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Question 1
Correct
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A 27-year-old woman is worried about the appearance of her toenails. She has noticed a whitish discoloration that extends up the nail bed in several toes on both feet. After confirming a dermatophyte infection, she has been diligently cutting her nails and applying topical amorolifine, but without success. What is the best course of treatment for her condition?
Your Answer: Oral terbinafine
Explanation:Treatment for Fungal Nail Infection
Fungal nail infection is a common condition that affects many adults. If self-care measures and topical treatments are not successful or appropriate, treatment with an oral antifungal agent should be offered. The first-line treatment recommended is Terbinafine, which is effective against both dermatophytes and Candida species. On the other hand, ‘-azoles’ such as fluconazole do not have as much efficacy against dermatophytes. It is important to seek medical advice and follow the recommended treatment plan to effectively manage fungal nail infection. For further information, resources such as CKS Fungal nail infections, GP Notebook, and Patient.info can be consulted. The British Association of Dermatologists also provides guidelines for the treatment of onychomycosis.
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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 35-year-old woman presents with a 4-year history of a progressively worsening rash on her face, characterised by dark-coloured lesions with periodic background scaling, burning and pruritus. Physical examination reveals well-defined patches of flaky skin which is yellow and dry on the scalp. There is also flaking in the nasolabial folds, eyebrows and behind the ears. The patient’s eyelids are also red and inflamed. They report itchiness and discomfort.
Given the likely diagnosis of this patient, what is the most appropriate treatment?Your Answer: Clotrimazole
Correct Answer: Ketoconazole
Explanation:Treatment Options for Seborrheic Dermatitis and Psoriasis
Seborrheic dermatitis and psoriasis are two common skin conditions that can cause discomfort and irritation. Fortunately, there are several treatment options available to help manage symptoms and improve overall skin health.
Ketoconazole is the preferred medication for treating seborrheic dermatitis in adults. It is available as a 2% cream and should be applied once or twice daily for at least four weeks. Antifungal shampoo can also be used on the scalp. For infants with seborrheic dermatitis, clotrimazole is a suitable option and should be applied 2-3 times a day for up to four weeks.
Emollients are often used to relieve symptoms of psoriasis by moisturizing dry skin and reducing itching. They can be used before starting steroid treatment for psoriasis. It is important to avoid using soap and shaving creams on the face, as they can exacerbate irritation. Instead, non-greasy emollients or emollient soaps can be used as an alternative.
Topical steroids are commonly used to treat psoriasis by reducing skin inflammation. Mild topical steroids can be used on the face or skinfolds. It is important to follow the instructions provided by your healthcare provider and to use these medications as directed.
In summary, there are several treatment options available for managing seborrheic dermatitis and psoriasis. By working with your healthcare provider, you can find the best approach to improve your skin health and overall quality of life.
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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 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: Pemphigoid
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.
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This question is part of the following fields:
- Dermatology
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Question 4
Incorrect
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For her 4-year-old son Oliver's atopic eczema, Mrs Simpson takes him to the general practice surgery. Despite using aqueous cream regularly, Oliver has not seen much improvement. The general practitioner suggests trying a topical steroid cream. Which topical steroid would be the most suitable option to try next?
Your Answer: Betnovate
Correct Answer: Hydrocortisone 1%
Explanation:Understanding Topical Steroid Creams for Atopic Eczema Treatment
Atopic eczema is a common skin condition that can be managed with the use of topical steroid creams. These creams come in different potencies, and it is important to use the least potent effective cream for children to avoid side effects. The first step in treatment is emollients such as aqueous cream, followed by mild potency hydrocortisone 1-2.5%. If there is no response, a moderately potent cream like Eumovate may be used. Potent creams like Betnovate and very potent creams like Dermovate are not appropriate next steps in management. Trimovate is a moderate steroid cream with antimicrobial effect. The goal is to achieve control of eczema and step down the ladder of potency until maintenance is achieved on the least potent agent. Understanding the different types of topical steroid creams can help in the effective management of atopic eczema.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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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.
