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Question 1
Correct
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A 14 year old girl presented with complaints of acne vulgaris over her face. The acne is exacerbated during her menstrual period. The most appropriate treatment option would be?
Your Answer: Topical benzoyl peroxide
Explanation:Topical benzoyl peroxide is used for the treatment of mild to moderate acne vulgaris. It is actually a peeling agent and it clears the pores and reduces the bacterial cell count.
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This question is part of the following fields:
- Dermatology
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Question 2
Correct
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All of the following are associated with yellow nail syndrome except:
Your Answer: Cardiomegaly
Explanation:Yellow nail syndrome is a very rare medical syndrome that includes pleural effusions, lymphedema (due to under development of the lymphatic vessels) and yellow dystrophic nails. Approximately 40% will also have bronchiectasis. It is also associated with chronic sinusitis and persistent coughing and it usually affects adults.
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This question is part of the following fields:
- Dermatology
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Question 3
Correct
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Which of the following is NOT a cause of onycholysis?
Your Answer: Mycoplasma pneumonia
Explanation:Onycholysis is the separation of the distal edge of the nail from the vascular nailbed causing whiteness of the free edge. Causes include:
– Idiopathic
– Trauma, excessive manicuring
– Infection: especially fungal
– Skin disease: psoriasis, dermatitis
– Impaired peripheral circulation e.g. Raynaud’s
– Systemic disease: hyper/hypothyroidism, reactive arthritis, porphyria cutanea tarda
– Sometimes a reaction to detergents (e.g. washing dishes with bare hands, using detergent-based shampoos or soaps).
– Patients with hepatocellular dysfunction may develop hair-thinning or hair loss and nail changes such as clubbing, leukonychia (whitening), or onycholysis. -
This question is part of the following fields:
- Dermatology
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Question 4
Correct
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Which is NOT a poor prognostic factor for patients with malignant melanoma?
Your Answer: Diameter of melanoma > 6 mm
Explanation:Features that affect prognosis are tumour thickness in millimetres (Breslow’s depth – the deeper the Breslow thickness the poorer the prognosis.), depth related to skin structures (Clark level – the level of invasion through the dermis), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumour-infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis. Malignant melanoma tends to grow radially before entering a vertical growth phase. The diameter it reaches has not been found to be a prognostic factor.
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This question is part of the following fields:
- Dermatology
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Question 5
Correct
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A 70 year old male presents with an ulcer between his toes - it has a punched-out appearance. He is known to both smoke and drinks heavily. Upon examination, the ulcer is yellow in colour. His foot also turns red when it hangs from the bed. From the list given, choose the single most likely diagnosis for this patient.
Your Answer: Arterial ischemia ulcer
Explanation:Arterial ischemia ulcers present with many of the symptoms observed in this patient: ulcer on the lower extremities, pain, swelling, yellow sores, a punched-out appearance, the foot turning red when dangling from a bed. Smoking a lot is also known to be a causative factor here. This type of ulcer develops due to damage to the arteries caused by a lack of blood flow to the tissue – they are also deep wounds. Venous ischemic ulcers usually form in the knee or inner ankle area as opposed to the foot.
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This question is part of the following fields:
- Dermatology
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Question 6
Correct
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Which of the following skin conditions is not associated with diabetes mellitus?
Your Answer: Sweet's syndrome
Explanation:Diabetic dermadromes constitute a group of cutaneous conditions commonly seen in people with diabetes with longstanding disease. Conditions included in this group are:
– Acral dry gangrene
– Carotenosis
– Diabetic dermopathy
– Diabetic bulla
– Diabetic cheiroarthropathy
– Malum perforans
– Necrobiosis lipoidica
– Limited joint mobility
– Scleroderma
– Waxy skin is observed in roughly 50%.Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia. It is not associated with diabetes mellitus.
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This question is part of the following fields:
- Dermatology
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Question 7
Correct
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A 72-year-old female presents with tiredness and weakness. On examination, she is pale and has a haemoglobin of 72 g/L with an MCV of 68 fL. Which nail changes may be seen in association with this patient's condition?
Your Answer: Koilonychia
Explanation:Koilonychia, known as spoon nails, is a condition of the nails bending inwards, taking the shape of a spoon. This is a strong indication of iron-deficiency anaemia (IDA). The rest of the patient’s symptoms further indicate IDA.
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This question is part of the following fields:
- Dermatology
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Question 8
Correct
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Which one of these features is typical of dermatomyositis?
