Dermatology Flashcards
Which ONE of the following patients is the SINGLE MOST likely to experience influenza-like symptoms as a side-effect of their treatment?
A. A 75-year-old man prescribed topical fluorouracil for actinic keratosis
B. A 22-year-old man prescribed topical adapalene for acne
C. A 12-year-old boy prescribed topical tacrolimus for atopic eczema
D. A 46-year-old woman prescribed topical metronidazole for rosacea
E. A 69-year-old man prescribed topical imiquimod for a superficial basal cell carcinoma
Answer: E. A 69-year-old man prescribed topical imiquimod for a superficial basal cell carcinoma
Justification: Imiquimod is an immune response modifier that may cause flu-like symptoms including fever, fatigue, headache, nausea, diarrhoea, and muscle pain. These are generally mild and treated with paracetamol.
Resource: RCGP Learning – Dermatology
A 29-year-old man presents with a deep bite to his left forearm after a fight. The wound has been cleaned and a tetanus vaccination administered.
Which is the SINGLE MOST appropriate antibiotic to prescribe?
A. Phenoxymethylpenicillin (penicillin V)
B. Metronidazole
C. Doxycycline
D. Co-amoxiclav
E. Cefalexin
Answer: D. Co-amoxiclav
Justification: Co-amoxiclav is first-line for human and animal bites. Consider doxycycline and metronidazole if penicillin-allergic.
Resource: RCGP Learning – Dermatology
A 22-year-old Middle Eastern student presents with a long-standing rash on upper arms and thighs. No other symptoms.
What is the SINGLE MOST likely diagnosis?
A. Pityriasis versicolor
B. Molluscum contagiosum
C. Acne
D. Keratosis pilaris
E. Psoriasis
Answer: D. Keratosis pilaris
Justification: KP is common in adolescents, typically on upper arms, thighs, buttocks. It is benign, with keratinous plugging.
Resource: PCDS – Keratosis pilaris
Match the following skin presentations with the correct diagnosis:
1. Intense itching and vesicles on palms
2. Widespread itch, blistering rash on chest (elderly patient)
3. Painful lesion on fingertip
Options:
A. Dermatitis herpetiformis
B. Bullous pemphigoid
C. Pompholyx
D. Herpetic whitlow
Answers:
1 → C. Pompholyx
2 → B. Bullous pemphigoid
3 → D. Herpetic whitlow
Justification: Classic appearances of eczema variants and herpes infections.
Resources: PCDS – Hand eczema, Bullous pemphigoid, Herpes simplex
A 76-year-old man presents with a rough, scaly lesion on his nose.
What is the SINGLE MOST likely diagnosis?
A. Actinic keratosis
B. Basal cell carcinoma
C. Seborrheic keratosis
D. Malignant melanoma
E. Dermatofibroma
Answer: A. Actinic keratosis
Justification: Sun-damaged, scaly lesions on exposed skin areas typical for actinic keratoses.
Resource: PCDS – Actinic keratosis
A young woman with a baby presents with irritant dermatitis of the hands.
What is the SINGLE MOST appropriate advice initially?
A. Apply coconut oil
B. Avoid nickel and tin
C. Use paper towels
D. Wash hands frequently with soap
E. Wear waterproof gloves with cotton lining
Answer: E. Wear waterproof gloves with cotton lining
Justification: Protecting the skin from irritants and water exposure is crucial. Emollients and steroids may help.
Resource: RCGP Learning – Dermatology
Middle-aged woman has multiple pigmented lesions on her back; two have enlarged.
What is the SINGLE MOST appropriate management?
A. Biopsy a large lesion
B. Diclofenac gel
C. Cryotherapy
D. Excision
E. Reassurance
Answer: E. Reassurance
Justification: Seborrheic keratoses are benign. Removal may be considered if troublesome.
Resource: PCDS – Seborrheic keratosis
You are prescribing a regular emollient for a 4-year-old with widespread eczema.
Which is the LEAST suitable option?
A. Aqueous cream
B. Doublebase gel
C. E45 cream
D. Epaderm ointment
E. Hydrous ointment
Answer: A. Aqueous cream
Justification: Aqueous cream may cause irritation and is unsuitable as a leave-on emollient.
Resource: RCGP Learning – Dermatology
Which nutritional deficiencies are associated with chronic spontaneous urticaria in children?
A. Vitamin A
B. Magnesium
C. Vitamin B12
D. Iron and vitamin D
E. Zinc
Answer: D. Iron and vitamin D
Justification: Chronic urticaria in children has links to iron and vitamin D deficiency, and autoimmune conditions.
Resource: InnovAiT 2019; 12(5): 264–270
A 45-year-old man has a 3-week history of itchy pink-purple plaques on the wrists and white lacy lesions in the buccal mucosa.
What treatment is MOST LIKELY to help?
A. Topical emollients
B. Oral prednisolone
C. Topical hydrocortisone
D. Oral methotrexate
E. Topical clobetasol
Answer: E. Topical clobetasol
Justification: This is lichen planus. Potent topical steroids are effective for cutaneous lesions.
Resources: RCGP – Dermatology; PCDS – Lichen planus
A 75-year-old woman presents with red, swollen skin on her leg after an insect bite. Temp 37.8°C.
What is the SINGLE MOST likely diagnosis?
A. Cellulitis
B. Varicose eczema
C. Gout
D. Ankle sprain
E. DVT
Answer: A. Cellulitis
Justification: Cellulitis is an infection of the dermis, often after trauma or insect bite. Characterised by erythema, swelling, warmth, pain.
Resource: InnovAiT 2019; 12(8): 454–458
Which feature SUPPORTS the diagnosis of atopic eczema in a 6-year-old boy with itchy rash?
A. Personal history of asthma
B. Onset over age two
C. Involvement of extensor surfaces
D. Dry skin as baby
E. Penicillin allergy
Answer: A. Personal history of asthma
Justification: Asthma, allergic rhinitis and dry skin are supportive criteria for atopic eczema diagnosis.
Resource: NICE CG57 (updated 2023)
73-year-old man post-chemo with itchy rash on both inner thighs.
What is the SINGLE MOST likely diagnosis?
A. Pityriasis versicolor
B. Seborrhoeic dermatitis
C. Granuloma annulare
D. Tinea cruris
E. Mycosis fungoides
Answer: D. Tinea cruris
Justification: Typical bilateral groin dermatophyte infection. Immunosuppressed status increases risk.
Resource: PCDS – Tinea corporis/cruris
38-year-old man presents with itchy rash in a small area on abdomen (near jeans button).
What is the SINGLE MOST likely diagnosis?
A. Actinic keratosis
B. Psoriasis
C. Sunburn
D. Pityriasis versicolor
E. Contact allergic dermatitis
Answer: E. Contact allergic dermatitis
Justification: Nickel allergy from belt buckle/jeans stud. Presents with localised eczema pattern.
Resource: PCDS – Contact allergic dermatitis
43-year-old man with ring-like nodular rash on hands.
Which systemic condition may be associated?
A. Diabetes mellitus
B. Rheumatoid arthritis
C. Lyme disease
D. Sarcoidosis
E. Primary biliary cirrhosis
Answer: A. Diabetes mellitus
Justification: Granuloma annulare can be associated with diabetes in rare cases.
Resources: RCGP – Dermatology; PCDS – Granuloma annulare
40-year-old man with scalp psoriasis and thick scaling.
What is the SINGLE MOST appropriate INITIAL treatment?
A. Tacrolimus cream
B. Tar shampoo
C. Calcipotriol solution
D. Fluocinolone gel
E. Betamethasone valerate
Answer: E. Betamethasone valerate
Justification: Potent topical steroids are first-line for thick plaque psoriasis of the scalp.
Resource: NICE CG153 – Psoriasis
83-year-old woman with longstanding, non-itchy pigmented facial lesions. No recent changes.
What is the SINGLE MOST likely diagnosis?
A. Seborrhoeic keratosis
B. SCC
C. Actinic keratosis
D. Melanoma
E. BCC
Answer: A. Seborrhoeic keratosis
Justification: Benign, pigmented, stuck-on lesions. Common with age.
Resource: PCDS – Seborrhoeic keratosis
85-year-old woman with longstanding red scaly patch on shin.
What is the MOST likely useful treatment?
A. 5-fluorouracil cream
B. Fusidic acid cream
C. Clobetasol cream
D. Terbinafine cream
E. Calcipotriol cream
Answer: A. 5-fluorouracil cream
Justification: Bowen’s disease (intraepidermal SCC) can be treated with topical chemotherapy.
Resource: RCGP Curriculum – Dermatology
7-year-old girl with 3-week itchy rash worse at night. Treated with emollients and hydrocortisone 1%.
Family history of atopy.
What is the SINGLE MOST likely diagnosis?
A. Erythema multiforme
B. Atopic eczema
C. Pityriasis rosea
D. Scabies
E. Eczema herpeticum
Answer: D. Scabies
Justification: Nocturnal pruritus and hand involvement are classical. Highly contagious.
Resource: PCDS – Scabies
Atopic adult with dry, blistering eczema on palms and soles (pompholyx).
Which is the MOST appropriate topical treatment with emollients?
A. Hydrocortisone 1%
B. Hydrocortisone 0.5%
C. Hydrocortisone 2.5%
D. Betamethasone valerate 0.1%
E. Clobetasone butyrate 0.05%
Answer: D. Betamethasone valerate 0.1%
Justification: Potent topical steroids are required for pompholyx. Step down as condition improves.
Resource: RCGP Curriculum – Dermatology
A patient aged 60 presents with this lesion on the dorsum of her forearm. It has been present for around a month and enlarged rapidly over that time.
What is the SINGLE MOST likely diagnosis?
A. Pyogenic granuloma
B. Seborrhoeic keratosis
C. Malignant melanoma
D. Nodular basal cell carcinoma
E. Dermatofibroma
Answer: C. Malignant melanoma
Justification: This should be referred urgently for excision.
Resource: RCGP Learning – Dermatology
A 37-year-old man has noticed alopecia and a scaly patch on his scalp. His children had similar issues recently, attributed to lice. The area feels slightly ‘boggy’.
What is the SINGLE MOST appropriate management?
A. Urgent dermatology referral
B. Erythromycin orally
C. Malathion topically
D. Steroid scalp application
E. Imidazole cream
Answer: A. Urgent dermatology referral
Justification: This is tinea capitis, which may lead to kerion. NICE recommends specialist referral.
Resource: NICE Guidance; RCGP Curriculum – Dermatology
A 12-year-old boy with eczema and recent oral prednisolone for asthma now develops widespread facial and trunk rash.
What is the SINGLE MOST likely primary infective cause?
