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Question 1
Incorrect
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A 19-year-old man is suffering from acne vulgaris, with inflamed, open comedones on his face, chest and neck. What micro-organism degrades sebum to produce inflammatory fatty acids in such cases?
Your Answer: Poxvirus
Correct Answer: Propionibacterium acnes
Explanation:Common Skin Infections and their Causes
Acne vulgaris is a prevalent skin condition among adolescents and young adults, particularly men. Hormonal changes stimulate the sebaceous glands to produce more sebum, leading to the formation of open comedones, which are inflamed follicles with a central dark plug of keratin. Propionibacterium acnes is responsible for breaking down complex lipids in sebum into free fatty acids, which cause inflammation of hair follicles. Treatment with antibiotics and 13-cis-retinoic acid can alleviate the symptoms of acne vulgaris.
Molluscum contagiosum is caused by the poxvirus, which leads to epidermal hyperplasia and ellipsoid molluscum bodies in the stratum corneum.
Impetigo is a bacterial infection of the skin caused by Staphylococcus aureus. It is highly contagious and often affects healthy children. The infection starts as a reddened macule and progresses to multiple serum-filled pustules that rupture and form a yellowish crust.
Papillomavirus causes warts or verrucae, which are common on the hands. They appear as several papules with a rough, irregular surface.
Tinea versicolor is caused by Malassezia furfur, a fungus that causes superficial fungal infections in the skin. Other forms of tinea are also caused by fungal infections.
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This question is part of the following fields:
- Dermatology
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Question 2
Incorrect
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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: Erythema
Correct 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.
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This question is part of the following fields:
- Dermatology
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Question 3
Incorrect
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A 35-year-old woman with a history of ulcerative colitis visits her General Practitioner (GP) complaining of a painful ulcer on her right shin that is rapidly increasing in size. The patient noticed a small blister in the area a few days ago, which has now broken down into an ulcer that is continuing to enlarge. The doctor suspects that the skin lesion may be pyoderma gangrenosum. What is the most commonly associated condition with pyoderma gangrenosum?
Your Answer: Osteoarthritis
Correct Answer: Rheumatoid arthritis
Explanation:Skin Conditions Associated with Various Diseases
Pyoderma gangrenosum is a skin condition characterized by a painful ulcer that rapidly enlarges. It is commonly associated with inflammatory bowel disease, hepatitis, rheumatoid arthritis, and certain types of leukemia. However, it is not commonly associated with HIV infection or coeliac disease. Dermatitis herpetiformis is a skin condition associated with coeliac disease, while patients with rheumatoid arthritis are at higher risk of developing pyoderma gangrenosum compared to those with osteoarthritis. Haematological malignancies commonly associated with pyoderma gangrenosum include acute myeloid leukemia and hairy cell leukemia, while cutaneous lesions in multiple myeloma are uncommon.
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This question is part of the following fields:
- Dermatology
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Question 4
Correct
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A teenage care assistant from a local nursing home presents with sudden onset of an intensely itchy rash. This covers her whole body. She has no history of skin problems. On examination there is a combination of raised erythematous papules covering her arms and trunk and linear marks to her forearms. There is excoriated skin in the inter-digital spaces.
What is the most appropriate treatment?Your Answer: Permethrin cream
Explanation:Understanding Scabies Treatment: Permethrin Cream and Other Options
Scabies is a skin infestation caused by the mite Sarcoptes scabiei, which can lead to symptoms such as itching and a rash with superficial burrows and pimples. The first-line treatment recommended by NICE is permethrin 5% dermal cream, which needs to be applied to the whole body and repeated a week later. In cases of moderate eczema, a regular emollient plus a moderately potent topical steroid may be used in addition to permethrin. However, a combination of moderately potent topical steroid and topical antifungal agent is not appropriate for scabies treatment. Oral antihistamines may provide symptomatic relief but are not a treatment for scabies. Malathion 5% aqueous solution can be used as a second-line treatment option for patients allergic to chrysanthemums who cannot use permethrin.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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A 7-year-old girl has a 3 cm-diameter patch of alopecia in the left parietal region with another smaller similar area nearby. The skin in the patch is itchy and the few remaining hairs seem to have fallen out near the scalp surface. Her father has noticed that the area of alopecia is spreading. There is no itching of the right scalp and there is no rash elsewhere on her body.
