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Question 1
Incorrect
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An 18 year old boy from Middle East presented with a 1 month history of a yellowish, crusted plaque over his scalp, along with some scarring alopecia. What will the likely diagnosis be?
Your Answer: Tinea capitis
Correct Answer: Favus
Explanation:Favus is a fungal infection of the scalp, resulting in the formation of a yellowish crusted plaque over the scalp and leads to scar formation with alopecia. Tinea capitus is a fungal infection of the scalp resulting in scaling and non scarring hair loss. Folliculitis presents with multiple perifollicular papules which can be caused by both bacteria and fungi. Cradle cap usually affects infants where the whole scalp is involved. It can lead to hair loss and responds to topical antifungals and keratolytics.
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This question is part of the following fields:
- Dermatology
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Question 2
Incorrect
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A 4 year old child was brought in by his mother with complaints of vesicular eruption over his palms, soles and oral mucosa for the last 5 days. He was slightly febrile. There were no other signs. The most likely causative organism in this case would be?
Your Answer: Rubella
Correct Answer: Coxsackie
Explanation:This patient is most likely suffering from hand, foot mouth disease which is caused by coxsackie virus A16. Its incubation period ranges from 5-7 days and only symptomatic treatment is required.
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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 14-year-old boy presents with a rash on his buttocks and extensor surfaces following a sore throat. What is the most probable diagnosis?
Your Answer: Rubella
Correct Answer: Henoch-Schönlein purpura (HSP)
Explanation:Henoch-Schönlein purpura (HSP) rashes are commonly found on the legs, feet, and buttocks while Immune thrombocytopenia (ITP) rashes manifest predominantly on the lower legs. HSP happens following a sore throat while ITP usually happens following an URTI or Flu. HSP is an inflammation of a blood vessel (vasculitis) while ITP is immune mediated insufficiency of platelets.
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This question is part of the following fields:
- Dermatology
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Question 4
Incorrect
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Which one of the following skin conditions is matched correctly with its treatment?
Your Answer: Erythema Nodosum and topical tetracycline
Correct Answer: Psoriasis and Vitamin D analogues
Explanation:One of the options of Psoriasis treatment is vitamin D analogues i.e. calcipotriol. Acne is exacerbated by steroids. Erythema nodosum can be caused by various diseases and the treatment of the primary condition resolves the symptoms. Lipomas require surgery, whereas Steven-Johnson syndrome requires use of steroids and eliminating the culprit drug, which is one of the most common causes.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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Which is NOT a poor prognostic factor for patients with malignant melanoma?
Your Answer: Clarke’s level IV
Correct Answer: Diameter of melanoma > 6 mm
Explanation:Features that affect prognosis are tumour thickness in millimetres (Breslow’s depth – the deeper the Breslow thickness the poorer the prognosis.), depth related to skin structures (Clark level – the level of invasion through the dermis), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumour-infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis. Malignant melanoma tends to grow radially before entering a vertical growth phase. The diameter it reaches has not been found to be a prognostic factor.
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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 9-year-old girl complains of perioral blisters and a burning sensation of her face. Some of the blisters are crusted and some are weeping. What is the most likely diagnosis?
Your Answer: Shingles
Correct Answer: Impetigo
Explanation:Impetigo appears more commonly on the face than other exposed areas like the limbs. Its blisters are clustered and may have a fluid discharge.
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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 35 year old lady presented with a hyperkeratotic, scaly rash over the palmar aspect of her hands and interdigital spaces. The most likely diagnosis would be?
Your Answer: Tinea manum
Explanation:Tinea manum is a superficial fungal infection of the hands characterised by dry scaly rash and also involves the interdigital spaces of the hands.
Tinea pedis is a fungal infection of feet, whereas onychomycosis represents a fungal infection of the nails, characterised by nail dystrophy, hyperkeratosis.
Kerion is the name given to secondarily infected tinea capitis leading to a soft boggy swelling over the scalp.
Psoriasis presents as silvery scales over the extensors of the body and it may involve the nails, scalp and joints.
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This question is part of the following fields:
- Dermatology
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Question 8
Correct
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All of the following are associated with yellow nail syndrome except:
Your Answer: Cardiomegaly
Explanation:Yellow nail syndrome is a very rare medical syndrome that includes pleural effusions, lymphedema (due to under development of the lymphatic vessels) and yellow dystrophic nails. Approximately 40% will also have bronchiectasis. It is also associated with chronic sinusitis and persistent coughing and it usually affects adults.