A. Varicella-zoster virus
B. Measles virus
C. Coxsackie virus
D. Herpes simplex virus
E. Parvovirus
Answer: D. Herpes simplex virus
Justification: Likely eczema herpeticum due to herpes simplex in a patient with atopic eczema.
Resource: RCGP Learning – Dermatology
You treat contact dermatitis on the palms with a potent steroid twice daily for 2 weeks.
Which tube size is appropriate?
A. 7.5 grams
B. 45 grams
C. 75 grams
D. 100 grams
E. 15 grams
Answer: E. 15 grams
Justification: 1g of steroid treats palm surfaces for a week. 15g covers both palms for 2 weeks.
Resource: RCGP Curriculum – Dermatology; BNF
A 6-year-old boy with crusty rash under his chin and nostrils. Diagnosed with impetigo.
How long should he be excluded from school?
A. Until lesions crust or heal
B. Seven days
C. No need to exclude
D. Three days
E. Five days
Answer: A. Until lesions crust or heal
Justification: Or 48 hours after starting antibiotics. Hydrogen peroxide 1% is first line in localised cases.
Resource: NICE NG153 – Impetigo (2020)
You are prescribing a leave-on emollient for a 4-year-old with widespread eczema.
Which is the LEAST suitable option?
A. Aqueous cream
B. Doublebase gel
C. E45 cream
D. Epaderm ointment
E. Hydrous ointment
Answer: A. Aqueous cream
Justification: Associated with skin reactions. Unsuitable as a leave-on moisturiser.
Resource: RCGP Curriculum – Dermatology
A 33-year-old man has had a slowly enlarging rash for 2 weeks.
What is the SINGLE MOST likely causative organism?
A. Borrelia burgdorferi
B. Streptococcus pyogenes
C. Staphylococcus aureus
D. Parvovirus
E. Atypical mycobacterium
Answer: A. Borrelia burgdorferi
Justification: Likely erythema migrans from Lyme disease. Treat with doxycycline or amoxicillin.
Resource: NICE; RCGP Curriculum – Dermatology
Match each dermatological appearance with the systemic disease.
Patient 1: Yellowish-brown shin patches
Patient 2: Swollen, lumpy pink skin over shins with ECG showing sinus tachycardia
Patient 3: Ulcerated leg lesion with Crohn’s history
Options:
- Amyloidosis
- Crohn’s disease
- Diabetes mellitus
- Grave’s disease
- Lyme disease
- Sarcoidosis
- Wilson’s disease
Answers:
1 → Diabetes mellitus (Necrobiosis lipoidica)
2 → Grave’s disease (Pretibial myxoedema)
3 → Crohn’s disease (Pyoderma gangrenosum)
Resources: RCGP Curriculum – Dermatology; Dermnet NZ – Systemic skin signs
76-year-old man with six-month rash on his scalp.
What is the SINGLE MOST likely diagnosis?
A. Rosacea
B. Actinic keratosis
C. Bowen’s disease
D. Seborrhoeic eczema
E. Psoriasis
Answer: B. Actinic keratosis
Justification: Sun-exposed scalp, erythema and scaling. Precancerous with risk of SCC.
Resource: PCDS – Actinic keratosis
36-year-old male hairdresser with itchy wrists, flat violet papules, and oral discomfort.
What is the SINGLE MOST likely diagnosis?
A. Irritant contact dermatitis
B. Atopic eczema
C. Pompholyx
D. Lichen planus
E. Hand, foot and mouth disease
Answer: D. Lichen planus
Justification: Itchy, violaceous, flat-topped papules with Wickham’s striae and oral lacy lesions.
Resource: PCDS – Lichen planus
26-year-old woman with axillary hyperhidrosis despite using aluminium chloride.
What is the SINGLE MOST likely effective treatment?
A. Ionotophoresis
B. Botulinum toxin type A
C. Diltiazem
D. Clonidine
E. No treatment
Answer: B. Botulinum toxin type A
Justification: Improves 75–90% of axillary hyperhidrosis cases. Lasts ~6 months.
Resources: Dermnet NZ; NICE CKS – Hyperhidrosis
6-year-old boy with mild facial impetigo for 2 days.
What is the SINGLE MOST appropriate treatment?
A. Topical neomycin
B. Topical hydrocortisone
C. Topical fusidic acid
D. Oral erythromycin
E. Oral phenoxymethylpenicillin
Answer: C. Topical fusidic acid
Justification: First-line for non-bullous impetigo. Hydrogen peroxide 1% is alternative.
Resource: NICE NG153 – Impetigo (2020)
Which ONE of the following is associated with polycystic ovary syndrome (PCOS)?
A. Mycosis fungoides
B. Acanthosis nigricans
C. Erythema nodosum
D. Pyoderma gangrenosum
E. Granuloma annulare
Answer: B. Acanthosis nigricans
Justification: Characteristic velvety thickened skin in insulin resistance (e.g., PCOS).
Resource: RCGP Curriculum – Dermatology
3-year-old boy with moderate eczema on forearms, helped by emollients.
What is the SINGLE MOST appropriate topical steroid?
A. Betamethasone valerate 0.1%
B. Clobetasol propionate 0.05%
C. Clobetasone butyrate 0.05%
D. Hydrocortisone 1%
E. Mometasone furoate 0.1%
Answer: C. Clobetasone butyrate 0.05%
Justification: Moderate-potency steroid appropriate for limbs in children.
Resource: PCDS – Atopic eczema
54-year-old man with type 2 diabetes and 3-day painful red leg, febrile and unwell.
Localised extreme tenderness.
What is the SINGLE MOST likely diagnosis?
A. Cellulitis
B. Necrotising fasciitis
C. Necrobiosis lipoidica
D. Erysipelas
E. Pyoderma gangrenosum
Answer: B. Necrotising fasciitis
Justification: Severe pain with mild signs. Rapidly progressing. Requires urgent treatment.
Resource: RCGP Learning – Dermatology
35-year-old breastfeeding woman with 4-month history of cheek flushing and pustules.
What is the SINGLE MOST appropriate treatment?
A. Topical hydrocortisone
B. Benzoyl peroxide cream
C. 5-fluorouracil cream
D. Oral flucloxacillin
E. Metronidazole gel
Answer: E. Metronidazole gel
Justification: Suitable topical for papulopustular rosacea in breastfeeding. Ivermectin not advised here.
Resource: NICE CKS – Rosacea
Middle-aged woman with transient weals lasting 6 hours over 48h.
What is the SINGLE MOST appropriate investigation?
A. Full blood count + ESR
B. No blood test required
C. Vasculitis screen
D. RAST
E. Complement (C4)
Answer: B. No blood test required
Justification: Acute urticaria typically resolves. History more useful than early tests.
Resource: RCGP Curriculum – Dermatology
What is the SINGLE MOST common subtype of basal cell carcinoma (BCC)?
A. Basosquamous
B. Superficial
C. Nodular
D. Superficial spreading
E. Morphoeic
Answer: C. Nodular
Justification: Nodular BCC is most common (60–80%). Pearly edges and telangiectasia typical.
Resource: InnovAiT 2021; 14(4): 250–257
11-year-old with persistent eczema in antecubital fossae despite 1 month mild steroid/emollient.
What is the SINGLE MOST appropriate next step?
A. Add topical antibiotic
B. Add antihistamine
C. Continue current treatment
D. Increase potency of corticosteroid
E. Use topical calcineurin inhibitor
Answer: D. Increase potency of corticosteroid
Justification: Treatment escalation per eczema severity. Tacrolimus reserved for failure of steroids.
Resource: NICE CG57 – Atopic eczema in under 12s
74-year-old woman with soft thigh swelling 3 months after insulin start. Uses same injection site.
What is the SINGLE MOST likely diagnosis?
A. Cellulitis
B. Lipid hypertrophy
C. Acanthosis nigricans
D. Necrobiosis lipoidica
E. Insulinoma
Answer: B. Lipid hypertrophy
Justification: Localised fat overgrowth due to repeated insulin injection at same site.
Resource: RCGP Curriculum – Dermatology
The following nutritional deficiency is associated with chronic spontaneous urticaria in children.
Which SINGLE option is MOST appropriate?
A. Magnesium
B. Iron
C. Vitamin B12
D. Zinc
E. Vitamin A
Answer: B. Iron
Justification: Common conditions diagnosed in infants and children with chronic spontaneous urticaria include nutritional deficiency (iron and vitamin D), coeliac disease, thyroid disease, SLE, and other autoimmune diseases.
Resource: Lee R, Michaelis L, Mahadevan J. Chronic urticaria in childhood. InnovAiT 2019; 12(5): 264–270.
For each of the following children with an acute rash, select the SINGLE MOST likely diagnosis:
- Child 1: 10-year-old with fever, cough, sore eyes, rash on face and Koplik’s spots
- Child 2: 5-year-old with fever, sore throat, vesicles over trunk and face
- Child 3: 10-year-old with flushed face, sore throat, sandpaper rash and perioral pallor
Options:
- Chickenpox
- Fifth Disease
- Hand Foot and Mouth
- Impetigo
- Measles
- Rubella
- Scarlet Fever
Answers:
1 → Measles
2 → Chickenpox
3 → Scarlet Fever
Justification:
- Measles shows prodrome with cough, coryza, conjunctivitis, and Koplik’s spots.
- Chickenpox presents with itchy vesicles after prodrome.
- Scarlet fever shows sandpaper rash and perioral pallor.
Resource: RCGP. Curriculum Topic Guides: children and young people. 2019.
A young woman presents with irritation of the hands. She has a baby and past asthma.
What is the SINGLE MOST appropriate advice initially?
A. Paper towels
B. Apply coconut oil
C. Waterproof gloves with cotton lining
D. Wash hands with soap
E. Avoid nickel and tin
Answer: C. Waterproof gloves with cotton lining
Justification: Likely irritant contact dermatitis. Avoid soap and water exposure; use emollients and barrier protection.
Resource: RCGP Learning – Dermatology
In management of plaque psoriasis, what is the MAXIMUM duration for potent corticosteroid use on trunk or limbs?
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
E. 12 weeks
Answer: D. 8 weeks
Justification: Potent corticosteroids should be used for a maximum of 8 weeks. Breaks of 4 weeks are recommended before restarting.
Resource: NICE CG153. Psoriasis: assessment and management. 2012 (updated 2017).
You are treating a 32-year-old hairdresser with persistent hand dermatitis.
What is the SINGLE MOST appropriate investigation?
A. Skin scrapings
B. RAST test
C. IgE test
D. Skin biopsy
E. Patch testing
Answer: E. Patch testing
Justification: Patch testing distinguishes allergic vs irritant dermatitis and is important in occupational dermatitis.
Resource: Byrne C. Contact dermatitis. InnovAiT 2022; 15(12): 693–696.
A 5-year-old presents with joint pain and a buttock rash.