What is the most probable diagnosis?Your Answer: Trichotillomania
Correct Answer: Tinea capitis
Explanation:Differentiating Causes of Hair Loss: A Guide
Hair loss can be a distressing experience, but it is important to identify the underlying cause in order to determine the appropriate treatment. Here are some common causes of hair loss and their distinguishing features:
Tinea Capitis: This fungal infection can cause abnormal scalp skin and alopecia. The affected area may be scaly or inflamed, and broken hairs do not taper at the base.
Alopecia Areata: This autoimmune disease results in circular areas of hair loss without scaling, inflammation, or broken hair.
Discoid Lupus Erythematosus: This condition causes red, scaly patches that leave white scars and permanent hair loss due to scarring alopecia.
Psoriasis: Thick scaling on the scalp may cause mild hair loss, but it does not result in permanent balding. Psoriasis may also be present elsewhere on the body.
Trichotillomania: Hair pulling disorder does not cause abnormalities to the scalp skin.
By understanding the distinguishing features of these causes of hair loss, prompt and appropriate treatment can be initiated to prevent permanent hair loss.
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This question is part of the following fields:
- Dermatology
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Question 6
Incorrect
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A 60-year-old man presents for a follow-up appointment. He has been experiencing facial flushing and developed a red rash on his face a few months ago. Upon examination, there are numerous erythaematous papules scattered across his cheeks and his nose appears red and bulbous.
What is the probable diagnosis?Your Answer: Acne vulgaris
Correct Answer: Acne rosacea
Explanation:Common Skin Conditions: Acne Rosacea, Systemic Lupus Erythaematosus, Seborrhoeic Dermatitis, Acne Vulgaris, and Nodulocystic Acne
Skin conditions can be a source of discomfort and embarrassment for many people. Here are five common skin conditions and their features:
Acne Rosacea is a chronic rash that affects the central face, typically in those aged 30 to 60. Symptoms include facial flushing, telangiectasia, rhinophyma, papules, and pustules. Treatment options include topical metronidazole and oral antibiotics.
Systemic Lupus Erythaematosus is an autoimmune disorder that can affect various organs, including the skin. Common dermatological signs include a butterfly malar rash and discoid lupus.
Seborrhoeic Dermatitis is a chronic or relapsing form of eczema that mainly affects the scalp, face, and upper trunk. Symptoms include indurated hyperpigmented plaques and creases around the nose, behind ears, and within eyebrows.
Acne Vulgaris is a common variety of acne that affects the pilosebaceous unit. It is most common in young adults with high levels of sex hormones and is graded according to the number of comedones and inflammatory lesions seen.
Nodulocystic Acne is a severe form of acne that affects the face, chest, and back, mainly in men. Symptoms include multiple inflamed and uninflamed nodules and scars.
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This question is part of the following fields:
- Dermatology
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Question 7
Incorrect
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A 32-year-old man with psoriasis affecting the scalp and legs visits his General Practitioner with ongoing symptoms despite using once-daily Betnovate® (potent steroid) and a vitamin D analogue for six weeks. What should be the next course of action in managing this patient?
Your Answer: Start an ultra-potent steroid regime
Correct Answer: Stop steroid treatment and continue vitamin D analogue twice daily
Explanation:Management of Psoriasis: Next Steps and Referral Considerations
Psoriasis management follows a stepwise approach, as per NICE guidance. For a patient who has already received eight weeks of once-daily potent steroid with a vitamin D analogue, the next step is to stop the steroid and start twice-daily vitamin D analogue. Steroids should not be applied at the same site for more than eight weeks, after which patients require a 4-week ‘treatment break’. If there is still no improvement in symptoms at the end of the 4-week steroid-free break, twice-daily steroids can be trialled or a coal tar preparation can be started.
Referral to Dermatology may be necessary if the patient is severely affected by psoriasis or struggling to manage the condition. However, starting the next stage of treatment, which is twice-daily vitamin D analogue, would be the most appropriate while awaiting secondary care review.
