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Guess who is back? Back again! That’s right, it is time for round two of skin infections and ulcers! Enjoy!

 

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Skin infections and ulcers - Part 2

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Question 1

Stem 1, question 1 of 5

Rory, a 7 year old male, presents to GP with pustules with golden coloured crusted erosions on his face that are itchy.

What is the most likely diagnosis?
A
Cellulitis
B
Folliculitis
C
Impetigo
D
Herpes simplex
E
Candidiasis
Question 1 Explanation: 
This is describing impetigo. This is caused by Staphlyococcus aureus and Streptococcus progenies and results in the hallmark golden crusting of the lesion. It mainly affects exposed areas around the face and hands. Children must stay off school until the crusts have dried out. https://dermnetnz.org/topics/impetigo/
Question 2

Stem 1, question 2 of 5

At the end of the appointment, you notice a pustular facial eruption on Rory's Father's face. The Father explains he has recently been to a spa.

What is the most likely causative organism of the folliculitis?
A
Staphylococcus aureus
B
Legionella
C
Candida albicans
D
Pseudomonas aeruginosa
E
Tinea capitis
Question 2 Explanation: 
Folliculitis is inflammation of the hair follicle due to infection, chemical irritation or physical injury. Bacterial is the most common form and is usually Staph. aureus. However, Spa Pool folliculitis is caused by Pseudomonas, as this bacteria loves water and thrives in low oxygen environments! https://dermnetnz.org/topics/bacterial-folliculitis/
Question 3

Stem 1, question 3 of 5

Later that day a 47 year old male presents with acute onset of pain, redness and swelling of the skin of his lower leg. He has a low grade fever and feels unwell, the skin has an orange peel appearance to it.

What is the most likely diagnosis?
A
Cellulitis
B
Erysipelas
C
Folliculitis
D
Pityriasis versicolor
E
Lymphangitis
Question 3 Explanation: 
This is a cellulitis. It is an acute onset of a red, painful, hot and swollen skin with an orange peel appearance and the individual feels unwell.
Question 4

Stem 1, question 4 of 5

If the patient presented with a well-dermacated, bright-red raised skin lesion, what is the most likely diagnosis now?
A
Cellulitis
B
Folliculitis
C
Pityriasis versicolor
D
Erysipelas
E
Lymphangitis
Question 4 Explanation: 
Erysipelas is a distinct form of superficial cellulitis with.a notable lymphatic involvement, it is raised and sharply demarcated from the uninvolved skin
Question 5

Stem 1, question 5 of 5

What is the treatment of cellulitis and erysipelas?
A
Nystatin
B
Fluconazole
C
Acyclovir
D
Flucloxacillin
E
Benzoyl peroxide
Question 5 Explanation: 
Both are treated in the same with flucloxacillin, as this provides cover for MRSA *Remember to ask about penicillin allergies!*. Nystatin is for oral candidiasis, fluconazole is an anti fungal. Acyclovir is an anti-viral and benzoyl peroxide is used for topical pseudomonas infections.
Question 6

Stem 2, question 1 of 4

Justin, a 26 year old male, presents with hypo pigmented, coppery brown, flaky patches on his trunk and neck which are middle itchy. He has just moved the England after living in Singapore for last 10 years.

What is the most likely diagnosis?
A
Molluscum contagiosum
B
Pityriasis versicolor
C
Candidiasis
D
Tinea capitis
E
Herpes Zoster
Question 6 Explanation: 
Pityriasis versicolor is a common yeast infection of the skin in which flaky discoloured patches appear on the chest and back. It most frequently affects young adults and is more common in hot, humid climates.
Question 7

Stem 2, question 2 of 4

A different patient presents with a erythematous and macerate plaques with peripheral scaling in the skin folds under the breast and axilla.

What is the most likely diagnosis?
A
Candidal intertrigo
B
Folliculitis
C
Tinea pedis
D
Tinea capitis
E
Candida
Question 7 Explanation: 
Candidal intertrigo refers to superficial skin fold infection caused by the years candida. It is caused by hot damp environments of skin folds with increased skin friction.
Question 8

Stem 2, question 3 of 4

Why may a HbA1c be checked in recurrent episodes of Candidal intertrigo?
A
Anaemia can signify underlying chronic disease
B
Diabetes mellitus is a risk factor for the infection
C
Indicates presence of disseminated intravascular coagulation
D
Indicates chronic inflammation
E
Coagulopathy can result in skin presentations
Question 8 Explanation: 
HbA1c gives an indication of the last 120 days of glycaemic control and can indicate if an person has diabetes mellitus. Diabetes mellitus results in immunosuppression and so can cause difficulties in clearing the infection, resulting in recurrent infections.
Question 9

Stem 2, question 4 of 4

What is the treatment for candidal skin infections?
A
Salicyclic acid
B
Acyclovir
C
Calamine lotion
D
Mupirocin
E
Imidazole
Question 9 Explanation: 
Topical imidazole can be used to treat the candiadial skin infections. Mupirocin is topical antibiotic, acyclovir is a antiviral, calamine lotion can be used in herpes zoster infections aka shingles.
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