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This question is part of the following fields:
- Dermatology
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Question 6
Incorrect
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Bethany Johnson, a 20-year-old student, visits her GP complaining of generalized itching. She reports no allergies or recent changes in cosmetic or detergent products. During the examination, the GP observes multiple excoriation marks throughout her body. Bethany also mentions experiencing fatigue and weight gain recently. What is the probable cause of her systemic pruritus?
Your Answer: Widespread dermatitis
Correct Answer: Hypothyroidism
Explanation:Causes and diagnostic workup of systemic pruritus
Systemic pruritus, or generalized itching, can have various underlying causes, including pregnancy, primary biliary cholangitis, renal failure, diabetes, leukaemia, polycythaemia, psychological factors, and hypothyroidism. To diagnose the condition, blood tests are typically performed to rule out these potential causes. Hypothyroidism may be suspected if the patient also experiences weight gain and fatigue. Treatment for systemic pruritus involves addressing the underlying condition, as well as using measures such as keeping the skin cool, applying emollients, and taking sedating antihistamines at night.
Other conditions that may cause pruritus but are less likely in this case include iron deficiency anaemia, which typically presents with pallor rather than weight gain, and cholestasis, which usually causes jaundice, dark urine, and pale stool. Lymphoma, a type of cancer affecting the lymphatic system, may cause weight loss and lymphadenopathy rather than weight gain. Widespread dermatitis, characterized by a rash, is another possible cause of pruritus.
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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 42-year-old black woman comes in with depigmented patches of skin on her hands and face. What is the probable diagnosis?
Your Answer: Albinism
Correct Answer: Vitiligo
Explanation:Common Skin Pigmentation Disorders
Vitiligo, Pityriasis alba, Albinism, Melasma, and Melanoma are all skin pigmentation disorders that affect people of different ages and ethnicities. Vitiligo is a rare autoimmune condition that destroys melanocytes, causing white patches on the skin. Pityriasis alba is a scaly, white patch that usually affects children’s facial skin. Albinism is a genetic disorder that reduces tyrosinase activity in melanocytes, resulting in a lack of pigment in the skin, hair, and irises. Melasma is a condition of increased pigmentation, usually occurring underneath the eyes, and is common in pregnant women and oral contraceptive users. Melanoma is a malignant skin cancer that develops from melanocytes and is characterized by irregular, highly pigmented moles. Understanding these disorders can help individuals identify and manage their skin conditions.
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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 mother brings her 9-month old to her General Practitioner (GP) worried about a raised red mark on the baby's cheek. The mark is now 7 mm in diameter, has a smooth outline, and is a regular circular shape with consistent color all over. It appeared about four months ago and has been gradually increasing in size. The baby was born at full term via normal vaginal delivery and has been generally healthy. What is the most probable diagnosis?
Your Answer: Malignant melanoma
Correct Answer: Infantile haemangioma (strawberry mark)
Explanation:Types of Birthmarks in Children: Characteristics and Considerations
Birthmarks are common in children and can vary in appearance and location on the body. Understanding the characteristics of different types of birthmarks can help parents and healthcare providers determine if further evaluation or treatment is necessary.
Infantile haemangiomas, also known as strawberry marks, are raised and red in color. They typically grow for the first six months of life and then shrink, disappearing by age 7. Treatment is usually not necessary unless they affect vision or feeding.
Café-au-lait spots are flat, coffee-colored patches on the skin. While one or two are common, more than six by age 5 may indicate neurofibromatosis.
Capillary malformations, or port wine stains, are dark red or purple and not raised. They tend to affect the face, chest, or back and may increase in size during puberty, pregnancy, or menopause.
Malignant melanoma is rare in children but should be considered if a lesion exhibits the ABCD rules.
Salmon patches, or stork marks, are flat and red or pink and commonly occur on the forehead, eyelids, or neck. They typically fade after a few months.
