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Question 1
Incorrect
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A 5-year-old boy presents with recurrent balanitis. He has swelling and redness of his glans penis and foreskin, and his mother reports a foul odor and slight discharge. What is the most frequently isolated organism in cases of balanitis?
Your Answer: Staphylococcus
Correct Answer: C. albicans
Explanation:Balanitis is most commonly caused by C. albicans, with group B beta-haemolytic streptococci being a less frequent cause among bacterial infections. The other options listed may also cause balanitis, but are not as commonly isolated.
Understanding Balanitis: Causes, Assessment, and Treatment
Balanitis is a condition characterized by inflammation of the glans penis and sometimes extending to the underside of the foreskin. It can be caused by a variety of factors, including bacterial and candidal infections, autoimmune conditions, and poor hygiene. Proper assessment of balanitis involves taking a thorough history and conducting a physical examination to determine the cause and severity of the condition. In most cases, diagnosis is made clinically based on the history and examination, but in some cases, a swab or biopsy may be necessary to confirm the diagnosis.
Treatment of balanitis involves a combination of general and specific measures. General treatment includes gentle saline washes and proper hygiene practices, while specific treatment depends on the underlying cause of the condition. For example, candidiasis is treated with topical clotrimazole, while bacterial balanitis may be treated with oral antibiotics. Dermatitis and circinate balanitis are managed with mild potency topical corticosteroids, while lichen sclerosus and plasma cell balanitis of Zoon may require high potency topical steroids or circumcision.
Understanding the causes, assessment, and treatment of balanitis is important for both children and adults who may be affected by this condition. By taking proper hygiene measures and seeking appropriate medical treatment, individuals with balanitis can manage their symptoms and prevent complications.
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This question is part of the following fields:
- Dermatology
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Question 2
Incorrect
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What condition is characterized by a rash that causes itching?
Your Answer: Dermatitis herpetiformis
Correct Answer: Meningococcal purpura
Explanation:Common Skin Rashes and Their Associated Conditions
Dermatitis herpetiformis is a skin rash that causes vesicles and intense itching. It is often linked to coeliac disease. Erythema chronicum migrans is a rash that appears as a red macule or papule and grows into an annular lesion. It is associated with Lyme disease, which is caused by a spirochaete infection. Erythema nodosum is a painful nodular rash that typically appears on the shins. If it is accompanied by arthritis of the ankles and wrists and bilateral hilar lymphadenopathy, it is indicative of acute sarcoidosis. Granuloma annulare is a benign condition that produces firm nodules that merge to form ring-shaped lesions. Finally, the non-blanching purpuric rash of meningococcal disease is not itchy.
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This question is part of the following fields:
- Dermatology
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Question 3
Correct
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A 58-year-old male is referred to dermatology by his physician for a lesion on his forearm. The lesion began as a small red bump and has since progressed into a deep, red, necrotic ulcer with a violaceous border. What is the probable diagnosis?
Your Answer: Pyoderma gangrenosum
Explanation:Understanding Shin Lesions: Differential Diagnosis and Characteristics
Shin lesions can be caused by various conditions, and it is important to differentiate between them 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 commonly caused by streptococcal infections, sarcoidosis, inflammatory bowel disease, and certain medications such as penicillins, sulphonamides, and 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 starts as a small red papule and later develops into deep, red, necrotic ulcers with a violaceous border. It is idiopathic in 50% of cases but may also be associated with 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.
Understanding the differential diagnosis and characteristics 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 4
Incorrect
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A 54-year-old lady comes to your clinic for a new patient health check. While conducting the examination, you observe an 8 mm pigmented lesion on her back. She informs you that she had no knowledge of the lesion. The lesion has a uniform pigmentation and a regular outline. It is dry and inflamed, but appears distinct from all of her other moles on her back. She also mentions that her brother was recently diagnosed with melanoma.
What is the best course of action?Your Answer: Refer urgently to a dermatologist
Correct Answer: Monitor for eight weeks
Explanation:Urgent Referral Needed for Suspicious Lesion
This lesion on the patient’s skin may be a melanoma, and there are several clinical concerns that warrant urgent referral. Firstly, the lesion appears to be new and is greater than 7 mm in diameter. Additionally, there is a family history of melanoma, and the lesion is inflamed. It is important to be aware of the ugly duckling sign, which refers to a pigmented lesion that looks different from the surrounding ones.
Given the patient’s age and family history, she is at high risk of melanoma and should be referred urgently to a dermatologist. It is important to note that excision in primary care should be avoided, as the guidance for excising lesions in primary care may differ depending on the country. Prompt referral and evaluation by a specialist is crucial in cases like this to ensure the best possible outcome for the patient.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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A 25-year-old woman has a pigmented lesion on her leg.
Select from the list the single feature that would be most suggestive of malignancy.Your Answer: Recent uniform increase in pigmentation
Correct Answer: Recent growth
Explanation:Identifying Suspicious Pigmented Lesions: Signs of Malignancy
When it comes to pigmented lesions, it’s important to approach new or growing ones with caution. While benign melanocytic naevi tend to remain stable over time, malignant lesions may exhibit signs of growth and other concerning features. These may include a size greater than 7mm, irregular pigmentation, asymmetry, and an irregular border or contour. While itching and bleeding may also be indicative of malignancy, they can also be caused by other factors such as trauma or seborrhoeic keratosis. To identify potential melanomas, healthcare professionals may use the Glasgow 7-point checklist or the ABCDE’s of melanoma. By remaining vigilant and aware of these warning signs, we can help ensure early detection and treatment of potentially dangerous pigmented lesions.
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This question is part of the following fields:
- Dermatology
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Question 6
Incorrect
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You saw a 9-year-old girl accompanied by her dad at the GP surgery with a one-day history of itchy rash on her ears. She is normally healthy and doesn't take any regular medication. On examination, you notice small blisters on the outer rims of her ear which causes mild discomfort on palpation. The rest of the skin appears normal. What is the most suitable initial treatment for this condition?
Your Answer: Oral steroid
Correct Answer: Emollient
Explanation:Emollients, potent topical steroids, and avoiding strong direct sunlight are effective treatments for juvenile spring eruption. Antihistamines can also be used to alleviate itching. Infection is not a known factor in this condition, which is associated with UV light exposure. In more severe cases or when there is widespread polymorphic light eruption, oral steroids and phototherapy may be necessary.
