FREE MSRA PODCAST — SJT (Ranking) 🎧
High-yield walkthrough of a medication-error scenario: immediate safety, escalation, candour, and governance. 🧠⚡️
Clinical vignette
You are an F2 in Acute Medicine on an evening shift. You realise a patient with a documented penicillin allergy received co-amoxiclav via e-prescribing two hours ago. The patient is currently stable with no signs of anaphylaxis. Nursing staff are busy with handovers and the on-call registrar is reviewing a deteriorating patient elsewhere. You must decide what to do next.
Question
Rank the following actions in order from most appropriate (1) to least appropriate (5).
Options
1) Offer the patient a timely, open apology and explain what happened and the plan under the duty of candour.
2) Record an accurate, time-stamped entry in the notes and submit an incident report (e.g., Datix) before the end of the shift.
3) Immediately review the patient, re-check observations, stop further doses, prescribe appropriate monitoring/treatment, and inform the nurse in charge.
4) Inform the on-call registrar and the on-call pharmacist as soon as possible to agree a management plan and reporting.
5) Amend the e-prescribing record to remove evidence of the error and plan to discuss it tomorrow to avoid causing alarm.
Answers shown at the end.
Explanation
Prioritise immediate clinical safety: see the patient now, confirm observations, stop further doses, and start appropriate monitoring with readiness to treat if symptoms evolve (e.g., antihistamines, steroids, adrenaline per protocol if indicated). Make allergy status clearly visible and involve the nurse in charge to coordinate observations and escalation.
Escalate early: the registrar provides senior oversight (observation period, thresholds for step-up care) and the pharmacist advises on allergy coding, safe alternatives, interaction checks, and to prevent repeat errors.
Apply duty of candour once you have a plan: apologise in plain language, explain what happened and the risks, outline monitoring/management, offer written information, and answer questions.
Complete governance: make a contemporaneous, factual, time-stamped record (who, what, when, actions taken) and file an incident report before the end of the shift to support continuity and learning.
Never conceal or alter records; it is unsafe, dishonest, and breaches probity.
Brief explanation
• Patient safety > admin: assess in person, stop the drug, monitor, treat.
• Early, structured escalation to senior and pharmacy ensures a safe, accurate plan.
• Candour requires honesty plus a concrete plan.
• Records and reporting enable continuity and system improvement.
• Concealment is always unacceptable.
Key takeaways
• SAFE: Stop harm & assess → Alert senior/pharmacy → be Frank with the patient → Enter notes & incident report.
• Prioritise: stabilise → escalate → disclose → document.
Links
https://www.passthemsra.com/courses/sjt-for-the-msra/
https://www.passthemsra.com/courses/sjt-msra-mock-papers-x-10/
— Correct Answers: —
Ranking (most → least appropriate): 3 → 4 → 1 → 2 → 5
3 — Immediate safety: Review the patient now, re-check observations, stop further doses on EPMA, initiate monitoring and have first-line treatments to hand; inform the nurse in charge so the ward response is coordinated.
4 — Escalation: Contact the on-call registrar and pharmacist promptly to agree the management plan (observation period, alternative therapy, allergy coding, EPMA safeguards) and reporting steps.
1 — Duty of candour: Offer a timely, open apology with an honest explanation and the agreed plan; provide written information and answer questions.
2 — Records & reporting: Make a clear, time-stamped entry and submit an incident report before end of shift to support continuity and learning.
5 — Concealment: Altering or deleting records is dishonest and unsafe; delaying disclosure to “avoid alarm” breaches probity and risks harm.
FREE MSRA PODCAST QUESTION— SJT (Priority) 🎧
High-yield breakdown of a classic “competing bleeps” scenario: triage under pressure, early escalation, and safe delegation. 🧠⚡️
Clinical vignette
You’re the medical SHO covering two wards on an early evening shift when several demands arrive at once: (a) a 72-year-old with pneumonia is acutely dyspnoeic with SpO₂ 82% on air; (b) ED wants TTAs for a stable discharge “in 30 minutes”; (c) Radiology phones with a routine outpatient US query; (d) an FY1 asks you to check warfarin dosing before 18:00; (e) a relative requests an update via switchboard. The nurse in charge can assist; the medical registrar is busy but contactable; ALS/2222 is available.
Question
Select the THREE most appropriate actions to take now.
Options
Go immediately to assess the hypoxic patient with ABCDE, give oxygen per protocol, request observations and a VBG.
Call 2222/ALS or the medical registrar for urgent support while en route, giving a concise SBAR.
Ask the nurse in charge to pause/redirect non-urgent bleeps; inform ED TTAs will be delayed; document reprioritisation.
Prioritise writing the ED TTAs first because patient flow targets must be met.
Tell the FY1 to hold warfarin and you’ll review later, without assessing the patient.
End the radiology call by telling them to ask the GP instead, as it’s not urgent.
Ask the ward clerk to take the relative’s details and arrange a call-back later; ensure consent/ID checks before any update.
Advise the nurse to escalate to outreach/critical care only if the patient arrests.
ANSWERS AT THE END (scroll to end)
Brief explanation
Immediate safety first: Severe hypoxia (SpO₂ 82%) demands ABCDE, oxygen, monitoring and early gas (NEWS2/NICE/GMC).
Early escalation: Alert 2222/ALS or the registrar on the move; use SBAR to save time and share risk.
Prioritisation & delegation: Insulate non-urgent tasks (TTAs, routine calls, relative update) via the nurse in charge; communicate delays and document decisions for continuity and governance.
A bit more (from the episode)
Concurrent actions matter: Calling for help en route accelerates definitive care without delaying bedside assessment.
Professional tone: Don’t dismiss colleagues (e.g., Radiology); defer politely and route via the nurse in charge.
Relatives & confidentiality: Arrange a call-back with proper ID/consent rather than splitting attention during an emergency.
Avoid unsafe shortcuts: Remote warfarin advice without assessment is risky; defer safely and review properly.
Documentation protects patients and you: Record who was informed, what changed, and why.
Key takeaways
TRIAGE: Treat the sickest first (ABCDE) → Raise help early (2222/SBAR) → Insulate non-urgent tasks → Acknowledge delays → Guidelines (NEWS2/NICE) → Enter clear notes.
Patient safety > admin targets.
Communicate, escalate, document.
📎 More MSRA resources to accompany this episode:
#MSRA #MSRASJT#CopingUnderPressure #Prioritisation #ABCDE #NEWS2 #GMC #Teamworking#Escalation #SBAR #NHS
Correct choices (Priority — best three): 1, 2, 3
A rapid-fire deep dive into the GMC’s core guidance and key UK laws for the MSRA SJT.
We compress 33 essential GMC guidelines into exam-ready actions, scenarios, and sticky mnemonics—so you can prioritise safety, escalate early, act lawfully, and document like a pro.
What you’ll learn
• Good Medical Practice (2024): safety first, work within competence, escalate early, document clearly.
• Confidentiality & Data Protection: minimum necessary info; implied vs explicit consent; secure handling.
• Education & Training: anonymise first; get explicit consent if identifiable/sensitive.
• Third-party reports (employers/insurers): written consent + relevant, factual, proportionate disclosure.
• Serious Communicable Disease & Public Interest: seek senior/Caldicott advice; document decisions.
• Fitness to Drive (DVLA/DVA): advise legal duty to notify; if persistent risk → inform DVLA and tell patient.
• Violence/Knife/Gunshot: treat first; safeguarding; usually inform police for non-accidental injuries.
• Social/News Criticism: never reveal patient info; keep responses general; get defence/comms advice.
• Personal Beliefs: no discrimination; conscientious objection only with seamless onward access; emergencies override.
• Conflicts of Interest: declare interests; don’t let them influence care; transparent fees/gifts.
• Social Media: same standards online; protect confidentiality; be clear about your role.
• Ending the Professional Relationship: only after genuine trust breakdown; follow process; ensure continuity.
• Safeguarding & 0–18s: best interests; Gillick/Fraser; lawful information-sharing; follow local pathways.
• Prescribing: adequate knowledge of patient; evidence-based; avoid self/family prescribing (except true emergency).
• Consent & Capacity: shared decisions; material risks; presume capacity; MCA best interests if lacking.
• Recordings/Images: implied consent for direct care; explicit consent for teaching/research/media; store securely.
• Research: REC approval; valid consent; protections for those lacking capacity.
• End-of-Life: DNACPR = CPR only; ADRTs/LPAs; early advance care planning; meticulous documentation.
• Leadership & Raising Concerns: speak up early; use formal channels; keep records.
• Duty of Candour: be open; sincere apology; explain; offer remedy; report and learn (near-misses too).
• Delegation vs Referral: check competence; transfer complete info; clarify responsibility.
• Legal/Witness/Reporting: duty to court; impartial evidence; tell GMC promptly about cautions/charges/findings.
• 2024–25 Update: GMC standards also apply to Physician Associates and Anaesthesia Associates (within scope).
