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  • Question 1 - A 25-year-old man without prior history of skin issues comes in with severe...

    Correct

    • A 25-year-old man without prior history of skin issues comes in with severe itching that worsens at night. The rash is made up of small, red, extremely itchy bumps on the limbs and torso. His girlfriend is also experiencing itching. Upon closer examination of his skin, what finding would most likely confirm the diagnosis?

      Your Answer: Burrows

      Explanation:

      Understanding Scabies: Symptoms and Characteristics

      Scabies is a skin condition caused by the infestation of the mite Sarcoptes scabiei, variety hominis. The female mite burrows into the skin, creating characteristic lesions known as burrows. However, the absence of burrows does not rule out a diagnosis of scabies. Other symptoms include erythema, or redness and scaling of the skin, and excoriations, or skin abrasions caused by scratching. In severe cases, crusting patches may develop, particularly in crusted scabies, a highly contagious variant of the condition. Prurigo nodules, or small bumps on the skin, may also occur in scabies, especially in young children. It is important to seek medical attention if you suspect you have scabies, as prompt treatment can prevent the spread of the condition.

    • This question is part of the following fields:

      • Dermatology
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  • Question 2 - A 35-year-old female patient complains of erythematous papulo-pustular lesions on the convexities of...

    Correct

    • A 35-year-old female patient complains of erythematous papulo-pustular lesions on the convexities of her face for the past two years. She also has a history of erythema and telangiectasia. What is the most probable diagnosis for this patient?

      Your Answer: Rosacea

      Explanation:

      Differentiating Skin Conditions

      Skin conditions can be easily differentiated based on their characteristic symptoms. Acne is identified by the presence of papules, pustules, and comedones. On the other hand, systemic lupus erythematosus (SLE) is characterized by a photosensitive erythematosus rash on the cheeks, along with other systemic symptoms. Meanwhile, polymorphous light eruption (PLE) does not cause telangiectasia.

      One telltale sign of acne is the presence of papules, pustules, and comedones. These are often accompanied by background erythema and telangiectasia. In contrast, SLE is identified by a photosensitive erythematosus rash on the cheeks, which may be accompanied by other systemic symptoms. PLE, on the other hand, does not cause telangiectasia. By the unique symptoms of each skin condition, healthcare professionals can accurately diagnose and treat their patients.

    • This question is part of the following fields:

      • Dermatology
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  • Question 3 - Which therapy is unsuitable for the given condition? ...

    Incorrect

    • Which therapy is unsuitable for the given condition?

      Your Answer: Coal tar for psoriasis

      Correct Answer: Surgical excision for a cavernous haemangioma 3 cm × 4 cm on the arm

      Explanation:

      Cavernous Haemangiomas and Alopecia Areata: Conditions and Treatment Options

      Cavernous haemangiomas are benign growths that typically appear within the first two weeks of life. They are usually found on the face, neck, or trunk and are well-defined and lobulated. Surgical excision is not recommended, but treatment may be necessary if the growths inhibit normal development, such as obstructing vision in one eye. Treatment options include systemic or local steroids, sclerosants, interferon, or laser treatment.

      Alopecia areata is an autoimmune condition that causes hair loss in discrete areas. Treatment options include cortisone injections into the affected areas and the use of topical cortisone creams. It is important to note that both conditions require medical attention and treatment to prevent further complications. With proper care and treatment, individuals with cavernous haemangiomas and alopecia areata can manage their conditions and improve their quality of life.

    • This question is part of the following fields:

      • Dermatology
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  • Question 4 - A 6-year-old girl with known coeliac disease develops a symmetrical prurigo with numerous...

    Incorrect

    • A 6-year-old girl with known coeliac disease develops a symmetrical prurigo with numerous vesicles on her shoulders, back, and buttocks. She is also currently experiencing several mouth ulcers.
      What is the probable diagnosis for her skin rash?

      Your Answer: Eczema pompholyx

      Correct Answer: Dermatitis herpetiformis

      Explanation:

      Common Skin Conditions: Symptoms and Treatments

      Dermatitis herpetiformis is a rare skin condition that is linked to gluten sensitivity. It causes clusters of blisters to appear symmetrically on the scalp, shoulders, buttocks, elbows, and knees. Treatment involves a gluten-free diet and medication to reduce itching.

      Atopic dermatitis, also known as eczema, is a chronic and itchy skin condition that is very common. It can appear anywhere on the body and is often treated with topical steroids and moisturizers.

      Seborrheic dermatitis is a chronic form of eczema that mainly affects the scalp and face. It causes redness, itching, and flaking of the skin. Treatment involves medicated shampoos and topical creams.

      Guttate psoriasis is a type of psoriasis that causes small, teardrop-shaped plaques all over the body. It often follows a streptococcal throat infection and is treated with topical steroids and phototherapy.

      Eczema pompholyx, also known as hand/foot eczema, is characterized by blisters on the hands and feet. Treatment involves avoiding irritants and using topical steroids and moisturizers.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - A 28-year-old accountant is referred to Dermatology after developing some patches of hypopigmentation....

    Correct

    • A 28-year-old accountant is referred to Dermatology after developing some patches of hypopigmentation. The patient reports a 2-month history of patchy areas of discolouration over her chest and back. She is feeling extremely distressed and self-conscious about these areas. The patient has stopped going to the beach due to the lesions, which she previously enjoyed.

      During examination, the patient has multiple patches of flaky, discoloured hypopigmented lesions distributed over the chest and back.

      What is the most likely cause of hypopigmented skin in this case?

