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Question 1
Incorrect
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A 50-year-old woman presents to dermatology after being referred by her physician for lesions on both shins. Upon examination, symmetrical erythematous lesions with an orange peel texture are observed. What is the probable diagnosis?
Your Answer: Erythema nodosum
Correct Answer: Pretibial myxoedema
Explanation:Pretibial myxoedema is a condition characterized by orange peel-like lesions on the skin of the shins, often associated with Grave’s disease.
Understanding Shin Lesions: Differential Diagnosis and Characteristic Features
Shin lesions can be caused by a variety of conditions, and it is important to differentiate between them in order to provide appropriate treatment. The four most common conditions that can cause shin lesions are erythema nodosum, pretibial myxoedema, pyoderma gangrenosum, and necrobiosis lipoidica diabeticorum.
Erythema nodosum is characterized by symmetrical, tender, erythematous nodules that heal without scarring. It is often caused by streptococcal infections, sarcoidosis, inflammatory bowel disease, or certain medications such as penicillins, sulphonamides, or oral contraceptive pills.
Pretibial myxoedema, on the other hand, is seen in Graves’ disease and is characterized by symmetrical, erythematous lesions that give the skin a shiny, orange peel appearance.
Pyoderma gangrenosum initially presents as a small red papule, which later develops into deep, red, necrotic ulcers with a violaceous border. It is idiopathic in 50% of cases, but may also be seen in inflammatory bowel disease, connective tissue disorders, and myeloproliferative disorders.
Finally, necrobiosis lipoidica diabeticorum is characterized by shiny, painless areas of yellow/red skin typically found on the shin of diabetics. It is often associated with telangiectasia.
In summary, understanding the differential diagnosis and characteristic features of shin lesions can help healthcare professionals provide appropriate treatment and improve patient outcomes.
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This question is part of the following fields:
- Dermatology
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Question 2
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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Question 3
Incorrect
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A 65-year-old woman comes to the clinic with a similar concern as the previous patient. She has noticed a volcano-like spot on her left arm that has been present for the past 3 months. Initially, she thought it was a simple spot, but it has not gone away. Upon examination, a 5 mm red, raised lesion with a central keratin-filled crater is observed. The doctor suspects a probable keratoacanthoma. What is the most appropriate course of action?
Your Answer: Non-urgent to dermatology
Correct Answer: Urgent referral to dermatology
Explanation:Keratoacanthoma is a benign lesion, but urgent excision is advised due to difficulty in clinically excluding squamous cell carcinoma.
Understanding Keratoacanthoma
Keratoacanthoma is a type of non-cancerous tumor that affects the epithelial cells. It is more commonly found in older individuals and is rare in young people. The tumor is characterized by a dome-shaped papule that resembles a volcano or crater. As it grows, it becomes filled with keratin and develops a central crater. While spontaneous regression of keratoacanthoma is common within three months, it often results in scarring. Therefore, it is important to urgently remove such lesions as it is difficult to clinically differentiate them from squamous cell carcinoma. Removal may also prevent scarring.
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This question is part of the following fields:
- Dermatology
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Question 4
Correct
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A 45-year-old woman presents to her General Practitioner with right lower-limb pain. This is mainly localised over a red patch that has recently developed on the inner part of her thigh.
On examination, there is a well-demarcated area of erythematous skin on the patient’s thigh, which is warm and tender to touch. There are no other rashes or skin changes present in the rest of her body. Her temperature is 37.5°C and the rest of her parameters are within normal limits.
Which of the following is the most likely diagnosis?
Your Answer: Cellulitis
Explanation:Differential Diagnosis for a Lower Limb Rash: Cellulitis, Atopic Dermatitis, Contact Dermatitis, Necrobiosis Lipoidica, and Pretibial Myxedema
The patient in question is most likely suffering from cellulitis, as evidenced by the presence of erythema, warmth, tenderness, and swelling in the affected area. Cellulitis typically presents as a unilateral rash in the lower limbs, with a well-defined margin and potential skin breakdown or ulceration in severe cases. Localized lymph node swelling may also occur, and systemic symptoms such as tachycardia, fever, confusion, or respiratory distress may be present in more severe cases. It is important to examine the skin carefully for potential points of entry for pathogens, such as wounds, local skin infections, or recent injection sites.