Mnemonics featured
ACCESS • REPORT • CONTACT • DRIVE • STAB • SILENT • BELIEF • SOCIAL • CONTINUE • CHILD • SAFER • INFORM • CROPP • VALID • ADVANCE • TEAMS • SPEAKUP • APOLOGY • SAFE TRANSFER • HONEST
📎 More MSRA resources to accompany this episode:
• PassTheMSRA – Home: https://www.passthemsra.com
• SJT for the MSRA (course): https://www.passthemsra.com/courses/sjt-for-the-msra/
• SJT Mock Papers (x10): https://www.passthemsra.com/courses/sjt-msra-mock-papers-x-10/
• YouTube channel (free videos): https://www.youtube.com/@PasstheMSRA
Educational only—always follow your local policies and the most current national guidance.
Free MSRA SJT deep dive—practical, high-yield, and jargon-light. We cut dense UK guidance (GMC Good Medical Practice 2024, Montgomery 2015, MCA 2005, Equality Act 2010, Accessible Information Standard, PSIRF/LFPSE) into real-world tools, mnemonics and checklists so you can think clearly under pressure and score safely.
What you’ll learn
• Core Mindset: Patient safety first; escalate early; act within competence; if it’s not documented, it didn’t happen.
• Ethics & Law (Adults): Shared decision-making, material risks (Montgomery), valid consent beyond a signature, teach-back, meticulous documentation.
• Children & Young People: Gillick competence & Fraser guidelines; 16–17s and FLRA; confidentiality with safeguarding limits.
• Capacity (MCA 2005): Five principles; two-stage, decision-specific test; maximise capacity; best-interest decisions using the least restrictive option; IMCA trigger.
• End of Life: DNACPR = CPR only (all other appropriate care continues); ADRT validity/applicability; LPAs within scope; sensitive conversations, clear notes.
• Resource Stewardship: Prioritising by clinical risk/benefit; fair allocation; equity lens (Core20PLUS5); avoid unnecessary tests; flow thinking.
• Equality, Diversity & Inclusion: Equality Act duties; zero tolerance of discrimination/microaggressions; reasonable adjustments; AIS (professional interpreters—never children).
• Communication Skills: SPIKES for breaking bad news; active listening (ICE/NURSE/teach-back); de-escalation; working with relatives & carers; safe use of interpreters.
• Time & Task Management: “Sickest first”, SBAR, Now–Next–Later boards, safe delegation (five rights), closed-loop communication, visible ownership and deadlines.
• Errors, Complaints & Candour: Prompt, sincere apology (not admission of liability); LFPSE reporting; PSIRF learning; practical complaint handling (acknowledge–apologise–action).
• Reflection & Learning: Safe, anonymised reflective practice (WSN: What/So-what/Now-what); turn learning into change.
• Supporting Colleagues: Just culture, compassionate support after incidents, safe removal from duties if impaired.
• Self-Care & Resilience: Recognising burnout (ICD-11), seeking help (e.g., Practitioner Health/BMA support), work-life balance, recognising your limits and asking for supervision.
• Safeguarding: Children (Working Together 2023; S17/S47; bruising in pre-mobile infants = red flag); Adults (Care Act S42; domestic abuse—DASH/MARAC; make-safeguarding-personal); accurate, contemporaneous notes and lawful information sharing.
• Scenario Technique (Exam): Pick-3 and rank-5 strategies; harm-minimisation; stabilise-escalate-document; penalise delay, dishonesty, unsafe delegation.
Handy mnemonics featured
• MATERIAL (consent), Consent-5, 4C-BEST (capacity), AIS-5, NOW–NEXT–LATER + ODT (owner/deadline/threshold), 3As (complaints), WSN (reflection).
Exam mindset refresher
Safety first → escalate early → candour when things go wrong → share the minimum necessary via secure channels → use professional interpreters → document everything.
Resources
• PassTheMSRA – Home: https://www.passthemsra.com
• SJT for the MSRA (course): https://www.passthemsra.com/courses/sjt-for-the-msra/
• SJT Mock Papers (x10): https://www.passthemsra.com/courses/sjt-msra-mock-papers-x-10/
• YouTube (free videos): https://www.youtube.com/@PasstheMSRA
Categories / Key Themes
SJT, Professionalism & Integrity, Patient Safety, Consent & Capacity, DNACPR/ADRT/LPA, Confidentiality & GDPR, Equality & AIS, Safeguarding, Communication Skills, Time & Task Management, Candour & Complaints, Reflection, Teamwork & Leadership, Exam Technique
Tags
#MSRA #SJT #GMC #PatientSafety #Candour #Consent #Capacity #DNACPR #Safeguarding #Equality #AIS #Communication #Leadership #UKFPO #NHS #ExamPrep #GPTraining
Educational only—always follow your local policies and current national guidance.
⚕️ FREE MSRA PODCAST – Mastering the SJT (1 of 3)
🎧 A clear, high-yield breakdown of SJT principles, traps, and mnemonics for safe, GMC-aligned decisions in real-world scenarios.
🧠 What You’ll Learn
• Professionalism & Integrity — Maintaining professional boundaries; Honesty & candour (duty of candour); Upholding GMC standards; Conflicts of interest; Professional appearance & behaviour; Self-awareness & insight; Maintaining competence & CPD.
• Patient Safety — Escalating clinical concerns (SBAR); Speaking up/whistleblowing; Managing fatigue & personal impairment; Prioritising patient safety over organisational interests; Incident reporting (Datix); Dealing with unsafe colleague behaviour; Safe handover.
• Confidentiality & Data Protection — Confidentiality principles & Caldicott; UK GDPR/Data Protection Act basics (lawful basis + Article 9 condition); Sharing with consent; Exceptions (safeguarding, public interest, notifiable diseases, DVLA); Social media & digital professionalism.
• Communication & Interpersonal Skills — Breaking bad news (SPIKES + WARN-PLAN); Active listening (ICE, NURSE, teach-back); De-escalation techniques; Working with relatives & carers (MCA, best interests); Communicating via professional interpreters (Accessible Information Standard).
• Teamwork & Leadership — Delegation (five rights; closed-loop); Supporting colleagues under pressure; Managing conflict (CALM-PACT); Taking responsibility for team outcomes (PSIRF mindset); MDT roles & referrals; Leadership in emergencies (2222, closed-loop, algorithms); Supervision of junior staff.
💡 Exam Mindset
• Patient safety first; escalate early; act within competence.
• Be open and candid when things go wrong; apologise and explain; document meticulously.
• Share the minimum necessary information via secure, approved channels.
• Use professional interpreters; don’t use children/family to interpret (except true emergencies, then document and follow up).
• Use SBAR; name owners & deadlines; document contemporaneously.
• Protect patients and yourself: don’t practise if impaired; arrange safe cover.
📎 More MSRA resources to accompany this episode:
• PassTheMSRA – Home: https://www.passthemsra.com
• SJT for the MSRA (course): https://www.passthemsra.com/courses/sjt-for-the-msra/
• SJT Mock Papers (x10): https://www.passthemsra.com/courses/sjt-msra-mock-papers-x-10/
• YouTube channel (free videos): https://www.youtube.com/@PasstheMSRA
🏷️ Categories / Key Themes
SJT, Professionalism & Integrity, Patient Safety, Confidentiality & GDPR, Communication Skills, Teamwork & Leadership, GMC Standards, Whistleblowing, Escalation, Safe Handover, Delegation, SPIKES, SBAR, CPD, MDT
Hashtags
#MSRA #SJT #GMC #PatientSafety #Candour #Confidentiality #GDPR #Communication #Leadership #Whistleblowing #UKFPO #NHS #ExamPrep #GPTraining
⚕️ FREE MSRA PODCAST – Nephrotic Syndrome
🎧 A clear, high-yield breakdown of this renal condition causing massive proteinuria and oedema – perfect for exam prep and real-life clinical scenarios.