What is the SINGLE MOST likely diagnosis?
A. Hereditary haemorrhagic telangiectasia
B. Measles
C. Chickenpox
D. Henoch–Schönlein purpura
E. Acute urticaria
Answer: D. Henoch–Schönlein purpura
Justification: HSP is a vasculitis causing purpura on extensor surfaces, arthralgia, abdominal pain, and renal issues.
Resource: PCDS – Vasculitis and Capillaritis
A 48-year-old man has sore, itchy lichen planus on the underside of the penis.
What is the SINGLE MOST appropriate treatment?
A. Topical antifungal
B. Topical antibiotic
C. Topical emollient
D. Topical corticosteroid ointment
E. Circumcision
Answer: D. Topical corticosteroid ointment
Justification: Potent topical steroids relieve symptoms. Circumcision may be curative long-term but not a first-line option.
Resource: RCGP Learning – Dermatology
A 54-year-old man has a slowly growing, painless lump on his ear.
What is the SINGLE MOST likely diagnosis?
A. Ear abscess
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Pinna perichondritis
E. Pinna cellulitis
Answer: C. Basal cell carcinoma
Justification: Pearly rolled-edge nodule on helix is typical for BCC.
Resource: Juman C et al. Problems affecting the pinna. InnovAiT 2020; 13(12): 717–721.
32-year-old man with pitted fingernails, discolouration under nails, and rough elbows.
What is the SINGLE MOST likely diagnosis?
A. Iron deficiency anaemia
B. Rheumatoid arthritis
C. Onychogryphosis
D. Subacute bacterial endocarditis
E. Psoriasis
Answer: E. Psoriasis
Justification: Nail pitting, discolouration and elbow plaques are typical of nail psoriasis.
Resources: RCGP Curriculum – Dermatology; PCDS – Nail psoriasis
A 5-year-old boy has generalised eczema with frequent steroid use.
For which body site would tacrolimus 0.03% be MOST appropriate?
A. Feet
B. Lower legs
C. Face
D. Scalp
E. Arms
Answer: C. Face
Justification: Tacrolimus is suitable for facial eczema where steroid use is limited by risk of atrophy.
Resource: PCDS – Atopic eczema
A 64-year-old South Asian man asks what is the MOST common skin malignancy in his ethnic group.
Select ONE option.
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Malignant melanoma
D. Merkel cell carcinoma
E. Actinic keratosis
Answer: A. Squamous cell carcinoma
Justification: SCC is the most common skin malignancy in South Asian and African communities.
Resource: Pathak A, Perry M. Dermatological conditions in skin of colour. InnovAiT 2022; 15(8): 450–455.
A 19-year-old man with moderate facial and shoulder acne has had doxycycline and benzoyl peroxide for 3 months. No scarring yet.
What is the SINGLE MOST appropriate next step?
A. Add trimethoprim
B. Benzoyl peroxide + clindamycin gel
C. Change to oral lymecycline and topical retinoid
D. Start oral isotretinoin
E. Use drospirenone/ethinyl estradiol
Answer: C. Change to oral lymecycline and topical retinoid
Justification: If response to first-line oral antibiotic fails after 3 months, switch antibiotics and add retinoid.
Resources: RCGP. Acne; BNF – Treatment of acne.
Patient requests SPF 50 sunscreen on NHS ahead of holiday.
In which ONE circumstance is this permitted?
A. Previous NHS sunscreen issued
B. Fitzpatrick type 1 skin
C. Pharmacist recommendation
D. Age >65
E. Has vitiligo
Answer: E. Has vitiligo
Justification: NHS can prescribe sunscreen for abnormal photosensitivity, including vitiligo.
Resource: BNF – Borderline substances
A 26-year-old woman has urticarial rash daily for 8 weeks, with fatigue and heat sensitivity.
Which ONE test is MOST helpful?
A. Patch testing
B. Coeliac serology
C. TFTs and thyroid antibodies
D. Cow’s milk IgE
E. LFTs
Answer: C. TFTs and thyroid antibodies
Justification: Autoimmune thyroid disease can cause chronic urticaria.
Resource: RCGP Learning – Dermatology
According to NICE, which of the following is a MAJOR feature on the weighted 7-point checklist for pigmented lesions?
A. Change in sensation
B. Oozing
C. Irregular colour
D. Inflammation
E. Diameter ≥7 mm
Answer: C. Irregular colour
Justification: Major features (2 points): size change, irregular shape, irregular colour. Minor: inflammation, oozing, altered sensation, large size.
Resource: NICE NG12. Suspected Cancer. 2015 (updated 2023).
Which genetic syndrome increases malignant melanoma risk?
A. Gorlin’s syndrome
B. Xeroderma pigmentosum
C. Von Hippel–Lindau
D. Marfan’s syndrome
E. Bazex syndrome
Answer: B. Xeroderma pigmentosum
Justification: Autosomal recessive DNA repair disorder; early skin cancers incl. melanoma.
Resource: RCGP Curriculum – Dermatology
19-year-old woman with acne, failed adapalene + benzoyl peroxide. Taking Microgynon.
What is the NEXT most appropriate treatment?
A. Add amoxicillin
B. Add lymecycline
C. Change to co-cyprindiol
D. Change to desogestrel
E. Azelaic acid cream
Answer: B. Add lymecycline
Justification: Oral tetracycline + topical agent is next step if topical monotherapy fails.
Resource: NICE CKS – Acne (2023)
What is a well-recognised complication of local anaesthetic injection?
A. Bradycardia
B. Neurovascular injury
C. Headache
D. Hypotension
E. Respiratory failure
Answer: B. Neurovascular injury
Justification: Local injections may cause nerve damage or haematoma.
Resource: RCGP Learning – Dermatology
92-year-old woman with long-standing generalised pruritus and dry skin.
What is the MOST likely diagnosis?
A. Asteatotic eczema
B. Vasculitis
C. Psoriasis
D. Mycosis fungoides
E. Adverse drug reaction
Answer: A. Asteatotic eczema
Justification: “Willan’s itch” from skin dryness. Moisturisers are key.
Resource: RCGP Learning – Dermatology
71-year-old man with 3.5 cm forearm lesion that bleeds, background of solar keratoses.
What is the SINGLE MOST likely diagnosis?
A. Melanoma
B. Seborrhoeic dermatosis
C. Squamous cell carcinoma
D. Bowen’s disease
E. Basal cell carcinoma
Answer: C. Squamous cell carcinoma
Justification: Ulcerated, bleeding, keratinising lesions on sun-damaged skin suggest SCC.
Resource: RCGP Curriculum – Dermatology
A mother of a six-year-old who is currently being treated for impetigo asks for advice about the school exclusion period.
According to NICE guidelines, which SINGLE option is MOST appropriate?
A. Children should stay away from school for one week
B. Children should stay away from school until all lesions have disappeared
C. Children should stay away from school until the crusts have dried out or 48 hours after starting antibiotics
D. There is no school exclusion period for impetigo
E. Children should stay away from school until the crusts have dried out or 24 hours after starting antibiotics
Answer: C. Children should stay away from school until the crusts have dried out or 48 hours after starting antibiotics
Justification: People with impetigo should not attend settings such as school or work until lesions are dry, crusted or healed, or 48 hours after treatment begins.
Resource: NICE CKS. Impetigo. Revised 2024.
A 31-year-old woman who is 10 weeks pregnant has an infected discharging wound on her lower leg and is allergic to penicillin.
Which is the SINGLE MOST appropriate antibiotic to use?
A. Co-amoxiclav
B. Ciprofloxacin
C. Co-trimoxazole
D. Doxycycline
E. Erythromycin
Answer: E. Erythromycin
Justification: In penicillin-allergic pregnant women, erythromycin is preferred as doxycycline and others are contraindicated.
Resource: NICE CKS. Cellulitis and erysipelas.
For which SINGLE ONE of the following patients is an URGENT dermatology referral MOST appropriate?
A. A 10-year-old boy with plaque psoriasis
B. An 18-year-old girl with acute guttate psoriasis
C. A 26-year-old man with plaque psoriasis covering 5% BSA
D. A 38-year-old woman scoring 3 on PEST
E. A 45-year-old man who develops generalised pustular psoriasis
Answer: E. A 45-year-old man who develops generalised pustular psoriasis
Justification: Generalised pustular psoriasis requires urgent referral. Psoriatic arthritis should be referred to rheumatology.
Resource: NICE CG153. Psoriasis: assessment and management (2012, updated 2017).
A 29-year-old man sustained a deep human bite to his left forearm.
Which is the SINGLE MOST appropriate antibiotic to prescribe?
A. Cefalexin
B. Penicillin V
C. Metronidazole
D. Co-amoxiclav
E. Doxycycline
Answer: D. Co-amoxiclav
Justification: Co-amoxiclav is first-line for human/animal bites. If penicillin-allergic, use doxycycline + metronidazole.
Resource: NICE CKS. Human and animal bites.
A 72-year-old man has hyperpigmentation following treatment of a venous leg ulcer.
What is the SINGLE MOST likely cause?
A. Cellulitis
B. Necrobiosis lipoidica
C. Dermatitis neglecta
D. Haemosiderin deposition
E. Pyoderma gangrenosum
Answer: D. Haemosiderin deposition
Justification: Chronic venous disease leads to haemosiderin deposition and hyperpigmentation.
Resource: RCGP Curriculum – Dermatology
A 58-year-old woman on ramipril presents with sudden lip swelling.
What is the SINGLE MOST likely cause?
A. Paracetamol
B. Dental abscess
C. Oral candidiasis
D. Oral cancer
E. Ramipril
Answer: E. Ramipril
Justification: ACE inhibitors can cause angioedema. Exclude other oral pathologies on examination.
Resource: DermNet. ACE inhibitor-induced angioedema.
In evaluating a mole, which feature is a MAJOR concern on the Glasgow 7-point checklist?
A. Oozing
B. Inflammation
C. Diameter ≥7 mm
D. Irregular shape
E. Change in sensation
Answer: D. Irregular shape
Justification: Major features include size change, irregular shape, irregular colour. Minor: inflammation, oozing, sensation.
Resources: NICE NG12; PCDS. Melanoma overview.
Which questionnaire is used to assess the impact of skin disease on quality of life?
A. PHQ-9
B. SF-36
C. DLQI
D. QALY
E. GAD-7
Answer: C. DLQI
Justification: The Dermatology Life Quality Index (DLQI) is a validated tool assessing skin disease impact.
Resource: Finlay A, Khan G. DLQI, 1992.
A 7-year-old girl with itchy rash behind knees not controlled with hydrocortisone 1%.
What is the SINGLE MOST appropriate treatment?