Understanding Juvenile Spring Eruption
Juvenile spring eruption is a skin condition that occurs as a result of sun exposure. It is a type of polymorphic light eruption (PLE) that causes itchy red bumps on the light-exposed parts of the ears, which can turn into blisters and crusts. This condition is more common in boys aged between 5-14 years, and it is less common in females due to increased amounts of hair covering the ears.
The main cause of juvenile spring eruption is sun-induced allergy rash, which is more likely to occur in the springtime. Some patients may also have PLE elsewhere on the body, and there is an increased incidence in cold weather. The diagnosis of this condition is usually made based on clinical presentation, and no clinical tests are required in most cases. However, in aggressive cases, lupus should be ruled out by ANA and ENA blood tests.
The management of juvenile spring eruption involves providing patient education on sun exposure and the use of sunscreen and hats. Topical treatments such as emollients or calamine lotion can be used to provide relief, and antihistamines can help with itch relief at night-time. In more serious cases, oral steroids such as prednisolone can be used, as well as immune-system suppressants.
In conclusion, understanding juvenile spring eruption is important for proper diagnosis and management. By taking preventative measures and seeking appropriate treatment, patients can manage their symptoms and improve their quality of life.
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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 55-year-old man with a history of ulcerative colitis presents for follow-up. He underwent ileostomy surgery six years ago, which has been successful until recently. He is currently experiencing significant pain in the area around the stoma site. Upon examination, a deep erythematous ulcer with a ragged edge is observed, along with swollen and erythematous surrounding skin. What is the probable diagnosis?
Your Answer: Pyoderma gangrenosum
Explanation:Pyoderma gangrenosum, which can be observed around the stoma site, is linked to inflammatory bowel disease. Surgery is not recommended as it may exacerbate the condition, and immunosuppressants are typically used for treatment. It is important to consider malignancy as a possible alternative diagnosis, and lesions should be referred to a specialist for evaluation and potential biopsy. While irritant contact dermatitis is a common occurrence, it is unlikely to result in such a profound ulcer.
Understanding Pyoderma Gangrenosum
Pyoderma gangrenosum is a rare inflammatory disorder that causes painful skin ulceration. While it can affect any part of the skin, it is most commonly found on the lower legs. This condition is classified as a neutrophilic dermatosis, which means that it is characterized by the infiltration of neutrophils in the affected tissue. The exact cause of pyoderma gangrenosum is unknown in 50% of cases, but it can be associated with inflammatory bowel disease, rheumatological conditions, haematological disorders, and other conditions.
The initial symptoms of pyoderma gangrenosum may start suddenly with a small pustule, red bump, or blood-blister. The skin then breaks down, resulting in an ulcer that is often painful. The edge of the ulcer is typically described as purple, violaceous, and undermined. The ulcer itself may be deep and necrotic and may be accompanied by systemic symptoms such as fever and myalgia. Diagnosis is often made by the characteristic appearance, associations with other diseases, the presence of pathergy, histology results, and ruling out other causes of an ulcer.
Treatment for pyoderma gangrenosum typically involves oral steroids as first-line therapy due to the potential for rapid progression. Other immunosuppressive therapies, such as ciclosporin and infliximab, may be used in difficult cases. It is important to note that any surgery should be postponed until the disease process is controlled on immunosuppression to avoid worsening the condition. Understanding pyoderma gangrenosum and its potential causes and treatments can help patients and healthcare providers manage this rare and painful condition.
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This question is part of the following fields:
- Dermatology
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Question 8
Incorrect
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A patient with a history of tinea capitis presents due to a raised lesion on her scalp. The lesion has been getting gradually bigger over the past two weeks. On examination you find a raised, pustular, spongy mass on the crown of her head. What is the most likely diagnosis?
Your Answer:
Correct Answer: Kerion
Explanation:Understanding Tinea: Types, Causes, Diagnosis, and Management
Tinea is a term used to describe dermatophyte fungal infections that affect different parts of the body. There are three main types of tinea infections, namely tinea capitis, tinea corporis, and tinea pedis. Tinea capitis affects the scalp and is a common cause of scarring alopecia in children. If left untreated, it can lead to the formation of a raised, pustular, spongy/boggy mass called a kerion. The most common cause of tinea capitis in the UK and the USA is Trichophyton tonsurans, while Microsporum canis acquired from cats or dogs can also cause it. Diagnosis of tinea capitis is done through scalp scrapings, although lesions due to Microsporum canis can be detected through green fluorescence under Wood’s lamp. Management of tinea capitis involves oral antifungals such as terbinafine for Trichophyton tonsurans infections and griseofulvin for Microsporum infections. Topical ketoconazole shampoo is also given for the first two weeks to reduce transmission.
Tinea corporis, on the other hand, affects the trunk, legs, or arms and is caused by Trichophyton rubrum and Trichophyton verrucosum, which can be acquired from contact with cattle. It is characterized by well-defined annular, erythematous lesions with pustules and papules. Oral fluconazole can be used to treat tinea corporis.
Lastly, tinea pedis, also known as athlete’s foot, is characterized by itchy, peeling skin between the toes and is common in adolescence. Lesions due to Trichophyton species do not readily fluoresce under Wood’s lamp.
In summary, understanding the types, causes, diagnosis, and management of tinea infections is crucial in preventing their spread and ensuring effective treatment.
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This question is part of the following fields:
- Dermatology
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Question 9
Incorrect
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A 16-year-old girl comes to you with acne. Upon examination, you observe several whiteheads and blackheads, but no facial scarring. The patient expresses interest in treatment. What is the initial course of action in this scenario?
Your Answer:
Correct Answer: Topical retinoid
Explanation:For the treatment of mild acne, the NICE guidance recommends starting with a topical retinoid or benzoyl peroxide. This is particularly appropriate for boys. However, if the patient is female, a combined oral contraceptive may be prescribed instead of a retinoid due to the teratogenic effects of retinoids. Mild acne is characterized by the presence of blackheads, whiteheads, papules, and pustules. While scarring is unlikely, the condition can have a significant psychosocial impact. If topical retinoids and benzoyl peroxide are poorly tolerated, azelaic acid may be prescribed. Combined treatment is rarely necessary. Follow-up should be arranged after 6-8 weeks to assess the effectiveness and tolerability of treatment and the patient’s compliance.
