00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 42-year-old West Indian diplomat, while on secondment in the United Kingdom, develops...

    Incorrect

    • A 42-year-old West Indian diplomat, while on secondment in the United Kingdom, develops an uncomfortable raised rash on the anterior aspects of both her lower legs. She has prided herself with her remarkably good health over the years. She has recently visited Nigeria, Guyana and Vietnam for her work.
      What would be the most appropriate initial investigation to conduct?

      Your Answer: Skin biopsy

      Correct Answer: Chest X-ray

      Explanation:

      The patient is presenting with erythema nodosum, which may have an unknown cause or could be related to their extensive travel history. While a skin biopsy may provide a definitive diagnosis, the best initial investigation is a chest X-ray to rule out tuberculosis and sarcoidosis. A blood film is not necessary as there is no indication of malaria. An ultrasound of the abdomen is not useful in this case, as the skin lesions are the primary concern. Stool microbiology is not necessary as there is no mention of diarrhea. While a skin biopsy may provide information on the lesions themselves, it does not aid in identifying the underlying cause.

    • This question is part of the following fields:

      • Dermatology
      37.1
      Seconds
  • Question 2 - In what condition is lupus pernio observed? ...

    Correct

    • In what condition is lupus pernio observed?

      Your Answer: Sarcoidosis

      Explanation:

      Lupus Pernio in Sarcoidosis

      Lupus pernio is a distinct skin manifestation that is commonly associated with sarcoidosis. This condition is characterized by the presence of chronic, hardened papules or plaques that primarily affect the mid-face, particularly the alar rim of the nose. Even small papules in this area may indicate the presence of granulomatous infiltration in the nasal mucosa and upper respiratory tract, which can lead to the formation of masses, ulcerations, or even life-threatening airway obstruction. Therefore, it is important to promptly diagnose and manage lupus pernio in patients with sarcoidosis to prevent further complications. Proper treatment may involve the use of systemic corticosteroids, immunosuppressive agents, or other targeted therapies.

    • This question is part of the following fields:

      • Dermatology
      69.2
      Seconds
  • Question 3 - A 27-year-old man with a history of eczema presents with itchy, red patches...

    Incorrect

    • A 27-year-old man with a history of eczema presents with itchy, red patches of skin on his antecubital fossae, lateral thighs, and popliteal fossae. The skin on his right thigh is weeping and inflamed. He reports feeling fatigued and wonders if he has had a fever. His vital signs are within normal limits. Based on your examination, you diagnose him with moderately severe eczema.
      What is the best course of action for managing his condition?

      Your Answer:

      Correct Answer: Regular Diprobase® ointment and once-daily betamethasone valerate 0.025% cream plus 10 days of oral flucloxacillin

      Explanation:

      Treatment Regime for Moderately Severe Eczema with Superimposed Infection

      Moderately severe eczema with evidence of superimposed infection requires a specific treatment regime. The severity of eczema is categorized into four categories: clear, mild, moderate, and severe. In this case, the patient has small areas of dry skin mainly in the flexures, and there is evidence of infected eczema/cellulitis with an erythematosus, weeping patch of skin in the lateral thigh.

      The treatment regime should include a regular emollient ointment, such as Diprobase®, applied generously to the skin multiple times a day. Additionally, a moderately potent topical corticosteroid, such as betamethasone valerate 0.025% or clobetasone butyrate 0.05%, should be used sparingly on the inflamed areas once a day. The patient must be advised to apply the steroid first and allow 15-20 minutes for it to be absorbed before applying the emollient. Treatment should last 7-14 days and continue until 48 hours after the eczematous patches have cleared.

      Furthermore, oral antibiotics are necessary for the treatment of infected eczema. Oral flucloxacillin is considered first-line, and treatment usually lasts for a 10-day period.

      Treatment Regime for Moderately Severe Eczema with Superimposed Infection

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 4 - A 25-year-old female with a history of systemic lupus erythematosus presents with symmetrical...

    Incorrect

    • A 25-year-old female with a history of systemic lupus erythematosus presents with symmetrical reticulated, violaceous patches. These patches become more prominent in cold weather and involve both lower limbs. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Livedo reticularis

      Explanation:

      Livedo Reticularis

      Livedo reticularis is a skin condition characterized by a net-like pattern of blue or purple discoloration on the skin. This occurs due to the dilation of capillary blood vessels and the stagnation of blood within these vessels. The condition is more pronounced in cold weather and is commonly found on the legs, arms, and trunk.

      Livedo reticularis can be idiopathic, meaning it has no known cause, or it can be secondary to other conditions such as malignancy, vasculitis, SLE, or cholesterol embolization. The condition is caused by the accumulation of blood in the capillaries, which leads to the discoloration of the skin.

      In summary, livedo reticularis is a skin condition that causes a net-like pattern of blue or purple discoloration on the skin. It is caused by the accumulation of blood in the capillaries and can be idiopathic or secondary to other conditions. The condition is more pronounced in cold weather and is commonly found on the legs, arms, and trunk.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 5 - A 25-year-old woman is distressed about her acne vulgaris, which includes papules, pustules,...

    Incorrect

    • A 25-year-old woman is distressed about her acne vulgaris, which includes papules, pustules, and comedones. She experienced acne during her adolescent years, and it has continued to persist. Her weight and menstrual cycle are normal, and there is no hirsutism. What is a probable cause of her condition?

