OSCE REVISION

Lecture Rules
OSCE Exam formed of:
1- Static stations (slides)

2- Interactive stations
Woods lamp
OSCE REVISION
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 OSCE REVISION

Wheals of Urticaria
 OSCE REVISION

Wheals of Urticaria
Angioedema
 OSCE REVISION

Angioedema
 OSCE REVISION

Hypopigmented Pityriasis versicolor

 OSCE REVISION

Hypopigmented Pityriasis versicolor

 OSCE REVISION

Hypopigmented Pityriasis versicolor

 OSCE REVISION

scaly tinea capitis (Grey patches)

 OSCE REVISION

scaly tinea capitis (Grey patches)

 OSCE REVISION

scaly tinea capitis (Grey patches)

 OSCE REVISION

black dot tinea capitis

 OSCE REVISION

Kerion tinea capitis

Kerion
tinea
capitis
 OSCE REVISION

Favus tinea capitis

Favus tinea capitis
 OSCE REVISION

DD/ toes wab maceration or Tinea pedis

 OSCE REVISION

Tinea cururis
 OSCE REVISION

Onychomycosis ==> inves?? & DD

OSCE REVISION
Tinea circinata or corporis
 OSCE REVISION

Napkin candidiasis Oral candidiasis

Napkin candidiasis
Candidal intertrigo
Oral candidiasis (Oral thrush)
 OSCE REVISION

Molluscum contagiosum
 OSCE REVISION

Molluscum contagiosum
 OSCE REVISION

Molluscum contagiosum
 OSCE REVISION

Herpes zoster
 OSCE REVISION

Herpes zoster with 2ry bacterial infection

 OSCE REVISION

Herpes zoster
 OSCE REVISION

Herpes Labialis
OSCE REVISION

Herpes Labialis
 OSCE REVISION

Nits of Pediculosis Capitis

 OSCE REVISION

Common warts (verruca vulgaris)

 OSCE REVISION

Common warts (verruca vulgaris)

OSCE REVISION

Plantar wart
OSCE REVISION

Filiform wart
OSCE REVISION

Plane wart
 OSCE REVISION

Infantile Eczema of ATOPIC DERMATITIS

Childhood Eczema of ATOPIC DERMATITIS
Childhood type of ATOPIC DERMATITIS
(Eczema)
Seborrheic Dermatitis
OSCE REVISION

Impetigo contagiosum
 OSCE REVISION

Impetigo contagiosum
Ecthyma
OSCE REVISION

Erysipelas
Erysipelas
Koebner phenomenon
Fixed drug eruption
 OSCE REVISION

target lesion of Erythema multiform

OSCE REVISION

Scabies
OSCE REVISION
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OSCE REVISION
 Fluorescent light (Woods lamp examination)
Woods lamp is ultraviolet A lamp that has been filtered such that most of the radiation has a
wavelength of 365nm.

Interpretation

 Erythrasma: lesions will give coral red fluorescence

 Pityriasis versicolour: lesions will give golden yellow fluorescence
 Tinea capitis due to microsporum species will give bright blue-green flouresence
 Depigmented lesions e.g; vitiligo & halo nevus will appear milky white to be
differentiated from other hypopigmented lesions e.g; Pityriasis Alba, Pityriasis
Versicolour & post inflammatory hypopigmentation.
 Epidermal melanin pigmentation becomes accentuated under woods light while dermal
melanin pigmentation does not.
 In patients with scabies, fluorescein solution fills the burrow & can be viewed by woods
light

Electrodessication & curettage

The device used can be either a monopolar device e.g; the Hyfrecator which does not require
grounding plate or a unipolar device e.g; Bovie which requires grounding plate

Indications:\

 Destruction of benign superficial lesions e.g; warts, molluscum contagiosum, skin tags &
seborrheic keratoses .
 Hemostasis & ablation of vascular growths e.g; angiomas
 Destruction of some malignant tumors of skin e.g; basal cell carcinoma, squamous cell
carcinoma, keratoacanthoma & bowen disease

Advantages:

 Excision with minimal bleeding

 No suturing is required

Disadvantages:

 Healing by secondary intension causing prolonged healing time & scarring

 No tissue specimen available for histological examination
 Care should be taken when electrosurgery is used on patients with pacemakers
 Transmission of viral infections e.g; hepatitis B & C, AIDS when using reusable
nonsterilized electrode tips
 Cryotherapy
Definition:

Cryotherapy is a technique that uses an extremely cold liquid or instrument to freeze and destroy
abnormal skin cells that require removal.

Mechanism of action:

The mechanism of action in cryotherapy can be divided into 3 phases: (1) heat transfer, (2) cell
injury, and (3) inflammation.

Heat transfer

There is quick transfer of heat from the skin to the cryogen. The most commonly used cryogen is
liquid nitrogen. When using the spray cryotherapy technique, the liquid nitrogen is applied
directly on the skin causing quick transfer of heat from the skin to the liquid nitrogen. This
process results in the liquid nitrogen evaporation. When using a cryoprobe, conduction heat
transfer occurs where the heat is transferred via the copper-metal probe.

