Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Rash on extensor surfaces and joint pains

Clinical Discipline(s)/Organ System(s)
Dermatology, Rheumatology, Immunology
Progress Test Topic(s)
Musculoskeletal, Skin
An 45 year old NZ European man, who is obese, hypertensive, and smokes cigarettes, goes to see his GP about a rash. It has been present for some 20 years on his elbows and knees but is now becoming widespread. This rash bothers him a lot as he feels it is unsightly. On further questioning it becomes apparent that he experiences joint pains of the fingers, wrists and ankles.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Pathogenesis of psoriasis and psoriatic arthritis (predominantly genetic basis with environmental aggravators)
   - Explain that: psoriasis can be associated with inflammatory psoriatic arthritis; severe early-onset chronic large-plaque psoriasis is an independent risk factor for cardiovascular disease
   - Pharmacology of topical steroids, calcipotriol (vitamin D analogue) and coal tar; systemic methotrexate, ciclosporin, acitretin, biologics (tumour necrosis factor-alpha antagonists - adalimumab, etanercept, infliximab; interleukin 12/23 inhibitor - ustekinemab)
   - Understand the mechanism of action of phototherapy in treating inflammatory skin disorders
Clinical and Communication Skills 
   - History of psoriasis, related conditions and previous management (how treatments were used, efficacy and side effects)
   - Skin examination to determine the extent and severity of psoriasis
   - Describe the cutaneous features using dermatological terminology
   - Establish a provisional treatment plan appropriate for the patient, the nature and extent of his psoriasis and his lifestyle
   - Undertake a general health review including medical and drug history, examination and appropriate investigations. Address any reversible cardiovascular risk factors
   - Provide the patient with verbal and written information about chronic plaque psoriasis and the chosen treatment
   - Establish the psychosocial effect of psoriasis for this patient and his family/whānau
Personal and Professional Skills 
   - Establish a multidisciplinary treatment programme, which may involve a GP, dermatologist, rheumatologist and general physician
   - Establish a therapeutic relationship with the patient and realistic treatment goals in the management of a chronic disorder, including addressing physical and psychological aspects
Hauora Māori 
   - Engage appropriately with whānau as well as the patient for management of chronic skin disease
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
Population Health 
   - Epidemiology of psoriasis
Conditions to be considered relating to this scenario
psoriasis, seborrhoeic dermatitis, tinea corporis, lichen simplex chronicus
Less common but 'important not to miss'
erythrodermic psoriasis, pustular psoriasis
multiple superficial spreading basal cell cancers, multiple squamous cell carcinoma in situ