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  • Question 1 - A 78-year-old woman with a history of ischaemic heart disease is evaluated at...

    Correct

    • A 78-year-old woman with a history of ischaemic heart disease is evaluated at a nursing home. She presents with tense blistering lesions on her legs, measuring approximately 1 to 3 cm in diameter, and reports mild itching. Her mouth and vulva examination are normal. What is the probable diagnosis?

      Your Answer: Bullous pemphigoid

      Explanation:

      If there are blisters or bullae present without any involvement of the mucosal lining, the condition is likely to be bullous pemphigoid. However, if there is mucosal involvement, the condition is more likely to be pemphigus vulgaris.

      Understanding Bullous Pemphigoid

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

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

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 2 - A 25-year-old woman presents to her General Practitioner concerned about a red, itchy...

    Correct

    • A 25-year-old woman presents to her General Practitioner concerned about a red, itchy rash that developed while she was on holiday in Spain. On examination, she has an inflamed eczematous rash on her face, neck, arms and legs, with a few blisters. She has sparing of skin in areas that have been covered by her swimwear. She is currently being treated for acne and takes no other regular medications. She has no other known medical conditions.
      Which of the following medications is most likely to have caused this patient’s rash?

      Your Answer: Oral lymecycline

      Explanation:

      Understanding Photosensitivity and Acne Treatments

      Photosensitivity is a common side-effect of certain medications used to treat acne. This abnormal reaction to ultraviolet (UV) radiation can cause a rash, particularly when exposed to UVA rays. Primary photosensitive conditions include polymorphic light eruption or solar urticaria, while secondary photosensitivity may be caused by medications such as tetracyclines or retinoids, or exposure to psoralens released by plants.

      Lymecycline, a tetracycline antibiotic commonly used to treat acne, is known to cause photosensitivity. Oral erythromycin, a macrolide antibiotic used to treat acne, does not typically cause photosensitive skin reactions. Topical azelaic acid and clindamycin are also used to treat acne but are not known to cause photosensitivity. Topical benzoyl peroxide may cause local skin reactions but is not associated with photosensitivity. It is important to be aware of the potential side-effects of acne treatments and to take precautions to protect the skin from UV radiation.

    • This question is part of the following fields:

      • Dermatology
      23
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  • Question 3 - A 45-year-old man presents to the Emergency Department with a rash and feeling...

    Correct

    • A 45-year-old man presents to the Emergency Department with a rash and feeling generally unwell. He has a history of epilepsy and recently started taking phenytoin three weeks ago. He developed mouth ulcers, malaise, and a cough about a week ago. Two days ago, he developed a widespread red rash that has now formed large fluid-filled blisters, covering approximately 30% of his body area. The lesions separate when slight pressure is applied. Upon examination, his temperature is 38.3ºC and pulse is 126/min. Blood results reveal:
      Na+ 144 mmol/l
      K+ 4.2 mmol/l
      Bicarbonate 19 mmol/l
      Urea 13.4 mmol/l
      Creatinine 121 µmol/l
      What is the most likely diagnosis?

      Your Answer: Toxic epidermal necrolysis

      Explanation:

      Understanding Toxic Epidermal Necrolysis

      Toxic epidermal necrolysis (TEN) is a severe skin disorder that can be life-threatening and is often caused by a reaction to certain drugs. It is characterized by extensive scalding of the skin, and is considered by some experts to be the most severe form of a range of skin disorders that includes erythema multiforme and Stevens-Johnson syndrome. Symptoms of TEN include fever, rapid heartbeat, and a positive Nikolsky’s sign, which means that the epidermis separates easily with slight lateral pressure.

      The most effective way to manage TEN is to stop the use of the drug that caused the reaction. Supportive care is also necessary, and patients are often treated in an intensive care unit to monitor for potential complications such as electrolyte imbalances and fluid loss. Intravenous immunoglobulin is a commonly used first-line treatment for TEN, and has been shown to be effective. Other treatment options include immunosuppressive agents like ciclosporin and cyclophosphamide, as well as plasmapheresis.

    • This question is part of the following fields:

      • Dermatology
      21.3
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  • Question 4 - An 80-year-old man visits his GP complaining of a painful lesion on his...

    Incorrect

    • An 80-year-old man visits his GP complaining of a painful lesion on his ear that has been bothering him for a year. The lesion has remained the same for several months but is causing him significant discomfort when he lies down. He reports no other symptoms.
      Upon examination, the doctor observes a well-defined, 10mm, flesh-colored nodule on the superior helix of the ear. The nodule is firm, very tender to touch, and covered with some scales.
      What is the most probable diagnosis?