Acne vulgaris is a common skin condition that usually affects teenagers and is characterized by the obstruction of hair follicles with keratin plugs, resulting in comedones, inflammation, and pustules. The severity of acne can be classified as mild, moderate, or severe, depending on the number and type of lesions present. Treatment for acne typically involves a step-up approach, starting with single topical therapy and progressing to combination therapy or oral antibiotics if necessary. Tetracyclines are commonly used but should be avoided in certain populations, and a topical retinoid or benzoyl peroxide should always be co-prescribed to reduce the risk of antibiotic resistance. Combined oral contraceptives can also be used in women, and oral isotretinoin is reserved for severe cases under specialist supervision. Dietary modification has no role in the management of acne.
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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 26-year-old male attends your morning surgery five days after an insect bite. He has presented today as the area surrounding the bite is becoming increasingly red and itchy.
On examination, you notice a 3-4 cm area of erythema surrounding the bite area and excoriation marks. The is some pus discharging from the bite mark. Observations are all within the normal range. You decide to prescribe antibiotics to cover for infection and arrange a repeat review in 48 hours.
On reviewing his medical records you note he is on isotretinoin for acne and has a penicillin allergy.
Which of the following antibiotics would you consider prescribing?Your Answer:
Correct Answer: Clindamycin
Explanation:Combining oral isotretinoin with tetracyclines is not recommended as it may lead to benign intracranial hypertension. Trimethoprim is not suitable for treating skin or soft tissue infections. Clindamycin, a lincomycin antibiotic, can be used for such infections, especially if the patient is allergic to penicillin. Co-amoxiclav doesn’t interact with isotretinoin, but it cannot be used in patients with penicillin allergy. Doxycycline, a tetracycline antibiotic, should be avoided when a patient is taking isotretinoin due to the risk of benign intracranial hypertension.
Understanding Isotretinoin and its Adverse Effects
Isotretinoin is a type of oral retinoid that is commonly used to treat severe acne. It has been found to be effective in providing long-term remission or cure for two-thirds of patients who undergo a course of treatment. However, it is important to note that isotretinoin also comes with several adverse effects that patients should be aware of.
One of the most significant adverse effects of isotretinoin is its teratogenicity, which means that it can cause birth defects in fetuses if taken during pregnancy. For this reason, females who are taking isotretinoin should ideally be using two forms of contraception to prevent pregnancy. Other common adverse effects of isotretinoin include dry skin, eyes, and lips/mouth, low mood, raised triglycerides, hair thinning, nosebleeds, and photosensitivity.
It is also worth noting that there is some controversy surrounding the potential link between isotretinoin and depression or other psychiatric problems. While these adverse effects are listed in the British National Formulary (BNF), further research is needed to fully understand the relationship between isotretinoin and mental health.
Overall, while isotretinoin can be an effective treatment for severe acne, patients should be aware of its potential adverse effects and discuss any concerns with their healthcare provider.
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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 62-year-old woman presents with pruritus vulvae. On examination, there are white thickened shiny patches on the labia minora. There is no abnormal vaginal discharge. The patient reports intense itching.
What is the most probable diagnosis?Your Answer:
Correct Answer: Lichen sclerosus
Explanation:Dermatological Conditions of the Anogenital Region
Lichen sclerosus is a chronic inflammatory skin condition that commonly affects the anogenital region in women and the glans penis and foreskin in men. It presents as white thickened or crinkled patches that can be extremely itchy or sore and may bruise or ulcerate due to friction. Adhesions or scarring can occur in the vulva or foreskin.
Psoriasis, on the other hand, forms well-demarcated plaques that are bright red and lacking in scale in the flexures. Candidiasis of the groins and vulval area presents with an erythematous inflammatory element and inflamed satellite lesions.
Vitiligo, characterized by the loss of pigment, doesn’t cause itching and is an unlikely diagnosis for this patient. Vulval carcinoma, which involves tumour formation and ulceration, is also not present in this case.
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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 49-year-old woman visits her General Practitioner with a complaint of itching, fatigue and malaise for the past six months. She has had no major medical history and is not on any regular medications. There are no visible signs of a skin rash.
What is the most suitable investigation that is likely to result in a diagnosis?Your Answer:
Correct Answer: Liver function tests (LFTs)
Explanation:Diagnosis of Pruritis without a Rash: Primary Biliary Cholangitis
Pruritis without a rash can be a challenging diagnosis. In this case, the symptoms suggest the possibility of primary biliary cholangitis, an autoimmune disease of the liver that leads to cholestasis and can progress to fibrosis and cirrhosis. To diagnose this condition, a full blood count, serum ferritin, erythrocyte sedimentation rate, urea and electrolytes, thyroid function tests, and liver function tests are necessary. A chest X-ray may be useful to rule out malignancy, but skin biopsy and skin scraping for microscopy are unlikely to be helpful in the absence of a rash. Low serum B12 is not relevant to pruritis. Overall, a thorough evaluation is necessary to diagnose pruritis without a rash, and primary biliary cholangitis should be considered as a potential cause.
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This question is part of the following fields:
- Dermatology
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Question 13
Incorrect
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A 10-year-old boy has two circular patches of hair loss in close proximity on his scalp. Choose the one characteristic that would indicate a diagnosis of tinea capitis instead of alopecia areata from the options provided.
Your Answer:
Correct Answer: Scaly skin in the area of hair loss
Explanation:Understanding Tinea Capitis: Causes, Symptoms, and Treatment
Tinea capitis, also known as scalp ringworm, is a fungal infection that affects the scalp and hair follicles. It is caused by dermatophytes Microsporum spp. and Trichophyton spp. and is more common in children and people of Afro-Caribbean background. If left untreated, it can lead to permanent hair loss.
Symptoms of tinea capitis include scaly patches on the scalp, inflammation, and pus-filled bumps known as kerion. To confirm the diagnosis, scalp scrapings including hairs and hair fragments should be examined.