Your Answer: Gottron's papules over knuckles of fingers
Explanation:Dermatomyositis is a long-term inflammatory disorder which affects muscles. Its symptoms are generally a skin rash and worsening muscle weakness in the proximal muscles (for example, the shoulders and thighs) over time. These may occur suddenly or develop over months. Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity. Complications may include calcium deposits in muscles or skin.
The skin rash may manifest as aheliotrope (a purplish color) or lilac, but may also be red. It can occur around the eyes along with swelling, as well as the upper chest or back ( shawl sign) or V-sign above the breasts and may also occur on the face, upper arms, thighs, or hands. Another form the rash takes is called Gottron’s sign which are red or violet, sometimes scaly, slightly raised papules that erupt on any of the finger joints (the metacarpophalangeal joints or the interphalangeal joints) -
This question is part of the following fields:
- Dermatology
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Question 9
Correct
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A 52-year-old man has squamous-cell carcinoma of his lower lip. Which of the following is most likely to be a feature of this type of carcinoma?
Your Answer: It is capable of metastasising via the lymphatics
Explanation:Squamous-cell skin cancer usually presents as a hard lump with a scaly top but can also form an ulcer. Onset is often over months and it is more likely to spread to distant areas than basal cell cancer vie the lymphatics. The greatest risk factor is high total exposure to ultraviolet radiation from the Sun. Other risks include prior scars, chronic wounds, actinic keratosis, lighter skin, Bowen’s disease, arsenic exposure, radiation therapy, poor immune system function, previous basal cell carcinoma, and HPV infection. While prognosis is usually good, if distant spread occurs five-year survival is ,34%
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This question is part of the following fields:
- Dermatology
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Question 10
Correct
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A 9-year-old girl complains of perioral blisters and a burning sensation of her face. Some of the blisters are crusted and some are weeping. What is the most likely diagnosis?
Your Answer: Impetigo
Explanation:Impetigo appears more commonly on the face than other exposed areas like the limbs. Its blisters are clustered and may have a fluid discharge.
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This question is part of the following fields:
- Dermatology
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Question 11
Correct
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A neonate was brought in by her mother, for a skin lesion present over the neonate's back which is bluish in colour, but otherwise asymptomatic. The most appropriate course of action will be?
Your Answer: Reassure
Explanation:A Mongolian spot can be present in new born babies which usually appears over the back and fades with time. There is nothing to worry about.
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This question is part of the following fields:
- Dermatology
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Question 12
Correct
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How would you advise your patient to apply an emollient and a steroid cream, in order to treat her eczema?
Your Answer: First use emollient then steroids.
Explanation:If steroid is applied first, applying an emollient after could spread it from where it had been applied. If steroid is applied immediately after the emollient then it cannot be absorbed, this is why there should be a time interval of around thirty minutes between these two treatments in order for them to be effective.
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This question is part of the following fields:
- Dermatology
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Question 13
Incorrect
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A 4 year old child was brought in by his mother with complaints of vesicular eruption over his palms, soles and oral mucosa for the last 5 days. He was slightly febrile. There were no other signs. The most likely causative organism in this case would be?
Your Answer: Cytomegalovirus
Correct Answer: Coxsackie
Explanation:This patient is most likely suffering from hand, foot mouth disease which is caused by coxsackie virus A16. Its incubation period ranges from 5-7 days and only symptomatic treatment is required.
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This question is part of the following fields:
- Dermatology
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Question 14
Correct
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Which of the following involving the scalp may produce alopecia (hair loss)?
Your Answer: Discoid lupus erythematosus
Explanation:Infective causes of hair loss include:
Dissecting cellulitis
Fungal infections (such as tinea capitis)
Folliculitis
Secondary syphilis
Demodex folliculorum
Lupus erythematosus (hair loss may be permanent due to scarring of the hair follicles).
Psoriasis and seborrheic dermatitis commonly involve the scalp but do not produce hair loss. -
This question is part of the following fields:
- Dermatology
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Question 15
Correct
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Which of the following is FALSE with regards to vitiligo?
Your Answer: A positive family history is not a risk factor
Explanation:The cause of Vitiligo is typically unknown. It is believed to be due to genetic susceptibility that is triggered by an environmental factor such that an autoimmune disease occurs. This results in the destruction of skin pigment cells. Risk factors include a family history of the condition or other autoimmune diseases, such as hyperthyroidism, alopecia areata, and pernicious anaemia. Vitiligo is classified into two main types: segmental and non-segmental. Most cases are non-segmental meaning they affect both sides and typically get worse with time. The prevalence of vitiligo is 0.5-1% of populations worldwide. Typical sites include backs of hands, wrists, knees, neck and around body orifices. The Koebner phenomenon refers to skin lesions appearing on lines of trauma. This occurs in vitiligo secondary to scratching.