      Your Answer: Squamous cell carcinoma

      Correct Answer: Chondrodermatitis nodularis helicis

      Explanation:

      Chondrodermatitis nodularis helicis is a painful, non-cancerous nodule that commonly occurs on the ear, particularly in men. Based on the patient’s level of pain and the stable nature of the lesion, this is the most likely diagnosis. While squamous cell carcinoma is a possible differential, it typically progresses more rapidly than this lesion. Similarly, basal cell carcinoma usually develops gradually and is not typically associated with significant pain. Although actinic keratosis can cause a scaly lesion on the ear, it is usually not as painful as chondrodermatitis nodularis helicis and tends to progress slowly over time.

      Understanding Chondrodermatitis Nodularis Helicis

      Chondrodermatitis nodularis helicis (CNH) is a harmless condition that is characterized by the formation of a painful nodule on the ear. It is believed to be caused by various factors such as continuous pressure on the ear, trauma, or exposure to cold. This condition is more prevalent in men and tends to occur more frequently as one ages.

      To manage CNH, it is essential to reduce pressure on the ear. This can be achieved by using foam ear protectors while sleeping. Other treatment options include cryotherapy, steroid injection, and collagen injection. However, surgical treatment may be necessary in some cases, although there is a high likelihood of recurrence.

      Overall, understanding CNH is crucial in managing this condition effectively. By taking the necessary precautions and seeking appropriate treatment, individuals can alleviate the pain and discomfort associated with CNH.

    • This question is part of the following fields:

      • Dermatology
      14
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  • Question 5 - A 75-year-old man presents to his GP with persistent itch that has been...

    Incorrect

    • A 75-year-old man presents to his GP with persistent itch that has been bothering him for several months. The itch is widespread, affecting his torso and back, and he has not noticed any changes in his skin or overall health. Despite having an extensive medical history, there have been no recent changes to his medications. Upon examination, there are no focal skin changes other than widespread excoriation marks. The GP suspects that a systemic condition may be the underlying cause of the patient's itch. Based on his medical history, which of the following conditions is most likely to be responsible for his symptoms?

      Your Answer: Hypoparathyroidism

      Correct Answer: Chronic kidney disease

      Explanation:

      Pruritus is a symptom of chronic kidney disease, which can cause severe itching and distress for patients. Even in the early stages of the disease, hyperuricemia can lead to intense itchiness.

      Causes of Pruritus and their Characteristics

      Pruritus, commonly known as itching, can be caused by various underlying conditions. Liver disease, often associated with a history of alcohol excess, can present with stigmata of chronic liver disease such as spider naevi, bruising, palmar erythema, and gynaecomastia. Iron deficiency anaemia can cause pallor and other signs such as koilonychia, atrophic glossitis, post-cricoid webs, and angular stomatitis. Pruritus in polycythaemia is particularly noticeable after a warm bath and is accompanied by a ruddy complexion. Chronic kidney disease can present with lethargy, pallor, oedema, weight gain, hypertension, and fatigue. Lymphoma can cause night sweats, lymphadenopathy, splenomegaly, hepatomegaly, and fatigue. Other causes of pruritus include hyper- and hypothyroidism, diabetes, pregnancy, senile pruritus, urticaria, and skin disorders such as eczema, scabies, psoriasis, and pityriasis rosea. It is important to identify the underlying cause of pruritus to provide appropriate treatment and alleviate symptoms.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - A 50-year-old man is brought to the Emergency Department by his wife after...

    Correct

    • A 50-year-old man is brought to the Emergency Department by his wife after developing a severe cutaneous hypersensitivity reaction. He has a history of rheumatoid arthritis for which he was taking non-steroidal anti-inflammatory drugs (NSAIDs). Still, his symptoms did not improve, and his rheumatologist prescribed him methotrexate a few days ago.
      On examination, Nikolsky’s sign is present and affects 45% of his body’s surface area.
      What is the underlying condition?

      Your Answer: Toxic epidermal necrolysis

      Explanation:

      Common Skin Hypersensitivity Reactions and their Causes

      Skin hypersensitivity reactions can range from mild to life-threatening. Here are some common types and their causes:

      Toxic Epidermal Necrolysis: This is the most serious skin hypersensitivity reaction, with a high mortality rate. It is usually caused by drugs such as NSAIDs, steroids, methotrexate, allopurinol and penicillins.

      Erythema Multiforme: This is a target-like lesion that commonly occurs on the palms and soles. It is usually caused by drugs such as penicillins, phenytoin, NSAIDs and sulfa drugs. Mycoplasma and herpes simplex infections can also cause erythema multiforme.

      Erythema Nodosum: This is an inflammatory condition of subcutaneous tissue. The most common causes are recent streptococcal infection, sarcoidosis, tuberculosis and inflammatory bowel disease.

      Fixed Drug Reaction: This is a localised allergic drug reaction that recurs at the same anatomic site of the skin with repeated drug exposure. It is most commonly caused by aspirin, NSAIDs, tetracycline and barbiturate.