Prompt treatment with systemic terbinafine or griseofulvin is necessary. Griseofulvin is the most effective agent for Microsporum canis infections, while terbinafine is more effective for Trichophyton infections. However, terbinafine is not licensed for use in children under 12 years old.
It is important to note that broken hairs in tinea capitis do not taper at the base, unlike the exclamation mark hairs seen in alopecia areata. Nail pitting, on the other hand, is a symptom of psoriasis and may also occur in alopecia areata. In alopecia areata, hair regrowth usually begins with fine white hairs, and onset is most common in childhood and adolescence.
Understanding the causes, symptoms, and treatment of tinea capitis is crucial in preventing permanent hair loss and managing the infection effectively.
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This question is part of the following fields:
- Dermatology
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Question 14
Incorrect
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You encounter a 70-year-old man who is experiencing an issue with his penis. He has been unable to retract his foreskin for a few years now, and the tip of his penis is quite sore. He also reports a foul odor. Apart from this, he is in good health. He believes that this problem developed gradually over several years.
During the examination, you observe that the man is not circumcised, and there is a tight white ring around the tip of his foreskin. The glans penis is barely visible through the end of the foreskin, and it appears to be inflamed.
What is the specific condition responsible for causing this man's balanitis?Your Answer:
Correct Answer: Lichen sclerosis
Explanation:Understanding Lichen Sclerosus
Lichen sclerosus, previously known as lichen sclerosus et atrophicus, is an inflammatory condition that commonly affects the genitalia, particularly in elderly females. It is characterized by the formation of white plaques that lead to atrophy of the epidermis. The condition can cause discomfort, with itch being a prominent symptom. Pain during intercourse or urination may also occur.
Diagnosis of lichen sclerosus is usually based on clinical examination, although a biopsy may be necessary if atypical features are present. Treatment typically involves the use of topical steroids and emollients. However, patients with lichen sclerosus are at an increased risk of developing vulval cancer, so regular follow-up is recommended.
According to the Royal College of Obstetricians and Gynaecologists, skin biopsy is not necessary for diagnosis unless the woman fails to respond to treatment or there is clinical suspicion of cancer. The British Association of Dermatologists also advises that biopsy is not always essential when the clinical features are typical, but it is advisable if there are atypical features or diagnostic uncertainty. Biopsy is mandatory if there is any suspicion of neoplastic change. Patients under routine follow-up will need a biopsy if there is a suspicion of neoplastic change, if the disease fails to respond to treatment, if there is extragenital LS, if there are pigmented areas, or if second-line therapy is to be used.
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This question is part of the following fields:
- Dermatology
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Question 15
Incorrect
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A 14-year-old girl presents to the clinic with concerns about hair loss on her scalp. She has a history of atopic eczema and has depigmented areas on her hands. What is the most probable diagnosis?
Your Answer:
Correct Answer: Trichotillomania
Explanation:Co-Existence of Vitiligo and Alopecia Areata
This girl is experiencing a combination of vitiligo and alopecia areata, two conditions that can co-exist and have a similar autoimmune cause. Alopecia areata is highly suggested by the presence of discrete areas of hair loss and normal texture on the scalp. These conditions can cause significant emotional distress and impact a person’s self-esteem.
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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 21-year-old farmer presents to the General Practitioner with a boggy inflamed lump on the upper central forehead that extends into the hairline. The lump has multiple small pustular areas on the surface and is of recent onset. Additionally, there is hair loss from the affected area of the scalp. What is the most probable diagnosis?
Your Answer:
Correct Answer: Kerion
Explanation:Understanding Kerion: An Inflammatory Mass Caused by Zoophilic Dermatophyte Fungal Infection
Kerion is a rare form of tinea infection that results in an inflammatory mass caused by a zoophilic dermatophyte fungal infection. Unlike the more common anthropophilic dermatophytes that produce a mild, chronic inflammation, zoophilic dermatophytes of animal origin produce an intense inflammatory response. The scalp is most commonly affected by zoophilic organisms such as Microsporum canis from domestic pets or Trichophyton verrucosum from cattle and horses.
Kerion is often misdiagnosed as a bacterial infection, and failure to diagnose it early can result in permanent alopecia in the affected areas. Symptoms may include enlarged regional lymph nodes, fever, and malaise. Definitive diagnosis is made by isolating the fungus from culture of hair and scalp scales, but fungal culture is often negative due to the difficulty in isolating the fungus. In such cases, treatment may be initiated based on clinical suspicion.
Treatment for kerion involves oral antifungal agents such as terbinafine, itraconazole, or griseofulvin for at least six to eight weeks. Antibiotics may also be needed if there is a bacterial infection present. Understanding the causes, symptoms, and treatment options for kerion is crucial for proper diagnosis and management of this uncommon fungal infection.
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This question is part of the following fields:
- Dermatology
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Question 17
Incorrect
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A 32-year-old Caucasian woman with a history of type 1 diabetes presents for review. She has just returned from a summer holiday in Spain and has noticed some patches on her limbs that do not appear to have tanned. Otherwise the skin in these patches appears normal.
Select from the list the single most likely diagnosis.Your Answer:
Correct Answer: Vitiligo
Explanation:Understanding Vitiligo: Causes, Symptoms, and Treatment Options
Vitiligo is a skin condition that results in the loss of melanocyte function, leading to areas of depigmentation on the skin. It is believed to be an autoimmune disorder and is often associated with other autoimmune diseases. While it affects around 0.4% of the Caucasian population, it can be more distressing for those with darker skin tones. Symptoms include patches of skin that fail to tan, particularly during the summer months.
Treatment options for vitiligo include using strong protection on affected areas and using potent topical corticosteroids for up to two months to stimulate repigmentation. However, these should not be used on the face or during pregnancy. Hospital referral may be necessary if more than 10% of the body is involved, and treatment may include topical calcineurin inhibitors or phototherapy.
It is important to differentiate vitiligo from other skin conditions such as pityriasis versicolor, lichen sclerosus, psoriasis, and chloasma. Macules and patches are flat, while papules and plaques are raised. A lesion becomes a patch or a plaque when it is greater than 2 cm across.
