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Question 1
Correct
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A 6-year-old boy is presented for surgery after the appearance of multiple small, umbilicated lesions on his right leg. He has no prior history of such lesions and is generally healthy, except for a history of allergies. What is the best course of action for management?
Your Answer: Reassure
Explanation:Understanding Molluscum Contagiosum
Molluscum contagiosum is a viral skin infection that is commonly seen in children, particularly those with atopic eczema. It is caused by the molluscum contagiosum virus and can be transmitted through direct contact or contaminated surfaces. The infection presents as pinkish or pearly white papules with a central umbilication, which can appear anywhere on the body except for the palms of the hands and soles of the feet. In children, lesions are commonly seen on the trunk and in flexures, while in adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen.
While molluscum contagiosum is a self-limiting condition that usually resolves within 18 months, it is important to avoid sharing towels, clothing, and baths with uninfected individuals to prevent transmission. Scratching the lesions should also be avoided, and treatment may be considered if the itch is problematic. However, treatment is not usually recommended, and if necessary, simple trauma or cryotherapy may be used. In some cases, referral may be necessary, such as for individuals who are HIV-positive with extensive lesions or those with eyelid-margin or ocular lesions and associated red eye.
Overall, understanding molluscum contagiosum and taking appropriate precautions can help prevent transmission and alleviate symptoms.
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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 28-year-old patient presents to you with an itchy rash on both elbows that has been getting worse over the past week. Upon examination, you observe multiple flat-topped papular lesions that are polygonal and measure 5mm in diameter on the flexural surface of her elbows bilaterally. There are no other rashes on the rest of her body. What is the most probable diagnosis?
Your Answer: Eczema
Correct Answer: Lichen planus
Explanation: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.
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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 60-year-old man comes to the clinic complaining of worsening psoriasis. He reports feeling more stressed lately and suspects it may be contributing to his flare-up. Additionally, he has recently started taking a new medication. During the physical examination, scaly plaques on the extensor surfaces and trunk that are erythematous are observed. Which of the following medications could potentially trigger exacerbations in his condition?
Your Answer: Furosemide
Correct Answer: Lithium
Explanation:The medication lithium has been known to worsen psoriasis in some patients and can even cause psoriasis in those who did not previously have it, even at normal therapeutic levels. It is important to inform both the patient and their psychiatrist of this potential effect. Furosemide, on the other hand, does not typically worsen or cause drug-induced psoriasis, but can lead to electrolyte imbalances. Amiodarone also does not worsen or cause drug-induced psoriasis, but can cause a bluish discoloration of the skin.
Psoriasis can be worsened by various factors. These include physical trauma, consumption of alcohol, and certain medications such as beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, and infliximab. Additionally, stopping the use of systemic steroids can also exacerbate psoriasis. It is important to note that streptococcal infection can trigger guttate psoriasis, a type of psoriasis characterized by small, drop-like lesions on the skin. Therefore, individuals with psoriasis should be aware of these exacerbating factors and take necessary precautions to manage their condition.
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This question is part of the following fields:
- Dermatology
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Question 4
Correct
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You are examining a 7-month-old infant who has a capillary haemangioma located on the right cheek that is beginning to interfere with their vision. Following a conversation with the parents, you have decided to initiate treatment for this area due to the potential impact on eyesight.
What is the primary treatment option for capillary haemangioma?Your Answer: Propranolol
Explanation:When it comes to capillary haemangiomas that require intervention, the preferred treatment is propranolol. Other options include laser therapy or systemic steroids, but topical steroids are unlikely to be effective. Surgery is generally not recommended for most cases.
Understanding Strawberry Naevus
Strawberry naevus, also known as capillary haemangioma, is a type of skin condition that usually develops in infants within the first month of life. It is characterized by raised, erythematous, and multilobed tumours that commonly appear on the face, scalp, and back. While it is not present at birth, it can grow rapidly and reach its peak size at around 6-9 months before regressing over the next few years. In fact, around 95% of cases resolve before the child reaches 10 years of age. However, there are potential complications that may arise, such as obstructing visual fields or airway, bleeding, ulceration, and thrombocytopaenia.
Capillary haemangiomas are more common in white infants, particularly in female and premature infants, as well as those whose mothers have undergone chorionic villous sampling. In cases where treatment is necessary, propranolol is now the preferred choice over systemic steroids. Topical beta-blockers like timolol may also be used. It is important to note that there is a deeper type of capillary haemangioma called cavernous haemangioma. Understanding the nature of strawberry naevus is crucial in managing its potential complications and providing appropriate treatment.
