MRCP Preparation

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 Medical Higher Study
Mentor

Dr. ZYED MD. ADNAN SHAMEEM

MRCP( P-1), BCS (Health),
FCPS (Medicine, P-2 trainee),
MD Residency (Internal Medicine)
Assistant Registrar
Department of Medicine
Mymensingh Medical College Hospital

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 Must-Read Notes of

Dermatology

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 • Red scaly patches on sun exposed areas like lower limbs is = Bowen's disease type of intra
epidermal squamous cell carcinoma
• Treatment of Bowen's disease type of intra epidermal squamous cell carcinoma is:
• topical 5FU or imiquoid, croyrotherpy, excision.
• Foot pain + pain provoked by walking + pain worse at night + smoker + dorsalis pedis difficult to
feel toes are cold and dusky + angiography shows distal stenosis in limb with corkscrew formation
+ ANCA negative is = thromboangitis obliterans.
Calcineurin inhibitor are alternative to topical steriods in Eczema
• Well defined annular erythematous lesion with pustules and papules on body is = Tinae corporis
• Treatment Of Tinae corporis is: oral fluconazole.
• Itchy peeling skin between toes in adolescence is = Tinae pedis (athletes' foot).
• Pressure sore with exudate is treated by = Alginate based dressings.

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 • Waterlow score used to identify patients at risk of pressure sores Happens on sacrum or heel Moist
wound treated by ulcer healing hydrocolloid dressing and hydrogels.
• Unusual shaped lesion linear or geometric pattern demarcated from surrounding skin usually by
nails ,caustic soda cigarette due to psychologically stress is = Dermatitis arcfecta
• Blisters/bullae no mucosal involvement (in exams at least*): bullous pemphigoid mucosal
involvement: pemphigus vulgaris.
• Isotretnoin adverse effects teratogenicity - females MUST be taking contraception, low mood, dry
eyes and lips, raised triglycerides, hair thinning, nose bleeds.
• Seborrhoeic dermatitis - first-line treatment is topical ketoconazole.
• Acne rosacea treatment: mild/moderate: topical metronidazole severe/resistant: oral tetracycline
• Dry skin is the most common side-effect of isotretnoin.
• Dermatophyte nail infections - use oral terbinafine.

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 • Hereditary haemorrhagic telangiectasia - autosomal dominant
• In scabies treatment failure, if application was applied appropriately ,then treat with difference
insecticide e.g. Malathion 0.5% or permethrin 5%.
• Thickened Erythema as plaque indurated + later waxy either pale or hyperpigemented + 20-40 years +
absence systematic symptoms = Morphoe
• Treatment of Morphoe is: local steriods, topical and Vitamin D light therapy
• Planus, purple, prurutic, polygonal rash on flexor surface on palms, soles, gentila flexor of arms +
Wickham's Striae over surface +oral involvement is = Lichen planus
• Treatment of Lichen planus is: topical steriods mainstay, Extensive :oral steriods or
immunosuppressant.
• Drugs causing lichen planus are: Gold, Quinine, Thiazides
• Scalp psoriasis first line treatment is topical potent corticosteroids

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 • Associated conditions with Vitiligo are: Type 1DM, Addison disease, Autoimmune thyroid disease
• Pernicious anaemia, Alopecia Areta
• Skin manifestation in SLE are: Photosensitive butterfly rash, Discoid lupus, Alopecia, Livedo
reticularis net like rash
• Upper GI endoscopy is useful for gastric carcinoma
• Oral steriods mainstay treatment for Bullous pemphigoid
• Zinc defienancy causes: acral dermatitis, alopecia, diarrhoea, failure to thrive, acrodermatitis
enteropathtica beau's lines
• Aceniform eruption is iatrogenic acne caused by steriods.
• Koebnar phenomenon seen in: Wart And ALL: Wart Autoimmune, psorsis, Vitiligo, Molluscum
contiogsum, AIDS, Lichen planus, Lichen sclerosis.
• Well demarcated patches of depigmented skin peripheral mostly + koebnar phenomenon is = Vitiligo

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 • Treatment of Vertilgo: sun block, camouflage, topical steriods Topical tacrolimus, phototherapy
• Porphyria cutanea tarda- blistering photosensitive rash hypertrichosis hyperpigmentation
• Keloid scars - more common in young, black, male adults .
• Melanoma: the invasion depth of the tumour is the single most important prognostic factor .
• Dermatts herpetiformis - caused by IgA deposition in the dermis.
• Management of venous ulceration - compression bandaging .
• Acne vulgaris in pregnancy - use oral erythromycin if treatment needed
• Topical steroids moderate: Clobetasone butyrate 0.05% potent: Betamethasone valerate 0.1% very
potent: Clobetasol propionate 0.05%
• Lentgo maligna melanoma: Suspicious freckle on face or scalp of chronically sun-exposed patents
Polymorphic eruption of pregnancy is not associated with blistering
• Scalp psoriasis first line treatment is topical potent corticosteroids.