Cell injury

Cell injury occurs during the thaw, after the cell is frozen. Intracellular ice crystals form when
tissue temperature reaches -5°C to -10°C. The transformation of water to ice concentrates the
extracellular solutes causing increase of the intracellular osmotic pressure and an osmotic
gradient across the cell membrane, causing cell damage. Keratinocytes need to be frozen to -
50°C for optimum destruction. Melanocytes are more delicate and only require a temperature of -
5°C for destruction. This fact is the reason for the resulting hypopigmentation following
cryotherapy on darker-skinned individuals. Malignant skin cancers usually need a temperature of
-50°C, while benign lesions only require a temperature of -20°C to -25°C.

Inflammation

The last response to cryotherapy is inflammation, which is usually observed as erythema and
edema. Inflammation is the response to cell death and helps in local cell destruction. A thorough
cryotherapy treatment causes basement membrane separation, which may result in blister
formation.
Other actions

 Recrystallization caused by repeated cycles of freezing & slow thawing causes cellular
destruction
 Decrease cellular metabolism since mitochondrial enzymes become inactive at a low
temperature
 Promote vasoconstriction of the blood vessels supplying the lesion causing its ischemia &
necrosis
 Activate the natural killer cells which attack virally infected cells & tumor cells.

Cryogens

 Liquid nitrogen: the most commonly used with freezing point of -196
 Other less commonly used cryogens with less freezing points
Nitrous oxide, liquid
Carbon dioxide, solid
Freon

Technique

 Application of the cryogen to the lesion by a cotton tipped applicator from a thermos-
type bottle multiple times until blanching occurs
 Spray technique: liquid nitrogen is sprayed out of a nozzle for 15 – 30 seconds
 Cryoprobe technique: the probe surface is cooled by immersing it in the cryogen or by
circulating the cryogen inside or through it then the probe is applied to the lesion

Reaction

 Frozen area turns white

 Later on edema & erythema occurs
 Then bullae formation that may be hemorrhagic due to freezing deeper than the epidermis

Advantages:

 No anesthesia is required
 No bleeding
 It is possible to freeze deep enough to treat malignant lesions
 The treated area remains sterile as long as the induced blister remains intact

Disadvantages:

 Prolonged healing time

 Unavailability of tissues for histologic examination
 Painful
  Hemorrhagic blister may occur
 Secondary bacterial infection of ruptured blister may occur
 Hypertrophic scar formation may occur after freezing too deep
 Pigmentary changes ( hypopigmentation or hyperpigmentation) may occur
 Superficial nerve damage may occur e.g; sides of fingers, post auricular area or the
peroneal nerve
 Perminant nail dystrophy in periungual lesions
 Reccurency of the lesion, especially warts, may occur

Indications

 Keratotic & preneoplastic lesions

 Warts
 Molluscum contagiosum
 Seborrheic keratosis & solar keratosis
 Cutaneous horn
 Keratoacanthoma
 Bowenoid disease
 Vascular lesions
 Telangiectasia
 Spider nevi
 Pyogenic granuloma
 Kaposi sarcoma
 Hemangiomas
 Lymphangiomas
 Carcinomas
 Squamous cell carcinoma
 Basal cell carcinoma
 Lentigo maligna
 leukoplakia
 Nevi
 Pigmented
 Epidermal
 Cysts
 Epidermal
 Mucus cyst

Contraindications

 Patients with cold related diseases e.g; Raynauds disease, cryoglobulinemia, cold
urticaria
  Patients with skin dark skin ( phototypes IV – VI) due to the possibility of hyper or
hypopigmentation

Potassium hydroxide preparation

Indications

KOH is used microscopically to identify fungus or yeast from epidermal skin scrapings

Technique

Specimen

 Skin scraping: from the edge of the lesion or from the roof of pustules or vesicles on to a
glass slide
 Nails: scrape the subungual debris on to a glass slide
 Hair: pluck 5-10 hairs from the active scaling area & place them on a slide.

Apply 2 or 3 drops of 20% KOH with or without 40% dimethylsulfoxide to the slide then apply a
coverslip

Heat the slide gently. KOH will digest proteins, lipids & other cellular debris in the specimen.
The fungal element will resist this treatment due to the chitin & glycoproteins in the fungal cell
wall

Examine the slide under the microscope

Interpretation

 Pityriasis versicolor: short fungal hyphae & rounded spores ( spaghetti & meatballs)
 Dermatophytes & candidal infection: thin, long hyphae & few spores. KOH can’t
differentiate between true hyphae of dermatophyte infection from pseudohyphae of
candidal infection & diagnosis depends mainly on clinical presentation
 Artifacts e;g: hairs (lack branching that appear with hyphae)
Cotton threads (thick, lack branching & no parallel sides)
 (1)Fungal infections

shceme for Management of fungal infections

Give topical & systemic antifungal for

1. Hair
2. Nail
3. Skin if wide distribution of lesion only or failure of topical treatment
after 1 - 2 weeks

Others give topical only

Duration of treatment
Skin 1 to 2 weeks
Hair 6 to 8 weeks
Finger Nail 3 to 6 months
Toe nail 9 months to one year
Vulvovaginitis 2 to 3 days