      Your Answer: Pityriasis versicolor

      Explanation:

      Skin Conditions and Pigmentation Changes

      Pigmentation changes in the skin can be caused by various factors, including skin conditions and hormonal imbalances. Here are some examples:

      Pityriasis versicolor: This common skin complaint is characterized by flaky, discoloured, hypopigmented patches that mainly appear on the chest and back. It is caused by the overgrowth of a yeast called Malassezia furfur.

      Whipple’s disease: This rare bacterial infection can cause hyperpigmentation in some cases.

      High oestriol: Elevated levels of this hormone, which can occur during pregnancy, are associated with hyperpigmentation.

      Neurofibromatosis type I: This genetic disorder causes numerous café-au-lait patches, which are hyperpigmented patches.

      Urticaria pigmentosa: This condition, which typically develops in childhood, causes hyperpigmented patches that usually fade by the teenage years.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - A 35-year-old recently arrived female with several skin blisters comes in for assessment....

    Incorrect

    • A 35-year-old recently arrived female with several skin blisters comes in for assessment. A few of the blisters have burst, resulting in a sore, exposed region. The base of one of the erosive lesions is scraped for Tzanck test. Upon examination, acantholytic keratinocytes with significant hyperchromatic nuclei are detected under the microscope.

      What is the probable diagnosis?

      Your Answer: Chickenpox

      Correct Answer: Pemphigus vulgaris

      Explanation:

      Distinguishing Skin Conditions on Tzanck Smear: Pemphigus Vulgaris, Cytomegalovirus, Herpes Simplex, Chickenpox, and Bullous Pemphigoid

      When examining a patient’s bullous skin lesions on a Tzanck smear, it is important to distinguish between various skin conditions. In the case of acantholytic keratinocytes, the most likely diagnosis is pemphigus vulgaris. This autoimmune disorder is caused by an antibody against intraepithelial desmosomal junctions, resulting in the separation of keratinocytes and the formation of intraepithelial blisters.

      Cytomegalovirus, herpes simplex, and chickenpox can also present with multinucleated giant cells on a Tzanck smear. However, these conditions are caused by viral infections rather than autoimmune disorders.

      Bullous pemphigoid, on the other hand, is caused by an antibody against the dermal-epidermal junction. The associated blisters are sub-epidermal in location and do not contain acantholytic keratinocytes.

      In summary, a Tzanck smear can provide valuable information in diagnosing various skin conditions, including pemphigus vulgaris, cytomegalovirus, herpes simplex, chickenpox, and bullous pemphigoid. Proper diagnosis is crucial in determining the appropriate treatment plan for the patient.

    • This question is part of the following fields:

      • Dermatology
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  • Question 7 - A 7-year-old boy visits his pediatrician with skin lesions. Upon conducting a thorough...

    Correct

    • A 7-year-old boy visits his pediatrician with skin lesions. Upon conducting a thorough examination and taking a medical history, the doctor informs the mother that the skin lesions are likely caused by a viral infection.
      What is the most probable condition that could be caused by a virus in this case?

      Your Answer: Molluscum contagiosum

      Explanation:

      Common Skin Infections and Their Causes

      Molluscum contagiosum is a viral infection that spreads through direct contact and causes pink papules with a central umbilicus. The lesions contain cheese-like material and can be treated with cryotherapy or imiquimod.

      Cellulitis is a bacterial infection that affects the lower dermis and subcutaneous tissue, causing red, swollen, and painful skin. It is commonly caused by Streptococcus pyogenes and Staphylococcus aureus.

      Folliculitis is an inflammation of the hair follicles, often caused by staphylococcal infections.

      Impetigo is a bacterial infection that results in pustules and honey-colored, crusted erosions. It is commonly caused by S. aureus.

      Necrotizing fasciitis is a severe bacterial infection that affects soft tissue and fascia. The bacteria release toxins and enzymes that lead to thrombosis and destruction of soft tissue and fascia. Bacterial causes include S. aureus and Clostridium perfringens, among others.

      Overview of Common Skin Infections and Their Causes

    • This question is part of the following fields:

      • Dermatology
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  • Question 8 - A 54-year-old patient presented to the general practitioner with complaints of bloody diarrhoea...

    Incorrect

    • A 54-year-old patient presented to the general practitioner with complaints of bloody diarrhoea that has persisted for the past 6 months. The patient also reported experiencing fever, weight loss, abdominal pain, and a painful, erythematosus rash on the anterior surface of the leg. A positive faecal occult blood test was obtained, and colonoscopy revealed crypt abscesses. What type of skin lesion is frequently observed in this patient?

      Your Answer: Erythema multiforme

      Correct Answer: Erythema nodosum

      Explanation:

      Common Skin Conditions and Their Causes

      Erythema Nodosum: A subcutaneous inflammation, erythema nodosum is often associated with inflammatory bowel disease, tuberculosis, sarcoidosis, or a recent streptococcal infection. It is characterized by raised nodules on the lower extremities.

      Morbilliform Rash: A mild hypersensitivity skin reaction, the morbilliform rash is a maculopapular eruption that blanches with pressure. It is caused by drugs such as penicillin, sulfonylurea, thiazide, allopurinol, and phenytoin.

      Erythema Multiforme: A target-like lesion that commonly appears on the palms and soles, erythema multiforme is usually caused by drugs such as penicillins, phenytoin, NSAIDs, or sulfa drugs. It can also be caused by Mycoplasma or herpes simplex.

      Tinea Corporis: A fungal infection, tinea corporis is characterized by ring-shaped, scaly patches with central clearing and a distinct border.