      Your Answer:

      Correct Answer: Bacteria

      Explanation:

      Understanding the Aetiology of Acne: Factors and Myths

      Acne vulgaris is a common skin condition that affects individuals beyond their teenage years, particularly women. The presence and activity of Propionibacterium acnes, a normally commensal bacteria, is a significant factor in the development of acne. Other aetiological factors include genetic predisposition, seborrhoea, sensitivity to normal levels of circulating androgen, blockage of the pilosebaceous duct, and immunological factors. Polycystic ovary syndrome is an unlikely cause of acne. P. acnes thrives in acne lesions due to elevated sebum production or follicle blockage, triggering inflammation. Diet and poor personal hygiene are not involved in the aetiology of acne. Combined oral contraceptives can be beneficial in treating acne. It is a myth that chocolate or dirt causes acne. Understanding these factors and myths can help in the effective management of acne.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 6 - A 28-year-old patient presents with a history of well demarcated, erythematous lesions with...

    Incorrect

    • A 28-year-old patient presents with a history of well demarcated, erythematous lesions with silvery-white scaling plaques on the extensor surfaces of the elbows. There is evidence of nail pitting.
      What is the most appropriate management?

      Your Answer:

      Correct Answer: Topical betnovate + vitamin D

      Explanation:

      The recommended first-line treatment for psoriasis is the application of betnovate (or another potent steroid) plus vitamin D for four weeks. If there is no or minimal improvement, referral to a specialist may be considered. Dermovate, a very potent steroid, should only be initiated by a specialist who may alter the treatment or advance it to include phototherapy or biologics. Hydrocortisone is not recommended for psoriasis treatment as it is not potent enough. Phototherapy is not the first-line treatment and should only be initiated by a dermatologist after considering all risks and benefits. Biologics are the last stage of treatment and are only initiated by a dermatologist if the detrimental effects of psoriasis are heavily impacting the patient’s life, despite other treatments.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 7 - A 14-year-old boy comes to the clinic with scaly patches on his scalp....

    Incorrect

    • A 14-year-old boy comes to the clinic with scaly patches on his scalp. Upon examination, circular areas of hair loss with scaling and raised margins, measuring 2-5 cm in diameter, are observed. There is no scarring. What is the probable cause of this condition in the patient?

      Your Answer:

      Correct Answer: Tinea capitis

      Explanation:

      Causes of Non-Scarring and Scarring Alopecia

      Non-scarring alopecia is a condition where hair loss occurs without any visible scarring on the scalp. The most common causes of this type of alopecia include telogen effluvium, androgenetic alopecia, alopecia areata, tinea capitis, and traumatic alopecia. In some cases, non-scarring alopecia can also be associated with lupus erythematosus and secondary syphilis.

      Tinea capitis, caused by invasion of hairs by dermatophytes, most commonly Trichophyton tonsurans, is a common cause of non-scarring alopecia. This type of alopecia is characterized by hair loss in circular patches on the scalp.

      On the other hand, scarring alopecia is a condition where hair loss occurs with visible scarring on the scalp. This type of alopecia is more frequently the result of a primary cutaneous disorder such as lichen planus, folliculitis decalvans, cutaneous lupus, or linear scleroderma (morphea). Scarring alopecia can be permanent and irreversible, making early diagnosis and treatment crucial.

      In conclusion, the different causes of non-scarring and scarring alopecia is important in determining the appropriate treatment plan for patients experiencing hair loss.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 8 - What is a true statement about atopic eczema? ...

    Incorrect

    • What is a true statement about atopic eczema?

      Your Answer:

      Correct Answer: Usually starts in the first year of life

      Explanation:

      Atopic Eczema

      Atopic eczema is a skin condition that is more likely to occur in individuals who have a family history of asthma, hay fever, and eczema. One of the common causes of this condition is cow’s milk, and switching to a milk hydrolysate may help alleviate symptoms. The condition typically affects the face, ears, elbows, and knees.

      It is important to note that topical steroids should only be used sparingly if symptoms cannot be controlled. Atopic eczema often develops in the first year of life, making it crucial for parents to be aware of the symptoms and seek medical attention if necessary. By the causes and symptoms of atopic eczema, individuals can take steps to manage the condition and improve their quality of life.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 9 - A 28-year-old builder comes to the GP complaining of large itchy silvery white...

    Incorrect

    • A 28-year-old builder comes to the GP complaining of large itchy silvery white scaly patches on his elbows and knees. He has no history of skin problems, but his father had psoriasis. What is the most suitable initial treatment to prescribe?

      Your Answer:

      Correct Answer: Topical steroid and topical calcipotriol

      Explanation:

      Topical Treatments for Chronic Plaque Psoriasis: NICE Recommendations

      Chronic plaque psoriasis is a common skin condition that can be managed with topical treatments. The National Institute for Health and Care Excellence (NICE) recommends a stepwise approach to treatment, with different options depending on the severity of the condition and the response to previous therapies.

      First-line treatment for chronic plaque psoriasis is a potent corticosteroid applied once daily, combined with a vitamin D analogue, for up to 4 weeks. This combination therapy has been shown to be effective in reducing inflammation and improving symptoms.

      If there is no improvement with both steroid and calcipotriol after 8 weeks, topical calcipotriol alone can be used as a second-line management option. However, it is insufficient to prescribe alone as a first-line treatment.

      Topical steroid alone is a third-line management option for psoriasis if there is no improvement after 8-12 weeks. This is because long-term use of topical steroids can have side effects such as skin thinning and increased risk of infection.

      Short-acting dithranol could be used as a fourth-line option, but not as initial management. Topical coal tar is also part of third-line management for psoriasis.