Overall, understanding the causes, symptoms, and treatment options for vitiligo can help individuals manage this condition and improve their quality of life.
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This question is part of the following fields:
- Dermatology
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Question 18
Incorrect
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You are evaluating a 26-year-old female who has a medical history of seborrhoeic dermatitis and eczema, which have been well controlled for a few years. However, over the past two months, she has experienced a flare-up, particularly around her mouth. She attempted to alleviate the symptoms with an over-the-counter steroid cream, but it only made the condition worse.
During the examination, you observed clustered erythematous papules around her mouth, but the skin immediately adjacent to the vermilion border was unaffected. Her cheeks and forehead were also unaffected.
Based on the most probable diagnosis, which of the following management options is the most appropriate?Your Answer:
Correct Answer: Oral lymecycline tablets
Explanation:Peri-oral dermatitis cannot be treated with potent steroids as they are not effective. Emollients are also not recommended for improving the condition. Patients are advised to stop using all face care products until the flare-up of peri-oral dermatitis has subsided. The British Association of Dermatology (BAD) provides a useful leaflet on this condition that should be consulted.
Understanding Periorificial Dermatitis
Periorificial dermatitis is a skin condition that is commonly observed in women between the ages of 20 and 45 years old. The use of topical corticosteroids, and to a lesser extent, inhaled corticosteroids, is often linked to the development of this condition. The symptoms of periorificial dermatitis include the appearance of clustered erythematous papules, papulovesicles, and papulopustules, which are typically found in the perioral, perinasal, and periocular regions. However, the skin immediately adjacent to the vermilion border of the lip is usually spared.
When it comes to managing periorificial dermatitis, it is important to note that steroids may actually worsen the symptoms. Instead, the condition should be treated with either topical or oral antibiotics. By understanding the features and management of periorificial dermatitis, individuals can take the necessary steps to address this condition and improve their skin health.
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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 30-year-old man comes to you with a bothersome skin rash. He has been experiencing this for a few weeks now and has not found relief with an emollient cream. The itching is described as 'severe' and has caused him difficulty sleeping. Upon examination, you observe a mixture of papules and vesicles on his buttocks and the extensor surface of his knees and elbows. What is the probable diagnosis?
Your Answer:
Correct Answer: Dermatitis herpetiformis
Explanation:Understanding Dermatitis Herpetiformis
Dermatitis herpetiformis is a skin disorder that is linked to coeliac disease and is caused by the deposition of IgA in the dermis. It is characterized by itchy, vesicular skin lesions that appear on the extensor surfaces such as the elbows, knees, and buttocks.
To diagnose dermatitis herpetiformis, a skin biopsy is performed, and direct immunofluorescence is used to show the deposition of IgA in a granular pattern in the upper dermis.
The management of dermatitis herpetiformis involves a gluten-free diet and the use of dapsone. By adhering to a gluten-free diet, patients can reduce the severity of their symptoms and prevent further damage to their skin. Dapsone is a medication that can help to alleviate the symptoms of dermatitis herpetiformis by reducing inflammation and suppressing the immune system.
In summary, dermatitis herpetiformis is a skin disorder that is associated with coeliac disease and is caused by the deposition of IgA in the dermis. It is characterized by itchy, vesicular skin lesions and can be managed through a gluten-free diet and the use of dapsone.
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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 58-year-old woman has recently been diagnosed as suffering from lentigo maligna on her face.
Which of the following factors is most important in determining her prognosis?
Your Answer:
Correct Answer: Thickness of the lesion
Explanation:Understanding Lentigo Maligna: Early Stage Melanoma
Lentigo maligna is a type of melanoma that is in its early stages and is confined to the epidermis. It is often referred to as ‘in situ’ melanoma. This type of melanoma typically appears as a flat, slowly growing, freckle-like lesion on the facial or sun-exposed skin of patients in their 60s or older. Over time, it can extend to several centimetres and eventually change into an invasive malignant melanoma.
To identify lentigo maligna, the ABCDE rule can be used. This rule stands for Asymmetry, Border irregularity, Colour variation, large Diameter, and Evolving. If there is a change in size, outline, colour, surface, contour, or elevation of the lesion, malignant change should be suspected. Lentigo maligna spreads via the lymphatics, and satellite lesions are commonly seen.
The prognosis of lentigo maligna is directly related to the thickness of the tumour assessed at histological examination. The thickness is measured using the Breslow thickness or Clark level of invasion. The site of the lesion also affects the prognosis. Patients with lesions on the trunk fare better than those with facial lesions but worse than those with lesions on the limbs.
In conclusion, understanding lentigo maligna is crucial in identifying and treating early-stage melanoma. Regular skin checks and following the ABCDE rule can help detect any changes in the skin and prevent the progression of lentigo maligna into invasive malignant melanoma.
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This question is part of the following fields:
- Dermatology
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Question 21
Incorrect
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A 36-year-old woman presents with a painful boil in her axilla. She reports a history of abscess in the other axillae which required incision and drainage, and now wants to prevent it from happening again. She also complains of frequently having spots and pustules in the groin area. Upon examination of the affected axillae, there is a small inflamed pustule, along with a few other nodules and scarring. What is the probable diagnosis?
Your Answer:
Correct Answer: Hidradenitis suppurativa
Explanation:Hidradenitis suppurativa is a skin disorder that is chronic, painful, and inflammatory. It is characterized by the presence of nodules, pustules, sinus tracts, and scars in areas where skin folds overlap, such as the armpits, groin, and inner thighs.
This condition is more common in women, smokers, and individuals with a higher body mass index. Over time, the lesions can lead to the development of scars and sinus tracts.
Acanthosis nigricans, on the other hand, is a skin condition characterized by thickening and discoloration of the skin in skin folds. It is often a sign of an underlying disease such as diabetes or malignancy.
Acne vulgaris is another skin condition that can present with papules and pustules, but it typically affects the face, upper back, and chest rather than the areas affected by hidradenitis suppurativa.
Rosacea is a skin condition that causes redness and inflammatory papules on the face, particularly on the cheeks and nose.
