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  • Question 1 - A 3-year-old child with a history of atopic eczema presents to the clinic....

    Incorrect

    • A 3-year-old child with a history of atopic eczema presents to the clinic. The child's eczema is typically managed well with emollients, but the parents are worried as the facial eczema has worsened significantly overnight. The child now has painful blisters clustered on both cheeks, around the mouth, and on the neck. The child's temperature is 37.9ºC. What is the best course of action for management?

      Your Answer: Add hydrocortisone 1%

      Correct Answer: Admit to hospital

      Explanation:

      IV antivirals are necessary for the treatment of eczema herpeticum, which is a severe condition.

      Understanding Eczema Herpeticum

      Eczema herpeticum is a serious skin infection caused by herpes simplex virus 1 or 2. It is commonly observed in children with atopic eczema and is characterized by a rapidly progressing painful rash. The infection can be life-threatening, which is why it is important to seek medical attention immediately.

      During examination, doctors typically observe monomorphic punched-out erosions, which are circular, depressed, and ulcerated lesions that are usually 1-3 mm in diameter. Due to the severity of the infection, children with eczema herpeticum should be admitted to the hospital for intravenous aciclovir treatment. It is important to understand the symptoms and seek medical attention promptly to prevent any complications.

    • This question is part of the following fields:

      • Dermatology
      46
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  • Question 2 - A 70-year-old man is seen on a home visit by his General Practitioner...

    Incorrect

    • A 70-year-old man is seen on a home visit by his General Practitioner as his wife is concerned about an ulcer on his lower leg, which has been present for a couple of weeks. It is starting to leak clear fluid. He has a history of chronic congestive cardiac failure and chronic obstructive pulmonary disease. A diagnosis of a venous ulcer is suspected.
      Which of the following examination findings would best support this diagnosis?

      Your Answer: Hairless and pale skin on the lower legs

      Correct Answer: Atrophie blanche

      Explanation:

      Signs and Symptoms of Leg Ulcers: Differentiating Arterial, Venous, and Inflammatory Causes

      Leg ulcers can have various causes, including arterial, venous, and inflammatory conditions. Here are some signs and symptoms that can help differentiate between these causes:

      Atrophie Blanche: This is a white atrophic scar surrounded by areas of hyperpigmentation, which is a sign of severe venous insufficiency.

      Ankle Brachial Pressure Index (ABPI) of 0.4: ABPI is the ratio of systolic blood pressure in the ankle compared with the arm. An ABPI < 0.5 indicates severe arterial disease, suggesting that the ulcer is most likely arterial, rather than venous, in nature. Hairless and Pale Skin on the Lower Legs: Pallor of the skin and a lack of hair growth on the lower legs is a sign of arterial disease, pointing towards a diagnosis of an arterial ulcer rather than a venous ulcer. Necrobiosis Lipoidica: This is a rare granulomatous condition that usually affects people with insulin-dependent diabetes. Plaques are present on the shins, often with telangiectasia in the center and may ulcerate. The cause for the leg ulcer is, therefore, inflammatory rather than venous in origin. Reduced Light-Touch Sensation in Both Feet: Reduced sensation in the feet could be neuropathic in nature (diabetes, multiple sclerosis) or the result of severe arterial disease. Venous insufficiency does not usually affect sensation, so this finding on examination would support a diagnosis of arterial or neuropathic ulcer. By recognizing these signs and symptoms, healthcare professionals can better diagnose and treat leg ulcers based on their underlying causes.

    • This question is part of the following fields:

      • Dermatology
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  • Question 3 - A 45-year-old woman presents to the Dermatology Clinic for regular follow-up of her...

    Incorrect

    • A 45-year-old woman presents to the Dermatology Clinic for regular follow-up of her psoriasis. This had previously been well controlled after phototherapy six months ago; however, she has recently deteriorated.
      Her current treatment regime includes topical calcipotriol (Dovonex), topical coal tar ointment and topical hydromol ointment, in addition to amoxicillin for a recent respiratory infection. She is otherwise fit and well.
      On examination, she has an erythematous rash covering much of her back, with widespread patches on her arms and legs. The rash is tender and warm, though she appears to be shivering. There are no oral lesions. Her pulse is 98 beats per minute, while her blood pressure (BP) is 95/50 mmHg and her temperature is 38.2 °C.
      What is the most important next step in this woman's treatment?

      Your Answer: Commence methotrexate orally

      Correct Answer: Arrange hospital admission

      Explanation:

      Urgent Hospital Admission Required for Erythrodermic Psoriasis

      Erythrodermic psoriasis is a severe dermatological emergency that requires urgent hospital admission. This is evident in a patient who presents with a drop in blood pressure, tachycardia, borderline pyrexia, and rigors. While the patient’s psoriasis needs more intensive management, it is not appropriate to manage erythroderma in the community.

      The treatment for erythrodermic psoriasis includes supportive care, such as intravenous fluids, cool, wet dressings, and a systemic agent. The choice of a systemic agent depends on the patient and may involve rapid-acting therapies like ciclosporin or slower agents like methotrexate. However, it is important to note that starting any systemic agent requires investigations, including baseline blood tests and a viral screen, to ensure it is not contraindicated.

      It is crucial to differentiate erythrodermic psoriasis from other dermatological emergencies like Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN), which is a severe drug reaction associated with amoxicillin and anti-epileptic therapies. However, in this case, the patient’s history features a slow deterioration of pre-existing psoriasis, and the rash is not desquamating, and there are no oral lesions. Therefore, hospital admission is required for erythrodermic psoriasis.

      It is essential to avoid repeating phototherapy in a patient with erythrodermic psoriasis as it can worsen the condition. In a well patient, phototherapy would not be reattempted six months after a poor response, and an alternate approach would most likely be sought.

