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  • Question 1 - A 57-year-old accountant presents with an acute onset of widespread blistering of the...

    Correct

    • 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: 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
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  • Question 2 - A teenage care assistant from a local nursing home presents with sudden onset...

    Incorrect

    • A teenage care assistant from a local nursing home presents with sudden onset of an intensely itchy rash. This covers her whole body. She has no history of skin problems. On examination there is a combination of raised erythematous papules covering her arms and trunk and linear marks to her forearms. There is excoriated skin in the inter-digital spaces.
      What is the most appropriate treatment?

      Your Answer: Regular emollient plus a moderately potent topical steroid

      Correct Answer: Permethrin cream

      Explanation:

      Understanding Scabies Treatment: Permethrin Cream and Other Options

      Scabies is a skin infestation caused by the mite Sarcoptes scabiei, which can lead to symptoms such as itching and a rash with superficial burrows and pimples. The first-line treatment recommended by NICE is permethrin 5% dermal cream, which needs to be applied to the whole body and repeated a week later. In cases of moderate eczema, a regular emollient plus a moderately potent topical steroid may be used in addition to permethrin. However, a combination of moderately potent topical steroid and topical antifungal agent is not appropriate for scabies treatment. Oral antihistamines may provide symptomatic relief but are not a treatment for scabies. Malathion 5% aqueous solution can be used as a second-line treatment option for patients allergic to chrysanthemums who cannot use permethrin.

    • This question is part of the following fields:

      • Dermatology
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  • Question 3 - An 80-year-old nursing home resident with a history of hypothyroidism and heart failure...

    Incorrect

    • An 80-year-old nursing home resident with a history of hypothyroidism and heart failure presents to you with a complaint of dry, itchy skin that is particularly bothersome on her legs. Upon examination, you observe erythematosus, dry skin on her legs with an unusual pattern. What is the most probable diagnosis?

      Your Answer: Lichen planus

      Correct Answer: Asteatotic eczema

      Explanation:

      Common Skin Conditions: Asteatotic Eczema, Contact Dermatitis, Lichen Planus, Scabies, and Venous Ulceration

      Asteatotic eczema is a skin condition that commonly affects elderly individuals due to over-washing and dry winter climate. It can also be associated with diuretic use and hypothyroidism. The condition causes dry, itchy skin with a unique crazy paving pattern on the limbs. Treatment involves using emollients and mild topical steroids.

      Contact dermatitis, on the other hand, is caused by friction and environmental factors such as cold or exposure to chemicals like detergents and solvents. It typically affects the hands and does not display the crazy paving pattern seen in asteatotic eczema.

      Lichen planus is characterized by a pruritic, papular eruption with a violaceous color and polygonal shape. It presents with a lace-like pattern, unlike the crazy paving pattern seen in asteatotic eczema.

      Scabies is an itchy rash caused by mites that burrow under the skin’s surface. It often affects the very young and elderly, particularly those who live in crowded areas or institutional care. It presents with burrows, particularly on the web spaces between fingers, followed by a hypersensitivity rash. Treatment involves using topical insecticides like 5% permethrin.

      Finally, venous ulceration is present on the lower limbs and can be itchy if associated with venous eczema. However, the legs often display a brown pigmentation of haemosiderin, and a venous ulcer would not present as described in this question.

      In summary, understanding the characteristics of these common skin conditions can help with accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Dermatology
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  • Question 4 - A 32-year-old woman presents with four episodes of oral ulceration in the course...

    Incorrect

    • A 32-year-old woman presents with four episodes of oral ulceration in the course of 1 year. These have taken up to 3 weeks to heal properly. She has also suffered from painful vaginal ulceration. Additionally, there have been intermittent headaches, pain and swelling affecting both knees, and intermittent diarrhoea. On examination, there are several mouth ulcers of up to 1 cm in diameter. She also has erythema nodosum.
      Investigations:
      Investigation Result Normal value
      Haemoglobin 129 g/l 115–155 g/l
      White cell count (WCC) 6.9 × 109/l 4–11 × 109/l
      Platelets 190 × 109/l 150–400 × 109/l
      Erythrocyte sedimentation rate (ESR) 45 mm/h 0–10mm in the 1st hour
      C-reactive protein (CRP) 50 mg/l 0–10 mg/l
      Elevated level of immunoglobulin A (IgA)
      ANCA (antineutrophil cytoplasmic antibody) negative
      antiphospholipid antibody negative
      Which of the following diagnoses fits best with this clinical picture?

