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  • Question 1 - A 32-year-old woman visits her doctor complaining of a skin rash caused by...

    Incorrect

    • A 32-year-old woman visits her doctor complaining of a skin rash caused by her new wristwatch. The doctor suspects an allergy to nickel. What is the most appropriate test to confirm this suspicion?

      Your Answer: Serum IgE

      Correct Answer: Skin patch test

      Explanation:

      Understanding Nickel Dermatitis

      Nickel dermatitis is a type of allergic contact dermatitis that is commonly caused by exposure to nickel. This condition is an example of a type IV hypersensitivity reaction, which means that it is caused by an immune response to a specific substance. In the case of nickel dermatitis, the immune system reacts to nickel, which is often found in jewelry such as watches.

      To diagnose nickel dermatitis, a skin patch test is typically performed. This involves applying a small amount of nickel to the skin and monitoring the area for any signs of an allergic reaction. If a reaction occurs, it is likely that the individual has nickel dermatitis and will need to avoid exposure to nickel in the future.

      Overall, understanding nickel dermatitis is important for anyone who may be at risk of developing this condition. By recognizing the symptoms and avoiding exposure to nickel, individuals can manage their symptoms and prevent further complications.

    • This question is part of the following fields:

      • Dermatology
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  • Question 2 - A teenager presents with rash which clinically looks like Henoch-Schönlein purpura (HSP).
    Which statement...

    Incorrect

    • A teenager presents with rash which clinically looks like Henoch-Schönlein purpura (HSP).
      Which statement is true?

      Your Answer: The platelet count is decreased

      Correct Answer: The condition normally lasts six months

      Explanation:

      Henoch-Schönlein Purpura: Symptoms and Duration

      Henoch-Schönlein Purpura (HSP) is a condition characterized by a rash on the back and thighs that is palpable and non-blanching, but is a non-thrombocytopenic purpura. Children with HSP may experience abdominal pain and bloody stools, which are cardinal symptoms of the disease. The kidneys are also often involved, and patients may have frank haematuria. The disease typically lasts about four weeks and resolves spontaneously.

    • This question is part of the following fields:

      • Dermatology
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  • Question 3 - A 25-year-old male comes to the surgery with a chronic issue of excessive...

    Incorrect

    • A 25-year-old male comes to the surgery with a chronic issue of excessive sweating in his armpits. Apart from this, he is healthy, but the problem is impacting his self-esteem and social activities. What would be the best course of action for managing this condition?

      Your Answer:

      Correct Answer: Topical aluminium chloride

      Explanation:

      Hyperhidrosis is typically treated with topical preparations containing aluminium chloride as the first-line option.

      Managing Hyperhidrosis

      Hyperhidrosis is a condition characterized by excessive sweating. To manage this condition, there are several options available. The first-line treatment is the use of topical aluminium chloride preparations, which can cause skin irritation as a side effect. Another option is iontophoresis, which is particularly useful for patients with palmar, plantar, and axillary hyperhidrosis. Botulinum toxin is also licensed for axillary symptoms. Surgery, such as endoscopic transthoracic sympathectomy, is another option, but patients should be informed of the risk of compensatory sweating. Overall, there are several management options available for hyperhidrosis, and patients should work with their healthcare provider to determine the best course of treatment for their individual needs.

    • This question is part of the following fields:

      • Dermatology
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  • Question 4 - A 28-year-old woman visits her GP due to sudden appearance of lesions on...

    Incorrect

    • A 28-year-old woman visits her GP due to sudden appearance of lesions on her arms. She was convinced by her mother to attend the appointment as she was not interested in seeking medical attention. The patient is unable to provide a clear history of the lesions' progression. Her medical history includes mild asthma, depression, and generalised anxiety disorder.

      Upon examination, the patient has well-defined, linear skin lesions on both arms. The lesions do not appear to be dry or scaly but seem to be excoriated. There are no apparent signs of infection.

      What is the most probable diagnosis for this patient?