By understanding the characteristics and considerations of different types of birthmarks, parents and healthcare providers can ensure appropriate evaluation and treatment if necessary.
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This question is part of the following fields:
- Dermatology
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Question 9
Incorrect
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Which statement about nail changes is accurate?
Your Answer: Koilonychia is the result of vitamin B12 deficiency
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.
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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 50-year-old pharmacist with a longstanding diagnosis of sarcoidosis presents to the Dermatology Clinic with an unsightly rash. The rash has been present for a number of years, but the area affected is becoming more prominent and is making her feel very self-conscious. She has been told previously that the rash is connected to her sarcoidosis; however, she would like to know if anything can be done to treat it.
Which one of the following dermatological conditions is diagnostic of chronic sarcoidosis?Your Answer: Keloid formation
Correct Answer: Lupus pernio
Explanation:Cutaneous Manifestations of Sarcoidosis
Sarcoidosis is a systemic disease that can affect multiple organs, including the skin. Cutaneous manifestations of sarcoidosis can vary and may present differently depending on the stage of the disease. Here are some common cutaneous manifestations of sarcoidosis:
Lupus pernio: This is a specific skin involvement that affects the bridge of the nose and the area beneath the eyes and cheeks. It is diagnostic for the chronic form of sarcoidosis. The lesions are typically large, bluish-red and dusky purple, infiltrated, plaque-like nodules.
Erythema nodosum: This is seen in the acute stage of sarcoidosis, but it is also seen in many other diseases.
Keloid formation: This is a classic cutaneous lesion of sarcoidosis, but it is not diagnostic of chronic sarcoidosis.
Subcutaneous nodules: These can also be seen in rheumatoid arthritis and are not diagnostic of sarcoidosis.
It is important to note that cutaneous manifestations of sarcoidosis can be nonspecific and may resemble other skin conditions. Therefore, a thorough evaluation by a healthcare provider is necessary for proper diagnosis and treatment.
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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 6-year-old girl visits her GP with her mother, complaining of a sore and itchy patch around her upper lip for the past 3 days. The mother noticed a few small blisters on the lip that burst, leaving brown and/or honey-coloured crusts on the affected area. The patch has been gradually increasing in size. After examination, the GP diagnoses impetigo.
What is the most probable cause of impetigo in this case?Your Answer: Staphylococcus epidermidis
Correct Answer: Staphylococcus aureus
Explanation:Understanding Impetigo and its Causes
Impetigo is a highly contagious skin infection that commonly affects children. It is caused by Staphylococcus aureus, which presents as red sores and blisters on the face, leaving behind golden crusts. While the condition is usually self-limiting, treatment is recommended to prevent spreading to others. Staphylococcus epidermidis, a normal human flora, is an unlikely cause of impetigo, but may infect immunocompromised patients in hospital settings. Staphylococcus saprophyticus is associated with urinary tract infections, while Streptococcus viridans is found in the oral cavity and can cause subacute bacterial endocarditis. Candida albicans, a pathogenic yeast, commonly causes candidiasis in immunocompromised individuals.
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This question is part of the following fields:
- Dermatology
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Question 12
Incorrect
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A toddler is brought to the clinic with severe eczema. What is the appropriate treatment for this condition?
Your Answer: Should not be immunised against pertussis
Correct Answer: Might benefit from a diet free of cow's milk
Explanation:Managing Eczema in Infants
Eczema is a common skin condition in infants that can cause discomfort and distress. Cow’s milk allergy may trigger severe eczema, but switching to a soy-based formula may help alleviate symptoms. While complete cure may not be possible, appropriate preventative measures and topical preparations can minimize the condition’s impact. Most infants outgrow eczema by the age of 2-3 years.
There is no evidence to suggest that infants with eczema should not receive measles or pertussis immunization, but they should avoid immunization if they have a concurrent skin infection. Oral steroids are a last resort and are rarely used in infants with severe eczema. By following these guidelines, parents and caregivers can help manage eczema in infants and improve their quality of life.
