DERMATOLOGY FELLOWSHIP QUESTIONS



DERMATOLOGY FELLOWSHIP QUESTIONSQUESTION 1A 70 year old man with past history of COAD presents with two days of rash and fever. His only medications are metered aerosol inhalers of salmeterol and fluticasone.His observations are all within normal limits.Q1. Describe the appearance of this rash? (2)Q2. What are the potential causes of this rash? (5 marks)Q3. List the potential complications of this rash condition (4 Marks)QUESTION 2A 70 year old diabetic man presents to the emergency department complaining of painful feet.Q1. Describe the abnormalities seen in the photo (6 marks)Q2. What are the likely causes of this appearance (3)Q1. Describe the appearances seen in this photo ( 2 marks)Q2. What is the single most likely cause of this appearance? (1 mark)Q3. List the steps in the investigation, management and disposition of this child? (5 marks)Question 3A 70 year old man presents with a painful facial rash that started 5 days ago. He has had a recent viral illness with a cough and lethargy but is “feeling better”. There have been no new skin lesions for 24 hrs.Obs are all within normal but he seems to have significant pain and is distressedQ1. Describe the appearances seen in this photograph (3 marks)Q2. What is the most likely diagnosis? (1 mark)Q2. List the 4 examination findings that you will seek to exclude complications of this condition? ( 8 marks)ComplicationExam Finding SoughtQ4. Outline your management/disposition for this patient (5 Marks)Q5. The patient represents 3 weeks later with an improved rash but intolerable pain. He has been taking panadeine forte and nurofen regularly with minimal effect. What is this condition? (1 mark)Q6. What additional 3 pharmacological options are available for the outpatient treatment of this pain? List 2 complications of each these drugs (9 marks)DRUG and INITIAL DOSECOMMON COMPLICATIONS (2 each)MCQ Dermatology, Haematology, Rheumatology1.Which rash is not characteristically found on the hands?secondary syphiliserythema multiformegonococcusmeningococcusherpes simplex2.In what dermatological condition is a Tsanck smear used to aid diagnosis?Skin lesions of meningococcusHerpes vesicular lesionsSecondary syphilisUrticariaEBV3.Which is not true of erythema multiforme?less than 30% of the skin must be blistered to make this diagnosisclassically there are target lesions, especially on the peripherythere tends to be associated fever and arthralgiait settles within 7-10 days if left untreatedsteroids orally quicken the recovery4.Which drug is not likely to cause toxic epidermal necrolysis?penicillintrimethoprimcarbamazepinecimetidinepiroxicam5.Which is not a possible cause of a blistered patient?molluscum contagiosumhand, foot and mouth diseaseeczema herpeticumallergic contact dermatitisbites6.Which is NOT TRUE of staphylococcal scalded skin syndrome?it is most commonly seen in infantsit is toxin mediatiedthere is no mucosal invovementit tends to be less severe than toxic epidermal necrolysisthe focus for infection may be non cutaneous7.Which infectious erythema is purely caused by toxin alone and not from the infectious process as well?toxic shock syndromescarlet feverstreptococcal toxic shock syndromestaphylococcal scalded skin syndromeall of the above8.Which rash is not usually itchy?urticariaeczema scabiesbitesscarlet fever9.Which is not true of scarlet fever?the erythema appears very early after the prodrome beginsthe rash does not blanchethere is circumoral pallorthere is often pharyngotonsillitis there is a strawberry tongue10.Which is not one of the five criteria other then fever required to make the diagnosis of Kawasakis disease?cervical LNperipheral changes. Eg erythema and oedemabilateral non purulent conjunctivitispolymorphous rashpustular tonsillitis11.Which dose not tend to produce palpable purpura?meningococcusvasculitisSLE, rheumatoid arthritisClotting disordersHenoch schonlein purpura12.Which is not associated with erythema nodosum?sarcoidcrohns diseaseleukemiasalmonellahep B13.Which is not associated with pyoderma gangrenosum?IBDRheumatoid arthritisLeukemiasalmonellamyeloma14.Which is NOT TRUE of pemphigus and pemphigoid?the prognosis of pemphigoid is betterpemphigous lesions are intra dermal where as the lesions in pemphigoid are subdermalmucosa is more often involved in pemhigousclinically the two can be usually differentiated with a good examinationthey are both autoimmune disorders15.Which is the usual causative organism in toxic shock syndrome?staph aureuse colipneumococcusstrep pyogenesmeningococcus16.Which medication does not commonly cause photosensitivity eruptions?thiazide diureticsspironolactoneloop diureticsamioderonesulfonylureas17.Which is not true of antiviral medications if given within 72 hours of vesicle formation in herpes zoster?it decreases time to healingit decreases new lesion formationit decreases recurrenceit possibly decreases pain it possibly decreases duration of post herpetic neuralgia18.Which is not true of measles?Koplicks spots are seen a few days after the onset of rashThe rash appears a few days after the prodrome, starting at the