      Urticaria: A hypersensitivity reaction that results in wheals and hives, urticaria is most often associated with drug-induced mast cell activation. Aspirin, NSAIDs, and phenytoin are common culprits.

      Understanding Common Skin Conditions and Their Causes

    • This question is part of the following fields:

      • Dermatology
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  • Question 9 - A 32-year-old professional footballer comes to the Dermatology Clinic with a lesion on...

    Correct

    • A 32-year-old professional footballer comes to the Dermatology Clinic with a lesion on his leg. The lesion started as a small cut he got during a match, but it has progressed over the past few weeks, becoming a large, painful ulcer.
      During the examination, the doctor finds that the lesion is 50 mm × 75 mm and ulcerated with a necrotic centre. The patient has no medical history, but his general practitioner (GP) recently investigated him for a change in bowel habit, including bloody stools, and fatigue.
      The patient's anti-neutrophil cytoplasmic antibody test comes back positive, and no organisms grow from the wound swab. The doctor prescribes systemic steroids, and the patient experiences rapid improvement.
      What is the most likely diagnosis?

      Your Answer: Pyoderma gangrenosum

      Explanation:

      Differential Diagnosis for a Painful Cutaneous Ulcer in a Patient with IBD Symptoms

      When presented with a painful cutaneous ulcer, it is important to consider the underlying cause in order to provide appropriate treatment. In this case, the patient is experiencing fatigue and change in bowel habit, which could be indicative of underlying inflammatory bowel disease (IBD). One possible diagnosis is pyoderma gangrenosum, which is commonly associated with IBD, rheumatoid arthritis, or hepatitis. This condition presents with a rapidly progressing, painful, necrolytic cutaneous ulcer that responds well to systemic steroids. Livedo reticularis, erythema nodosum, and lupus pernio are other possible diagnoses, but they do not typically present with ulceration in this pattern or are not associated with IBD. While squamous cell carcinoma should be considered, it is unlikely in this case due to the patient’s young age and the rapid deterioration of the ulcer. Overall, a thorough differential diagnosis is necessary to accurately diagnose and treat the underlying condition causing the cutaneous ulcer.

    • This question is part of the following fields:

      • Dermatology
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  • Question 10 - An 85-year-old man who lives alone visits his General Practitioner complaining of a...

    Incorrect

    • An 85-year-old man who lives alone visits his General Practitioner complaining of a worsening itchy, red rash over his trunk, arms and legs. He has a medical history of psoriasis, hypertension and high cholesterol. Upon examination, the doctor observes an extensive erythematosus rash with scaling covering a large portion of his body. The patient has a normal temperature, a blood pressure of 110/88 mmHg and a heart rate of 101 bpm. What is the most appropriate course of action for this patient, considering the probable diagnosis?

      Your Answer: Urgent outpatient Dermatology appointment

      Correct Answer: Admit to hospital

      Explanation:

      Management of Erythroderma in an Elderly Patient Living Alone

      Erythroderma is a dermatological emergency that requires urgent treatment. In elderly patients who are systemically unwell and live alone, urgent admission to the hospital is necessary. This is the case for an 86-year-old man with a history of psoriasis who presents with erythroderma. The patient needs to be managed in the hospital due to the high risk of infection and dehydration. Topical emollients and steroids are essential in the management of erythroderma, but this patient requires intravenous fluids and close monitoring. Oral antibiotics are not indicated in the absence of features of infection. A topical steroid with a vitamin D analogue would be appropriate for a patient with psoriasis, but urgent assessment by Dermatology in an inpatient setting is necessary. An urgent outpatient Dermatology appointment is not appropriate for an elderly patient with abnormal observations and living alone.

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      • Dermatology
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  • Question 11 - A 45-year-old man came to the clinic during the summer with complaints of...

    Incorrect

    • A 45-year-old man came to the clinic during the summer with complaints of itching and blistering on his hands and forehead. Upon examination, small areas of excoriation were found on the backs of his hands. What is the probable diagnosis?

      Your Answer: Dermatitis herpetiformis

      Correct Answer: Porphyria cutanea tarda (PCT)

      Explanation:

      Photosensitivity and Skin Lesions: A Possible Case of PCT

      The distribution of the skin lesions in this case suggests that there may be a photosensitive element involved. While both lupus erythematosus and porphyria cutanea tarda (PCT) are associated with photosensitivity, it is more commonly seen in PCT. This condition is characterized by blistering of the hands and forehead, which can lead to small scars and milia formation as they heal. Excessive alcohol intake is also a known risk factor for PCT.

      Overall, the presence of photosensitivity and the specific distribution of the lesions in this case point towards a possible diagnosis of PCT. Further testing and evaluation will be necessary to confirm this diagnosis and determine the best course of treatment.

    • This question is part of the following fields:

      • Dermatology
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  • Question 12 - A 29-year-old Romanian immigrant presents to his general practitioner, complaining of firm and...

    Incorrect

    • A 29-year-old Romanian immigrant presents to his general practitioner, complaining of firm and tender reddish-blue raised nodules on the front of both shins. These have been present for a number of months. He has also lost weight and suffered from a chronic cough since the beginning of the year. On examination, there are multiple red/purple, firm, painful lesions affecting both shins. Investigations:
      Investigation Result Normal value
      Haemoglobin 105 g/l 135–175 g/l
      White cell count (WCC) 9.2 × 109/l 4–11 × 109/l
      Platelets 220 × 109/l 150–400 × 109/l
      Sodium (Na+) 139 mmol/l 135–145 mmol/l
      Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
      Creatinine 110 μmol/l 50–120 µmol/l
      Chest X-ray Calcified hilar lymph nodes,
      area of upper lobe fibrosis in the right lung
      Induced sputum Acid- and alcohol-fast bacilli seen
      Which of the following is the most likely diagnosis for his rash?