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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 42-year-old man visits his primary care physician complaining of thick, well-defined, red patches with silvery scales on the extensor surfaces of his elbows and knees. He has been experiencing these skin lesions intermittently for the past 3 years. The lesions tend to improve during the summer months, worsen during times of stress, and reappear at the site of trauma, particularly where he scratches. A skin biopsy specimen reveals epidermal hyperplasia and parakeratosis, with neutrophils present within the epidermis. What is the most probable diagnosis?
Your Answer: Tinea corporis
Correct Answer: Plaque psoriasis
Explanation:Differentiating Skin Conditions: A Brief Overview
Psoriasis is a skin condition characterized by a rash with typical histology and location. The Koebner phenomenon, where lesions occur at sites of trauma, is a common feature of psoriasis. Treatment involves exposure to ultraviolet light, tar-based treatments, and immunosuppressant drugs. Pruritus is not always present.
Seborrhoeic dermatitis presents as itchy, ill-defined erythema and greasy scaling on the scalp, nasolabial folds, or post-auricular skin in adults and adolescents.
Lichen planus is characterized by flat-topped, pruritic, polygonal, red-to-violaceous papules or plaques. Lesions are often located on the wrist, with papules demonstrating central dimpling.
Atopic dermatitis is a chronic inflammatory skin disease characterized by itchy, red rashes often found in the flexor areas of joints.
Tinea corporis is a ringworm infection characterized by expanding patches with central clearing and a well-defined active periphery. The active periphery is raised, pruritic, moist, erythematosus, and scaly, with papules, vesicles, and pustules.
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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 35-year-old woman comes to her GP complaining of facial erythema. She has developed papules and pustules with visible telangiectasia. What is the most probable diagnosis?
Your Answer: Pityriasis rosea
Correct Answer: Acne Rosacea
Explanation:Common Skin Conditions: Causes, Symptoms, and Treatments
Acne Rosacea:
Acne rosacea is a chronic skin condition that typically affects women and people with fair skin between the ages of 30-50. The exact cause is unknown, but environmental factors such as alcohol, caffeine, heat, and stress can aggravate the condition. Symptoms include a persistent erythematosus rash on the face, particularly over the nose and cheeks, with associated telangiectasia. Treatment involves lifestyle modifications and pharmacological interventions with topical or oral antibiotics.Acne Vulgaris:
Acne vulgaris is an inflammatory response to Propionibacterium acnes, a normal skin commensal. It commonly affects adolescents and presents with a variety of lesions ranging from comedones to cysts and scars. It predominantly affects areas with high concentrations of sebaceous glands, such as the face, back, and chest.Discoid Lupus Erythematosus:
Discoid lupus erythematosus is a cutaneous form of lupus erythematosus that affects sun-exposed areas of the skin. It typically presents in women between the ages of 20-40 and presents as red patches on the nose, face, back of the neck, shoulders, and hands. If left untreated, it can cause hypertrophic, wart-like scars.Pityriasis Rosea:
Pityriasis rosea is a self-limiting skin condition that affects young adults, mostly women. It presents with salmon-pink, flat or slightly raised patches with surrounding scale known as a collarette. The rash is usually symmetrical and distributed predominantly on the trunk and proximal limbs.Psoriasis:
Psoriasis is an autoimmune skin condition that presents with red scaly patches on the extensor surfaces of the limbs and behind the ears. Treatment involves topical or systemic medications to control symptoms and prevent flares. -
This question is part of the following fields:
- Dermatology
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Question 15
Correct
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A 25-year-old woman presents with severe itching, mainly affecting her groin. The problem has been worsening over the past few weeks and is now unbearable. She admits to having slept with a new partner a few weeks before she noticed the problem. You notice an erythematosus, papular rash affecting the web spaces on the hands. She also has erythematous papules and scratch marks around the groin in particular. Investigations reveal normal values for haemoglobin, white cell count, platelets, sodium, potassium, and creatinine. When you draw on the web spaces between her fingers with a felt-tip, rubbing off the excess reveals a number of burrows. What is the most likely diagnosis?