      Your Answer: Herpes simplex

      Correct Answer: Behçet’s disease

      Explanation:

      Differentiating Behçet’s Disease from Other Conditions: A Guide

      Behçet’s disease is a syndrome characterized by recurrent painful oral ulceration, genital ulcers, ophthalmic lesions, skin lesions, and possible cerebral vasculitis. However, these symptoms can also be present in other conditions, making diagnosis challenging. Granulomatosis with polyangiitis (GPA) mainly affects the lungs, kidneys, and upper respiratory tract, but does not typically present with ulceration. Herpes simplex is not associated with systemic features, while bullous pemphigoid affects the skin and rarely the mouth. Pemphigus, on the other hand, presents with oral bullae and skin bullae but does not involve elevated levels of IgA. Treatment for Behçet’s disease is complex and depends on the extent of organ involvement and threat to vital organ function.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - A 22-year-old woman presents to her dermatologist with a 4-year history of acne...

    Correct

    • A 22-year-old woman presents to her dermatologist with a 4-year history of acne on her back, chest and face. She has comedones, pustules and scars that have not improved with previous treatments. The dermatologist decides to prescribe isotretinoin. What other medication should be prescribed alongside this?

      Your Answer: Combined oral contraceptive

      Explanation:

      The patient has severe acne and topical treatment has not been effective. The dermatologist will prescribe oral isotretinoin, which is a specialist drug that can only be prescribed in secondary care. However, isotretinoin is teratogenic, so women of reproductive age must use at least two methods of contraception while taking the drug. The combined oral contraceptive pill is often co-prescribed with isotretinoin to help balance the hormonal profile and improve the skin condition. Topical retinoids are the treatment of choice for mild to moderate acne, but they are not indicated for severe acne. Oral oxytetracycline can be used in combination with a topical retinoid or benzoyl peroxide for moderate acne, but it is contraindicated in pregnancy. Topical erythromycin is used for mild to moderate acne and should always be prescribed in combination with benzoyl peroxide to prevent microbial resistance. Topical benzoyl peroxide is used for mild or moderate acne and can be combined with a topical retinoid or antibiotic, or an oral antibiotic for moderate acne.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - A 35-year-old woman with uncontrolled psoriasis is returning with deteriorating symptoms. Despite using...

    Incorrect

    • A 35-year-old woman with uncontrolled psoriasis is returning with deteriorating symptoms. Despite using potent topical treatments, her psoriasis remains uncontrolled.

      What is the next appropriate step in managing her condition?

      Your Answer: Stop steroids and start narrow-band UVB phototherapy

      Correct Answer: Add in narrow-band ultraviolet B (UVB) phototherapy

      Explanation:

      Next Steps in Psoriasis Treatment: Narrow-Band UVB Phototherapy

      When topical treatments fail to improve psoriasis symptoms, the next step in treatment is often narrow-band ultraviolet B (UVB) phototherapy. While it has a reasonable success rate, it also comes with potential complications such as an increased risk of skin cancer. Patients with a history of skin cancer may not be recommended for this treatment.

      Changing topical steroids would not be an appropriate step in the management plan. Instead, it is necessary to move onto the next step of the psoriasis treatment ladder. Biologics are not indicated at this stage and should only be considered as an end-stage treatment due to their high cost and significant side effects.

      Psoralen with local ultraviolet A (UVA) irradiation may be appropriate for patients with palmoplantar pustulosis. However, for most patients, stopping steroids is not recommended. Instead, narrow-band UVB phototherapy should be commenced without stopping steroids to optimize treatment and increase the chances of success.

    • This question is part of the following fields:

      • Dermatology
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  • Question 7 - A 50-year-old woman presents with multiple, ring-shaped, papular rashes on her forearms. She...

    Incorrect

    • A 50-year-old woman presents with multiple, ring-shaped, papular rashes on her forearms. She has recently noticed a white lacy intra-oral lesion.
      What is the most likely cause of this?

      Your Answer: Ringworm

      Correct Answer: Lichen planus

      Explanation:

      Skin Conditions: Lichen Planus, Erythema Multiforme, Tinea Versicolour, Psoriasis, and Ringworm

      Lichen planus is an inflammatory skin condition that affects both cutaneous and mucosal surfaces. It is characterized by flat-topped plaques and papules with a purple hue and white striae. Topical steroids and immunomodulators are used to treat it, as it can increase the risk of squamous cell carcinoma if left untreated.