Atopic dermatitis, on the other hand, typically presents as an itchy rash in a flexural distribution, with a history of atopy and episodic flares starting from a young age. Contact dermatitis, which can be either irritant or allergic, is characterized by erythema and may present with crusting or vesicles in rare cases. Necrobiosis lipoidica is a condition that typically occurs in diabetic patients, presenting as shiny, painless areas of yellow or red skin on the shins, often with telangiectasia. Pretibial myxedema, which occurs in patients with Graves’ disease, presents as a shiny, waxy, orange-peel texture on the shins.
In summary, a lower limb rash can have various causes, and a careful examination of the skin and consideration of the patient’s medical history can help narrow down the differential diagnosis.
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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 29-year-old woman presents with painful, purple lesions on her shins. Which medication is the most probable cause of this condition?
Your Answer: Combined oral contraceptive pill
Explanation:Understanding Erythema Nodosum
Erythema nodosum is a condition characterized by inflammation of the subcutaneous fat, resulting in tender, erythematous, nodular lesions. These lesions typically occur over the shins but may also appear on other parts of the body such as the forearms and thighs. The condition usually resolves within six weeks, and the lesions heal without scarring.
There are several possible causes of erythema nodosum, including infections such as streptococci, tuberculosis, and brucellosis. Systemic diseases like sarcoidosis, inflammatory bowel disease, and Behcet’s can also lead to the condition. In some cases, erythema nodosum may be associated with malignancy or lymphoma. Certain drugs like penicillins, sulphonamides, and the combined oral contraceptive pill, as well as pregnancy, can also trigger the condition.
Overall, understanding the causes and symptoms of erythema nodosum is important for prompt diagnosis and treatment.
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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 35-year-old woman with a history of eczema and Crohn's disease presents with a pruritic, red rash in the right and left popliteal regions. She works as a nurse and frequently scratches the back of her knees while on duty. This is the third time she has experienced such a popliteal rash. She reports having had similar skin conditions affecting her posterior neck and inguinal areas in the past.
Upon examination, both popliteal areas are inflamed with mild swelling and exudation. There are some accompanying vesicles and papules.
What is the most probable diagnosis?Your Answer: Dermatitis herpetiformis
Correct Answer: Atopic dermatitis
Explanation:Dermatological Conditions and Their Distribution: Understanding the Diagnosis
When it comes to diagnosing skin conditions, the location and distribution of the rash or lesion are just as important as their appearance. For instance, a rash in the flexural regions of an adult patient, such as the popliteal region, is likely to be atopic dermatitis, especially if the patient has a history of asthma. Acute dermatitis typically presents with erythema, oedema, vesicles, and papules.
On the other hand, dermatitis herpetiformis, which is often associated with coeliac disease and malabsorption, presents with grouped vesicles and papules over the extensor surfaces of the elbows, knees, upper back, and buttocks. A rash limited to the popliteal region is unlikely to be dermatitis herpetiformis.
Lichen planus, characterized by flat-topped, pruritic, polygonal, red-to-violaceous papules or plaques, is mostly found on the wrists, ankles, or genitalia. Psoriasis, which presents with silvery, scaling, erythematous plaques, is primarily found on the extensor surfaces. Seborrhoeic dermatitis, which is found in the distribution of the sebaceous glands, such as the nasolabial folds, scalp, eyebrows, genitalia, and presternal regions, is unlikely to be the cause of a rash limited to the popliteal region.
In summary, understanding the distribution and location of skin lesions is crucial in making an accurate diagnosis of dermatological conditions.
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This question is part of the following fields:
- Dermatology
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Question 7
Correct
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A 26-year-old presents with a rash that developed after a camping trip. He mentions being bitten by a tick during the trip. He explains that the rash is red, not itchy, and began at the site of the bite before spreading outward. The center of the rash has now cleared, resulting in a bulls-eye appearance. What is the name of this rash?