A. Mild corticosteroid
B. Mild corticosteroid + antibiotic
C. Moderately potent corticosteroid
D. Potent corticosteroid
E. Potent corticosteroid + antibiotic
Answer: C. Moderately potent corticosteroid
Justification: Moderate eczema should be treated with appropriately potent steroids. Topical antibiotics are not routinely indicated.
Resource: NICE CG57. Atopic eczema in under 12s (updated 2023).
Which ONE of the following is a MODERATELY potent topical corticosteroid?
A. Hydrocortisone 1%
B. Hydrocortisone 2.5%
C. Betamethasone valerate 0.1%
D. Clobetasol propionate 0.05%
E. Clobetasone butyrate 0.05%
Answer: E. Clobetasone butyrate 0.05% (Eumovate®)
Justification: It is classed as a moderately potent steroid, suitable for moderate eczema.
Resource: BNF – Topical corticosteroids.
A patient has a lesion unresponsive to hydrocortisone cream. It is enlarging and scaly.
What is the SINGLE MOST appropriate treatment?
A. Calcipitriol topically
B. Terbinafine orally
C. Griseofulvin orally
D. Betamethasone valerate topically
E. Miconazole topically
Answer: E. Miconazole topically
Justification: Classic presentation of tinea. Topical imidazoles are first-line unless severe.
Resource: RCGP Learning – Dermatology
41-year-old woman presents with a shiny swelling on her distal finger causing nail grooving.
What is the SINGLE MOST likely diagnosis?
A. Myxoid cyst
B. Dermatofibroma
C. Onychomycosis
D. Basal cell carcinoma
E. Viral wart
Answer: A. Myxoid cyst
Justification: Benign mucous cysts often cause nail ridging. Treatment optional.
Resource: PCDS – Ganglion cysts
Three-month-old girl has had a pale pink patch on the nape of her neck since birth.
What is the SINGLE MOST likely diagnosis?
A. Non-accidental injury
B. Port wine stain
C. Erythema toxicum
D. Atopic eczema
E. Salmon patch
Answer: E. Salmon patch
Justification: Common capillary malformation seen at birth. Often fades on face but may persist on neck.
Resource: PCDS – Salmon patch
A 67-year-old woman presents with dry, cracked skin over her shins.
Which is the SINGLE MOST likely systemic cause?
A. Type 2 diabetes
B. Coeliac disease
C. Cushing’s disease
D. Addison’s disease
E. Hypothyroidism
Answer: E. Hypothyroidism
Justification: Asteatotic eczema (eczema craquelé) may be related to hypothyroidism.
Resource: PCDS – Asteatotic eczema
23-year-old with light brown skin has worsening acne.
Which treatment is especially useful for people with darker skin?
A. Topical steroids
B. Topical antibiotics
C. Benzoyl peroxide
D. Azelaic acid
E. Adapalene
Answer: D. Azelaic acid
Justification: Anti-pigmentary and anti-inflammatory; useful in acne in skin of colour.
Resource: Pathak A, Perry M. InnovAiT 2022; 15(8): 450–455.
25-year-old man with red, scaly, demarcated patches on trunk and elbows.
What is the SINGLE MOST appropriate first-line topical treatment?
A. Coal tar and salicylic acid
B. Betamethasone 0.05% + Calcipotriol
C. Tazarotene 0.05%
D. Tacrolimus 0.1%
E. Clotrimazole 1%
Answer: B. Betamethasone 0.05% + Calcipotriol
Justification: First-line treatment for plaque psoriasis on trunk/limbs.
Resource: NICE CG153. Psoriasis (2012, updated 2017).
Six-year-old girl has head lice.
What is the SINGLE MOST appropriate treatment?
A. Ketoconazole shampoo daily
B. Wet-combing and malathion 0.5%
C. Dermatology referral
D. Steroid scalp application
E. Reassurance only
Answer: B. Wet-combing and malathion 0.5%
Justification: Wet-combing with insecticide such as malathion is standard care.
Resource: NICE CKS – Head lice
Patient presents with herald patch followed by generalised oval lesions in Christmas tree pattern.
What is the SINGLE MOST appropriate management?
A. Conservative treatment
B. Oral macrolides
C. Oral acyclovir
D. Topical antifungals
E. Oral antifungals
Answer: A. Conservative treatment
Justification: Pityriasis rosea is self-limiting within 6–12 weeks. Symptomatic relief only if needed.
Resource: Shah M, Adeel S. InnovAiT 2024; 17(11–12): 483–487.
21-year-old man on methadone with flaking red rash on scalp, brows and nasolabial folds.
Which is the SINGLE MOST likely cause?
A. HIV
B. Syphilis
C. Psoriasis
D. TB
E. Iron deficiency
Answer: A. HIV
Justification: Seborrhoeic dermatitis may be an early sign of HIV infection.
Resource: PCDS – Seborrhoeic dermatitis
91-year-old woman with healing venous leg ulcer and mild discharge.
What is the SINGLE MOST appropriate management option?
A. Apply topical antibiotic
B. Continue current treatment
C. Refer for varicose vein surgery
D. Swab + start flucloxacillin
E. Vascular team referral
Answer: B. Continue current treatment
Justification: No signs of infection. Compression therapy is effective and should continue.
Resource: NICE NG199. Leg ulcer – venous (2022).
A 37-year-old female presents with a sudden patch of scalp hair loss. Exam shows oval, well-demarcated area with tapered hairs at the edge. No scarring, inflammation or scale.
What is the SINGLE MOST likely diagnosis?
A. Alopecia areata
B. Traction alopecia
C. Lichen planopilaris
D. Frontal fibrosing alopecia
E. Trichotillomania
Answer: A. Alopecia areata
Justification: Alopecia areata presents with rapid-onset, non-scarring, featureless patches of hair loss and exclamation point hairs at the margin. Typically no inflammation or scale.
Resource: Middleton D, McCourt C. Female hair loss. InnovAiT 2019; 12(10): 589–594.
A 15-year-old boy with multiple facial comedones but no pustules.
What is the SINGLE MOST appropriate first-line topical treatment?
A. Topical Adapalene only
B. Doxycycline orally
C. Lymecycline orally
D. Topical adapalene with topical benzoyl peroxide
E. Oral Erythromycin
Answer: D. Topical adapalene with topical benzoyl peroxide
Justification: NICE NG198 recommends fixed combination therapies such as adapalene + benzoyl peroxide for comedonal acne.
Resource: NICE. Acne vulgaris: management. NG198. 2021 (updated 2023).
A 40-year-old man with coeliac disease presents with an itchy rash on his elbows.
Which ONE skin condition is MOST commonly associated with coeliac disease?
A. Erythema multiforme
B. Pyoderma gangrenosum
C. Dermatitis herpetiformis
D. Erythema nodosum
E. Vitiligo
Answer: C. Dermatitis herpetiformis
Justification: 60–80% of patients with DH have underlying coeliac disease. It presents with symmetrical, itchy vesicles.
Resource: RCGP. Diagnosis and management of coeliac disease.
Case 1: 27-year-old man post-foreign holiday with non-itchy trunk eruption.
Case 2: 25-year-old footballer with smelly foot rash not improved with athlete’s foot treatment.
What are the MOST appropriate topical therapies?
Answer:
Case 1: Pityriasis versicolor → Ketoconazole shampoo
Case 2: Pitted keratolysis → Topical antibiotics like fusidic acid and antiseptics
Justification: Pityriasis versicolor is fungal; pitted keratolysis is bacterial due to hyperhidrosis.
Resources:
RCGP. Curriculum Topic Guides: dermatology. 2019
PCDS. Pityriasis versicolor & Pitted keratolysis
24-year-old man with pruritus, burning and white plaques on glans penis worsened by intercourse.
What is the SINGLE MOST likely diagnosis?
A. Lichen sclerosus
B. Psoriasis
C. Intraepithelial neoplasia
D. Syphilis
E. Squamous cell carcinoma
Answer: A. Lichen sclerosus
Justification: White plaques, tenderness, and pruritus on glans penis are typical. Common in genital areas.
Resource: PCDS. Lichen sclerosus
85-year-old woman with non-itchy red scaly patch on shin, slowly enlarging over years.
What is the SINGLE MOST useful treatment?
A. Terbinafine cream
B. Calcipotriol cream
C. Fusidic acid cream
D. Clobetasol cream
E. 5-fluorouracil cream
Answer: E. 5-fluorouracil cream
Justification: Bowen’s disease (intraepidermal SCC) treated with topical chemotherapy such as 5-FU.
Resource: PCDS. Bowen’s disease
Three-year-old with burn to entire front and back of left hand.
What % of total body surface area (TBSA) is affected?
A. 5%
B. 0.5%
C. 2%
D. 9%
E. 12%
Answer: C. 2%
Justification: Each hand surface (palm/back) = 1% TBSA → both = 2%. Important for assessing severity.
Resource: Baker M. Burns: Classification and Community Management. InnovAiT 2011; 5(9): 520–526.
Patient with excessive sweating affecting both feet and axillae, never treated before.
What is the SINGLE MOST appropriate first-line treatment?
A. Glycopyrronium iontophoresis
B. Aluminium chloride preparation
C. Botulinum toxin injection
D. Salicylic acid
E. Oral oxybutynin
Answer: B. Aluminium chloride preparation
Justification: First-line treatment for focal hyperhidrosis. Others are second-line or specialist.
Resource: NICE CKS – Hyperhidrosis
40-year-old woman with irregular pigmented leg lesion, diagnosed as malignant melanoma.
Which SINGLE factor is MOST prognostic?
A. Tumour depth
B. Increasing size
C. Multiple benign moles
D. Bleeding
E. Irregular edge
Answer: A. Tumour depth
Justification: Breslow thickness strongly predicts prognosis in melanoma.
Resource: NICE NG12; PCDS. Melanoma overview
20-year-old man with mild sore throat and trunk rash unresponsive to betamethasone.
What is the SINGLE MOST appropriate NEXT management step?
A. Refer to a dermatologist
B. Increase steroid potency
C. Start oral antivirals
D. Add calcipotriol
E. Start phenoxymethylpenicillin
Answer: A. Refer to a dermatologist
Justification: Likely guttate psoriasis; referral needed if unresponsive to topicals. UVB phototherapy may help.
Resource: NICE CG153. Psoriasis: assessment and management. 2012 (updated 2017).
Patient requests SPF 50 sunscreen for holiday.
Under what condition is NHS prescription allowed?
A. Diabetes mellitus
B. Fitzpatrick type 1
C. Vitiligo
D. Age over 60
E. Pharmacist recommendation
Answer: C. Vitiligo
Justification: NHS permits prescription for abnormal cutaneous photosensitivity, including vitiligo.
Resource: BNF. Borderline substances.
45-year-old man with 5-day rash post sore throat. Round scaly plaques on trunk and limbs.