      Erythema multiforme is a skin condition that presents with targetoid lesions with a central depression, usually starting on the acral extensor surfaces. It can be caused by medications, infections, or underlying conditions such as sarcoidosis and non-Hodgkin’s lymphoma.

      Tinea versicolour, also known as pityriasis versicolor, is a fungal skin infection that causes pale or dark patches on the arms, neck, and trunk. It does not involve mucosal surfaces.

      Psoriasis is an autoimmune chronic skin condition that presents with erythematous plaques with overlying grey scale on the extensor surfaces of extremities. It is not associated with intra-oral mucosal lesions.

      Ringworm, also known as tinea corporis, is a fungal skin infection that causes erythematosus, scaly patches on the skin surface of the trunk, back, and extremities. It is not usually seen on the scalp, groin, palms, and soles. The patches progressively enlarge and worsen, and can lead to the formation of pustules or vesicles. Following central resolution, the lesions can remain annular.

    • This question is part of the following fields:

      • Dermatology
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  • Question 8 - A 42-year-old man visits his primary care physician complaining of thick, well-defined, red...

    Correct

    • 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: 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
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  • Question 9 - 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: Regular Diprobase® ointment and once-daily hydrocortisone 1% cream plus 10 days of oral flucloxacillin

      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
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  • Question 10 - A 45-year-old man came to the clinic during the summer with complaints of...

    Correct

    • 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: 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
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  • Question 11 - A 42-year-old black woman comes in with depigmented patches of skin on her...

    Correct

    • A 42-year-old black woman comes in with depigmented patches of skin on her hands and face. What is the probable diagnosis?

      Your Answer: Vitiligo

      Explanation:

      Common Skin Pigmentation Disorders

      Vitiligo, Pityriasis alba, Albinism, Melasma, and Melanoma are all skin pigmentation disorders that affect people of different ages and ethnicities. Vitiligo is a rare autoimmune condition that destroys melanocytes, causing white patches on the skin. Pityriasis alba is a scaly, white patch that usually affects children’s facial skin. Albinism is a genetic disorder that reduces tyrosinase activity in melanocytes, resulting in a lack of pigment in the skin, hair, and irises. Melasma is a condition of increased pigmentation, usually occurring underneath the eyes, and is common in pregnant women and oral contraceptive users. Melanoma is a malignant skin cancer that develops from melanocytes and is characterized by irregular, highly pigmented moles. Understanding these disorders can help individuals identify and manage their skin conditions.

    • This question is part of the following fields:

      • Dermatology
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  • Question 12 - A 19-year-old man is suffering from acne vulgaris, with inflamed, open comedones on...

    Incorrect

    • A 19-year-old man is suffering from acne vulgaris, with inflamed, open comedones on his face, chest and neck. What micro-organism degrades sebum to produce inflammatory fatty acids in such cases?

      Your Answer: Papillomavirus

      Correct Answer: Propionibacterium acnes

      Explanation:

      Common Skin Infections and their Causes

      Acne vulgaris is a prevalent skin condition among adolescents and young adults, particularly men. Hormonal changes stimulate the sebaceous glands to produce more sebum, leading to the formation of open comedones, which are inflamed follicles with a central dark plug of keratin. Propionibacterium acnes is responsible for breaking down complex lipids in sebum into free fatty acids, which cause inflammation of hair follicles. Treatment with antibiotics and 13-cis-retinoic acid can alleviate the symptoms of acne vulgaris.

      Molluscum contagiosum is caused by the poxvirus, which leads to epidermal hyperplasia and ellipsoid molluscum bodies in the stratum corneum.

      Impetigo is a bacterial infection of the skin caused by Staphylococcus aureus. It is highly contagious and often affects healthy children. The infection starts as a reddened macule and progresses to multiple serum-filled pustules that rupture and form a yellowish crust.

      Papillomavirus causes warts or verrucae, which are common on the hands. They appear as several papules with a rough, irregular surface.

      Tinea versicolor is caused by Malassezia furfur, a fungus that causes superficial fungal infections in the skin. Other forms of tinea are also caused by fungal infections.

    • This question is part of the following fields:

      • Dermatology
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  • Question 13 - What is the probable reason for the nail changes observed in Mr Williams,...

    Incorrect

    • What is the probable reason for the nail changes observed in Mr Williams, an 86-year-old retired dock worker with a history of hypertension and mitral valve replacement, who visited his general practitioner with symptoms of fever, night sweats and fatigue? During examination, his hands showed loss of angle between the nail fold and nail plate, a bulbous fingertip, and painful, erythematous nodules present on both hands.

