Thursday, May 16, 2013

Clinical Sign : Erythema Nodosum

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1- What is the name of ths sign ?

Erythema nodosum

2- What are the causes ?

- In about 30-50% of cases, the cause of EN is unknown
- infectious : Hep C , TB , Leprosy , Strepto , M.pneumonia , EPV , Yersinia , coccidiodis immitis

- autoimmune : IBD , Bachet
- sacroidosis , pregnancy , cancer
- medication ( sulfonamides , oral contraceptives, bromides ) & vaccination .

Mnemonics :  SORE SHINS
(Streptococci, OCP , Rickettsia , Eponymous (Bechet) , Sulfonamides , Hansen's Disease (Leprosy), IBD , NHL , Sarcoidosis.



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Clinical Sign : Erythema Multifrom

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1- What is the name of this sign ?

Erythema multifrom

2- What are the causes ?

HSV present in almost all cases 
50% of cases are idiopathic
others :
- Fungal
- Parasitic (Trichomonas species, Toxoplasma gondii)
- Viral (especially Herpes simplex). 
- Drug reactions, most commonly to: Antibiotics (including, sulphonamides, penicillin), anticonvulsants (phenytoin, barbiturates), aspirin, antituberculoids, and allopurinol and many others. 
- Physical factors - Radiotherapy, cold, sunlight 
- Others - Collagen diseases, vasculitides, non-Hodgkin lymphoma, leukaemia, multiple myeloma, myeloid metaplasia, polycythemia


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Wednesday, May 15, 2013

Blueprint Notes & Cases Pharmacology

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MCQs:Pharmacology

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Explanation in ( Blueprint Notes and Cases Pharmacology )

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Tuesday, May 14, 2013

MCQs:Anatomy ( Abdomen )

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1- Which statement best describes the planes of the abdomen?
a. The transpyloric plane lies halfway between the xiphoid and the symphysis pubis.
b. The transpyloric plane passes through the hilar of the kidneys.
c. The subcostal plane is at the level of the body of L2.
d. The iliac crests lie at the level of L5.
e. The umbilicus usually lies at the level of the L4/L5 disc.
Answer :
b. The transpyloric plane also passes through the pylorus, the pancreatic neck, the duodenojejunal flexure and the fundus of the gall bladder. The spinal cord also ends at the level of the transpyloric plane.
 
2- Which statement about the regions of the abdomen is correct?
a. The epigastrium lies medial to the mid-clavicular line and above the transpyloric plane.
b. The suprapubic region lies between the midclavicular lines, the transpyloric plane and the
intertubercular line.
c. The iliac fossa lies lateral to the mid-clavicular line
and above the intertubercular line.
d. The hypochondrium lies below the transpyloric plane and medial to the mid-clavicular line.
e. The mid-clavicular line crosses the midpoint of the inguinal ligament.
Answer :
a. The abdomen is conventionally divided into nine regions by the two mid-clavicular lines running vertically, and the transpyloric plane and intertubercular plane running horizontally.
The intertubercular plane joins the tubercles of the iliac crests. The epigastrium is in the position described relative to these lines.
3- Which statement correctly describes the abdominal wall?
a. The superficial fascia of the abdominal wall contains Camper’s fascia.
b. The deep fascia of the abdominal wall is known as Scarpa’s fascia.
c. Scarpa’s fascia adheres to the superficial fascia of the thigh.
d. The umbilicus receives sensory fibres from T8.
e. The groin is innervated by T12.
Answer :
a. Camper’s fascia is the superficial fatty layer of the fascia of the abdominal wall. This fatty layer is continuous with the fat of the rest of the body.
4- Which statement about the rectus abdominis is correct?
a. It has the transversalis fascia posteriorly throughout its length.
b. It has three tendinous intersections which are visible posteriorly.
c. It has the aponeuroses of the three oblique abdominal muscles anterior to it below the arcuate line.
d. The lower free border of the anterior rectus sheath is called the arcuate line.
e. The linea alba is a highly vascular structure.
Answer :
c. Below the arcuate line the aponeuroses of all three oblique muscles pass in front of the rectus abdominis. Above the arcuate line the external oblique aponeurosis passes anterior, the transverse oblique aponeurosis passes behind, and the internal oblique aponeurosis splits to enclose the rectus muscle.
5- Which statement about the oblique abdominal muscles is incorrect?
a. The fibres of external oblique pass antero-inferiorly.
b. The lower fibres of internal oblique form the inguinal ligament.
c. The external oblique arises from the lower eight ribs.
d. Internal oblique arises from the lumbar fascia.
e. The internal oblique has a free lower border.
Answer :
b. The lower border of the external oblique aponeurosis forms the inguinal ligament.
6- Which statement best completes this sentence? The inguinal canal:
a. Has a deep ring, which is a defect in the transversus abdominis muscle.
b. Is bounded posteriorly by the inguinal ligament.
c. Has the internal oblique as part of its posterior wall throughout.
d. Has the conjoint tendon superiorly.
e. Transmits the ilioinguinal nerve, which enters the canal through the deep ring.