🧠 Key Learning Points
📌 Definition
• Nephrotic syndrome is a glomerular disorder marked by:
– Heavy proteinuria >3.5g/24h
– Hypoalbuminaemia <30g/L
– Oedema
– Hyperlipidaemia
📌 Causes & Risk Factors
• Primary renal causes:
– Minimal change disease (esp. in children)
– FSGS (focal segmental glomerulosclerosis)
– Membranous nephropathy
– Membranoproliferative GN
• Secondary causes:
– Diabetes, SLE, amyloidosis
– Infections: Hep B/C, HIV, malaria
– Malignancy: myeloma, lymphoma
– Drugs: NSAIDs, captopril
– Pregnancy (pre-eclampsia), transplant rejection
🧠 Mnemonic: “HOPED” – Heavy proteinuria, Oedema, low Protein (albumin), Elevated lipids, Differential causes
📌 Pathophysiology
• Glomerular damage → increased permeability
• Albumin leaks → ↓ oncotic pressure → fluid shifts → oedema
• Liver compensates → ↑ lipoprotein synthesis → hyperlipidaemia
• Immunoglobulin & antithrombin loss → infection + clot risk
📌 Symptoms
• Generalised oedema: ankles, periorbital, ascites
• Foamy urine (from proteinuria)
• Fatigue, weight gain
• SOB (pleural effusion), oliguria
• In children: delayed growth/puberty
🧠 Pearl: Look for “Muehrcke’s lines” – transverse white nail bands in hypoalbuminaemia
📌 Differential Diagnosis
• Acute glomerulonephritis
• CKD
• Diabetic nephropathy
• Cardiac/liver failure (causing oedema)
• Protein-losing enteropathy
📌 Diagnosis
• Urine:
– Dipstick: +++ protein
– PCR or ACR (spot or 24h)
– Urine microscopy: fatty casts
• Bloods:
– ↓ Albumin, ↑ lipids
– U&Es, LFTs, immunology (ANA, complement, serum light chains)
• Imaging:
– Renal US
– CXR (pleural effusion)
• Renal biopsy:
– Essential in adults to define glomerular disease
– Often not needed in typical paediatric minimal change disease
📌 Management
• Treat underlying cause
• Corticosteroids – 1st line for minimal change
• Other immunosuppressants: cyclophosphamide, mycophenolate, tacrolimus
• ACEi/ARBs: reduce proteinuria + control BP
• Diuretics: loop diuretics ± thiazides for oedema
• Statins for hyperlipidaemia
• Anticoagulation if VTE or high clot risk
• IV albumin: only for severe hypoalbuminaemia
• Vaccination: pneumococcal, varicella
• Diet: salt restriction, fluid restriction, weight monitoring
• Daily weights + leg elevation helpful in oedema control
• Urgent nephrology referral always indicated
📌 Complications
• Thromboembolism (DVT, renal vein thrombosis)
• Infections (due to immunoglobulin loss + immunosuppression)
• Acute kidney injury
• Chronic kidney disease/ESRD
• Hypocalcaemia, bone disease, hypothyroidism, anaemia
📌 Prognosis
• Minimal change disease: excellent in children, remission likely
• FSGS: ~50% adults progress to ESRD in 5–10 years
• Depends on underlying cause and response to therapy
• Early diagnosis and tailored management are key to outcome
📎 More MSRA Resources for Nephrotic Syndrome
📝 Revision Notes:
https://www.passthemsra.com/topic/nephrotic-syndrome-revision-notes/
🧠 Flashcards:
https://www.passthemsra.com/topic/nephrotic-syndrome-flashcards/
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/nephrotic-syndrome-accordion-qa-notes/
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/nephrotic-syndrome-rapid-quiz/
🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/nephrotic-syndrome/
🎓 Full Course:
https://www.passthemsra.com/courses/renal-for-the-msra/
📣 All resources are part of the Renal for the MSRA course at
https://www.passthemsra.com – your hub for high-yield, NICE-based revision 🚀
Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #NephroticSyndrome #Renal
✅ MSRA Deep Dive: Pyogenic Granuloma – Rapid Red Lesions Made Simple
In this high-yield episode, we break down pyogenic granuloma, a common and exam-relevant dermatological lesion. Despite the name, it’s not infectious and not a true granuloma. We clarify what it really is, why it forms, how to manage it, and how to confidently tell it apart from dangerous mimics like melanoma or SCC—critical for both safe practice and MSRA success.
🧠 Key Learning Points
📌 Definition
• Benign vascular tumour – fast-growing overgrowth of capillaries
• Not associated with pus or granulomatous inflammation
• Also called lobular capillary haemangioma
📌 Pathophysiology
• Triggered by minor trauma, hormonal changes, or certain medications
• Local healing response becomes overactive → dense growth of blood vessels
• Classic feature: rapid growth, friable, bleeds easily
🧪 Causes & Triggers
• Minor skin trauma, cuts, friction
• Hormonal changes – especially pregnancy
• Medications: retinoids, protease inhibitors, some chemo agents
• Possibly associated with Staph aureus, though less clearly proven
👩⚕️ Who Gets It?
• Bimodal peak: young children (esp. age 6–7) and young women
• Common in pregnancy and in people with prior skin irritation
• Often linked to oral contraceptives
🔍 Clinical Features
• Bright red or reddish-brown nodule
• Common on fingers, face, lips, scalp, and oral mucosa
• Typically painless but bleeds easily
• Grows rapidly over days to weeks
• Polypoid or “mushroom-like” shape is typical
• May ulcerate or develop satellite lesions after trauma
⚠️ Differential Diagnoses
• Amelanotic melanoma – red, non-pigmented but malignant
• Squamous cell carcinoma, Kaposi’s sarcoma, angiosarcoma
• Hemangioma, bacillary angiomatosis, infected skin lesions
💡 Always biopsy if diagnosis is unclear or lesion is atypical
🧪 Diagnosis
• Primarily clinical, but biopsy is crucial to rule out malignancy
• Histology confirms lobular capillary growth
• Dermoscopy is less useful (too vascular, patternless)
• Always send lesion for histology if excised or treated
💊 Management
• Watch and wait if small, especially in pregnancy (often regress post-delivery)
• Excision or curettage + electrocautery preferred for tissue diagnosis + treatment
• Other options: cryotherapy, laser, topical beta blockers (e.g. timolol), imiquimod
• For large or bleeding lesions → surgical removal is best
• Avoid cryotherapy if histological confirmation needed
• Wound care and follow-up essential to monitor healing and recurrence
📈 Prognosis
• Excellent – completely benign
• Most respond well to treatment
• Recurrence common if base not fully treated (deep vascular roots)
• Lesions linked to pregnancy often resolve postnatally
⚠️ Complications
• Bleeding, ulceration
• Cosmetic concerns
• Local recurrence
• Rarely mistaken for malignant lesions
💡 MSRA Exam Tip
A red, fast-growing, bleeding nodule? Think pyogenic granuloma—but always rule out cancer.
🔬 Biopsy is essential in adults or atypical cases.
📚 Revision Resources
📝 Notes: https://www.passthemsra.com/topic/pyogenic-granuloma-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/pyogenic-granuloma-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/pyogenic-granuloma-accordion-qa-notes/
🧪 Rapid Quiz: https://www.passthemsra.com/topic/pyogenic-granuloma-rapid-quiz/
📘 Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
🏷️ Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAFlashcards #PyogenicGranuloma #MSRAExam #Dermatology #PassTheMSRA #MSRAQuiz #GPTraining
✅ MSRA Deep Dive: Pompholyx – Vesicles, Triggers, and Management
In this focused MSRA revision episode, we explore Pompholyx (also called dyshidrotic eczema), a distinct form of eczema that causes intensely itchy vesicles on the hands and feet. If you're revising dermatology, this one is high-yield. We break down everything from presentation and differentials to treatment and prognosis, following UK NICE-aligned content.
🧠 Key Learning Points
📌 Definition
• Pompholyx is a vesicular eczema primarily affecting palms, fingers, and soles
• Also known as dyshidrotic eczema, but not due to sweat gland blockage
• Name comes from Greek “pompholix” meaning “bubble”
📌 Pathophysiology
• Caused by inflammatory skin changes, not sweat retention
• Thought to involve skin barrier dysfunction, immune dysregulation, and environmental triggers
📌 Triggers
• Stress, heat, humidity, excessive handwashing, contact allergens, and irritants
• More common in people with atopic background (eczema, asthma, hay fever)
🔍 Clinical Features
• Sudden onset of small fluid-filled blisters (1–2mm vesicles) on sides of fingers, palms, or soles
• Severe itching or burning
• Lesions may burst, peel, or crust, leaving behind dry, cracked skin
• Flares typically last 3–4 weeks
• Nail changes (transverse ridges or pits) if inflammation involves nail matrix
🧠 Differential Diagnoses
• Pustular psoriasis (palmar/plantar)
• Tinea infections
• Contact dermatitis (allergic or irritant)
• Bullous impetigo, bullous pemphigoid, linear IgA disease
• Juvenile plantar dermatosis, erythema multiforme, herpes simplex, and fixed drug eruptions
📌 Key point: Always consider testing or referral if the clinical picture is unclear or resistant to treatment
🧪 Diagnosis
• Clinical diagnosis in most cases
• Investigations if atypical or recurrent:
• Bacterial swabs (if secondary infection suspected)
• Fungal scrapings or biopsy (to rule out tinea)
• Patch testing (for contact allergens)
• Bloods/HTLV1 only if suspecting rare T-cell lymphoma variant
💊 Management
🎯 First-line
• Emollients – restore skin barrier
• Topical corticosteroids – reduce inflammation
• Cold compresses, antihistamines (for itching)
• Avoidance of triggers (soaps, irritants, allergens)
🎯 Second-line
• Oral steroids (e.g. prednisolone) for short-term flare control
• Topical calcineurin inhibitors (tacrolimus/pimecrolimus)
• Phototherapy (UV light) for resistant cases
🎯 Severe/Refractory Cases
• Immunosuppressants: methotrexate, azathioprine, mycophenolate, cyclosporin
• Botulinum toxin (may help reduce sweat triggers)
• Allotretinoin (retinoid under specialist care)
• Drainage of tense bullae if painful
• Antibiotics if secondary infection develops
📈 Prognosis
• Usually chronic and relapsing
• Flares resolve in 3–4 weeks, but recurrences are common
• Quality of life often affected due to pain, itch, and disrupted sleep/work
• Secondary infection, lichenification, and post-inflammatory pigmentation may occur
• Prognosis generally good with trigger control and consistent treatment
🩺 MSRA Exam Tip
If you see itchy vesicles on hands/feet, think Pompholyx.