      Your Answer: Erythema infectiosum

      Correct Answer: Erythema nodosum

      Explanation:

      Understanding Erythema Nodosum and Differential Diagnosis

      Erythema nodosum is a painful, raised rash that typically occurs on the anterior aspect of the lower legs. It is a type of panniculitis and is often associated with tuberculosis and sarcoidosis. To rule out these serious conditions, a chest radiograph is usually performed at diagnosis. Diagnosis is made on clinical grounds, and patients are screened for associated medical conditions. Treatment involves managing the underlying condition, such as tuberculosis chemotherapy, and using non-steroidals for the skin rash.

      Other conditions that may present with similar symptoms include erythema infectiosum, which is caused by Parvovirus B19 and presents as a rash on the cheeks. Erythema multiforme causes target lesions that appear on the hands and feet before spreading to other areas of the body. Superficial thrombophlebitis, on the other hand, is inflammation of a superficial vein and is not associated with tuberculosis. Insect bites may cause swollen red lumps, but they are unlikely to cause the nodules seen in erythema nodosum.

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      • Dermatology
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  • Question 13 - A 26-year-old woman visits her General Practitioner concerned about excessive hair growth on...

    Correct

    • A 26-year-old woman visits her General Practitioner concerned about excessive hair growth on her face, back, and arms. Despite trying various hair removal methods and bleaching, she is considering treatment to prevent hair growth. Her BMI is 30 kg/m2, and she reports irregular periods, menstruating once every 7-9 months. Her recent blood tests showed elevated levels of testosterone and luteinising hormone. What is the best course of action for this patient, considering the probable diagnosis?

      Your Answer: Oral combined contraceptive pill

      Explanation:

      Management of Hirsutism in Polycystic Ovary Syndrome: First-Line Options

      Polycystic ovary syndrome (PCOS) is a condition characterized by irregular menstrual cycles, excess hair growth, and raised hormone levels. In patients with PCOS experiencing hirsutism and irregular periods, the first-line management option is the oral combined contraceptive pill. This medication reduces hyperandrogenism by suppressing ovarian androgen secretion and increasing binding of androgens, thereby reducing excess hair growth. Metformin can also be used to improve insulin resistance and aid weight management, but it would not be the first-line choice for managing hirsutism. Eflornithine can be used for hirsutism, but in this patient, starting the contraceptive pill will not only treat her hirsutism but also allow for regular withdrawal bleeds and regulate her menstrual cycle. The progesterone-only pill and topical minoxidil are not recommended as first-line options for managing hirsutism in PCOS patients.

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      • Dermatology
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  • Question 14 - A 30-year-old female patient expresses concerns about her hair loss. She has noticed...

    Incorrect

    • A 30-year-old female patient expresses concerns about her hair loss. She has noticed patches of hair loss for the past three months without any associated itching. The patient has a medical history of hypothyroidism and takes 100 micrograms of thyroxine daily. She also takes the combined oral contraceptive and has regular withdrawal bleeds. On physical examination, the patient appears healthy with a BMI of 22 kg/m2 and a blood pressure of 122/72 mmHg. Two distinct patches of hair loss, approximately 2-3 cm in diameter, are visible on the vertex of her head and the left temporo-occipital region. What is the most probable cause of her hair loss?

      Your Answer: Drug induced

      Correct Answer: Alopecia areata

      Explanation:

      Hair Loss and Autoimmune Conditions

      Hair loss can be caused by a variety of factors, including autoimmune conditions and thyroid disease. In the case of alopecia areata, which is a type of hair loss characterized by discrete patches of hair loss, about 1% of cases are associated with thyroid disease. However, this type of hair loss is not typically seen in systemic lupus erythematosus (SLE), which often presents with scarring alopecia. Androgenic alopecia, which is the most common type of hair loss in both men and women, typically causes thinning at the vertex and temporal areas rather than discrete patches of hair loss. Over-treatment with thyroxine to cause hyperthyroidism or the use of oral contraceptives can also lead to general hair loss. It is important to identify the underlying cause of hair loss in order to determine the appropriate treatment.

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      • Dermatology
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  • Question 15 - Samantha Masters, a 16-year-old high school student, visits the Dermatology Clinic with concerns...

    Incorrect

    • Samantha Masters, a 16-year-old high school student, visits the Dermatology Clinic with concerns about her appearance. She has been struggling with severe acne for a few years and has tried various over-the-counter treatments and antibiotics, but none have worked. She has been researching Roaccutane® (isotretinoin) and is interested in trying it. What is the most frequent side effect Samantha may encounter while taking Roaccutane®?

      Your Answer: Photosensitivity

      Correct Answer: Dry skin and lips

      Explanation:

      Understanding the Side-Effects of Roaccutane®: Dry Skin and Lips

      Roaccutane® is a powerful medication used to treat severe acne when other treatments have failed. While it is highly effective, it is also associated with a range of side-effects that patients should be aware of. One of the most common side-effects is severe dry skin and lips, which can be uncomfortable and require additional moisturizing. Other potential side-effects include dryness of the eyes, mucous membranes, and scalp, as well as muscle pain and hair loss.