Your Answer: Erythema migrans
Explanation:Lyme Disease: Symptoms and Progression
Lyme disease is a bacterial infection that is transmitted through the bite of an infected tick. The disease progresses in two stages, with early and later features. The early features of Lyme disease include erythema migrans, which is a small papule that often appears at the site of the tick bite. This papule develops into a larger annular lesion with central clearing, resembling a bulls-eye. This occurs in 70% of patients and is accompanied by systemic symptoms such as malaise, fever, and arthralgia.
In the later stages of Lyme disease, patients may experience cardiovascular symptoms such as heart block and myocarditis. Neurological symptoms may also occur, including cranial nerve palsies and meningitis. Additionally, patients may develop polyarthritis, which is inflammation in multiple joints. It is important to seek medical attention if any of these symptoms occur after a tick bite, as early treatment can prevent the progression of the disease.
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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 25-year-old Asian woman presents with completely depigmented patches of skin on her arms and legs.
What is the most likely diagnosis?Your Answer: Vitiligo
Explanation:Common Skin Pigmentation Disorders
Skin pigmentation disorders are conditions that affect the color of the skin. Here are some of the most common ones:
Vitiligo: This rare condition is believed to be caused by the immune system attacking melanocytes, resulting in patches of skin with no pigment. It is more common in people of African descent.
Albinism: This genetic disorder reduces the activity of tyrosinase in melanocytes, resulting in a complete lack of pigment in the skin, hair, and eyes.
Melanoma: This is a type of skin cancer that develops from melanocytes. It is characterized by irregular, highly pigmented moles.
Melasma: This condition causes increased pigmentation, usually under the eyes. It is common in pregnant women and users of oral contraceptives.
Pityriasis alba: This condition causes white, scaly patches on the face, and is most commonly seen in children.
Understanding these skin pigmentation disorders can help individuals identify and manage them effectively.
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This question is part of the following fields:
- Dermatology
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Question 9
Correct
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A 65-year-old woman comes to see her GP for a skin condition that has been slowly progressing over the years. She has had dry patches of skin that eventually turned into plaques, which have been treated as psoriasis. However, the lesions have continued to worsen and now have nodules. Some of these nodules have become painful and have discharged fluid. A biopsy is taken to further assess the lesions, and the pathology report shows lymphocytic and atypical T-cell infiltrates in the dermis and epidermis, with some Pautrier microabscesses. Based on this information, what is the most likely diagnosis?
Your Answer: Mycosis fungoides
Explanation:Mycosis fungoides, a severe form of T-cell lymphoma that mimics eczema or psoriasis, is a rare but concerning skin condition. The patient’s atypical medical history, previous diagnostic uncertainty, and laboratory results suggest that they may have cutaneous T-cell lymphoma. Biopsy results showing Pautrier microabscesses are a common feature of mycosis fungoides. Harlequin ichthyosis is a genetic disorder that manifests from birth, making it an unlikely diagnosis. Although syphilis can cause various skin symptoms, the biopsy findings do not support this diagnosis. Discoid eczema, also known as nummular dermatitis, has a different clinical course than the patient’s condition, and the biopsy results do not indicate it.
Understanding Mycosis Fungoides
Mycosis fungoides is a rare type of T-cell lymphoma that primarily affects the skin. It is characterized by the presence of itchy, red patches that may appear in different colors, unlike eczema or psoriasis where the lesions are more uniform in color. These patches may progress to form plaques, which can be seen in the later stages of the disease.
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This question is part of the following fields:
- Dermatology
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Question 10
Correct
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You are conducting an 8-week examination on a baby with a prominent purplish birthmark. The mother was informed that it may not disappear on its own and could be linked to other vascular issues. What is the probable diagnosis?
Your Answer: Port wine stain
Explanation:Understanding Port Wine Stains
Port wine stains are a type of birthmark that are characterized by their deep red or purple color. Unlike other vascular birthmarks, such as salmon patches and strawberry hemangiomas, port wine stains do not go away on their own and may even become more prominent over time. These birthmarks are typically unilateral, meaning they only appear on one side of the body.
Fortunately, there are treatment options available for those who wish to reduce the appearance of port wine stains. Cosmetic camouflage can be used to cover up the birthmark, while laser therapy is another option that requires multiple sessions. It’s important to note that while these treatments can help reduce the appearance of port wine stains, they may not completely eliminate them. Understanding the nature of port wine stains and the available treatment options can help individuals make informed decisions about managing these birthmarks.