      Your Answer:

      Correct Answer: Dermatitis artefacta

      Explanation:

      The sudden appearance of linear, well-defined skin lesions with a lack of concern or emotional response, known as ‘la belle indifference’, strongly suggests dermatitis artefacta or factitious dermatitis. This rare condition involves self-inflicted skin damage, and patients often deny their involvement. Treatment requires a collaborative approach between dermatologists and psychiatrists, with a focus on building a positive relationship with the patient. Other conditions such as dermatitis herpetiformis, lichen planus, and neurotic excoriations have different clinical presentations and are not consistent with the scenario described.

      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.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - A 21-year-old female patient comes to you with bilateral, symmetrical depigmented lesions on...

    Incorrect

    • A 21-year-old female patient comes to you with bilateral, symmetrical depigmented lesions on her upper limbs that have been getting larger since she first noticed them 3 weeks ago. You suspect vitiligo and want to start medication while she waits for her dermatology appointment. Which of the following medications should you consider?

      Your Answer:

      Correct Answer: Potent topical corticosteroids

      Explanation:

      In the early stages of vitiligo, the use of potent topical corticosteroids may be beneficial in reversing the changes. However, it is important to note that medications such as topical tacrolimus or oral steroids should only be prescribed by a dermatologist. Oral tacrolimus and topical miconazole are not effective in managing vitiligo, unless a fungal infection is suspected.

      Understanding Vitiligo

      Vitiligo is a medical condition that occurs when the immune system attacks and destroys melanocytes, leading to the loss of skin pigmentation. It is estimated to affect about 1% of the population, with symptoms typically appearing in individuals between the ages of 20 and 30 years. The condition is characterized by well-defined patches of depigmented skin, with the edges of the affected areas being the most prominent. Trauma to the skin may also trigger the development of new lesions, a phenomenon known as the Koebner phenomenon.

      Vitiligo is often associated with other autoimmune disorders such as type 1 diabetes mellitus, Addison’s disease, autoimmune thyroid disorders, pernicious anemia, and alopecia areata. While there is no cure for vitiligo, there are several management options available. These include the use of sunblock to protect the affected areas of skin, camouflage make-up to conceal the depigmented patches, and topical corticosteroids to reverse the changes if applied early. Other treatment options may include topical tacrolimus and phototherapy, although caution is advised when using these treatments on patients with light skin. Overall, early diagnosis and management of vitiligo can help to improve the quality of life for affected individuals.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - John is a 35-year-old man with a body mass index of 32 kg/m²...

    Incorrect

    • John is a 35-year-old man with a body mass index of 32 kg/m² who has presented with a recurrence of boils in his axilla. He has had this numerous times before requiring antibiotics and has even had an incision and drainage on one occasion. He also described one episode of such boils on his vulva a few years ago. On this occasion, you notice large red lumps in his right axilla. There is some scarring of the skin and you also notice a little hole with pus discharging out of it.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Hidradenitis suppurativa

      Explanation:

      The development of sinus tracts and fistulas can be a possible complication of hidradenitis suppurativa.

      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-like’ 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.

    • This question is part of the following fields:

      • Dermatology
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  • Question 7 - A 60-year-old patient visits their doctor after experiencing an urticarial skin rash upon...

    Incorrect

    • A 60-year-old patient visits their doctor after experiencing an urticarial skin rash upon starting a new medication. What is the most probable cause of the rash?

      Your Answer:

      Correct Answer: Aspirin

      Explanation:

      Urticaria is frequently observed as a result of aspirin, despite the fact that all medications have the potential to cause it.

      Urticaria, also known as hives, can be caused by various drugs. Some of the most common drugs that can trigger urticaria include aspirin, penicillins, nonsteroidal anti-inflammatory drugs (NSAIDs), and opiates. These medications can cause an allergic reaction in some individuals, leading to the development of hives.

    • This question is part of the following fields:

      • Dermatology
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  • Question 8 - A 55-year-old man with a history of ischaemic heart disease and psoriasis presents...