Continuing steroids for a further four weeks would result in an excessively long duration of steroid treatment and risk side-effects such as skin thinning. Patients should have a minimum of four weeks steroid-free after an 8-week treatment course.
While some patients with severe psoriasis may require an ultra-potent steroid, this patient has already received eight weeks of a potent steroid and requires a 4-week steroid-free break. Following this, it may be appropriate to trial a short course of an ultra-potent steroid or to retrial the potent steroid twice daily.
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This question is part of the following fields:
- Dermatology
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Question 8
Incorrect
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A 50-year-old man with a long-standing history of extensive psoriasis affecting the trunk, arms, buttock and nail beds is seen for review in Dermatology Outpatients. He has previously completed a course of phototherapy, with minimal improvement, and has shown no benefit on methotrexate for the past 12 months.
What is the next most appropriate step in the management of this patient?Your Answer: Topical tacrolimus
Correct Answer: Infliximab
Explanation:Management of Severe Extensive Psoriasis: Consideration of Anti-TNF Alpha Therapy
Psoriasis is a chronic inflammatory skin condition that is managed in a stepwise manner, as per the National Institute of Health Care and Excellence (NICE) guidelines. For patients with extensive psoriasis who have failed topical therapy, phototherapy, and systemic agents such as methotrexate, acitretin, and ciclosporin, or where these are not tolerated and/or contraindicated, the next step in management is to trial an anti-tumour necrosis factor (TNF) alpha, such as infliximab, etanercept, or adalimumab, given by injection.
While on anti-TNF alpha therapy, patients are at an increased risk of pneumococcal and seasonal influenzae, and should receive vaccination against these illnesses. Live vaccines should be avoided.
Repeating a further course of phototherapy may not be the most appropriate answer for patients who have already failed systemic therapy and previously showed only minimal response to phototherapy. Hydroxychloroquine is not commonly used in the management of plaque psoriasis, and rituximab is not indicated for psoriasis.
Topical tacrolimus may be used in the management of psoriasis affecting the face or flexural regions, but for patients with severe extensive psoriasis on the trunk, arms, and buttocks who have already tried and failed management with oral regimes and phototherapy, it is unlikely to be of benefit. If it has not already been used, it would not be unreasonable to trial tacrolimus for a short period. However, the next most appropriate step in management is an anti-TNF alpha.
In summary, for patients with severe extensive psoriasis who have failed previous therapies, consideration of anti-TNF alpha therapy is the next step in management, with appropriate vaccination and monitoring for potential adverse effects.
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This question is part of the following fields:
- Dermatology
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Question 9
Incorrect
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A 36-year-old African-American man undergoes a pre-employment health check. Chest radiograph demonstrates bilateral hilar lymphadenopathy. More detailed history and examination reveals painful red papules on both shins of recent onset. He is otherwise well. Basic blood tests are normal.
What rash does the patient have?Your Answer: Kaposi’s sarcoma
Correct Answer: Erythema nodosum
Explanation:Differentiating Skin Rashes: A Comparison of Erythema Nodosum, Erythema Multiforme, Kaposi’s Sarcoma, Tinea Corporis, and Steven-Johnson’s Syndrome
Erythema nodosum is a rash characterized by painful red papules caused by inflammation of the subcutaneous fat. It is commonly seen on the extensor surfaces of the lower limbs and can be linked to various conditions such as streptococcal and tuberculous infection, inflammatory bowel disease, lymphoma, drug-related causes, and sarcoidosis.
Erythema multiforme, on the other hand, presents with typical target lesions on the extremities. It is an uncommon condition that can be mistaken for other skin rashes.
Kaposi’s sarcoma is an AIDS-defining malignancy caused by human herpes virus 8. It appears as red/purple papules on the skin or mucosal surfaces. However, the description of the rash, normal blood results, and an otherwise healthy patient make this diagnosis unlikely.
Tinea corporis, also known as ringworm, is a fungal infection transmitted from common pets or human-to-human. It presents as an erythematosus, scaly ring-like rash with central clearing.
Steven-Johnson’s syndrome is a severe form of erythema multiforme with multiple erythematosus macules on the face and trunk, epidermal detachment, and mucosal ulceration. It is a rare condition that can cause significant morbidity and mortality.