Hypo or hyperpigmented Pityriasis versicolor

Causative organism:
pityrosporum ovale (malassezia furfur)

Primary lesion:
multiple well-defined macules and patches + branny scales "fine
cigarette paper like scales"

Site:
back of neck, trunk, proximal arm (lipophilic areas)
 Investigation:
woods light examination: light golden yellow fluorescence
direct examination by KOH "spaghitti & meat ball"

differential diagnosis of hypopigmented Pityriasis versicolor

1. Pityriasis alba
2. Post inflammatory hypopigmentation
3. Vitiligo
4. Halonevus

Lines of ttt:
avoid humidity
topical
sodium thiosulphate 20%
OR zinc pyrithione ‫شامبو هيد آند شولدرز‬
OR selenium sulphide 2.5%
+ Ketoconazole
systemic antifungal "fluconazole"

Scaly tinea capitis (grey patch)

(Non inflammatory)

causative organism
trichophyton violaceum
microsporum canis

describe the lesion

many scaly patches & shortly cut hair

investigations
Woods light examination
M. Canis & audounii: green fluoresce
T. Violaceum: not fluoresce
direct microscopy KOH examination
Hyphae & spores
culture
Sabouraud's agar (2 to 4 weeks)

differential diagnosis of scaly scalp

1.seborrheic dermatitis
2. Impetigo
3. Psoriasis

lines of treatment
Duration: 6 to 8 weeks
topical anti fungal
ketoconazole
systemic anti fungal
1. Grisofulvin 12.5 mg/kg for 6-8 weeks
(Each tab 125mg - max 6 tablets)
OR
2. Itraconazole
OR
3. Terbinafine

black dot tinea capitis

(Non inflammatory)

causative organism
trichophyton violaceum

describe the lesion

single or multiple scaly patches & shortly
cut hair (black stump)

investigations
Woods light examination
T. Violaceum: not fluoresce
 direct microscopy KOH examination
Hyphae & spores
culture
Sabouraud's agar (2 to 4 weeks)

differential diagnosis of localized central non-cicatricial alopecia

1.alopecia areata
2. Trichotillomania
3. Male baldness

lines of treatment
Duration: 6 to 8 weeks
topical anti fungal
ketoconazole
systemic anti fungal
1. Grisofulvin 12.5 mg/kg for 6-8 weeks
(Each tab 125mg - max 6 tablets)
OR
2. Itraconazole
OR
3. Terbinafine
 kerion tinea capitis
(inflammatory)

causative organism
trichophyton verrucosum & bacterial
pathogen may play a role.
trichophyton mentagrophytes.

describe the lesion

single or multiple boggy swellings &
loose or easily detached hair & when
detached, it oozes sero pus
few pustules

investigations
Woods light examination
direct microscopic KOH examination
culture
Sabouraud's agar (2 to 4 weeks)

differential diagnosis of kerion?

Pyogenic abscess is painful along its course, unlike kerion which is
painless at its early course only.

lines of treatment
Duration: 6 to 8 weeks
topical anti fungal
ketoconazole
systemic anti fungal
1. Grisofulvin 12.5 mg/kg for 6-8 weeks
(Each tab 125mg - max 6 tablets)
OR
2. Itraconazole
OR
3. Terbinafine

favus tinea capitis (inflammatory)

causative organism
trichophyton schoenleinii

describe the lesion

central cicatracial alopecia

investigations
Woods light examination
direct microscopic KOH examination
culture
Sabouraud's agar (2 to 4 weeks)

differential diagnosis of cicatricial

alopecia
1.trauma :physical / chemical
2. Tumor: basal cell carcinoma
3. Infection:
staph infection & lupus vulgaris
Herpes zoster
Kerion
4. Autoimmune: scleroderma / lichen plannus
5. Idiopathic

lines of treatment
Duration: 6 to 8 weeks
topical anti fungal
ketoconazole
systemic anti fungal
1. Grisofulvin 12.5 mg/kg for 6-8 weeks
(Each tab 125mg - max 6 tablets)
OR
2. Itraconazole
OR
3. Terbinafine

differentaial diagnosis of Toe web maceration.