head and moving downwardsUnimmunised contacts should be given MMR within 72 hours if over 6 months of ageIf greater than 72 hours immunoglobulin should be given i.m.Unimmunised contacts should be excluded from school for 2 weeks19.Which is not true of henoch schonlein purpura?it is a vasculitis of unknown causepurpura are classically on the lower limbsabdominal pain and malena are documentedrenal disease is a potentially serious complicationsteroids diminish the likelihood of renal complications20.Which of these is no a cause of a macrocytosis?hypothroidismchronic alcohol intakephenytoinreticulocytosisB12 and folate deficiency21.Which is not a cause of a microcytic anaemia?anemia of chronic diseasethalassemiasiderobliastic anaemiafe deficiencychemotherapeutic drugs22.Which is a neurological sequelie of prolonged B12 deficiency?subactue degeneration of the spinal cordperipheral neuropathyhigher center disfunctionall of the abovenone of the above23.Which of these below is not a micrangiopathic hemolytic anaemia?TTPHemolytic uremic syndromeHELLPITPDIC24.Regarding TTP and HUS, which statement below is false?they are probably of the same pathological entitythey both usually present with neurological abnormalitiesthey both cause a hemolytic anaemiathey both cause a thrombocytopeniathey both have normal coagulation25.Which statement is false?In both hemophilia A and B the INR will be normalIn both hemophilia A and B the APTT will be abnormalHemophilia A is more common than BThe desired treatment of Hemophilia B is administration of Factor IXThe desired treatment of Hemophilia A is the administration of cryoprecipitate26.Which agent/s can be used to treat bleeding with von Willibrands disease?desmopressinfactor VIII concentratefactor IX concentrateplatelet transfusionA and B27.Which is not a common precipitant of sickle cell crises?hot weatherdehydrationinfectionhigh altitudeall of the above are precipitants 28.Which statement is false regarding Disseminated Intravascular coagulation?pts usually present with hemorrhagemicrothrombi/emboli are seen in some patientsreplacement of clotting factors if the patient is bleeding has been shown to improve outcometreatment of microthrombi with systemic heparin has been shown to improve outcome all of the above are true statements29.Which laboratory abnormality would you not expect to see in DIC?decreased platelet counthigh fibrinogen levelprolonged INRelevated FDPelevated D dimmer30.Which of these commonly used drugs does NOT cause platelet dysfunction?aspirinpenicillinsphenytoinverapamiltricyclic antidepressants31.Which agent is not in cryoprecipitate?factor VIIIfactor IXfibronectinvon willebrand factorfibrinogen32.In which disease is there a high incinence of philidephia chromosome?CLLCMLPolycythemia rubra veraAMLALL33.Which statement is true regarding secondary polycythemia?the erythropoeitn level is elevatedthere is hepatoslenomegallyparietis is not a featureit is usually secondary to states of low oxygen tensionthe WBC and platelet counts are normal34.Which is not a feature of tumour lysis syndrome?hypercalcemiahyperkalemiahyperuricemiahyper phosphatemialactic acidosis 35.What number of WBC would you expect to see in a tap of a septic joint?<200200-40002000-500005000 – 150000nil36.What number of WBC would you usually expect to see in a tap of an inflamed joint with gout?<200200-40002000-5000050000-150000nil37.Which organism is not thought to be associated with Reiters syndrome?yersiniacampylobactersalmonellae colichlamydia38.Which is TRUE of Reiters syndrome?the arthropathy usually occurs at the time of the acute infectious processthe arthropathy is usually involves 2-3 jointsthere is usually associated uveitisantibiotics are usually part of the treatment regimenall of the above are true39.Which arthropathy is not typically migratory?viralacute rheumatic feverpseudogoutSLEGonococcal40.What proportion of joint aspirates culture positive for gonoccocal arthritis?90 –100%75-90%50-75%25-50%<25%41.How should flexor tenosynovitis be managed?immobilize, NSAIDSimmobilize oral antibiotics, NSAIDSregular hand exercises, ice, elevationsteroid injectionsadmit, IV antibiotics, consider surgical intervention42.Which of these is not a risk factor for gout?alkalosislow dose aspirindiureticspsoariasishaemolysis43.Which joint/s are typically spared in rheumatoid arthritis?DIPPIPMCPWristsC spine44.Which is not classically a monoarthritis?goutpseudogoutsepsisreitersall of the above are usually a monoarthritis45.Which of these is usually an oligoathritis (2-3 joints), not a polyarthritis?retersgonococcalRARheumatic feverAnkylosing spondylitis46. Which is not true of pseudogout?joint aspitate show crystals that are positive birefringentit is caused by calcium pyrophosphate crystalsthe knee is the most common joint involvedtreatement involves NSAIDS or colchicineit is more common in the older age spectrum47.Which is false with regards to olecrenon and pre patellar bursitis?usually these are simply inflammatoryit is very uncommon for these to become septicbursa aspiration is a safe and accurate way of differentiating them from a septic processgm