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  • Question 1 - Which therapy is unsuitable for the given condition? ...

    Incorrect

    • Which therapy is unsuitable for the given condition?

      Your Answer: Cortisone cream for alopecia areata

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

      Explanation:

      Cavernous Haemangiomas and Alopecia Areata: Conditions and Treatment Options

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

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 2 - A 50-year-old woman came to the skin clinic with flaccid blisters on the...

    Incorrect

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

      Your Answer: Dermatitis herpetiformis

      Correct Answer: Pemphigus vulgaris

      Explanation:

      Skin Disorders: Pemphigus Vulgaris, Bullous Pemphigoid, Dermatitis Herpetiformis, Epidermolysis Bullosa, and Tuberous Sclerosis

      Skin disorders can manifest in various ways, including blistering and erosions on the skin and/or mucous membranes. Pemphigus vulgaris is an autoimmune disease that causes blistering and erosions on the skin and mucous membranes, with IgG autoantibodies to desmoglein 3 being a key characteristic. In contrast, bullous pemphigoid involves sub-epidermal splitting and tense blisters that are less easily ruptured. Dermatitis herpetiformis is characterised by intensely pruritic blisters on specific areas of the body, often associated with coeliac disease. Epidermolysis bullosa is a rare inherited disorder that causes fragile skin, while tuberous sclerosis is not associated with blistering. Diagnosis and treatment vary depending on the specific disorder.

    • This question is part of the following fields:

      • Dermatology
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  • Question 3 - A 25-year-old man without prior history of skin issues comes in with severe...

    Correct

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

      Your Answer: Burrows

      Explanation:

      Understanding Scabies: Symptoms and Characteristics

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 4 - A 36-year-old African-American man undergoes a pre-employment health check. Chest radiograph demonstrates bilateral...

    Correct

    • A 36-year-old African-American man undergoes a pre-employment health check. Chest radiograph demonstrates bilateral hilar lymphadenopathy. More detailed history and examination reveals painful red papules on both shins of recent onset. He is otherwise well. Basic blood tests are normal.
      What rash does the patient have?

      Your Answer: Erythema nodosum

      Explanation:

      Differentiating Skin Rashes: A Comparison of Erythema Nodosum, Erythema Multiforme, Kaposi’s Sarcoma, Tinea Corporis, and Steven-Johnson’s Syndrome

      Erythema nodosum is a rash characterized by painful red papules caused by inflammation of the subcutaneous fat. It is commonly seen on the extensor surfaces of the lower limbs and can be linked to various conditions such as streptococcal and tuberculous infection, inflammatory bowel disease, lymphoma, drug-related causes, and sarcoidosis.

      Erythema multiforme, on the other hand, presents with typical target lesions on the extremities. It is an uncommon condition that can be mistaken for other skin rashes.

      Kaposi’s sarcoma is an AIDS-defining malignancy caused by human herpes virus 8. It appears as red/purple papules on the skin or mucosal surfaces. However, the description of the rash, normal blood results, and an otherwise healthy patient make this diagnosis unlikely.

      Tinea corporis, also known as ringworm, is a fungal infection transmitted from common pets or human-to-human. It presents as an erythematosus, scaly ring-like rash with central clearing.

      Steven-Johnson’s syndrome is a severe form of erythema multiforme with multiple erythematosus macules on the face and trunk, epidermal detachment, and mucosal ulceration. It is a rare condition that can cause significant morbidity and mortality.

      In summary, differentiating between these skin rashes is crucial for proper diagnosis and treatment. A thorough evaluation of the patient’s medical history, physical examination, and laboratory tests can help identify the underlying cause of the rash.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - A 21-year-old woman presents with acne vulgaris. On examination there are mixed comedones...

    Incorrect

    • A 21-year-old woman presents with acne vulgaris. On examination there are mixed comedones and pustules. She has three slight acne scars to her left cheek. The lesions are multiple and prominent but do not extend beyond the face. She has not tried any medications for the acne to date and is requesting your advice on treatment. You note that she last attended for an emergency contraception prescription, which was in the last 6 weeks. She does not use any regular contraception and does not want to commence contraception as she indicates she is no longer sexually active. She says that she does not feel overly self-conscious about her acne but wants something to help improve the appearance of the spots.
      Which treatment plan is most appropriate?