In summary, differentiating between these skin rashes is crucial for proper diagnosis and treatment. A thorough evaluation of the patient’s medical history, physical examination, and laboratory tests can help identify the underlying cause of the rash.
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This question is part of the following fields:
- Dermatology
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Question 10
Incorrect
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A 33-year-old construction worker presents with an area of redness on his right foot. The area of redness has grown in size over the past day and is warmer than the surrounding normal skin. The patient mentions that the area is also tender to touch.
Following taking a history and examining the patient, the physician suspects a diagnosis of cellulitis.
Which of these terms is best used to describe ‘cellulitis’?Your Answer: A pus-containing collection at the skin’s surface
Correct Answer: Localised inflammation and cellular debris accumulation
Explanation:Understanding Different Forms of Skin Inflammation
Cellulitis, inflammation of subcutaneous tissue, is caused by Streptococcus pyogenes and requires urgent treatment with antibiotics. Surgical wounds and malignant tumors can also cause inflammation, but the latter is a response by the immune system to control malignancy. Inflammation of the epidermis can be caused by various non-infective processes, such as sunburns or abrasions. Localized infection may lead to an abscess, which requires incision and drainage. It is important to understand the distinct pathology and treatment for each form of skin inflammation.
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This question is part of the following fields:
- Dermatology
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Question 11
Incorrect
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A 35-year-old man presents to the Dermatology Outpatient Department with mildly itchy, erythematous plaques with oily, yellow scales on the scalp, forehead and behind his ears. The plaques have been present for two weeks. He has no significant medical history and is otherwise well.
What is the definitive management for this patient?Your Answer: Antihistamines
Correct Answer: Ketoconazole shampoo and topical corticosteroid therapy
Explanation:Treatment Options for Seborrhoeic Dermatitis: Focus on Ketoconazole Shampoo and Topical Corticosteroid Therapy
Seborrhoeic dermatitis is a common skin condition characterized by erythematous patches with fine scaling on the scalp, forehead, and behind the ears. To manage this condition, a four-week course of mild-potency topical corticosteroid therapy with ketoconazole shampoo is recommended. This treatment approach has been shown to improve the signs and symptoms of seborrhoeic dermatitis. While antihistamines can provide symptomatic relief, they do not address the underlying cause of the disease. Oral corticosteroids and retinoids are not recommended for the treatment of seborrhoeic dermatitis. Vitamin C also has no role in the management of this condition. Overall, the combination of ketoconazole shampoo and topical corticosteroid therapy is a safe and effective treatment option for seborrhoeic dermatitis.
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This question is part of the following fields:
- Dermatology
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Question 12
Correct
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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: 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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This question is part of the following fields:
- Dermatology
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Question 13
Incorrect
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A 57-year-old diabetic patient presents with an abscess on the nape of his neck with multiple discharging sinuses.
Which one of the following terms would you use to describe the presentation?Your Answer: Necrotising fasciitis
Correct Answer: Carbuncle
Explanation:Common Skin Infections and Conditions
Carbuncles, cellulitis, furuncles, infected sebaceous cysts, and necrotising fasciitis are all common skin infections and conditions that can cause discomfort and pain. Carbuncles are collections of pus that discharge to the surface via multiple sinuses and are usually caused by staphylococcal infection. Cellulitis is a bacterial infection of the lower dermis and subcutaneous tissue, presenting with a localised area of painful, red, swollen skin and fever. Furuncles are perifollicular abscesses, also typically caused by staphylococcal infection. Infected sebaceous cysts are round, dome-shaped, encapsulated lesions containing fluid or semi-fluid material. On the other hand, necrotising fasciitis is a serious bacterial infection of the soft tissue and fascia that can result in extensive tissue loss and death if not promptly recognised and treated with antibiotics and debridement. It is important to seek medical attention if any of these conditions are suspected, especially in patients with diabetes or those who are immunosuppressed. Clinical assessment and appropriate diagnostic tests should be conducted to ensure proper treatment and management.
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This question is part of the following fields:
- Dermatology
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Question 14
Incorrect
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A 7-year-old child has developed itchy, oozing sores on their body, palms, and soles. The child's two siblings are also experiencing similar symptoms. What is the best course of treatment for this patient?