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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 72-year-old female presents with tiredness and weakness. On examination, she is pale and has a haemoglobin of 72 g/L with an MCV of 68 fL. Which nail changes may be seen in association with this patient's condition?
Your Answer: Koilonychia
Explanation:Koilonychia, known as spoon nails, is a condition of the nails bending inwards, taking the shape of a spoon. This is a strong indication of iron-deficiency anaemia (IDA). The rest of the patient’s symptoms further indicate IDA.
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This question is part of the following fields:
- Dermatology
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Question 10
Incorrect
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A 32 year old man presents with blistering and hyperpigmentation on his face and hands, after a beach holiday with friends. Tests reveal high levels of uroporphyrinogen in the urine. The most likely diagnosis is:
Your Answer: Acute intermittent porphyria
Correct Answer: Porphyria cutanea tarda
Explanation:Porphyria cutanea tarda (PCT) is the most common of the porphyries. It is characterised by fragility and blistering of exposed skin. Typically, patients who are ultimately diagnosed with PCT first seek treatment following the development photosensitivities in the form of blisters and erosions on commonly exposed areas of the skin. This is usually observed in the face, hands, forearms, and lower legs. It heals slowly and with scarring. Though blisters are the most common skin manifestations of PCT, other skin manifestations like hyperpigmentation (as if they are getting a tan) and hypertrichosis (mainly on top of the cheeks) also occur. Risk factors for the development of PCT include alcohol and sun.
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This question is part of the following fields:
- Dermatology
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Question 11
Incorrect
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A 35 year old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?
Your Answer: Trypanosomiasis
Correct Answer: Leishmaniasis
Explanation:The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.
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This question is part of the following fields:
- Dermatology
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Question 12
Correct
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Which of the following is FALSE with regards to vitiligo?
Your Answer: A positive family history is not a risk factor
Explanation:The cause of Vitiligo is typically unknown. It is believed to be due to genetic susceptibility that is triggered by an environmental factor such that an autoimmune disease occurs. This results in the destruction of skin pigment cells. Risk factors include a family history of the condition or other autoimmune diseases, such as hyperthyroidism, alopecia areata, and pernicious anaemia. Vitiligo is classified into two main types: segmental and non-segmental. Most cases are non-segmental meaning they affect both sides and typically get worse with time. The prevalence of vitiligo is 0.5-1% of populations worldwide. Typical sites include backs of hands, wrists, knees, neck and around body orifices. The Koebner phenomenon refers to skin lesions appearing on lines of trauma. This occurs in vitiligo secondary to scratching.
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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 56-year-old female patient is complaining of a swollen upper limb after an insect bite. Although the bite site looks better, the gross oedema is still present. What is the most likely aetiology? Keep in mind that she has a history of breast cancer and radical mastectomy with axillary lymphadenectomy 10 years ago.
Your Answer: Lymphedema
Explanation:Lymphedema is most commonly the result of removal or damage to lymph nodes.
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This question is part of the following fields:
- Dermatology
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Question 14
Correct
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A 52-year-old man has squamous-cell carcinoma of his lower lip. Which of the following is most likely to be a feature of this type of carcinoma?
Your Answer: It is capable of metastasising via the lymphatics
Explanation:Squamous-cell skin cancer usually presents as a hard lump with a scaly top but can also form an ulcer. Onset is often over months and it is more likely to spread to distant areas than basal cell cancer vie the lymphatics. The greatest risk factor is high total exposure to ultraviolet radiation from the Sun. Other risks include prior scars, chronic wounds, actinic keratosis, lighter skin, Bowen’s disease, arsenic exposure, radiation therapy, poor immune system function, previous basal cell carcinoma, and HPV infection. While prognosis is usually good, if distant spread occurs five-year survival is ,34%
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This question is part of the following fields:
- Dermatology
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Question 15
Incorrect
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Which of the following statements regarding psoriasis is incorrect?
Your Answer: Phototherapy is a form of treatment
Correct Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease which is characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly commonly on the extensor surfaces. Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression. Psoriatic arthritis affects up to 30% of individuals with psoriasis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response, rather than type 2 helper T cells
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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 72-year-old with varicose veins complains of swollen, red, itchy legs. Which is the most likely diagnosis?