      Your Answer: Sarcoidosis

      Correct Answer: Infective endocarditis

      Explanation:

      The patient’s nail signs suggest a diagnosis of clubbing, which is commonly seen in various internal conditions such as cardiac issues like infective endocarditis and cyanotic congenital heart disease, respiratory problems like bronchial cancer, tuberculosis, sarcoidosis, cystic fibrosis, and pulmonary fibrosis, gastrointestinal issues like inflammatory bowel disease, biliary cirrhosis, and malabsorption, and other conditions like thyroid acropachy. The presence of Osler’s nodes, painful nodules caused by immune complex deposition, further supports a diagnosis of infective endocarditis, which is commonly associated with this symptom. Although the patient has a history of potential asbestos exposure, the history of heart valve replacement, current symptoms, and nail signs point towards infective endocarditis as the likely diagnosis. Other conditions like inflammatory bowel disease, pulmonary fibrosis, sarcoidosis, and tuberculosis can cause clubbing but not Osler’s nodes.

    • This question is part of the following fields:

      • Dermatology
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  • Question 14 - An 18-year-old man visits his GP with complaints of painful lesions on his...

    Correct

    • An 18-year-old man visits his GP with complaints of painful lesions on his face, neck, and upper back. He has no significant medical history and is not taking any medications. Upon examination, the GP observes multiple pustules on erythematous bases that express serosanguinous fluid and occasional pus. Based on these findings, the GP makes a tentative diagnosis and recommends daily application of topical benzoyl peroxide. What structure is most likely responsible for the development of this patient's skin condition?

      Your Answer: Sebaceous glands

      Explanation:

      The Skin and its Glands: A Brief Overview

      The skin is the largest organ of the human body and is responsible for protecting the body from external factors such as bacteria, viruses, and physical trauma. It is composed of several layers, with the outermost layer being the stratum corneum, a keratinised squamous epithelial layer.

      One of the most common skin conditions is acne, which is caused by the sebaceous glands associated with hair follicles secreting sebum and plugging the hair follicle. If left untreated, acne can cause scars or pock marks after the lesions heal. Treatment options include benzoyl peroxide, tetracycline antibiotics, or retinoic acid.

      Apocrine glands secrete a viscous, milky substance and are found in the axillary and genital regions. They become active during puberty and are associated with a characteristic foul odor due to bacteria consuming the fluid expressed from these glands.

      Eccrine glands are sweat glands and are found all over the body. They play a crucial role in regulating body temperature and eliminating waste products.

      Hemidesmosomes connect basal cells to the underlying basal membrane. Antibodies to hemidesmosomes can lead to the formation of bullous pemphigoid, a rare autoimmune disorder that causes blistering of the skin and mucous membranes.

      Understanding the different glands and layers of the skin can help in the diagnosis and treatment of various skin conditions.

    • This question is part of the following fields:

      • Dermatology
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  • Question 15 - A 23-year-old man presents to his GP with complaints of redness and itching...

    Incorrect

    • A 23-year-old man presents to his GP with complaints of redness and itching on his face and hands. He has been to another GP for similar issues in the past two years and has been on sick leave from his job as a builder. He is currently receiving benefits and is in the process of making an insurance claim for loss of earnings. He mentions that there was one ointment that worked for him, but he has not been able to find it again. On examination, there are no visible skin lesions or rash. The patient appears unconcerned and requests that his GP sign his insurance claim paperwork. What is the most likely diagnosis?

      Your Answer: Conversion disorder

      Correct Answer: Malingering

      Explanation:

      Somatoform Disorders, Malingering, and Munchausen’s Syndrome

      Somatoform disorders are characterized by the unconscious drive to produce illness and the motivation to seek medical attention. On the other hand, malingering involves a conscious effort to fake or claim a disorder for personal gain, such as financial compensation. Meanwhile, Munchausen’s syndrome is a chronic condition where patients have a history of multiple hospital admissions and are willing to undergo invasive procedures.

      In somatoform disorders, patients are not intentionally faking their symptoms. Instead, their unconscious mind is producing physical symptoms as a way to cope with psychological distress. This can lead to a cycle of seeking medical attention and undergoing unnecessary tests and procedures. In contrast, malingering is a deliberate attempt to deceive medical professionals for personal gain. Patients may exaggerate or fabricate symptoms to receive compensation or avoid legal consequences.