Don’t forget the misnomer: not caused by sweat ducts.
Differentiate from tinea, psoriasis, and contact dermatitis.
📚 MSRA Revision Resources
📝 Notes: https://www.passthemsra.com/topic/pompholyx-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/pompholyx-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/pompholyx-accordion-qa-notes/
🧪 Rapid Quiz: https://www.passthemsra.com/topic/pompholyx-rapid-quiz/
🎯 Full Quiz: https://www.passthemsra.com/quizzes/pompholyx/
📘 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
🏷️ Hashtags
#MSRA #MSRARevision #Pompholyx #DyshidroticEczema #MSRAPodcast #MSRAFlashcards #MSRAQuiz #PassTheMSRA #FreeMSRA #Dermatology
🩺 FREE MSRA PODCAST – Livedo Reticularis: The Clue Beneath the Skin
Get the high-yield facts on livedo reticularis: the net-like, purplish skin pattern that can be a signpost to something much deeper. Perfect for your MSRA revision.
Key Learning Points
🔎 Definition
• Livedo reticularis is a vascular pattern: mottled, net-like purplish discolouration of the skin
• Most visible on limbs, worsens with cold
⚖️ Causes
• Primary (idiopathic): Benign, no underlying disease
• Secondary: Linked to serious conditions (systemic lupus erythematosus, antiphospholipid syndrome, polyarteritis nodosa, cryoglobulinaemia, vasculitis, medications, cold, clotting disorders)
🧬 Pathophysiology
• Arteriolar constriction/sluggish blood flow leads to deoxygenated blood pooling in superficial venules
• Can be due to vessel spasm, inflammation, clots, or abnormal proteins blocking flow
🩺 Clinical Features
• Lace-like, purplish (sometimes reddish-blue) network on skin
• Symmetrical, most common on legs and arms
• Pattern accentuated by cold; may fade with warmth
• No pain/itch unless underlying disease
🧠 Mnemonic: “NET CLASP” for Causes
N: None (idiopathic)
E: Endocrine/autoimmune (SLE)
T: Thrombotic (APS)
C: Cold
L: Lupus/vasculitis
A: Antiphospholipid syndrome
S: Systemic diseases
P: Polyarteritis nodosa/Proteins (cryoglobulinaemia)
🧪 Differential Diagnoses
• Cutis marmorata (transient in infants)
• Acrocyanosis (bluish extremities, no net pattern)
• Livedoid vasculopathy (painful, ulcerative)
• Embolic phenomena (acute, localised changes)
🔬 Diagnosis
• Clinical examination of skin pattern
• Investigate for secondary causes if red flags: full blood count, autoantibodies (ANA, anti-dsDNA), clotting screen, inflammatory markers
• Skin biopsy if uncertain or systemic disease suspected
💊 Management
• Primary: Reassure, keep warm, protect from cold
• Secondary: Treat underlying cause—immunosuppression (e.g., for lupus/vasculitis), anticoagulation (for APS), supportive care
• Regular follow-up for systemic disease
⚠️ Complications
• Primary: Benign, cosmetic only
• Secondary: Depends on underlying condition—risk of ulceration, tissue damage, stroke or thrombosis (in APS), organ involvement (vasculitis, lupus)
📚 MSRA Revision Resources for Livedo Reticularis
📝 Revision Notes: https://www.passthemsra.com/topic/livedo-reticularis-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/livedo-reticularis-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/livedo-reticularis-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/livedo-reticularis-rapid-quiz/
🧪 Full Quiz: https://www.passthemsra.com/quizzes/livedo-reticularis/
🎓 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
🌐 For more free & premium revision resources:
https://www.passthemsra.com
#MSRA #LivedoReticularis #MSRARevision #DermatologyMSRA #Autoimmune #APS #Lupus #Vasculitis #PassTheMSRA #FreeMSRA #MSRAFlashcards
🧑⚕️ FREE MSRA PODCAST – Stevens-Johnson Syndrome (SJS): Emergency Recognition & Management
🔥 Your essential, high-yield crash course on SJS—perfect for the MSRA and real-life practice. Listen up for life-saving revision!
Key Learning Points
📌 Definition & Spectrum
• Stevens-Johnson Syndrome (SJS) is a rare but severe mucocutaneous reaction—most often to medications, sometimes infections
• Marked by blistering rash, widespread skin detachment, and mucosal involvement
• Part of the SJS-TEN spectrum (differentiated by % body surface area involved)
🚩 Causes & Risk Factors
• Drugs: Sulphonamides, anticonvulsants (carbamazepine, lamotrigine), allopurinol, NSAIDs
• Infections: Mycoplasma pneumoniae, herpes simplex, influenza (especially in children)
• Genetic predisposition (HLA alleles), HIV infection, previous SJS, immunosuppression
🩺 Clinical Features
• Prodrome: Fever, malaise, sore throat, then sudden widespread erythematous/purpuric rash
• Blistering and epidermal detachment, positive Nikolsky sign
• Severe, painful mucosal erosions: mouth, eyes, genitals
• Lesions start on trunk, spread to limbs, palms, soles
• May rapidly progress to multi-organ involvement
🧠 Mnemonic: SJS
S: Stop the drug immediately
J: Junctions (mucosal) involved
S: Sloughing of skin
🔬 Diagnosis & Classification
• Clinical diagnosis is key—history of new drug exposure or recent infection
• Biopsy confirms keratinocyte necrosis (for unclear cases or to rule out differentials)
• Classify:
SJS: <10% BSA
SJS/TEN overlap: 10–30% BSA
TEN: >30% BSA
⚡ Differential Diagnoses
• Toxic epidermal necrolysis (TEN)
• Erythema multiforme
• Bullous pemphigoid, pemphigus vulgaris
• Staphylococcal scalded skin syndrome (SSSS)
• Drug-induced rashes
🏥 Investigations
• FBC, U&Es, LFTs, CRP/ESR, coagulation, cultures
• Skin swabs, serology if infection suspected
• SCORTEN score predicts severity/mortality
💊 Management (UK/NICE)
• Immediate withdrawal of offending drug—non-negotiable
• Admit to ITU/burns unit for specialist supportive care
• IV fluids, wound care, analgesia, nutritional and eye support
• Monitor for sepsis, multi-organ failure
• Steroids/IVIG: Specialist advice only—controversial role
🌟 Prognosis & Complications
• Mortality: SJS 5–10%, TEN >30%
• Long-term: Skin scarring, pigment changes, strictures, chronic eye disease, blindness
• Acute: Sepsis, dehydration, respiratory failure, DIC, multi-organ failure
📎 More MSRA Revision for Stevens-Johnson Syndrome:
📝 Revision Notes: https://www.passthemsra.com/topic/stevens-johnson-syndrome-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/stevens-johnson-syndrome-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/stevens-johnson-syndrome-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/stevens-johnson-syndrome-rapid-quiz/
🧪 Full Quiz: https://www.passthemsra.com/quizzes/stevens-johnson-syndrome/
🎓 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
🌐 For more free & premium revision resources:
https://www.passthemsra.com
#MSRA #StevensJohnsonSyndrome #SJS #Dermatology #MSRARevision #MSRATextbook #PassTheMSRA #FreeMSRA #NikolskySign #TEN #MedicalEducation #MSRAFlashcards
⚕️ FREE MSRA PODCAST – Venous Ulcer
🎧 A high-yield breakdown of this common leg ulcer – caused by venous hypertension, key for MSRA and clinical practice.
🧠 Key Learning Points
📌 Definition
• Venous ulcers are chronic, shallow wounds that develop due to poor venous return and increased venous pressure in the lower limbs, especially around the medial malleolus.