      Your Answer: Trial of oral antibiotics for an 8 week period

      Correct Answer: Topical application of clindamycin and benzoyl peroxide

      Explanation:

      Treatment Options for Acne Vulgaris: A Comprehensive Guide

      Acne vulgaris is a common skin condition that affects many individuals, particularly during adolescence. It is characterized by blocked hair follicles and sebaceous glands, resulting in inflammatory and non-inflammatory lesions on the face, back, and chest. The severity of acne can range from mild to severe, with the latter causing scarring and significant distress to the patient.

      There are several treatment options available for acne vulgaris, depending on the severity of the condition. For mild to moderate acne, topical benzoyl peroxide can be prescribed as monotherapy. However, for moderate acne with a risk of scarring, a combination therapy of a topical antibiotic and benzoyl peroxide, such as clindamycin aqueous solution, is recommended.

      In cases of extensive acne on the back or shoulders, or if there is a significant risk of scarring or skin pigmentation, an oral antibiotic may be considered for an 8-week period. However, it is important to note that oral antibiotics should be used judiciously to avoid the development of antibiotic resistance.

      For severe acne or acne causing severe distress to the patient, referral to a dermatologist for treatment with isotretinoin may be necessary. Isotretinoin is a retinoid that is used for systemic treatment of severe acne. However, it should only be given to women on contraception as it is teratogenic.

      In conclusion, the treatment of acne vulgaris requires a tailored approach based on the severity of the condition and the risk of scarring or other complications. A combination of topical and oral therapies, as well as referral to a dermatologist when necessary, can help to effectively manage this chronic skin condition.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - A 68-year-old rancher comes in with a small white spot on his right...

    Correct

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

      Your Answer: Basal cell carcinoma

      Explanation:

      Lesion on the Face: Indications of Basal Cell Carcinoma

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

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 7 - An 18-year-old man visits his GP with complaints of painful lesions on his...

    Correct

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

      Your Answer: Sebaceous glands

      Explanation:

      The Skin and its Glands: A Brief Overview

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

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

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

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

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

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 8 - A 55-year-old carpenter presents with a complaint of widespread pruritus that has been...

    Correct

    • A 55-year-old carpenter presents with a complaint of widespread pruritus that has been bothering him for the past 2 weeks. He has no significant medical history, but is currently staying at his sister's house due to marital issues. He reports that the itching is most severe at night. Upon examination, he has several linear erythaematous lesions on the backs of his hands and between his fingers.
      What is the most suitable initial treatment option for this probable diagnosis?

      Your Answer: Permethrin cream applied from neck down for 8-14 h

      Explanation:

      Treatment Options for Scabies Infestation

      Scabies infestation is a common condition that can affect anyone, but is more prevalent in individuals with poor personal hygiene, immunocompromisation, low socioeconomic status, and those working in industrial settings. The first-line treatment for scabies is the application of Permethrin 5% cream from the neck down for 8-14 hours, followed by washing it off. It is important to treat all household contacts simultaneously, even if they are symptom-free. Additionally, all affected linens should be washed and cleaned immediately.

      While emollient cream can be applied regularly from the neck down, it will not treat the underlying infestation. Similarly, 5% Hydrocortisone cream applied twice daily to the hands will not address the underlying infestation. Oral antihistamines may provide relief from the symptomatic itch, but they do not treat the underlying infestation.

      In cases where Permethrin is not effective, Malathion cream can be used as a second-line treatment for scabies. It should be applied from the neck down for 24 hours and then washed off. It is important to follow the instructions carefully and consult a healthcare professional if symptoms persist.

    • This question is part of the following fields:

      • Dermatology
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  • Question 9 - A 32-year-old woman presents with shiny, flat, red papules over her anterior wrists...