stain and culture is usually positive in a septic processthese bursitis’s should be given prophylactic antibiotics48.The usual organisms in septic arthritis in a healthy adult are?staph aureus, gonococcuspseudomonassalmonellahemophilus influenzianaerobesMCQs Dermatology 1 Which statement is FALSE about SJS and TEN ? A SJS involves < 30% epidermal detachment B Ocular involvement can occur C TEN tends to occur in those > 40 y.o D Nikolsky sign only positive in TEN Answer 2 With regard to skin conditions A Pemphigus is more common than pemphigoid B Pemphigoid occurs in older patients ~( 65 years) C Pemphigus most commonly is thick-skinned bullae on erythematous skin D Pemphigoid usually affects mucus membranes as well as skin Answer 3 Which of the following is true regarding toxic epidermal necrolysis (TEN) A There is a high mortality in children with infectious TEN B Staphylococcal infection is most common between ages 5–15 years C Drug-related TEN has a mortality of < 5% D Staphylococcal TEN in children does not involve the mucous membranes Answer 4 Which of the following is characteristic of the rash of measles? A Begins as a maculopapular rash, then becomes vesicular B “Slapped cheek” appearance and lacy reticular pattern C Pustules on an erythematous base D Maculopapular eruption starting on upper trunk and spreading downward Answer 5 Erythema nodosum is an example of A Serum sickness B Panniculitis C Vasculitis D Erythroderma Answer MCQs Wounds 1 Percutaneous sutures will leave needle marks in the skin if left in place for any longer than A 24 hours B 2 days C 8 days D 14 days Answer 2 A wound slicing obliquely through the skin of the back would be best repaired by any of the following EXCEPT A Edges trimmed with a scalpel blade perpendicular to the skin then simple interrupted sutures B Sutured with a vertical mattress to prevent one edge sliding over the other C Exiting the needle superficially on the high side and deeper on the low side using a continuous suture D Undermining the low side edge to allow for the high side edge to slide underneath it prior to loose interrupted sutures Answer 3 Which of the following is FALSE in regard to finger tendon injuries? A All require prophylactic antibiotics. B All flexor tendon injuries needing repair should be done by a plastic/ hand surgeon. C Division of up to 80% of extensor tendon may be managed non-operatively. D All tendon injuries need to be repaired within 24 hrs. Answer4 Regarding wounds, which are CORRECT? A Patients who are not tetanus immunized, all wounds require ADT and TIG. B Jagged edged wound has more skin tension per unit length than linear, so scars more C Shaving scalp hair prior to suturing decreases infection rate D A puncture wound to the foot may involve pseudomonas infection and should be treated with ciprofloxacin Answer 5 Regarding tissue adhesives for wound closure, which is TRUE? A Animal bites are not a contraindication to their use. B Dermabond (Octylcyanoacrylate) has half the strength of Histoacryl (N-Z- butylcyanoacrylate) C Tissue adhesive requires one minute to dry completely D Histoacryl (N-Z-butylcyanoacrylate) tissue adhesive has less tensile strength than 5\0 sutures Answer 6 Regarding wound repair A If using Ketamine, an IV cannula should always be inserted prior to procedure B Glue has the same tensile strength as 4/0 sutures C Staples have a low tissue reactivity D Adhesive tapes shouldn’t be used together with glue Answer MCQs Burns 1 Which one of the following statements regarding burn wounds is TRUE: A A patient sustaining a high-voltage electrical injury should receive an increased volume of resuscitation fluid per kilogram (as compared to what the Parkland formula would usually recommend) B With superficial partial thickness burns, the dermis is not involved C Burns often lead to early haemodynamic compromise D In Australia, sepsis is the major contributor to mortality following burns Answer 2 Which one of the following statements regarding chemical burns is TRUE: A Alkaline burns cause liquefactive necrosis of the tissue involved B A patient that presents without significant pain following a 15% hydrofluoric acid burn, can be reassured that his/her pain is unlikely to get worse C Acid burns typically penetrate the skin deeper than alkaline burns D Hydrofluoric acid burns do not cause tissue corrosion Answer 6 Which of the following options is least preferred for analgesia of Hydrofluoric acid burns? A Irrigation with H20. B Bier’s block technique using Calcium gluconate C IV Morphine in titrated aliquots. D Intra-arterial Calcium gluconate for finger burns. Answer 4 Regarding Burns which is TRUE? A The adult formulae using the rule of nines cannot be used in children B Fluid resuscitation rates are calculated and the time to administer it begins form the time patient arrives in the ED C Colloid fluid replacement has proven to be more beneficial in burn resuscitation than crystalloids D Using a child’s hand to determine % of burns, you must include the palm and the fingers as one unit Answer ................
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