1. Tenia pedis
2. Candidal interdigital maceration
3. Erythrasma "brownish"
4. Pseudomonas infection "greenish"

Tinea cruris

causative organism
epidermophyton floccusum
trichophyton rubrum

describe the lesion

circinate itchy erythematous patch with raised active edge (minute
papules, pustules & crusts) at the upper medial side of the thigh &
extends to the buttocks

differential diagnosis of intertriginous

1. Erythrasma
2. Candidiasis of the groin
3. Intertrigo
4. Flexural psoriasis
5. Seborrheic dermatitis

lines of treatment
avoid humidity
 topical
1. Whitefield ointment
OR tolnaftate ointment
OR castelani paint
systemic
Fluconazole

onycomycosis / fungal nail infection

causative organism
candida
mould
dermatophyte

describe the lesion

lusterless, brittle, friable, subungual
hyperkeratosis.

differential diagnosis
1. Candidal onycomycosis
2. Aspergillus onycomycosis
3. psoriasis

investigations
woods light examination
direct KOH microscopic examination
fungal culture "sensitivity to certain anti-fungal drugs"

lines of treatment
Duration of treatment: 3 - 6 months
avoid humidity
topical
Whitefield ointment
OR tolnaftate ointment
OR castelani paint
 systemic antifungal
terbinafine is the drug of choice

Tinea circinata OR corporis

describe the lesion

circinate itchy erythematous patch
with raised active edge "minute papules,
pustules & crusts"

differential diagnosis
circinate impetigo
pityriasis rosea

investigations
Woods light examination
direct KOH microscopic examination

lines of treatment
avoid humidity
topical only for 1 - 2 weeks
Whitefield ointment
OR tolnaftate ointment
OR castelani paint
systemic anti fungal if wide distribution of lesion or failure of topical
treatment
Grisofluvin 12.5 mg/kg
 Oral candidiasis / oral thrush

describe the lesion

Whitish crude like patches
"pseudomembrane" of tongue & mucosa
if scrubbed: erythematous base

investigations
Woods light examination
direct microscopic KOH examination
culture
Sabouraud's agar (2 to 4 weeks)

lines of treatment
avoid humidity
topical therapy
1. Clotrimazole
2. Tincture iodine
3. Whitefield ointment
4. Sodium hyposulphite
systemic antifungal
Fluconazole
Napkin candidiasis / candidial intertrigo

describe the lesion

well defined erythematous patch in groin with affection of skin folds
edge is festooned with satellite papules & pustules

DDx of Napkin dermatitis

1. Contact dermatitis "ill defined + free skin folds"
2. Bullous impetigo
3. Candidal dermatitis
4. Scabies
5. Seborrheic dermatitis
6. Psoriasis " well-defined border + no
active rash"
7. T. Cruris " raised active border

investigations
Woods light examination
direct microscopic KOH
examination
culture
Sabouraud's agar (2 to 4 weeks)

lines of treatment
avoid humidity
topical therapy
1. Clotrimazole
2. Tincture iodine
3. Whitefield ointment
4. Sodium hyposulphite
systemic antifungal
Fluconazole

(2)Viral infections
 Lines of treatment of warts

plane wart on face"HPV"

1. topical retenoid "vitamin A derivative"
2. Keratolytic "salicylic acid"
3. Fractional CO2 Laser removal

Notes
if single lesion, you may use electocautary
do not use chemical cautary on face as TCA
cryocautary is contraindicated as it causes scarring &
dyspigmentation
do not use topical immunotherapy

verruca valgaris / ordinary wart / filliform by HPV type 2 &

4 followed by 1, 3, 27, 29 & 57
1. Cryotherapy
2. Electrocautary
3. Chemical cautary
4. Fractional CO2 laser removal
5. Topical immunotherapy

Note do not use intralesional vaccines " BCG, MMR or

candidal antigen"

plantar wart/verruca plantaris "HPV type 1 followsd by 2, 3,

4, 27, 29 & 57"
1. Cryotherapy
2. Laser removal
3. Chemical destruction
4. Immunotherapy " BCG, MMR or candida antigen"

Note electrocautary & surgery are contraindicated in plantar

wart

molluscum contagiosum "Pox virus"

1. chemical destruction by "phenol / TCA / salicylic acid"
2. electrocautary
3. cryotherapy "liquid nitrogen -196⁰C"
4. topical immunotherapy

genital warts "condyloma accuminata"

If small
1. cryotherapy
2. Electrocautary
3. Chemical destruction
if large
Podophyllin 25% in tincture benzoin
Or topical imiquimoid
If pregnant, give tricchloro acetic acid (TCA) 70-90%

Describe the lesion

 Plantar warts
tender inwardly growing
myrmecia on the sole due to HPV
type 1
clusters of superficial less painful
mosaic wart due to HPV type 2
differential diagnosis of wart on
plantar aspect of foot
wart:
1. Intrrupted skin markings
2. Pin point red / black dots when the
wart is pared down
3. pinpoint bleeding from patent
capillaries on scratching
4. Dermoscopy assists visualization of
papillary capillaries (Vs seborrheic
keratosis)
plantar callus:
Exaggerated skin markings
Not friable
plantar corn: filliform warts