      Munchausen’s syndrome is a rare condition where patients repeatedly seek medical attention and undergo invasive procedures despite having no actual medical condition. This behavior is driven by a desire for attention and sympathy from medical professionals. Patients with Munchausen’s syndrome may go to great lengths to maintain their deception, including intentionally harming themselves to produce symptoms.

      In summary, somatoform disorders, malingering, and Munchausen’s syndrome are all conditions that involve the production or faking of physical symptoms. However, the motivations behind these behaviors differ. these conditions can help medical professionals provide appropriate care and support for patients.

    • This question is part of the following fields:

      • Dermatology
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  • Question 16 - A 28-year-old accountant is referred to Dermatology after developing some patches of hypopigmentation....

    Incorrect

    • A 28-year-old accountant is referred to Dermatology after developing some patches of hypopigmentation. The patient reports a 2-month history of patchy areas of discolouration over her chest and back. She is feeling extremely distressed and self-conscious about these areas. The patient has stopped going to the beach due to the lesions, which she previously enjoyed.

      During examination, the patient has multiple patches of flaky, discoloured hypopigmented lesions distributed over the chest and back.

      What is the most likely cause of hypopigmented skin in this case?

      Your Answer:

      Correct Answer: Pityriasis versicolor

      Explanation:

      Skin Conditions and Pigmentation Changes

      Pigmentation changes in the skin can be caused by various factors, including skin conditions and hormonal imbalances. Here are some examples:

      Pityriasis versicolor: This common skin complaint is characterized by flaky, discoloured, hypopigmented patches that mainly appear on the chest and back. It is caused by the overgrowth of a yeast called Malassezia furfur.

      Whipple’s disease: This rare bacterial infection can cause hyperpigmentation in some cases.

      High oestriol: Elevated levels of this hormone, which can occur during pregnancy, are associated with hyperpigmentation.

      Neurofibromatosis type I: This genetic disorder causes numerous café-au-lait patches, which are hyperpigmented patches.

      Urticaria pigmentosa: This condition, which typically develops in childhood, causes hyperpigmented patches that usually fade by the teenage years.

    • This question is part of the following fields:

      • Dermatology
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  • Question 17 - Which statement about nail changes is accurate? ...

    Incorrect

    • Which statement about nail changes is accurate?

      Your Answer:

      Correct Answer: Ridges in the nails may be seen in psoriasis

      Explanation:

      Common Nail Changes and Their Causes

      Nail changes can be a sign of underlying health conditions. Here are some common nail changes and their causes:

      Psoriasis: Ridges, pits, and onycholysis (separation of the nail from the nail bed) are features of psoriasis.

      Splinter haemorrhages: Although splinter haemorrhages occur in bacterial endocarditis, trauma is the most common cause. They can also be associated with rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and psoriasis.

      White nails: White nails are a feature of hypoalbuminaemia.

      Koilonychia: Iron deficiency causes koilonychia and may cause onycholysis. Vitamin B12 deficiency does not cause nail changes.

      Clubbing: Ischaemic heart disease does not cause clubbing.

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      • Dermatology
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  • Question 18 - A 50-year-old man is brought to the Emergency Department by his wife after...

    Incorrect

    • A 50-year-old man is brought to the Emergency Department by his wife after developing a severe cutaneous hypersensitivity reaction. He has a history of rheumatoid arthritis for which he was taking non-steroidal anti-inflammatory drugs (NSAIDs), but his symptoms did not improve and his general practitioner prescribed him methotrexate a few days ago. On examination, Nikolsky’s sign is present and affects 45% of his body’s surface area.
      Which of the following is the underlying condition?

      Your Answer:

      Correct Answer: Toxic epidermal necrolysis

      Explanation:

      Common Skin Hypersensitivity Reactions and Their Causes

      Toxic epidermal necrolysis is a severe skin hypersensitivity reaction that can be fatal and affects a large portion of the body’s surface area. It is often caused by drugs such as NSAIDs, steroids, and penicillins.

      Morbilliform rash is a milder skin reaction that appears as a generalised rash that blanches with pressure. It is caused by drugs like penicillin, sulfa drugs, and phenytoin.

      Erythema nodosum is an inflammatory condition that causes painful nodules on the lower extremities. It can be caused by streptococcal infections, sarcoidosis, tuberculosis, and inflammatory bowel disease.

      Fixed drug reaction is a localised allergic reaction that occurs at the same site with repeated drug exposure. It is commonly caused by drugs like aspirin, NSAIDs, and tetracycline.

      Erythema multiforme is characterised by target-like lesions on the palms and soles. It is caused by drugs like penicillins, phenytoin, and NSAIDs, as well as infections like mycoplasma and herpes simplex.