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This question is part of the following fields:
- Dermatology
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Question 5
Correct
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A 26-year-old male patient visits his GP complaining of a firm, round swelling over the angle of his jaw that has been growing for two years. The patient is having difficulty shaving his beard due to the size of the swelling. The GP suspects a sebaceous cyst and the patient is eager for treatment to alleviate his symptoms. What is the best course of action to prevent further discomfort?
Your Answer: Surgical excision
Explanation:To prevent the sebaceous cyst from recurring, it is necessary to surgically remove the entire structure. This can be done by a general practitioner or a surgical team, but funding for the procedure may be limited due to its lower clinical priority. Patients may opt to have the surgery done privately. Incision and drainage or fine needle aspiration may provide temporary relief, but the cyst is likely to return. Intralesional steroids are not recommended in this case, as there is no infection present. Oral antibiotics are also unnecessary. Complete surgical excision offers the best chance for long-term resolution of the patient’s symptoms.
Understanding Sebaceous Cysts
Sebaceous cysts refer to a group of cysts that include both epidermoid and pilar cysts. However, the term is not entirely accurate and should be avoided if possible. Epidermoid cysts occur when there is an overgrowth of epidermal cells in the dermis, while pilar cysts, also known as trichilemmal cysts or wen, originate from the outer root sheath of the hair follicle. These cysts can appear anywhere on the body, but are most commonly found on the scalp, ears, back, face, and upper arm, and will typically have a punctum.
To prevent recurrence, it is essential to remove the entire cyst wall during excision. While sebaceous cysts are generally harmless, they can become infected and cause discomfort or pain.
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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 42-year-old woman comes to the clinic complaining of itchy, violaceous papules on the flexor aspects of her wrists. She has no significant medical history and has never experienced a similar rash before. Based on the probable diagnosis, what other symptom is she most likely to exhibit?
Your Answer: Pain in small joints
Correct Answer: Mucous membrane involvement
Explanation:Lichen planus is a skin condition characterized by a rash of purple, itchy, polygonal papules on the flexor surfaces of the body. The affected area may also have Wickham’s striae. Oral involvement is common. In addition, elderly women may experience itchy white spots on the vulva, known as lichen sclerosus. Mucous membrane involvement is also frequently observed in 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.
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This question is part of the following fields:
- Dermatology
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Question 7
Correct
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You see a 4-year-old child in surgery with his mother. He has been diagnosed with molluscum contagiosum and she is keen to have him treated.
Which of the following statements about molluscum contagiosum is true?Your Answer: The condition resolves spontaneously
Explanation:Molluscum Contagiosum: Myths and Facts
Molluscum contagiosum is a common skin infection caused by a poxvirus. However, there are several myths surrounding this condition that need to be debunked. Firstly, it is not true that the condition resolves spontaneously. While most cases do clear up on their own within 6-9 months, some can last up to 4 years. Secondly, molluscum contagiosum is highly infectious and can be transmitted through contact with infected persons or objects, including swimming pools. Sexual transmission is also possible.
Another myth is that patients can treat themselves by squeezing the spots. This is not recommended as it can lead to scarring. Additionally, molluscum contagiosum is not limited to children. While it does present mainly in young children, there is also a later peak in young adults, some of which is attributable to sexual transmission.
Finally, piercing the lesions with an orange stick dipped in phenol is not the treatment of choice. In fact, the condition usually requires no treatment and resolves on its own. Treatment may be recommended for adults or older children with particularly unsightly spots or in the immunosuppressed, where it can take several years to resolve. Topical applications such as benzyl peroxide or potassium hydroxide, as well as curettage and cryotherapy, can be used to treat the condition.
In conclusion, it is important to separate fact from fiction when it comes to molluscum contagiosum. While it is a common and often harmless condition, it is important to seek medical advice if you have concerns or if the spots are causing discomfort or affecting your quality of life.
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This question is part of the following fields:
- Dermatology
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Question 8
Correct
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A 29-year-old woman presents to her GP with complaints of hair loss. She reports noticing that her hair has become significantly thinner and that she is shedding more hair than usual, both on her pillow and in the shower drain. She denies any other symptoms and has no significant medical history except for giving birth to her first child 6 months ago. She is not taking any medications regularly and there is no family history of hair loss. On examination, her scalp hair is uniformly thin, but there are no areas of complete hair loss. Her systemic examination is unremarkable and her vital signs are within normal limits. Blood tests, including iron studies and thyroid function, are all normal. What is the most likely diagnosis?