      In summary, the NICE recommendations for topical treatments for chronic plaque psoriasis involve a stepwise approach, with combination therapy as the first-line option and other treatments used if there is no improvement or if side effects occur. It is important to work with a healthcare provider to find the most effective and safe treatment plan for each individual.

      NICE Recommendations for Topical Treatments for Chronic Plaque Psoriasis

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 10 - A 42-year-old man visits his primary care physician complaining of thick, well-defined, red...

    Incorrect

    • A 42-year-old man visits his primary care physician complaining of thick, well-defined, red patches with silvery scales on the extensor surfaces of his elbows and knees. He has been experiencing these skin lesions intermittently for the past 3 years. The lesions tend to improve during the summer months, worsen during times of stress, and reappear at the site of trauma, particularly where he scratches. A skin biopsy specimen reveals epidermal hyperplasia and parakeratosis, with neutrophils present within the epidermis. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Plaque psoriasis

      Explanation:

      Differentiating Skin Conditions: A Brief Overview

      Psoriasis is a skin condition characterized by a rash with typical histology and location. The Koebner phenomenon, where lesions occur at sites of trauma, is a common feature of psoriasis. Treatment involves exposure to ultraviolet light, tar-based treatments, and immunosuppressant drugs. Pruritus is not always present.

      Seborrhoeic dermatitis presents as itchy, ill-defined erythema and greasy scaling on the scalp, nasolabial folds, or post-auricular skin in adults and adolescents.

      Lichen planus is characterized by flat-topped, pruritic, polygonal, red-to-violaceous papules or plaques. Lesions are often located on the wrist, with papules demonstrating central dimpling.

      Atopic dermatitis is a chronic inflammatory skin disease characterized by itchy, red rashes often found in the flexor areas of joints.

      Tinea corporis is a ringworm infection characterized by expanding patches with central clearing and a well-defined active periphery. The active periphery is raised, pruritic, moist, erythematosus, and scaly, with papules, vesicles, and pustules.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 11 - A 57-year-old accountant presents with an acute onset of widespread blistering of the...

    Incorrect

    • A 57-year-old accountant presents with an acute onset of widespread blistering of the skin. She is usually healthy but has been taking regular ibuprofen for the past two days due to a headache.
      On examination, the patient has numerous tense bullae across the trunk and limbs. There is no involvement of the mouth. The dermatologist suspects bullous pemphigoid and wonders which adhesive structure is disrupted by autoimmune mechanisms in this condition.

      Your Answer:

      Correct Answer: Hemidesmosome

      Explanation:

      Cell Junctions: Types and Functions

      Cell junctions are specialized structures that connect adjacent cells and play a crucial role in maintaining tissue integrity and function. There are several types of cell junctions, each with a unique structure and function.

      Hemidesmosome: Hemidesmosomes are structures that anchor cells of the stratum basale of the skin to the underlying epidermal basement membrane. Autoantibodies to hemidesmosome components can cause bullous pemphigoid, a disease characterized by large, fluid-filled blisters.

      Desmosome: Desmosomes bind cells together in the more superficial layers of the epidermis. Desmogleins are important proteins for desmosome integrity. Autoantibodies to desmogleins can cause pemphigus vulgaris and other types of pemphigus.

      Zonula occludens: The zonula occludens is a tight junction that fuses the outer leaflets of the plasma membrane, preventing the passage of small molecules between cells.

      Zonula adherens: The zonula adherens is an intercellular adhesion site that contains small gaps between adjacent plasma membranes in the junctional complex. It is reinforced by intracellular microfilaments.

      Gap junction: Gap junctions create an aqueous channel between adjacent cells, allowing the passage of small signaling molecules for the coordination of various physiological activities.

      In summary, cell junctions are essential for maintaining tissue integrity and function. Each type of junction has a unique structure and function, and disruptions in their integrity can lead to various diseases.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 12 - A 50-year-old pharmacist with a longstanding diagnosis of sarcoidosis presents to the Dermatology...

    Incorrect

    • A 50-year-old pharmacist with a longstanding diagnosis of sarcoidosis presents to the Dermatology Clinic with an unsightly rash. The rash has been present for a number of years, but the area affected is becoming more prominent and is making her feel very self-conscious. She has been told previously that the rash is connected to her sarcoidosis; however, she would like to know if anything can be done to treat it.
      Which one of the following dermatological conditions is diagnostic of chronic sarcoidosis?

      Your Answer:

      Correct Answer: Lupus pernio

      Explanation:

      Cutaneous Manifestations of Sarcoidosis

      Sarcoidosis is a systemic disease that can affect multiple organs, including the skin. Cutaneous manifestations of sarcoidosis can vary and may present differently depending on the stage of the disease. Here are some common cutaneous manifestations of sarcoidosis:

      Lupus pernio: This is a specific skin involvement that affects the bridge of the nose and the area beneath the eyes and cheeks. It is diagnostic for the chronic form of sarcoidosis. The lesions are typically large, bluish-red and dusky purple, infiltrated, plaque-like nodules.

      Erythema nodosum: This is seen in the acute stage of sarcoidosis, but it is also seen in many other diseases.

      Keloid formation: This is a classic cutaneous lesion of sarcoidosis, but it is not diagnostic of chronic sarcoidosis.

      Subcutaneous nodules: These can also be seen in rheumatoid arthritis and are not diagnostic of sarcoidosis.

      It is important to note that cutaneous manifestations of sarcoidosis can be nonspecific and may resemble other skin conditions. Therefore, a thorough evaluation by a healthcare provider is necessary for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 13 - A 28-year-old man who has been experiencing a lot of stress at work...

