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  • Question 1 - A 50-year-old woman comes to the skin clinic with flaccid blisters on the...

    Correct

    • A 50-year-old woman comes to the skin clinic with flaccid blisters on the inside of her mouth and the front of her chest, accompanied by red and weeping areas. The dermatologist performs a skin biopsy, which reveals a superficial intra-epidermal split just above the basal layer with acantholysis. What is the probable diagnosis?

      Your Answer: Pemphigus vulgaris

      Explanation:

      Pemphigus vulgaris is an autoimmune disease that causes blistering and erosions on the skin and mucous membranes, particularly in the mouth. It is caused by autoantibodies to desmoglein 3, a component of the desmosome. The blisters are thin-walled and easily ruptured, leaving painful erosions. Diagnosis is made with a skin biopsy, and treatment involves high-dose corticosteroids or other immunosuppressive drugs.

      Bullous pemphigoid is another blistering disorder, but it involves sub-epidermal splitting and tense blisters that are less easily ruptured than in pemphigus vulgaris. Mucous membranes are typically not affected.

      Dermatitis herpetiformis is characterised by intensely pruritic clusters of small blisters on the elbows, knees, back, and buttocks. It is associated with HLA-DQ2 and DQ8 and is often seen in patients with coeliac disease.

      Epidermolysis bullosa is a rare inherited disorder that causes the skin to become very fragile, leading to blistering and erosions. Symptoms appear at birth or shortly afterwards.

      Tuberous sclerosis is not associated with blistering and is a genetic disorder that causes benign tumours to grow in various organs, including the skin.

    • This question is part of the following fields:

      • Dermatology
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  • Question 2 - A 67-year-old woman presents with blistering lesions on her leg and is suspected...

    Incorrect

    • A 67-year-old woman presents with blistering lesions on her leg and is suspected to have bullous pemphigoid. What would be the most suitable course of action for management?

      Your Answer: Trial of topical corticosteroids and review in 2 weeks

      Correct Answer: Refer to secondary care

      Explanation:

      Understanding Bullous Pemphigoid

      Bullous pemphigoid is an autoimmune disease that causes blistering of the skin due to the development of antibodies against hemidesmosomal proteins BP180 and BP230. This condition is more common in elderly patients and is characterized by itchy, tense blisters that typically appear around flexures. However, the blisters usually heal without scarring, and there is usually no mucosal involvement.

      To diagnose bullous pemphigoid, a skin biopsy is necessary, and immunofluorescence shows IgG and C3 at the dermoepidermal junction. Treatment for this condition involves referral to a dermatologist for biopsy and confirmation of diagnosis, as well as the use of oral corticosteroids as the mainstay of treatment. Topical corticosteroids, immunosuppressants, and antibiotics may also be used.

      It is worth noting that while mucosal involvement is seen in some patients, it is not a classic feature of bullous pemphigoid and is therefore not always mentioned in exam questions. Overall, understanding the symptoms, diagnosis, and treatment of bullous pemphigoid is crucial for healthcare professionals to provide appropriate care for patients with this condition.

    • This question is part of the following fields:

      • Dermatology
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  • Question 3 - A 60-year-old smoker presents with non-healing sores on his lower lip that have...

    Correct

    • A 60-year-old smoker presents with non-healing sores on his lower lip that have been gradually enlarging for several months. Upon examination, a lesion is found at the vermilion border of the lower lip. What is the most probable type of lesion?

      Your Answer: Squamous cell carcinoma (SCC)

      Explanation:

      Common Skin Lesions and Cancers: Characteristics and Clinical Presentations

      Squamous cell carcinoma (SCC), actinic keratosis, Bowen’s disease, cold sores, and leukoplakia are common skin lesions and cancers that have distinct characteristics and clinical presentations.

      SCC is a malignant tumour that commonly affects the backs of the hands and forearms, the upper part of the face, and the lower lip and pinna in men. The first clinical sign is induration, which may take on nodular, plaque-like, verrucous, or ulcerated characteristics. The limits of induration are not sharp and usually extend beyond the visible margins of the lesion. The surrounding tissue is often inflamed. SCCs rarely metastasize.