    • This question is part of the following fields:

      • Dermatology
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  • Question 4 - A 25-year-old female patient complains of hypopigmented skin lesions on her chest and...

    Incorrect

    • A 25-year-old female patient complains of hypopigmented skin lesions on her chest and back. She has just come back from a trip to Spain and has a tanned complexion. During examination, the lesions appear to be slightly scaly. What is the probable diagnosis?

      Your Answer: Porphyria cutanea tarda

      Correct Answer: Pityriasis versicolor

      Explanation:

      Understanding Pityriasis Versicolor

      Pityriasis versicolor, also known as tinea versicolor, is a fungal infection that affects the skin’s surface. It is caused by Malassezia furfur, which was previously known as Pityrosporum ovale. This condition is characterized by patches that may be hypopigmented, pink, or brown, and it is most commonly found on the trunk. The patches may become more noticeable following a suntan, and scaling is a common symptom. Mild pruritus may also occur.

      Pityriasis versicolor can affect healthy individuals, but it is more likely to occur in those who are immunosuppressed, malnourished, or have Cushing’s syndrome. Treatment typically involves the use of topical antifungal medications, with ketoconazole shampoo being the recommended option due to its cost-effectiveness for larger areas. If topical treatment fails, alternative diagnoses should be considered, and oral itraconazole may be prescribed. Scrapings may also be sent for confirmation of the diagnosis. Understanding the features, predisposing factors, and management of pityriasis versicolor can help individuals recognize and effectively treat this common fungal infection.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - A 55-year-old woman comes to see her general practitioner complaining of a progressively...

    Incorrect

    • A 55-year-old woman comes to see her general practitioner complaining of a progressively worsening erythematous rash on her nose, forehead, and cheeks accompanied by telangiectasia and papules for the past year. The rash is exacerbated by exposure to sunlight and consumption of hot and spicy foods. She has previously sought medical attention for this condition and has been treated with topical metronidazole, but her symptoms persist. She has no allergies and is otherwise healthy.
      What is the most suitable course of action for managing this patient's condition?

      Your Answer: Topical erythromycin

      Correct Answer: Oral doxycycline

      Explanation:

      The patient has an erythematous rash on the nose, forehead, and cheeks with telangiectasia and papules, worsened by sun exposure and spicy food, suggesting a diagnosis of rosacea. The first-line treatment for mild to moderate cases is topical metronidazole, while severe or resistant cases require oral tetracycline. However, in this case, oral doxycycline should be given instead of metronidazole as it has been ineffective. Oral clarithromycin, erythromycin, and flucloxacillin are not appropriate treatments for rosacea.

      Understanding Rosacea: Symptoms and Management

      Rosacea, also known as acne rosacea, is a chronic skin condition that has no known cause. It typically affects the nose, cheeks, and forehead, and the first symptom is often flushing. Over time, telangiectasia (visible blood vessels) may appear, followed by persistent redness with papules and pustules. In some cases, rhinophyma (enlarged nose) may develop, and there may be ocular involvement, such as blepharitis. Sunlight can exacerbate symptoms.

      Mild cases of rosacea may be treated with topical metronidazole, while topical brimonidine gel may be used for patients with predominant flushing but limited telangiectasia. More severe cases may require systemic antibiotics like oxytetracycline. Patients are advised to apply high-factor sunscreen daily and use camouflage creams to conceal redness. Laser therapy may be appropriate for those with prominent telangiectasia, and patients with rhinophyma should be referred to a dermatologist.

      Overall, understanding the symptoms and management of rosacea can help individuals manage their condition and improve their quality of life.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - A 26-year-old presents with a rash that developed after a camping trip. He...

    Correct

    • A 26-year-old presents with a rash that developed after a camping trip. He mentions being bitten by a tick during the trip. He explains that the rash is red, not itchy, and began at the site of the bite before spreading outward. The center of the rash has now cleared, resulting in a bulls-eye appearance. What is the name of this rash?

      Your Answer: Erythema migrans

      Explanation:

      Lyme Disease: Symptoms and Progression

      Lyme disease is a bacterial infection that is transmitted through the bite of an infected tick. The disease progresses in two stages, with early and later features. The early features of Lyme disease include erythema migrans, which is a small papule that often appears at the site of the tick bite. This papule develops into a larger annular lesion with central clearing, resembling a bulls-eye. This occurs in 70% of patients and is accompanied by systemic symptoms such as malaise, fever, and arthralgia.

      In the later stages of Lyme disease, patients may experience cardiovascular symptoms such as heart block and myocarditis. Neurological symptoms may also occur, including cranial nerve palsies and meningitis. Additionally, patients may develop polyarthritis, which is inflammation in multiple joints. It is important to seek medical attention if any of these symptoms occur after a tick bite, as early treatment can prevent the progression of the disease.

    • This question is part of the following fields:

      • Dermatology
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  • Question 7 - A father brings his 4-year-old daughter to see her General Practitioner with a...

    Incorrect

    • A father brings his 4-year-old daughter to see her General Practitioner with a rash covering her face, trunk, arms and legs. She had a fever for a couple of days with a runny nose before the rash appears but is now well and afebrile. The rash is mainly vesicular with small fluid-filled blisters and there are a few scabbed lesions. Her father is concerned as she is scratching the lesions, especially at night. She is otherwise fit and well and is up-to-date with her vaccinations.
      Which of the following is the most appropriate treatment?

      Your Answer: Flucloxacillin

      Correct Answer: Chlorphenamine

      Explanation:

      Treatment Options for chickenpox in Children

      chickenpox is a common viral infection in children that presents with a characteristic vesicular rash. While there is no specific treatment for chickenpox, symptomatic relief can be provided to alleviate itching and fever. Here are some treatment options for chickenpox in children:

      1. Chlorphenamine: This sedating antihistamine can be used at night-time to help with itching.

      2. Aciclovir: This antiviral medication is recommended for patients who are immunosuppressed or have risk factors for developing complications from infection, such as adults or newborns.