What is the SINGLE MOST likely diagnosis?
A. Cutaneous lupus erythematosus
B. Guttate psoriasis
C. Lichen planus
D. Nummular eczema
E. Pityriasis rosea
Answer: B. Guttate psoriasis
Justification: Acute psoriasis variant triggered by strep throat; exacerbated by smoking and beta-blockers.
Resource: PCDS. Guttate psoriasis
27-year-old man to start isotretinoin for acne. Which pre-treatment test is required in addition to LFTs?
A. Chest x-ray
B. Renal function
C. Blood pressure
D. Serum lipids
E. Visual acuity
Answer: D. Serum lipids
Justification: Isotretinoin can elevate serum lipids. Baseline lipid monitoring required.
Resource: BNF. Isotretinoin
15-year-old girl with worsening severe acne and new scarring. Has had lymecycline + BPO, then doxy + azelaic acid.
What is the SINGLE MOST appropriate management?
A. Add adapalene
B. Refer to dermatologist
C. Start isotretinoin
D. Switch antibiotic
E. Continue doxycycline
Answer: B. Refer to dermatologist
Justification: Referral indicated after multiple failed treatments and presence of scarring or distress.
Resource: NICE NG198. Acne vulgaris
36-year-old obese woman with itchy rash under breast for 2 weeks.
What is the SINGLE MOST likely underlying cause?
A. Intertrigo
B. Bowen’s disease
C. Dermatitis herpetiformis
D. Ringworm
E. Contact allergic dermatitis
Answer: A. Intertrigo
Justification: Common in skin folds; aggravated by obesity and sweat. May involve secondary Candida.
Resource: PCDS. Intertrigo
26-year-old athlete with toenail dystrophy. OTC amorolfine ineffective.
What is the BEST advice?
A. No role for topical treatments
B. Nail infections need no treatment
C. All nail dystrophy is fungal
D. Confirm fungal cause before treatment
E. Nail infections have no complications
Answer: D. Confirm fungal cause before treatment
Justification: Only 50% of dystrophy is fungal. Mycological confirmation required. Systemic therapy often needed.
Resource: PCDS – Onychomycosis
15-year-old with rapid-onset salmon pink papules on trunk/arms post sore throat.
What is the SINGLE MOST likely diagnosis?
A. Scabies
B. Measles
C. Scarlatina
D. Guttate psoriasis
E. Pityriasis rosea
Answer: D. Guttate psoriasis
Justification: Tear-drop shaped pink papules post-streptococcal illness. Common in adolescents.
Resource: RCGP. Curriculum Topic Guides: dermatology. 2019
35-year-old woman with fatigue, diarrhoea, itchy rash with blisters on scalp, elbows and knees.
Positive IgA tissue transglutaminase.
What is the SINGLE MOST likely skin condition?
A. Thrombophlebitis migrans
B. Acanthosis nigricans
C. Erythema nodosum
D. Dermatitis herpetiformis
E. Pyoderma gangrenosum
Answer: D. Dermatitis herpetiformis
Justification: Autoimmune blistering disease associated with coeliac. Presents with symmetrical itchy papules.
Resource: PCDS – Dermatitis herpetiformis
8-year-old with eczema unresponsive to potent topical steroids, showing skin atrophy.
What is the SINGLE MOST appropriate next step?
A. Oral antibiotics
B. Oral steroids
C. Topical antibiotics
D. Topical calcineurin inhibitors
E. Stronger steroid
Answer: D. Topical calcineurin inhibitors
Justification: Used when steroids fail or cause adverse effects like atrophy. Non-steroidal immune modulator.
Resource: InnovAiT 2024; 17(8): 388–395
76-year-old man with large, tense blisters on arms and trunk. Diagnosis: bullous pemphigoid.
What is the SINGLE MOST appropriate initial management?
A. Flucloxacillin
B. Emollients
C. Dermatology referral
D. Benzylpenicillin
E. Wet wrapping
Answer: C. Dermatology referral
Justification: Autoimmune blistering disorder needs specialist management. Treatment includes steroids or immunosuppressants.
Resource: PCDS – Bullous pemphigoid
A 16-year-old male presents with a one month history of a painless, non-itchy pale patch on the back of his head and neck. He has a family history of Type 1 diabetes mellitus and thyroid disease.
Which ONE of the following is the SINGLE MOST likely diagnosis?
A. Human immunodeficiency virus (HIV)
B. Neurofibromatosis
C. Leprosy
D. Vitiligo
E. Pityriasis versicolor
Answer: D. Vitiligo
Justification: Vitiligo is an autoimmune condition causing depigmentation due to destruction of melanocytes. It often has a family history and associations with thyroid disease and diabetes.
Resources:
- RCGP. Curriculum Topic Guides: dermatology. 2019
- PCDS. Vitiligo
Which one of the following is MOST likely to improve acne?
A. Probiotic yoghurt
B. High glycaemic index diet
C. Topical hydrocortisone
D. Ultraviolet light
E. Oral vitamin B12
Answer: D. Ultraviolet light
Justification: UV light can be beneficial for acne. The other options may exacerbate it.
Resource: PCDS. Acne vulgaris. Updated 2024
The mother of a five-year-old girl recently diagnosed with chronic urticaria asks about first-line management.
Which SINGLE option is MOST appropriate?
A. Corticosteroids
B. Sedating antihistamines
C. Non-sedating antihistamines
D. Montelukast
E. Omalizumab
Answer: C. Non-sedating antihistamines
Justification: Second-generation antihistamines are first-line for chronic urticaria due to better safety profile.
Resource: NICE CKS. Urticaria. 2024
A middle-aged woman is concerned about multiple skin lesions on her back.
Which is the SINGLE MOST appropriate management plan?
A. Excision of the enlarging lesions
B. Cryotherapy over several weeks
C. Reassurance
D. Diclofenac gel
E. Biopsy of a large lesion
Answer: C. Reassurance
Justification: Seborrhoeic keratoses are benign and commonly proliferate. Removal is only for troublesome lesions.
Resource: Clinical judgment based on dermatoses management guidelines
Which of the following statements regarding burns is CORRECT?
A. Keeping the wound environment moist is a key feature in optimal wound healing
B. Opioid analgesia is contraindicated in children under one year
C. Hot charred clothing should not be removed for 30 minutes
D. Iced water should be used to cool a deep burn
E. Household bleach typically causes an acid burn
Answer: A. Keeping the wound environment moist is a key feature in optimal wound healing
Justification: Moist environments promote epithelialisation. Charred clothing should be removed immediately. Iced water is contraindicated. Household bleach causes alkali, not acid burns.
Resource: Baker M. Burns: classification and community management. InnovAiT 2011; 5(9): 520–526
A nine-year-old boy has developed widespread infected atopic eczema.
Which is the SINGLE MOST appropriate antibiotic treatment?
A. Cefalexin oral suspension
B. Erythromycin oral suspension
C. Flucloxacillin oral suspension
D. Fusidic acid 2% and hydrocortisone acetate 1% cream
E. Mupirocin 2% cream
Answer: C. Flucloxacillin oral suspension
Justification: Flucloxacillin is first-line for widespread bacterial infection in eczema. Topical antibiotics should only be used in localised infection.
Resources:
- NICE CG57 (updated 2023)
- RCGP Curriculum Topic Guides: dermatology. 2019
Which ONE of the following signs is consistent with a stage 1 pressure ulcer?
A. Full thickness skin loss (fat visible)
B. Full thickness tissue loss (muscle or bone visible)
C. Non-blanchable redness of intact skin
D. Partial thickness skin loss or blister
Answer: C. Non-blanchable redness of intact skin
Justification: This defines a stage 1 ulcer per the NPUAP-EPUAP system.
Resource: NICE CKS. Pressure ulcers. 2024
A 19-year-old male has moderate acne with widespread comedones and numerous inflamed papules/pustules.
Which is the SINGLE MOST appropriate initial treatment?
A. Oral clindamycin alone
B. Oral lymecycline + topical adapalene
C. Oral isotretinoin + topical adapalene
D. Topical betamethasone + topical adapalene
E. Topical fusidic acid + topical adapalene
Answer: B. Oral lymecycline + topical adapalene
Justification: NICE recommends this combination for moderate to severe acne. Avoid oral or topical antibiotic monotherapy.
Resource: NICE NG198. Acne vulgaris. 2021 (updated 2023)
You see a 10-year-old struggling to sleep due to eczema flare.
What is the SINGLE MOST appropriate management?
A. Amitriptyline
B. Melatonin
C. Zopiclone
D. Mirtazapine
E. Sedating antihistamine
Answer: E. Sedating antihistamine
Justification: Can be used short-term (up to 14 days) to aid sleep during eczema flares in children over six months.
Resource: InnovAiT 2024; 17(8): 388–395
A 7-year-old girl with 3-week itchy rash worse at night.
What is the SINGLE MOST likely diagnosis?
A. Scabies
B. Pityriasis rosea
C. Erythema multiforme
D. Atopic eczema
E. Eczema herpeticum
Answer: A. Scabies
Justification: Intense nocturnal itch and burrows suggest scabies. Family transmission likely.
Resource: PCDS. Scabies
An elderly patient presents with a lesion that has been slowly enlarging over several months.
What is the SINGLE MOST likely diagnosis?
A. Squamous cell carcinoma
B. Cystic basal cell carcinoma
C. Amelanotic melanoma
D. Actinic keratosis
E. Pyogenic granuloma
Answer: B. Cystic basal cell carcinoma
Justification: Rolled edge, slow growth and site suggest BCC. Variants include cystic and superficial types.
Resource: PCDS. Basal cell carcinoma
Which SINGLE ONE of the following has a higher INCIDENCE in people with psoriasis?
A. Hypoparathyroidism
B. Malignant melanoma
C. Osteoarthritis
D. Ovarian cancer
E. Venous thromboembolism
Answer: E. Venous thromboembolism
Justification: Chronic inflammation increases risks of VTE, CVD and depression in psoriasis.
Resource: NICE CG153. Psoriasis. 2012 (updated 2017)
A 20-year-old woman has been diagnosed with vitiligo.
Which is the SINGLE MOST appropriate blood test to consider?
A. Full blood count
B. ESR
C. Urea and electrolytes
D. Liver function
E. Thyroid function
Answer: E. Thyroid function
Justification: Vitiligo is associated with autoimmune thyroid disease; TFTs are recommended.
Resource: BAD. Vitiligo. 2021
A 20-year-old woman presents with mildly itching trunk rash, preceded by buttock lesion.
What is the SINGLE MOST likely diagnosis?
A. Pityriasis rosea
B. Lichen planus
C. Dermatitis herpetiformis
D. Lupus erythematosus
E. Guttate psoriasis
Answer: A. Pityriasis rosea
Justification: Herald patch followed by ‘Christmas tree’ distribution. Self-limiting in young adults.