      Understanding Common Skin Hypersensitivity Reactions and Their Causes

    • This question is part of the following fields:

      • Dermatology
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  • Question 19 - A 7-year-old child has developed itchy, oozing sores on their body, palms, and...

    Incorrect

    • A 7-year-old child has developed itchy, oozing sores on their body, palms, and soles. The child's two siblings are also experiencing similar symptoms. What is the best course of treatment for this patient?

      Your Answer:

      Correct Answer: Topical permethrin

      Explanation:

      Scabies: Symptoms, Causes, and Treatment

      Scabies is a skin infestation that can cause lesions on the palms and soles, accompanied by intense itching. If a sibling has a similar history, it is likely that they are also infested with scabies. The lesions are caused by scratching and can become exudative. The treatment of choice for scabies is topical permethrin or malathion. These medications can help to kill the mites that cause scabies and alleviate the symptoms of itching and skin irritation.

    • This question is part of the following fields:

      • Dermatology
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  • Question 20 - A 10-year-old boy comes to his General Practitioner (GP) complaining of generalised itch...

    Incorrect

    • A 10-year-old boy comes to his General Practitioner (GP) complaining of generalised itch for the past few days. He mentions that it is causing him to lose sleep at night. Upon examination, the GP observes linear burrows on the hands and evidence of excoriation on the abdomen and limbs. The GP suspects scabies as the underlying cause.
      What is the initial treatment recommended for non-crusted scabies?

      Your Answer:

      Correct Answer: Permethrin 5% cream

      Explanation:

      Treatment Options for Scabies: Understanding the Role of Different Medications

      Scabies is a skin condition caused by the Sarcoptes scabiei parasite. The primary treatment for non-crusted scabies is permethrin 5% cream, which is an insecticide. If permethrin is not tolerated or contraindicated, malathion can be used as a second-line agent. It is important to apply permethrin cream over the entire body and wash it off after 8-12 hours. Treatment should be repeated after one week.

      Clotrimazole 2% cream, which is an antifungal medication, is not effective in treating scabies. Similarly, topical antibiotics like fusidic acid cream are not used to treat scabies unless there is a secondary bacterial infection.

      Steroids like hydrocortisone 1% ointment are not used to treat scabies directly, but they can be used to alleviate symptoms like itching. Oral antibiotics like flucloxacillin are only necessary if there is a suspected secondary bacterial infection.

      In summary, understanding the role of different medications in treating scabies is crucial for effective management of the condition.

    • This question is part of the following fields:

      • Dermatology
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  • Question 21 - A 57-year-old diabetic patient presents with an abscess on the nape of his...

    Incorrect

    • A 57-year-old diabetic patient presents with an abscess on the nape of his neck with multiple discharging sinuses.
      Which one of the following terms would you use to describe the presentation?

      Your Answer:

      Correct Answer: Carbuncle

      Explanation:

      Common Skin Infections and Conditions

      Carbuncles, cellulitis, furuncles, infected sebaceous cysts, and necrotising fasciitis are all common skin infections and conditions that can cause discomfort and pain. Carbuncles are collections of pus that discharge to the surface via multiple sinuses and are usually caused by staphylococcal infection. Cellulitis is a bacterial infection of the lower dermis and subcutaneous tissue, presenting with a localised area of painful, red, swollen skin and fever. Furuncles are perifollicular abscesses, also typically caused by staphylococcal infection. Infected sebaceous cysts are round, dome-shaped, encapsulated lesions containing fluid or semi-fluid material. On the other hand, necrotising fasciitis is a serious bacterial infection of the soft tissue and fascia that can result in extensive tissue loss and death if not promptly recognised and treated with antibiotics and debridement. It is important to seek medical attention if any of these conditions are suspected, especially in patients with diabetes or those who are immunosuppressed. Clinical assessment and appropriate diagnostic tests should be conducted to ensure proper treatment and management.

    • This question is part of the following fields:

      • Dermatology
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  • Question 22 - A 42-year-old Irish man presents to the Dermatology clinic with a 3-cm pigmented...

    Incorrect

    • A 42-year-old Irish man presents to the Dermatology clinic with a 3-cm pigmented lesion on his right shin. He also has a Fitzpatrick skin type 1. The lesion appears macular and contains three different shades of pigment. What is the most crucial next step?