Your Answer: Metronidazole
Correct Answer: Topical permethrin
Explanation:Scabies: Symptoms, Causes, and Treatment
Scabies is a skin infestation that can cause lesions on the palms and soles, accompanied by intense itching. If a sibling has a similar history, it is likely that they are also infested with scabies. The lesions are caused by scratching and can become exudative. The treatment of choice for scabies is topical permethrin or malathion. These medications can help to kill the mites that cause scabies and alleviate the symptoms of itching and skin irritation.
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This question is part of the following fields:
- Dermatology
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Question 15
Incorrect
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A 23-year-old woman injures her arm on a sharp object while hiking. Within a few days, a small blister forms at the site of the injury, which eventually turns into an open sore. The sore has an uneven purple edge and quickly becomes wider and deeper. The woman experiences severe pain at the site of the sore.
What is the probable medical diagnosis for this patient?Your Answer: Coeliac disease
Correct Answer: Crohn’s disease
Explanation:Skin Conditions Associated with Various Diseases
Pyoderma gangrenosum is a skin condition associated with Crohn’s disease. It is diagnosed based on clinical history and examination, and treatment options include topical or systemic steroid therapy. Coeliac disease is not associated with pyoderma gangrenosum, but is linked to dermatitis herpetiformis, which causes itchy papules on the scalp, shoulders, buttocks, or knees. Pretibial myxoedema is a skin condition associated with Grave’s disease, characterized by waxy, discolored induration on the Pretibial areas. SLE is not associated with pyoderma gangrenosum, but is linked to a facial butterfly rash. T1DM is not associated with pyoderma gangrenosum, but is linked to necrobiosis lipoidica and granuloma annulare, which cause tender patches and discolored plaques, respectively.
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This question is part of the following fields:
- Dermatology
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Question 16
Incorrect
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A 60-year-old male patient complains of a sudden worsening of his pre-existing psoriasis over the past three days. Is it possible that one of his medications is responsible for this acute deterioration?
Your Answer: Omeprazole
Correct Answer: Bisoprolol
Explanation:Medications that can worsen psoriasis
Psoriasis is a chronic skin condition that can be triggered or worsened by certain medications. Beta-blockers, commonly used to treat high blood pressure and heart conditions, are known to induce psoriasis or make existing psoriasis worse. Other medications that can exacerbate psoriasis include non-steroidal anti-inflammatory drugs, antimalarials, and lithium. These medications can contribute to erythrodermic and pustular eruptions, which can be severe and require medical attention. It’s important to note that reactions to these medications can occur anywhere from less than a month to a year after starting the medication. Additionally, tapering doses of steroids can also lead to a worsening of psoriasis symptoms.
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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 50-year-old woman presents with multiple large, ruptured, eroded plaques on her upper arm, scalp and groin, along with an ulcerated blister on the mucosa of her lower lip. The cause is determined to be pemphigus vulgaris, with the pathogenesis of the disease attributed to IgG autoantibodies against which protein?
Your Answer: Desmoglein
Explanation:Autoantibodies and Skin Disorders: Understanding the Role of Desmoglein, Bullous Pemphigoid Antigen, Collagen Type XVIII, Keratin, and Desmoplakin
Skin disorders can be caused by various factors, including autoimmune reactions. In particular, autoantibodies targeting specific proteins have been linked to several skin conditions. Here are some of the key proteins involved in these disorders:
Desmoglein: This protein is targeted by autoantibodies in about 80% of pemphigus cases, specifically in pemphigus vulgaris. The autoantibodies disrupt desmosomes, leading to blister formation above the stratum basale.
Bullous pemphigoid antigen and collagen type XVIII: These proteins are associated with bullous pemphigoid, which is characterized by autoimmune disruption of the hemidesmosome. This structure attaches the basal surface of cells in the stratum basale to the underlying epidermal basement membrane.
Keratin: Mutations in genes encoding keratin have been linked to epidermolysis bullosa, a disorder that causes blistering and skin fragility.
Desmoplakin: This intracellular protein links keratin intermediate filaments to desmosomes, but it is not directly involved in the pathogenesis of pemphigus vulgaris.