Resources:
- RCGP. Dermatology Curriculum Guide
- PCDS. Pityriasis rosea
A 45-year-old man with intensely itchy plaques on wrists and buccal mucosa lesions.
What is the SINGLE MOST appropriate treatment?
A. Topical emollients
B. Oral methotrexate
C. Topical clobetasol
D. Oral prednisolone
E. Topical hydrocortisone acetate
Answer: C. Topical clobetasol
Justification: Lichen planus responds to potent topical steroids. Oral forms may need topical or systemic therapy.
Resources:
- RCGP Curriculum Guide
- PCDS. Lichen planus
A 58-year-old man has a pigmented back lesion, 15 mm, asymptomatic.
What is the SINGLE MOST likely diagnosis?
A. Seborrhoeic keratosis
B. Compound naevus
C. Malignant melanoma
D. Sebaceous naevus
E. Blue naevus
Answer: C. Malignant melanoma
Justification: Meets ABCD rule for melanoma suspicion—refer urgently.
Resource: RCGP Curriculum – Dermatology
Which condition is MOST appropriate for lidocaine-containing treatment?
A. Paronychia
B. Trigeminal neuralgia
C. Lichen planus
D. Aphthous ulcer
E. Carpal tunnel syndrome
Answer: D. Aphthous ulcer
Justification: Lidocaine spray/gel provides symptomatic relief in oral ulcers.
Resources:
- NICE CKS. Aphthous ulcer. 2022
- Allen G, Butler R. InnovAiT 2022; 15(4): 233–237
A 26-year-old pregnant woman (24 weeks) has painful vulval rash diagnosed as herpes.
What is the SINGLE MOST appropriate treatment?
A. Topical aciclovir
B. Refer urgently to sexual health
C. Oral famciclovir
D. Topical idoxuridine
E. Topical penciclovir
Answer: B. Refer urgently to sexual health
Justification: Primary herpes in pregnancy requires urgent specialist input; aciclovir often used.
Resource: BNF. Herpesvirus infections
23-year-old man develops widespread vesicular rash typical of chickenpox. Temp 37.6°C.
What is the SINGLE MOST appropriate treatment?
A. Aciclovir topically five times a day
B. Aciclovir 200 mg orally five times a day
C. Aciclovir 400 mg orally three times a day
D. Aciclovir 800 mg orally five times a day
E. Admit for intravenous aciclovir
Answer: D. Aciclovir 800 mg orally five times a day
Justification: Recommended dose for immunocompetent adults if seen within 24h of rash onset.
Resources:
- NICE CKS – Chickenpox
- BNF – Aciclovir
30-year-old man with pale skin patches and family history of thyroid disease.
What is the SINGLE MOST appropriate FIRST-LINE treatment per BAD guidance?
A. Adapalene 0.1% gel
B. Hydrocortisone 1% ointment
C. Miconazole nitrate 2% cream
D. Mometasone furoate 0.1% ointment
E. Tacrolimus 0.03% ointment
Answer: D. Mometasone furoate 0.1% ointment
Justification: Potent topical steroids used as first-line for vitiligo for trial of up to two months.
Resource: BAD. Vitiligo
A 60-year-old man presents with a facial rash that has been worsening over the last three months. It affects his forehead, cheeks and nose. It gets worse in sunlight or in a warm environment and also after eating spicy foods.
Which of the following treatments would be the SINGLE MOST appropriate?
A. Isotretinoin cream
B. Metronidazole gel
C. Aqueous cream
D. Hydrocortisone cream
E. Ketoconazole cream
Answer: B. Metronidazole gel
Justification: This man has mild-to-moderate rosacea. Rosacea should no longer be referred to as ‘acne rosacea’. It is characterised by erythema with papules and pustules. He should be advised to avoid any lifestyle or trigger factors. The papules and pustules of rosacea respond to topical metronidazole or azelaic acid.
Resource: Primary Care Dermatology Society (PCDS). Rosacea.
A ten-year-old child has moderately severe eczema. It is not currently significantly inflamed but there is extensive dryness of the skin. After discussion of the options, his mother has no particular preference with regard to emollient formulation.
Which formulation is the SINGLE MOST appropriate to consider for this patient?
A. Spray
B. Ointment
C. Lotion
D. Gel
E. Cream
Answer: B. Ointment
Justification: Ointments are more effective for dry skin, last longer, and cause less irritation. The best emollient is the one the patient will use regularly.
Resources: NICE CKS. Eczema: atopic - emollients. 2024; Ridd M et al., BMJ 2019.
A 40-year-old man has scalp psoriasis with very thick scaling affecting most of the scalp area.
After using an emollient to remove the scale, which is the SINGLE MOST appropriate next treatment for him?
A. Daily hair washing with tar shampoo
B. Twice daily application of fluocinolone gel
C. Once daily application of calcipotriol solution
D. Once daily application of betamethasone valerate
E. Twice daily application of tacrolimus cream
Answer: D. Once daily application of betamethasone valerate
Justification: Potent topical steroids are recommended after emollient treatment to remove thick scaling.
Resource: NICE. Psoriasis: assessment and management. CG153. 2012 (updated 2017).
A 65-year-old woman has an itchy rash with oozing on her forearm. She does suffer with eczema. She is systemically well and wishes to be treated at home.
Which is the SINGLE MOST appropriate treatment?
A. A potent topical corticosteroid and antibiotic combination
B. A potent topical corticosteroid and oral antibiotic
C. An oral antibiotic
D. A topical antibiotic
E. A potent topical corticosteroid
Answer: E. A potent topical corticosteroid
Justification: In systemically well patients with eczema and suspected secondary infection, NICE advises not to routinely offer topical or oral antibiotics. A potent topical steroid is appropriate.
Resource: NICE CKS. Eczema - atopic. 2024.
Children with skin rashes: Match scenario to diagnosis.
Scenario 1: 7-year-old with facial rash and mild flu-like symptoms for 5 days
Scenario 2: 13-year-old boy with chest rash preceded by a single lesion
Scenario 3: 6-year-old with 5-day pustular rash
Scenario 4: 3-week-old with spots on face
Options:
- Measles
- Milia
- Molluscum contagiosum
- Parvovirus infection
- Pityriasis rosea
- Pityriasis alba
- Staphylococcal infection
Answers:
Scenario 1 → Parvovirus infection (fifth disease)
Scenario 2 → Pityriasis rosea (herald patch followed by widespread rash)
Scenario 3 → Staphylococcal infection (impetigo)
Scenario 4 → Milia (common, benign, self-limiting in newborns)
Resources: PHE. Viral rash in pregnancy; PCDS. Impetigo, Milia, Viral exanthems.
A 69-year-old lady comes to see you with a pigmented lesion on her foot. You decide to use a scoring system to help decide whether she needs to be referred urgently to a dermatologist.
Which SINGLE MOST appropriate option?
A. Framingham risk score
B. Weighted 7-point checklist
C. Ranson criteria
D. ABCD score
E. Gleason grading system
Answer: B. Weighted 7-point checklist
Justification: Includes major features (size change, irregular shape/colour) scoring 2 points each, and minor features (inflammation, oozing, diameter ≥7 mm, change in sensation) scoring 1 point each. Score ≥3 → urgent referral.
Resource: NICE NG12. Suspected cancer.
A 73-year-old lady presents with a six-month history of a gradually enlarging spot on the back of her hand.
What is the SINGLE MOST likely diagnosis?
A. Basal cell carcinoma
B. Granuloma annulare
C. Seborrhoeic keratosis
D. Squamous cell carcinoma
E. Ringworm
Answer: D. Squamous cell carcinoma
Justification: Sun-exposed location, gradual growth, and keratotic appearance indicate SCC. Urgent referral required.
Resources: NICE NG12; PCDS. Squamous cell carcinoma.
You are reviewing a 6-year-old with single-site mild impetigo that has failed to respond to regular cleansing and hydrogen peroxide cream. Swab shows MRSA.
What is the SINGLE MOST appropriate management option?
A. Topical fusidic acid
B. Oral erythromycin
C. Topical mupirocin
D. Oral flucloxacillin
E. Consult with microbiologist
Answer: E. Consult with microbiologist
Justification: MRSA requires microbiology input. Mupirocin may be appropriate if sensitivity confirmed.
Resources: NICE NG153. Impetigo: antimicrobial prescribing; Gleeson D. InnovAiT 2019.
A 15-year-old boy has warts on his hands. What percentage would MOST LIKELY represent the proportion of simple hand warts persisting beyond six months of first-line treatment?
A. 70%
B. 90%
C. 10%
D. 30%
E. 50%
Answer: D. 30%
Justification: Up to one-third of non-genital warts persist beyond six months despite treatment.
Resources: BAD Guidelines 2014; Cochrane Review 2012.
Match facial skin lesions to diagnosis:
Scenario 1: 22F with blood blisters on lips, recurrent nosebleeds, tiredness, iron deficiency anaemia
Scenario 2: 8-year-old with white patches on face, no symptoms
Scenario 3: 11-year-old with rapidly growing mole on face
Scenario 4: 76-year-old with long-standing rough spot on cheek
Options:
- Actinic keratosis
- Hereditary haemorrhagic telangiectasia
- Pityriasis alba
- Spitz naevus
Answers:
Scenario 1 → Hereditary haemorrhagic telangiectasia
Scenario 2 → Pityriasis alba
Scenario 3 → Spitz naevus (urgent referral needed)
Scenario 4 → Actinic keratosis
Resources: PCDS. Telangiectases, Pityriasis alba, Spitz naevus, Actinic keratosis
You see a 22-year-old concerned about spots on his scrotum.
What is the SINGLE MOST likely diagnosis?
A. Genital warts
B. Folliculitis
C. Genital herpes
D. Molluscum contagiosum
E. Fordyce spots
Answer: E. Fordyce spots
Justification: Small, painless, pale papules 1–3 mm in diameter. Common normal variant.
Resource: PCDS. Fordyce spots (syn. Fordyce’s granules).
A 45-year-old woman with rheumatoid arthritis presents with a two-week history of hair loss. On examination: three circular patches of hair loss with broken hairs at the edge.
Which of the following factors is associated with a poor prognosis for hair regrowth?
A. Short history at presentation
B. Adult onset
C. Sparing the scalp margins
D. Presence of other autoimmune disease
E. Presence of fungal spores in skin scrapings
Answer: D. Presence of other autoimmune disease
Justification: Alopecia areata prognosis is worse with autoimmune disease, childhood onset, and extensive scalp involvement.
Resources: RCGP Curriculum; PCDS. Alopecia areata
A 21-year-old female with plaque psoriasis on her limbs wants rapid improvement before a summer ball.
