PREVIOUS OSCE EXAMS OF DERMATOLOGY & ANDROLOGY 1-Describe the lesion • shiny pearly white, dome shape, sessile papules that are variable in size. • The surface may be umbilicated which is diagnostic for molluscum contagiosum. • On squeezing the lesion, white cheesy material can be expressed 2- Diagnosis Molluscum Contagiosum 3- Mode of infection Contact with patient or contaminated objects Auto inoculation. 4-Treatment destruction of lesions by: Curettage Electrocautry. Cryotherapy. Caustics, e.g, silver nitrate, phenol. 1- Describe the lesion Asymptomatic, sessile, firm, dome-shaped papule skin-colored with rough surface 2- Diagnosis Common wart 3- Other types • • • • • Plane wart. Filiform wart. Digitiform wart. Plantar wart. Genital wart (condyloma accuminatum). 4- Mention 3 lines of treatment • Electrocautry: used in painful and resistant warts, but carries risk of scarring • Cryotherapy: tissue freezing with solid carbon dioxide or liquid nitrogen • Chemical cautry • Other methods Topical retinoic acid: in plane warts Levamizole tab. Interferon 1- Describe the lesion Well circumscribed round to oval areas of alopecia without evidence of inflammation or scarring. Alopecia extends in a band along the scalp margin 2- Diagnosis Alopecia areata (ophiasis) 3- Mention 2 bad prognostic factors 1- Ophiasis. 2- Total and universal alopecia. 3- Alopecia areata in atopic patient. 4- Presence of nail changes. 4- Mention 2 lines of topical treatment • Topical minoxidil 2% solution • Topical or intralesional steroid for localized lesion 1- Diagnosis Herpes zoster 2- Treatment ➢ Topical: antiseptic, antibiotic. ➢ Systemic: Acyclovir (dose: 800mg five times daily for 7 days) ➢ For neuralgic pain: a) Carbamazepine (Tegretol tab) 200 - 800 mg / day. b) Amitriptyline (Tryptizol tab) 25 - 100 mg / day. c) Neurosurgical advice is required if severe pain persists. 3- Complications 1- Secondary bacterial infection. 2- Keratitis in ophthalmic HZ may result in impairment of vision. 3- Facial palsy (Ramsay-Hunt syndrome): Affection of geniculate ganglion leading to ear pain, vesicles on ear pinna and external auditory canal and facial palsy. 4- Post herpetic neuralgia: Persistence of pain or parasthesia after healing of the lesions is usually seen in elderly. 5- Motor palsy and encephalitis are rare. 1- Describe the lesion well-defined plaques with active spreading raised border covered with scales The center of the lesion is clearer giving the lesion a circinate appearance 2- Diagnosis Tinea corporis (tinea circinata) 3- D.D 1. Circinate impetigo. 2. Pityriasis rosea. 3. Circinate psoriasis. 4. Annular lichen planus. 5. Discoid eczema. 4- Treatment 1- Describe the lesion Discrete erythematous papules rapidly change to tense clear vesicles surrounded by red areola. The lesions occur in successive crops and thus all stages of development may be seen within one area (polymorphic). 2- Diagnosis Chickenpox (Varicella) 3- Complications 1- Secondary infection. 2- Cutaneous gangrene. 3- Purpura. 4- Pneumonia. 5- Encephalitis (rare). 6- Foetal damage if infection occurs early in pregnancy. 4- Treatment a- Antipyretic for fever. b- Antihistamine for itching. c- Antibiotic for secondary infection. d- Topical antiseptic. Systemic acyclovir (dose: 800mg five times daily for 7 days) 1- Describe the lesion Well-defined, red papules and plaques covered with silvery white scales. Removal of scales by scraping gives rise to small bleeding points (Auspitz sign) which is pathognomonic for psoriasis 2- Diagnosis Psoriasis vulgaris 3- Pathology 1- Hyperkeratosis, parakeratosis and acanthosis. 2- Absent granular layer. 3- Munro micro abscesses: collection of neutrophiles in the horny layer. 4- Dermis: Papillary blood vessels are dilated and tortuous. Dermal papillae are elongated, club shape with thin suprapapillary epidermis. Cellular infiltrate of lymphocytes and neutrophiles in the upper dermis. 