Understanding the role of these proteins in skin disorders can help researchers develop better treatments and therapies for these conditions.
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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 21-year-old student presents to his GP a few days after returning from a regeneration project working with a fishing community in South America. His main complaint is of an itchy, erythematosus rash predominantly affecting both feet. He has no past medical history of note. On examination he has erythematosus, edematous papules and vesicles affecting both feet. There are serpiginous erythematosus trails which track 2-3 cm from each lesion. Investigations:
Investigation Result Normal value
Haemoglobin 138 g/l 135–175 g/l
White cell count (WCC) 8.0 × 109/l
(slight peripheral blood eosinophilia) 4–11 × 109/l
Platelets 245 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
Creatinine 79 μmol/l 50–120 µmol/l
Chest X-ray Normal lung fields
Which of the following diagnoses fits best with this clinical scenario?Your Answer: Cutaneous larva migrans
Explanation:Cutaneous Larva Migrans and Other Skin Conditions: A Differential Diagnosis
Cutaneous larva migrans is a common skin condition caused by the migration of nematode larvae through the skin. It is typically found in warm sandy soils and can be diagnosed based on the history and appearance of serpiginous lesions. Treatment involves the use of thiobendazole. Other skin conditions, such as impetigo, tinea pedis, and photoallergic dermatitis, have different causes and presentations and are less likely to be the correct diagnosis. Larva currens, caused by Strongyloides stercoralis, is another condition that can cause itching and skin eruptions, but it is typically associated with an intestinal infection and recurrent episodes. A differential diagnosis is important to ensure proper treatment and management of these skin conditions.
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This question is part of the following fields:
- Dermatology
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Question 19
Incorrect
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A General Practitioner is summoned to the nursing home to examine a 70-year-old man with dementia and severe pruritus. During the examination, the doctor observes excoriations on the patient's trunk and limbs. The patient also has scaling on his palms, particularly in the web spaces. What is the most probable diagnosis?
Your Answer: Diabetes
Correct Answer: Scabies infestation
Explanation:Understanding Scabies Infestation
Scabies infestation is a skin condition caused by the Sarcoptes scabiei mite. It is commonly transmitted through close contact and is prevalent in nursing homes and other institutions. The primary symptom of scabies is severe itching, and if present, burrows (linear crusted lesions) and penile papules are highly suggestive. The condition typically affects the web-spaces and around the nipples, with scalp involvement only occurring in young babies and debilitated adults. Excoriations are also common.
The treatment for scabies usually involves the use of permethrin, and close contacts should be treated simultaneously. Atopic eczema is unlikely to present at this age, and chronic kidney disease and diabetes are associated with several skin conditions but do not typically cause pruritus. Iron-deficiency anaemia may cause pruritus, but it is rarely as severe as scabies.
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This question is part of the following fields:
- Dermatology
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Question 20
Incorrect
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A 28-year-old man who has been experiencing a lot of stress at work lately presents with an itchy, red rash above the right corner of his mouth. The rash appeared 4 months ago, went away briefly, and then returned. He has used a topical corticosteroid to alleviate the symptoms, but had to discontinue it due to a flare-up of his facial acne. He admits to drinking excessive amounts of alcohol recently. On examination, there is a poorly defined red rash on the right side of his face, affecting the nasolabial fold. Additionally, there are fine, oily scales present.
What is the most probable diagnosis?Your Answer: Atopic dermatitis
Correct Answer: Seborrhoeic dermatitis
Explanation:Common Skin Conditions and Their Characteristics
Seborrhoeic Dermatitis: This condition is characterized by an ill-defined, itchy, erythematosus rash with fine, greasy scales. It typically affects the scalp, nasolabial fold, or post-auricular skin in adolescents and adults.
Dermatitis Herpetiformis: Often seen in patients with coeliac disease and malabsorption, this condition presents with intensely itchy grouped vesicles/papules over the extensor surfaces of the elbow, knee, upper back, and buttocks.
Lichen Planus: This condition is characterized by flat-topped, pruritic, red to violaceous polygonal papules or plaques. Lesions are often located on the wrists.