📌 Causes & Risk Factors
• Chronic venous insufficiency
• Varicose veins
• Deep vein thrombosis (DVT)
• Prolonged standing/sitting
• Obesity
• Older age
• Leg injury or trauma
• Pregnancy
• Family history
💡 Mnemonic: VOLD-FLIP
Varicose veins, Obesity, Long-standing/sitting, DVT, Family history, Low calf pump, Impaired mobility, Pregnancy
📌 Pathophysiology
• Incompetent venous valves → retrograde flow → chronic venous hypertension
• Capillary leakage of fibrinogen → fibrin cuffing
• Impaired oxygen diffusion → tissue hypoxia
• Inflammation + poor healing → skin breakdown → ulcer
📌 Symptoms
• Shallow, irregular ulcers (typically gaiter region)
• Mild discomfort or painless ulcer
• Surrounding signs: haemosiderin pigmentation, venous eczema, atrophie blanche, oedema, lipodermatosclerosis
• Often bilateral or recurrent
📌 Differential Diagnosis
• Arterial ulcer – painful, punched-out, weak pulses
• Neuropathic ulcer – painless, plantar foot
• Pressure ulcer – over bony prominences
• Malignancy (Marjolin’s ulcer) – non-healing, rolled edges
• Vasculitis or RA-related ulcers
📌 Diagnosis
• Clinical – typical site + surrounding signs
• Must assess ABPI (Ankle-Brachial Pressure Index)
<0.8: contraindicates compression
1.3: suggests calcified arteries (e.g. diabetes) → false reading
• Consider: venous Doppler, biopsy (non-healing), ulcer swabs (if infected), patch testing (dermatitis)
📌 Management
• Compression therapy – gold standard for healing and preventing recurrence
• Debridement and wound dressings (e.g. foam, hydrocolloids)
• Topical steroids – for venous eczema
• Antibiotics – only if signs of infection
• Pentoxifylline 400mg TDS – for refractory ulcers
• Lifestyle: leg elevation, mobility, skin care
• Long-term compression hosiery (Class 2 or 3) post-healing
• Referral to vascular if ABPI <0.8, suspected malignancy, poor healing, or unusual site
📌 Complications
• Local infection, cellulitis
• Pain, delayed healing
• Psychological impact
• Malignant transformation (Marjolin’s ulcer)
• High recurrence if compression not maintained
📌 Prognosis
• ~45% heal within 6 months in community
• ~70% heal with specialist care
• Recurrence in 26–70%, especially if ulcer >1 year or large
• Poor prognostic signs: chronicity, large size, arterial disease, poor compliance
📎 More MSRA Resources for Venous Ulcer
📝 Revision Notes: https://www.passthemsra.com/topic/venous-ulcer-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/venous-ulcer-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/venous-ulcer-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/venous-ulcer-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialtyRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #VenousUlcer #Dermatology
🧑⚕️ FREE MSRA PODCAST – Lichen Planus: Mastering the Purple Pruritic Rash
🎯 A deep dive into lichen planus, one of the MSRA’s favourite inflammatory skin conditions—covering core facts, memorable mnemonics, diagnosis, management, and red flags.
Key Learning Points
🔍 Definition
• Lichen planus is a chronic, immune-mediated inflammatory disorder affecting the skin, mucous membranes, hair, and nails.
• Classic description: the “6 Ps”—Pruritic, Purple, Polygonal, Planar, Papules, and Plaques.
• Wickham striae: fine, white, lacy lines seen on the surface of papules and in the mouth.
💡 Causes & Risk Factors
• Precise cause unknown, but believed to be T-cell mediated autoimmunity.
• Strong associations: Hepatitis C infection (particularly oral LP), certain medications (e.g., NSAIDs, beta-blockers, thiazides), stress, and family history.
🧬 Pathophysiology
• CD8+ T-cell attack on basal keratinocytes in the skin and mucous membranes
• Triggers: drugs, viral infections, genetic susceptibility
🩺 Clinical Features
• Itchy, purple, flat-topped, polygonal papules—flexor wrists, forearms, shins, lumbar region
• Wickham striae: white, lacy lines (esp. in oral or genital mucosa)
• Oral/genital ulcers may be painful and chronic
• Nail changes: ridging, thinning, pterygium, or loss
• Scalp involvement: lichen planopilaris—patchy, permanent hair loss
• Post-inflammatory hyperpigmentation is common after lesions heal
📌 Mnemonic: The 6 Ps
• Pruritic (itchy)
• Purple
• Polygonal
• Planar
• Papules
• Plaques
📝 Differential Diagnoses
• Psoriasis
• Eczema
• Lichenoid drug eruptions
• Chronic eczema (simplex)
• Oral: Thrush, leukoplakia, oral lichenoid reaction
🔬 Diagnosis
• Clinical appearance often sufficient
• Skin or mucosal biopsy—shows “sawtooth” lymphocytic infiltrate, hypergranulosis, basal cell degeneration
• Test for hepatitis C if risk factors or oral involvement
💊 Management
• Remove any causative drug if identified
• First line: potent topical corticosteroids (with or without occlusion)
• For oral/genital LP: topical steroids (mouthwashes, pastes), local anaesthetics
• Widespread, severe, or resistant disease: systemic corticosteroids, immunosuppressants (azathioprine, mycophenolate), retinoids, phototherapy (UVB/PUVA)
• Antihistamines for pruritus
• Regular monitoring for oral/genital LP (risk of squamous cell carcinoma)
📈 Prognosis
• Cutaneous LP is often self-limiting (resolves in 1–2 years), but recurrences may occur
• Oral/genital LP: chronic, relapsing course, higher risk of persistent symptoms and malignant change
• Watch for post-inflammatory pigmentation, scarring (scalp/nails), or persistent discomfort
⚠️ Complications
• Malignant transformation (especially oral/genital LP; ~1% lifetime risk—higher with smoking, Hep C)
• Scarring, particularly on the scalp (permanent alopecia) or nails
• Persistent pain, ulceration, or impaired quality of life
📎 More MSRA Revision for Lichen Planus:
📝 Revision Notes: https://www.passthemsra.com/topic/lichen-planus-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/lichen-planus-flashcards/
🧠 Accordion Q&A: https://www.passthemsra.com/topic/lichen-planus-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/lichen-planus-rapid-quiz/
🧪 Full Quiz: https://www.passthemsra.com/quizzes/lichen-planus/
🎓 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
🌐 For the full premium revision toolkit:
https://www.passthemsra.com
#MSRA #LichenPlanus #Dermatology #MSRARevision #MSRAFlashcards #PassTheMSRA #FreeMSRA #MSRAExam #6Ps #WickhamStriae #SkinRash #OralLichenPlanus
✅ MSRA Deep Dive: Erythroderma (Exfoliative Dermatitis)
In this urgent episode, we unpack one of the most severe dermatological emergencies – erythroderma, also known as exfoliative dermatitis. Whether you're preparing for the MSRA or want to sharpen your clinical knowledge, this revision-focused discussion covers the must-know facts that could save lives.
🧠 Key Learning Points
📌 Definition
• Erythroderma is a severe, widespread inflammatory skin condition involving >90% of body surface area
• Marked by intense erythema, scaling, and systemic symptoms
• Often signals a deeper, underlying issue—it's not just "a skin rash"
📌 Causes
Erythroderma is a final common pathway for many conditions:
• Drug reactions (e.g. penicillins, sulfonamides, anticonvulsants, NSAIDs)
• Inflammatory dermatoses: psoriasis, eczema, contact dermatitis
• Infections: HIV, hepatitis, fungal infections
• Malignancy: cutaneous T-cell lymphoma, leukaemia
• Idiopathic (no clear cause in ~30%)
📌 Pathophysiology
• Involves skin barrier breakdown + widespread immune dysregulation
• Leads to massive fluid, protein, and heat loss, increased metabolic demand, and infection risk
• The body enters a vicious inflammatory cycle
🚩 High-Risk Groups
• Older adults
• Patients with chronic skin conditions (psoriasis, eczema)
• Immunocompromised individuals
• History of drug sensitivity or allergic reactions
🔍 Differential Diagnoses
Distinguish erythroderma from:
• Stevens-Johnson syndrome (SJS) / Toxic epidermal necrolysis (TEN) – mucosal involvement, blistering
• Pityriasis rubra pilaris (PRP)
• Severe seborrhoeic dermatitis
• Severe psoriasis
🩺 Clinical Features
• >90% body surface area red and inflamed
• Scaling, pruritus, warmth, tenderness
• Systemic symptoms: fever, chills, malaise
• Desquamation – sheets of skin may peel off
• Complications: dehydration, infection, hypothermia, electrolyte imbalance
🧪 Investigations
• History & Examination: medication changes, systemic signs, underlying dermatoses
• Skin biopsy: confirms diagnosis, rules out malignancy
• Blood tests: CBC, ESR, CRP, U&Es, LFTs
• Serology: HIV, hepatitis
• Cultures if infection suspected
🚨 Emergency Management
🧭 Hospitalisation
• For monitoring, fluid/electrolyte management, and rapid intervention
• Monitor vital signs, fluid balance, and risk of sepsis
💊 Treatment
• Stop offending drug immediately
• Supportive care: emollients, wet wraps, temperature regulation
• Topical steroids – often not enough alone
• Systemic corticosteroids – first-line in many cases
• Other immunosuppressants may be needed depending on cause
• Treat complications (infection, sepsis, organ failure) as they arise
📉 Prognosis
• Depends on underlying cause and speed of treatment
• Drug-induced cases with early withdrawal → better outcomes
• Malignancy-linked or severe cases → guarded prognosis
• Mortality rate 20–40% in severe presentations due to sepsis, fluid loss, organ failure
💥 Complications to Watch For
• Sepsis (from secondary skin infections)
• Electrolyte imbalance, dehydration, hypothermia
• ARDS (Acute Respiratory Distress Syndrome)
• Multi-organ failure
• Protein loss, nutritional deficiency
🎯 Key Exam Reminder
If >90% of the skin is red, itchy, scaling, and the patient is systemically unwell → think erythroderma and act fast. Investigate underlying cause, initiate supportive care, and hospitalise immediately.