Which ONE topical treatment is MOST appropriate?
A. Coal tar soap
B. Calcipotriol/betamethasone diproprionate
C. Dithranol
D. Tazarotene
E. Hydrocortisone 0.05%
Answer: B. Calcipotriol/betamethasone diproprionate
Justification: Effective, cosmetically acceptable combination. Others either too weak or cosmetically problematic.
Resource: NICE CG153. Psoriasis: assessment and management.
Which combined oral contraceptive pill is licensed for moderate-to-severe hirsutism?
A. Gedarel (ethinylestradiol/desogestrel)
B. Dianette (ethinylestradiol/cyproterone acetate)
C. Microgynon (ethinylestradiol/levonorgestrel)
D. Yasmin (ethinylestradiol/drospirenone)
E. Any of the above
Answer: B. Dianette
Justification: Dianette is licensed for hirsutism. Discontinue after 3–4 months due to VTE risk.
Resource: Hardway M, Younas K. InnovAiT 2019; 12(8): 448–453.
A 75-year-old lady presents with unilateral erythematous swelling on the leg post insect bite. Temperature 37.8°C. What is the SINGLE MOST likely diagnosis?
A. Gout
B. Ankle sprain
C. Cellulitis
D. Varicose eczema
E. DVT
Answer: C. Cellulitis
Justification: Unilateral erythema and swelling following minor skin trauma suggests cellulitis.
Resource: Gleeson D. Bacterial skin infections. InnovAiT 2019; 12(8): 454–458.
Match the following hand conditions to diagnosis:
Scenario 1: 24M with symmetrical circular target lesions
Scenario 2: 34M with painful finger and vesicles
Scenario 3: 38F care worker with itchy hand rash, spreading
Scenario 4: 56F chef with slowly growing non-itchy rash on hand
Options:
- Erythema multiforme
- Herpetic whitlow
- Scabies
- Granuloma annulare
Answers:
Scenario 1 → Erythema multiforme
Scenario 2 → Herpetic whitlow
Scenario 3 → Scabies
Scenario 4 → Granuloma annulare
Resources: PCDS. Erythema multiforme, Herpetic whitlow, Scabies, Granuloma annulare
29-year-old woman with PCOS and acne unresponsive to topicals/antibiotics.
Which is the MOST appropriate medication?
A. Desogestrel
B. Levonorgestrel
C. Ethinylestradiol/drospirenone
D. Co-cyprindiol
E. Norethisterone
Answer: D. Co-cyprindiol
Justification: Licensed for acne in PCOS; contains anti-androgen. Should be reviewed after 3 months.
Resources: NICE NG198; BNF. Co-cyprindiol.
Elderly patient with rough forehead skin, history of chronic sun exposure.
What is the SINGLE MOST likely diagnosis?
A. Actinic keratoses
B. Seborrhoeic keratoses
C. Pyogenic granulomata
D. Viral warts
E. Metastases
Answer: A. Actinic keratoses
Justification: Sun-damaged skin; precursor to SCC. Treat with cryotherapy or topical therapies.
Resource: BAD Guidelines 2017.
19-year-old male with 3-year acne on face/chest/back. Failed tetracycline and erythromycin. Referral made.
What would be your expectation?
A. Doxycycline
B. Trimethoprim
C. Retinoid orally
D. Minocycline
E. Spironolactone
Answer: C. Retinoid orally
Justification: Specialist-only oral isotretinoin is standard after failure of antibiotics and scarring acne.
Resources: NICE NG198; BMJ 2023; 381: p1114
69-year-old man has painful leg rash followed by vesicles in same area. Planning holiday with grandson.
Which statement is TRUE?
A. Rash caused by HSV-1
B. Flucloxacillin is indicated
C. Antivirals unlikely to help
D. Grandson may develop shingles
E. He is at risk of neuropathic pain
Answer: E. He is at risk of neuropathic pain
Justification: Shingles may lead to post-herpetic neuralgia. Start antivirals within 72h. Grandson cannot catch shingles.
Resources: PCDS. Herpes zoster; BNF; PHE Green Book Ch. 28a
Which ONE of the following proprietary topical corticosteroid preparations is considered to be VERY POTENT?
A. Dermovate®
B. Betnovate-C®
C. Betnovate-N®
D. Eumovate®
E. Betnovate®
Answer: A. Dermovate®
Justification: Potency of topical corticosteroid depends on both formulation and steroid. Dermovate (clobetasol propionate) is classed as very potent.
Resource: BNF. Topical corticosteroids.
What is the recommended WEEKLY QUANTITY (in grams) of emollient for an adult with widespread dermatitis?
A. 100
B. 1000
C. 250
D. 50
E. 500
Answer: E. 500
Justification: Adults with widespread dermatitis require 500 g per week applied 2–4 times daily.
Resource: Primary Care Dermatology Society. Emollient - treatment. 2021.
69-year-old man with a painful lump on his right ear pinna for 5 months.
A. Actinic keratosis
B. Basal cell carcinoma
C. Keratoacanthoma
D. Chondrodermatitis nodularis
E. Perichondrial hematoma
Answer: D. Chondrodermatitis nodularis
Justification: Painful nodules on helix/antihelix in elderly men; may ulcerate and resemble BCC.
Resource: PCDS. Chondrodermatitis nodularis helicis.
67-year-old woman with ulcerative colitis and a new, rapidly enlarging painful leg ulcer.
A. Venous ulcer
B. Pyoderma gangrenosum
C. Necrobiosis lipoidica
D. Squamous cell carcinoma
E. Erythema nodosum
Answer: B. Pyoderma gangrenosum
Justification: Necrotic ulcers with purple edge, often associated with IBD, arthritis, haematological disorders.
Resource: PCDS. Pyoderma gangrenosum.
26-year-old woman trying to conceive, failed topical acne treatments.
A. Topical erythromycin / tretinoin
B. Oral erythromycin and topical benzoyl peroxide
C. Oral lymecycline and topical benzoyl peroxide
D. Oral erythromycin and topical adapalene
E. Topical clindamycin / tretinoin
Answer: B. Oral erythromycin and topical benzoyl peroxide
Justification: Erythromycin is preferred in pregnancy. Avoid lymecycline and retinoids. Combine systemic and topical agents.
Resource: PCDS. Acne: acne vulgaris.
23-year-old man with 8-month history of focal sweating on back. Positive family history.
A. Painful sweat ducts
B. Sweating continues during sleep
C. Frequency of one episode at least once weekly
D. Unilateral symptoms
E. Continuation of work despite symptoms
Answer: C. Frequency of one episode at least once weekly
Justification: One of six diagnostic criteria for primary focal hyperhidrosis.
Resource: Webber L. Hyperhidrosis. InnovAiT 2017. 10(7): 409–416.
48-year-old woman with 2-week rash increasing in size; likely erythema migrans.
A. Erythema annulare
B. Erythema migrans
C. Erythema infectiosum
D. Erythema nodosum
E. Erythema multiforme
Answer: B. Erythema migrans
Justification: Typical of Lyme disease; occurs 1–4 weeks post tick bite. Treat empirically if suspected.
Resource: NICE. Lyme disease guidance.
52-year-old woman with intense vulval itching and white thickened skin.
A. Lichen simplex
B. Candidiasis
C. Tinea cruris
D. Vulval intraepithelial neoplasia
E. Lichen sclerosus
Answer: E. Lichen sclerosus
Justification: Affects genital skin; appears white, thickened or crinkled. Autoimmune mechanism suspected.
Resources: PCDS. Lichen sclerosus; DermNet NZ. Candidiasis.
Hair loss scenarios:
1. 53F with vertex thinning and irregular periods
2. 34M with total scalp hair loss, but retained body hair
Select from:
Alopecia areata, Alopecia totalis, Alopecia universalis, Female pattern baldness, etc.
Answers:
1 → Female pattern baldness
2 → Alopecia totalis
Justification: Female pattern baldness shows vertex thinning; alopecia totalis = complete scalp hair loss.
Resource: RCGP. Dermatology Topic Guides
16-year-old with pustular acne and hyperpigmentation, failed lymecycline + BPO.
A. Add POP (desogestrel)
B. Add co-cyprindiol
C. Switch to azelaic acid
D. Switch to erythromycin
E. Refer for oral isotretinoin
Answer: E. Refer for oral isotretinoin
Justification: Persistent pigmentary changes or treatment-resistant acne warrant dermatology referral.
Resource: NICE NG198. Acne vulgaris
24-year-old woman with 5 mm firm yellow lesion on shin after insect bite. Positive pinch test.
A. Cryotherapy
B. Curettage and cauterisation
C. Excision
D. 5-Fluorouracil cream
E. Reassurance
Answer: E. Reassurance
Justification: Dermatofibromas are benign. Excision leaves scar resembling lesion.
Resource: PCDS. Dermatofibroma
6-year-old girl with urticarial rash, cough, runny nose, temp. Rash blanches, no drug history.
A. Heat urticaria
B. Chronic spontaneous urticaria
C. Paracetamol-induced urticaria
D. New dairy allergy
E. Viral (infective) urticaria
Answer: E. Viral urticaria
Justification: Infections account for most acute urticaria cases in children.
Resource: PCDS. Urticaria
40-year-old man with severe eczema, worst on palms.
A. Hydrocortisone 1%
B. Betamethasone valerate 0.1%
C. Clobetasol propionate 0.05%
D. Mometasone furoate 0.1%
E. Clobetasone butyrate 0.05%
Answer: C. Clobetasol propionate 0.05%
Justification: Very potent steroid recommended for severe hand eczema.
Resources: BNF; PCDS. Hand eczema
67-year-old man with chronic urticaria controlled with 4x daily antihistamines.
Which has greatest anticholinergic effect?
A. Acrivastine
B. Cetirizine
C. Loratadine
D. Chlorphenamine
E. Fexofenadine
Answer: D. Chlorphenamine
Justification: Sedating antihistamines have higher anticholinergic burden.
Resource: BNF. Antihistamines
38-year-old woman with painful boils in axillae, longstanding history.
A. Clarithromycin
B. Co-amoxiclav
C. Flucloxacillin
D. Phenoxymethylpenicillin
E. Doxycycline
Answer: E. Doxycycline
Justification: First-line antibiotic for hidradenitis suppurativa.
Resources: BAD Guidelines; Cochrane Review on HS
43-year-old man with nodular ring-like rash on hands.
Systemic condition associated?
A. Sarcoidosis
B. Lyme disease
C. Rheumatoid arthritis
D. Diabetes mellitus
E. PBC
Answer: D. Diabetes mellitus
Justification: Generalised granuloma annulare may be associated with diabetes.