Understanding Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) is a chronic skin disorder that causes painful and inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas. It is more common in women and typically affects adults under 40. HS occurs due to chronic inflammatory occlusion of folliculopilosebaceous units that obstructs the apocrine glands and prevents keratinocytes from properly shedding from the follicular epithelium. Risk factors include family history, smoking, obesity, diabetes, polycystic ovarian syndrome, and mechanical stretching of skin.
The initial manifestation of HS involves recurrent, painful, and inflamed nodules that can rupture and discharge purulent, malodorous material. The axilla is the most common site, but it can also occur in other areas such as the inguinal, inner thighs, perineal and perianal, and inframammary skin. Coalescence of nodules can result in plaques, sinus tracts, and ‘rope-likeâ scarring. Diagnosis is made clinically.
Management of HS involves encouraging good hygiene and loose-fitting clothing, smoking cessation, and weight loss in obese patients. Acute flares can be treated with steroids or antibiotics, and surgical incision and drainage may be needed in some cases. Long-term disease can be treated with topical or oral antibiotics. Lumps that persist despite prolonged medical treatment are excised surgically. Complications of HS include sinus tracts, fistulas, comedones, scarring, contractures, and lymphatic obstruction.
HS can be differentiated from acne vulgaris, follicular pyodermas, and granuloma inguinale. Acne vulgaris primarily occurs on the face, upper chest, and back, whereas HS primarily involves intertriginous areas. Follicular pyodermas are transient and respond rapidly to antibiotics, unlike HS. Granuloma inguinale is a sexually transmitted infection caused by Klebsiella granulomatis and presents as an enlarging ulcer that bleeds in the inguinal area.
Overall, understanding HS is crucial for early diagnosis and effective management of this chronic and painful skin disorder.
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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 couple approaches you with concerns about their toddler's birthmark. They notice a dark red patch on their child's cheek that appears irregular. After examination, you diagnose it as a port wine stain. What should the parents know about this type of birthmark?
Your Answer:
Correct Answer: Tend to darken over time
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 can help to fade the color and reduce the raised appearance of the stain. However, it’s important to note that multiple laser sessions may be required to achieve the desired results. Overall, understanding 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 23
Incorrect
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During a 4-week baby check, you observe a flat, pink-colored, vascular skin lesion measuring 30x20mm over the baby's nape. The lesion blanches on pressure and has been present since birth without any significant changes. The baby is developing normally. What is the probable underlying diagnosis?
Your Answer:
Correct Answer: Salmon patch
Explanation:Salmon patches are a type of birthmark caused by excess blood vessels, but they typically go away on their own. If a person has a flat birthmark that was present from birth, it could only be a port-wine stain or a salmon patch. Salmon patches are more common and often appear as a pink discoloration on the back of the neck. Atopic dermatitis, a type of eczema, doesn’t appear at birth but may develop later in life, often on the neck and other areas that bend. Strawberry birthmarks, on the other hand, usually appear shortly after birth and are raised above the skin’s surface. They can either disappear, shrink, or remain the same over time.
Understanding Salmon Patches in Newborns
Salmon patches, also known as stork marks or stork bites, are a type of birthmark that can be found in approximately 50% of newborn babies. These marks are characterized by their pink and blotchy appearance and are commonly found on the forehead, eyelids, and nape of the neck. While they may cause concern for new parents, salmon patches typically fade over the course of a few months. However, marks on the neck may persist. These birthmarks are caused by an overgrowth of blood vessels and are completely harmless. It is important for parents to understand that salmon patches are a common occurrence in newborns and do not require any medical treatment.
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This question is part of the following fields:
- Dermatology
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Question 24
Incorrect
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A 49-year-old woman comes in for follow-up after a laparoscopic appendectomy that went smoothly. She reports feeling fine and has no issues to report. During the examination, linear, clearly defined abrasions are observed on her forearms and scalp. The patient appears unconcerned about these lesions and has a history of severe anxiety and depression. A punch biopsy is performed, which reveals nonspecific results.
What could be the probable reason for these symptoms?Your Answer:
Correct Answer: Dermatitis artefacta
Explanation:The sudden appearance of linear, well-defined skin lesions with a lack of concern from the patient may indicate dermatitis artefacta, a condition where the lesions are self-inflicted. A punch biopsy has ruled out other potential causes, and the patient’s history of psychiatric disorders supports this diagnosis. Atopic dermatitis is a possibility, but typically presents with additional symptoms such as pruritus and scaly erythematous plaques. Cutaneous T-cell lymphoma cannot be ruled out without a biopsy, and lichen planus is unlikely due to the patient’s lack of distress from pruritus.
Understanding Dermatitis Artefacta
Dermatitis artefacta is a rare condition that affects individuals of any age, but is more common in females. It is characterised by self-inflicted skin lesions that patients typically deny are self-induced. The condition is strongly associated with personality disorder, dissociative disorders, and eating disorders, with a prevalence of up to 33% in patients with bulimia or anorexia.
Patients with dermatitis artefacta present with well-demarcated linear or geometric lesions that appear suddenly and do not evolve over time. The lesions may be caused by scratching with fingernails or other objects, burning skin with cigarettes, or chemical exposure. Commonly affected areas include the face and dorsum of the hands. Despite the severity of the skin lesions, patients may display a nonchalant attitude, known as la belle indifference.
Diagnosis of dermatitis artefacta is based on clinical history and exclusion of other dermatological conditions. Biopsy of skin lesions is not routine but may be helpful to exclude other conditions. Psychiatric assessment may be necessary. Differential diagnosis includes other dermatological conditions and factitious disorders such as Munchausen syndrome and malingering.
Management of dermatitis artefacta involves a multidisciplinary approach with dermatologists, psychologists, and psychiatrists. Direct confrontation is unhelpful and may discourage patients from seeking medical help. Treatment includes providing occlusive dressing, topical antibiotics, and bland emollients. Selective serotonin reuptake inhibitors and cognitive behavioural therapy may be helpful, although evidence is limited.
In summary, dermatitis artefacta is a rare condition that requires a multidisciplinary approach for management. Understanding the clinical features, risk factors, and differential diagnosis is crucial for accurate diagnosis and appropriate treatment.