📚 MSRA Dermatology Resources
📝 Revision Notes: https://www.passthemsra.com/topic/erythroderma-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/erythroderma-flashcards/
🧠 Q&A Notes: https://www.passthemsra.com/topic/erythroderma-accordion-qa-notes/
🎓 Full Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
🏷️ Hashtags
#MSRA #Erythroderma #DermEmergency #MSRAQuiz #MSRAFlashcards #MSRATextbook #ExfoliativeDermatitis #MSRARevision #PassTheMSRA #Dermatology
⚕️ FREE MSRA PODCAST – Urticaria (Hives)
🎧 A high-yield breakdown of this itchy, wheal-forming skin condition – crucial for exams and everyday clinical practice.
🧠 Key Learning Points
📌 Definition
• Urticaria (hives) is a transient, pruritic skin eruption characterised by raised, red or pale wheals that resolve within 24 hours.
• Angioedema may accompany it and involves deeper skin swelling.
📌 Causes & Risk Factors
• Allergic triggers – food, medications, insect stings
• Non-allergic – cold, heat, pressure, sunlight, vibration, stress
• Infections (especially viral), autoimmune diseases (e.g. thyroid)
• Chronic idiopathic urticaria – no identifiable cause
💡 Mnemonic: "PHYSICAL" – Pressure, Heat, Infection, Cold, Idiopathic, Autoimmune, Latex/drugs
📌 Pathophysiology
• Mast cell degranulation → histamine release
• Histamine → vasodilation + increased capillary permeability
• Results in fluid leakage → wheals + intense itching
• Angioedema = same process, but deeper tissues affected
📌 Symptoms
• Sudden onset of raised, itchy wheals (pink/red) with pale centres
• Lesions last <24 hours and move around
• Angioedema: deeper swelling of lips, eyelids, genitals
• Chronic urticaria: symptoms ≥6 weeks
📌 Differential Diagnosis
• Urticarial vasculitis (painful, persistent >24h, bruising)
• Dermatitis herpetiformis (coeliac-related itchy blisters)
• Eczema (dry, scaly, fixed)
• Bullous pemphigoid
• Polymorphic eruption of pregnancy
• Mastocytosis (urticaria pigmentosa)
📌 Diagnosis
• Primarily clinical – based on transient wheals + history
• Investigations guided by clinical suspicion
• Skin prick or IgE tests for suspected allergy
• Challenge tests for inducible types (e.g. ice for cold urticaria)
• Biopsy only if urticarial vasculitis suspected
📌 Management
• Identify and avoid triggers (physical, food, drugs, etc.)
• First-line: non-sedating H1 antihistamines (e.g. cetirizine, loratadine)
• Increase dose up to 4x for chronic urticaria if needed
• Short course of oral steroids for acute severe flares
• Second-line: montelukast, omalizumab (anti-IgE), or immunosuppressants in refractory cases
• Educate on avoidance of exacerbating factors: stress, alcohol, NSAIDs
📌 Complications
• Angioedema (esp. lips, eyelids, airway)
• Anaphylaxis in allergic urticaria – medical emergency
• Chronic symptoms → sleep disturbance, anxiety, depression
📌 Prognosis
• Acute urticaria usually self-limiting (resolves in days)
• Chronic urticaria: ~50% resolve within 3–5 years
• Persistent symptoms in ~20% after 10 years
• Poorer prognosis if associated with angioedema or autoimmune markers (e.g. antithyroid antibodies)
📎 More MSRA Resources for Urticaria
📝 Revision Notes: https://www.passthemsra.com/topic/urticaria-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/urticaria-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/urticaria-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/urticaria-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialtyRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #Urticaria #Dermatology
⚕️ FREE MSRA PODCAST – Toxic Epidermal Necrolysis
🎧 A clear, high-yield breakdown of this life-threatening blistering skin emergency – perfect for exam prep and rapid clinical recognition.
🧠 Key Learning Points
📌 Definition
• Toxic Epidermal Necrolysis (TEN) is a rare, severe mucocutaneous reaction, typically to medications, characterised by widespread epidermal necrosis and detachment affecting >30% of the body surface area.
• It’s the most extreme form of the SJS/TEN spectrum.
📌 Causes & Risk Factors
• Drugs are the most common trigger (90%+):
– Antibiotics (esp. sulphonamides)
– Anticonvulsants (e.g. carbamazepine, lamotrigine)
– NSAIDs (oxicam class)
– Allopurinol
• Other triggers:
– Mycoplasma pneumoniae, HSV
– HLA-B*1502 allele (esp. in East Asian populations)
– HIV, SLE, malignancy
– Recent vaccination or transplant
📌 Pathophysiology
• A delayed hypersensitivity reaction (Type IV)
• Immune activation → cytotoxic T cells release granulysin and perforin, destroying keratinocytes
• Results in full-thickness epidermal necrosis
📌 Symptoms
• Prodrome: flu-like illness (fever, sore throat, conjunctivitis)
• Mucosal involvement early (eyes, mouth, genitals)
• Rapidly spreading erythematous macules, then blisters and sloughing
• Positive Nikolsky’s sign – skin peels with lateral pressure
💡 Mnemonic: "Fever + Fragile skin + Facial mucosa"
📌 Differential Diagnosis
• Stevens-Johnson syndrome (SJS) – less skin involved
• Staphylococcal scalded skin syndrome (SSSS)
• Bullous pemphigoid / pemphigus vulgaris
• Burns
• Erythroderma, Toxic shock syndrome, Erythema multiforme
📌 Diagnosis
• Clinical diagnosis based on history and skin signs
• Skin biopsy: shows full-thickness epidermal necrosis
• Bloods: FBC, U&Es, LFTs, CRP – assess severity
• Cultures: screen for secondary infection
• Rule out SSSS and autoimmune blistering with biopsy + DIF
🧠 No specific blood test confirms TEN
📌 Management
• Stop causative drug immediately
• Admit to burns/ICU unit
• Supportive care:
– Fluid/electrolyte replacement
– Nutritional support (often NG feeds)
– Temperature regulation
– Skin care: non-adhesive dressings, barrier nursing
– Pain relief
• Controversial pharmacological therapies:
– IVIG, cyclosporin, TNF-α inhibitors (limited evidence)
– Steroids: debated
• Multidisciplinary care: dermatology, critical care, ophthalmology
📌 Complications
• Sepsis, pneumonia, renal failure, DIC
• Ocular complications (dry eye, scarring, blindness)
• Esophageal strictures, urogenital stenosis, joint contractures
• Psychological trauma, chronic pain
📌 Prognosis
• High mortality (up to 30–50%)
• SCORTEN score predicts mortality:
– Score ≥5 → ~90% mortality
• Prognosis depends on:
– BSA involvement
– Age, comorbidities
– Speed of recognition and referral
• Lifelong avoidance of causative drug is essential
📎 More MSRA Resources for Toxic Epidermal Necrolysis
📝 Revision Notes:
https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-revision-notes/
🧠 Flashcards:
https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-flashcards/
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-accordion-qa-notes/
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-rapid-quiz/
🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/toxic-epidermal-necrolysis/
🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/
🎓 This episode is part of the Dermatology for the MSRA course
Explore full revision guides, flashcards, quizzes, and more at:
👉 https://www.passthemsra.com
#MSRA #ToxicEpidermalNecrolysis #TEN #StevensJohnsonSyndrome #MSRATextbook #MSRARevision #MSRAQuiz #MSRAFlashcards #MSRAAccordions #MSRAPodcast #MSRAQandA #MSRAResources #MultiSpecialityRecruitmentAssessment #DermatologyForMSRA
⚕️ FREE MSRA PODCAST – Tinea (Ringworm)
🎧 A high-yield breakdown of this common fungal skin infection – perfect for exams and daily clinical practice.
🧠 Key Learning Points
📌 Definition
• Tinea (ringworm) is a superficial fungal infection caused by dermatophytes, affecting keratinised tissues: skin, hair, or nails.
• The name "ringworm" refers to the classic ring-shaped rash – no actual worms involved!