    Incorrect

    • A 55-year-old man with a history of ischaemic heart disease and psoriasis presents with a significant worsening of his plaque psoriasis on his elbows and knees over the past two weeks. His medications have been recently altered at the cardiology clinic. Which medication is most likely to have exacerbated his psoriasis?

      Your Answer:

      Correct Answer: Atenolol

      Explanation:

      Plaque psoriasis is known to worsen with the use of beta-blockers.

      Psoriasis can be worsened by various factors, including trauma, alcohol consumption, and certain medications such as beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs, ACE inhibitors, and infliximab. Additionally, the sudden withdrawal of systemic steroids can also exacerbate psoriasis symptoms. It is important to note that streptococcal infection can trigger guttate psoriasis, a type of psoriasis characterized by small, drop-like lesions on the skin. Therefore, individuals with psoriasis should be aware of these exacerbating factors and take steps to avoid or manage them as needed.

    • This question is part of the following fields:

      • Dermatology
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  • Question 9 - A 45-year-old Jewish woman presents with recurrent mouth ulcers for several months. Recently,...

    Incorrect

    • A 45-year-old Jewish woman presents with recurrent mouth ulcers for several months. Recently, she has developed painful blisters on her back that seem to be spreading after attempting to pop them with a needle.

      The patient is typically healthy and not taking any medications. She works at an elementary school and denies using any over-the-counter drugs recently.

      During the examination, the patient exhibits mucosal blistering and extensive flaccid vesicles and bullae that are sensitive to touch. She has no fever.

      A biopsy of the lesions reveals acantholysis.

      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Pemphigus vulgaris

      Explanation:

      Mucosal blistering is a common symptom of Pemphigus vulgaris, while skin blisters are typically painful but not itchy. This condition is often seen in middle-aged patients and is characterized by flaccid blisters and erosions that are Nikolsky’s sign positive. Mucous membrane involvement is also frequently observed. Bullous pemphigoid is a similar condition but is more prevalent in the elderly and features tense blisters without acantholysis on biopsy.

      Pemphigus vulgaris is an autoimmune condition that occurs when the body’s immune system attacks desmoglein 3, a type of cell adhesion molecule found in epithelial cells. This disease is more prevalent in the Ashkenazi Jewish population. The most common symptom is mucosal ulceration, which can be the first sign of the disease. Oral involvement is seen in 50-70% of patients. Skin blistering is also a common symptom, with easily ruptured vesicles and bullae. These lesions are typically painful but not itchy and may appear months after the initial mucosal symptoms. Nikolsky’s sign is a characteristic feature of pemphigus vulgaris, where bullae spread following the application of horizontal, tangential pressure to the skin. Biopsy results often show acantholysis.

      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 manage the disease.

    • This question is part of the following fields:

      • Dermatology
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  • Question 10 - A 27-year-old woman schedules a routine visit with you. She is currently 18...

    Incorrect

    • A 27-year-old woman schedules a routine visit with you. She is currently 18 weeks pregnant and has a lengthy history of acne vulgaris. Before her pregnancy, she effectively managed her acne with a topical retinoid and the combined oral contraceptive. However, she discontinued both treatments prior to becoming pregnant and has noticed a resurgence of her acne. Despite trying over-the-counter benzoyl peroxide, she has not seen any improvement.

      What would be the best course of action for managing her acne during pregnancy?

      Your Answer:

      Correct Answer: Combined topical benzoyl peroxide + clindamycin gel

      Explanation:

      During pregnancy, acne is a common issue and many typical treatments are not appropriate. However, it is safe to use topical antibiotics for managing acne during pregnancy. It is recommended to prescribe a combination of topical antibiotics and benzoyl peroxide. On the other hand, topical retinoids should not be used during pregnancy. If topical treatments are not effective, oral erythromycin can be considered as an option.

      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.

    • This question is part of the following fields:

      • Dermatology
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