      3. Flucloxacillin: This antibiotic is used to treat secondary bacterial infections that can occur with chickenpox. However, it is not necessary for a child who is well and afebrile.

      4. Ibuprofen: While ibuprofen and paracetamol are both used as antipyretics in children with febrile illnesses, the use of ibuprofen in children with chickenpox is linked to an increased risk of severe skin infection. Paracetamol is recommended instead.

      5. Malathion: This treatment is for scabies, not chickenpox. Scabies presents with a different type of rash and does not have a prodromal illness.

      In summary, treatment for chickenpox in children is mainly symptomatic. Antihistamines and calamine lotion can help with itching, while paracetamol can be used for fever. Antibiotics and antivirals are only necessary in certain cases.

    • This question is part of the following fields:

      • Dermatology
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  • Question 8 - A 25-year-old man comes to his General Practitioner complaining of an itchy rash...

    Correct

    • A 25-year-old man comes to his General Practitioner complaining of an itchy rash on both his wrists that has been present for 1 week. Upon examination, the doctor notes small purplish papules on the flexural aspect of both wrists with a flat top and small white lines on the surface. The patient also has areas of hyperpigmentation on the inner aspect of his elbows. What is the most probable diagnosis?

      Your Answer: Lichen planus

      Explanation:

      The patient’s symptoms and medical history suggest a diagnosis of lichen planus, a skin condition with an unknown cause that is likely immune-mediated. The rash is typically itchy and appears as papules with a shiny, purplish color in areas such as the palms, soles, genitalia, and flexor surfaces of the arms. The rash often has a polygonal shape and may have white lines known as Wickham’s striae. Over time, the papules flatten and are replaced by hyperpigmentation. Oral involvement is common, with a white-lace pattern on the buccal mucosa. Management usually involves topical steroids, but more severe cases may require oral steroids or immunosuppressants. Atopic eczema, irritant eczema, molluscum contagiosum, and psoriasis are different skin conditions that do not fit the patient’s symptoms.

    • This question is part of the following fields:

      • Dermatology
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  • Question 9 - A 62-year-old man visits his primary care physician with worries about a growth...

    Correct

    • A 62-year-old man visits his primary care physician with worries about a growth on his right lower eyelid. The lesion has been there for at least 3 months and has not increased in size. During examination, you observe a 3 mm lesion with rolled, pearly edges. Your suspicion is a basal cell carcinoma.
      What would be the best course of action for management?

      Your Answer: Urgent referral for surgical excision

      Explanation:

      When it comes to basal cell carcinoma, surgical excision is typically recommended and can be referred routinely. However, for high-risk areas such as the eyelids and nasal ala, urgent referral under the 2-week wait is necessary to prevent potential damage from delay.

      Basal cell carcinoma (BCC) is a type of skin cancer that is commonly found in the Western world. It is one of the three main types of skin cancer and is characterized by slow growth and local invasion. BCC lesions are also known as rodent ulcers and rarely metastasize. The majority of BCC lesions are found on sun-exposed areas, particularly the head and neck. The most common type of BCC is nodular BCC, which initially appears as a pearly, flesh-colored papule with telangiectasia. As the lesion progresses, it may ulcerate, leaving a central crater. If BCC is suspected, a routine referral should be made. Management options include surgical removal, curettage, cryotherapy, topical cream such as imiquimod or fluorouracil, and radiotherapy.

    • This question is part of the following fields:

      • Dermatology
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  • Question 10 - A 28-year-old man with psoriasis affecting the scalp and legs visits his General...

    Incorrect

    • A 28-year-old man with psoriasis affecting the scalp and legs visits his General Practitioner with ongoing symptoms despite using once-daily Betnovate® (a potent steroid) and a vitamin D analogue for six weeks.
      What should be the next course of action in managing this patient?

      Your Answer: Continue potent steroid and vitamin D analogue for a further four weeks

      Correct Answer: Stop steroid treatment and continue vitamin D analogue twice daily

      Explanation:

      Psoriasis management follows a stepwise approach, as per NICE guidelines. In this case, the patient has already received eight weeks of potent steroid with a vitamin D analogue. The next step is to stop the steroid and increase the vitamin D analogue to twice daily. Steroids should not be used at the same site for more than eight weeks, and patients require a 4-week steroid-free break. If symptoms persist, twice-daily steroids or a coal tar preparation can be tried. Referral to Dermatology may be necessary for severe cases, but starting the next stage of treatment while awaiting review is appropriate. An ultra-potent steroid may be considered after the steroid-free break or as a short course if necessary.

    • This question is part of the following fields:

      • Dermatology
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  • Question 11 - A middle-aged woman comes to you with concerns about skin lesions on her...

    Correct

    • A middle-aged woman comes to you with concerns about skin lesions on her chest. Upon examination, you notice two small red papules with visible fine vessels surrounding them. The lesions blanch when pressure is applied. What commonly used medication could be causing these lesions?

      Your Answer: Combined oral contraceptive

      Explanation:

      Spider naevi are a type of skin angioma that are typically found in the distribution of the superior vena cava. While they can occur without any apparent cause, the presence of multiple lesions may indicate an excess of oestrogen in the body. This is often associated with liver cirrhosis, as the liver is responsible for processing oestrogens. However, it can also occur during pregnancy or as a side effect of oestrogen-containing medications.

      Understanding Spider Naevi

      Spider naevi, also known as spider angiomas, are characterized by a central red papule surrounded by capillaries. These lesions can be identified by their ability to blanch upon pressure. Spider naevi are typically found on the upper part of the body and are more common in childhood, affecting around 10-15% of people.

