Dermatology

100 Pages·1990·1.496 MB·English

by  Bernard Roger Allen MB ChB, FRCP (auth.)

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Roger Allen
Dermatology
Springer-Verlag
London Berlin Heidelberg New York
Paris Tokyo Hong Kong
Bernard Roger Allen, MB ChB, FRCP
Consultant Dermatologist, Department of Dermatology,
University Hospital, Queen's Medical Centre,
Nottingham NG7 2UH, UK
Publisher's note: The "Brainscan" logo is reproduced by courtesy of
The Editor, Geriatric Medicine, Modern Medicine GB Ltd.
ISBN -l3: 978-3-540-19607-5 e-ISBN -l3 :978-1-4471-1772-8
DOl: 10.1007/978-1-4471-1772-8
British Library Cataloguing in Publication Data
Allen, Roger, 1940-
Dermatology.
1. Medicine. Dermatology I. Title 616.5
ISBN-13:978-3-540-19607 -5
Library of Congress Cataloging-in-Publication Data
Allen, Roger, 1940-
Dermatology/Roger Allen.
p. cm.
ISBN -13 :978-3-540-19607-5
1. Dermatology-Examinations, questions, etc. I. Title.
[DNLM: 1. Skin Diseases-examination questions. WR 18 A428d]
RL74.2.A44 1990 616.5'0076-<1c20 DNLM/oLc
for Library of Congress 90-9651
CIP
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Typeset by Photo·graphics, Honiton, Devon
2128/3916-543210 Printed on acid-free paper
Preface
Dermatology is a fascinating subject. This is a statement you
might expect from a dermatologist, but what is the justification?
It is a highly clinical specialty and sophisticated techniques of
diagnosis are very much of secondary importance compared
with clinical skills. The skin is important not only as an organ
with vital physiological functions but also as a flag by which
we communicate with the outside world. A perfect skin is
desired by all, and upon this wish is based the multi-million
pound cosmetics industry. Skin disease therefore places a
strain on sufferers out of proportion to the disturbances in
function which the pathology produces. A "leper" complex is
frequent, and social and sexual contact may be shunned
because of the embarrassment caused. It is also easy to overlook
the contribution that cutaneous physical signs make towards
diagnoses of internal disorders. Even straightforward factors
such as the pallor of anaemia, the icterus of biliary obstruction
or, quite simply, the age and sex of the patient are recognised
immediately from visible signs in the skin. Like most other
organs the skin has a limited repertoire of reactions, but these
can occur in patients of all ages, combined together in an
almost infinite number of permutations; hence the fascination
referred to above.
It has been estimated that 10% of consultations with general
practioners are because of a skin-related problem, and therefore
a working knowledge of dermatology is essential for anyone
who has regular clinical contact with patients. This book is
aimed not only at medical students but also at those undertaking
a VTS course for general practice or studying for the MRCP
diploma, for whom it should provide a useful revision guide.
Nottingham Roger Allen
1989
How to Use This Book
As a method of examination the use of multiple choice
questions is likely to be a permanent and expanding feature
on the educational scene. MCQs have their critics, but because
of the wide range of topics which can be covered in one paper,
and the ease with which responses can be marked by computer
and analysed for effectiveness using such systems as the
Kuder-Richardson reliability index, they have, in many fields,
replaced more traditional examinations. They also lend them
selves admirably to an efficient method of revision, and that
is what has prompted this series of MCQs in dermatology.
There is no doubt that the best method of revision is not to
read repeatedly through notes or texts but to answer questions
("What are the clinical features of Ehlers-Danlos syndrome?"
"What are the symptoms of acute vitamin A toxicity?"). An
attempt to apply a combination of knowledge and logic to a
question followed then by reference to a book or notes will fix
the subject in the mind to a degree surpassed only by having
to carry out the same exercise in front of others. (To make a
mistake in public greatly sharpens the mind.) It is with this
approach that this series of multiple choice questions should
be tackled. By considering and working through the 200 stems
and 1000 suggested answers contained in this book it should
be possible to acquire a reasonable basic grounding in the
field of dermatology.
Many of the questions have been derived from a series of
examination papers developed to assess the students at
Nottingham University Medical School, where a two-month
attachment to the Department of Dermatology is part of the
middle-year curriculum. Most of the questions can be answered
with a knowledge of one of the shorter undergraduate textbooks
such as Essentials of Dermatology by J.L. Burton (Churchill
Livingstone) or Clinical Dermatology: Illustrated Textbook by
R.M. Mackie (Oxford University Press), but not all of them.
There has to be an element of challenge, and reference to a