Answer:

d. The conjoint tendon, comprising of the fused fibres of the internal and transverse oblique muscles, arches over the inguinal canal to attach to the pubic crest.
7- Which of the following statements about the peritoneum is correct?
a. The median umbilical fold contains the obliterated remnant of the umbilical artery.
b. The greater omentum consists of four layers of peritoneum.
c. The gastrosplenic ligament contains the splenic vessels.
d. The lienorenal ligament contains the short gastric vessels.
e. The lesser omentum connects the liver to the transverse colon.
Answer :
b. The greater omentum is formed by two double layers of
peritoneum. The anterior two layers are continuous with
the peritoneal layers enclosing the stomach. They then turn,
double over and blend with the peritoneum of the transverse
colon and mesocolon.
8- Which statement about the lesser sac is not correct?
a. It is connected to the greater sac via the epiploic foramen.
b. The stomach is related anteriorly.
c. The pancreas is a posterior relation.
d. The greater omentum is an anterior relation.
e. The right border is formed by the lienorenal and gastrosplenic ligaments.

Answer:
e. These ligamentous structures form the left border of the
lesser sac.

9- Which statement about the borders of the epiploic foramen is correct?
a. The second part of the duodenum forms the inferior border.
b. The quadrate process of the liver forms the superior border.
c. The hepatic vein forms the posterior border.
d. The free edge of the greater omentum forms the anterior border.
e. The common bile duct is contained within the anterior border.

Answer:
e. The free border of the lesser omentum, which forms
the anterior border, contains the hepatic artery and common
bile duct anteriorly and the portal vein posteriorly. The
hepatic artery is found on the left of the common bile duct.
This arrangement of structures allows compression of the
hepatic artery between finger and thumb (Pringle’s manoeuvre)
to control bleeding from the cystic artery and the liver.

10- Which of the following statements regarding peritoneal compartments is correct?
a. The infracolic compartment lies below the lesser omentum.
b. The right and left subphrenic spaces are separated by the coronary ligament.
c. The right subhepatic space lies between the right lobe of the liver and the right kidney.
d. The left subhepatic space is also known as the hepatorenal pouch.
e. The right paracolic gutter lies medial to the colon.

Answer:
c. This space communicates medially with the lesser sac via
the epiploic foramen. The lateral border is the diaphragm. The
superior border is the inferior border of the coronary ligament
and the triangular ligament.

11- Which of these statements about the coeliac trunk is not correct?
a. It supplies the foregut and its derivatives.
b. It leaves the aorta at the level of L1.
c. It gives a left gastric branch that supplies the oesophagus.
d. It gives a splenic branch.
e. It gives rise to the gastroduodenal artery via its hepatic branch.

Answer:
b. The coeliac trunk arises from the aorta at the level of T12,
a little below the median arcuate ligament.

12- Which statement best describes the blood supply of the
stomach?
a. It is derived entirely from the superior mesenteric artery.
b. The gastroepiploic arteries supply the lesser curvature.
c. The right gastric artery is a direct branch of the coeliac axis.
d. The left gastroepiploic artery arises directly from the coeliac trunk.
e. The short gastric arteries arise from the splenic artery.

Answer:
e. The short gastric arteries are variable in number. Most
commonly six are present. They run in the gastrosplenic ligament
to supply the lateral surface of the stomach.

13- Which statement best describes the venous drainage of
the alimentary tract?
a. All blood drains into the portal system.
b. The portal vein is formed from the union of the inferior mesenteric and splenic veins.
c. The superior mesenteric vein crosses the uncinate process of the pancreas.
d. The inferior mesenteric vein passes behind the left renal vein.
e. The prepyloric vein is variable in position.

Answer:
c. The superior mesenteric vein passes over the uncinate
process of the pancreas before joining the splenic vein behind
its neck. It is trapped in this position by the fusion of the dorsal
and ventral pancreatic diverticulae during development of
the pancreas.

14- Which statement best completes this sentence? The
superior mesenteric artery:
a. Supplies the gut from the pylorus to the terminal ileum.
b. Arises from the aorta at the level of L1.
c. Runs in front of the body of the pancreas.
d. Crosses the second part of the duodenum.
e. Supplies the appendix via its right colic branch.

Answer:
b. The superior mesenteric artery arises from the aorta at
the level of L1 and then descends. It then passes behind the
splenic vein and the body of the pancreas.

15- Which statement best describes the inferior mesenteric artery?
a. It arises from the aorta at the level of the transpyloric plane.
b. It supplies the mucus membrane of the gut as far as the mid-rectum.
c. It gives off a left colic branch.
d. It crosses the pelvic brim at the point of bifurcation of the right common iliac vessels.
e. It anastomoses with the superior mesenteric artery via its sigmoid branch.