      To differentiate spider naevi from telangiectasia, one can press on the lesion and observe how it fills. Spider naevi fill from the center, while telangiectasia fills from the edge. It is important to note that spider naevi may be associated with liver disease, pregnancy, and the use of combined oral contraceptive pills.

      In summary, understanding spider naevi is important for proper diagnosis and management. By recognizing their distinct characteristics and potential associations, healthcare professionals can provide appropriate care for their patients.

    • This question is part of the following fields:

      • Dermatology
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  • Question 12 - A 28-year-old woman with a history of thyroid disorder presents to the clinic...

    Correct

    • A 28-year-old woman with a history of thyroid disorder presents to the clinic with concerns about darkened skin on her neck.
      Which of the following is the most probable cause?

      Your Answer: Acanthosis nigricans

      Explanation:

      Common Skin Conditions: A Brief Overview

      Acanthosis Nigricans: A condition characterized by darkened patches of thickened skin, often described as velvet-like. It is usually benign but can sometimes be associated with underlying autoimmune conditions or gastric cancer.

      Dermatitis: Inflammation of the skin that can cause blistering, oozing, crusting, or flaking. Examples include eczema, dandruff, and rashes caused by contact with certain substances.

      Hidradenitis Suppurativa: A chronic condition that affects the apocrine glands in skin folds, causing painful nodules that can develop into pustules and eventually rupture. Scarring is common.

      Intertrigo: An inflammatory condition of skin folds caused by friction, often leading to secondary bacterial or fungal infections. Commonly found in the groin, axillae, and inframammary folds.

      Cowden’s Syndrome: An autosomal dominant condition characterized by hair follicle tumors, a cobblestone appearance of the oral epithelium, oral papillomas, and multiple skin tags. Associated with a high incidence of breast, thyroid, and gastrointestinal cancers.

    • This question is part of the following fields:

      • Dermatology
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  • Question 13 - A 35-year-old office worker complains of widespread pruritus for the last 2 weeks....

    Incorrect

    • A 35-year-old office worker complains of widespread pruritus for the last 2 weeks. She has no particular history of note, though she is currently staying with her parents due to financial difficulties. She has noticed the itching is particularly bad at night. On examination, she has several circular erythematous lesions on her arms and legs.
      Given the likely diagnosis, what is the most appropriate first-line treatment option?

      Your Answer: Malathion cream applied from neck down for 24 hours

      Correct Answer: Permethrin cream applied from neck down for 8-14 hours

      Explanation:

      Treatment Options for Scabies Infestation

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

      While 5% Hydrocortisone cream can be applied twice daily to relieve itching, it will not treat the underlying infestation. Similarly, emollient cream can be applied regularly to moisturize the skin, but it will not treat the infestation.

      If Permethrin is not effective, Malathion cream can be used as a second-line treatment. It should be applied from the neck down for 24 hours and then washed off.

      Oral antihistamines can be used to treat the symptomatic itch, but they do not address the underlying infestation. Therefore, it is important to follow the recommended treatment plan and seek medical advice if symptoms persist.

    • This question is part of the following fields:

      • Dermatology
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  • Question 14 - A 25-year-old woman in her first trimester of pregnancy presents for a check-up....

    Incorrect

    • A 25-year-old woman in her first trimester of pregnancy presents for a check-up. She is experiencing a resurgence of her chronic acne and is interested in finding a solution. What should she steer clear of?

      Your Answer: Topical benzoyl peroxide

      Correct Answer: Topical isotretinoin

      Explanation:

      Acne vulgaris is a common skin condition that typically affects adolescents, with the face, neck, and upper trunk being the most commonly affected areas. It is characterized by the obstruction of hair follicles with keratin plugs, leading to the formation of comedones, inflammation, and pustules. The severity of acne can be classified as mild, moderate, or severe, depending on the presence and extent of inflammatory lesions, papules, and pustules.

      The management of acne vulgaris typically involves a step-up approach, starting with single topical therapy such as topical retinoids or benzoyl peroxide. If this is not effective, topical combination therapy may be used, which includes a topical antibiotic, benzoyl peroxide, and topical retinoid. Oral antibiotics such as tetracyclines may also be prescribed, but they should be avoided in pregnant or breastfeeding women and children under 12 years of age. Erythromycin may be used in pregnancy, while minocycline is now considered less appropriate due to the possibility of irreversible pigmentation. Oral antibiotics should be used for a maximum of three months and always co-prescribed with a topical retinoid or benzoyl peroxide to reduce the risk of antibiotic resistance.

      Combined oral contraceptives (COCP) are an alternative to oral antibiotics in women, and Dianette (co-cyrindiol) may be used as it has anti-androgen properties. However, it has an increased risk of venous thromboembolism compared to other COCPs, so it should generally be used second-line and for only three months. Oral isotretinoin is a potent medication that should only be used under specialist supervision, and it is contraindicated in pregnancy. Finally, there is no evidence to support dietary modification in the management of acne vulgaris.

    • This question is part of the following fields:

      • Dermatology
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  • Question 15 - A 67-year-old woman presents with extensive mucosal ulceration and blistering lesions on her...

    Incorrect

    • A 67-year-old woman presents with extensive mucosal ulceration and blistering lesions on her torso and arms. The blisters are flaccid and rupture easily upon contact. What is the probable diagnosis?

      Your Answer: Epidermolysis bullosa

      Correct Answer: Pemphigus vulgaris

      Explanation:

      Blisters or bullae with no involvement of the mucosa may indicate bullous pemphigoid, while the presence of mucosal involvement may suggest pemphigus vulgaris.