Your Answer: Lymphedema
Correct Answer: Varicose eczema
Explanation:Varicose eczema is a common problem, particularly in elderly patients due to stasis or blood pooling from insufficient venous return; the alternative name of varicose eczema comes from a common cause of this being varicose veins. It is often mistaken for cellulitis, but cellulitis is rarely bilateral and is painful rather than itchy.
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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 2 year old child was brought to casualty with recurrent episodes of eczematoid rash over the cheeks and flexural regions of his body. Which one of the following statement best suit this condition?
Your Answer: Hydrocortisone 1% ointment should be applied sparingly to areas of active eczema
Explanation:Atopic dermatitis is an allergic condition which is more apparent in those children who have a positive family history in their 1st or 2nd degree relatives. In some cases, there might be a positive history of bronchial asthma. The best treatment option in this case would be topical application of 1% hydrocortisone ointment to the affected areas of the child. We cannot prescribe a strong ointment to the face because it may lead to skin atrophy, telangiectasia and other steroid related topical complications.
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This question is part of the following fields:
- Dermatology
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Question 18
Incorrect
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Which one of these features is typical of dermatomyositis?
Your Answer: Distal muscle weakness
Correct Answer: Gottron's papules over knuckles of fingers
Explanation:The main symptom of dermatomyositis include skin rash and symmetric proximal muscle weakness (in over 90% of patients) which may be accompanied by pain and tenderness. It occurs more commonly in females. Skin findings include:
Gottron’s sign – an erythematous, scaly eruption occurring in symmetric fashion over the MCP and interphalangeal joints
Heliotrope or lilac rash – a violaceous eruption on the upper eyelids and in rare cases on the lower eyelids as well, often with itching and swelling
Shawl (or V-) sign is a diffuse, flat, erythematous lesion over the back and shoulders or in a V over the posterior neck and back or neck and upper chest, which worsens with UV light.
Erythroderma is a flat, erythematous lesion similar to the shawl sign but located in other areas, such as the malar region and the forehead.
Periungual telangiectasias and erythema occur. -
This question is part of the following fields:
- Dermatology
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Question 19
Incorrect
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Café-au-lait spots are seen in each of the following, except:
Your Answer: Neurofibromatosis
Correct Answer: Friedreich's ataxia
Explanation:Café-au-lait spots is hyperpigmented lesions that vary in colour from light brown to dark brown, with borders that may be smooth or irregular. Causes include:
Neurofibromatosis type I
McCune–Albright syndrome
Legius syndrome
Tuberous sclerosis
Fanconi anaemia
Idiopathic
Ataxia-telangiectasia
Basal cell nevus syndrome
Benign congenital skin lesion
Bloom syndrome
Chediak-Higashi syndrome
Congenital nevus
Gaucher disease
Hunter syndrome
Maffucci syndrome
Multiple mucosal neuroma syndrome
Noonan syndrome
Pulmonary Stenosis
Silver–Russell syndrome
Watson syndrome
Wiskott–Aldrich syndrome -
This question is part of the following fields:
- Dermatology
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Question 20
Correct
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A 21-year-old woman presents with painful vesicles in her right ear and a fever for some time. What is the most probable diagnosis?
Your Answer: Herpes zoster
Explanation:Herpes zoster oticus is a viral infection of the inner, middle, and external ear. It manifests as severe otalgia with associated cutaneous vesicular eruption, usually of the external canal and pinna. When associated with facial paralysis, the infection is called Ramsay Hunt syndrome.
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This question is part of the following fields:
- Dermatology
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Question 21
Incorrect
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Which features may suggest malignant changes in a melanocytic naevi?
Your Answer: Irregularity of surface
Correct Answer: Decrease in size
Explanation:Melanocytic naevi are skin tumours produced by melanocytes. They usually present in childhood but increase during puberty. The mnemonic A-B-C-D, is used by institutions to assess for suspicion of malignancy. The letters stand for asymmetry, border, colour, and diameter. If a mole starts changing in size, colour, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include if it begins to crust over, bleed, itch, or become inflamed.
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This question is part of the following fields:
- Dermatology
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Question 22
Incorrect
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A 14 year old girl presented with complaints of acne vulgaris over her face. The acne is exacerbated during her menstrual period. The most appropriate treatment option would be?