      Actinic keratosis is a sun-induced scaly or hyperkeratotic lesion that has the potential to become malignant. It is characterized by multifocal, scaly, hyperpigmented or scaly lesions, usually brown with a scaly base, occurring on the head, neck, forearms, and hands.

      Bowen’s disease is an intraepidermal (in situ) squamous cell carcinoma that arises in sun-exposed sites, especially the lower legs in women. It is characterized by well-defined pink and scaly patches or plaques that may become crusty, fissured, or ulcerated as lesions grow.

      Cold sores are recurrent infections of orofacial herpes simplex that present as grouped vesicles, especially of the lips and perioral skin. The eruption is often preceded by a tingling, itching, or burning sensation. Over a few days, the vesicles form a crust, and the eruption resolves within 7–10 days.

      Leukoplakia is a white patch or plaque of the oral mucosa that cannot be characterized clinically or pathologically as any other condition.

      A non-healing lesion is also of concern, especially in patients with a history of smoking and advanced age, as it may indicate a malignant cause. Early detection and treatment are crucial in preventing the progression of these skin lesions and cancers.

    • This question is part of the following fields:

      • Dermatology
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  • Question 4 - Which one of the following statements regarding scabies is untrue? ...

    Correct

    • Which one of the following statements regarding scabies is untrue?

      Your Answer: Patients who complain of pruritus 4 weeks following treatment should be retreated

      Explanation:

      It is typical for itching to continue for a period of 4-6 weeks after elimination.

      Scabies: Causes, Symptoms, and Treatment

      Scabies is a skin condition caused by the Sarcoptes scabiei mite, which is spread through prolonged skin contact. It is most commonly seen in children and young adults. The mite burrows into the skin and lays its eggs in the stratum corneum, leading to intense itching. This itching is caused by a delayed-type IV hypersensitivity reaction to the mites/eggs, which occurs about 30 days after the initial infection. Symptoms of scabies include widespread itching, linear burrows on the fingers, interdigital webs, and flexor aspects of the wrist. In infants, the face and scalp may also be affected. Scratching can lead to secondary features such as excoriation and infection.

      The first-line treatment for scabies is permethrin 5%, while malathion 0.5% is second-line. Patients should be advised to avoid close physical contact with others until treatment is complete. All household and close physical contacts should be treated at the same time, even if asymptomatic. Clothing, bedding, and towels should be laundered, ironed, or tumble-dried on the first day of treatment to kill off mites. The insecticide should be applied to all areas, including the face and scalp, contrary to the manufacturer’s recommendation. Patients should apply the insecticide cream or liquid to cool, dry skin, paying close attention to areas between fingers and toes, under nails, armpit area, and creases of the skin such as at the wrist and elbow. The insecticide should be left on the skin for 8-12 hours for permethrin or 24 hours for malathion before washing off. Treatment should be repeated 7 days later.

      Crusted scabies, also known as Norwegian scabies, is seen in patients with suppressed immunity, especially HIV. The crusted skin will be teeming with hundreds of thousands of organisms. Isolation is essential, and ivermectin is the treatment of choice.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - Which one of the following is not a management option for individuals with...

    Incorrect

    • Which one of the following is not a management option for individuals with hyperhidrosis?

      Your Answer: Iontophoresis

      Correct Answer: Topical atropine

      Explanation:

      Hyperhidrosis is a condition characterized by the excessive production of sweat. To manage this condition, there are several options available. The first-line treatment is the use of topical aluminium chloride preparations, although it may cause skin irritation as a side effect. Iontophoresis is another option that is particularly useful for patients with palmar, plantar, and axillary hyperhidrosis. Botulinum toxin is also licensed for axillary symptoms. Surgery, such as Endoscopic transthoracic sympathectomy, is another option, but patients should be informed of the risk of compensatory sweating. Overall, there are various management options available for hyperhidrosis, and patients should discuss with their healthcare provider to determine the best course of action.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - A 21-year-old woman presents with a two day history of increasing dysuria. During...