Increased pain with direct pressure, cluster of fine fronds emerging

from narrow pedicle base usually
Friable found on the face
seborrheic keratosis digitate / finger like
squamous cell carcinoma

plane wart by HPV type 3 & 10

multiple small flat topped skin-colored papules
sites: face, hand and shins
 Molluscum contagiosum

causative organism
pox virus (double stranded
DNA)

Incubation period
2 weeks up to 6 months

sites
Face, head, neck, trunk &
genitalia

describe the lesion

single or multiple/ grouped
Epidermal growth 0.1 - 1 cm
shiny pearly white
umbilicated papule in the
centre
contain white cheasy
material

differential diagnosis of
wart on plantar aspect of foot
wart:
1. Intrrupted skin markings
2. Pin point red / black dots when the wart is pared down
3. pinpoint bleeding from patent capillaries on scratching
4. Dermoscopy assists visualization of papillary capillaries
(Vs seborrheic keratosis)
5. Relatively rapid onset
6. May or may not be on a bony prominance
7. Skin lines pass around the lesion
8. Maximun pain felt on squeezing side to side
9. rapid recurrance after shaving
plantar callus:
1. Exaggerated skin markings
2. Not friable
plantar corn:
1. Develop over months / years
2. Localized over bony prominence
3. Skin lines pass through the lesion

4. Maximun pain felt with direct pressure,

5. Friable
6. Slow recurrance "at least a week after shaving"
seborrheic keratosis
squamous cell carcinoma

investigations
1. Dermoscopy
assists visualization of papillary capillaries.
2. Skin biopsy if SCC is suspected
lines of treatment
physical / destruction
1. chemical destruction by "phenol / TCA / salicylic acid"
2. electrocautary
3. cryotherapy "liquid nitrogen -196⁰C"
4. topical immunotherapy
medical
1. Anti-septic
Hydrogen peroxide cream
Povidone iodine solution
2. Cantharidine solution for children with multiple lesions

Herpes zoster

causative organism
varicella zoster virus

common sites
1. Thoracic affection.
2. Cervical spine C 2, 3 & 4
3. Trigeminal affection
(ophthalmic division)
4. Lumbosacral affection.

describe the lesion

grouped vesicles on
erythematous base
unilateral taking one
dermatomal distribution of
"intercostal nerves / cervial
nerves"
pustules due to secondary bacterial infection " may be
present or not"
 complications
post herpetic neuralgia
"Persistance of pain after healing of cutaneous lesions"
pneumonia
encephalitis
meningitis
secondary infection
scarring of the skin after 2ry bacterial infection
gangrene of the skin
herpes zoster ophthalmicus
Ramsay Hunt syndrome due to affection of geniculate
ganglion

lines of treatment
topical antiseptics
1. Gentian violet paint
2. K permanganate solution
3. Topical antibiotic & topical antiviral
systemic (within 72 hours)
1. Acyclovir 800 mg / 5 times / for 7 to 10 days
2. Pain killer

Herpes libialis

causative organism
HSV type 1 and rarely HSV type 2
 Incubation period
up to 1 week

describe the lesion

grouped vesicles on
erythematous base at the uper part
of right angle of the mouth

common sites of HSV-1

1.herpetic gingivostomatitis
2. Herpetic keratoconjunctivitis
3. Herpetic whitlow "most
important"
(Finger affection, when a dentist
put his finger in a mouth of a patient suffering from Herpetic
gingivostomatitis)

lines of treatment
topical antiseptics
1. Gentian violet 2%
2. K permanganate 1 / 8000
3. topical ayclovir cream (5 times / day for 7 days)
systemic
Acyclovir 200 mg / 5 times / for 7 to 10 days

Common warts/ verruca valgaris

causative organism
 human papilloma virus type 2
& 3 most common

Incubation period
2 to 6 months up to one year

describe the lesion

solitary or multiple cauliflower
like papules with rough
papillomatous hyperkeratotic
surface
greyish in color
range from 1mm to 1 cm or
more
tiny red / black dots appear in the wart "papillary
capillaries"

Site
knees or back of finger & toes
periungual " around nails

(3)parasitic skin infections

Nits of pediculosis ( head louse)

causative organism
pediculus humans capitis

describe the lesion

 oval shaped stucked to the hair shaft near to the scalp
if yellowish: still alive
If whitish: dead

lines of treatment
general measurement
Removal of nits with fine toothed comb with or without
vinegar.
general treatment
1. Systemic antibiotic
2. Anti-histaminic for itching
specific treatment
Anti-pediculosis agent "day 1 & 8"
Topical
1. Permethrin 2.5% for children and 5% for adults
2. Benzyle benzoate emulsion 25%
3. Malathion 0.5%: crab like
systemic
Oral ivermectin

Scabies

Causative organism
sarcoptes scabiei huminis

common sites
panis "nodules & papules are
pathognomonic"
flexor aspect of wrist & albow
interdigital of hand
axillary folds
 no face involvement except infants

Investigation
10% k hydroxide: eggs & fragmented chills

(4)Allergic skin diseases

Urticaria

Primary lesion wheals (hive)

Descripe the lesions central well demarcated pale or

erythematous swelling surrounded by reflex erythema.