    Correct

    • A 32-year-old woman presents with shiny, flat, red papules over her anterior wrists and forearms. The papules are extremely pruritic and some of them have a central depression. Similar papules are seen along the scratch line at the volar surface of the forearm. The patient is a nurse and has had at least three needlestick injuries during the past 2 years. Human immunodeficiency virus (HIV) enzyme-linked immunosorbent assay is negative. Hepatitis B surface antigen and anti-HBc antibody are negative, but anti-HBs antibody is positive. Anti-hepatitis C (HCV) antibody is positive.
      What is the most likely diagnosis for this patient?

      Your Answer: Lichen planus

      Explanation:

      Common Skin Conditions and Associated Antibodies

      Lichen Planus: This skin condition is associated with viral hepatitis, specifically hepatitis B and C. Antibodies may indicate the presence of hepatitis and other conditions such as erythema multiforme, urticaria, polyarteritis nodosa, cryoglobulinemia, and porphyria cutanea tarda.

      Chronic Hepatitis B: A negative anti-HBc antibody status suggests that the patient has not been exposed to the hepatitis B virus. A positive anti-HBs antibody status may indicate vaccination.

      Dermatitis Herpetiformis: This condition is characterized by extremely itchy papulovesicles on the elbows, knees, upper back, and buttocks. It is often associated with gluten-sensitive enteropathy. Autoantibodies such as anti-gliadin, anti-endomysial, and anti-tissue transglutaminase may be present.

      Essential Mixed Cryoglobulinemia: This condition presents with palpable purpura and arthritis, among other signs of systemic vasculitis. It is also associated with hepatitis C virus infection, and rheumatoid factor is usually positive.

      Dermatomyositis: Gottron’s papules, which are violet, flat-topped lesions, are associated with dermatomyositis and the anti-Jo-1 autoantibody. They are typically seen over the metacarpophalangeal or interphalangeal joints.

      Skin Conditions and Their Antibody Associations

    • This question is part of the following fields:

      • Dermatology
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  • Question 10 - An 80-year-old nursing home resident with a history of hypothyroidism and heart failure...

    Incorrect

    • An 80-year-old nursing home resident with a history of hypothyroidism and heart failure presents to you with a complaint of dry, itchy skin that is particularly bothersome on her legs. Upon examination, you observe erythematosus, dry skin on her legs with an unusual pattern. What is the most probable diagnosis?

      Your Answer: Venous ulceration

      Correct Answer: Asteatotic eczema

      Explanation:

      Common Skin Conditions: Asteatotic Eczema, Contact Dermatitis, Lichen Planus, Scabies, and Venous Ulceration

      Asteatotic eczema is a skin condition that commonly affects elderly individuals due to over-washing and dry winter climate. It can also be associated with diuretic use and hypothyroidism. The condition causes dry, itchy skin with a unique crazy paving pattern on the limbs. Treatment involves using emollients and mild topical steroids.

      Contact dermatitis, on the other hand, is caused by friction and environmental factors such as cold or exposure to chemicals like detergents and solvents. It typically affects the hands and does not display the crazy paving pattern seen in asteatotic eczema.

      Lichen planus is characterized by a pruritic, papular eruption with a violaceous color and polygonal shape. It presents with a lace-like pattern, unlike the crazy paving pattern seen in asteatotic eczema.

      Scabies is an itchy rash caused by mites that burrow under the skin’s surface. It often affects the very young and elderly, particularly those who live in crowded areas or institutional care. It presents with burrows, particularly on the web spaces between fingers, followed by a hypersensitivity rash. Treatment involves using topical insecticides like 5% permethrin.

      Finally, venous ulceration is present on the lower limbs and can be itchy if associated with venous eczema. However, the legs often display a brown pigmentation of haemosiderin, and a venous ulcer would not present as described in this question.

      In summary, understanding the characteristics of these common skin conditions can help with accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Dermatology
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  • Question 11 - You are asked to see a 40-year-old man with difficult-to-treat psoriasis. He has...

    Incorrect

    • You are asked to see a 40-year-old man with difficult-to-treat psoriasis. He has extensive plaque psoriasis and has tried a number of therapies, including retinoids, topical corticosteroids and photochemotherapy (PUVA).
      What would be the next best step in management?

