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Which one of the following statements regarding fungal nail infections is incorrect?ia A. Candida accounts for less than 10% of casesia A

B. Diagnosis should be confirmed by microbiology before A starting treatmentia

C. Treatment is successful in around 85% of peopleia A

D. Thickened, rough, opaque nails are typicallyia A

E. Suitable investigations include nail clippingsia A
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Fungal nail infections sqweqwesf erwrewfsdfs adasd dhe Onychomycosis is fungal infection of the nails. This may be caused by

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dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases yeasts - such as Candida non-dermatophyte moulds

Features • • 'unsightly' nails are a common reason for presentation thickened, rough, opaque nails are the most common finding

Investigation • • nail clippings scrapings of the affected nail

Management • • treatment is successful in around 50% of people diagnosis should be confirmed by microbiology before starting treatment

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dermatophyte infection: oral terbinafine is currently recommended first-line with oral itraconazole as an alternative. Six weeks therapy is needed for fingernail infections whilst toenails should be treated for 12 weeks Candida infection: mild disease should be treated with topical antifungals (e.g. amorolfine) whilst more severe infections should be treated with oral itraconazole for a period of 12 weeks Bottom of Form Reference ranges Top of Form End session

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Question 80 of 86 A 19-year-old man is started on isotretinoin for severe nodulo-cystic acne. Which one of the following side-effects is most likely to occur?ia A. Low moodia A

B. Thrombocytopaeniaia A

C. Raised plasma A triglyceridesia

D. Reversible alopeciaia A

E. Dry skinia A
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Dry skin is the most common side-effect of isotretinoin

Isotretinoin sqweqwesf erwrewfsdfs adasd dhe Isotretinoin is an oral retinoid used in the treatment of severe acne. Two-thirds of patients have a long term remission or cure

following a course of oral isotretinoin Adverse effects

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teratogenicity: females MUST be using two forms of contraception (e.g. combined oral contraceptive pill and condoms) dry skin, eyes and lips: the most common side-effect of isotretinoin low mood raised triglycerides hair thinning nose bleeds (caused by dryness of the nasal mucosa) benign intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason Bottom of Form

Question 81 of 86 Which of the following skin conditions associated with malignancy are not correctly paired?ia A. Erythroderma and lymphomaia A

B. Necrolytic migratory erythema and A gastrinomaia

C. Acanthosis nigricans and A gastrointestinal canceria

D. Sweet's syndrome and myelodysplasiaia A

E. Erythema gyratum repens and lung A canceria
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Necrolytic migratory erythema is associated with glucagonomas Skin disorders associated with malignancy sqweqwesf erwrewfsdfs adasd dhe Paraneoplastic syndromes associated with internal malignancies:

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acanthosis nigricans - gastrointestinal cancer acquired ichthyosis - lymphoma acquired hypertrichosis lanuginosa - gastrointestinal and lung cancer dermatomyositis - bronchial and breast cancer erythema gyratum repens - lung cancer erythroderma: lymphoma migratory thrombophlebitis - pancreatic cancer necrolytic migratory erythema - glucagonoma pyoderma gangrenosum (bullous and non-bullous forms) - myeloproliferative disorders Sweet's syndrome - haematological malignancy e.g. myelodysplasia - tender, purple plaques Bottom of Form Top of Form Bottom of Form Top of Form T o p o f F o r m B o tt o m
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Bottom of Form Question stats A B C D E 4.3% 64.3 % 4.1% 13.7 % 13.7 %

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64.3% of users answered this question correctly Session score = 35.8% External links DermNet NZ Picture of acanthosis nigricans DermNet NZ Picture of Sweet's syndrome DermNet NZ Picture of dermatomyositis DermNet NZ Picture of erythema gyratum repens DermNet NZ Picture of pyoderma gangrenosum All contents of this site are ©2009 passmedicine.com - Terms and Conditions passmedicine.com Top of Form Question 82 of 86 A 65-year-old woman with blistering lesions on her leg is diagnosed as having bullous pemphigoid. What is the most appropriate initial management?ia A. Reassuranceia A Reference ranges End session

B. Topical corticosteroidsia A

C. Oral itraconazoleia A

D. Screen for solid-tumour A malignanciesia

E. Oral corticosteroidsia A
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Top of Form Question 82 of 86 A 65-year-old woman with blistering lesions on her leg is diagnosed as having bullous pemphigoid. What is the most appropriate initial management?ia A. Reassuranceia A