Primary acting immune cell mast cell

the main mediator histamine

Examination dermographism + chest examination

Investigations not needed

2 Lines of ttt
treat the cause " stop aspirin, NSAIDs & penicillin & avoid food
additives, salicylates"
general: cooling
medical:
1. second generation anti histamine "loratidine".
2. Corticosteroid for 10 days then taper at time of exacerbation.
3. Immune modulator may be used.
treat angioedema if present
Adrenaline 1:1000 subcutaneous
 Infantile eczema of atopic dermatitis (acute)

Describe the lesion

ill defined erythematous patches
showing vesicles, exudation "oozing"&
crustation & erosion of both cheeks

sites
cheeks & extensor surfaces of limb
sparing diaper area

type of hypersensitivity
type 1

childhood eczema of atopic

dermatitis (subacute)

describe the lesion

erythatous papules & scaling
xerosis & roughness
itchy plaques & lichenified plaques in
both antecubital fossae

sites
neck
flexor aspect "antecubital & popliteal fosae"

Adulthood type of atopic eczema (chronic)

describe the lesion

 mainly lichenification
xerosis & roughness

sites
neck
hand
feet
flexural aspects " antecubital & popliteal fossae"

seborrheic dermatitis

describe the lesion

red sharply marginated lesion benhind the
ear
covered with greasy looking scales

sites "areas rich in sebaceous glands"

behind the ear
scalp & face
upper trunk & flexural areas

Fixed drug eruption

etiology
sulfonamide & NSAID

describe the lesion

maculopapular dusky violaceous lesion.

sites
skin, penis, lips & mouth

lines of ttt
 stop the drug
emollient & topical steroid

target / iris lesions of erythema multiform

describe the lesion

erythematous macules or papules,
vesicles and sometimes bullae charactarized
by iris or target lesion "circular
erythematous with vesicle or papule in
centre"

sites "symmetrical distribution"

palm & soles
wrist & forearm

lines of ttt
ttt of cause
If recurrent "more than 6 times per year" herpes with erythema
multiform, give long term acyclovir 400mg twice per day for 3 months
OR 10mg/kg for6 months
ttt of hypersensitivity
Topical & systemic steroid
ttt of itching
Anti-histaminic
(5)bacterial infection

Ordinary impetigo contagiosum

causative organism
staphylococcus aureus
streptococcus pyogenes

Primary lesion
thin vesicles

describe the lesion

thin vesicles & pustules that rupture and ooze
resulting in honey colored yellowish/brwon
crustation & erosions around the mouth

sites
exposed sites in infants & child as around mouth & nose and extremeties

investigations
culture & sensitivity
if recurrent: ASO titre & BUN & Creatinine

lines of treatment
ttt of predisposing factors "pediculosis & scabies"
topical
K permanganate
Olive oil
Topical antibiotic
systemic antibiotic for 7 days
cephalexin
OR
Erythromycin
OR
azithromycin
 Ecthyma (ulcerative impetigo)

definition
deep type of impetigo causing
ulceration & includes the basement
membrane & the ulcer is covered by
crust and heals by secondary
intension.

causative organism
streptococci

primary lesion
thin vesicle

describe the lesion

dark ulcers, variable in sizes up to 5 cm, saucer shaped, raised edges
& indurated, violaceous margin

sites
shine of tibia & feet " sites of trauma"

investigations
culture & sensitivity
if recurrent: ASO titre & BUN & Creatinine

lines of treatment
ttt of predisposing factors "pediculosis & scabies"
topical
K permanganate
Olive oil
Topical antibiotic
systemic antibiotic for 14 days
cephalexin
OR
Erythromycin
OR
azithromycin

Erysipelas

causative organism
streptococci through abrasions & wound
staphylococcus

describe the lesion

well-demarcated erythematous area +
hotness & swelling
may have vesicles & pustules

sites
face & leg

investigations
culture & sensitivity
if recurrent: ASO titre & BUN &
Creatinine

lines of treatment
hospitalization
rest & antipyretics "fucidic acid"
anti-edematous "alphintern"
k permanganate
systemic antibiotic injection "unictam / unacin"
 oral augmented penicillin "hibiotic"
If not responding to penicillin, give macrolide antibiotic

Isomorphic phenomenon (koebnerization)

definition
injury of skin induces the lesion

differential diagnosis
1. Plane wart
2. Molluscum contagiosum
3. Psoriasis
4. Lichen plannus
5. Vitiligo
ANDROLOGY
OSCE
Static
A- Label the following

