OSCE CLINICAL SKILLS EXAM QUESTIONS AND ANSWERS
LATEST UPDATE A+ GRADED
Describe the skin microbiome
o Microbiological barrier
o Skin as a delicately balanced ecosystem
o Symbiotic relationship but may contribute to common skin disorders
If barrier is disrupted, can increase risk of many common skin conditions
Occlusive moisturisers
o Prevent evaporation of water from the skin by forming an oily film that impedes
transepidermal water loss
o Promotes stratum corneum repair mechanisms e.g. petrolatum, liquid paraffin,
dimethicone, cocoa butter, lanolin
Humectants moisturisers
o Draw water from deeper skin layers up to the stratum corneum
o Promote absorption of water from external environment into skin e.g. glycerol, urea
Dermatitis definiton
Inflammation of the skin
Types of dermatitis
o Exogenous / contact (external factors)
o Endogenous (genetic factors)
Irritant contact dermatitis
o Occurs soon after exposure to irritating substances on the first or subsequent
exposure.
o Irritant must penetrate stratum corneum (outermost layer of skin/ barrier) to invoke
physiological response
o Severity of rxn depends on
- type of irritant
- the concentration
- quantity involved
- length of exposure
Triggers for allergic contact dermatitis
- Costume jewellery
- Topical corticosteroids
- Cosmetics (perfume, nail varnish)
- Rubber/ latex
- Resins/ dye
- Certain plants (Grevillea)
Triggers for irritant contant dermatitis
- Alkaline cleaning agents (detergents and soaps)
- Solvents and abrasives
- Oils
- Acids and alkalis
- Prolonged exposure to water/ moisture
,Symptoms for contact dermatitis (exogenous)
- Red, itchy, inflamed
- May see papules and vesicles
- Broken or weeping skin from scratching
- Skin is cracked and fissured (chronic)
Lesions appear within 6-12 hrs of contact
Triggers for referral - Contact dermatitis
Symptoms present for >2 weeks
Extension questions - Contact dermatitis
- Household/ close contacts
- Occupational history
- Improvement on holiday from work
Treatment - Contact dermatitis
o Topical corticosteroids: Short course topical hydrocortisone (0.5- 1%), clobetasone,
mometasone
o Regular emollient use: Apply bd-tds
- Improve skin barrier function, reduce itching
- Greasy, paraffin-based - most effective
- Increases efficacy of topical corticosteroids
- Use Sodium-lauryl-sulfate-free: SLS can irritate
o Antihistamines
- Non-sedating antihistamines have little value
- Sedating a/h's can be used short term for sleep disturbance e.g. dexchlorpheniramine
(Polaramine®)
Tar Preparations: e.g. Pinetarsol® - antipruritic, may be useful
Severe case:
Systemic steroid (Rx only, usually prednisolone)
Endogenous dermatitis types
o Atopic
o Seborrhoeic
Atopic dermatitis
Chronic, relapsing, itchy skin condition
o 70% have personal or family history of atopy (eczema, hayfever and asthma)
o Individuals have exaggerated IgE response
o Can be triggered by allergic contact dermatitis
o Onset within first year of life (may be delayed)
Lesion distribution - Atopic dermatitis
o Often symmetrical
o Location can be agerelated:
o Infancy - face, neck and extensor, nappy area spared (nappy contact derm)
, o Childhood - flexures, wrist and ankles
o Adults - variable/widespread, hands, feet, eye area
Atopic dermatitis susceptability
20% children
2-10% adults
- Diabetics
- Immunocompromised
Symptoms - Atopic dermatitis
- Symmetrical distribution
- Acute, chronic, mild, severe
- Bleeding, yellow crusts
- Infection
Lesions appear within 6-12 hrs of contact
Triggers - Atopic dermatitis
o Genetic
o Medication induced (topical antiseptics/ anaesthetics)
Treatment - Atopic dermatitis
- Soap substitutes / Bath Oils
- Moisturisers / emollients
- Topical corticosteroids (OTC)
- Tar preparation (Pinetarsol®)
- Oatmeal preparations (Dermaveen®)
Types of topical corticosteroids
o Hydrocortisone (DermAid®, Sigmacort®)
o Clobetasone (Eumovate or Kloxema®)
o Mometasone (Zatamil®)
Action of topical corticosteroids
Anti-inflammatory, immunosuppressive and antimitotic activity against cutaneous
fibroblasts and epidermal cells
Dosage - Topical corticosteroids
Apply bd to control flare-ups for max of 7 days
(Mometasone - apply once a day)
Side effects - Topical corticosteroids
Burning, stinging, folliculitis (inflamed hair follicles in area)
ADRs - Topical corticosteroids
Rare if used correctly : delayed wound healing, skin atrophy
C/In - Topical corticosteroids
Caution in children - <12 yo avoid clobetasone and mometasone, use hydrocortisone
(if <1yo - refer)
Pregnancy: use hydrocortisone at lowest potency for shortest time
Breastfeeding: safe but keep breast area free
Infantile seborrheic dermatitis (Cradle cap)
LATEST UPDATE A+ GRADED
Describe the skin microbiome
o Microbiological barrier
o Skin as a delicately balanced ecosystem
o Symbiotic relationship but may contribute to common skin disorders
If barrier is disrupted, can increase risk of many common skin conditions
Occlusive moisturisers
o Prevent evaporation of water from the skin by forming an oily film that impedes
transepidermal water loss
o Promotes stratum corneum repair mechanisms e.g. petrolatum, liquid paraffin,
dimethicone, cocoa butter, lanolin
Humectants moisturisers
o Draw water from deeper skin layers up to the stratum corneum
o Promote absorption of water from external environment into skin e.g. glycerol, urea
Dermatitis definiton
Inflammation of the skin
Types of dermatitis
o Exogenous / contact (external factors)
o Endogenous (genetic factors)
Irritant contact dermatitis
o Occurs soon after exposure to irritating substances on the first or subsequent
exposure.