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This question is part of the following fields:
- Dermatology
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Question 11
Incorrect
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You are examining a 65-year-old individual with acanthosis nigricans. You suggest screening for diabetes. Due to the widespread skin alterations, including some oral changes, what other potential underlying condition should be taken into account?
Your Answer: Inflammatory bowel disease
Correct Answer: Internal malignancy
Explanation:While acanthosis nigricans may occur on its own in individuals with dark skin, it is typically a sign of insulin resistance and associated conditions such as type 2 diabetes, polycystic ovarian syndrome, Cushing’s syndrome, and hypothyroidism. Certain medications, including corticosteroids, insulin, and hormone medications, can also cause this condition. If acanthosis nigricans appears suddenly and in unusual areas such as the mouth, it may indicate the presence of an internal malignancy, particularly gastric cancer.
Acanthosis nigricans is a condition characterized by the presence of symmetrical, brown, velvety plaques on the neck, axilla, and groin. This condition can be caused by various factors such as type 2 diabetes mellitus, gastrointestinal cancer, obesity, polycystic ovarian syndrome, acromegaly, Cushing’s disease, hypothyroidism, familial factors, Prader-Willi syndrome, and certain drugs like the combined oral contraceptive pill and nicotinic acid. The pathophysiology of acanthosis nigricans involves insulin resistance, which leads to hyperinsulinemia. This, in turn, stimulates the proliferation of keratinocytes and dermal fibroblasts through interaction with insulin-like growth factor receptor-1 (IGFR1).
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This question is part of the following fields:
- Dermatology
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Question 12
Incorrect
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A 55-year-old diabetic female patient comes in with bilateral erythematous lesions on her shins that have been present for four months. The lesions are surrounded by telangiectasia. What is the probable diagnosis?
Your Answer: Erythema nodosum
Correct Answer: Necrobiosis lipoidica
Explanation:There is no association between erythema nodosum and telangiectasia in the surrounding area.
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 13
Correct
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A 35-year-old man presents to his General Practitioner (GP) with concerns about a mole on his leg. He has noticed over the past few months that it has increased in size. On examination, the mole is 7 mm in diameter and has an irregular border but is a consistent colour.
What is the most appropriate management option for this patient?
Your Answer: 2-week wait referral to dermatology
Explanation:Understanding Referral Guidelines for Suspicious Pigmented Lesions
When assessing pigmented lesions, the National Institute of Health and Care Excellence (NICE) recommends using the 7-point scoring system.
The 7-point checklist includes:
Major features (2 points each):
change in size
irregular shape or border
irregular colour.
Minor features (1 point each):
> 7 mm at greatest diameter
inflammation
oozing or crusting
change in sensation including itch.Lesions scoring 3 or more or with other suspicious features of melanoma should be referred urgently via the cancer fast-track pathway to dermatology.
For lesions with a low suspicion of melanoma, a photo should be taken with a ruler and the patient advised to return in eight weeks for review. However, lesions scoring 5 on the checklist, like those with a change in size, irregular shape or border, and irregular color, should be referred urgently to a dermatologist to avoid any delay in diagnosis and subsequent treatment.
Excision of lesions suspicious of melanoma should be avoided in primary care as this can delay treatment, and incomplete excision is more common. Routine referral to dermatology would be suitable for a pigmented lesion which scores less than 3 on the 7-point checklist if there are no other features to suggest melanoma. Referral to genetics is recommended if three or more family members have been diagnosed with melanoma.
It is important to understand these referral guidelines to ensure timely and appropriate management of suspicious pigmented lesions.
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This question is part of the following fields:
- Dermatology
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Question 14
Incorrect
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A 56-year-old man with a history of type 2 diabetes mellitus and benign prostatic hyperplasia presents to dermatology with multiple lesions on his shin. Upon examination, symmetrical, tender, erythematous nodules are observed. The lesions are healing without scarring. What is the probable diagnosis?
Your Answer: Necrobiosis lipoidica diabeticorum
Correct Answer: Erythema nodosum
Explanation:The relevant diagnosis for this question relies solely on the description of the lesions, as the patient’s medical history is not a factor. Specifically, the tender shin lesions are indicative of erythema nodosum.