      Understanding Pemphigus Vulgaris

      Pemphigus vulgaris is an autoimmune disease that occurs when the body’s immune system attacks desmoglein 3, a type of protein that helps cells stick together. This condition is more common in the Ashkenazi Jewish population. The disease is characterized by mucosal ulceration, which is often the first symptom. Oral involvement is seen in 50-70% of patients. Skin blistering is also common, with flaccid, easily ruptured vesicles and bullae. These lesions are typically painful but not itchy and may develop months after the initial mucosal symptoms. Nikolsky’s sign, which describes the spread of bullae following application of horizontal, tangential pressure to the skin, is also a common feature. Acantholysis, or the separation of cells in the skin, is seen on biopsy.

      The first-line treatment for pemphigus vulgaris is steroids, which help to reduce inflammation and suppress the immune system. Immunosuppressants may also be used to help control the disease. It is important to work closely with a healthcare provider to manage symptoms and prevent complications.

    • This question is part of the following fields:

      • Dermatology
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  • Question 16 - A 25-year-old Asian woman presents with completely depigmented patches of skin on her...

    Incorrect

    • A 25-year-old Asian woman presents with completely depigmented patches of skin on her arms and legs.
      What is the most likely diagnosis?

      Your Answer: Melanoma

      Correct Answer: Vitiligo

      Explanation:

      Common Skin Pigmentation Disorders

      Skin pigmentation disorders are conditions that affect the color of the skin. Here are some of the most common ones:

      Vitiligo: This rare condition is believed to be caused by the immune system attacking melanocytes, resulting in patches of skin with no pigment. It is more common in people of African descent.

      Albinism: This genetic disorder reduces the activity of tyrosinase in melanocytes, resulting in a complete lack of pigment in the skin, hair, and eyes.

      Melanoma: This is a type of skin cancer that develops from melanocytes. It is characterized by irregular, highly pigmented moles.

      Melasma: This condition causes increased pigmentation, usually under the eyes. It is common in pregnant women and users of oral contraceptives.

      Pityriasis alba: This condition causes white, scaly patches on the face, and is most commonly seen in children.

      Understanding these skin pigmentation disorders can help individuals identify and manage them effectively.

    • This question is part of the following fields:

      • Dermatology
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  • Question 17 - A 21-year-old woman presents with a rash on her trunk that developed a...

    Correct

    • A 21-year-old woman presents with a rash on her trunk that developed a few weeks after a sore throat. On examination, small, drop-shaped, salmon-pink plaques are observed. What is the most probable cause of this rash?

      Your Answer: Guttate psoriasis

      Explanation:

      Understanding Different Skin Conditions: Guttate Psoriasis, Dermatitis, Hand, Foot and Mouth Disease, Pityriasis Rosea, and Pustular Psoriasis

      Skin conditions can be uncomfortable and sometimes even painful. Here are some common skin conditions and their characteristics:

      Guttate psoriasis is a type of psoriasis that causes small, drop-shaped plaques on the chest, arms, legs, and scalp. It is usually caused by a streptococcal infection and can last for up to three months. Topical agents, such as steroids or calcipotriol, can be used to treat it.

      Dermatitis, also known as eczema, results in rough patches of skin that are dry and itchy, particularly with exposure to irritants. In children and adults with long-standing disease, eczema is often localised to the flexure of the limbs.

      Hand, foot and mouth disease (HFMD) is an acute viral illness characterised by vesicular eruptions in the mouth and papulovesicular lesions of the distal limbs. It should not be confused with foot and mouth disease of animals, which is caused by a different virus.

      Pityriasis rosea is a skin rash that is characterised by distinctive, scaly, erythematous lesions. It is thought to be a reaction to exposure to infection.

      Pustular psoriasis is a rarer type of psoriasis that causes pus-filled blisters (pustules) to appear on your skin. Different types of pustular psoriasis affect different parts of the body.

      It is important to consult a healthcare professional for proper diagnosis and treatment of any skin condition.

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      • Dermatology
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  • Question 18 - A 28-year-old newly qualified nurse presents with a bilateral erythematous rash on both...

    Correct

    • A 28-year-old newly qualified nurse presents with a bilateral erythematous rash on both hands. She has recently moved from the Philippines and has no significant medical history. The suspected diagnosis is contact dermatitis. What is the most appropriate test to determine the underlying cause?

      Your Answer: Skin patch test

      Explanation:

      The skin patch test can be beneficial in this scenario as it has the potential to detect irritants in addition to allergens.

      Types of Allergy Tests

      Allergy tests are used to determine if a person has an allergic reaction to a particular substance. There are several types of allergy tests available, each with its own advantages and limitations. The most commonly used test is the skin prick test, which is easy to perform and inexpensive. Drops of diluted allergen are placed on the skin, and a needle is used to pierce the skin. A wheal will typically develop if a patient has an allergy. This test is useful for food allergies and pollen.

      Another type of allergy test is the radioallergosorbent test (RAST), which determines the amount of IgE that reacts specifically with suspected or known allergens. Results are given in grades from 0 (negative) to 6 (strongly positive). This test is useful for food allergies, inhaled allergens (e.g. pollen), and wasp/bee venom.

      Skin patch testing is useful for contact dermatitis. Around 30-40 allergens are placed on the back, and irritants may also be tested for. The patches are removed 48 hours later, and the results are read by a dermatologist after a further 48 hours. Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines. Overall, allergy tests are an important tool in diagnosing and managing allergies.

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      • Dermatology
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  • Question 19 - A 26-year-old male patient visits his GP complaining of a firm, round swelling...

    Incorrect

    • A 26-year-old male patient visits his GP complaining of a firm, round swelling over the angle of his jaw that has been growing for two years. The patient is having difficulty shaving his beard due to the size of the swelling. The GP suspects a sebaceous cyst and the patient is eager for treatment to alleviate his symptoms. What is the best course of action to prevent further discomfort?