Resources: PCDS. Granuloma annulare; RCGP Topic Guide
Most effective scabies treatment:
A. Malathion lotion
B. Phenothrin lotion
C. Benzyl benzoate
D. Carbaryl liquid
E. Permethrin cream
Answer: E. Permethrin cream
Justification: 5% permethrin is safe, effective, and first-line for scabies.
Resource: PCDS. Scabies
6-year-old boy with elbow lesion, itchy, scale, sibling with similar lesion.
A. Erythema multiforme
B. Atopic eczema
C. Granuloma annulare
D. Tinea corporis
E. Pityriasis rosea
Answer: D. Tinea corporis
Justification: Ringworm caused by dermatophyte; contagious, scaly, ringed.
Resource: PCDS. Tinea corporis
55-year-old farmer with facial lesion.
Predisposing condition to SCC?
A. Erythema multiforme
B. Vitiligo
C. Actinic keratosis
D. Benign naevus
E. Cavernous haemangioma
Answer: C. Actinic keratosis
Justification: AK can transform into SCC; common on sun-exposed areas.
Resource: PCDS. SCC overview
7-year-old with longstanding eczema, sudden deterioration, vesicles, fever.
A. Eczema herpeticum
B. Molluscum contagiosum
C. Impetigo
D. Scabies
E. Scalded skin syndrome
Answer: A. Eczema herpeticum
Justification: Severe herpes simplex infection in eczematous skin. Requires antivirals.
Resources: PCDS. Eczema herpeticum; RCGP Topic Guide
A 60-year-old former dockyard worker presents with changes to his nails and fingers.
To what malignant condition is this MOST LIKELY related?
A. Thyroid carcinoma
B. Testicular carcinoma
C. Hypernephroma
D. Mesothelioma
E. Adrenocortical carcinoma
Answer: D. Mesothelioma
Justification: Occupational asbestos exposure suggests mesothelioma, a pleural cause of hypertrophic pulmonary osteoarthropathy (HPOA).
Resources: RCGP Curriculum Topic Guides; DermNet NZ – Hypertrophic osteoarthropathy
An 85-year-old woman has a superficial, grade 1 pressure ulcer with a wound swab growing Staphylococcus aureus.
What is the SINGLE MOST appropriate treatment?
A. Erythromycin tablets
B. Flucloxacillin tablets
C. Fusidic acid cream
D. Mupirocin cream
E. No antibiotic needed
Answer: E. No antibiotic needed
Justification: Antibiotics are not indicated without clinical signs of infection.
Resource: NICE CG179. Pressure ulcers: prevention and management (2014)
A 6-year-old boy with a flare of eczema and a golden-crusted lesion on his chin.
What is the SINGLE MOST appropriate management?
A. Hydrogen peroxide
B. Aciclovir cream
C. Triclosan solution
D. Chlorhexidine solution
E. Miconazole cream
Answer: A. Hydrogen peroxide
Justification: Suggests localised impetigo; treat with topical antibiotic like hydrogen peroxide or fusidic acid.
Resource: InnovAiT 2024; 17(8): 388–395
A 30-year-old woman has recurrent eczema flares responding to topical steroids.
What is the SINGLE MOST appropriate topical preventative regime?
A. Once daily hydrocortisone 1%
B. Once weekly clobetasol propionate 0.05%
C. Twice weekly fusidic acid
D. Two consecutive days weekly betamethasone valerate 0.1%
E. Two consecutive days weekly tacrolimus 0.1%
Answer: D. Two consecutive days weekly betamethasone valerate 0.1%
Justification: “Weekend steroid” strategy helps reduce recurrence of flares.
Resource: PCDS. Eczema: atopic eczema (2024)
76-year-old woman with painful, well-defined ulcer on medial malleolus and ABPI of 0.5.
What is the SINGLE MOST likely cause?
A. Arterial
B. Malignant
C. Vasculitis
D. Neuropathic
E. Venous
Answer: A. Arterial
Justification: ABPI <0.8 suggests arterial disease. Ulcers are painful with defined margins.
Resource: PCDS. Leg ulcers
Match the following scenarios to the SINGLE MOST appropriate treatment:
1. 68M with erysipelas on face and fever
2. 4-day-old neonate with benign pustular rash
3. 32M with herald patch and viral prodrome
4. 74M with multiple scaly scalp lesions
Options include: Oral co-amoxiclav, Advice and reassurance, Diclofenac gel
Answers:
1 → Oral co-amoxiclav (erysipelas)
2 → Advice and reassurance (erythema toxicum neonatorum)
3 → Advice and reassurance (pityriasis rosea)
4 → Diclofenac gel (actinic keratoses)
Resources: PCDS. Cellulitis, Pityriasis rosea, Actinic keratosis
Adult with blistering eczema on palms and soles.
Which is the SINGLE MOST appropriate topical treatment?
A. Betamethasone valerate 0.1%
B. Clobetasone butyrate 0.05%
C. Hydrocortisone 2.5%
D. Hydrocortisone 1%
E. Hydrocortisone 0.5%
Answer: A. Betamethasone valerate 0.1%
Justification: Pompholyx requires potent topical corticosteroids.
Resource: RCGP Curriculum Topic Guide: dermatology (2019)
20-year-old woman with axillary psoriasis not responsive to betamethasone 0.025%.
What is the SINGLE MOST appropriate next step?
A. Referral to a dermatologist
B. Calcipotriol
C. Tazarotene
D. Coal tar
E. Mometasone
Answer: A. Referral to a dermatologist
Justification: Psoriasis in flexures unresponsive to mild steroids → refer for specialist input.
Resource: NICE CG153. Psoriasis (2012, updated 2017)
What condition significantly increases NMSC risk in actinic keratosis patients?
A. Vitamin D deficiency
B. Type 2 diabetes
C. Immunosuppressive therapy
D. Psoriasis
E. Colorectal cancer
Answer: C. Immunosuppressive therapy
Justification: Especially post-transplant, immunosuppression increases NMSC risk 50–100x.
Resource: NICE; PCDS. Actinic keratoses
25-year-old man with plaque psoriasis on elbows, knees, and back.
What is the SINGLE MOST appropriate initial treatment?
A. Calcipotriol and betamethasone
B. Coal tar and salicylic acid
C. Dithranol
D. Pimecrolimus
E. Tazarotene
Answer: A. Calcipotriol and betamethasone
Justification: NICE and PCDS recommend combination therapy for rapid improvement and adherence.
Resource: NICE CG153; PCDS. Psoriasis management
A 40-year-old HIV+ patient presents with purplish skin lesions.
What is the SINGLE MOST likely diagnosis?
A. Toxic epidermal necrolysis
B. Vasculitis
C. Melanoma
D. Kaposi’s sarcoma
E. Blood blister
Answer: D. Kaposi’s sarcoma
Justification: Purple macules or nodules on skin/mucosa common in immunosuppressed (e.g. HIV).
Resources: RCGP Curriculum Topic Guide; DermNet NZ
A 90-year-old with facial nodule, ulceration, and telangiectasia.
Which treatment has the highest cure rate?
A. Topical antibiotics
B. Topical steroids
C. Photodynamic therapy
D. Cryotherapy
E. Mohs micrographically controlled excision
Answer: E. Mohs micrographically controlled excision
Justification: Mohs surgery has highest cure rate for BCC, especially in cosmetically sensitive areas.
Resource: DermNet NZ – Basal cell carcinoma
42-year-old man with painful, red, swollen leg and fever. Allergic to penicillin.
What is the SINGLE MOST appropriate management option?
A. Flucloxacillin
B. Clindamycin
C. Doxycycline
D. Ciprofloxacin
E. Co-amoxiclav
Answer: C. Doxycycline
Justification: First-line for cellulitis in penicillin-allergic patients.
Resource: NICE CKS. Cellulitis
5-year-old boy with facial eczema not improving on hydrocortisone 1% for 4 weeks.
What is the SINGLE MOST appropriate next step?
A. Betamethasone valerate 0.1%
B. Calcipotriol
C. Clobetasol propionate
D. Fluticasone propionate
E. Pimecrolimus 1%
Answer: E. Pimecrolimus 1%
Justification: NICE recommends pimecrolimus or tacrolimus as second-line for facial eczema in children.
Resource: NICE CG57. Atopic eczema in under 12s
38-year-old woman with generalised pruritus and normal bloods.
What is the SINGLE MOST appropriate additional investigation?
A. Calcium
B. Folate
C. Vitamin B12
D. Vitamin D
E. Ferritin
Answer: E. Ferritin
Justification: Iron deficiency is a common systemic cause of pruritus even without anaemia.
Resource: NICE CKS. Pruritus
27-year-old pregnant woman in 3rd trimester with intensely pruritic rash in striae, sparing umbilicus.
What is the SINGLE MOST appropriate initial treatment?
A. Oral prednisolone
B. Oral antibiotics
C. Topical steroid cream
D. Topical malathion
E. Oral ursodeoxycholic acid
Answer: C. Topical steroid cream
Justification: Polymorphic eruption of pregnancy (PUPPP) managed with emollients, mild/moderate topical steroids.
Resource: PCDS. Polymorphic eruption of pregnancy
30-year-old woman develops a firm, mauve then white plaque under right breast after tick bite.
What is the SINGLE MOST likely diagnosis?
A. Morphoea
B. Lyme’s disease
C. Candidiasis
D. Contact dermatitis
E. Psoriasis
Answer: A. Morphoea
Justification: Localised scleroderma presents as thickened skin; may follow trauma or tick bite.
Resources: PCDS. Morphoea; RCGP Topic Guides
Which feature SUPPORTS diagnosis of atopic eczema in a 6-year-old with itchy rash?
A. Personal history of asthma
B. Penicillin allergy
C. Dry skin as a baby
D. Onset over the age of two
E. Involvement of extensor surfaces
Answer: A. Personal history of asthma
Justification: Atopic triad (eczema, asthma, allergic rhinitis) support diagnosis in children.
Resource: NICE CG57. Atopic eczema under 12s
64-year-old woman develops recurrent blister on same finger; fades to brown mark.
What is the SINGLE MOST likely diagnosis?
A. Pemphigus foliaceus
B. Bullous pemphigoid
C. Fixed drug eruption
D. Epidermolysis bullosa
E. Erythema multiforme
Answer: C. Fixed drug eruption
Justification: Recurs at same site after specific medication. Often blistering, leaves hyperpigmentation.
Resource: DermNet NZ – Drug eruptions
37-year-old cleaner with inflamed proximal nail folds.
What is the SINGLE MOST likely causative organism?
A. Candida albicans
B. Parapox virus
C. Trichophyton rubrum
D. Streptococcus pyogenes
E. Staphylococcus aureus
Answer: A. Candida albicans
Justification: Chronic paronychia due to irritant dermatitis, often complicated by Candida.
Resource: PCDS. Paronychia