      Your Answer:

      Correct Answer: Biopsy

      Explanation:

      Importance of Biopsy in Diagnosing Melanoma

      When a patient with type 1 or 2 skin presents with a pigmented lesion that is large and has multiple colors, it is suggestive of melanoma. It is crucial to inquire about any changes over time and symptoms such as bleeding or itching. A comprehensive medical history should include family history of skin cancers, risk factors such as sun exposure, hobbies, travel, sunburns as a child, previous skin cancers or abnormal moles, and history of immunosuppression. The ABCDE rule should be followed for suspicious pigmented lesions.

      A biopsy is necessary for diagnosis and determining the prognosis of melanoma based on the Breslow depth. Clinical photographs and follow-up in 3 months may be appropriate in some cases, but if there is a suspicion of melanoma, an urgent biopsy is necessary. Scrapings for mycology are not useful in diagnosing pigmented lesions, and measuring ACE levels is not appropriate in this scenario.

      In conclusion, a biopsy is essential in diagnosing melanoma and determining its prognosis. It is crucial to follow the ABCDE rule and obtain a comprehensive medical history to identify any risk factors. Early detection and prompt treatment can significantly improve the patient’s outcome.

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      • Dermatology
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  • Question 23 - 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.

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      • Dermatology
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  • Question 24 - A 55-year-old carpenter presents with a complaint of widespread pruritus that has been...

    Incorrect

    • A 55-year-old carpenter presents with a complaint of widespread pruritus that has been bothering him for the past 2 weeks. He has no significant medical history, but is currently staying at his sister's house due to marital issues. He reports that the itching is most severe at night. Upon examination, he has several linear erythaematous lesions on the backs of his hands and between his fingers.
      What is the most suitable initial treatment option for this probable diagnosis?

      Your Answer:

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

      Explanation:

      Treatment Options for Scabies Infestation

      Scabies infestation is a common condition that can affect anyone, but is more prevalent in individuals with poor personal hygiene, immunocompromisation, low socioeconomic status, and those working in industrial settings. 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 emollient cream can be applied regularly from the neck down, it will not treat the underlying infestation. Similarly, 5% Hydrocortisone cream applied twice daily to the hands will not address the underlying infestation. Oral antihistamines may provide relief from the symptomatic itch, but they do not treat the underlying infestation.

      In cases where Permethrin is not effective, Malathion cream can be used as a second-line treatment for scabies. It should be applied from the neck down for 24 hours and then washed off. It is important to follow the instructions carefully and consult a healthcare professional if symptoms persist.

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      • Dermatology
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  • Question 25 - 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.

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      • Dermatology
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  • Question 26 - Bethany Johnson, a 20-year-old student, visits her GP complaining of generalized itching. She...

    Incorrect

    • Bethany Johnson, a 20-year-old student, visits her GP complaining of generalized itching. She reports no allergies or recent changes in cosmetic or detergent products. During the examination, the GP observes multiple excoriation marks throughout her body. Bethany also mentions experiencing fatigue and weight gain recently. What is the probable cause of her systemic pruritus?

      Your Answer:

      Correct Answer: Hypothyroidism

      Explanation:

      Causes and diagnostic workup of systemic pruritus

      Systemic pruritus, or generalized itching, can have various underlying causes, including pregnancy, primary biliary cholangitis, renal failure, diabetes, leukaemia, polycythaemia, psychological factors, and hypothyroidism. To diagnose the condition, blood tests are typically performed to rule out these potential causes. Hypothyroidism may be suspected if the patient also experiences weight gain and fatigue. Treatment for systemic pruritus involves addressing the underlying condition, as well as using measures such as keeping the skin cool, applying emollients, and taking sedating antihistamines at night.

      Other conditions that may cause pruritus but are less likely in this case include iron deficiency anaemia, which typically presents with pallor rather than weight gain, and cholestasis, which usually causes jaundice, dark urine, and pale stool. Lymphoma, a type of cancer affecting the lymphatic system, may cause weight loss and lymphadenopathy rather than weight gain. Widespread dermatitis, characterized by a rash, is another possible cause of pruritus.

    • This question is part of the following fields:

      • Dermatology
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  • Question 27 - A 32-year-old professional footballer comes to the Dermatology Clinic with a lesion on...

