MSRA Category: Dermatology

MSRA-0363

A 45-year-old man presents to the Emergency Department with a rash and feeling generally unwell. He has a history of epilepsy and recently started taking phenytoin three weeks ago. He developed mouth ulcers, malaise, and a cough about a week ago. Two days ago, he developed a widespread red rash that has now formed large fluid-filled blisters, covering approximately 30% of his body area. The lesions separate when slight pressure is applied. Upon examination, his temperature is 38.3ºC and pulse is 126/min. Blood results reveal:
Na+ 144 mmol/l
K+ 4.2 mmol/l
Bicarbonate 19 mmol/l
Urea 13.4 mmol/l
Creatinine 121 µmol/l
What is the most likely diagnosis?

MSRA-0364

A 35-year-old woman presents for review at her local general practice surgery. She has noticed a number of patches of pale skin on her hands over the past few weeks. The patient has tried using emollients and topical clotrimazole with no result.
On examination, a number of depigmented patches on the dorsum of both hands are noted. Her past medical history includes thyrotoxicosis for which she takes carbimazole and thyroxine.
Given the likely diagnosis, which of the following is most appropriate before starting treatment?
Select the SINGLE best option from the list below.
Select ONE option only.

MSRA-0365

A 45-year-old woman presents to the Dermatology Clinic for regular follow-up of her psoriasis. This had previously been well controlled after phototherapy six months ago; however, she has recently deteriorated.
Her current treatment regime includes topical calcipotriol (Dovonex), topical coal tar ointment and topical hydromol ointment, in addition to amoxicillin for a recent respiratory infection. She is otherwise fit and well.
On examination, she has an erythematous rash covering much of her back, with widespread patches on her arms and legs. The rash is tender and warm, though she appears to be shivering. There are no oral lesions. Her pulse is 98 beats per minute, while her blood pressure (BP) is 95/50 mmHg and her temperature is 38.2 °C.
What is the most important next step in this woman’s treatment?

MSRA-0366

A 67-year-old woman comes to her General Practitioner complaining of severe mucosal ulceration and blistering lesions on her torso and arms. Upon examination, the blisters are flaccid and rupture easily upon contact. What is the most appropriate course of action for this likely diagnosis? Choose the BEST management option from the list below.

MSRA-0367

A 60-year-old woman comes to the doctor’s office with concerns about small spots on her shoulder. She reports that the lesions are accompanied by several tiny blood vessels that radiate from the center. During the examination, you observe that applying pressure to the spots causes them to turn white and then refill from the center. What condition is typically associated with this type of lesion?

MSRA-0368

A 62-year-old man visits his primary care physician with worries about a growth on his right lower eyelid. The lesion has been there for at least 3 months and has not increased in size. During examination, you observe a 3 mm lesion with rolled, pearly edges. Your suspicion is a basal cell carcinoma.
What would be the best course of action for management?

MSRA-0369

You are examining a 7-month-old infant who has a capillary haemangioma located on the right cheek that is beginning to interfere with their vision. Following a conversation with the parents, you have decided to initiate treatment for this area due to the potential impact on eyesight.

What is the primary treatment option for capillary haemangioma?

MSRA-0370

A 27-year-old female presents to a dermatology appointment with several new scaly plaques on her scalp that are causing itching and redness, especially around the occipital region. She has a past medical history of chronic plaque psoriasis that is typically managed well with topical treatment and emollients. The dermatologist confirms a diagnosis of scalp psoriasis. What is the best course of action for treating her recent diagnosis?

MSRA-0371

A 28 year-old carpenter complains of itchy and painful skin on his hands and wrists. He suspects that it might be due to something he is exposed to at work. What test would be most appropriate to investigate this hypothesis?

MSRA-0372

You are examining a 65-year-old individual with acanthosis nigricans. You suggest screening for diabetes. Due to the widespread skin alterations, including some oral changes, what other potential underlying condition should be taken into account?