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This question is part of the following fields:
- Dermatology
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Question 16
Correct
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A 32 year old man presents with blistering and hyperpigmentation on his face and hands, after a beach holiday with friends. Tests reveal high levels of uroporphyrinogen in the urine. The most likely diagnosis is:
Your Answer: Porphyria cutanea tarda
Explanation:Porphyria cutanea tarda (PCT) is the most common of the porphyries. It is characterised by fragility and blistering of exposed skin. Typically, patients who are ultimately diagnosed with PCT first seek treatment following the development photosensitivities in the form of blisters and erosions on commonly exposed areas of the skin. This is usually observed in the face, hands, forearms, and lower legs. It heals slowly and with scarring. Though blisters are the most common skin manifestations of PCT, other skin manifestations like hyperpigmentation (as if they are getting a tan) and hypertrichosis (mainly on top of the cheeks) also occur. Risk factors for the development of PCT include alcohol and sun.
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This question is part of the following fields:
- Dermatology
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Question 17
Correct
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A 72-year-old with varicose veins complains of swollen, red, itchy legs. Which is the most likely diagnosis?
Your Answer: Varicose eczema
Explanation:Varicose eczema is a common problem, particularly in elderly patients due to stasis or blood pooling from insufficient venous return; the alternative name of varicose eczema comes from a common cause of this being varicose veins. It is often mistaken for cellulitis, but cellulitis is rarely bilateral and is painful rather than itchy.
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This question is part of the following fields:
- Dermatology
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Question 18
Correct
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A 54 year old gentleman presented with a 3 month history of a nodular growth over the dorsum of the his nose, about 0.6 cm in size. The base of nodule is slightly ulcerated and its margins are raised. The most likely diagnosis would be?
Your Answer: Basal cell carcinoma
Explanation:Basal cell carcinoma is usually located on sun exposed sites. It has got many variants and clinically it presents as a slow growing mass/nodule with rolled margins and an ulcerated base.
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This question is part of the following fields:
- Dermatology
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Question 19
Correct
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A 35 year old patient presented with a cough, wheezing and difficulty in breathing which wakes him up in the night. He also has a itchy, dry and scaly skin rash. Which of the following is the most probable diagnosis?
Your Answer: Eczema
Explanation:The skin lesion is most probably eczema. It is common among atopic people. Asthma is a common association.
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This question is part of the following fields:
- Dermatology
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Question 20
Correct
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Which of the following conditions is least likely to exhibit the Koebner phenomenon?
Your Answer: Lupus vulgaris
Explanation:The Koebner phenomenon refers to skin lesions appearing on lines of trauma, exposure to a causative agents including: molluscum contagiosum, warts and toxicodendron dermatitis or secondary to scratching rather than an infective or chemical cause include vitiligo, psoriasis, lichen planus, lichen nitidus, pityriasis rubra pilaris, and keratosis follicularis (Darier disease).
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This question is part of the following fields:
- Dermatology
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Question 21
Correct
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An 18 year old boy from Middle East presented with a 1 month history of a yellowish, crusted plaque over his scalp, along with some scarring alopecia. What will the likely diagnosis be?
Your Answer: Favus
Explanation:Favus is a fungal infection of the scalp, resulting in the formation of a yellowish crusted plaque over the scalp and leads to scar formation with alopecia. Tinea capitus is a fungal infection of the scalp resulting in scaling and non scarring hair loss. Folliculitis presents with multiple perifollicular papules which can be caused by both bacteria and fungi. Cradle cap usually affects infants where the whole scalp is involved. It can lead to hair loss and responds to topical antifungals and keratolytics.
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This question is part of the following fields:
- Dermatology
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Question 22
Correct
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A 38-year-old woman has a melanocytic naevi on her left forearm. Which of the following features do not suggest malignant change?
Your Answer: Decrease in size
Explanation:Melanocytic nevi are benign neoplasms or hamartomas composed of melanocytes. Melanocytes are derived from the neural crest and migrate during embryogenesis to selected ectodermal sites (primarily the skin and the CNS), but also to the eyes and the ears.
They tend to appear during early childhood and during the first 30 years of life. They may change slowly, becoming raised, changing color or gradually fading.. Pregnancy can increase the number of naevi as well as the degree of hyperpigmentation.