Your Answer: Topical retinoids
Correct Answer: Topical benzoyl peroxide
Explanation:Topical benzoyl peroxide is used for the treatment of mild to moderate acne vulgaris. It is actually a peeling agent and it clears the pores and reduces the bacterial cell count.
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This question is part of the following fields:
- Dermatology
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Question 23
Correct
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Which one of the following interventions has the least role in management of acne rosacea?
Your Answer: Low-dose topical corticosteroids
Explanation:Mild cases are often not treated at all, or are simply covered up with normal cosmetics and avoiding sun exposure. Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions. The two primary modalities of rosacea treatment are topical and oral antibiotic agents (including metronidazole and tetracyclines). Laser therapy may be appropriate for patients with prominent telangiectasia.
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This question is part of the following fields:
- Dermatology
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Question 24
Correct
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How would you advise your patient to apply an emollient and a steroid cream, in order to treat her eczema?
Your Answer: First use emollient then steroids.
Explanation:If steroid is applied first, applying an emollient after could spread it from where it had been applied. If steroid is applied immediately after the emollient then it cannot be absorbed, this is why there should be a time interval of around thirty minutes between these two treatments in order for them to be effective.
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This question is part of the following fields:
- Dermatology
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Question 25
Correct
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A 65 year old gentleman presented with 4 months history of a non healing lesion over the right ear. It is about 1cm in size and bleeds when palpated. The most likely diagnosis will be?
Your Answer: Squamous cell carcinoma
Explanation:Squamous cell carcinoma like other skin cancers mostly arise on photo exposed sites. A patient usually presents with a history of a non healing lesion or wound. Confirmatory diagnosis requires a skin biopsy and histopathological screening. It is rarely metastatic and treatment of choice is surgical excision.
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This question is part of the following fields:
- Dermatology
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Question 26
Correct
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Which of the following statements regarding psoriasis is incorrect?
Your Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease characterized by patches of skin typically red, dry, itchy, and scaly. Psoriasis can affect the nails and produces a variety of changes in the appearance of finger and toe nails including pitting and onycholysis. Nail psoriasis occurs in 40–45% of people with psoriasis affecting the skin and has a lifetime incidence of 80–90% in those with psoriatic arthritis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response.
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This question is part of the following fields:
- Dermatology
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Question 27
Incorrect
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A diagnosed case of scabies presented in OPD for some medical advice. Which of the following statements best suits scabies?
Your Answer: Is best treated by salicylate emulsion
Correct Answer: It causes itchiness in the skin even where there is no obvious lesion to be seen
Explanation:Scabies is an infection caused by a microscopic mite known as Sarcoptes scabies. The chief presenting complaint is itching especially in skin folds and mostly during night. It spreads from one person to another through skin contact, and therefore it is more prevalent in crowded areas like hospitals, hostels and even at homes where people live in close contact with each other. Treatment options include benzyl benzoate, ivermectin, sulphur and permethrin.
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This question is part of the following fields:
- Dermatology
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Question 28
Incorrect
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A girl suffered full thickness circumferential burn to her right arm. What is best step in management?
Your Answer: Refer to burn unit
Correct Answer: Escharotomy
Explanation:An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.
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This question is part of the following fields:
- Dermatology
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Question 29
Correct
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A 59-year-old woman has an 11mm skin lesion on her right forearm, which bleeds easily on contact and has changed in appearance over the last 11 months.
Your Answer: Malignant melanoma
Explanation:Melanoma is more common in men than women. Reasons for the disease includes: UV light and genetic predisposition or mutations. Diagnosis is by biopsy and analysis of any skin lesion that has signs of being potentially cancerous.
Early warning signs of melanoma ABCDE:
Asymmetry
Borders (irregular with edges and corners)
Colour (variegated)
Diameter (greater than 6 mm)
Evolving over time -
This question is part of the following fields:
- Dermatology
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Question 30
Correct
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A 21 year old patient presents with multiple itchy wheals on his skin. The wheals are of all sizes and they are exacerbated by scratching. The symptoms started after a viral infection and can last up to an hour. What is the most likely diagnosis?
Your Answer: Urticaria
Explanation:Urticaria is a group of disorders that share a distinct skin reaction pattern, namely the occurrence of itchy wheals anywhere on the skin. Wheals are short-lived elevated erythematous lesions ranging from a few millimetres to several centimetres in diameter and can become confluent. The itching can be prickling or burning and is usually worse in the evening or night time. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear.
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This question is part of the following fields:
- Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