    Correct

    • A 21-year-old woman presents with a two day history of increasing dysuria. During examination, inflamed blisters are observed on the outer labia.
      What is the most suitable treatment option?

      Your Answer: Aciclovir

      Explanation:

      Understanding Genital Herpes and Treatment Options

      Genital herpes is a sexually transmitted infection caused by the herpes simplex viruses (HSV-1 or HSV-2). It presents as clusters of papules and vesicles on the outer genitals in both men and women, usually appearing 4-7 days after sexual exposure to HSV for the first time. Unfortunately, there is no cure for genital herpes, but treatment with aciclovir can reduce the duration of symptoms. Other treatment options include antibiotics like azithromycin and clindamycin for bacterial infections, antifungal agents like fluconazole for fungal infections, and metronidazole for anaerobic bacteria and protozoa. It is important to seek medical attention and start treatment as soon as possible to manage symptoms and prevent transmission to others.

    • This question is part of the following fields:

      • Dermatology
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  • Question 7 - A 16-year-old boy presents to you with complaints of excessive sweating in his...

    Correct

    • A 16-year-old boy presents to you with complaints of excessive sweating in his hands. He reports feeling embarrassed in social situations, particularly when he has to shake hands with someone. He is also concerned about how this may impact his upcoming A-level exams.

      Which of the following is the most appropriate initial management approach for this condition?

      Your Answer: Aluminium chloride

      Explanation:

      Hyperhidrosis is not treated with beta blockers like propranolol or calcium channel blockers like nifedipine.

      Hyperhidrosis is a condition characterized by the excessive production of sweat. To manage this condition, there are several options available. The first-line treatment is the use of topical aluminium chloride preparations, although it may cause skin irritation as a side effect. Iontophoresis is another option that is particularly useful for patients with palmar, plantar, and axillary hyperhidrosis. Botulinum toxin is also licensed for axillary symptoms. Surgery, such as Endoscopic transthoracic sympathectomy, is another option, but patients should be informed of the risk of compensatory sweating. Overall, there are various management options available for hyperhidrosis, and patients should discuss with their healthcare provider to determine the best course of action.

    • This question is part of the following fields:

      • Dermatology
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  • Question 8 - A 50-year-old woman comes to the clinic complaining of an itchy papular rash...

    Incorrect

    • A 50-year-old woman comes to the clinic complaining of an itchy papular rash on her palms and forearms. The rash has white lines visible across its surface and scratching has worsened it. Additionally, she has noticed thinning of her nails with longitudinal ridges visible. What is the most appropriate first-line treatment?

      Your Answer: Topical calcipotriol

      Correct Answer: Potent topical steroids

      Explanation:

      The primary treatment for lichen planus is potent topical steroids. Emollients are not effective for this condition, and oral steroids may only be necessary in severe or resistant cases. Calcipotriol, a synthetic vitamin D derivative, is used for psoriasis and not lichen planus. Fusidic acid is an antibiotic used for staphylococcal skin infections, such as impetigo, and is not indicated for lichen planus.

      Understanding Lichen Planus

      Lichen planus is a skin condition that is believed to be caused by an immune response, although the exact cause is unknown. It is characterized by an itchy, papular rash that typically appears on the palms, soles, genitalia, and flexor surfaces of the arms. The rash often has a polygonal shape and a distinctive white-lines pattern on the surface, known as Wickham’s striae. In some cases, new skin lesions may appear at the site of trauma, a phenomenon known as the Koebner phenomenon.

      Oral involvement is common in around 50% of patients, with a white-lace pattern often appearing on the buccal mucosa. Nail changes may also occur, including thinning of the nail plate and longitudinal ridging. Lichenoid drug eruptions can be caused by certain medications, such as gold, quinine, and thiazides.

      The main treatment for lichen planus is potent topical steroids. For oral lichen planus, benzydamine mouthwash or spray is recommended. In more extensive cases, oral steroids or immunosuppression may be necessary.

