Passmed

Question 1

A 38-year-old man presents with a sudden onset rash. He is otherwise well in himself and has no notable past medical history. You see from his notes he has had recent tonsillitis for which he received amoxicillin. On examination, there are multiple papules on his trunk and proximal extremities. There is a fine scale on several of these lesions. What is the most likely diagnosis?

Answer 1

Guttate psoriasis

Guttate psoriasis usually presents in children and adults younger than 30 years of age. It can occur as the first presentation of psoriasis or as an acute exacerbation of plaque psoriasis, particularly after acute streptococcal infection (usually of the throat) or viral infection.

Group A strep

Question 2

What is the diagnosis?

Answer 2

Basal cell carcinoma

The rolled, pearly edges with telangiectasia surrounding a central crater make basal cell carcinoma the most likely diagnosis.

Question 3

“Herald patch” followed by a widespread rash = what derm condition?

Answer 3

Pityriasis rosea

Question 4

What is the diagnosis?

Answer 4

Signs of SCC include – a firm, red nodule; a flat sore with a scanty crust; fast-growing.

Question 5

Malignant or benign?

Answer 5

Malignant because ABCDE:

• A – asymmetrical
• B – irregular border
• C – more then one colour
• D – large diameter (more then 6mm)
• E – evolving

Question 6

What is the diagnosis?

Answer 6

Malignant melanoma

Question 7

Diagnosis?

Answer 7

Benign Naevus

Question 8

How would you describe this condition?

Answer 8

Vitiligo is characterised by symmetrical depigmented macules. Hands, perioral, perioccular areas and genitialia are characteristic sites.

Question 9

How would you describe this condtion of acne vulgaris?

Answer 9

This patient has inflammatory pustules, papules and scarring. Other features of acne include open and closed comedones, nodules and cysts.

Question 10

How is psoriasis treated?

Answer 10

Calcitriol and a steriod.

Question 11

Migraine is contraindication in women taking what medication?

Answer 11

COCP

Question 12

A 22-year-old woman presents due to hypopigmented skin lesions on her chest and back. She has recently returned from holiday in Spain and has tanned skin. On examination the lesions are slightly scaly. What is the most likely diagnosis?

Answer 12

Pityriasis versicolor

Question 13

Eczema herpeticum requires what treatment?

Answer 13

IV antivirals

Question 14

Common medication known to exacerbate plaque psoriasis.

Answer 14

Beta-blockers are known to exacerbate plaque psoriasis.

Question 15

Where are basal cell carcinomas most commonly located?

Answer 15

Basal cell carcinomas are usually localised to the face, scalp, nose or ear. They are classically described as pearly-shaped rodent ulcers with telangiectasia and do not metastasise.

Question 16

Squamous cell carcinoma is common in what patients?

Answer 16

Squamous cell carcinomas tend to have ulceration present and there is a significantly increased risk of developing squamous cell carcinoma in patients who are immunosuppressed e.g. patients who have had a renal transplant, have HIV, etc. The knee pain in this question raises the possibility that the cancer has metastasised.

Question 17

Intrahepatic cholestasis of pregnancy presents with itching and results in secondary skin changes due to pruritus.

Answer 17

Intrahepatic cholestasis of pregnancy presents with itching and results in secondary skin changes due to pruritus.

Question 18

What is the treatment for pityriasis versicolor?

Answer 18

Ketoconazole shampoo is used to treat pityriasis versicolor.

Question 19

You are working in general practice and see a 24-year-old male with a likely diagnosis of pityriasis rosea. What most commonly precedes this condition?

Answer 19

Pityriasis rosea often follows a viral infection.

Question 20

Pityriasis rosea often follows a viral infection. Streptococcal throat infection tends to trigger guttate psoriasis, dermatophyte fungal skin infection tends to result in pityriasis versicolor.

Answer 20

Pityriasis rosea often follows a viral infection. Streptococcal throat infection tends to trigger guttate psoriasis, dermatophyte fungal skin infection tends to result in pityriasis versicolor.

Question 21

The parents of an 8-year-old girl have noticed a small growth on the sole of her foot for the last 3 months that has become painful. On examination, there is a small, firm, hyperkeratotic growth with tiny overlying black dots.

Diagnosis and treatment:

Answer 21

This child has a plantar wart, also known as a verruca. The tiny black dots are caused by thrombosed capillaries. They often self-resolve, but if treatment is desired, topical salicylic acid (15–50%) applied daily for up to 12 weeks can be tried.

Question 22

A 53-year-old man presents complaining of an itchy scalp and dandruff. On examination he is noted to have eczema on his scalp, behind his ears and around his nose.

Diagnosis?

Answer 22

Seborrhoeic dermatitis

Question 23

First line treatment for Seborrhoeic dermatitis?

Answer 23

Seborrhoeic dermatitis - first-line treatment is topical ketoconazole.

Question 24

What treatment is used to treat pityriasis versicolor?

Answer 24

Ketoconazole shampoo

Question 25

How long should the break be in break in between courses of topical corticosteroids in patients with psoriasis.

Answer 25

Aim for a 4 week break in between courses of topical corticosteroids in patients with psoriasis.

Question 26

Dermatophyte nail infections - use what?

Answer 26

Dermatophyte nail infections - use oral terbinafine.