larger work such as Textbook of Dermatology edited by A. Rook,
0.5. Wilkinson, F.J.G. Ebling and J.L. Burton (Blackwell
Scientific Publications) may occasionally be required.
Each question consists of a stem followed by five statements,
none of which derives from or excludes any of the others. At
least one correct and one incorrect answer follows each stem.
A correct answer, either true or false, should be scored as + 1,
an abstention as 0 and an incorrect answer as -1.
Two medical aphorisms are that one should never say "Never"
and that the more one knows about a subject the more difficult
it is to give a straight "Yes" or "No" answer to a multiple
choice question. Bear this in mind and use these questions
sensibly, without looking for tricks and without believing that
you should know about every exception to the general rule. It
is worth remembering that examiners setting MCQs will tend
to give false examples that are well outside the normal findings
so that there can be less argument about whether the response
is correct or not.
Go through the papers with a friend and argue about the
answers - it is a good way to learn and can be fun, though
that might depend on the friend. General guidelines for
answering these and other MCQs are:
1. Read the question carefully. This seems obvious but it is
often a source of simple mistakes. For example, is the question
asking for a positive or a negative answer (" All 'x' do show
'y'" or "All 'x' do not show 'y''')? After reading the stem it is
worth thinking about the topic for a moment or two before
looking at the alternatives presented. For example, if the stem
says "In basal cell carcinomata ..." think briefly about what
you know about the lesions. Then look at what is given; some
of the things you have thought about may be in front of you.
2. Do not guess. Most multiple choice wrong answers are
included because they have a certain familiar ring about them;
they are close to the truth but not quite close enough. Therefore,
if you are totally ignorant about a subject do not try to answer
the questions.
3. Be decisive. If you think an answer is correct mark it as
such and move on. If you spend too long on thinking about
an answer you can almost always persuade yourself that it is
right, or wrong as the case may be.
4. If the answer is not obvious after careful reading miss
the question out and come back to it at the end.
5. Ignore statistics. Just answer each question as it is set and
do not try to work on the basis either of how many marks
you have already scored or how many right or wrong answers
have been presented.
The questions in this book have been divided into 10 revision
papers of 20 questions each. Each paper covers a wide range
of topics. Many of the answers are followed by brief explanatory
comments, but when tackling the questions it is a good idea
to have a textbook to hand so that you can carry out further
reading on an immediate basis whilst the subject is still fresh
in your mind.
Contents
Paper 1 .................................................................................. 2
Paper 2 .................................................................................. 14
Paper 3 .................................................................................. 24
Paper 4 .................................................................................. 34
Paper 5 .................................................................................. 44
Paper 6 .................................................................................. 54
Paper 7 .................................................................................. 64
Paper 8 .................................................................................. 74
Paper 9 .................................................................................. 84
Paper 10 ................................................................................ 94
Paper 1
Questions
Q.l.l Psoriasis
a. may involve the external auditory meatus
b. is likely to be more severe if close relatives have the
disease
c. may be associated with an ankylosing spondylitis type of
arthritis
d. can cause actual disappearance of the phalanges
e. occurs in a pustular form only on the hands and feet
Q.l.2 Neurofibromatosis
a. is an autosomal recessive condition
b. may start with cafe au lait patches
c. produces characteristic hard nodules in the skin
d. usually first becomes evident at the time of puberty
e. is a cosmetic problem only in the vast majority of patients
Q.l.3 Purpura may be a feature of
a. Henoch-Schonlein disease
b. excessive use of 1 % hydrocortisone
c. lichen planus
d. amyloidosis
e. a positive Hess test
Q.1.4 Venous insufficiency of the lower limb
a. is always the result of damage to the veins
b. causes an eczema in most cases
c. is defined as occurring when tissue osmotic pressure
exceeds venous capillary pressure
d. may produce "atrophie blanche" even in the absence of
ulceration
e. may damage the muscles
For answers see over
3