      Your Answer: 7-day course of oral flucloxacillin

      Correct Answer: Surgical excision

      Explanation:

      To prevent the sebaceous cyst from recurring, it is necessary to surgically remove the entire structure. This can be done by a general practitioner or a surgical team, but funding for the procedure may be limited due to its lower clinical priority. Patients may opt to have the surgery done privately. Incision and drainage or fine needle aspiration may provide temporary relief, but the cyst is likely to return. Intralesional steroids are not recommended in this case, as there is no infection present. Oral antibiotics are also unnecessary. Complete surgical excision offers the best chance for long-term resolution of the patient’s symptoms.

      Understanding Sebaceous Cysts

      Sebaceous cysts refer to a group of cysts that include both epidermoid and pilar cysts. However, the term is not entirely accurate and should be avoided if possible. Epidermoid cysts occur when there is an overgrowth of epidermal cells in the dermis, while pilar cysts, also known as trichilemmal cysts or wen, originate from the outer root sheath of the hair follicle. These cysts can appear anywhere on the body, but are most commonly found on the scalp, ears, back, face, and upper arm, and will typically have a punctum.

      To prevent recurrence, it is essential to remove the entire cyst wall during excision. While sebaceous cysts are generally harmless, they can become infected and cause discomfort or pain.

    • This question is part of the following fields:

      • Dermatology
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  • Question 20 - A 50-year-old woman presents to dermatology after being referred by her physician for...

    Incorrect

    • A 50-year-old woman presents to dermatology after being referred by her physician for lesions on both shins. Upon examination, symmetrical erythematous lesions with an orange peel texture are observed. What is the probable diagnosis?

      Your Answer: Erythema nodosum

      Correct Answer: Pretibial myxoedema

      Explanation:

      Pretibial myxoedema is a condition characterized by orange peel-like lesions on the skin of the shins, often associated with Grave’s disease.

      Understanding Shin Lesions: Differential Diagnosis and Characteristic Features

      Shin lesions can be caused by a variety of conditions, and it is important to differentiate between them in order to provide appropriate treatment. The four most common conditions that can cause shin lesions are erythema nodosum, pretibial myxoedema, pyoderma gangrenosum, and necrobiosis lipoidica diabeticorum.

      Erythema nodosum is characterized by symmetrical, tender, erythematous nodules that heal without scarring. It is often caused by streptococcal infections, sarcoidosis, inflammatory bowel disease, or certain medications such as penicillins, sulphonamides, or oral contraceptive pills.

      Pretibial myxoedema, on the other hand, is seen in Graves’ disease and is characterized by symmetrical, erythematous lesions that give the skin a shiny, orange peel appearance.

      Pyoderma gangrenosum initially presents as a small red papule, which later develops into deep, red, necrotic ulcers with a violaceous border. It is idiopathic in 50% of cases, but may also be seen in inflammatory bowel disease, connective tissue disorders, and myeloproliferative disorders.

      Finally, necrobiosis lipoidica diabeticorum is characterized by shiny, painless areas of yellow/red skin typically found on the shin of diabetics. It is often associated with telangiectasia.

      In summary, understanding the differential diagnosis and characteristic features of shin lesions can help healthcare professionals provide appropriate treatment and improve patient outcomes.

    • This question is part of the following fields:

      • Dermatology
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  • Question 21 - A 58-year-old male is referred to dermatology by his physician for evaluation of...

    Correct

    • A 58-year-old male is referred to dermatology by his physician for evaluation of a lesion on his shin. During the examination, the dermatologist observes shiny, painless areas of yellow skin with numerous telangiectasia. What is the probable diagnosis?

      Your Answer: Necrobiosis lipoidica diabeticorum

      Explanation:

      Necrobiosis lipoidica diabeticorum is a condition characterized by waxy yellow shin lesions that often occur in individuals with diabetes.

      Understanding Shin Lesions: Differential Diagnosis and Characteristic Features

      Shin lesions can be caused by a variety of conditions, and it is important to differentiate between them in order to provide appropriate treatment. The four most common conditions that can cause shin lesions are erythema nodosum, pretibial myxoedema, pyoderma gangrenosum, and necrobiosis lipoidica diabeticorum.

      Erythema nodosum is characterized by symmetrical, tender, erythematous nodules that heal without scarring. It is often caused by streptococcal infections, sarcoidosis, inflammatory bowel disease, or certain medications such as penicillins, sulphonamides, or oral contraceptive pills.

      Pretibial myxoedema, on the other hand, is seen in Graves’ disease and is characterized by symmetrical, erythematous lesions that give the skin a shiny, orange peel appearance.

      Pyoderma gangrenosum initially presents as a small red papule, which later develops into deep, red, necrotic ulcers with a violaceous border. It is idiopathic in 50% of cases, but may also be seen in inflammatory bowel disease, connective tissue disorders, and myeloproliferative disorders.

      Finally, necrobiosis lipoidica diabeticorum is characterized by shiny, painless areas of yellow/red skin typically found on the shin of diabetics. It is often associated with telangiectasia.

      In summary, understanding the differential diagnosis and characteristic features of shin lesions can help healthcare professionals provide appropriate treatment and improve patient outcomes.

    • This question is part of the following fields:

      • Dermatology
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  • Question 22 - A 58-year-old with a history of acne rosacea seeks guidance on treatment options....

    Correct

    • A 58-year-old with a history of acne rosacea seeks guidance on treatment options. Which of the following interventions is least helpful in managing the condition?