    Incorrect

    • A 28-year-old man who has been experiencing a lot of stress at work lately presents with an itchy, red rash above the right corner of his mouth. The rash appeared 4 months ago, went away briefly, and then returned. He has used a topical corticosteroid to alleviate the symptoms, but had to discontinue it due to a flare-up of his facial acne. He admits to drinking excessive amounts of alcohol recently. On examination, there is a poorly defined red rash on the right side of his face, affecting the nasolabial fold. Additionally, there are fine, oily scales present.

      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Seborrhoeic dermatitis

      Explanation:

      Common Skin Conditions and Their Characteristics

      Seborrhoeic Dermatitis: This condition is characterized by an ill-defined, itchy, erythematosus rash with fine, greasy scales. It typically affects the scalp, nasolabial fold, or post-auricular skin in adolescents and adults.

      Dermatitis Herpetiformis: Often seen in patients with coeliac disease and malabsorption, this condition presents with intensely itchy grouped vesicles/papules over the extensor surfaces of the elbow, knee, upper back, and buttocks.

      Lichen Planus: This condition is characterized by flat-topped, pruritic, red to violaceous polygonal papules or plaques. Lesions are often located on the wrists.

      Atopic Dermatitis: This condition involves flexural regions in adult patients and is often associated with a history of atopy. The acute form of atopic dermatitis presents with erythema, oedema, vesicles, and papules.

      Psoriasis: This condition is characterized by thick, well-demarcated erythematous plaques with silvery scaling over the extensor surface of the elbows and knees.

      Characteristics of Common Skin Conditions

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 14 - A 35-year-old woman comes to her GP complaining of facial erythema. She has...

    Incorrect

    • A 35-year-old woman comes to her GP complaining of facial erythema. She has developed papules and pustules with visible telangiectasia. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Acne Rosacea

      Explanation:

      Common Skin Conditions: Causes, Symptoms, and Treatments

      Acne Rosacea:
      Acne rosacea is a chronic skin condition that typically affects women and people with fair skin between the ages of 30-50. The exact cause is unknown, but environmental factors such as alcohol, caffeine, heat, and stress can aggravate the condition. Symptoms include a persistent erythematosus rash on the face, particularly over the nose and cheeks, with associated telangiectasia. Treatment involves lifestyle modifications and pharmacological interventions with topical or oral antibiotics.

      Acne Vulgaris:
      Acne vulgaris is an inflammatory response to Propionibacterium acnes, a normal skin commensal. It commonly affects adolescents and presents with a variety of lesions ranging from comedones to cysts and scars. It predominantly affects areas with high concentrations of sebaceous glands, such as the face, back, and chest.

      Discoid Lupus Erythematosus:
      Discoid lupus erythematosus is a cutaneous form of lupus erythematosus that affects sun-exposed areas of the skin. It typically presents in women between the ages of 20-40 and presents as red patches on the nose, face, back of the neck, shoulders, and hands. If left untreated, it can cause hypertrophic, wart-like scars.

      Pityriasis Rosea:
      Pityriasis rosea is a self-limiting skin condition that affects young adults, mostly women. It presents with salmon-pink, flat or slightly raised patches with surrounding scale known as a collarette. The rash is usually symmetrical and distributed predominantly on the trunk and proximal limbs.

      Psoriasis:
      Psoriasis is an autoimmune skin condition that presents with red scaly patches on the extensor surfaces of the limbs and behind the ears. Treatment involves topical or systemic medications to control symptoms and prevent flares.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 15 - A 6-year-old girl is brought to the General Practitioner (GP) by her mother....

    Incorrect

    • A 6-year-old girl is brought to the General Practitioner (GP) by her mother. She has suffered an insect bite, and her mother is concerned about a small lump on the back of her hand.
      Which of the following conditions is not pre-malignant?

      Your Answer:

      Correct Answer: Dermatofibroma

      Explanation:

      Common Pre-Malignant Skin Conditions

      There are several pre-malignant skin conditions that can occur due to various factors. One such condition is dermatofibroma, which is an overgrowth of fibrous tissue in the dermis. It is usually benign and can be caused by minor skin trauma like an insect bite.

      Another pre-malignant condition is Bowen’s disease, which is a type of intraepidermal carcinoma. It presents as scaly, erythematosus lesions and is often associated with sun exposure.

      Lentigo maligna, also known as melanoma in situ, is an early form of melanoma that develops slowly over time. It typically appears on sun-exposed areas of the skin.

      Leukoplakia is a pre-malignant condition that presents as white or grey patches in the oral cavity. It is important to have these patches evaluated by a healthcare professional.

      Actinic keratoses, or solar keratoses, are pre-malignant conditions that occur due to chronic exposure to ultraviolet light. They are more common in fair-skinned individuals and typically affect sun-exposed areas of the skin. Regular skin checks and sun protection can help prevent these conditions from developing into skin cancer.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 16 - A 30-year-old man with a history of asthma and ulcerative colitis presents with...

    Incorrect

    • A 30-year-old man with a history of asthma and ulcerative colitis presents with an itchy, red rash in the right and left popliteal regions. He works as a teacher and continuously scratches the back of his knees when he is at work. This is the second time he has suffered from such a popliteal rash. He states that previously he has had similar skin conditions affecting his anterior wrist and antecubital areas. On examination, both popliteal areas are erythematosus with slight oedema and weeping. There are some overlying vesicles and papules.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Atopic dermatitis

      Explanation:

      Differentiating Skin Conditions Based on Location and Distribution

      When it comes to diagnosing skin conditions, the location and distribution of the rash or lesion are just as important as its appearance. For example, a rash in the flexural regions of an adult patient, such as the popliteal region, is likely to be atopic dermatitis. This is especially true if the patient has a history of asthma, indicating an atopic tendency. Acute dermatitis typically presents with redness, swelling, vesicles, and papules.