Answer:
c. The left colic artery has ascending and descending branches.
In a sigmoid colectomy the ascending branch is preserved to
maintain the blood supply of the proximal descending colon.

16- Which statement best describes the lymphatics of the
gastrointestinal tract?
a. They generally follow routes which are distinct from those taken by the venous drainage of the bowel.
b. Peyer’s patches are found on the mesenteric surface of the large bowel.
c. Lymphoid follicles become less numerous in the distal part of the gut.
d. Preaortic nodes lie at the origins of major blood vessels.
e. Lymph from the alimentary tract eventually passes into the portal system of veins.

Answer:
d. There are coeliac, superior mesenteric and inferior
mesenteric groups of lymph nodes which lie around the origins
of the major blood vessels and drain lymph from their
territories of supply.

17- Which statement best describes the stomach?
a. Lymph from the superior 2/3 of the stomach drains into the suprapancreatic nodes.
b. All lymph from the stomach drains through the coeliac nodes.
c. The gastric branches of the vagi are given of in the greater curve.
d. The lower oesophageal sphinchter is supplied by the nerves of Latarjet.
e. The antral part of the stomach secretes an acid solution.

Answer:
b. All the lymph drainage from the stomach eventually
drains into the coeliac nodes and then into the cisterna chyli.

18- Which of the following statements about the duodenum is incorrect?
a. The second part overlies the right kidney.
b. The transverse mesocolon attaches over the second part.
c. The ampulla of Vater lies in the third part.
d. The inferior vena cava and aorta lie directly behind the third part.
e. The gall bladder overlies the first part.

Answer:
c. The ampulla of Vater opens into the second part of the
duodenum. It opens onto an eminence called the duodenal
papilla which is formed by the union of the common bile duct
and pancreatic duct.

19- Which statement regarding the jejunum and ileum is incorrect?
a. The ileum has thicker walls than the jejunum.
b. The proximal small intestine is of greater diameter than the distal.
c. The mesentery of the small intestine is thicker distally.
d. The jejunum lies mainly in the umbilical region.
e. The mesenteric vessels form more numerous arcades in the ileum.

Answer:
a. The jejunum has thicker walls than the ileum as the valvulae
conniventes are larger proximally.

20- Which of these statements regarding Meckel’s diverticulum is correct?
a. It is found in about 4% of the population.
b. Is always found on the antimesenteric border of the ileum.
c. Is usually about 2 cm in length.
d. Is usually located about 20 cm from the ileocaecal junction.
e. Is usually attached to the umbilicus.

Answer:
b. Meckel’s diverticulum represents the proximal remnant
of the embryonic yolk stalk, and as such is found at the site
of attachment of the yolk stalk at the border of the intestine
opposite its mesenteric attachment.
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MCQs:Dermatology

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A 36 year old factory worker developed itchy, annular scaly plaques in both groins. Application of a corticosteroid ointment led to temporary relief but the plaques continued to extend at the periphery. The most likely diagnosis is:
A. Erythema annulare centrifugum
B. Granuloma annulare
C. Annular lichen planus
D. Tinea cruris
 
Correct answer : D. Tinea cruris
Tinea cruris is characterised by itchy, annular scaly plaques in both groins. There is central clearing and advancement at the periphery.
 
An 8 year old boy from Bihar presents with a 6 months history of an ill defined, hypopigmented slightly atrophic macule on the face. The most likely diagnosis is:
A. Pityriasis alba
B. Indeterminate leprosy
C. Morphea
D. Calcium deficiency
Correct answer : B. Indeterminate leprosy
Bihar is a known endemic region for leprosy.
 
All of the following drugs are effective in the treatment of pityriasis versicolor except:
A. Selenium sulphide
B. Ketoconazole
C. Griseofulvin
D. Clotrimazole
Correct answer : C. Griseofulvin
Griseofulvin is used in the treatment of dermatophyte infections.
 
 
A 16 year-old boy presented with asymptomatic, multiple, erythematous, annular lesions with a collarette of scales at the periphery of the lesions present on the trunk. The most likely diagnosis is:
A. Pityriasis versicolor
B. Pityriasis alba
C. Pityriasis rosea
D. Pityriasis rubra pilaris
Correct answer : C. Pityriasis rosea
The classical lesions of pityriasis rosea are described in the question.
 
In which of the following conditions Parakeratosis most frequently occurs?
A. Actinic keratoses
B. Seborrheic keratoses
C. Molluscum contagiosum
D. Basal cell carcinoma
Correct answer : A. Actinic keratoses
Parakeratosis refers to the persistance of cellular nuclei in the stratum corneum of skin.
 