      Your Answer: Low-dose topical corticosteroids

      Explanation:

      Understanding Rosacea: Symptoms and Management

      Rosacea, also known as acne rosacea, is a chronic skin condition that has no known cause. It typically affects the nose, cheeks, and forehead, and the first symptom is often flushing. Over time, telangiectasia (visible blood vessels) may appear, followed by persistent redness with papules and pustules. In some cases, rhinophyma (enlarged nose) may develop, and there may be ocular involvement, such as blepharitis. Sunlight can exacerbate symptoms.

      Mild cases of rosacea may be treated with topical metronidazole, while topical brimonidine gel may be used for patients with predominant flushing but limited telangiectasia. More severe cases may require systemic antibiotics like oxytetracycline. Patients are advised to apply high-factor sunscreen daily and use camouflage creams to conceal redness. Laser therapy may be appropriate for those with prominent telangiectasia, and patients with rhinophyma should be referred to a dermatologist.

      Overall, understanding the symptoms and management of rosacea can help individuals manage their condition and improve their quality of life.

    • This question is part of the following fields:

      • Dermatology
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  • Question 23 - A 35-year-old woman in her third trimester of pregnancy reports an itchy rash...

    Incorrect

    • A 35-year-old woman in her third trimester of pregnancy reports an itchy rash around her belly button during an antenatal check-up. She had no such issues during her previous pregnancy. Upon examination, blistering lesions are observed in the peri-umbilical area and on her arms. What is the probable diagnosis?

      Your Answer: Lichen planus

      Correct Answer: Pemphigoid gestationis

      Explanation:

      Blistering is not a characteristic of polymorphic eruption of pregnancy.

      Skin Disorders Associated with Pregnancy

      During pregnancy, women may experience various skin disorders. The most common one is atopic eruption of pregnancy, which is characterized by an itchy red rash. This condition does not require any specific treatment. Another skin disorder is polymorphic eruption of pregnancy, which is a pruritic condition that usually appears during the last trimester. The lesions often first appear in abdominal striae, and management depends on the severity of the condition. Emollients, mild potency topical steroids, and oral steroids may be used. Pemphigoid gestationis is another skin disorder that causes pruritic blistering lesions. It usually develops in the peri-umbilical region and later spreads to the trunk, back, buttocks, and arms. This condition is rarely seen in the first pregnancy and usually presents in the second or third trimester. Oral corticosteroids are usually required for treatment.

    • This question is part of the following fields:

      • Dermatology
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  • Question 24 - A 25-year-old man visits his GP complaining of a rash that has spread...

    Correct

    • A 25-year-old man visits his GP complaining of a rash that has spread across his trunk over the last 4 days. He is worried about the appearance of the rash. The patient has no significant medical history except for completing a course of phenoxymethylpenicillin for tonsillitis last week and takes no other regular medications. Upon examination, the doctor observes multiple scaly papules on the patient's trunk and upper limbs. The lesions are small and have a teardrop shape. What is the most probable diagnosis?

      Your Answer: Guttate psoriasis

      Explanation:

      The tear-drop scaly papules that have suddenly appeared on the patient’s trunk and limbs suggest guttate psoriasis. This type of psoriasis is commonly seen in children and young adults who have recently had a Streptococcus infection, such as the tonsillitis infection that this patient had. The rash is characterized by multiple small scaly and red patches that have a teardrop shape.

      Disseminated varicella zoster, pityriasis rosea, and pityriasis versicolor are not likely diagnoses for this patient. Disseminated varicella zoster causes a different type of rash that includes macular, papular, and vesicular lesions that crust over time. Pityriasis rosea presents with a large round herald patch on the chest, abdomen, or back, and is thought to be triggered by viral or bacterial infections. Pityriasis versicolor is a fungal infection that causes patches that are paler than the surrounding skin, and is commonly found on the upper limbs and neck. However, exposure to heat and moisture can increase the risk of developing this rash.

      Guttate psoriasis is a type of psoriasis that is more commonly seen in children and adolescents. It is often triggered by a streptococcal infection that occurred 2-4 weeks prior to the appearance of the lesions. The name guttate comes from the Latin word for drop, as the lesions appear as small, tear-shaped papules on the trunk and limbs. These papules are pink and scaly, and the onset of the condition is usually acute, occurring over a few days.

      In most cases, guttate psoriasis will resolve on its own within 2-3 months. There is no clear evidence to support the use of antibiotics to treat the underlying streptococcal infection. Treatment options for guttate psoriasis include topical agents commonly used for psoriasis and UVB phototherapy. In cases where the condition recurs, a tonsillectomy may be necessary.

      It is important to differentiate guttate psoriasis from pityriasis rosea, another skin condition that can present with similar symptoms. Guttate psoriasis is often preceded by a streptococcal sore throat, while pityriasis rosea may be preceded by a respiratory tract infection. The appearance of guttate psoriasis is characterized by tear-shaped papules on the trunk and limbs, while pityriasis rosea presents with a herald patch followed by multiple oval lesions with a fine scale. While guttate psoriasis resolves within a few months, pityriasis rosea typically resolves after around 6 weeks.

    • This question is part of the following fields:

      • Dermatology
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  • Question 25 - A 29-year-old woman presents to her GP with complaints of hair loss. She...

    Incorrect

    • A 29-year-old woman presents to her GP with complaints of hair loss. She reports noticing that her hair has become significantly thinner and that she is shedding more hair than usual, both on her pillow and in the shower drain. She denies any other symptoms and has no significant medical history except for giving birth to her first child 6 months ago. She is not taking any medications regularly and there is no family history of hair loss. On examination, her scalp hair is uniformly thin, but there are no areas of complete hair loss. Her systemic examination is unremarkable and her vital signs are within normal limits. Blood tests, including iron studies and thyroid function, are all normal. What is the most likely diagnosis?