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 • Acral lentigious melanoma: Pigmentation of nail bed affecting proximal nail fold suggests
melanoma (Hutchinson's sign)
• Flexural psoriasis - topical steroid.
• Keloid scars are most common on the sternum.
• Impetgo - topical fusidic acid → oral Flucloxacillin / topical retapamulin.
• Psoriasis: common triggers are beta-blockers and lithium.
• Lichen planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over
surface. Oral involvement common sclerosis: itchy white spots typically seen on the vulva of elderly
women
• Symetrical + brown + velvet plaques on neck, axilla and groin is acanthosis nigricans
• Causes of Acanthosis nigricans: Adenocarcinoma of stomach, DM, Obesity, PCOS, Acromegaly,
Cushing syndrome, Hypothyroidism, Familial Prader Willi syndrome,
• Drugs: OCP nicotinic acid

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• Shiny painless areas if yellow red skin on shin of DM patient thickened blood vessel is = Nacrobiasis
lipodica
• Treatment of Nacrobiasis lipodica is: topical steroids Injectable steroids Camouflage creams
• Tender erythema nodular lesion on shins is = Erythema nodosum
• Treatment of Erythema Nodosum is: usually resolve with in 6weeksNsaids ,light compression.
• Causes of Erythema nodosum: Streptococcus infection most common, Brucellosis , tuberculosis ,
• sarcodosis , Behcets, SLE, Malignancy
• Drugs causing Erythema nodosum: OCP, Sulphonamides, Penicillin, Antipyretics, Montoleukast, Hepatitis
B vaccination, Omeprazole, Pregnancy, HLA B 27 27
• Pinkish pearly white papules with central umbilical on occur anywhere except palms and soles + children
+ HIV less than 200 count is = Molluscum contagiosum by pox virus
• Treatment of Molluscum contagiosum is: usually resolved watchful waiting
• Troublesome: simple trauma cryotherapy topical imiquoid cathardin Itchy: topical steroids fusidic acid.

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 • Skin disease associated with HIV: Molluscum contagiosum, Corweign scabies, Saeborrhic
dermatitis
• Sysmmetrical erythematous lesion and raised pinkish indurated lesion and shiny orange peel skin is
= Pretibial myxoedema seen in graves disease
• Skin disorders with Tuberculosis are: Lupus Vulgaris, Erythema nodsum, Scarring alopecia,
Scrofuloderma, Verrucosa cutis, Gumma
Erythmatous flat plaque elevated ulcerated with apply jelly colour and centre scar is = Lupus vulagris
• Treatment of Lupus Vulagris is: AntiTuberculosis Drugs
• Papular lesion hyper pigmented depressed centrally associated with DM,HIV lymphoma is =
Granulomas annulare
• Treatment of Granuloma annulare is: Resolved spontaneous Steriods
• Mainstay treatment of granuloma annulare is = Observation.

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• Infrated radiation sitting to fire heater + reticulated erythematous patches hyperpigemented
telangiectasia + hypothyroidism is = Erythema Ab igne If not treated with develop squamous cell cancer
• Well circumscribed raised erythematous lesion on finger tender which bleeds when touched = Pyogenic
granuloma.
• Solitary lesion with central areas of ulceration volcano or crater is = Keratoacanthoma
• Treatment of Keratoacanthoma is: Regress with in 3 min Such lesion should be excised
• Red indurated papules later narcotic black easchar at centre + middle East with cattle/sheep/goat is =
Cutaneous anthrax
• Treatment of Cutaneous anthrax is: Penicillin
• IgA deposit within blood vessel = HSP Granular IgA deposit in Basement membrane is = dermatitis
herpertiformris.
• Intracellular igA deposit in pemphigus.