Your Answer: Sarcoptes scabiei hominis infection
Explanation:Skin Conditions: Differential Diagnosis
Scabies Infection
A scabies infection is a likely diagnosis for a patient presenting with itching between the web spaces and in the groin. The infection is typically acquired through skin-to-skin contact, often after sexual intercourse. Symptoms may not appear until three to four weeks after initial contact, and treatment involves the use of a topical agent such as permethrin cream.Atopic Dermatitis
Atopic dermatitis, or eczema, is an unlikely diagnosis for a patient presenting with symptoms in the groin and web spaces. It typically presents with a rash and itching on the flexor aspects of the joints and is unrelated to sexual activity.Folliculitis
Folliculitis is an unlikely diagnosis for a patient presenting with symptoms in the groin and web spaces. It typically presents with pinpoint erythematosus lesions on the chest, face, scalp, or back and is unrelated to sexual activity.Erythema Infectiosum Infection
Erythema infectiosum infection is a very unlikely diagnosis for a patient presenting with symptoms in the groin and web spaces. It primarily affects children and results from infection with parvovirus B19. Symptoms include a slapped cheek appearance, fever, headache, and coryza.Keratosis Pilaris Infection
Keratosis pilaris is an unlikely diagnosis for a patient presenting with symptoms in the groin and web spaces. It typically affects the upper arms, buttocks, and thighs and presents with small white lesions that make the skin feel rough. It results from the buildup of keratin and is more common in patients with dry skin. It is unrelated to sexual activity.Differential Diagnosis of Skin Conditions
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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 29-year-old male patient comes to you with a complaint of an erythematosus rash in his groin area. He reports that the rash was initially raised and red, but it has now healed and left behind hyperpigmentation. Interestingly, he mentions that he has experienced this same rash in the same location before. Upon further questioning, he reveals that he had taken ibuprofen for a strained ankle prior to the onset of the rash. What is the probable cause of this presentation?
Your Answer: Herpes genitalis
Correct Answer: Fixed drug eruption
Explanation:Fixed Drug Eruptions: Recurring Lesions Caused by Medications
Fixed drug eruptions are a type of skin reaction that occurs when a person takes a medication to which they are allergic. These eruptions are characterized by circular, violaceous, and oedematous plaques that appear in the same area where the offending drug was given. The lesions usually occur within 30 minutes to eight hours after drug administration and can be found in various parts of the body, with the hands, feet, and genitalia being the most common locations.
One of the distinguishing features of fixed drug eruptions is that the lesions tend to recur in the same area whenever the person takes the offending drug again. The lesions may resolve on their own, but they often leave behind macular hyperpigmentation, which is a darkening of the skin in the affected area. In some cases, perioral and periorbital lesions may also occur.
Overall, fixed drug eruptions can be a frustrating and uncomfortable experience for those who suffer from them. It is important to identify the offending drug and avoid it in the future to prevent further outbreaks.
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This question is part of the following fields:
- Dermatology
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Question 17
Incorrect
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A 25-year-old woman is distressed about her acne vulgaris, which includes papules, pustules, and comedones. She experienced acne during her adolescent years, and it has continued to persist. Her weight and menstrual cycle are normal, and there is no hirsutism. What is a probable cause of her condition?
Your Answer: Poor personal hygiene
Correct Answer: Bacteria
Explanation:Understanding the Aetiology of Acne: Factors and Myths
Acne vulgaris is a common skin condition that affects individuals beyond their teenage years, particularly women. The presence and activity of Propionibacterium acnes, a normally commensal bacteria, is a significant factor in the development of acne. Other aetiological factors include genetic predisposition, seborrhoea, sensitivity to normal levels of circulating androgen, blockage of the pilosebaceous duct, and immunological factors. Polycystic ovary syndrome is an unlikely cause of acne. P. acnes thrives in acne lesions due to elevated sebum production or follicle blockage, triggering inflammation. Diet and poor personal hygiene are not involved in the aetiology of acne. Combined oral contraceptives can be beneficial in treating acne. It is a myth that chocolate or dirt causes acne. Understanding these factors and myths can help in the effective management of acne.