      It is important to note that Roaccutane® is highly teratogenic, meaning it can cause birth defects if taken during pregnancy. Women who are taking Roaccutane® should use at least two forms of contraception to prevent pregnancy. Additionally, all patients should have their liver function and lipid levels monitored before and during treatment, as Roaccutane® can cause elevated levels of both.

      While night sweats and peptic ulceration are not recognised side-effects of Roaccutane®, photosensitivity is a potential side-effect, although it is not the most common. Weight gain is also not a recognised side-effect. Patients taking Roaccutane® should be aware of these potential side-effects and discuss any concerns with their healthcare provider.

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      • Dermatology
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  • Question 16 - An 80-year-old man visits his General Practitioner (GP) with a growth on the...

    Correct

    • An 80-year-old man visits his General Practitioner (GP) with a growth on the left side of his cheek. The growth has been present for around six months, and it is not causing any discomfort. Upon examination, it is a raised pearly papule with central telangiectasia and a rolled edge. The GP suspects it to be a basal cell carcinoma, measuring approximately 8 mm in diameter.
      What is the best course of action for management?

      Your Answer: Refer the patient routinely to Dermatology

      Explanation:

      Management of Basal Cell Carcinoma: Referral and Treatment Options

      Basal cell carcinomas (BCCs) are slow-growing skin cancers that require prompt referral to a dermatologist for assessment and management. While not urgent, referral should be routine to ensure timely treatment and prevent further growth and potential complications. Treatment options may include surgical excision, curettage and cautery, radiotherapy, or cryotherapy, depending on the size and location of the lesion.

      5-fluorouracil cream and diclofenac topical gel are not recommended for the treatment of BCCs but may be used for pre-malignant lesions such as solar keratoses. Referral to oncology for radiotherapy may be considered, but dermatology should be consulted first to explore less invasive treatment options.

      A watch-and-wait approach is not recommended for suspected BCCs, as delaying referral can lead to more extensive treatments and potential complications. All lesions suspected of malignancy should be referred to a specialist for further assessment and definitive treatment.

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      • Dermatology
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  • Question 17 - A 55-year-old man with a history of hypercholesterolaemia and psoriasis is admitted to...

    Correct

    • A 55-year-old man with a history of hypercholesterolaemia and psoriasis is admitted to the hospital after experiencing central crushing chest pain. He was diagnosed with a non-ST elevation myocardial infarction (NSTEMI) and received appropriate treatment. While in the hospital, he had a psoriasis flare-up.
      Which medication is most likely responsible for the psoriasis flare-up?

      Your Answer: Beta blockers

      Explanation:

      Medications and Psoriasis: Which Drugs to Avoid

      Psoriasis is a chronic skin condition that can be triggered by various factors, including stress, infection, and certain medications. While sunlight can help alleviate psoriasis symptoms in most patients, it can worsen the condition in some individuals. Among the drugs that can exacerbate psoriasis are β blockers, antimalarials, lithium, and interferons. Therefore, if possible, people with psoriasis should avoid taking these medications. However, drugs such as clopidogrel, glyceryl trinitrate spray, low-molecular-weight heparin, and statins are not known to cause psoriasis flares. It is important to consult with a healthcare provider before taking any medication if you have psoriasis.

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      • Dermatology
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  • Question 18 - A 28-year-old fair-skinned woman presents with a facial rash and is concerned it...

    Correct

    • A 28-year-old fair-skinned woman presents with a facial rash and is concerned it may be acne. She is frustrated as she did not experience it severely during her teenage years. The rash is characterized by erythema on the cheeks, nose, and centre of the forehead, with additional lesions present in the affected area. Based on this presentation, what skin lesion would suggest a diagnosis of acne vulgaris rather than rosacea?

      Your Answer: Comedone

      Explanation:

      Differences and Similarities between Acne and Rosacea

      Acne vulgaris and rosacea are two common skin conditions that affect the face. While they share some similarities, they also have distinct differences.

      Acne vulgaris is characterized by a mixture of comedones, papules, pustules, nodules, and cysts. Comedones are formed when the cells lining the sebaceous duct proliferate excessively and block the duct. Open comedones are blackheads, while closed comedones are whiteheads. Other types of comedones include giant comedones and solar comedones. Acne vulgaris usually starts in puberty and can continue into adulthood.

      On the other hand, rosacea is a chronic or intermittent rash that affects the central face. It is characterized by blushing or flushing and persistent redness and telangiectasia. Telangiectasias are small, dilated blood vessels that appear as red lines on the skin. Papules and pustules may also develop, and the skin may be dry and flaky. The nose may have prominent pores due to sebaceous gland hyperplasia.

      While both acne and rosacea can present with papules, pustules, and crusting, comedones are a characteristic feature of acne and are not present in rosacea. Additionally, acne vulgaris usually starts in puberty and is more common in younger individuals, while rosacea typically affects those aged 30-60.

      In summary, while acne and rosacea share some similarities in their presentation, they also have distinct differences that can help differentiate between the two conditions.

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      • Dermatology
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  • Question 19 - A 70-year-old man presents with erythema, vesicles and crusted ulcerations on the right...

    Incorrect

    • A 70-year-old man presents with erythema, vesicles and crusted ulcerations on the right scalp, forehead and periorbital region. The affected area is swollen and causing him pain. Additionally, there are some vesicles present at the tip of his nose. He reports experiencing a headache in that area several days prior to the onset of the rash. What is the most probable causative organism for this rash?