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 • Streptococal sore throat 2-4 weeks + tear drop scaly papules on trunk and limbs is = Guttate psoriasis
• Treatment of Guttate Psoriasis is : if lesion not widespread (<10%body surface areas) not impacted
physically, psychologically or socially = no treatment resolved within 2-3month
• if patient desire treatment then topical agents, If lesion widespread >10%body surface area =Refer
urgent dermatologist phototherapy UVB phototherapy = recurrent episodes referral ENT should be
considered = Tonsillectomy.
• Erythmatous sharply demarcated papules and rounded plaques covered by silvery scales + HLA-
B13,B17 cw6 + nail pitting oncycholysis koebnar phenomenon + anterior uveitis = Psoriasis
• Complications of Psoriasis are: Psoriatic arthropathy, Metabolic syndrome, Increased CVS disease,
Venous thromboembolism Psychologically distress.
• Drugs causing psoriasis are: Beta blockers, Lithium, Antimalarial (chloroquine, Hydroxychloroquine),
Gold, Nsaids, ACEi infliximab BB >ACEI, Withdrawal systematic steroid, Trauma, Alcohols.

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 • Treatment of Psoriasis is: Topical steroids 1st line: potent steroids once daily + vitamin D
• 2nd line: vitamin D twice daily
• Third line: potent steroids twice daily diatharnol Side effects are : steroids skin atrophy Striae
rebound symptoms.
• Secondary management: UV B light : phototherapy psoralen + UV A light (PUVA) it's Side affects are:
skin ageing Squamous cell carcinoma Systematic :oral methotrexate cyclosporine TNF inhibitor like
• brodalumab = IL-17, Rituximab = CD20, Toculzumab = IL-6, ustekinumab =IL12 and IL-23 Side effects
are: dental ulceration.
• Never use Oral steroids in Psoriasis.
• Treatment of pyogenic granuloma Lesion in pregnancy and post partum resolve spontaneously
• If persist then removal curettage and electrocautery cryotherapy excision
• Herpes simplex virus is commonest cause of Erythema multiforme.

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 • Target lesion like bulls eye and symmetrical distribution on dorsal surfaces of extensor extremities
is = Erythema multiforme
• Treatment: supportive.
• Causes of Erythema multiforme are: Virus herpes simplex virus, Mycoplasma streptococcus
• Drugs: Penicillin, sulphonylurea, barbiturates, carbamazepine, Allopurinol, NSAIDS, OCP nevirapine
• SLE, IBD, Sarcodosis, Malignancy.
• Severe macular atypical target lesion mucosal involvement on face and trunk + less than 10% body
involvement+ fever arthralgia is = Steven Johnson syndrome Causes are same as EM.
• Pyrexia + tachycardia + niklosky sign positive + severe mucocutaneous exfolitive disease is =Toxic
epidermal Nacrolysis
• Treatment of Toxic Epidermal Nacrolysis is: stop precipating, Iv immunoglobins, Immunosuppressive
cyclosporine, cyclophosphamide, plasmaphresis.

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• Male > 60years + HTN/DM/ hyperlipidaemia/ smoking + severe pain on heel metatarsal regular deep
green absent swelling + ABI <0.75 no hair rubor thin shiny skin is = Arterial ulcer
• Causes of scarring alopecia (destruction of hair follicle) are: Trauma, Burns, Radiotherapy, Lichen planus,
• Discoid lupus, Tinae capitis.
• Causes of non-scarring alopecia (preservation of hair follicle are: Male pattern baldness,
• Drugs: cytotoxic drugs , carbimazole,heparin ,OCP colchine Iron zinc defienancy, Alopecia Areta, Tolgen
effluvium, Trichotillomania.
• Localized patches of nonscarring hair loss + exclamation marks tapered towards base is = Alopecia Areta
• 92.Treatment of Alopecia Areta is: hair will regrow in 50%Topical or intralesional steroids most
appropriate Others topical minoxdil, photo therapy diathronl immunotherapy wig
• After puberty diffuse slow hair loss with characteristic loss over temporal regions and vertex in male is =
Androgenetic alopecia

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• 1 to 3 month after viral illness, surgery, childbirth , emotional stress diffuse hair loss + hair loss never
complete usually stops after 3 to 5 month is = Tolgen effluvium
• Treatment : hair regrowth.
• Children + localized hair loss but in bizarre pattern + patient pull their own hair + hairs of different length
is =Trichotillomania
• Scarring alopecia + atrophic with visible loss of hair follicle is = Discoid lupus erythramatous
• Permanent bald patches with no visible follicles is = Cicatrical alopecia
• Treatment of Cicatrical Alopecia is: treatment of underlying cause like (DLE,lichen palnus ) topical
Steriods.
• Elderly patient sun exposure + at head and neck pearly flesh colured papule with telangiectasia ulcerated
leaving central crater is = Basal cell carcinoma
• Treatment of basal cell carcinoma is: Surgical removal, Curettage, Cryotherapy
• Topical cream: imiquoid fluorouracil Radiotherapy