Understanding Shin Lesions: Differential Diagnosis and Characteristic Features
Shin lesions can be caused by a variety of conditions, and it is important to differentiate between them in order to provide appropriate treatment. The four most common conditions that can cause shin lesions are erythema nodosum, pretibial myxoedema, pyoderma gangrenosum, and necrobiosis lipoidica diabeticorum.
Erythema nodosum is characterized by symmetrical, tender, erythematous nodules that heal without scarring. It is often caused by streptococcal infections, sarcoidosis, inflammatory bowel disease, or certain medications such as penicillins, sulphonamides, or oral contraceptive pills.
Pretibial myxoedema, on the other hand, is seen in Graves’ disease and is characterized by symmetrical, erythematous lesions that give the skin a shiny, orange peel appearance.
Pyoderma gangrenosum initially presents as a small red papule, which later develops into deep, red, necrotic ulcers with a violaceous border. It is idiopathic in 50% of cases, but may also be seen in inflammatory bowel disease, connective tissue disorders, and myeloproliferative disorders.
Finally, necrobiosis lipoidica diabeticorum is characterized by shiny, painless areas of yellow/red skin typically found on the shin of diabetics. It is often associated with telangiectasia.
In summary, understanding the differential diagnosis and characteristic features of shin lesions can help healthcare professionals provide appropriate treatment and improve patient outcomes.
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This question is part of the following fields:
- Dermatology
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Question 15
Correct
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A father brings his 4-year-old daughter to see her General Practitioner with a rash covering her face, trunk, arms and legs. She had a fever for a couple of days with a runny nose before the rash appears but is now well and afebrile. The rash is mainly vesicular with small fluid-filled blisters and there are a few scabbed lesions. Her father is concerned as she is scratching the lesions, especially at night. She is otherwise fit and well and is up-to-date with her vaccinations.
Which of the following is the most appropriate treatment?Your Answer: Chlorphenamine
Explanation:Treatment Options for chickenpox in Children
chickenpox is a common viral infection in children that presents with a characteristic vesicular rash. While there is no specific treatment for chickenpox, symptomatic relief can be provided to alleviate itching and fever. Here are some treatment options for chickenpox in children:
1. Chlorphenamine: This sedating antihistamine can be used at night-time to help with itching.
2. Aciclovir: This antiviral medication is recommended for patients who are immunosuppressed or have risk factors for developing complications from infection, such as adults or newborns.
3. Flucloxacillin: This antibiotic is used to treat secondary bacterial infections that can occur with chickenpox. However, it is not necessary for a child who is well and afebrile.
4. Ibuprofen: While ibuprofen and paracetamol are both used as antipyretics in children with febrile illnesses, the use of ibuprofen in children with chickenpox is linked to an increased risk of severe skin infection. Paracetamol is recommended instead.
5. Malathion: This treatment is for scabies, not chickenpox. Scabies presents with a different type of rash and does not have a prodromal illness.
In summary, treatment for chickenpox in children is mainly symptomatic. Antihistamines and calamine lotion can help with itching, while paracetamol can be used for fever. Antibiotics and antivirals are only necessary in certain cases.
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This question is part of the following fields:
- Dermatology
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Question 16
Incorrect
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A 30-year-old man presents with multiple, ring-shaped, papular rashes on his legs. He has recently noticed a red, raised intra-oral lesion.
What is the most likely diagnosis?Your Answer: Tinea versicolour
Correct Answer: Lichen planus
Explanation:Skin Conditions: Lichen Planus, Erythema Multiforme, Psoriasis, Ringworm, and Tinea Versicolor
Lichen Planus: A skin condition that affects cutaneous and mucosal surfaces, characterised by flat-topped plaques and papules with a purple hue and white striae. It can be treated with topical steroids and immunomodulators.
Erythema Multiforme: A skin condition characterised by targetoid lesions with a central depression, usually starting on the acral extensor surfaces and progressing to involve the trunk and back. It can be caused by medications, infections, or underlying conditions.