      Your Answer: Start oral steroids

      Correct Answer: Start methotrexate

      Explanation:

      Treatment Options for Chronic Plaque Psoriasis

      Chronic plaque psoriasis can be a challenging condition to manage, especially when topical therapies are not effective. In such cases, systemic therapies may be considered. Methotrexate and ciclosporin are two such options that can be effective in inducing remission. However, it is important to weigh the potential side-effects of these medications before starting treatment. Vitamin D analogues and coal tar products may not be effective in severe cases of psoriasis. Oral steroids are also not recommended as a long-term solution. Biological therapy, such as etanercept, should only be considered when standard systemic therapies have failed. It is important to follow NICE guidelines and trial other treatments before considering biological agents.

    • This question is part of the following fields:

      • Dermatology
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  • Question 12 - A 26-year-old woman visits her General Practitioner concerned about excessive hair growth on...

    Incorrect

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

      Your Answer: Progesterone-only pill

      Correct Answer: Oral combined contraceptive pill

      Explanation:

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

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 13 - A 28-year-old man who has been experiencing a lot of stress at work...

    Incorrect

    • A 28-year-old man who has been experiencing a lot of stress at work lately presents with an itchy, red rash above the right corner of his mouth. The rash appeared 4 months ago, went away briefly, and then returned. He has used a topical corticosteroid to alleviate the symptoms, but had to discontinue it due to a flare-up of his facial acne. He admits to drinking excessive amounts of alcohol recently. On examination, there is a poorly defined red rash on the right side of his face, affecting the nasolabial fold. Additionally, there are fine, oily scales present.

      What is the most probable diagnosis?

      Your Answer: Dermatitis herpetiformis

      Correct Answer: Seborrhoeic dermatitis

      Explanation:

      Common Skin Conditions and Their Characteristics

      Seborrhoeic Dermatitis: This condition is characterized by an ill-defined, itchy, erythematosus rash with fine, greasy scales. It typically affects the scalp, nasolabial fold, or post-auricular skin in adolescents and adults.

      Dermatitis Herpetiformis: Often seen in patients with coeliac disease and malabsorption, this condition presents with intensely itchy grouped vesicles/papules over the extensor surfaces of the elbow, knee, upper back, and buttocks.

      Lichen Planus: This condition is characterized by flat-topped, pruritic, red to violaceous polygonal papules or plaques. Lesions are often located on the wrists.

      Atopic Dermatitis: This condition involves flexural regions in adult patients and is often associated with a history of atopy. The acute form of atopic dermatitis presents with erythema, oedema, vesicles, and papules.

      Psoriasis: This condition is characterized by thick, well-demarcated erythematous plaques with silvery scaling over the extensor surface of the elbows and knees.

      Characteristics of Common Skin Conditions

    • This question is part of the following fields:

      • Dermatology
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  • Question 14 - A 27-year-old man with a history of eczema presents with itchy, red patches...

    Incorrect

    • A 27-year-old man with a history of eczema presents with itchy, red patches of skin on his antecubital fossae, lateral thighs, and popliteal fossae. The skin on his right thigh is weeping and inflamed. He reports feeling fatigued and wonders if he has had a fever. His vital signs are within normal limits. Based on your examination, you diagnose him with moderately severe eczema.
      What is the best course of action for managing his condition?

      Your Answer: Oral flucloxacillin alone for 10 days with regular Diprobase® ointment

      Correct Answer: Regular Diprobase® ointment and once-daily betamethasone valerate 0.025% cream plus 10 days of oral flucloxacillin

      Explanation:

      Treatment Regime for Moderately Severe Eczema with Superimposed Infection

      Moderately severe eczema with evidence of superimposed infection requires a specific treatment regime. The severity of eczema is categorized into four categories: clear, mild, moderate, and severe. In this case, the patient has small areas of dry skin mainly in the flexures, and there is evidence of infected eczema/cellulitis with an erythematosus, weeping patch of skin in the lateral thigh.

      The treatment regime should include a regular emollient ointment, such as Diprobase®, applied generously to the skin multiple times a day. Additionally, a moderately potent topical corticosteroid, such as betamethasone valerate 0.025% or clobetasone butyrate 0.05%, should be used sparingly on the inflamed areas once a day. The patient must be advised to apply the steroid first and allow 15-20 minutes for it to be absorbed before applying the emollient. Treatment should last 7-14 days and continue until 48 hours after the eczematous patches have cleared.