      Your Answer: Herpes simplex virus infection

      Correct Answer: Varicella-zoster virus

      Explanation:

      Common Skin Infections and Their Causes

      Skin infections can be caused by a variety of pathogens, including viruses, fungi, and bacteria. Here are some common skin infections and their causes:

      Varicella-zoster virus: This virus causes shingles, which is a reactivation of the virus that has been dormant in the dorsal root ganglia after the patient’s initial exposure to the virus in the form of chickenpox. A live attenuated vaccine is now available that is effective in preventing shingles.

      Herpes simplex virus infection: This virus can occasionally appear in a dermatomal distribution, mimicking shingles. It presents with erythema and vesicles, but the area of skin involved is usually much less than in shingles and pain is not as prominent.

      Malassezia furfur: This fungus causes tinea versicolor, a common benign, superficial cutaneous fungal infection characterized by hypopigmented or hyperpigmented macules and patches on the chest and back.

      Trichophyton verrucosum: This dermatophyte fungus of animal origin (zoophilic) causes a kerion, a severely painful inflammatory reaction with deep suppurative lesions on the scalp or beard area.

      Staphylococcus aureus: This bacterium causes impetigo, sycosis, ecthyma, and boils.

      Common Skin Infections and Their Causes

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      • Dermatology
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  • Question 20 - A 72-year-old retired gardener is referred to the Dermatology Clinic with a 2-month...

    Incorrect

    • A 72-year-old retired gardener is referred to the Dermatology Clinic with a 2-month history of an ulcerated lesion on the left ear. He explains that the lesion was initially a small white lump which was present for many months, which then broke down into the ulcer.
      On examination, a 0.5 cm ulcerated lesion is noted on the left pinna, with a rolled pearly edge. Closer inspection with a dermatoscope shows some telangiectasia around the edge. The dermatologist suspects that the lesion is a rodent ulcer.
      Which one of the following statements is true regarding rodent ulcers?

      Your Answer: They show epithelial pearls

      Correct Answer: They are basal cell carcinomas

      Explanation:

      Understanding Rodent Ulcers: Characteristics and Treatment Options

      Rodent ulcers, also known as basal cell carcinomas, are malignant skin lesions that commonly occur on the upper part of the face and ears, particularly in sun-exposed areas. They present as a pearly white nodule with telangiectasia and may ulcerate with a rolled edge as they enlarge. Unlike squamous cell carcinomas, rodent ulcers rarely metastasize via the bloodstream. Instead, they are malignant through local invasion, causing significant tissue damage by eroding into local tissue.

      Treatment options for rodent ulcers depend on the depth of the ulcer. Surgical excision with an excision margin of 3-5 mm, Mohs micrographic surgery, radiotherapy, and curettage, cautery, and cryotherapy are all viable options. Mohs micrographic surgery is particularly useful for lesions on the face where wide excision is not appropriate.

      In contrast, squamous cell carcinomas are malignant skin lesions that usually present as an ulcerated lesion with hard and raised edges in sun-exposed areas. They can occur on the lips in smokers and can metastasize, although spread is typically local. Treatment for squamous cell carcinomas involves excision and radiotherapy.

      In summary, understanding the characteristics and treatment options for rodent ulcers is crucial for effective management of this type of skin cancer.

    • This question is part of the following fields:

      • Dermatology
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  • Question 21 - Which statement about nail changes is accurate? ...

    Incorrect

    • Which statement about nail changes is accurate?

      Your Answer: Bacterial endocarditis is the most common cause of splinter haemorrhages

      Correct Answer: Ridges in the nails may be seen in psoriasis

      Explanation:

      Common Nail Changes and Their Causes

      Nail changes can be a sign of underlying health conditions. Here are some common nail changes and their causes:

      Psoriasis: Ridges, pits, and onycholysis (separation of the nail from the nail bed) are features of psoriasis.

      Splinter haemorrhages: Although splinter haemorrhages occur in bacterial endocarditis, trauma is the most common cause. They can also be associated with rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and psoriasis.

      White nails: White nails are a feature of hypoalbuminaemia.

      Koilonychia: Iron deficiency causes koilonychia and may cause onycholysis. Vitamin B12 deficiency does not cause nail changes.

      Clubbing: Ischaemic heart disease does not cause clubbing.

    • This question is part of the following fields:

      • Dermatology
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  • Question 22 - A 68-year-old rancher comes in with a small white spot on his right...

    Incorrect

    • A 68-year-old rancher comes in with a small white spot on his right cheek that has been gradually increasing in size over the past few months. It has now developed a central ulcer. What is the probable type of this lesion?

      Your Answer: Basal cell papilloma (seborrhoeic keratosis)

      Correct Answer: Basal cell carcinoma

      Explanation:

      Lesion on the Face: Indications of Basal Cell Carcinoma

      A slow-growing lesion on the face with a central ulcer located above a line drawn from the angle of the mouth to the ear lobe is a possible indication of basal cell carcinoma. This type of cancer tends to develop slowly, and the presence of an ulcer in the center of the lesion is a common characteristic. In contrast, squamous cell carcinoma grows much faster than basal cell carcinoma.

      Another skin condition that may be mistaken for basal cell carcinoma is seborrhoeic keratoses. However, seborrhoeic keratoses have a papillary warty surface, which is different from the smooth surface of basal cell carcinoma.

    • This question is part of the following fields:

      • Dermatology
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  • Question 23 - A patient has been diagnosed with a melanoma on his left hand, which...

    Incorrect

    • A patient has been diagnosed with a melanoma on his left hand, which measures 1.5 cm. He is booked in to have surgery to remove it.
      During the excision biopsy what margin size will be taken?

