentation. Because in vitiligo- there is absence of melanocyte – colour of the skin become “chalk-white”

17. Among drugs can caused drug eruption are A. TRUE - “ACEI can cause pemphigus.” -Kumar & Clark pg.1359-B. TRUE - “Several drugs have been implicated in psoriasiform drug eruptions. Beta-blockers have been a frequently reported cause ” -http://dermatology.cdlib.org/93/case_reports/metformin/koca.htmlC. TRUE - “Sulphonamides cause a variety of skin eruption including TEN, SJS n etc.” -Kumar & Clark pg.37-D. TRUE - “Aspirin can cause urticaria.” -Kumar & Clark pg.1359-

18. Regarding scabies, all are true except

A) F B) F – risk factors are young age, presence of many children in household, illiteracy, low family income, poor housing, sharing clothes and towels. (emedicine.medscape.com. Scabies epidemiology) C) T - Treatment is recommended for members of the same household as the person with scabies, particularly those persons who have had prolonged skin-to-skin contact with the infested person. All persons should be treated at the same time to prevent reinfestation. Kat sini xcakap if is symptomatic. http://www.cdc.gov/parasites/scabies/gen_info/faqs.html

D) T – in children, EBB should be diluted to 10%, In infants over 2 months, use EBB mixed with three parts of water (http://www.drugs.com/cons/benzyl-benzoate-topical.html) E) F – sites:fingers,wrist,nipples, abdomen,axillae,cubitus,web spaces, sides of palm,groin,buttocks. (ABC of dermatology, MCCQE 2002 review notes. –infections)

19. This statement are true about patch test exceptA. TRUEB. FALSE: usually 48hoursC. FALSE: Ntah le...the patient should stop taking any oral or topical, IV cortisone ..bukan nye

Piriton and prednisolone ONLY as ABOVED. XSURE: irritation tu yelah..tapi yang anaphylactoid tu unsure..sorry sgt2…E. FALSE: it should be adhere to the skin…avoid sweating a lot

20. PsoriasisA. F: The condition cannot be spread to others, it is not infectious disease.

(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/, 24.4.11, 7.43pm)B. T: In term of etiology, there is strong genetic component involve in psoriasis. Food involvements

mainly cause dermatitis or eczema which require skin patch test to confirm the allergen.(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/, 24.4.11, 7.43 pm, Lecture Note on Dermatology by Robin and Tony, 8th Edition, pg 67)

C. F: Benda yg trigger psoriatic attack:a. Bacteria or viral infections, including strep throat and upper respiratory infectionsb. Dry air or dry skinc. Injury to the skin, including cuts, burns, and insect bitesd. Some medicines, including antimalaria drugs, beta-blockers, and lithiume. Stressf. Too little sunlightg. Too much sunlight (sunburn)h. Too much alcohol(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/, 24.4.11, 7.43pm)

D. T: Treatment for psoriasis:a. Topical Emollient, Salicylic acid, TAR, Topical steroids, Dithranol (anthralin), Vit D & A

analogues, UV radiationb. Systemic PUVA (psoralen + ultraviolet A), retinoids, cytotoxic drugs (methothrexate),

systemic steroids and cyclosporine(Lecture Note on Dermatology by Robin and Tony, 8th Edition, pg 73)

E. T: because of itchiness it can affect sexual activity but in term the sexual function it is normal.

21. It is true regarding acne vulgarisSebelum menjawab mari kita lihat apa itu acne..from ABC of dermatology punye buku

Acne lesions develop from the sebaceous glands associated with hair follicles—on the face, external auditory meatus, back,chest, and anogenital area. (Sebaceous glands are also found on the eyelids and mucosa, prepuce and cervix, where they are not associated with hair follicles.) The sebaceous gland contains holocrine cells that secrete triglycerides, fatty acids, wax, esters, and sterols as “sebum”. The main changes in acne are:(1) an increase in sebum secretion;(2) thickening of the keratin lining of the sebaceous duct, to produce blackheads or comedones—the colour of blackheads is due to melanin, not dirt;(3)an increase in Propionibacterium acnes bacteria in the duct;(4) an increase in free fatty acids;(5) inflammation around the sebaceous gland, probably as a result of the release of bacterial enzymes.

A) TrueB) True

Acne vulgaris is a self-limited disorder of the skin, commonly occurring during puberty and affecting primarily the face, chest, and back, in which the formation of small cysts, called comedones, is accompanied by varying degrees of inflammation.

http://www.harrisonspractice.com

C) TrueComedone can be whiteheads or blackheads

www.aad.org

D) True – kat atas banyak dah infoE) True – ABC of Dermatology

Additional info

Oral treatment. The mainstay of treatment is oxytetracycline, which should be given for a week at 1 g daily then 500 mg (250 mg twice daily) on an empty stomach. Minocycline, ordoxycycline are alternatives that can be taken with food. Erythromycinis an alternativetotetracycline, and co-trimoxazole can be usedfor Gram negative folliculitis. Tetracycline might theoretically interfere with the absorption of progesterone types of birth control pill and should not be given in pregnancy.

Topicalantibiotics. Erythromycin, the tetracyclines, andclindamycin have been used topically. There is the risk of producing colonies of resistant organisms.

Antiandrogens. Cyproterone acetate combined withethinyl oestradiol is effective in some women; it is also a contraceptive.

Synthetic retinoids. For severe cases resistant to other treatments these drugs, which can be prescribed only in hospital, are very effective and clear most cases in a few months. 13-cis-Retinoic acid (isotretinoin) is usually used for acne. They are teratogenic, so there must be no question of pregnancy, and can cause liver changes with raised serum lipid values. Regular blood tests are therefore essential. A three month course of treatment usually gives a long remission. Recently topical isotretinoin gel has been introduced. (ABC of dermatology)