      Furthermore, oral antibiotics are necessary for the treatment of infected eczema. Oral flucloxacillin is considered first-line, and treatment usually lasts for a 10-day period.

      Treatment Regime for Moderately Severe Eczema with Superimposed Infection

    • This question is part of the following fields:

      • Dermatology
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  • Question 15 - A 57-year-old diabetic patient presents with an abscess on the nape of his...

    Incorrect

    • A 57-year-old diabetic patient presents with an abscess on the nape of his neck with multiple discharging sinuses.
      Which one of the following terms would you use to describe the presentation?

      Your Answer: Infected sebaceous cyst

      Correct Answer: Carbuncle

      Explanation:

      Common Skin Infections and Conditions

      Carbuncles, cellulitis, furuncles, infected sebaceous cysts, and necrotising fasciitis are all common skin infections and conditions that can cause discomfort and pain. Carbuncles are collections of pus that discharge to the surface via multiple sinuses and are usually caused by staphylococcal infection. Cellulitis is a bacterial infection of the lower dermis and subcutaneous tissue, presenting with a localised area of painful, red, swollen skin and fever. Furuncles are perifollicular abscesses, also typically caused by staphylococcal infection. Infected sebaceous cysts are round, dome-shaped, encapsulated lesions containing fluid or semi-fluid material. On the other hand, necrotising fasciitis is a serious bacterial infection of the soft tissue and fascia that can result in extensive tissue loss and death if not promptly recognised and treated with antibiotics and debridement. It is important to seek medical attention if any of these conditions are suspected, especially in patients with diabetes or those who are immunosuppressed. Clinical assessment and appropriate diagnostic tests should be conducted to ensure proper treatment and management.

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      • Dermatology
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  • Question 16 - A 16-year-old girl has been diagnosed with scabies.

    Scabies is a skin condition...

    Correct

    • A 16-year-old girl has been diagnosed with scabies.

      Scabies is a skin condition caused by tiny mites that burrow into the skin and lay eggs. It is highly contagious and can spread through close physical contact or sharing of personal items such as clothing or bedding. Symptoms include intense itching, rash, and small bumps or blisters on the skin. Treatment typically involves prescription creams or lotions that kill the mites and their eggs. It is important to seek medical attention if you suspect you have scabies to prevent further spread of the condition.

      Your Answer: It causes itchiness in the skin even where there is no obvious lesion to be seen

      Explanation:

      Scabies: Causes, Symptoms, and Treatment

      Scabies is a skin infestation caused by the microscopic mite Sarcoptes scabiei. It is a common condition that affects people of all races and social classes worldwide. The infestation spreads rapidly in crowded conditions where there is frequent skin-to-skin contact between people, such as in hospitals, institutions, child-care facilities, and nursing homes. Scabies can be transmitted through direct, prolonged, skin-to-skin contact with an infested person, and it can also spread by sharing clothing, towels, and bedding.

      The symptoms of scabies include papular-like irritations, burrows, or rash of the skin, particularly in the webbing between the fingers, skin folds on the wrist, elbow, or knee, the penis, the breast, or shoulder blades. The condition is highly contagious and can easily spread to sexual partners and household members. However, a quick handshake or hug is usually not enough to spread the infestation.

      Fortunately, there are several treatments available for scabies, including permethrin ointment, benzyl benzoate, and oral ivermectin for resistant cases. Antihistamines and calamine lotion may also be used to alleviate itching.

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      • Dermatology
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  • Question 17 - A 65-year-old man on the Stroke Ward has been found to have a...

    Incorrect

    • A 65-year-old man on the Stroke Ward has been found to have a grade 2 pressure ulcer over his sacrum.
      Which of the following options correctly describes a grade 2 pressure ulcer?

      Your Answer: Full-thickness skin loss involving damage/necrosis of subcutaneous tissue

      Correct Answer: Partial-thickness skin loss and ulceration

      Explanation:

      Understanding the Different Grades of Pressure Ulcers

      Pressure ulcers, also known as bedsores, are a common problem for people who are bedridden or have limited mobility. These ulcers can range in severity from mild to life-threatening. Understanding the different grades of pressure ulcers is important for proper treatment and prevention.