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This question is part of the following fields:
- Dermatology
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Question 18
Incorrect
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A 6-year-old girl is brought to the General Practitioner (GP) by her mother. She has suffered an insect bite, and her mother is concerned about a small lump on the back of her hand.
Which of the following conditions is not pre-malignant?Your Answer: Bowen’s disease
Correct Answer: Dermatofibroma
Explanation:Common Pre-Malignant Skin Conditions
There are several pre-malignant skin conditions that can occur due to various factors. One such condition is dermatofibroma, which is an overgrowth of fibrous tissue in the dermis. It is usually benign and can be caused by minor skin trauma like an insect bite.
Another pre-malignant condition is Bowen’s disease, which is a type of intraepidermal carcinoma. It presents as scaly, erythematosus lesions and is often associated with sun exposure.
Lentigo maligna, also known as melanoma in situ, is an early form of melanoma that develops slowly over time. It typically appears on sun-exposed areas of the skin.
Leukoplakia is a pre-malignant condition that presents as white or grey patches in the oral cavity. It is important to have these patches evaluated by a healthcare professional.
Actinic keratoses, or solar keratoses, are pre-malignant conditions that occur due to chronic exposure to ultraviolet light. They are more common in fair-skinned individuals and typically affect sun-exposed areas of the skin. Regular skin checks and sun protection can help prevent these conditions from developing into skin cancer.
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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 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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This question is part of the following fields:
- Dermatology
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Question 20
Correct
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A 72-year-old retired farmer has switched his General Practitioner (GP) and comes in for a check-up. During the appointment, he asks for a review of several lesions on his forehead.
Upon examination, he is bald and has multiple scaly, crusted lesions on his mid-frontal scalp, along with a keratinous horn with a smooth base on the helix of his right ear. He mentions that he had similar lesions on his scalp before. These were treated with a cream that made the lesions worse for four weeks before completely resolving when the treatment was finished.
What is the most probable diagnosis?Your Answer: Actinic keratosis
Explanation:Differentiating Skin Lesions: Actinic Keratosis, Chondrodermatitis Nodularis Helicis, Basal Cell Carcinoma, Lentigo Maligna, and Seborrhoeic Keratosis
Skin lesions can be difficult to differentiate, but understanding their characteristics can aid in diagnosis and treatment. Actinic keratosis is a pre-malignant condition that is more common in sun-exposed patients, often presenting as scaly lesions on bald areas. Treatment with Efudix may initially worsen the lesions before improving. Chondrodermatitis nodularis helicis is a benign condition characterized by a tender, firm lesion on the ear due to pressure from sleeping on that side. It is treated with strong topical steroids and is not associated with a keratinous horn. Basal cell carcinoma is a common skin cancer associated with sun exposure, presenting with telangiectasia and a rolled edge. Lentigo maligna is a malignant lesion associated with sun exposure, typically pigmented and occurring on the face. Seborrhoeic keratosis is a common benign lesion that can mimic other lesions, but is not associated with sun exposure and is often found on the back, appearing stuck-on rather than scaly. Understanding the characteristics of these skin lesions can aid in accurate diagnosis and appropriate treatment.
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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 14-year-old boy comes to the clinic with scaly patches on his scalp. Upon examination, circular areas of hair loss with scaling and raised margins, measuring 2-5 cm in diameter, are observed. There is no scarring. What is the probable cause of this condition in the patient?
Your Answer: Lichen planus
Correct Answer: Tinea capitis
Explanation:Causes of Non-Scarring and Scarring Alopecia
Non-scarring alopecia is a condition where hair loss occurs without any visible scarring on the scalp. The most common causes of this type of alopecia include telogen effluvium, androgenetic alopecia, alopecia areata, tinea capitis, and traumatic alopecia. In some cases, non-scarring alopecia can also be associated with lupus erythematosus and secondary syphilis.