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This question is part of the following fields:
- Dermatology
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Question 25
Incorrect
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A 60-year-old man presents with a painful rash consisting of erythematous, swollen plaques with clusters of small vesicles. These are present in a band on the left side of the body extending from the lower dorsal area of the back around the front of the abdomen but not crossing the midline. The rash has been present for 48 hours.
Which of the following is the most appropriate drug to prescribe for a patient presenting at this stage of the illness?
Your Answer:
Correct Answer: Aciclovir
Explanation:Treatment for Herpes Zoster (Shingles)
Herpes zoster, commonly known as shingles, is a viral infection that affects a specific dermatome. It is recommended to start antiviral treatment, such as aciclovir, within 72 hours of rash onset for individuals over 50 years old. Aciclovir has been shown to reduce the duration of symptoms and the risk of post-herpetic neuralgia. It is also indicated for those with ophthalmic herpes zoster, non-truncal rash, moderate to severe pain or rash, and immunocompromised individuals. Prednisolone may be added to aciclovir, but results are mixed. Pain relief can be achieved with co-codamol, but stronger medications may be necessary. Amitriptyline or gabapentin may be used for post-herpetic neuralgia. Antiviral treatment is not recommended for immunocompetent children with mild symptoms.
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This question is part of the following fields:
- Dermatology
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Question 26
Incorrect
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A 56-year-old man visits his GP complaining of a rash. During the examination, the doctor observes multiple distinct purple papules on the patient's forearms. The papules have thin white lines visible on them. The patient reports that the lesions are extremely itchy but not painful and wants to know if there is any treatment available to alleviate the symptoms. What is the best course of action for managing this condition?
Your Answer:
Correct Answer: Topical steroids
Explanation:The first-line treatment for lichen planus is potent topical steroids.
This statement accurately reflects the recommended treatment for lichen planus, which is a rash characterized by itchy purple polygonal papules with white lines known as Wickham’s striae. While the condition can persist for up to 18 months, topical steroids are typically effective in relieving symptoms. Oral steroids may be necessary in severe cases, but are not typically used as a first-line treatment. No treatment is not recommended, as the symptoms can be distressing for patients. Topical retinoids are not indicated for lichen planus, as they are used for acne vulgaris.
Lichen planus is a skin condition that has an unknown cause, but is believed to be related to the immune system. It is characterized by an itchy rash that appears as small bumps on the palms, soles, genital area, and inner surfaces of the arms. The rash often has a polygonal shape and a distinctive pattern of white lines on the surface, known as Wickham’s striae. In some cases, new skin lesions may appear at the site of trauma, a phenomenon known as the Koebner phenomenon. Oral involvement is common, with around 50% of patients experiencing a white-lace pattern on the buccal mucosa. Nail changes, such as thinning of the nail plate and longitudinal ridging, may also occur.
Lichenoid drug eruptions can be caused by certain medications, including gold, quinine, and thiazides. Treatment for lichen planus typically involves the use of potent topical steroids. For oral lichen planus, benzydamine mouthwash or spray is recommended. In more severe cases, oral steroids or immunosuppressive medications may be necessary. Overall, lichen planus can be a challenging condition to manage, but with proper treatment, symptoms can be controlled and quality of life can be improved.
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This question is part of the following fields:
- Dermatology
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Question 27
Incorrect
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The School Nurse requests your evaluation of a leg ulcer she has been treating, as it is not improving. The ulcer is situated on the lower leg, has an irregular shape, and a purple border that is undermined. The student reports that it began as a tiny red bump on the skin and that the ulcer is causing discomfort. What is the probable diagnosis?
Your Answer:
Correct Answer: Pyoderma gangrenosum
Explanation:When faced with a skin ulcer that doesn’t heal, it is important to consider pyoderma gangrenosum as a possible diagnosis. This condition typically begins as a red bump that eventually turns into a painful ulcer with a purple, indented border. It is often linked to autoimmune disorders in approximately 50% of cases.
Understanding Pyoderma Gangrenosum
Pyoderma gangrenosum is a rare inflammatory disorder that causes painful skin ulceration. While it can affect any part of the skin, it is most commonly found on the lower legs. This condition is classified as a neutrophilic dermatosis, which means that it is characterized by the infiltration of neutrophils in the affected tissue. The exact cause of pyoderma gangrenosum is unknown in 50% of cases, but it can be associated with inflammatory bowel disease, rheumatological conditions, haematological disorders, and other conditions.
The initial symptoms of pyoderma gangrenosum may start suddenly with a small pustule, red bump, or blood-blister. The skin then breaks down, resulting in an ulcer that is often painful. The edge of the ulcer is typically described as purple, violaceous, and undermined. The ulcer itself may be deep and necrotic and may be accompanied by systemic symptoms such as fever and myalgia. Diagnosis is often made by the characteristic appearance, associations with other diseases, the presence of pathergy, histology results, and ruling out other causes of an ulcer.
Treatment for pyoderma gangrenosum typically involves oral steroids as first-line therapy due to the potential for rapid progression. Other immunosuppressive therapies, such as ciclosporin and infliximab, may be used in difficult cases. It is important to note that any surgery should be postponed until the disease process is controlled on immunosuppression to avoid worsening the condition. Understanding pyoderma gangrenosum and its potential causes and treatments can help patients and healthcare providers manage this rare and painful condition.
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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 15-year-old male with a history of asthma is brought in by his worried father due to the sudden appearance of a rash on his leg. The patient reports no new product usage or trauma. His father also expresses concerns about his recent lack of motivation in school.
Upon examination, there are distinct linear lesions forming geometric shapes on the left lower leg and dorsal aspect of the foot. The patient appears healthy, and there are no other notable findings.
What is the probable diagnosis?Your Answer:
Correct Answer: Dermatitis artefacta
Explanation:The sudden appearance of well-defined skin lesions in a linear pattern, accompanied by a lack of concern or emotional response, is indicative of dermatitis artefacta. This condition is often associated with self-inflicted injuries that stem from underlying psychological issues, such as deliberate self-harm or attention-seeking behavior. The lesions are typically geometric in shape and appear in easily accessible areas, such as the limbs or face. Patients with dermatitis artefacta may deny causing the lesions themselves. The patient’s declining grades may be linked to psychological difficulties that have led to this form of self-harm.