B. Topical corticosteroidsia A

C. Oral itraconazoleia A

D. Screen for solid-tumour A malignanciesia

E. Oral corticosteroidsia A

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Bullous pemphigoid sqweqwesf erwrewfsdfs adasd dhe Bullous pemphigoid is an autoimmune condition causing sub-epidermal blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230 Bullous pemphigoid is more common in elderly patients. Features include • • itchy, tense blisters typically around flexures mouth is usually spared

Skin biopsy

immunofluorescence shows IgG and C3 at the dermoepidermal junction

Management • • referral to dermatologist for biopsy and confirmation of diagnosis oral corticosteroids are the mainstay of treatment topical corticosteroids, immunosuppressants and antibiotics are also used Bottom of Form Top of Form Bottom of Form Top of Form T o p o f F o r m B o tt o m
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Bottom of Form Question stats A B C D E 7.8% 26.5 % 5.6% 6.3% 53.9 %

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53.9% of users answered this question correctly Session score = 35.4% External links DermNet NZ Picture of bullous pemphigoid British Association of Dermatologists Bullous pemphigoid guidelines All contents of this site are ©2009 passmedicine.com - Terms and Conditions passmedicine.com Reference ranges End session

Top of Form Question 83 of 86 A 36-year-old female with a history of ulcerative colitis is diagnosed as having pyoderma gangrenosum. She presented 4 days ago with a 1 cm lesion on her right shin which rapidly ulcerated and is now painful. What is the most appropriate management?ia A. Topical steroidsia A

B. Oral A prednisoloneia

C. Surgical A debridementia

D. Topical A tacrolimusia

E. Infliximabia A

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Topical therapy does have a role in pyoderma gangrenosum and it may seem intuitive to try this first before moving on to systemic treatment. However, pyoderma gangrenosum has the potential to evolve rapidly and for this reason oral prednisolone is usually given as initial treatment. For a review see BMJ 2006;333:181-184 Pyoderma gangrenosum sqweqwesf erwrewfsdfs adasd dhe Features • • typically on the lower limbs initially small red papule later deep, red, necrotic ulcers with a violaceous border may be accompanied systemic systems e.g. fever, myalgia

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Causes* • idiopathic in 50% IBD: ulcerative colitis, Crohn's rheumatoid arthritis, SLE myeloproliferative disorders lymphoma, myeloid leukaemias


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monoclonal gammopathy (IgA) primary biliary cirrhosis

Management

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the potential for rapid progression is high in most patients and whilst topical and intralesional steroids have a role in management most doctors advocate oral steroids as first-line treatment other immunosuppressive therapy, for example ciclosporin and infliximab, have a role in difficult cases

*note whilst pyoderma gangrenosum can occur in diabetes mellitus it is rare and is generally not included in a differential of potential causes Bottom of Form Top of Form Bottom of Form Top of Form T o p o f F o r m B o tt o m
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53% of users answered this question correctly May 2007 exam Session score = 34.9% External links DermNet NZ Picture of pyoderma gangrenosum

DermNet NZ Stoma skin problems All contents of this site are ©2009 passmedicine.com - Terms and Conditions passmedicine.com Top of Form Question 84 of 86 Each one of the following is associated with hypertrichosis, except:ia A. Anorexia nervosaia A Reference ranges End session

B. Porphyria cutanea A tardaia

C. Psoriasisia A

D. Minoxidilia A

E. Ciclosporinia A
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Top of Form Question 84 of 86 Each one of the following is associated with hypertrichosis, except:ia A. Anorexia nervosaia A

B. Porphyria cutanea A tardaia

C. Psoriasisia A

D. Minoxidilia A

E. Ciclosporinia A

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Hirsuitism and hypertrichosis sqweqwesf erwrewfsdfs adasd dhe Hirsuitism is often used to describe androgen-dependent hair growth in women, with hypertrichosis being used for androgen-independent hair growth Causes of hirsuitism • • • • polycystic ovarian syndrome Cushing's syndrome congenital adrenal hyperplasia androgen therapy adrenal tumour androgen secreting ovarian tumour drugs: phenytoin

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Causes of hypertrichosis

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drugs: minoxidil, ciclosporin, diazoxide congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis porphyria cutanea tarda anorexia nervosa Bottom of Form Top of Form Bottom of Form Top of Form T o p o f F o