Tinea capitis, caused by invasion of hairs by dermatophytes, most commonly Trichophyton tonsurans, is a common cause of non-scarring alopecia. This type of alopecia is characterized by hair loss in circular patches on the scalp.
On the other hand, scarring alopecia is a condition where hair loss occurs with visible scarring on the scalp. This type of alopecia is more frequently the result of a primary cutaneous disorder such as lichen planus, folliculitis decalvans, cutaneous lupus, or linear scleroderma (morphea). Scarring alopecia can be permanent and irreversible, making early diagnosis and treatment crucial.
In conclusion, the different causes of non-scarring and scarring alopecia is important in determining the appropriate treatment plan for patients experiencing hair loss.
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This question is part of the following fields:
- Dermatology
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Question 22
Incorrect
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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: Systemic lupus erythematosus (SLE)
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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This question is part of the following fields:
- Dermatology
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Question 23
Incorrect
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A 32-year-old woman presents with four episodes of oral ulceration in the course of 1 year. These have taken up to 3 weeks to heal properly. She has also suffered from painful vaginal ulceration. Additionally, there have been intermittent headaches, pain and swelling affecting both knees, and intermittent diarrhoea. On examination, there are several mouth ulcers of up to 1 cm in diameter. She also has erythema nodosum.
Investigations:
Investigation Result Normal value
Haemoglobin 129 g/l 115–155 g/l
White cell count (WCC) 6.9 × 109/l 4–11 × 109/l
Platelets 190 × 109/l 150–400 × 109/l
Erythrocyte sedimentation rate (ESR) 45 mm/h 0–10mm in the 1st hour
C-reactive protein (CRP) 50 mg/l 0–10 mg/l
Elevated level of immunoglobulin A (IgA)
ANCA (antineutrophil cytoplasmic antibody) negative
antiphospholipid antibody negative
Which of the following diagnoses fits best with this clinical picture?Your Answer: Pemphigoid
Correct Answer: Behçet’s disease
Explanation:Differentiating Behçet’s Disease from Other Conditions: A Guide
Behçet’s disease is a syndrome characterized by recurrent painful oral ulceration, genital ulcers, ophthalmic lesions, skin lesions, and possible cerebral vasculitis. However, these symptoms can also be present in other conditions, making diagnosis challenging. Granulomatosis with polyangiitis (GPA) mainly affects the lungs, kidneys, and upper respiratory tract, but does not typically present with ulceration. Herpes simplex is not associated with systemic features, while bullous pemphigoid affects the skin and rarely the mouth. Pemphigus, on the other hand, presents with oral bullae and skin bullae but does not involve elevated levels of IgA. Treatment for Behçet’s disease is complex and depends on the extent of organ involvement and threat to vital organ function.
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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 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.
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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 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: Cowpox
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.
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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 22-year-old woman presents to her dermatologist with a 4-year history of acne on her back, chest and face. She has comedones, pustules and scars that have not improved with previous treatments. The dermatologist decides to prescribe isotretinoin. What other medication should be prescribed alongside this?
Your Answer: Oral oxytetracycline
Correct Answer: Combined oral contraceptive
Explanation:The patient has severe acne and topical treatment has not been effective. The dermatologist will prescribe oral isotretinoin, which is a specialist drug that can only be prescribed in secondary care. However, isotretinoin is teratogenic, so women of reproductive age must use at least two methods of contraception while taking the drug. The combined oral contraceptive pill is often co-prescribed with isotretinoin to help balance the hormonal profile and improve the skin condition. Topical retinoids are the treatment of choice for mild to moderate acne, but they are not indicated for severe acne. Oral oxytetracycline can be used in combination with a topical retinoid or benzoyl peroxide for moderate acne, but it is contraindicated in pregnancy. Topical erythromycin is used for mild to moderate acne and should always be prescribed in combination with benzoyl peroxide to prevent microbial resistance. Topical benzoyl peroxide is used for mild or moderate acne and can be combined with a topical retinoid or antibiotic, or an oral antibiotic for moderate acne.