      Your Answer: 4 mm

      Correct Answer: 2 mm

      Explanation:

      Surgical Margins for Skin Cancer Excision

      When removing skin cancer through excision biopsy, it is important to use appropriate surgical margins to ensure complete removal of the cancerous cells. The size of the margin depends on the type and thickness of the cancer.

      For melanomas, a 2 mm margin is used for the initial excision biopsy. After calculating the Breslow thickness, an additional wide excision is made with margins ranging from 1 cm to 2 cm, depending on the thickness of the melanoma. A 1 cm margin is used for melanomas measuring 1.0–4.0 mm, while a 2 cm margin is used for melanomas measuring >4 mm.

      Squamous-cell carcinoma (SCC) requires a 4 mm excision margin, while basal-cell carcinoma (BCC) requires a 3 mm margin.

      Using appropriate surgical margins is crucial for successful removal of skin cancer and preventing recurrence.

    • This question is part of the following fields:

      • Dermatology
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  • Question 24 - A 45-year-old man visits his GP with a lump on the side of...

    Correct

    • A 45-year-old man visits his GP with a lump on the side of his head. During the examination, the GP suspects that the lump may be a basal cell carcinoma. What characteristic is most indicative of this diagnosis?

      Your Answer: Telangiectasia

      Explanation:

      Understanding Basal Cell Carcinomas: Characteristics and Warning Signs

      Basal cell carcinomas are the most common type of skin cancer, typically found in sun-exposed areas such as the face and neck. They can be familial and associated with certain syndromes. A basal cell carcinoma often appears as a slow-growing, skin-colored, pearly nodule with surface telangiectasia, or fine vessels on the surface. It may also be an ulcerated lesion with rolled edges. Biopsy confirms the diagnosis, and treatment involves excision with a clear margin. While basal cell carcinomas rarely metastasize, they can be locally invasive and destructive. Pigmentation is a feature of melanocytic lesions, but basal cell carcinomas may rarely show pigmentation. Size is not a specific feature of malignancy, but sudden increases in size should be referred for further assessment. Other warning signs include crusted edges and unprovoked bleeding.

    • This question is part of the following fields:

      • Dermatology
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  • Question 25 - A 14-year-old female has been experiencing multiple, non-tender, erythematosus, annular lesions with a...

    Incorrect

    • A 14-year-old female has been experiencing multiple, non-tender, erythematosus, annular lesions with a collarette of scales at the periphery for the past two weeks. These lesions are only present on her trunk. What is the most probable diagnosis?

      Your Answer: Pityriasis alba

      Correct Answer: Pityriasis rosea

      Explanation:

      Pityriasis Rosea

      Pityriasis rosea (PR) is a common skin condition that typically affects adolescents and young adults. It is often associated with upper respiratory infections and is characterized by a herald patch, which is a circular or oval-shaped lesion that appears on the trunk, neck, or extremities. The herald patch is usually about 1-2 cm in diameter and has a central, salmon-colored area surrounded by a dark red border.

      About one to two weeks after the herald patch appears, a generalized rash develops. This rash is symmetrical and consists of macules with a collarette scale that aligns with the skin’s cleavage lines. The rash can last for up to six weeks before resolving on its own.

      Overall, PR is a benign condition that does not require treatment. However, if the rash is particularly itchy or uncomfortable, topical corticosteroids or antihistamines may be prescribed to alleviate symptoms. It is important to note that PR is not contagious and does not pose any serious health risks.

    • This question is part of the following fields:

      • Dermatology
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  • Question 26 - A 50-year-old man was seen in the Dermatology Outpatient Clinic with a chronic...

    Incorrect

    • A 50-year-old man was seen in the Dermatology Outpatient Clinic with a chronic ulcer on his left forearm. On enquiry by the consultant, he revealed that he suffered full-thickness burn at the site of the ulcer nearly 20 years ago. The consultant told the patient he had a Marjolin’s ulcer.
      Which of the following statements best describes a Marjolin’s ulcer?

      Your Answer: It is a sarcoma which develops in a scar

      Correct Answer: It is often painless

      Explanation:

      Understanding Marjolin’s Ulcer: A Squamous Cell Carcinoma in Scar Tissue

      Marjolin’s ulcer is a type of squamous cell carcinoma that develops in scar tissue. This condition is often associated with chronic wounds and scar tissues, which are prone to an increased risk for skin cancer. While it most frequently occurs in old burn scars, it can also develop in relation to other types of injuries and wounds.

      One of the unique characteristics of Marjolin’s ulcer is that it grows slowly due to the scar tissue being relatively avascular. Additionally, it is painless because the tissue contains no nerves. While it typically appears in adults around 53-59 years of age, the latency period between the initial injury and the appearance of cancer can be 25-40 years.

      Contrary to popular belief, Marjolin’s ulcer is not a sarcoma. Instead, it is a squamous cell carcinoma that can invade normal tissue surrounding the scar and extend at a normal rate. While secondary deposits do not occur in the regional lymph nodes due to the destruction of lymphatic vessels, lymph nodes can become involved if the ulcer invades normal tissue.

      In conclusion, understanding Marjolin’s ulcer is crucial for individuals who have experienced chronic wounds or scar tissue. Early detection and treatment can greatly improve outcomes and prevent further complications.

    • This question is part of the following fields:

      • Dermatology
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  • Question 27 - A 28-year-old patient presents with a history of well demarcated, erythematous lesions with...

    Incorrect

    • A 28-year-old patient presents with a history of well demarcated, erythematous lesions with silvery-white scaling plaques on the extensor surfaces of the elbows. There is evidence of nail pitting.
      What is the most appropriate management?