o Irritant must penetrate stratum corneum (outermost layer of skin/ barrier) to invoke
physiological response
o Severity of rxn depends on
- type of irritant
- the concentration
- quantity involved
- length of exposure
Triggers for allergic contact dermatitis
- Costume jewellery
- Topical corticosteroids
- Cosmetics (perfume, nail varnish)
- Rubber/ latex
- Resins/ dye
- Certain plants (Grevillea)
Triggers for irritant contant dermatitis
- Alkaline cleaning agents (detergents and soaps)
- Solvents and abrasives
- Oils
- Acids and alkalis
- Prolonged exposure to water/ moisture
,Symptoms for contact dermatitis (exogenous)
- Red, itchy, inflamed
- May see papules and vesicles
- Broken or weeping skin from scratching
- Skin is cracked and fissured (chronic)
Lesions appear within 6-12 hrs of contact
Triggers for referral - Contact dermatitis
Symptoms present for >2 weeks
Extension questions - Contact dermatitis
- Household/ close contacts
- Occupational history
- Improvement on holiday from work
Treatment - Contact dermatitis
o Topical corticosteroids: Short course topical hydrocortisone (0.5- 1%), clobetasone,
mometasone
o Regular emollient use: Apply bd-tds
- Improve skin barrier function, reduce itching
- Greasy, paraffin-based - most effective
- Increases efficacy of topical corticosteroids
- Use Sodium-lauryl-sulfate-free: SLS can irritate
o Antihistamines
- Non-sedating antihistamines have little value
- Sedating a/h's can be used short term for sleep disturbance e.g. dexchlorpheniramine
(Polaramine®)
Tar Preparations: e.g. Pinetarsol® - antipruritic, may be useful
Severe case:
Systemic steroid (Rx only, usually prednisolone)
Endogenous dermatitis types
o Atopic
o Seborrhoeic
Atopic dermatitis
Chronic, relapsing, itchy skin condition
o 70% have personal or family history of atopy (eczema, hayfever and asthma)
o Individuals have exaggerated IgE response
o Can be triggered by allergic contact dermatitis
o Onset within first year of life (may be delayed)
Lesion distribution - Atopic dermatitis
o Often symmetrical
o Location can be agerelated:
o Infancy - face, neck and extensor, nappy area spared (nappy contact derm)
, o Childhood - flexures, wrist and ankles
o Adults - variable/widespread, hands, feet, eye area
Atopic dermatitis susceptability
20% children
2-10% adults
- Diabetics
- Immunocompromised
Symptoms - Atopic dermatitis
- Symmetrical distribution
- Acute, chronic, mild, severe
- Bleeding, yellow crusts
- Infection
Lesions appear within 6-12 hrs of contact
Triggers - Atopic dermatitis
o Genetic
o Medication induced (topical antiseptics/ anaesthetics)
Treatment - Atopic dermatitis
- Soap substitutes / Bath Oils
- Moisturisers / emollients
- Topical corticosteroids (OTC)
- Tar preparation (Pinetarsol®)
- Oatmeal preparations (Dermaveen®)
Types of topical corticosteroids
o Hydrocortisone (DermAid®, Sigmacort®)
o Clobetasone (Eumovate or Kloxema®)
o Mometasone (Zatamil®)
Action of topical corticosteroids
Anti-inflammatory, immunosuppressive and antimitotic activity against cutaneous
fibroblasts and epidermal cells
Dosage - Topical corticosteroids
Apply bd to control flare-ups for max of 7 days
(Mometasone - apply once a day)
Side effects - Topical corticosteroids
Burning, stinging, folliculitis (inflamed hair follicles in area)
ADRs - Topical corticosteroids
Rare if used correctly : delayed wound healing, skin atrophy
C/In - Topical corticosteroids
Caution in children - <12 yo avoid clobetasone and mometasone, use hydrocortisone
(if <1yo - refer)
Pregnancy: use hydrocortisone at lowest potency for shortest time
Breastfeeding: safe but keep breast area free
Infantile seborrheic dermatitis (Cradle cap)