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This question is part of the following fields:
- Dermatology
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Question 27
Correct
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A 35-year-old woman with uncontrolled psoriasis is returning with deteriorating symptoms. Despite using potent topical treatments, her psoriasis remains uncontrolled.
What is the next appropriate step in managing her condition?Your Answer: Add in narrow-band ultraviolet B (UVB) phototherapy
Explanation:Next Steps in Psoriasis Treatment: Narrow-Band UVB Phototherapy
When topical treatments fail to improve psoriasis symptoms, the next step in treatment is often narrow-band ultraviolet B (UVB) phototherapy. While it has a reasonable success rate, it also comes with potential complications such as an increased risk of skin cancer. Patients with a history of skin cancer may not be recommended for this treatment.
Changing topical steroids would not be an appropriate step in the management plan. Instead, it is necessary to move onto the next step of the psoriasis treatment ladder. Biologics are not indicated at this stage and should only be considered as an end-stage treatment due to their high cost and significant side effects.
Psoralen with local ultraviolet A (UVA) irradiation may be appropriate for patients with palmoplantar pustulosis. However, for most patients, stopping steroids is not recommended. Instead, narrow-band UVB phototherapy should be commenced without stopping steroids to optimize treatment and increase the chances of success.
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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 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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This question is part of the following fields:
- Dermatology
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Question 29
Incorrect
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A 35-year-old lifeguard presents with a lesion on the ear. The lesion had been present for a number of months and he claims it is slowly growing. On examination, there is 1 cm red, ulcerating exophytic nodule with heaped up margins. Excision of the lesion is performed and histology reveals a completely excised lesion containing irregular masses of anaplastic epidermal cells proliferating down to the dermis with keratin pearls.
Which of the following is true regarding this lesion?Your Answer: It is more commonly found on the upper lip than lower lips
Correct Answer: It may arise from actinic keratosis
Explanation:Understanding Squamous Cell Carcinoma of the Skin
Squamous cell carcinoma (SCC) of the skin is a common type of skin cancer that typically affects older men with a history of sun exposure. It may also arise from chronic inflammation or pre-existing actinic keratosis. SCC is slow-growing and locally invasive, but spread to locoregional lymph nodes is uncommon. The typical appearance is small, red, ulcerating, exophytic nodules with varying degrees of scaling on sun-exposed areas. Biopsy features include keratin pearls. Treatment may involve topical creams or excision. SCC is the second commonest skin cancer after basal cell carcinoma. It is commonly found on the lower lip or ears, and spread to regional lymph nodes is uncommon. There is no link to preceding dermatophyte infection.
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This question is part of the following fields:
- Dermatology
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Question 30
Correct
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A 14-year-old girl came to the clinic with several erythematosus lesions on her trunk. The lesions had a collarette of scales at their periphery and were asymptomatic. What is the most probable diagnosis?
Your Answer: Pityriasis rosea
Explanation:Pityriasis Rosea: Symptoms, Causes, and Treatment
Pityriasis rosea is a skin condition that typically begins with a single patch, known as the herald or mother patch. This is followed by smaller patches that appear in clusters, resembling a Christmas tree pattern on the upper trunk of the body. These patches have a fine ring of scales around their edges, known as a collarette. The condition is believed to be caused by a viral infection and typically lasts for six to eight weeks. While there is no specific treatment for pityriasis rosea, symptoms can be managed with over-the-counter medications and topical creams.
Pityriasis rosea is a common skin condition that can cause discomfort and embarrassment for those affected. the symptoms, causes, and treatment options can help individuals manage the condition and alleviate symptoms.
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This question is part of the following fields:
- Dermatology
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