      Other skin conditions have different characteristic distributions. Dermatitis herpetiformis, which is associated with coeliac disease and malabsorption, typically appears as grouped vesicles or papules on the elbows, knees, upper back, and buttocks. Seborrhoeic dermatitis is found in areas with sebaceous glands, such as the scalp, eyebrows, and presternal regions. Lichen planus presents as flat-topped, pruritic, polygonal, red-to-violaceous papules or plaques, usually on the wrists, ankles, or genitalia. Psoriasis, on the other hand, produces silvery, scaling, erythematosus plaques, primarily on the extensor surfaces.

      In summary, understanding the location and distribution of a skin condition can help clinicians make an accurate diagnosis and provide appropriate treatment.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 17 - A 36-year-old African-American man undergoes a pre-employment health check. Chest radiograph demonstrates bilateral...

    Incorrect

    • A 36-year-old African-American man undergoes a pre-employment health check. Chest radiograph demonstrates bilateral hilar lymphadenopathy. More detailed history and examination reveals painful red papules on both shins of recent onset. He is otherwise well. Basic blood tests are normal.
      What rash does the patient have?

      Your Answer:

      Correct Answer: Erythema nodosum

      Explanation:

      Differentiating Skin Rashes: A Comparison of Erythema Nodosum, Erythema Multiforme, Kaposi’s Sarcoma, Tinea Corporis, and Steven-Johnson’s Syndrome

      Erythema nodosum is a rash characterized by painful red papules caused by inflammation of the subcutaneous fat. It is commonly seen on the extensor surfaces of the lower limbs and can be linked to various conditions such as streptococcal and tuberculous infection, inflammatory bowel disease, lymphoma, drug-related causes, and sarcoidosis.

      Erythema multiforme, on the other hand, presents with typical target lesions on the extremities. It is an uncommon condition that can be mistaken for other skin rashes.

      Kaposi’s sarcoma is an AIDS-defining malignancy caused by human herpes virus 8. It appears as red/purple papules on the skin or mucosal surfaces. However, the description of the rash, normal blood results, and an otherwise healthy patient make this diagnosis unlikely.

      Tinea corporis, also known as ringworm, is a fungal infection transmitted from common pets or human-to-human. It presents as an erythematosus, scaly ring-like rash with central clearing.

      Steven-Johnson’s syndrome is a severe form of erythema multiforme with multiple erythematosus macules on the face and trunk, epidermal detachment, and mucosal ulceration. It is a rare condition that can cause significant morbidity and mortality.

      In summary, differentiating between these skin rashes is crucial for proper diagnosis and treatment. A thorough evaluation of the patient’s medical history, physical examination, and laboratory tests can help identify the underlying cause of the rash.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 18 - A 35-year-old patient with a chronic skin condition is under annual review with...

    Incorrect

    • A 35-year-old patient with a chronic skin condition is under annual review with the Dermatology team. At her review appointment, the patient mentions that she has been experiencing episodes of new skin lesions appearing in areas where she has scratched, often appearing in straight lines. The doctor examines a typical lesion, and notes that they are examples of Koebner phenomenon.
      In which one of the following conditions is the Koebner phenomenon MOST likely to be seen?

      Your Answer:

      Correct Answer: Psoriasis

      Explanation:

      The Koebner Phenomenon: Skin Conditions and Cutaneous Injury

      The Koebner phenomenon is a term used to describe the appearance of new skin lesions in areas of cutaneous injury, often caused by scratching, in otherwise healthy skin. This phenomenon is commonly seen in skin conditions such as psoriasis, vitiligo, and lichen planus. It may also manifest in association with other conditions such as viral warts, pyoderma gangrenosum, and molluscum contagiosum.

      In cases where the Koebner phenomenon occurs, the new lesions have the same clinical and histological features as the patient’s original skin disease. They are often linear in nature, following the route of cutaneous injury.

      It is important to note that not all skin conditions exhibit the Koebner phenomenon. Rosacea, eczema, pityriasis rosea, and cellulitis are examples of skin conditions that do not exhibit this phenomenon.

      In summary, the Koebner phenomenon is a unique characteristic of certain skin conditions that can occur in response to cutaneous injury. Understanding this phenomenon can aid in the diagnosis and management of these skin conditions.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 19 - A 25-year-old man without prior history of skin issues comes in with severe...

    Incorrect

    • A 25-year-old man without prior history of skin issues comes in with severe itching that worsens at night. The rash is made up of small, red, extremely itchy bumps on the limbs and torso. His girlfriend is also experiencing itching. Upon closer examination of his skin, what finding would most likely confirm the diagnosis?

      Your Answer:

      Correct Answer: Burrows

      Explanation:

      Understanding Scabies: Symptoms and Characteristics

      Scabies is a skin condition caused by the infestation of the mite Sarcoptes scabiei, variety hominis. The female mite burrows into the skin, creating characteristic lesions known as burrows. However, the absence of burrows does not rule out a diagnosis of scabies. Other symptoms include erythema, or redness and scaling of the skin, and excoriations, or skin abrasions caused by scratching. In severe cases, crusting patches may develop, particularly in crusted scabies, a highly contagious variant of the condition. Prurigo nodules, or small bumps on the skin, may also occur in scabies, especially in young children. It is important to seek medical attention if you suspect you have scabies, as prompt treatment can prevent the spread of the condition.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 20 - A 45-year-old man came to the clinic during the summer with complaints of...