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59.8% of users answered this question correctly Session score = 34.5% All contents of this site are ©2009 passmedicine.com - Terms and Conditions passmedicine.com Reference ranges End session

Top of Form Question 85 of 86 A 17-year-old male is reviewed six weeks after starting an oral antibiotic for acne vulgaris. He stopped taking the drug two weeks ago due to perceived alteration in his skin colour, and denies been exposed to strong sunlight for the past six months. On examination he has generalised increased skin pigmentation, including around the buttocks. Which one of the following antibiotics was he likely to be taking?ia A. Doxycyclineia A

B. Oxytetracycli A neia

C. Tetracyclineia A

D. Erythromycini A a

E. Minocyclineia A

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Minocycline can cause irreversible skin pigmentation and is now considered a second line drug in acne. Photosensitivity secondary to tetracycline/doxycycline is less likely given the generalised distribution of the pigmentation and the failure to improve following drug withdrawal Acne vulgaris: management sqweqwesf erwrewfsdfs adasd dhe Acne vulgaris is a common skin disorder which usually occurs in adolescence. It typically affects the face, neck and upper trunk and is characterised by the obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules. Acne may be classified into mild, moderate or severe:


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mild: open and closed comedones with or without sparse inflammatory lesions. moderate acne: widespread non-inflammatory lesions and numerous papules and pustules severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring

A simple step-up management scheme often used in the treatment of acne is as follows:

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single topical therapy (topical retinoids, benzyl peroxide) topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid) oral antibiotics: e.g. oxytetracycline, doxycycline. Improvement may not be seen for 3-4 months. Minocycline is now considered second line treatment due to the possibility of irreversible pigmentation. Gram negative folliculitis may occur as a complication of long-term antibiotic use - high-dose oral trimethoprim is effective if this occurs oral isotretinoin: only under specialist supervision

There is no role for dietary modification in patients with acne Bottom of Form Top of Form Bottom of Form Top of Form

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53.3% of users answered this question correctly Session score = 34.1% External links Clinical Knowledge Summaries Acne vulgaris guidelines All contents of this site are ©2009 passmedicine.com - Terms and Conditions passmedicine.com Top of Form Question 86 of 86 A 33-year-old man presents complaining of an itchy scalp and dandruff. On examination he is noted to have eczema on his scalp, behind his ears and around his nose. He has tried 'Head and Shoulders' and 'Neutrogen T-gel' but with poor results. Which one of the following is the most appropriate treatment for his scalp?ia A. Topical A hydrocortisoneia Reference ranges End session

B. Topical dermovateia A

C. Topical selenium A sulphideia

D. Oral terbinafineia A

E. Topical A ketoconazoleia
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Top of Form Question 86 of 86 A 33-year-old man presents complaining of an itchy scalp and dandruff. On examination he is noted to have eczema on his scalp, behind his ears and around his nose. He has tried 'Head and Shoulders' and 'Neutrogen T-gel' but with poor results. Which one of the following is the most appropriate treatment for his scalp?ia A. Topical A hydrocortisoneia

B. Topical dermovateia A

C. Topical selenium A sulphideia

D. Oral terbinafineia A

E. Topical A ketoconazoleia

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Seborrhoeic dermatitis in adults sqweqwesf erwrewfsdfs adasd dhe Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population Features

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eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds otitis externa and blepharitis may develop

Associated conditions include • • HIV Parkinson's disease

Scalp disease management

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over the counter preparations containing zinc pyrithione ('Head & Shoulders') and tar ('Neutrogena T/Gel') are first-line the preferred second-line agent is ketoconazole selenium sulphide and topical corticosteroid may also be useful

Face and body management


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topical antifungals: e.g. ketoconazole topical steroids: best used for short periods difficult to treat - recurrences are common Bottom of Form Top of Form Bottom of Form Top of Form T o p o f F o r m B o tt o m
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Question stats A B C D E 11.4 % 6% 30% 11.8 % 40.8 %

40.8% of users answered this question correctly Session score = 33.7% External links DermNet NZ Overview and pictures of seborrhoeic dermatitis Clinical Knowlegde Summaries Seborrhoeic dermatitis guidelines All contents of this site are ©2009 passmedicine.com - Terms and Conditions