Psoriasis: An autoimmune chronic skin condition presenting with erythematous plaques and greyscale on the extensor surfaces of extremities. It is not associated with intra-oral mucosal lesions.
Ringworm: A fungal skin infection characterised by erythematous, scaly patches on the skin surface of the trunk, back, and extremities. It can lead to the formation of pustules or vesicles.
Tinea Versicolor: A fungal skin infection characterised by pale or dark, copper-coloured patches on the arms, neck, and trunk. It does not involve mucosal surfaces.
Understanding Different Skin Conditions
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This question is part of the following fields:
- Dermatology
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Question 17
Correct
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A 50-year-old woman 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.
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This question is part of the following fields:
- Dermatology
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Question 18
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 19
Incorrect
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A 24-year-old pregnant woman visits her General Practitioner with a rapidly growing lesion on the tip of her index finger. It began as a small spot but has rapidly increased in size over the past five days. It is dark red in colour and causes discomfort and easy bleeding when working in her café.
What is the most probable diagnosis?
Choose the ONE most likely diagnosis from the options below.Your Answer:
Correct Answer: Pyogenic granuloma
Explanation:Differentiating Skin Lesions: Pyogenic Granuloma, BCC, Haemangioma, Melanoma, and Viral Wart
Skin lesions can be caused by various factors, and it is important to differentiate them to determine the appropriate treatment. Here are some common skin lesions and their characteristics:
Pyogenic Granuloma
Pyogenic granulomas are benign vascular lesions that grow rapidly and bleed easily. They appear as a fleshy nodule and can be polyploid. They commonly occur in children, young adults, and pregnancy and are often found on the fingers and hands.Basal Cell Carcinoma (BCC)
BCC is a slow-growing, locally invasive lesion that appears on sun-exposed skin. It has a characteristic rolled edge and is more prevalent in elderly patients with fair skin and a history of sun exposure. BCC can be skin-colored, pink, or pigmented.Haemangioma
Haemangiomas are benign lesions caused by a collection of blood vessels under the skin. They commonly occur in infants and are known as strawberry marks. A new lesion that grows rapidly is unlikely to be a haemangioma.Melanoma
Melanoma is a malignant tumour that arises from the over-proliferation of cutaneous melanocytes. It can occur anywhere on the body and has characteristic asymmetry, border irregularity, color variation, and large diameter. The ABCDE criteria of melanoma can help in identifying it.Viral Wart
Viral warts are benign skin lesions caused by human papillomavirus infection. They commonly occur in school-aged children and have a rough, hyperkeratotic surface.In conclusion, identifying the characteristics of different skin lesions can help in determining the appropriate treatment and management. It is important to seek medical advice if there is any doubt about the nature of a skin lesion.
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This question is part of the following fields:
- Dermatology
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Question 20
Incorrect
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A 5-year-old girl is brought to the pediatrician's office by her father, who is concerned about a red rash on her arms and chest. She has been feeling sick, with cold-like symptoms preceding the rash. The rash is erythematous, macular and symmetrical to both arms and chest and is non-blanching. She is currently without fever and appears to be in good health.
What is the most probable cause?Your Answer:
Correct Answer: Henoch–Schönlein purpura
Explanation:Distinguishing Between Different Skin Conditions: A Guide for Healthcare Professionals
Henoch–Schönlein purpura, eczema, intertrigo, meningococcal disease, and systemic lupus erythematosus are all skin conditions that can present with various rashes and symptoms. It is important for healthcare professionals to be able to distinguish between these conditions in order to provide appropriate treatment.
Henoch–Schönlein purpura is an autoimmune hypersensitivity vasculitis that presents with a non-blanching rash, joint and abdominal pain, and nephritis. Eczema is characterized by areas of erythema that are blanching, dry skin with fine scales, and excoriations. Intertrigo primarily affects the flexures with erythematous patches that may progress to intense inflammation. Meningococcal disease presents with a non-blanching rash that rapidly progresses to purpura and requires immediate treatment. Systemic lupus erythematosus is rare in children and presents with a malar or butterfly rash on the face, joint pain, fever, or weight loss.
By understanding the unique features of each condition, healthcare professionals can accurately diagnose and treat their patients.
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This question is part of the following fields:
- Dermatology
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