Understanding Dermatitis Artefacta
Dermatitis artefacta is a rare condition that affects individuals of any age, but is more common in females. It is characterised by self-inflicted skin lesions that patients typically deny are self-induced. The condition is strongly associated with personality disorder, dissociative disorders, and eating disorders, with a prevalence of up to 33% in patients with bulimia or anorexia.
Patients with dermatitis artefacta present with well-demarcated linear or geometric lesions that appear suddenly and do not evolve over time. The lesions may be caused by scratching with fingernails or other objects, burning skin with cigarettes, or chemical exposure. Commonly affected areas include the face and dorsum of the hands. Despite the severity of the skin lesions, patients may display a nonchalant attitude, known as la belle indifference.
Diagnosis of dermatitis artefacta is based on clinical history and exclusion of other dermatological conditions. Biopsy of skin lesions is not routine but may be helpful to exclude other conditions. Psychiatric assessment may be necessary. Differential diagnosis includes other dermatological conditions and factitious disorders such as Munchausen syndrome and malingering.
Management of dermatitis artefacta involves a multidisciplinary approach with dermatologists, psychologists, and psychiatrists. Direct confrontation is unhelpful and may discourage patients from seeking medical help. Treatment includes providing occlusive dressing, topical antibiotics, and bland emollients. Selective serotonin reuptake inhibitors and cognitive behavioural therapy may be helpful, although evidence is limited.
In summary, dermatitis artefacta is a rare condition that requires a multidisciplinary approach for management. Understanding the clinical features, risk factors, and differential diagnosis is crucial for accurate diagnosis and appropriate treatment.
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This question is part of the following fields:
- Dermatology
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Question 29
Incorrect
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You see a 49-year-old man in your afternoon clinic who has a history of flexural psoriasis. He reports a recent flare-up over the past 2 weeks, with both axillae and groin involvement. The patient is not currently on any treatment and has no known drug allergies.
What would be the most suitable initial therapy for this patient's psoriasis?Your Answer:
Correct Answer: Mild or moderate potency topical corticosteroid applied once or twice daily
Explanation:For the treatment of flexural psoriasis, the correct option is to use a mild or moderate potency topical corticosteroid applied once or twice daily. This is because the skin in flexural areas is thinner and more sensitive to steroids compared to other areas. The affected areas in flexural psoriasis are the groin, genital region, axillae, inframammary folds, abdominal folds, sacral and gluteal cleft. In this case, the patient has axillary psoriasis, and the treatment should begin with a mild or moderate potency corticosteroid for up to two weeks. If there is a good response, repeated short courses of topical corticosteroids may be used to maintain disease control. Potent topical corticosteroids are not advisable for flexural regions, and the use of Vitamin D preparations is not supported by evidence. If there is ongoing treatment failure, we should consider an alternative diagnosis and refer the patient to a dermatologist who may consider calcineurin inhibitors as a second-line treatment. We should also advise our patients to use emollients regularly and provide appropriate lifestyle advice.
Psoriasis is a chronic skin condition that can also affect the joints. The National Institute for Health and Care Excellence (NICE) has released guidelines for managing psoriasis and psoriatic arthropathy. For chronic plaque psoriasis, NICE recommends a stepwise approach starting with regular use of emollients to reduce scale loss and itching. First-line treatment involves applying a potent corticosteroid and vitamin D analogue separately, once daily in the morning and evening, for up to 4 weeks. If there is no improvement after 8 weeks, a vitamin D analogue twice daily can be used as second-line treatment. Third-line options include a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily. Phototherapy and systemic therapy are also options for managing psoriasis.
For scalp psoriasis, NICE recommends using a potent topical corticosteroid once daily for 4 weeks. If there is no improvement, a different formulation of the corticosteroid or a topical agent to remove adherent scale can be used before applying the corticosteroid. For face, flexural, and genital psoriasis, a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks is recommended.
When using topical steroids, it is important to be aware of potential side effects such as skin atrophy, striae, and rebound symptoms. The scalp, face, and flexures are particularly prone to steroid atrophy, so topical steroids should not be used for more than 1-2 weeks per month. Systemic side effects may occur when potent corticosteroids are used on large areas of the body. NICE recommends a 4-week break before starting another course of topical corticosteroids and using potent corticosteroids for no longer than 8 weeks at a time and very potent corticosteroids for no longer than 4 weeks at a time. Vitamin D analogues, such as calcipotriol, can be used long-term and tend to reduce the scale and thickness of plaques but not the redness. Dithranol and coal tar are other treatment options with their own unique mechanisms of action and potential adverse effects.
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This question is part of the following fields:
- Dermatology
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Question 30
Incorrect
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A 56-year-old man presents with a painful rash on his lower back that has been bothering him for the past 7 days. He had visited the doctor 4 days ago and was prescribed aciclovir for shingles, but the pain persists despite taking paracetamol, ibuprofen, codeine, and amitriptyline. The pain is described as a severe burning sensation with a mild itch, which is affecting his daily functioning and sleep.
During the examination, the man's temperature is recorded at 37ÂșC. The rash is located on the left lower back and is characterized by closely grouped red papules and vesicles with surrounding erythema.
What would be the most appropriate course of action for managing this man's condition?Your Answer:
Correct Answer: Prednisolone
Explanation:If simple analgesia and neuropathic analgesia are not effective in treating refractory pain in shingles, corticosteroids such as prednisolone can be used, but only for acute shingles. This is according to the NICE CKS guideline, which recommends considering oral corticosteroids in the first 2 weeks following rash onset in immunocompetent adults with localized shingles if the pain is severe, but only in combination with antiviral treatment. In the case of a patient who has been on antiviral treatment for seven days and has tried several analgesics without relief, a course of prednisolone would be an appropriate treatment option. Chlorphenamine, an antihistamine medication, may help alleviate itching symptoms but is not the most appropriate treatment option for severe pain. Flucloxacillin, an antibiotic, is not necessary unless there is evidence of co-existing cellulitis. Fluoxetine, a selective serotonin reuptake inhibitor, has no role in shingles management. Morphine, an opioid medication, may be considered if the pain doesn’t respond to corticosteroids.
Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.
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This question is part of the following fields:
- Dermatology
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