Your Answer: Telogen effluvium
Explanation:Telogen effluvium is characterized by hair loss and thinning as a result of experiencing significant stress. In this case, the patient’s recent physical stress from giving birth is a likely cause of her hair becoming thinner due to telogen effluvium. The hair loss patterns observed do not match those of alopecia areata or alopecia totalis, which respectively cause distinct areas of complete hair loss or complete loss of all hair on the head and face.
Input:
Alopecia may be divided into scarring (destruction of hair follicle) and non-scarring (preservation of hair follicle). Scarring alopecia can be caused by trauma, burns, radiotherapy, lichen planus, discoid lupus, and untreated tinea capitis. Non-scarring alopecia can be caused by male-pattern baldness, drugs such as cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, and colchicine, nutritional deficiencies such as iron and zinc deficiency, autoimmune conditions such as alopecia areata, telogen effluvium, hair loss following a stressful period such as surgery, and trichotillomania.Output:
– Alopecia can be categorized into scarring and non-scarring types.
– Scarring alopecia is caused by trauma, burns, radiotherapy, lichen planus, discoid lupus, and untreated tinea capitis.
– Non-scarring alopecia is caused by male-pattern baldness, drugs such as cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, and colchicine, nutritional deficiencies such as iron and zinc deficiency, autoimmune conditions such as alopecia areata, telogen effluvium, hair loss following a stressful period such as surgery, and trichotillomania. -
This question is part of the following fields:
- Dermatology
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Question 9
Correct
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Which of the following skin conditions is not linked to diabetes mellitus?
Your Answer: Sweet's syndrome
Explanation:Sweet’s syndrome is a condition associated with acute myeloid leukemia, also known as acute febrile neutrophilic dermatosis, but not with diabetes mellitus.
Skin Disorders Linked to Diabetes
Diabetes mellitus is a chronic metabolic disorder that affects various organs in the body, including the skin. Several skin disorders are associated with diabetes, including necrobiosis lipoidica, infections such as candidiasis and staphylococcal, neuropathic ulcers, vitiligo, lipoatrophy, and granuloma annulare. Necrobiosis lipoidica is characterized by shiny, painless areas of yellow, red, or brown skin, typically on the shin, and is often associated with surrounding telangiectasia. Infections such as candidiasis and staphylococcal can also occur in individuals with diabetes. Neuropathic ulcers are a common complication of diabetes, and vitiligo and lipoatrophy are also associated with the condition. Granuloma annulare is a papular lesion that is often slightly hyperpigmented and depressed centrally, but recent studies have not confirmed a significant association between diabetes mellitus and this skin disorder. It is important for individuals with diabetes to be aware of these potential skin complications and to seek medical attention if they notice any changes in their skin.
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This question is part of the following fields:
- Dermatology
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Question 10
Correct
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A 26-year-old patient comes in with lesions on their lower abdomen that have been present for six weeks. At first, there was only one lesion, but more have appeared since then. During the examination, around 10 raised lesions with an umbilicated appearance, each around 1-2 mm in diameter, are observed. What is the most probable diagnosis?
Your Answer: Molluscum contagiosum
Explanation:Molluscum contagiosum is typically observed in children, but the following is a classical depiction of the condition.
Understanding Molluscum Contagiosum
Molluscum contagiosum is a viral skin infection that is commonly seen in children, particularly those with atopic eczema. It is caused by the molluscum contagiosum virus and can be transmitted through direct contact or contaminated surfaces. The infection presents as pinkish or pearly white papules with a central umbilication, which can appear anywhere on the body except for the palms of the hands and soles of the feet. In children, lesions are commonly seen on the trunk and in flexures, while in adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen.
While molluscum contagiosum is a self-limiting condition that usually resolves within 18 months, it is important to avoid sharing towels, clothing, and baths with uninfected individuals to prevent transmission. Scratching the lesions should also be avoided, and treatment may be considered if the itch is problematic. However, treatment is not usually recommended, and if necessary, simple trauma or cryotherapy may be used. In some cases, referral may be necessary, such as for individuals who are HIV-positive with extensive lesions or those with eyelid-margin or ocular lesions and associated red eye.
Overall, understanding molluscum contagiosum and taking appropriate precautions can help prevent transmission and alleviate symptoms.
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This question is part of the following fields:
- Dermatology
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