Atopic Dermatitis: This condition involves flexural regions in adult patients and is often associated with a history of atopy. The acute form of atopic dermatitis presents with erythema, oedema, vesicles, and papules.
Psoriasis: This condition is characterized by thick, well-demarcated erythematous plaques with silvery scaling over the extensor surface of the elbows and knees.
Characteristics of Common Skin Conditions
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This question is part of the following fields:
- Dermatology
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Question 21
Incorrect
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A 55-year-old woman comes to the clinic with blisters on her skin. She reports that some of the blisters have healed and left scars, but others are still growing and new ones are appearing. Despite taking antibiotics prescribed by her primary care physician, the blisters have not improved. Upon examination, the patient has multiple superficial skin lesions and oral lesions that easily slough off. A skin punch biopsy with immunofluorescent examination reveals circular intra-epidermal deposits. What other symptoms may this patient be experiencing?
Your Answer: Psoriatic plaques behind the elbows and knees
Correct Answer: Antibodies against desmosomes
Explanation:Understanding Pemphigus Vulgaris: An Autoimmune Blistering Condition
Pemphigus vulgaris is a blistering condition that primarily affects middle-aged individuals. It is caused by IgG autoantibodies against desmosomal components, specifically desmogleins 1 and 3, in the superficial layers of the skin. This results in flaccid blisters that easily rupture, leading to erosions and scarring. The oral mucosa is often affected early on, and Nikolsky’s sign is positive. Immunofluorescence reveals intra-epidermal circular deposits, and antibodies against desmosomes are typically positive. Treatment involves high-dose steroids and may require life-long maintenance doses. In contrast, bullous pemphigoid, which affects older individuals, is characterized by antibodies against hemidesmosomes in the deeper basement membrane of the skin, resulting in tense, firm blisters that do not rupture easily. Psoriasis, alopecia, and HIV are not linked to pemphigus vulgaris.
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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 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.
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This question is part of the following fields:
- Dermatology
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Question 23
Incorrect
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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: Guttate psoriasis
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.
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This question is part of the following fields:
- Dermatology
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Question 24
Incorrect
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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 due to localised areas of fat necrosis
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.
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This question is part of the following fields:
- Dermatology
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Question 25
Incorrect
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A 21-year-old woman presents to her general practitioner because she is concerned about patches of depigmentation on her skin. There are patches on the back of her hands and her elbows, but she is particularly concerned about depigmentation around her mouth and affecting her breasts. Her only other past history of note is a tendency to gain weight over the past few months. Investigations:
Investigation Result Normal value
Haemoglobin 119 g/l 115–155 g/l
Platelets 320 × 109/l 150–400 × 109/l
White cell count (WCC) 5.9 × 109/l 4–11 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 80 μmol/l 50–120 µmol/l
Thyroid stimulating hormone (TSH) 6.0 µU/l 0.17–3.2 µU/l
Depigmented skin areas fluoresce bright blue-white on Wood’s lamp inspection.
Which of the following is the most likely diagnosis?Your Answer: Leprosy
Correct Answer: Vitiligo
Explanation:Dermatological Conditions: Vitiligo, Lichen Planus, Leprosy, Pityriasis Versicolor, and Idiopathic Hypomelanosis
Vitiligo: This condition is characterized by depigmentation and is often associated with autoimmune diseases such as hypothyroidism, diabetes mellitus, Addison’s disease, and alopecia. It is caused by the destruction of melanocytes in the interfollicular dermis and can be treated with phototherapy, corticosteroids, and tacrolimus ointment.
Lichen Planus: This condition presents as a pruritic, papular eruption with a violaceous color and polygonal shape, often with a fine scale.
Leprosy: This infectious disease is caused by Mycobacterium leprae and is most commonly found in South East Asia, Africa, and South America. Diagnosis requires the presence of reddish patches or hypopigmented areas of skin with reduced sensation, thickened peripheral nerves, and the presence of acid-fast bacilli in skin smears or biopsies.
Pityriasis Versicolor: This common skin complaint is caused by the proliferation of the yeast Malassezia furfur and presents as flaky, discolored patches mainly on the chest and back.