4- Clinical types o Psoriasis vulgaris. o Erythrodermic psoriasis. o Pustular psoriasis. o Arthropathic psoriasis 5- Treatment 6- D.D Lichen planus – Tinea corporis – Discoid eczema- Pityriasis rosea – Seborrheic dermatitis & pityriasis drug eruption 1- Describe the lesion flat topped; polygonal violaceous papules. The surface of the papule shows white fine dots 2- Diagnosis Lichen planus 3- Clinical verities ➢ Actinic lichen planus ➢ Hypertrophic lichen planus ➢ Linear lichen planus ➢ Follicular lichen planus ➢ Bullous lichen planus 4- Treatment 1- Describe the lesion There are ruptured vesicles on erythematous base forming yellowish crusts 2- Diagnosis Non bullous impetigo 3- Treatment 1. Topical: for mild and localized infection ➢ Gentle removal of the crust by olive oil ➢ Antiseptic cleansing and drying lotions, e.g., K. permanganate ➢ Antibiotics, e.g., neomycin, bacitracin, sodium fusidate or garamycin 2. Systemic antibiotic ➢ Penicillinase-resistant penicillin ➢ Erythromycin if the patient is sensitive to penicillin 3. Treatment of predisposing factors Any pre-existing skin disease should be treated When pediculosis is present, it should be treated after control of impetigo because pediculocidal drugs are toxic and cannot be applied on raw areas 1- Describe the lesion Well-defined milky white (depigmented) macules and patches 2- Clinical types 1- Focal: macules in a single area but not segmental. 2- Segmental: unilateral macules in a dermatomal distribution. 3- Acrofacial: Involving distal extremities and face. 4- Generalized: Scattered macules and patches affecting up to 50% of skin. 5- Universal: disease affects more than 50% of skin surface. 3- D.D • Albinism • pityriasis alba, • hypopigmented pityriasis versicolor, • hypopigmented macules of tuberculoid leprosy, • post inflammatory hypopigmentation, • chemical depigmentation after exposure to phenolic chemicals. 4- Treatment )(من الكتاب 1- Describe the lesion? Boggy swelling with rough surface and multiple follicular pustules the hairs overlying the swelling are loose and when removed seropus comes out.Thick crusting with matting of adjacent hair together 2- Diagnosis Tinea capitis Inflammatory type (Kerion) 3- D.D Pyogenic abscess but kerion chr. By Rough surface Less pain and absence of constitutional symptoms It contains no pus if incised by mistake 1- Describe the lesion The affected area shows loss of hair and is studded with black dots due to breaking off hair shafts at the skin surface 2- Diagnosis? Tinea capitis Black dot type 3- Causative organism? Trichophyton tonsurans + violaceum 4- D.D? Alopecia areata 1- Describe the lesion Well defined patch with grayish fine scales, the hairs are broken at varying length and are lustreless, dull grey in color. 2- Causative organism? a. Microsporum canis + audouinii 3- Diagnosis? Tinea capitis scaly type 4- D.D 1- Psoriasis 2- Seborrheic dermatitis 3- PRP 4- Alpecia areata 1- Describe the lesion Well defined whitish hypopigmented macules and patches of different sizes and shapes 2- Causative organism a. Malassezia furfur 3- Diagnosis Hypopigmented pityriasis versicolor 4- D.D 1- Hypopigmentation a. Vitiligo (non-scaly depigmented macules and patches) b. Pityriasis alba (ill-defined scaly hypopigmented patches) 2- Hyperpigmentation a. Erythrasma (coral red) b. Seorrheic dermatitis 1- Describe the lesion? The is purulent irregular ulcer may be due to removal of thick crust that follow ruptured vesicles. 2- Diagnosis? Ulcerative impetigo (Ecthyma) 3- Complications? Post streptococcal glomerulonephritis 4- Treatment )(من الكتاب 1- Describe the lesion? The lateral toe cleft is sodden , white ,macerated and fissured 2- Diagnosis? Macerated toe web infection most probably Interdigital Tinea pedis 3- Other clinical types? a. Scaly hyperkeratotic type b. Vesiculo bullous type 4- D.D? 1- Erythrasma 2- Candidiasis 3- Pseudomonas 4- Psoriasis 5- Contact dermatitis Andrology ➢ Semen analysis of a patient has asthenospermia Comment on the following 1- Microscopic features 2- Causes of this case 3- Investigations 4- Treatment ➢ A man with 1ry infertility and his semen analysis shows no sperms Comment on the following 1- Diagnosis 2- Testicular causes 3- Other investigations ➢ Case of a patient has difficulty in attaining normal erection for 2 years ago 1- List 4 causes of this case 2- List 4 investigations 3- Mentions 4 lines of treatment ➢ 123- Erectile dysfunction Diagnosis Investigations Treatment ➢ Case of gonorrhea في راوند جالهم حالة عنها بس مش عارف األسئلة اللي كانت عليها