    Incorrect

    • A 45-year-old man came to the clinic during the summer with complaints of itching and blistering on his hands and forehead. Upon examination, small areas of excoriation were found on the backs of his hands. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Porphyria cutanea tarda (PCT)

      Explanation:

      Photosensitivity and Skin Lesions: A Possible Case of PCT

      The distribution of the skin lesions in this case suggests that there may be a photosensitive element involved. While both lupus erythematosus and porphyria cutanea tarda (PCT) are associated with photosensitivity, it is more commonly seen in PCT. This condition is characterized by blistering of the hands and forehead, which can lead to small scars and milia formation as they heal. Excessive alcohol intake is also a known risk factor for PCT.

      Overall, the presence of photosensitivity and the specific distribution of the lesions in this case point towards a possible diagnosis of PCT. Further testing and evaluation will be necessary to confirm this diagnosis and determine the best course of treatment.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 21 - A 55-year-old woman comes to the clinic with blisters on her skin. She...

    Incorrect

    • A 55-year-old woman comes to the clinic with blisters on her skin. She reports that some of the blisters have healed and left scars, but others are still growing and new ones are appearing. Despite taking antibiotics prescribed by her primary care physician, the blisters have not improved. Upon examination, the patient has multiple superficial skin lesions and oral lesions that easily slough off. A skin punch biopsy with immunofluorescent examination reveals circular intra-epidermal deposits. What other symptoms may this patient be experiencing?

      Your Answer:

      Correct Answer: Antibodies against desmosomes

      Explanation:

      Understanding Pemphigus Vulgaris: An Autoimmune Blistering Condition

      Pemphigus vulgaris is a blistering condition that primarily affects middle-aged individuals. It is caused by IgG autoantibodies against desmosomal components, specifically desmogleins 1 and 3, in the superficial layers of the skin. This results in flaccid blisters that easily rupture, leading to erosions and scarring. The oral mucosa is often affected early on, and Nikolsky’s sign is positive. Immunofluorescence reveals intra-epidermal circular deposits, and antibodies against desmosomes are typically positive. Treatment involves high-dose steroids and may require life-long maintenance doses. In contrast, bullous pemphigoid, which affects older individuals, is characterized by antibodies against hemidesmosomes in the deeper basement membrane of the skin, resulting in tense, firm blisters that do not rupture easily. Psoriasis, alopecia, and HIV are not linked to pemphigus vulgaris.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 22 - A 21-year-old student presents to his GP a few days after returning from...

    Incorrect

    • A 21-year-old student presents to his GP a few days after returning from a regeneration project working with a fishing community in South America. His main complaint is of an itchy, erythematosus rash predominantly affecting both feet. He has no past medical history of note. On examination he has erythematosus, edematous papules and vesicles affecting both feet. There are serpiginous erythematosus trails which track 2-3 cm from each lesion. Investigations:
      Investigation Result Normal value
      Haemoglobin 138 g/l 135–175 g/l
      White cell count (WCC) 8.0 × 109/l
      (slight peripheral blood eosinophilia) 4–11 × 109/l
      Platelets 245 × 109/l 150–400 × 109/l
      Sodium (Na+) 140 mmol/l 135–145 mmol/l
      Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
      Creatinine 79 μmol/l 50–120 µmol/l
      Chest X-ray Normal lung fields
      Which of the following diagnoses fits best with this clinical scenario?

      Your Answer:

      Correct Answer: Cutaneous larva migrans

      Explanation:

      Cutaneous Larva Migrans and Other Skin Conditions: A Differential Diagnosis

      Cutaneous larva migrans is a common skin condition caused by the migration of nematode larvae through the skin. It is typically found in warm sandy soils and can be diagnosed based on the history and appearance of serpiginous lesions. Treatment involves the use of thiobendazole. Other skin conditions, such as impetigo, tinea pedis, and photoallergic dermatitis, have different causes and presentations and are less likely to be the correct diagnosis. Larva currens, caused by Strongyloides stercoralis, is another condition that can cause itching and skin eruptions, but it is typically associated with an intestinal infection and recurrent episodes. A differential diagnosis is important to ensure proper treatment and management of these skin conditions.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 23 - A 56-year-old woman with a 28-year history of psoriasis presents to the Dermatologist....

    Incorrect

    • A 56-year-old woman with a 28-year history of psoriasis presents to the Dermatologist. Despite treatment with ciclosporin, she has multiple patches on her arms, legs and scalp, which affect her sleep and work. The Dermatologist decides to initiate biological therapy with a TNF-alpha inhibitor. The patient has a past medical history of inactive tuberculosis.
      Which TNF-alpha inhibitor is the Dermatologist likely to prescribe for the patient's severe psoriasis?

      Your Answer:

      Correct Answer: Adalimumab

      Explanation:

      Biological Agents for the Treatment of Psoriasis

      Psoriasis is a chronic autoimmune disease that affects the skin and joints. Biological agents have revolutionized the treatment of psoriasis by targeting specific molecules involved in the immune response. Here are some commonly used biological agents for the treatment of psoriasis:

      Adalimumab: This agent targets tumor necrosis factor-alpha (TNF-alpha), a cytokine involved in systemic inflammation. Adalimumab is used when other systemic treatments have failed and the disease is severe.