      Morbilliform Rash: This is a mild hypersensitivity skin reaction that manifests as a generalised maculopapular eruption that blanches with pressure. The rash can be caused by penicillin, sulfa drugs, allopurinol and phenytoin.

    • This question is part of the following fields:

      • Dermatology
      13.9
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  • Question 7 - A 35-year-old man presents to his General Practitioner (GP) with concerns about a...

    Correct

    • 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.

    • This question is part of the following fields:

      • Dermatology
      9
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  • Question 8 - A 16-year-old female from Nigeria comes to the clinic with a swelling near...

    Incorrect

    • A 16-year-old female from Nigeria comes to the clinic with a swelling near her earlobe. She had her ears pierced three months ago and has noticed a gradual development of an erythematous swelling. Upon examination, a keloid scar is observed. What is the best course of action for management?

      Your Answer: Advise will spontaneously regress within 4-6 months

      Correct Answer: Refer for intralesional triamcinolone

      Explanation:

      Understanding Keloid Scars

      Keloid scars are abnormal growths that develop from the connective tissue of a scar and extend beyond the boundaries of the original wound. They are more common in people with dark skin and tend to occur in young adults. Keloids are most frequently found on the sternum, shoulder, neck, face, extensor surface of limbs, and trunk.

      To prevent keloid scars, incisions should be made along relaxed skin tension lines. However, if keloids do develop, early treatment with intra-lesional steroids such as triamcinolone may be effective. In some cases, excision may be necessary, but this should be approached with caution as it can potentially lead to further keloid scarring.

      It is important to note that the historical use of Langer lines to determine optimal incision lines has been shown to produce worse cosmetic results than following skin tension lines. Understanding the predisposing factors and treatment options for keloid scars can help individuals make informed decisions about their care.

    • This question is part of the following fields:

      • Dermatology
      16.8
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  • Question 9 - A 75 year-old woman comes to the clinic with a non-healing skin area...

    Correct

    • A 75 year-old woman comes to the clinic with a non-healing skin area on her ankle. She had a deep vein thrombosis 15 years ago after a hip replacement surgery. She is currently taking Adcal D3 and no other medications. During the examination, a superficial ulcer is observed in front of the medial malleolus. Apart from this, she is in good health. What test would be the most beneficial in deciding the next course of action?

      Your Answer: Ankle-brachial pressure index

      Explanation:

      The patient exhibits typical signs of a venous ulcer and appears to be in good overall health without any indications of infection. The recommended treatment for venous ulcers involves the use of compression dressings, but it is crucial to ensure that the patient’s arterial circulation is sufficient to tolerate some level of compression.

      Venous Ulceration and its Management

      Venous ulceration is a type of ulcer that is commonly seen above the medial malleolus. To assess for poor arterial flow that could impair healing, an ankle-brachial pressure index (ABPI) is important in non-healing ulcers. A normal ABPI is usually between 0.9 – 1.2, while values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, particularly in diabetics, due to false-negative results caused by arterial calcification.

      The only treatment that has been shown to be of real benefit for venous ulceration is compression bandaging, usually four-layer. Oral pentoxifylline, a peripheral vasodilator, can also improve the healing rate. There is some small evidence supporting the use of flavonoids, but little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy, and intermittent pneumatic compression. Proper management of venous ulceration is crucial to promote healing and prevent complications.

    • This question is part of the following fields:

      • Dermatology
      25.1
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  • Question 10 - A 32-year-old female patient comes to the clinic complaining of intermittent bloating and...

    Incorrect

    • A 32-year-old female patient comes to the clinic complaining of intermittent bloating and loose stools that have been going on for 5 months. She reports no blood in her stool but has lost a few kilograms in weight. Recently, she has noticed some itchy, vesicular rashes on her knees that have been persistent. Routine blood tests were ordered and all came back normal except for one positive result. What is the name of the dermatological condition she is experiencing?

      Your Answer: Psoriasis

      Correct Answer: Dermatitis herpetiformis

      Explanation:

      Understanding Dermatitis Herpetiformis

      Dermatitis herpetiformis is a skin condition that is linked to coeliac disease and is caused by the deposition of IgA in the dermis. It is an autoimmune blistering disorder that is characterized by itchy, vesicular skin lesions that appear on the extensor surfaces of the body, such as the elbows, knees, and buttocks.

      To diagnose dermatitis herpetiformis, a skin biopsy is required, which will show the deposition of IgA in a granular pattern in the upper dermis. This condition can be managed by following a gluten-free diet and taking dapsone medication.

      It is important to understand the symptoms and management of dermatitis herpetiformis to ensure that proper treatment is given. By following a gluten-free diet and taking medication, individuals with this condition can manage their symptoms and improve their quality of life.

    • This question is part of the following fields:

      • Dermatology
      20.6
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SESSION STATS - PERFORMANCE PER SPECIALTY

Dermatology (6/10) 60%
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