      Grade 1 pressure ulcers are the most superficial type of ulcer. They are characterized by non-blanching erythema of intact skin and skin discoloration. The skin remains intact, but it may hurt or itch, and it may feel either warm and spongy or hard to the touch.

      Grade 2 pressure ulcers involve partial-thickness skin loss and ulceration. Some of the outer surface of skin (epidermis) or the deeper layer of skin (dermis) is damaged, leading to skin loss. The ulcer looks like an open wound or a blister.

      Grade 3 pressure ulcers involve full-thickness skin loss involving damage/necrosis of subcutaneous tissue. Skin loss occurs throughout the entire thickness of the skin and the underlying tissue is also damaged. The underlying muscles and bone are not damaged. The ulcer appears as a deep, cavity-like wound.

      Grade 4 pressure ulcers are the most severe type of ulcer. They involve extensive destruction (with possible damage to muscle, bone or supporting structures). The skin is severely damaged and the surrounding tissue begins to die (tissue necrosis). The underlying muscles or bone may also be damaged. People with grade 4 pressure ulcers have a high risk of developing a life-threatening infection.

      It is important to note that any ulcer with focal loss of skin integrity ± pus/blood is not a pressure ulcer and may require different treatment. Understanding the different grades of pressure ulcers can help healthcare professionals provide appropriate care and prevent further complications.

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      • Dermatology
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  • Question 18 - A 35-year-old woman presents with a 4-year history of a progressively worsening rash...

    Incorrect

    • 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: Emollients

      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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      • Dermatology
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  • Question 19 - A 38-year-old man comes to his primary care clinic complaining of an itchy...

    Incorrect

    • A 38-year-old man comes to his primary care clinic complaining of an itchy rash on his arm. During the examination, you observe polygonal, violaceous papules on the inner part of his forearm. Some of these papules have merged to form plaques. He has no history of skin disorders and is not presently taking any medications.
      What is the most probable diagnosis?

      Your Answer: Atopic dermatitis

      Correct Answer: Lichen planus

      Explanation:

      Dermatological Disorders: Characteristics and Differences

      Lichen planus is a skin disorder that is believed to be autoimmune in nature. It is characterized by a purple, polygonal, and papular rash that is often accompanied by itching. This condition is rare in both young and elderly populations and typically appears acutely on the flexor aspect of the wrists, forearms, and legs.

      Atopic dermatitis, also known as eczema, is a condition that usually presents as a red, itchy rash on the flexural areas of joints such as the elbows and knees. It is most commonly seen in children under the age of 5. As the patient in question has no history of skin disease, it is unlikely that he has eczema.

      Scabies is a contagious skin condition that is most commonly seen in children, young adults, and older adults in care homes. It causes widespread itching and linear burrows on the sides of fingers, interdigital webs, and the flexor aspect of the wrists.

      Lichen sclerosus is a chronic inflammatory skin disease that typically presents with itchy white spots. It is most commonly seen on the vulva in elderly women or on the penis in men.

      Plaque psoriasis is a skin condition that presents as itchy white or red plaques on the extensor surfaces of joints such as the elbows.

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      • Dermatology
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  • Question 20 - A 35-year-old woman with uncontrolled psoriasis is returning with deteriorating symptoms. Despite using...

    Correct

    • 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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      • Dermatology
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  • Question 21 - A 7-year-old child has developed itchy, oozing sores on their body, palms, and...

    Incorrect

    • A 7-year-old child has developed itchy, oozing sores on their body, palms, and soles. The child's two siblings are also experiencing similar symptoms. What is the best course of treatment for this patient?

      Your Answer: 1% Hydrocortisone topical

      Correct Answer: Topical permethrin

      Explanation:

      Scabies: Symptoms, Causes, and Treatment

      Scabies is a skin infestation that can cause lesions on the palms and soles, accompanied by intense itching. If a sibling has a similar history, it is likely that they are also infested with scabies. The lesions are caused by scratching and can become exudative. The treatment of choice for scabies is topical permethrin or malathion. These medications can help to kill the mites that cause scabies and alleviate the symptoms of itching and skin irritation.