Vas Seminal
deference vessel

Urethra prostate

epidermis
Volume: 0.5 ml
A- Mention three
Liquefaction time: 20 minutes.
abnormal findings in
Color: grayish white this Semen analysis
PH: 7.2 Report ( WHO 2010)
Count: 35 million / ml and mention their
Motility : normal values :
 Progressive motility: 15% 1-V: 0.5 (1.5) = oligo or
 Non-progressive: 25% hypo - spermia
 Immotile :60% 2-PM 15 (32) =
astheno-zoospermia
Morphology: 97% abnormal forms
3-mo 97 (96)=
Vitality: 78% Terato-zoospermia
Agglutination: 10%
Red blood cells: 3-4/HPF
Spermatogenic cells: 2-3/HPF
Pus cells: 0-5/ HPF
• Volume: 2 ml
• Liquefaction time: 20 min A-In the following
• PH: 7.4 semen analysis (
• Count: 67 million / ml WHO 2010)
• Motility : 1- Mention the
• Progressive motility: 11% abnormal finding?
• Non-progressive: 22% PM 11 (32)
• Immotile :67% TM 33 (40)
• Morphology: 95% abnormal =
forms astheno-zoospermia
• Vitality: 69%
• Pus cells: 1-2 / HPF
• Volume: 2 ml A-In the following
• Liquefaction time: 20 min semen analysis (
• PH: 7.4 WHO 2010)
• Count: 67 million / ml 2- Mention four
• Motility : possible causes of
• Progressive motility: 11% this finding ?
• Non-progressive: 22% 1- immotile cilia
• Immotile :67% syndrome.
• Morphology: 95% abnormal 2- traumatic.
forms 3- varicocele.
• Vitality: 69% 4- chronic prostatits
• Pus cells: 1-2 / HPF
A- 32 years old male patient presented to the
Andrology Clinic complaining of 1ry
infertility of 3 years duration with
azoospermia and high FSH and LH levels.
Mention 4 different etiologies for this case

Testicular problem
1-Klinfilter syndrome.
2.Testicular malignancy
3-radiation & Chemotherapy
5-Trumatic, Heat, torsion
6-varicocele.
A- Mention three abnormal findings & their normal
values in this semen analysis report ( WHO 2010)

• Volume: 1 ml
• Liquefaction time: 20 minutes.
• PH: 7.4
1- V: 1ml (1.5) =
• Count: 67 million / ml hypo-spermia.
• Motility : 2-PM :28 (32) =
• Progressive motility: astheno-zoospermia
28%
• Non-progressive: 3- vitality 50 (58)=
22% necro-zoospermia
• Immotile :50%
Morphology: 95% abnormal •
forms
• Vitality: 50%
• Pus cells: 0-5/ HPF
• C- List 3 causes of hypogonadotropic
hypogonadism
Pituitary problem
• 1-pituitary tumor
• 2-hyperprolactinemia
• 3-radiation & Chemotherapy
• 4-hemochromatosis
• 5-kallman syndrome
 He gave a history of primary infertility with Azoospermia
2- mention 3 investigations to diagnose the type of Azoospermia

1-semen analysis
2-hermons ( fsh, lh, prolactin)
3-testicular biobsy.
4-crytyping
5- surem marker(fructose, l creatinine)
B) 35 years old sexually active male patient
presented to the Andrology Clinic complaining
of Uretheral discharge of 10 days duration.
1- Mention 4 differential diagnoses for this
discharge

1- Neisseria genoghreal.
2-trichomonous vaginals.
3-chlamydia trachomatis
4-candidia albicans.
5-mycoplasma.
29 years old patient presented with genital
ulcer and diagnosed as primary stage
syphilis
1. Mention 3 confirmatory tests to diagnose the
case?
1-Dark ground microscopy.

2-VDRL ( venereal disease research laboratory ).

3- RPL ( Rapid plasma reagin )

4- TpHA ( treponema pallidum haemagglutination )

5- FTA ( fluorescent treponemal antibody absorption test )

6- TpI ( Treponema pallidum immobilization)

29 years old patient presented with genital
ulcer and diagnosed as primary stage
syphilis
1. Mention drug and dose of choice to treat this
case?
Benzathine penicillin 2.4 million units, IM, single dose.

Procaine penicillin 600000 IU/d Im

IF allergy – erythromycin 500 mg/6h

29 years old patient presented with genital
ulcer and diagnosed as primary stage
syphilis
1. Mention 4 causes of non sexually transmitted
genital ulcers.
 Candida. Contact dermatits

 Cylomegalovirus. Fixed drug eruption

 Salmonla squamous cell carcinoma

 Pseudomonoas . Trumatic
A
 1- Mention the name of tha causative organism HPV
(condyloma acuminate)
 2- Enumerate 4 methods of Treatment
1- cryotherapy. 2- electroquatry.
3. Laser treatment co2.
4-chemical cautery. Pendol
5- intra-lesional alpha interferion.
 30 years old male patient presented to the Andrology
clinic with erectile dysfunction, he is diabetic on
insulin therapy and hypertensive on oral beta blockers.

1- Mention 3 Andrological investigations can be used to

diagnose this case?