      Your Answer: Alopecia areata

      Correct Answer: Telogen effluvium

      Explanation:

      Telogen effluvium is characterized by hair loss and thinning as a result of experiencing significant stress. In this case, the patient’s recent physical stress from giving birth is a likely cause of her hair becoming thinner due to telogen effluvium. The hair loss patterns observed do not match those of alopecia areata or alopecia totalis, which respectively cause distinct areas of complete hair loss or complete loss of all hair on the head and face.

      Input:
      Alopecia may be divided into scarring (destruction of hair follicle) and non-scarring (preservation of hair follicle). Scarring alopecia can be caused by trauma, burns, radiotherapy, lichen planus, discoid lupus, and untreated tinea capitis. Non-scarring alopecia can be caused by male-pattern baldness, drugs such as cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, and colchicine, nutritional deficiencies such as iron and zinc deficiency, autoimmune conditions such as alopecia areata, telogen effluvium, hair loss following a stressful period such as surgery, and trichotillomania.

      Output:
      – Alopecia can be categorized into scarring and non-scarring types.
      – Scarring alopecia is caused by trauma, burns, radiotherapy, lichen planus, discoid lupus, and untreated tinea capitis.
      – Non-scarring alopecia is caused by male-pattern baldness, drugs such as cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, and colchicine, nutritional deficiencies such as iron and zinc deficiency, autoimmune conditions such as alopecia areata, telogen effluvium, hair loss following a stressful period such as surgery, and trichotillomania.

    • This question is part of the following fields:

      • Dermatology
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  • Question 26 - An 80-year-old man visits his GP complaining of a painful lesion on his...

    Incorrect

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

      Your Answer: Basal cell carcinoma

      Correct Answer: Chondrodermatitis nodularis helicis

      Explanation:

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

      Understanding Chondrodermatitis Nodularis Helicis

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

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

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 27 - A 32-year-old male patient comes in for mole removal. Which areas of the...

    Incorrect

    • A 32-year-old male patient comes in for mole removal. Which areas of the body are more prone to developing keloid scars?

      Your Answer: Abdomen

      Correct Answer: Sternum

      Explanation:

      Understanding Keloid Scars

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

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

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

    • This question is part of the following fields:

      • Dermatology
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  • Question 28 - You are examining a 65-year-old individual with acanthosis nigricans. You suggest screening for...

    Incorrect

    • You are examining a 65-year-old individual with acanthosis nigricans. You suggest screening for diabetes. Due to the widespread skin alterations, including some oral changes, what other potential underlying condition should be taken into account?

      Your Answer: Liver cirrhosis

      Correct Answer: Internal malignancy

      Explanation:

      While acanthosis nigricans may occur on its own in individuals with dark skin, it is typically a sign of insulin resistance and associated conditions such as type 2 diabetes, polycystic ovarian syndrome, Cushing’s syndrome, and hypothyroidism. Certain medications, including corticosteroids, insulin, and hormone medications, can also cause this condition. If acanthosis nigricans appears suddenly and in unusual areas such as the mouth, it may indicate the presence of an internal malignancy, particularly gastric cancer.

      Acanthosis nigricans is a condition characterized by the presence of symmetrical, brown, velvety plaques on the neck, axilla, and groin. This condition can be caused by various factors such as type 2 diabetes mellitus, gastrointestinal cancer, obesity, polycystic ovarian syndrome, acromegaly, Cushing’s disease, hypothyroidism, familial factors, Prader-Willi syndrome, and certain drugs like the combined oral contraceptive pill and nicotinic acid. The pathophysiology of acanthosis nigricans involves insulin resistance, which leads to hyperinsulinemia. This, in turn, stimulates the proliferation of keratinocytes and dermal fibroblasts through interaction with insulin-like growth factor receptor-1 (IGFR1).

    • This question is part of the following fields:

      • Dermatology
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  • Question 29 - A 26-year-old patient comes in with lesions on their lower abdomen that have...

    Incorrect

    • A 26-year-old patient comes in with lesions on their lower abdomen that have been present for six weeks. At first, there was only one lesion, but more have appeared since then. During the examination, around 10 raised lesions with an umbilicated appearance, each around 1-2 mm in diameter, are observed. What is the most probable diagnosis?

      Your Answer: Keratosis pilaris

      Correct Answer: Molluscum contagiosum

      Explanation:

      Molluscum contagiosum is typically observed in children, but the following is a classical depiction of the condition.

      Understanding Molluscum Contagiosum

      Molluscum contagiosum is a viral skin infection that is commonly seen in children, particularly those with atopic eczema. It is caused by the molluscum contagiosum virus and can be transmitted through direct contact or contaminated surfaces. The infection presents as pinkish or pearly white papules with a central umbilication, which can appear anywhere on the body except for the palms of the hands and soles of the feet. In children, lesions are commonly seen on the trunk and in flexures, while in adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen.

      While molluscum contagiosum is a self-limiting condition that usually resolves within 18 months, it is important to avoid sharing towels, clothing, and baths with uninfected individuals to prevent transmission. Scratching the lesions should also be avoided, and treatment may be considered if the itch is problematic. However, treatment is not usually recommended, and if necessary, simple trauma or cryotherapy may be used. In some cases, referral may be necessary, such as for individuals who are HIV-positive with extensive lesions or those with eyelid-margin or ocular lesions and associated red eye.

      Overall, understanding molluscum contagiosum and taking appropriate precautions can help prevent transmission and alleviate symptoms.

    • This question is part of the following fields:

      • Dermatology
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  • Question 30 - A 75 year-old woman comes to the clinic with a non-healing skin area...

    Incorrect

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

      Your Answer: Lower limb doppler

      Correct Answer: Ankle-brachial pressure index

      Explanation:

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

      Venous Ulceration and its Management

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

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

    • This question is part of the following fields:

      • Dermatology
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