    Incorrect

    • A 32-year-old professional footballer comes to the Dermatology Clinic with a lesion on his leg. The lesion started as a small cut he got during a match, but it has progressed over the past few weeks, becoming a large, painful ulcer.
      During the examination, the doctor finds that the lesion is 50 mm × 75 mm and ulcerated with a necrotic centre. The patient has no medical history, but his general practitioner (GP) recently investigated him for a change in bowel habit, including bloody stools, and fatigue.
      The patient's anti-neutrophil cytoplasmic antibody test comes back positive, and no organisms grow from the wound swab. The doctor prescribes systemic steroids, and the patient experiences rapid improvement.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Pyoderma gangrenosum

      Explanation:

      Differential Diagnosis for a Painful Cutaneous Ulcer in a Patient with IBD Symptoms

      When presented with a painful cutaneous ulcer, it is important to consider the underlying cause in order to provide appropriate treatment. In this case, the patient is experiencing fatigue and change in bowel habit, which could be indicative of underlying inflammatory bowel disease (IBD). One possible diagnosis is pyoderma gangrenosum, which is commonly associated with IBD, rheumatoid arthritis, or hepatitis. This condition presents with a rapidly progressing, painful, necrolytic cutaneous ulcer that responds well to systemic steroids. Livedo reticularis, erythema nodosum, and lupus pernio are other possible diagnoses, but they do not typically present with ulceration in this pattern or are not associated with IBD. While squamous cell carcinoma should be considered, it is unlikely in this case due to the patient’s young age and the rapid deterioration of the ulcer. Overall, a thorough differential diagnosis is necessary to accurately diagnose and treat the underlying condition causing the cutaneous ulcer.

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      • Dermatology
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  • Question 28 - A 50-year-old man was seen in the Dermatology Outpatient Clinic with a chronic...

    Incorrect

    • A 50-year-old man was seen in the Dermatology Outpatient Clinic with a chronic ulcer on his left forearm. On enquiry by the consultant, he revealed that he suffered full-thickness burn at the site of the ulcer nearly 20 years ago. The consultant told the patient he had a Marjolin’s ulcer.
      Which of the following statements best describes a Marjolin’s ulcer?

      Your Answer:

      Correct Answer: It is often painless

      Explanation:

      Understanding Marjolin’s Ulcer: A Squamous Cell Carcinoma in Scar Tissue

      Marjolin’s ulcer is a type of squamous cell carcinoma that develops in scar tissue. This condition is often associated with chronic wounds and scar tissues, which are prone to an increased risk for skin cancer. While it most frequently occurs in old burn scars, it can also develop in relation to other types of injuries and wounds.

      One of the unique characteristics of Marjolin’s ulcer is that it grows slowly due to the scar tissue being relatively avascular. Additionally, it is painless because the tissue contains no nerves. While it typically appears in adults around 53-59 years of age, the latency period between the initial injury and the appearance of cancer can be 25-40 years.

      Contrary to popular belief, Marjolin’s ulcer is not a sarcoma. Instead, it is a squamous cell carcinoma that can invade normal tissue surrounding the scar and extend at a normal rate. While secondary deposits do not occur in the regional lymph nodes due to the destruction of lymphatic vessels, lymph nodes can become involved if the ulcer invades normal tissue.

      In conclusion, understanding Marjolin’s ulcer is crucial for individuals who have experienced chronic wounds or scar tissue. Early detection and treatment can greatly improve outcomes and prevent further complications.

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      • Dermatology
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  • Question 29 - A 35-year-old woman with a history of ulcerative colitis visits her General Practitioner...

    Incorrect

    • A 35-year-old woman with a history of ulcerative colitis visits her General Practitioner (GP) complaining of a painful ulcer on her right shin that is rapidly increasing in size. The patient noticed a small blister in the area a few days ago, which has now broken down into an ulcer that is continuing to enlarge. The doctor suspects that the skin lesion may be pyoderma gangrenosum. What is the most commonly associated condition with pyoderma gangrenosum?

      Your Answer:

      Correct Answer: Rheumatoid arthritis

      Explanation:

      Skin Conditions Associated with Various Diseases

      Pyoderma gangrenosum is a skin condition characterized by a painful ulcer that rapidly enlarges. It is commonly associated with inflammatory bowel disease, hepatitis, rheumatoid arthritis, and certain types of leukemia. However, it is not commonly associated with HIV infection or coeliac disease. Dermatitis herpetiformis is a skin condition associated with coeliac disease, while patients with rheumatoid arthritis are at higher risk of developing pyoderma gangrenosum compared to those with osteoarthritis. Haematological malignancies commonly associated with pyoderma gangrenosum include acute myeloid leukemia and hairy cell leukemia, while cutaneous lesions in multiple myeloma are uncommon.

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      • Dermatology
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  • Question 30 - 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
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