    • This question is part of the following fields:

      • Dermatology
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  • Question 9 - A 70-year-old man is seen on a home visit by his General Practitioner...

    Incorrect

    • A 70-year-old man is seen on a home visit by his General Practitioner as his wife is concerned about an ulcer on his lower leg, which has been present for a couple of weeks. It is starting to leak clear fluid. He has a history of chronic congestive cardiac failure and chronic obstructive pulmonary disease. A diagnosis of a venous ulcer is suspected.
      Which of the following examination findings would best support this diagnosis?

      Your Answer: Hairless and pale skin on the lower legs

      Correct Answer: Atrophie blanche

      Explanation:

      Signs and Symptoms of Leg Ulcers: Differentiating Arterial, Venous, and Inflammatory Causes

      Leg ulcers can have various causes, including arterial, venous, and inflammatory conditions. Here are some signs and symptoms that can help differentiate between these causes:

      Atrophie Blanche: This is a white atrophic scar surrounded by areas of hyperpigmentation, which is a sign of severe venous insufficiency.

      Ankle Brachial Pressure Index (ABPI) of 0.4: ABPI is the ratio of systolic blood pressure in the ankle compared with the arm. An ABPI < 0.5 indicates severe arterial disease, suggesting that the ulcer is most likely arterial, rather than venous, in nature. Hairless and Pale Skin on the Lower Legs: Pallor of the skin and a lack of hair growth on the lower legs is a sign of arterial disease, pointing towards a diagnosis of an arterial ulcer rather than a venous ulcer. Necrobiosis Lipoidica: This is a rare granulomatous condition that usually affects people with insulin-dependent diabetes. Plaques are present on the shins, often with telangiectasia in the center and may ulcerate. The cause for the leg ulcer is, therefore, inflammatory rather than venous in origin. Reduced Light-Touch Sensation in Both Feet: Reduced sensation in the feet could be neuropathic in nature (diabetes, multiple sclerosis) or the result of severe arterial disease. Venous insufficiency does not usually affect sensation, so this finding on examination would support a diagnosis of arterial or neuropathic ulcer. By recognizing these signs and symptoms, healthcare professionals can better diagnose and treat leg ulcers based on their underlying causes.

    • This question is part of the following fields:

      • Dermatology
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  • Question 10 - A 35-year-old man comes to his General Practitioner complaining of an itchy rash...

    Correct

    • A 35-year-old man comes to his General Practitioner complaining of an itchy rash on the flexural surface of both his arms that has been present for 1 week. On examination, the rash appears polygonal and shiny with a white lines pattern on the surface. What is the most appropriate next step?

      Your Answer: No further testing required, start treatment

      Explanation:

      Diagnostic Testing for Lichen Planus: Understanding Skin Patch Testing, Skin Prick Testing, and RAST

      Lichen planus is a clinical diagnosis that can be made based on the characteristic appearance of the rash. However, in some cases, a biopsy may be helpful if the presentation is atypical. The diagnosis is typically made without the need for further testing, and treatment can be started promptly.

      Skin patch testing and skin prick testing are not useful for diagnosing lichen planus, as they are mainly used for different types of hypersensitivity reactions. Skin patch testing is used for contact dermatitis and other type IV hypersensitivity reactions, while skin prick testing is used for type I hypersensitivity reactions, such as food allergies and pollen allergies.

      Radioallergosorbent testing (RAST) is also unsuitable for diagnosing lichen planus, as it is used to determine the amount of immunoglobulin E (IgE) that reacts specifically with suspected or known allergens. RAST is useful for food allergies, inhaled allergens (such as pollen), and wasp/bee venom.

      In summary, diagnostic testing is not typically required for lichen planus, as it can be diagnosed clinically. Skin patch testing, skin prick testing, and RAST are not useful for diagnosing lichen planus and are mainly used for different types of hypersensitivity reactions.

    • This question is part of the following fields:

      • Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Dermatology (6/10) 60%
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