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      • Dermatology
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  • Question 22 - A 54-year-old patient presented to the general practitioner with complaints of bloody diarrhoea...

    Correct

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

      Your Answer: Erythema nodosum

      Explanation:

      Common Skin Conditions and Their Causes

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

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

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

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

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

      Understanding Common Skin Conditions and Their Causes

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      • Dermatology
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  • Question 23 - A 9-month-old girl is brought to the clinic by her parents. She had...

    Incorrect

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

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

      What is the most probable diagnosis?

      Your Answer: Meningococcal septicaemia

      Correct Answer: Roseola infantum

      Explanation:

      Common Rashes and Their Characteristics

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

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

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

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

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

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  • Question 24 - A 28-year-old builder comes to the GP complaining of large itchy silvery white...

    Incorrect

    • A 28-year-old builder comes to the GP complaining of large itchy silvery white scaly patches on his elbows and knees. He has no history of skin problems, but his father had psoriasis. What is the most suitable initial treatment to prescribe?

      Your Answer: Topical coal tar

      Correct Answer: Topical steroid and topical calcipotriol

      Explanation:

      Topical Treatments for Chronic Plaque Psoriasis: NICE Recommendations

      Chronic plaque psoriasis is a common skin condition that can be managed with topical treatments. The National Institute for Health and Care Excellence (NICE) recommends a stepwise approach to treatment, with different options depending on the severity of the condition and the response to previous therapies.

      First-line treatment for chronic plaque psoriasis is a potent corticosteroid applied once daily, combined with a vitamin D analogue, for up to 4 weeks. This combination therapy has been shown to be effective in reducing inflammation and improving symptoms.

      If there is no improvement with both steroid and calcipotriol after 8 weeks, topical calcipotriol alone can be used as a second-line management option. However, it is insufficient to prescribe alone as a first-line treatment.

      Topical steroid alone is a third-line management option for psoriasis if there is no improvement after 8-12 weeks. This is because long-term use of topical steroids can have side effects such as skin thinning and increased risk of infection.

      Short-acting dithranol could be used as a fourth-line option, but not as initial management. Topical coal tar is also part of third-line management for psoriasis.

      In summary, the NICE recommendations for topical treatments for chronic plaque psoriasis involve a stepwise approach, with combination therapy as the first-line option and other treatments used if there is no improvement or if side effects occur. It is important to work with a healthcare provider to find the most effective and safe treatment plan for each individual.

      NICE Recommendations for Topical Treatments for Chronic Plaque Psoriasis

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  • Question 25 - Bethany Johnson, a 20-year-old student, visits her GP complaining of generalized itching. She...

    Correct

    • 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: 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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      • Dermatology
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  • Question 26 - A 6-month-old infant has been diagnosed with diaper rash. What is the best...

    Incorrect

    • A 6-month-old infant has been diagnosed with diaper rash. What is the best course of action for treating a mild case of diaper rash?

      Your Answer: Bactroban cream

      Correct Answer: Exposure to air

      Explanation:

      Napkin Rash: Causes and Treatment

      Napkin rash, also known as nappy rash, is a common skin condition that affects infants. It is caused by a variety of factors, including contact dermatitis, bacterial and fungal infections, psoriasis, and atopic dermatitis. The condition is often exacerbated by the presence of infantile eczema, but it is not more common in boys or less common in soy-fed infants.

      The primary cause of napkin rash is contact dermatitis, which occurs when the skin comes into contact with ammonia from urine. This can cause burning and irritation, leading to a rash. Infection with bacteria and Candida yeasts can also cause nappy rash, as can psoriasis and atopic dermatitis affecting the nappy area. Infection is often superimposed, making the condition more severe.

      Prevention is the best treatment for napkin rash. Frequent nappy changing and fluid feeding early in the day can help lessen night-time urination, reducing the risk of contact dermatitis. Anti-fungal lotions may also be useful in treating the condition. By the causes and treatment options for napkin rash, parents can help their infants avoid this uncomfortable and painful condition.

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  • Question 27 - A toddler is brought to the clinic with severe eczema. What is the...