They may become malignant and this should be suspected if the naevus increases in size, develops an irregular surface or becomes darker, itches or bleeds. -
This question is part of the following fields:
- Dermatology
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Question 23
Incorrect
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Which one of the following interventions has the least role in management of acne rosacea?
Your Answer: Topical metronidazole
Correct Answer: Low-dose topical corticosteroids
Explanation:Mild cases are often not treated at all, or are simply covered up with normal cosmetics and avoiding sun exposure. Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions. The two primary modalities of rosacea treatment are topical and oral antibiotic agents (including metronidazole and tetracyclines). Laser therapy may be appropriate for patients with prominent telangiectasia.
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This question is part of the following fields:
- Dermatology
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Question 24
Correct
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Which of the following nail changes are present in ulcerative colitis?
Your Answer: Clubbing
Explanation:Clubbing of the fingers can be present in many clinical conditions like CLD, bronchiectasis, lung abscess, Ulcerative colitis and Crohn’s Disease.
Koilonychia or spoon shaped nails are a typical finding in iron deficiency anaemia.
Splinter haemorrhages are pin point haemorrhages found in infective endocarditis and secondary to trauma.
Yellow nails are present in pulmonary and renal disease.
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This question is part of the following fields:
- Dermatology
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Question 25
Correct
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Which of the following statements regarding psoriasis is incorrect?
Your Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease characterized by patches of skin typically red, dry, itchy, and scaly. Psoriasis can affect the nails and produces a variety of changes in the appearance of finger and toe nails including pitting and onycholysis. Nail psoriasis occurs in 40–45% of people with psoriasis affecting the skin and has a lifetime incidence of 80–90% in those with psoriatic arthritis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response.
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This question is part of the following fields:
- Dermatology
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Question 26
Correct
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A 24-year-old female presents with generalised irritation and erythematous skin after sunbathing on the beach. Which is the most appropriate immediate treatment for this patient?
Your Answer: Emollient cream
Explanation:Sun burn reactions usually occur after individuals with a light skin tone have prolonged exposure to the sun. The usual symptoms are redness and itching of the skin. The best treatment plan would be further avoidance of sun exposure and the topical application of emollients. These are Ist degree burns and aggressive therapy is not required in such cases.
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This question is part of the following fields:
- Dermatology
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Question 27
Correct
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A 35 year old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?
Your Answer: Leishmaniasis
Explanation:The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.
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This question is part of the following fields:
- Dermatology
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Question 28
Correct
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A 21-year-old woman presents with painful vesicles in her right ear and a fever for some time. What is the most probable diagnosis?
Your Answer: Herpes zoster
Explanation:Herpes zoster oticus is a viral infection of the inner, middle, and external ear. It manifests as severe otalgia with associated cutaneous vesicular eruption, usually of the external canal and pinna. When associated with facial paralysis, the infection is called Ramsay Hunt syndrome.
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This question is part of the following fields:
- Dermatology
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Question 29
Correct
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Which one of the following is least associated with photosensitivity?
Your Answer: Acute intermittent porphyria
Explanation:Sunlight, especially its ultraviolet radiation component, can cause increased or additional types of damage in predisposed individuals, such as those taking certain phototoxic drugs, or those with certain conditions associated with photosensitivity, including:
– Psoriasis
– Atopic eczema
– Erythema multiforme
– Seborrheic dermatitis
– Autoimmune bullous diseases (immunobullous diseases)
– Mycosis fungoides
– Smith–Lemli–Opitz syndrome
– Porphyria cutanea tarda
Also, many conditions are aggravated by strong light, including:
– Systemic lupus erythematosus
– Sjögren’s syndrome
– Sinear Usher syndrome
– Rosacea
– Dermatomyositis
– Darier’s disease
– Kindler-Weary syndrome
Acute intermittent porphyria (AIP) belongs to the group inborn errors of metabolism and most patients with AIP are not light sensitive. -
This question is part of the following fields:
- Dermatology
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Question 30
Incorrect
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Which features may suggest malignant changes in a melanocytic naevi?
Your Answer: Irregularity of surface
Correct Answer: Decrease in size
Explanation:Melanocytic naevi are skin tumours produced by melanocytes. They usually present in childhood but increase during puberty. The mnemonic A-B-C-D, is used by institutions to assess for suspicion of malignancy. The letters stand for asymmetry, border, colour, and diameter. If a mole starts changing in size, colour, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include if it begins to crust over, bleed, itch, or become inflamed.
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This question is part of the following fields:
- Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
