Dermatology: Past Paper Questions Flashcards
You are the GP reviewing an 81-year-old man with varicose veins. When he removes his right sock, you notice an ill-defined area of ulceration in the region of the medial malleolus. There is also pedal oedema to the mid-shins and some cutaneous changes of chronic venous insufficiency. Pulses are present. You decide to refer to vascular surgery.
Alongside surgery for his varicose veins, which treatment would be most appropriate?
Oral flucloxacillin
Graduated compression hosiery
Femoral endarterectomy
Compression bandaging
Intermittent pneumatic compression
Management of venous ulceration - compression bandaging
A 49-year-old woman presented to her general practitioner with a 10-day history of a painful lesion on her ankle. She reports that she initially thought she caught her leg on a branch whilst gardening but since says the lesion has been growing in size. Other than occasional myalgia, there are no other symptoms to report.
On examination, her observations are within normal limits. Her leg is examined, as shown below:
What is the most likely diagnosis?
Arterial ulcer
Cellulitis
Necrotising fasciitis
Pyoderma gangrenosum
Venous ulcer
Pyoderm genrenosum
The image above shows an ulcerated, purple-coloured lesion with undefined borders. There is evidence of central bleeding through broken-down skin. This is in keeping with a diagnosis of pyoderma gangrenosum. Pyoderma gangrenosum is a rapidly enlarging, painful ulcer that often starts as a small red pustule following a minor injury. The condition is associated with autoimmune inflammatory conditions such as inflammatory bowel disease and rheumatoid arthritis, however, they do not need to be present to make the diagnosis.
A 17-year-old male presents with a new skin condition which his mum noticed when they were on holiday in Spain. On examination, he has skin type V, with multiple small patches of depigmentation to the upper back. The patches appear mildly flaky but they are asymptomatic. He is usually well and has never had this condition before. Which of the following is the most likely diagnosis?
Pityriasis rosea
Atopic eczema
Vitiligo
Guttate psoriasis
Pityriasis versicolor
This is a typical history of pityriasis versicolor, a skin condition caused by an overgrowth of Malassezia yeast. It is most common in young people, especially males. It causes multiple patches of skin discolouration, mainly to the trunk. The patches may appear pale brown, pink, or may appear depigmented especially in patients with dark skin. They may also be mildly flaky and itchy. The condition can often present after spending time in sunny, humid environments. It is treated with topical antifungals eg. ketoconazole shampoo.
A 78-year-old man asks you to look at a lesion on the right side of nose which has been getting slowly bigger over the past 2-3 months. On examination you observe a round, raised, flesh coloured lesion which is 3mm in diameter and has a central depression. The edges of the lesion appear rolled and contain some telangiectasia.
What is the single most likely diagnosis?
Molluscum contagiosum
Actinic keratosis
Squamous cell carcinoma
Malignant melanoma
Basal cell carcinoma
Basal cell carcinoma
A mother brings her 3-year-old son to your GP surgery. She has noticed that he has been itching his face, particularly around his mouth and that he has developed some ‘spots and scabs’ in the area. The patient does not appear systemically unwell or distressed. The child has a history of atopic eczema and viral-induced wheeze.
On examination of the child’s face you note the presence of pustules and vesicles surrounding the mouth and nose area along with some honey-coloured plaques. You diagnose impetigo and prescribe topical fusidic acid as well as advising good hygiene measures.
The mother is concerned about sending the child to daycare. What do you advise?
Now that the patient is on treatment he may return to daycare
The patient must have been on treatment for 24h before returning to daycare
The patient must have been on treatment for 48h before returning to daycare
The patient must wait until 4 days following the appearance of the lesions before returning to daycare
The patient can return to daycare immediately because he feels well
The patient must have been on treatment for 48h before returning to daycare
The most common malignancy associated with acanthosis nigricans is
is gastrointestinal adenocarcinoma
Beta-blockers are known to exacerbate
plaque psoriasis
A 5-year-old girl is brought to the general practice due to body lesions noticed by their father during bathing. There are 3 discrete lesions on the back - the lesions are raised pink papules with central umbilication. The child is unaware of them and is otherwise well.
What is the next best management step?
Cryotherapy
Oral fluconazole
Reassurance
Skin biopsy
Topical fusidic acid
Molluscum contagiosum in children - treatment is not usually recommended.
A 28-year-old Caucasian male presents with itchy red spots on is abdomen, back and arms, which he reports appeared quite suddenly. He has no significant past medical history, but states he had a sore throat a few weeks ago. On examination, you notice he has a white pus-like discharge over his palatine tonsils. He states that he a similar rash last winter, when he had a sore throat.
Which of the following is the most likely diagnosis?
Drug eruption
Urticaria
Guttate psoriasis
Lichen planus
Discoid eczema
Guttate psoriasis
A 28-year-old Caucasian male presents with itchy red spots on is abdomen, back and arms, which he reports appeared quite suddenly. He has no significant past medical history, but states he had a sore throat a few weeks ago. On examination, you notice he has a white pus-like discharge over his palatine tonsils. He states that he a similar rash last winter, when he had a sore throat.
Which of the following is the most likely diagnosis?
Drug eruption
Urticaria
Guttate psoriasis
Lichen planus
Discoid eczema
Guttate psoriasis
guttate psoriasis
Streptococcal throat infection may precipitate psoriasis (particularly guttate psoriasis). Patients with frequent exacerbations of guttate psoriasis due to streptococcal throat infections may benefit from tonsillectomy
A 42-year-old female presents to her general practitioner with a new-onset rash on her neck. She denies pruritus, but she has been recently troubled by a cold sore on her upper lip. She has a past medical history of sarcoidosis, well managed. Her rash is shown below:
Which one of the following is the most likely diagnosis?
Atopic dermatitis
Bullous pemphigoid
Erythema multiforme
Erythema nodosum
Stevens-Johnson syndrome
Erythema multiforme
This patient is presenting with some non-itchy target lesions on her neck. The name of target lesions comes from the fact they have three concentric colour zones, a darker centre with a blister, a ring around this that is paler pink and raised due to oedema and a bright red outermost ring. This shape of lesion is characteristic of erythema multiforme, a hypersensitivity reaction that is most commonly triggered by infections. In this case, the patient complains of a cold sore on her upper lip (herpes labials) that most likely triggered the reaction.
management of fungal toe nail infections
Trichophyton rubrum is one of the most common dermatophyte nail infection organisms. For dermatophyte nail infections, oral terbinafine is the first line.
No treatment is not correct here as he is symptomatic (pain on walking) and is keen on treatment.
Oral itraconazole would be more suitable for Candida infections, or second line for dermatophyte infections.