Idiopathic Hypomelanosis: This condition is characterized by flat, white spots on the shins and forearms, typically appearing as part of the aging process and possibly due to sun damage. However, the age and distribution of the patient make this diagnosis doubtful.
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This question is part of the following fields:
- Dermatology
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Question 26
Incorrect
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A 50-year-old woman presents with multiple, ring-shaped, papular rashes on her forearms. She has recently noticed a white lacy intra-oral lesion.
What is the most likely cause of this?Your Answer: Psoriasis
Correct Answer: Lichen planus
Explanation:Skin Conditions: Lichen Planus, Erythema Multiforme, Tinea Versicolour, Psoriasis, and Ringworm
Lichen planus is an inflammatory skin condition that affects both cutaneous and mucosal surfaces. It is characterized by flat-topped plaques and papules with a purple hue and white striae. Topical steroids and immunomodulators are used to treat it, as it can increase the risk of squamous cell carcinoma if left untreated.
Erythema multiforme is a skin condition that presents with targetoid lesions with a central depression, usually starting on the acral extensor surfaces. It can be caused by medications, infections, or underlying conditions such as sarcoidosis and non-Hodgkin’s lymphoma.
Tinea versicolour, also known as pityriasis versicolor, is a fungal skin infection that causes pale or dark patches on the arms, neck, and trunk. It does not involve mucosal surfaces.
Psoriasis is an autoimmune chronic skin condition that presents with erythematous plaques with overlying grey scale on the extensor surfaces of extremities. It is not associated with intra-oral mucosal lesions.
Ringworm, also known as tinea corporis, is a fungal skin infection that causes erythematosus, scaly patches on the skin surface of the trunk, back, and extremities. It is not usually seen on the scalp, groin, palms, and soles. The patches progressively enlarge and worsen, and can lead to the formation of pustules or vesicles. Following central resolution, the lesions can remain annular.
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This question is part of the following fields:
- Dermatology
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Question 27
Incorrect
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An 8-year-old girl visits her GP complaining of an itchy scalp. Upon detection combing, head lice are found. What is a recognized treatment for head lice?
Your Answer: Topical antibiotics
Correct Answer: Dimeticone 4% gel
Explanation:Treatment Options for Head Lice
Head lice infestations are a common problem, especially among children. There are several treatment options available, but not all of them are effective or recommended. Here are some of the commonly used treatments and their effectiveness:
Dimeticone 4% gel: This gel works by suffocating and coating the lice, making it a well-recognized treatment for head lice.
Ketoconazole shampoo: While this medicated shampoo is used to treat suspected fungal infections in the scalp, it is not a recognized treatment for head lice.
Permethrin 5% cream: Although permethrin is an insecticide used to treat scabies, it is not recommended for head lice treatment as the 10-minute contact time may not be enough for it to be effective.
Topical antibiotics: These are not recommended for head lice treatment.
Topical antifungal: Topical antifungals have no role in the management of head lice.
In conclusion, dimeticone 4% gel is a well-recognized treatment for head lice, while other treatments such as ketoconazole shampoo, permethrin 5% cream, topical antibiotics, and topical antifungal are not recommended. It is important to consult a healthcare professional for proper diagnosis and treatment of head lice.
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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 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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This question is part of the following fields:
- Dermatology
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Question 29
Incorrect
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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: Pyoderma gangrenosum
Correct 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.
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This question is part of the following fields:
- Dermatology
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Question 30
Incorrect
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In what condition is lupus pernio observed?
Your Answer: HIV infection
Correct Answer: Sarcoidosis
Explanation:Lupus Pernio in Sarcoidosis
Lupus pernio is a distinct skin manifestation that is commonly associated with sarcoidosis. This condition is characterized by the presence of chronic, hardened papules or plaques that primarily affect the mid-face, particularly the alar rim of the nose. Even small papules in this area may indicate the presence of granulomatous infiltration in the nasal mucosa and upper respiratory tract, which can lead to the formation of masses, ulcerations, or even life-threatening airway obstruction. Therefore, it is important to promptly diagnose and manage lupus pernio in patients with sarcoidosis to prevent further complications. Proper treatment may involve the use of systemic corticosteroids, immunosuppressive agents, or other targeted therapies.
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This question is part of the following fields:
- Dermatology
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