      Brodalumab: This agent targets the interleukin 17 receptor found on CD8+ cytotoxic T cells. It is used when methotrexate or ciclosporin have failed.

      Infliximab: This agent is also a TNF-alpha inhibitor, but it has been shown to reactivate latent tuberculosis. Therefore, it should be used with caution in patients with a history of tuberculosis.

      Guselkumab: This agent targets interleukin 23, which is involved in the activation of T17 lymphocytes. It is used in the treatment of moderate to severe psoriasis.

      Secukinumab: This agent targets interleukin 17, which is found on CD8+ cytotoxic T cells. It is used in the treatment of moderate to severe psoriasis.

      Before starting any of these agents, certain criteria must be met, such as failure of other treatments and severity of the disease. Additionally, some agents may be contraindicated in patients with certain medical histories, such as a history of tuberculosis.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 24 - A 35-year-old recently arrived female with several skin blisters comes in for assessment....

    Incorrect

    • A 35-year-old recently arrived female with several skin blisters comes in for assessment. A few of the blisters have burst, resulting in a sore, exposed region. The base of one of the erosive lesions is scraped for Tzanck test. Upon examination, acantholytic keratinocytes with significant hyperchromatic nuclei are detected under the microscope.

      What is the probable diagnosis?

      Your Answer:

      Correct Answer: Pemphigus vulgaris

      Explanation:

      Distinguishing Skin Conditions on Tzanck Smear: Pemphigus Vulgaris, Cytomegalovirus, Herpes Simplex, Chickenpox, and Bullous Pemphigoid

      When examining a patient’s bullous skin lesions on a Tzanck smear, it is important to distinguish between various skin conditions. In the case of acantholytic keratinocytes, the most likely diagnosis is pemphigus vulgaris. This autoimmune disorder is caused by an antibody against intraepithelial desmosomal junctions, resulting in the separation of keratinocytes and the formation of intraepithelial blisters.

      Cytomegalovirus, herpes simplex, and chickenpox can also present with multinucleated giant cells on a Tzanck smear. However, these conditions are caused by viral infections rather than autoimmune disorders.

      Bullous pemphigoid, on the other hand, is caused by an antibody against the dermal-epidermal junction. The associated blisters are sub-epidermal in location and do not contain acantholytic keratinocytes.

      In summary, a Tzanck smear can provide valuable information in diagnosing various skin conditions, including pemphigus vulgaris, cytomegalovirus, herpes simplex, chickenpox, and bullous pemphigoid. Proper diagnosis is crucial in determining the appropriate treatment plan for the patient.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 25 - A 45-year-old man visits his GP with a lump on the side of...

    Incorrect

    • A 45-year-old man visits his GP with a lump on the side of his head. During the examination, the GP suspects that the lump may be a basal cell carcinoma. What characteristic is most indicative of this diagnosis?

      Your Answer:

      Correct Answer: Telangiectasia

      Explanation:

      Understanding Basal Cell Carcinomas: Characteristics and Warning Signs

      Basal cell carcinomas are the most common type of skin cancer, typically found in sun-exposed areas such as the face and neck. They can be familial and associated with certain syndromes. A basal cell carcinoma often appears as a slow-growing, skin-colored, pearly nodule with surface telangiectasia, or fine vessels on the surface. It may also be an ulcerated lesion with rolled edges. Biopsy confirms the diagnosis, and treatment involves excision with a clear margin. While basal cell carcinomas rarely metastasize, they can be locally invasive and destructive. Pigmentation is a feature of melanocytic lesions, but basal cell carcinomas may rarely show pigmentation. Size is not a specific feature of malignancy, but sudden increases in size should be referred for further assessment. Other warning signs include crusted edges and unprovoked bleeding.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 26 - A 26-year-old woman visits her General Practitioner concerned about excessive hair growth on...

    Incorrect

    • A 26-year-old woman visits her General Practitioner concerned about excessive hair growth on her face, back, and arms. Despite trying various hair removal methods and bleaching, she is considering treatment to prevent hair growth. Her BMI is 30 kg/m2, and she reports irregular periods, menstruating once every 7-9 months. Her recent blood tests showed elevated levels of testosterone and luteinising hormone. What is the best course of action for this patient, considering the probable diagnosis?

      Your Answer:

      Correct Answer: Oral combined contraceptive pill

      Explanation:

      Management of Hirsutism in Polycystic Ovary Syndrome: First-Line Options

      Polycystic ovary syndrome (PCOS) is a condition characterized by irregular menstrual cycles, excess hair growth, and raised hormone levels. In patients with PCOS experiencing hirsutism and irregular periods, the first-line management option is the oral combined contraceptive pill. This medication reduces hyperandrogenism by suppressing ovarian androgen secretion and increasing binding of androgens, thereby reducing excess hair growth. Metformin can also be used to improve insulin resistance and aid weight management, but it would not be the first-line choice for managing hirsutism. Eflornithine can be used for hirsutism, but in this patient, starting the contraceptive pill will not only treat her hirsutism but also allow for regular withdrawal bleeds and regulate her menstrual cycle. The progesterone-only pill and topical minoxidil are not recommended as first-line options for managing hirsutism in PCOS patients.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 27 - A 70-year-old man presents with erythema, vesicles and crusted ulcerations on the right...

    Incorrect

    • A 70-year-old man presents with erythema, vesicles and crusted ulcerations on the right scalp, forehead and periorbital region. The affected area is swollen and causing him pain. Additionally, there are some vesicles present at the tip of his nose. He reports experiencing a headache in that area several days prior to the onset of the rash. What is the most probable causative organism for this rash?