1- Rigi scan.

2- ICI.

3-biothesiometry.

4-covernosonography.
 30 years old male patient presented to the Andrology
clinic with erectile dysfunction, he is diabetic on
insulin therapy and hypertensive on oral beta blockers.

2- Mention 4 lines of treatment can be used in this

patient?

1-control diabetes.

2-SildenafilIntra.

3- cavernous injection

4- Modification of beta blockers

B
 Mention 4 stigmata of
congenital syphilis
1-Rhagades
2-moon molar.
3-saddle nose
4-bulldog jow
B- List 3 Surgical techniques of varicocele
repair
1- open surgery. Inguinal.
2-microsurgery.
Inguinal and subinguinal and retroperitoneal
3-laproscope.
4- radiological.
 35 years old male patient presented to the
Andrology clinic with erectile dysfunction
occurred after motor car accident and fracture
spine, he is not diabetic or hypertensive or had a
history of dyslipidaemia.
1. What the type of erectile dysfunction in this patient?

Neurogenic ED
 35 years old male patient presented to the Andrology clinic
with erectile dysfunction occurred after motor car accident
and fracture spine, he is not diabetic or hypertensive or
had a history of dyslipidaemia.
Mention 3 Andrological investigations can be used to diagnose this
case?
1- Rigi scan.
2- ICI.
3-biothesiometry.
4-covernosonography.
 35 years old male patient presented to the
Andrology clinic with erectile dysfunction occurred
after motor car accident and fracture spine, he is
not diabetic or hypertensive or had a history of
dyslipidaemia.
1. Mention 4 lines of treatment can be used in this patient?
1-medical – sildenafil
2- ICI.
3- external vacuum and constriction
4-transurrtheral of alprostadil
5- penil prothesis
 C- List 4 types of erectile dysfunction
 1-pshyogenic
 2-neurogenic
 3-drug induced
 4-vascular
 5-endocrine..
B - List 3 causes of predominance of left varicocele
than right varicocele
1-left testis more dependent.
2-left testicular vein open in ther lt renal
perpendicular and rt open in IVC oblique.
3-compresss of lt renal vein between the lt renal
artery and superior mesenteriv
B) Choose the best answer
1- the incubation period of syphilis is

A- 2-20 days
B- 6-60 days
C- 9-90 days
D- 1-2 months
2- All of the following regarding neissseria
gonorrhea is true except

A- the drug of choice is ceftriaxone

B- gram positive kidney shaped diplococci
C- incubation period is 2-5 days
D- selective growth media is thayer martin agar
3- Agents causing genital ulcers include the
following except

A- chlamydia trachomatis
B- hemophilus ducreyi
C- klebsiella donovanis
D- HPV
4- Testosterone is mainly secreted by

A- leydig cells
B- sertoli cells
C- peritubular cells
D- germ cells
 A- True or false
1- Gumma is one of the features of tertiary syphilis. T

2- Neisserea Gonorrhea is a gram positive kidney shaped diplococc. F

3- The term aspermia means total absence of sperms. F

4- Peroxidase Test differentiates between live and dead spermatozoa. F

5- Scabies is considered a sexually transmitted disease T
6- Drug of choice of lymphogranuloma venereum is doxycyclin 100 mg twice per day for 21 days. T

7- Treponema pallidum can be cultured on sabaraud’s dextrose agar. F

8- Early morning erection and visual stimulation are absent in psychogenic erectile

dysfunction. F

9- Sildenafil is contraindicated in hypertensive and diabetic patients . F

 TRUE OR FALSE
1. Drug of choice of lymphogranuloma venereum is
doxycyclin 100 mg twice per day for 21 days. T

2. Treponema pallidum can be cultured on sabaraud’s

dextrose agar. F

3. Early morning erection and visual stimulation are

absent in psychogenic erectile dysfunction. F

4. Sildenafil is contraindicated in hypertensive and

diabetic patients . F
6. Rigi scan differentiates between psychogenic and
organic erectile dysfunction. T
7. Varicocele is more prevalent in primary infertility
than secondary infertility. F
8. Hypo osmotic swelling test differentiates between
living and dead sperms. T
9. FSH act on leydig cells to produce androgen
binding protein. F
10. Kleinfelter’s syndrome is the most common cause
of hypogonadotrophic hypogonadism. F
1- hypoosmotic swelling test is used to
differentiate between viable and non-viable
spermatozoa T
2. Varicocele is more common on left side. T
3. Chancroid is a painless genital ulcer. F
 B) True or false
1) Caversonography is one of the investigations
required in infertile patients with varicocele. F

2) Sildnafil, tadalafil and vardanafil are examples of

phosphodiastrase five inhibitors (PDE5I). T

3) Drug of choice of lymphogranuloma venereum is

doxycyclin 100 mg twice per day for 21 days. T

4) Eosin-Negrosin dye differentiates between pus cells

and spermatogenic cells in semen. F