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Look at this gentleman's skin! ( Station 5)

Discussion:

     Psoriasis is always a popular question in MRCP PACES Station 5. This common skin disease can be asked in the skin or locomotor substation in Station 5. I have covered psoriaitic athropathy in my previous issue. Today, we are going to revisit this common dermatological problem.Psoriasis is always described as ' well-demarcated salmon pink plaques with silvery white scale'. You notice this classical described lesion in extensor surface of this gentleman left upper limb. You must then proceed to find this similar lesion over other 'typical' places such as extensor surfaces ( over the lower limbs), scalp, peri-umbilical area and natal cleft. If you take a look at this gentleman's lower limbs, you will notice the similar lesion,

As I said before in all my previous issues, in your MRCP PACES examination, it is not enough for you just giving your examiners the diagnosis of your case, you have to tell them severity of the illness, the underlying aetiology or complications of the illness. Such as in this case, you have come to the diagnosis of psoriasis, you have to look and examine further to look for complications ( either due to the illness itself or treatment). Therefore, you must look hard for nail pitting, onycholysis and joint involvement.

If you are lucky to find presence of joint involvement, then you must proceed further to access the patient's functional status. As for the complications of the treatment, you know that patient may be put on immunosuppression such as cyclosporin, methotrexate, steroid or even mycophenolate mofetil, therefore look for these drugs side effects and complications such as gum hypertrophy, tremor, jaundice, Cushing's syndrome.....etc.

Common questions examiners would ask you,

1) What are the indications for systemic treatment for psoriasis?

( Failure of tropical medications, extensive disease, generalised pustular or erythrodermic psoriasis and severe psoriatic arthropathy)

2) What are the subtypes of psoriatic skin disease?

( All time favourite question in MRCP PACES, find this in any MRCP book)

Conclusion:

This gentleman has chronic plaque psoriasis!

Extra points:

Interesting Images In Clinical Medicine

Chest X Ray

Starting from this issue, I will upload some interesting images in clinical medicine which I have collected during my daily clinical practice or from other sources for your viewing.

I welcome all comments and I think to become a good physician, having good bed side skills is essential, however, you also need to equip yourself knowledge of interpreting common lab investigations.

This is the CXR I saw in my chest clinic who presented with 1-month cough with fever.

I think the diagnosis is easy.Yes,you are right, he was having active pulmonary tuberculosis

This is the second CXR I took after 1 month of TB treatment.

You notice the left upper lobe consolidation improves tremendously after treatment!

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