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 • Topical steroids
 moderate: Clobetasone butyrate 0.05%
 potent: Betamethasone valerate 0.1%
 very potent: Clobetasol propionate 0.05%
• Acne rosacea features:
 nose, cheeks and forehead
 flushing, erythema, telangiectasia → papules and pustules
• Oral lichen planus typically presents with buccal white-lace pattern lesions and ulcers
• Acne vulgaris in pregnancy - use oral erythromycin if treatment needed
• Acral lentiginous melanoma: Pigmentation of nail bed affecting proximal nail fold suggests
melanoma (Hutchinson's sign)
• Dermatitis herpetiformis - caused by IgA deposition in the dermis

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 • Pityriasis versicolor is caused by Malassezia furfur
• Blisters/bullae
 no mucosal involvement (in exams at least*): bullous pemphigoid
 mucosal involvement: pemphigus vulgaris
• Keloid scars - more common in young, black, male adults
• HIV is associated with seborrhoeic dermatitis
• Tender shin lesions - erythema nodosum
• Diabetic dermopathy is associated with increased age and longer duration of diabetes
• Topical aluminium chloride preparations are first-line for hyperhidrosis
• Dry skin is the most common side-effect of isotretinoin
• Dermatophyte nail infections - use oral terbinafine

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 • Grave's disease, orange peel shin lesions - pretibial myxoedema
• Scabies - permethrin treatment: all skin including scalp + leave for 12 hours + retreat in 7 days
• Management of venous ulceration - compression bandaging
• An itchy rash affecting the face and scalp distribution is commonly caused by seborrhoeic
dermatitis
• Nodular melanoma: Invade aggressively and metastasise early
• Hepatitis C may lead to porphyria cutanea tarda
• Eczema herpeticum is a serious condition that requires IV antivirals
• Porphyria cutanea tarda - photosensitive rash with blistering and skin fragility on the face and
dorsal aspect of hands
• Polymorphic eruption of pregnancy is not associated with blistering

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 • Keloid scars are most common on the sternum
• Beta-blockers are known to exacerbate plaque psoriasis
• Parkinson's disease is associated with seborrhoeic dermatitis
• Melanoma: the invasion depth of the tumour is the single most important prognostic factor
• Otitis externa and blepharitis are common complications of seborrhoeic dermatitis
• Lentigo maligna melanoma: Suspicious freckle on face or scalp of chronically sun-exposed
patients
• Psoriasis: lithium may trigger an exacerbation
• Ketoconazole shampoo is used to treat pityriasis versicolor
• Erythema gyratum repens is a paraneoplastic eruption with a 'wood-grain' pattern and figurate
erythema commonly seen in patients with lung cancer

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 • Lichen
 planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over surface.
Oral involvement common
 sclerosus: itchy white spots typically seen on the vulva of elderly women
• Topical eflornithine is the treatment of choice for facial hirsutism
• Livedo reticularis can be caused by SLE
• Diabetes, waxy yellow shin lesions - necrobiosis lipoidica diabeticorum
• Flexural psoriasis - topical steroid
• Same-day referral to a dermatologist is recommended if eczema herpeticum is suspected.
• An area of rapidly worsening painful eczema is an early sign of eczema herperticum
• Impetigo - topical fusidic acid is first-line

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 • Hereditary haemorrhagic telangiectasia - autosomal dominant
• Eczema herperticum rash can be described as monomorphic punched-out erosions (circular,
depressed, ulcerated lesions) usually 1–3 mm in diameter
• SCCs arising in a chronic scar are typically more aggressive and carry an increased risk of metastasis
• Pompholyx eczema is a subtype of eczema characterised by an intensely pruritic rash on the palms and
soles
• Eczema herpeticum is a primary infection of the skin caused by herpes simplex virus (HSV) and
uncommonly coxsackievirus
• A non-healing painless ulcer associated with a chronic scar is indicative of squamous cell carcinoma
(SCC)
• Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures
• The most common malignancy in the lower lip is a squamous cell carcinoma
• Zinc deficiency caused by total parenteral nutrition (TPN) can result in acrodermatitis herpetiformi

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 • Acne rosacea treatment: mild/moderate: topical metronidazole, severe/resistant: oral tetracycline
• Deficiency of niacin (B3) causes pellagra
• Herpes hominis virus 7 (HHV-7) is thought to play a role in the aetiology of pityriasis rosea
• Niacin (B3) deficiency is characterised by dermatitis, diarrhoea and dementia, a condition known as
pellagra
• Isotretinoin adverse effects
 teratogenicity - females MUST be taking contraception
 low mood
 dry eyes and lips
 raised triglycerides
 hair thinning
 nose bleeds
• Seborrhoeic dermatitis - first-line treatment is topical ketoconazole

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