      Your Answer:

      Correct Answer: Varicella-zoster virus

      Explanation:

      Common Skin Infections and Their Causes

      Skin infections can be caused by a variety of pathogens, including viruses, fungi, and bacteria. Here are some common skin infections and their causes:

      Varicella-zoster virus: This virus causes shingles, which is a reactivation of the virus that has been dormant in the dorsal root ganglia after the patient’s initial exposure to the virus in the form of chickenpox. A live attenuated vaccine is now available that is effective in preventing shingles.

      Herpes simplex virus infection: This virus can occasionally appear in a dermatomal distribution, mimicking shingles. It presents with erythema and vesicles, but the area of skin involved is usually much less than in shingles and pain is not as prominent.

      Malassezia furfur: This fungus causes tinea versicolor, a common benign, superficial cutaneous fungal infection characterized by hypopigmented or hyperpigmented macules and patches on the chest and back.

      Trichophyton verrucosum: This dermatophyte fungus of animal origin (zoophilic) causes a kerion, a severely painful inflammatory reaction with deep suppurative lesions on the scalp or beard area.

      Staphylococcus aureus: This bacterium causes impetigo, sycosis, ecthyma, and boils.

      Common Skin Infections and Their Causes

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 28 - A 72-year-old retired farmer has switched his General Practitioner (GP) and comes in...

    Incorrect

    • A 72-year-old retired farmer has switched his General Practitioner (GP) and comes in for a check-up. During the appointment, he asks for a review of several lesions on his forehead.

      Upon examination, he is bald and has multiple scaly, crusted lesions on his mid-frontal scalp, along with a keratinous horn with a smooth base on the helix of his right ear. He mentions that he had similar lesions on his scalp before. These were treated with a cream that made the lesions worse for four weeks before completely resolving when the treatment was finished.

      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Actinic keratosis

      Explanation:

      Differentiating Skin Lesions: Actinic Keratosis, Chondrodermatitis Nodularis Helicis, Basal Cell Carcinoma, Lentigo Maligna, and Seborrhoeic Keratosis

      Skin lesions can be difficult to differentiate, but understanding their characteristics can aid in diagnosis and treatment. Actinic keratosis is a pre-malignant condition that is more common in sun-exposed patients, often presenting as scaly lesions on bald areas. Treatment with Efudix may initially worsen the lesions before improving. Chondrodermatitis nodularis helicis is a benign condition characterized by a tender, firm lesion on the ear due to pressure from sleeping on that side. It is treated with strong topical steroids and is not associated with a keratinous horn. Basal cell carcinoma is a common skin cancer associated with sun exposure, presenting with telangiectasia and a rolled edge. Lentigo maligna is a malignant lesion associated with sun exposure, typically pigmented and occurring on the face. Seborrhoeic keratosis is a common benign lesion that can mimic other lesions, but is not associated with sun exposure and is often found on the back, appearing stuck-on rather than scaly. Understanding the characteristics of these skin lesions can aid in accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 29 - A 35-year-old teacher, has recently discovered a suspicious spot on her left arm....

    Incorrect

    • A 35-year-old teacher, has recently discovered a suspicious spot on her left arm. Worried about the potential of skin cancer, she has been researching online to learn how to identify malignant melanoma.
      What are the ABCDE characteristics that Samantha should be monitoring?

      Your Answer:

      Correct Answer: Asymmetry, border irregularity, colour variation, diameter >6mm, evolving

      Explanation:

      Understanding the ABCDE Criteria for Skin Lesion Screening

      Skin cancer, particularly malignant melanoma, is becoming increasingly common. To aid in early detection, the ABCDE criteria is a widely used tool in screening for melanoma. The criteria includes Asymmetry, Border irregularity, Colour variation, Diameter greater than 6mm, and Evolving. Other screening criteria, such as the Glasgow criteria, can also be used. It is important to note that an elevated lesion does not necessarily indicate pathology, and that crusting lesions should be examined carefully for other signs of suspicion. By understanding and utilizing these criteria, healthcare professionals can aid in the early detection and treatment of skin cancer.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 30 - What is the dermatological condition that is linked to neurofibromatosis type 1? ...

    Incorrect

    • What is the dermatological condition that is linked to neurofibromatosis type 1?

      Your Answer:

      Correct Answer: Café au lait spots

      Explanation:

      Neurofibromatosis Type 1 and Type 2

      Neurofibromatosis is a genetic disorder that affects the 17th chromosome and is inherited in an autosomal dominant manner. There are two types of neurofibromatosis: type 1 and type 2. Type 1 is also known as von Recklinghausen’s disease and is characterized by flat, light-brown skin lesions called café au lait spots, axillary freckling, small purple-colored lesions called dermal neurofibromas, nodular neurofibromas that can cause paraesthesia when compressed, and Lisch nodules on the iris. Complications of type 1 neurofibromatosis include nerve compression, phaeochromocytoma, mild learning disability, and epilepsy.

      Type 2 neurofibromatosis is much rarer than type 1 and also demonstrates autosomal dominant inheritance. In addition to café au lait spots, individuals with type 2 may also develop vestibular schwannomas (acoustic neuromas) and premature cataracts. It is important to note that while both types of neurofibromatosis share some similarities, they also have distinct differences in their clinical presentation and associated complications. these differences can aid in accurate diagnosis and management of these conditions.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Dermatology (1/2) 50%
Passmed