📌 Causes & Risk Factors
• Caused by dermatophyte fungi: Trichophyton, Microsporum, Epidermophyton
• Spread via direct contact (people, animals) or fomites (towels, combs, gym floors)
• Risk factors:
Warm, moist environments (e.g., communal showers)
Immunosuppression
Poor hygiene
Tight clothing
Children (especially Tinea capitis)
Afro-Caribbean children in urban UK areas → high-yield MSRA point
🧠 Mnemonic: “DAMP” – Direct contact, Animals, Moisture, Poor hygiene
📌 Pathophysiology
• Dermatophytes digest keratin → triggers inflammation
• Body reacts → erythema, scaling, itching
• Tinea capitis: infects hair shaft → brittle, black dot appearance
• Kerion: severe boggy inflammatory mass → urgent dermatology referral
📌 Symptoms
• Red, scaly, itchy patches
• May be ring-shaped (Tinea corporis)
• Tinea capitis: scaling + patchy alopecia, black dots, kerion
• Nail involvement: thick, brittle, discoloured nails
🧠 Mnemonic: “RING” – Redness, Itching, No hair (in scalp), Gritty nails
📌 Differential Diagnosis
• Alopecia areata (non-scaly)
• Seborrhoeic dermatitis
• Psoriasis (silvery plaques)
• Folliculitis
• Eczema
• Secondary syphilis (palms/soles + systemic)
• Id reaction (autoeczematisation)
📌 Diagnosis
• Clinical appearance + history
• Microscopy (KOH prep) – rapid confirmation
• Culture – slower but identifies fungal species
• Use scalp scrapings, plucked hairs, or toothbrush sampling
🧠 Tip: Keep samples at room temperature – refrigeration kills fungi!
📌 Management
• Topical antifungals (e.g., clotrimazole) for mild skin cases
• Oral antifungals (e.g., terbinafine, griseofulvin) for:
Tinea capitis
Nail involvement
Widespread/severe infections
• Tinea capitis:
Oral treatment is essential (fungus inside the hair shaft)
Add antifungal shampoo (e.g., ketoconazole) for 2 weeks to reduce transmission
Screen/treat close contacts & pets
• Urgent referral for kerion
• Reinforce hygiene: don’t share towels/hats, clean brushes
📌 Complications
• Secondary bacterial infection (cellulitis)
• Chronic skin changes
• Spread to other sites or contacts
• School outbreaks (esp. tinea capitis)
📌 Prognosis
• Excellent if treated
• Risk of recurrence if risk factors not addressed
• Carriers may shed spores without symptoms → contribute to transmission
📎 More MSRA Resources for Tinea
📝 Revision Notes: https://www.passthemsra.com/topic/tinea-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/tinea-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/tinea-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/tinea-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
#MSRA #MSRARevision #MSRATinea #MSRAFlashcards #MSRAQ&ANotes #MSRAQuiz #TineaCapitis #Ringworm #MSRADermatology #MSRAOnlineRevision #MSRAQuestionBank #MSRAAccordions
✅ MSRA Deep Dive: Strawberry Naevus (Infantile Haemangioma)
A must-know vascular condition for exams and clinical practice, this episode breaks down the high-yield essentials of strawberry naevus, also known as infantile haemangioma. Perfect for your revision toolkit, especially if you're preparing for the MSRA.
🧠 Key Learning Points
📌 Definition
• A benign vascular tumour in infancy
• Often appears as a bright red, raised, soft lesion resembling a strawberry
• Typically emerges after birth and follows a distinct growth and regression timeline
📌 Natural History
• Proliferative phase: Rapid growth for the first 9 months
• Involution phase: Slow regression over years, often resolving by age 5–10
• Most lesions require no treatment and resolve spontaneously
📌 Pathophysiology
• Caused by abnormal endothelial cell proliferation
• Exact cause is unknown but may involve genetics and hormones
• Thought to result from vascular malformation during fetal development
⚠️ Red Flags & Complications
• Lesions on the eyelid → risk of amblyopia (lazy eye)
• Lesions near airway/oral cavity → risk of breathing or feeding issues
• Midline back lesions → consider spinal dysraphism (e.g., occult spina bifida)
• >5 cutaneous lesions → screen for internal haemangiomas (especially liver)
• Ulceration, bleeding, and secondary infection are possible
• Rare associations:
– Kasabach-Merritt syndrome (platelet trapping, coagulopathy)
– PHACE syndrome (neurocutaneous syndrome with large facial haemangiomas)
📈 Risk Factors
• Female infants (3:1 ratio)
• Prematurity and low birth weight
• Caucasian ethnicity
• Family history
• Multiple gestation (e.g., twins)
• Chorionic villus sampling (CVS) during pregnancy
🔍 Clinical Features
• Appears within the first few weeks of life
• Raised, bright or deep red, compressible
• Common sites: head and neck (60%), trunk, limbs
• ~20% of cases present with multiple lesions
🧪 Diagnosis
• Clinical diagnosis based on appearance and evolution
• Imaging (e.g., ultrasound, MRI) only if:
– Atypical or deep lesion
– Functional impairment
– >5 cutaneous lesions (→ screen liver)
• Biopsy avoided unless diagnosis is unclear due to bleeding risk
💊 Management
✔️ Watchful waiting
• First-line for uncomplicated lesions due to natural regression
✔️ Active treatment indicated when:
• Vision, breathing, or feeding is threatened
• Disfigurement is likely (e.g., nose, lip)
• Lesion is ulcerated, painful, or infected
• Lesion grows very rapidly or causes psychological distress
✔️ First-line treatment:
• Oral propranolol – beta-blocker that promotes involution
• Topical timolol – for small, superficial lesions
✔️ Other options:
• Intralesional corticosteroids, interferon-alpha (rare)
• Surgical excision – for small lesions or post-involution correction
• Multidisciplinary care for life-threatening or complex cases
📊 Prognosis
• Excellent in the vast majority
• Most resolve fully by school age
• Some may leave minor cosmetic marks (e.g., telangiectasia, wrinkling)
• Early recognition and appropriate management reduce risks of complications
📚 Revision Resources
📝 Revision Notes: https://www.passthemsra.com/topic/strawberry-naevus-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/strawberry-naevus-flashcards/
🧠 Q&A Notes: https://www.passthemsra.com/topic/strawberry-naevus-accordion-qa-notes/
🧪 Rapid Quiz: https://www.passthemsra.com/topic/strawberry-naevus-rapid-quiz/
🎓 Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
🏷️ Hashtags
#MSRA #StrawberryNaevus #InfantileHaemangioma #MSRAFlashcards #MSRAQuiz #PassTheMSRA #MSRARevisionNotes #Dermatology #VascularTumour #Paediatrics
⚕️ FREE MSRA PODCAST – Squamous Cell Carcinoma (SCC)
🎧 A high-yield breakdown of this common but potentially serious skin cancer – essential for MSRA prep and clinical practice.
🧠 Key Learning Points
📌 Definition
• SCC is a malignant tumour of squamous cells in the epidermis.
• It is the second most common non-melanoma skin cancer and has metastatic potential.
📌 Causes & Risk Factors
• Chronic UV radiation exposure ☀️
• Fair skin, older age, male gender
• Immunosuppression (e.g. transplant patients, HIV)
• Chronic inflammation (old burns, scars, ulcers)
• Exposure to arsenic or past radiotherapy
• Premalignant lesions (actinic keratosis, Bowen’s disease)
• Genetic conditions (xeroderma pigmentosum, albinism)
💡 Mnemonic: "SUN BURN" – Sun, Ulcers, Neoplasia in situ (Bowen's), Burns, UV, Radiotherapy, Nevus (genetic)
📌 Pathophysiology
• UV-induced DNA mutations → dysregulated squamous cell growth
• Tumour invades dermis, then lymphatics or blood → local/distant spread
• Risk factors amplify mutation accumulation
📌 Symptoms
• Firm, red nodule or scaly ulcer that won’t heal
• Can bleed easily, ulcerate or crust over
• Typically found on sun-exposed areas: face, ears, lips, scalp, hands
• May arise from actinic keratosis or Bowen’s disease
📌 Differential Diagnosis
• Keratoacanthoma
• Basal cell carcinoma (pearly appearance)
• Amelanotic melanoma
• Actinic keratosis
• Pyogenic granuloma
• Warts or chronic verrucae (esp. periungual)
📌 Diagnosis
• Clinical suspicion + histological confirmation via biopsy
• Excisional or punch biopsy preferred
• Imaging (CT/MRI) if deep invasion suspected
• Always refer suspected cases via 2-week wait pathway
📌 Management
• Surgical excision with clear margins (4–6mm depending on size)
• Mohs surgery for high-risk or cosmetically sensitive areas
• Cryotherapy or curettage for superficial lesions
• Radiotherapy if surgery contraindicated
• Topical 5-FU or Imiquimod for SCC in situ (Bowen’s disease)
• MDT involvement for advanced or recurrent disease
📌 Complications
• Local invasion (e.g. lip, eye, cartilage, bone)
• Perineural spread (causing pain or numbness)
• Lymphatic or haematogenous metastasis (lungs, liver, brain)
• Cosmetic disfigurement, post-surgical scarring
📌 Prognosis
• Excellent with early diagnosis and complete excision
• Poorer outcomes if: lesion >20mm, depth >2–4mm, poor differentiation, perineural invasion, immunosuppressed, lip/ear site
• Most recurrences within first 2 years – regular follow-up vital
📎 More MSRA Resources for Squamous Cell Carcinoma
📝 Revision Notes: https://www.passthemsra.com/topic/squamous-cell-carcinoma-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/squamous-cell-carcinoma-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/squamous-cell-carcinoma-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/squamous-cell-carcinoma-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialtyRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #SquamousCellCarcinoma
⚕️ FREE MSRA PODCAST – Pemphigoid Gestationis
🎧 A clear, high-yield breakdown of this rare autoimmune blistering condition in pregnancy – perfect for exam prep and clinical diagnosis confidence.