    Incorrect

    • 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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      • Dermatology
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  • Question 28 - A 21-year-old woman presents to her general practitioner because she is concerned about...

    Correct

    • A 21-year-old woman presents to her general practitioner because she is concerned about patches of depigmentation on her skin. There are patches on the back of her hands and her elbows, but she is particularly concerned about depigmentation around her mouth and affecting her breasts. Her only other past history of note is a tendency to gain weight over the past few months. Investigations:
      Investigation Result Normal value
      Haemoglobin 119 g/l 115–155 g/l
      Platelets 320 × 109/l 150–400 × 109/l
      White cell count (WCC) 5.9 × 109/l 4–11 × 109/l
      Sodium (Na+) 140 mmol/l 135–145 mmol/l
      Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
      Creatinine 80 μmol/l 50–120 µmol/l
      Thyroid stimulating hormone (TSH) 6.0 µU/l 0.17–3.2 µU/l
      Depigmented skin areas fluoresce bright blue-white on Wood’s lamp inspection.
      Which of the following is the most likely diagnosis?

      Your Answer: Vitiligo

      Explanation:

      Dermatological Conditions: Vitiligo, Lichen Planus, Leprosy, Pityriasis Versicolor, and Idiopathic Hypomelanosis

      Vitiligo: This condition is characterized by depigmentation and is often associated with autoimmune diseases such as hypothyroidism, diabetes mellitus, Addison’s disease, and alopecia. It is caused by the destruction of melanocytes in the interfollicular dermis and can be treated with phototherapy, corticosteroids, and tacrolimus ointment.

      Lichen Planus: This condition presents as a pruritic, papular eruption with a violaceous color and polygonal shape, often with a fine scale.

      Leprosy: This infectious disease is caused by Mycobacterium leprae and is most commonly found in South East Asia, Africa, and South America. Diagnosis requires the presence of reddish patches or hypopigmented areas of skin with reduced sensation, thickened peripheral nerves, and the presence of acid-fast bacilli in skin smears or biopsies.

      Pityriasis Versicolor: This common skin complaint is caused by the proliferation of the yeast Malassezia furfur and presents as flaky, discolored patches mainly on the chest and back.

      Idiopathic Hypomelanosis: This condition is characterized by flat, white spots on the shins and forearms, typically appearing as part of the aging process and possibly due to sun damage. However, the age and distribution of the patient make this diagnosis doubtful.

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      • Dermatology
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  • Question 29 - A 7-year-old girl has a 3 cm-diameter patch of alopecia in the left...

    Incorrect

    • A 7-year-old girl has a 3 cm-diameter patch of alopecia in the left parietal region with another smaller similar area nearby. The skin in the patch is itchy and the few remaining hairs seem to have fallen out near the scalp surface. Her father has noticed that the area of alopecia is spreading. There is no itching of the right scalp and there is no rash elsewhere on her body.
      What is the most probable diagnosis?

      Your Answer: Alopecia areata

      Correct Answer: Tinea capitis

      Explanation:

      Differentiating Causes of Hair Loss: A Guide

      Hair loss can be a distressing experience, but it is important to identify the underlying cause in order to determine the appropriate treatment. Here are some common causes of hair loss and their distinguishing features:

      Tinea Capitis: This fungal infection can cause abnormal scalp skin and alopecia. The affected area may be scaly or inflamed, and broken hairs do not taper at the base.

      Alopecia Areata: This autoimmune disease results in circular areas of hair loss without scaling, inflammation, or broken hair.

      Discoid Lupus Erythematosus: This condition causes red, scaly patches that leave white scars and permanent hair loss due to scarring alopecia.

      Psoriasis: Thick scaling on the scalp may cause mild hair loss, but it does not result in permanent balding. Psoriasis may also be present elsewhere on the body.

      Trichotillomania: Hair pulling disorder does not cause abnormalities to the scalp skin.

      By understanding the distinguishing features of these causes of hair loss, prompt and appropriate treatment can be initiated to prevent permanent hair loss.

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      • Dermatology
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  • Question 30 - A 22-year-old woman presents to her dermatologist with a 4-year history of acne...

    Correct

    • 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: 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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      • Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Dermatology (12/30) 40%
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