      Your Answer: Phototherapy

      Correct Answer: Topical betnovate + vitamin D

      Explanation:

      The recommended first-line treatment for psoriasis is the application of betnovate (or another potent steroid) plus vitamin D for four weeks. If there is no or minimal improvement, referral to a specialist may be considered. Dermovate, a very potent steroid, should only be initiated by a specialist who may alter the treatment or advance it to include phototherapy or biologics. Hydrocortisone is not recommended for psoriasis treatment as it is not potent enough. Phototherapy is not the first-line treatment and should only be initiated by a dermatologist after considering all risks and benefits. Biologics are the last stage of treatment and are only initiated by a dermatologist if the detrimental effects of psoriasis are heavily impacting the patient’s life, despite other treatments.

    • This question is part of the following fields:

      • Dermatology
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  • Question 28 - A 9-month-old girl is brought to the clinic by her parents. She had...

    Correct

    • A 9-month-old girl is brought to the clinic by her parents. She had a fever for four days, and as this disappeared she was noted to have a rash.

      On examination, she is apyrexial, but has a macular rash on the trunk and lower limbs.

      What is the most probable diagnosis?

      Your Answer: Roseola infantum

      Explanation:

      Common Rashes and Their Characteristics

      Roseola infantum is a viral infection caused by herpesvirus 6. It is known to cause a rash that appears as small, pink, flat spots on the skin. The rash usually starts on the trunk and spreads to the limbs, neck, and face. Along with the rash, the infected person may also experience fever and swollen lymph nodes.

      Erythema multiforme is a skin condition that causes red, raised, and blistering lesions on the skin. The lesions are usually circular or oval in shape and have a target-like appearance. They can appear on any part of the body, but are most commonly found on the hands, feet, and face. The condition is often triggered by an infection or medication.

      Idiopathic thrombocytopenia is a blood disorder that causes a low platelet count. This can lead to easy bruising and bleeding, and in some cases, a petechial rash. Petechiae are small, red or purple spots on the skin that are caused by bleeding under the skin.

      Henoch-Schönlein purpura is a condition that causes inflammation of the blood vessels. This can lead to a purpuric rash on the buttocks and lower limbs, as well as joint pain and abdominal pain. The condition is most commonly seen in children.

      Meningococcal septicaemia is a serious bacterial infection that can cause a non-blanching purpuric rash. This means that the rash does not fade when pressure is applied to it. Other symptoms of the infection include fever, headache, and vomiting.

    • This question is part of the following fields:

      • Dermatology
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  • Question 29 - A 25-year-old female with a history of systemic lupus erythematosus presents with symmetrical...

    Correct

    • A 25-year-old female with a history of systemic lupus erythematosus presents with symmetrical reticulated, violaceous patches. These patches become more prominent in cold weather and involve both lower limbs. What is the probable diagnosis?

      Your Answer: Livedo reticularis

      Explanation:

      Livedo Reticularis

      Livedo reticularis is a skin condition characterized by a net-like pattern of blue or purple discoloration on the skin. This occurs due to the dilation of capillary blood vessels and the stagnation of blood within these vessels. The condition is more pronounced in cold weather and is commonly found on the legs, arms, and trunk.

      Livedo reticularis can be idiopathic, meaning it has no known cause, or it can be secondary to other conditions such as malignancy, vasculitis, SLE, or cholesterol embolization. The condition is caused by the accumulation of blood in the capillaries, which leads to the discoloration of the skin.

      In summary, livedo reticularis is a skin condition that causes a net-like pattern of blue or purple discoloration on the skin. It is caused by the accumulation of blood in the capillaries and can be idiopathic or secondary to other conditions. The condition is more pronounced in cold weather and is commonly found on the legs, arms, and trunk.

    • This question is part of the following fields:

      • Dermatology
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  • Question 30 - An 18-year-old man visits his GP with complaints of painful lesions on his...

    Correct

    • An 18-year-old man visits his GP with complaints of painful lesions on his face, neck, and upper back. He has no significant medical history and is not taking any medications. Upon examination, the GP observes multiple pustules on erythematous bases that express serosanguinous fluid and occasional pus. Based on these findings, the GP makes a tentative diagnosis and recommends daily application of topical benzoyl peroxide. What structure is most likely responsible for the development of this patient's skin condition?

      Your Answer: Sebaceous glands

      Explanation:

      The Skin and its Glands: A Brief Overview

      The skin is the largest organ of the human body and is responsible for protecting the body from external factors such as bacteria, viruses, and physical trauma. It is composed of several layers, with the outermost layer being the stratum corneum, a keratinised squamous epithelial layer.

      One of the most common skin conditions is acne, which is caused by the sebaceous glands associated with hair follicles secreting sebum and plugging the hair follicle. If left untreated, acne can cause scars or pock marks after the lesions heal. Treatment options include benzoyl peroxide, tetracycline antibiotics, or retinoic acid.

      Apocrine glands secrete a viscous, milky substance and are found in the axillary and genital regions. They become active during puberty and are associated with a characteristic foul odor due to bacteria consuming the fluid expressed from these glands.

      Eccrine glands are sweat glands and are found all over the body. They play a crucial role in regulating body temperature and eliminating waste products.

      Hemidesmosomes connect basal cells to the underlying basal membrane. Antibodies to hemidesmosomes can lead to the formation of bullous pemphigoid, a rare autoimmune disorder that causes blistering of the skin and mucous membranes.

      Understanding the different glands and layers of the skin can help in the diagnosis and treatment of various skin conditions.

    • This question is part of the following fields:

      • Dermatology
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