🧠 Key Learning Points
📌 Definition
• Pemphigoid Gestationis (PG) is a rare autoimmune subepidermal blistering disorder that occurs during pregnancy, usually in the 2nd or 3rd trimester.
• It involves IgG1 autoantibodies attacking the basement membrane zone of the skin.
📌 Causes & Risk Factors
• Pregnancy-related immune shifts (autoimmune trigger)
• Linked to hydatidiform mole or choriocarcinoma
• HLA-DR3 and HLA-DR4 associations
• Family or personal history of autoimmune disease
🧠 Mnemonic: “GHOST” – Gestation, HLA-DR3/4, Onset late, Skin attack, Thyroid risk
📌 Pathophysiology
• IgG1 antibodies bind to antigens in the lamina lucida → activate complement (C3)
• Leads to inflammation and dermal-epidermal separation
• Creates subepidermal bullae
• Shares antigenic similarities with bullous pemphigoid
📌 Symptoms
• Severe pruritus – hallmark feature, often before rash
• Begins with urticarial plaques (esp. periumbilical) → evolves into tense blisters
• Spares face, palms, soles, and mucosa in most cases
• Often worsens postpartum, but resolves over weeks/months
• May recur with future pregnancies, OCPs or menstruation
📌 Differential Diagnosis
• PUPPP (more common, lacks blisters)
• Bullous pemphigoid
• Linear IgA dermatosis
• Dermatitis herpetiformis
• Pruritic folliculitis of pregnancy
• Erythema multiforme
📌 Diagnosis
• Clinical picture + skin biopsy (from lesion edge)
• Direct immunofluorescence (DIF): linear C3 deposits at basement membrane
• Indirect immunofluorescence (IDIF): circulating IgG autoantibodies (PG factor)
• HLA-typing (supportive, not diagnostic)
🧠 Tip: DIF = deposits in skin, IDIF = antibodies in blood
📌 Management
• Oral corticosteroids (prednisolone 0.5–1 mg/kg/day) – mainstay
• Antihistamines – symptomatic relief for pruritus
• Emollients for skin comfort
• Severe/resistant cases: consider plasmapheresis or immunoadsorption
• Multidisciplinary care: dermatologist + obstetrician + paediatrician
📌 Complications
• Preterm labour (~20%)
• Small-for-gestational-age (SGA) infants
• Neonatal blisters (5–10%): transient, due to maternal IgG crossing placenta
• Psychological distress, sleep disruption from pruritus
📌 Prognosis
• Self-limiting postpartum, but may recur in future pregnancies or hormonal shifts
• Increased lifelong risk of autoimmune disease (e.g. Graves’, Hashimoto’s, Pernicious anaemia)
• Important for long-term autoimmune screening and counselling
📎 More MSRA Resources for Pemphigoid Gestationis
📝 Revision Notes:
https://www.passthemsra.com/topic/pemphigoid-gestationis-revision-notes/
🧠 Flashcards:
https://www.passthemsra.com/topic/pemphigoid-gestationis-flashcards/
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/pemphigoid-gestationis-accordion-qa-notes/
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/pemphigoid-gestationis-rapid-quiz/
🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/pemphigoid-gestationis/
🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/
🎓 This episode is part of the Dermatology for the MSRA course
Explore full revision guides, flashcards, quizzes, and more at:
👉 https://www.passthemsra.com
#MSRA #PemphigoidGestationis #MSRARevision #MSRATextbook #MSRADermatology #MSRAQuiz #MSRAFlashcards #MSRAQandANotes #MSRAPodcast #MultiSpecialtyRecruitmentAssessment #MSRAOnlineRevision #DermatologyForMSRA
🎧 MSRA Deep Dive: Shingles – High-Yield Revision Essentials
Get exam-ready with this concise breakdown of shingles (herpes zoster) – covering pathophysiology, risk factors, red flags, and NICE-aligned management. Perfect for MSRA prep! 🧠
🧠 Core Learning Points
📌 Definition
• Reactivation of latent Varicella-Zoster Virus (VZV)
• Causes painful, unilateral, vesicular rash in a dermatomal pattern
• Commonly affects thoracic dermatomes or cranial nerves
📌 Pathophysiology
• After chickenpox, VZV lies dormant in sensory dorsal root ganglia
• Reactivation → virus travels along nerve → dermatomal rash
• Triggered by immunosuppression, age, stress
🧠 Mnemonic: “VIRUS” – VZV Reactivation In Unilateral Segment
📌 Risk Factors
• Age >50
• HIV (15x increased risk)
• Chemotherapy, immunosuppressants, long-term steroids
• Bone marrow transplant, lymphoma
• Stress
• Hx of chickenpox is a prerequisite
📌 Clinical Features
Prodrome (2–3 days):
– Burning/tingling pain
– Fever, malaise, local lymphadenopathy
Eruptive Phase:
– Red → vesicular → crusting rash in one dermatome
– Does not cross midline
– Lasts 2–4 weeks
– Ophthalmic zoster: affects eye – URGENT referral
Postherpetic Neuralgia (PHN):
– Pain lasting ≥30 days after rash resolves
– Risk ↑ with age
📌 Differentials
• HSV
• Contact dermatitis
• Eczema herpeticum
• Impetigo
• Insect bites
• Migraine/angina (if prodrome only)
📌 Infectivity & Transmission
• Shingles = not contagious as shingles
• VZV from blister fluid can cause chickenpox in non-immune individuals
• Avoid contact with:
– Pregnant women without immunity 🤰
– Neonates 👶
– Immunocompromised 💉
📌 Investigations
• Clinical diagnosis is usually sufficient
• Consider PCR of vesicle fluid if:
– Atypical features
– Immunocompromised patient
– Disseminated or severe disease
• IgM, Tzanck smear (older method) rarely used
• Eye involvement → urgent ophthalmology assessment
📌 Management (NICE/CKS aligned)
💊 Antivirals (start within 72h ideally):
• Aciclovir, valaciclovir, famciclovir
• Give to:
– Adults >50
– Immunocompromised
– Severe pain or non-truncal involvement
🕒 Start even after 72h if high-risk or ongoing vesicle formation
💥 Pain Relief
• 1st line: Paracetamol ± NSAIDs
• 2nd line: Amitriptyline, gabapentin, pregabalin, duloxetine
• Topical lidocaine patches may help
• Corticosteroids: reserved for severe acute pain (selected adults)
👁️ Referral Needed If:
• Ophthalmic zoster
• Immunocompromised
• Disseminated rash or complications
• Neurological signs (e.g., meningitis)
• Pregnant women
• PHN – consider pain clinic
📌 Complications
• PHN – burning nerve pain (up to 30% in older adults)
• Ophthalmic zoster – uveitis, keratitis, vision loss
• Ramsey Hunt syndrome – facial paralysis, ear pain, hearing loss
• Skin scarring, pigmentation
• Secondary infection
• Neurological – meningitis, encephalitis, myelitis
• Disseminated zoster – esp. in immunocompromised
📌 Prognosis
• Most recover in 2–4 weeks
• PHN may persist for months/years
• Early antiviral treatment = ↓ PHN risk
• Mortality rare – mainly in immunocompromised
📌 Vaccination
• Shingles vaccine (Shingrix) offered to older adults to reduce risk
• Chickenpox vaccine not routine in UK (due to theoretical effects on herd immunity)
📎 More Free MSRA Shingles Resources
📝 Revision Notes
https://www.passthemsra.com/topic/shingles-revision-notes/
🧠 Flashcards
https://www.passthemsra.com/topic/shingles-flashcards/
💬 Accordion Q&A Notes
https://www.passthemsra.com/topic/shingles-accordion-qa-notes/
🚀 Rapid Quiz
https://www.passthemsra.com/topic/shingles-rapid-quiz/
🧪 Topic Quiz
https://www.passthemsra.com/quizzes/shingles/
🎓 Dermatology Course
https://www.passthemsra.com/courses/dermatology-for-the-msra/
🔖 Hashtags
#MSRA #Shingles #DermatologyMSRA #MSRARevision #MSRAFlashcards #MSRAQuiz #VZV #HerpesZoster #PostherpeticNeuralgia