 
A 6 month old infant had itchy erythematous papules and exudative lesions on the scalp, face, groins and axillae for one month. She also had vesicular lesions on the palms. The most likely diagnosis is:
A. Congenital shypilis
B. Seborrheic dermatitis
C. Scabies
D. Psoriasis
 
Correct answer : C. Scabies
 
A 45 year old farmer has itchy erythematous papular lesions on face, neck, ‘V‘ area of chest, dorsum of hands and forearms for 3 years. The lesions are more severe in summer and improve by 75% in winter. The most appropriate test to diagnose the condition would be:
A. Skin biopsy
B. Estimation of IgE levels in blood
C. Patch test
D. Intradermal prick test
 
Correct answer : C. Patch test
The history is suggestive of photodermatitis. Patch test is used for diagnosis of photodermatitis.
Patch test (photopatch test) : Here, 2 patches containing photosensitising material …
 
A 24-year old unmarried woman has multiple nodular, cystic, pustular and comedonal lesions on face, upper back and shoulders for 2 years. The drug of choice for her treatment would be:
A. Acitretin
B. Isotretinoin
C. Doxycycline
D. Azithromycin
 
Correct answer : B. Isotretinoin
The clinical picture is diagnostic of acne vulgaris. Isotretinoin is used in severe intractable acne.
 
Pterygium of nail is characteristically seen in:
A. Lichen planus
B. Psoriasis
C. Tinea unguium
D. Alopecia areata

Correct answer : A. Lichen planus
 
Air borne contact dermatitis can be diagnosed by:
a) Skin biopsy
b) Patch test
c) Prick test
d) Estimation of serum IgE levels
Correct answer : b) Patch test
In patch test, the suspected allergens are applied on the back of the patient under separate patches for 48 hours. The presence of dermatitis is then looked for.
 
The main cytokine, involved in erythema nodusum leprosum (ENL) reaction is:
a) Interleukin—2
b) Interferon-gamma
c) Tumor necrosis factor—alpha
d) Macrophage colony stimulating factor
 
Correct answer : c) Tumor necrosis factor—alpha
 
The following drug is not used for the treatment of type II lepra reaction:
a) Chloroquin
b) Thalidomide
c) Cyclosporine
d) Corticosteroids
Correct answer : c) Cyclosporine
Drugs used in treatment of type II lepra reaction are :
NSAID’s
Thalidomide
Chloroquine
Clofazimine
Corticosteroids
Parenteral antimony
 
 
Ivermectin in indicated in the treatment of
a) Syphilis
b) Scabies
c) Tuberculosis
d) Dermatophytosis
 
Correct answer : b) Scabies
Ivermectin the only orally effective treatment scabies.
 
Max. Joseph’s space is a histopathological feature of:
a) Psoriasis vulgaris
b) Lichen planus
c) Pityriasis rosea
d) Parapsoriasis
 
Correct answer : b) Lichen planus
 
‘Chancre redux’ is a clinical feature of:
a) Early relapsing syphlis
b) Late syphilis
c) Chancroid
d) Recurrent herpes simplex infection
Correct answer : a) Early relapsing syphilis
 
 True regarding Pityriasis Rosea is:
a) Self limiting
b) Chronic relapsing
c) Life threatening infection
d) Caused by dermatophytes
Correct answer : a) Self limiting
Pityriasis Rosea is a self limiting disease. Herald patch is the characteristic lesion.
 
 
Tuberculids are seen in
a) Lupus vulgaris
b) Scrofuloderma
c) Lichen scrofulosorum
d) Erythema nodosum
Correct answer : c) Lichen scrofulosorum
 
A 3 year old child has eczematous dermatitis on extensor surfaces, His mother has a history of Bronchial asthma. Diagnosis should be
a) Atopic dermatitis
b) Contact dermatitis
c) Seborrhic demiatitis
d) lnfantile eczematous dermatitis
Correct answer : a) Atopic dermatitis
 
 -------------------------------
 
A 22 year old presents with itchy purple papules on his wrists and fingers and in his mouth with overlying white reticulate appearance. Which of the following is the most likely diagnosis? 
Lichen Planus
correct answer
Atopic dermatitis 
Dermatitis Herpetiformis 
Psoriasis 
Reiters syndrome 
 Explanation:
Lichen planus is the most likely diagnosis which presents with very itchy, small and shiny, flat topped purplish papules with an overlying network of fine white lines. It normally presents on the flexural surfaces of the knees, elbows, ankles and wrists and often affecting the mucous membranes especially the mouth. Koebners phenomenon is present. Psoriasis does not normally lead to the lesions described nor do the other options. 
 
A 40 year old male presents with arthralgia and syncopal episodes. An ECG reveals complete heart block. He returned from a hill walking holiday 3 months ago and has noticed an annular, indurated erythematous areas on his legs. What is the most likely diagnosis?

Lyme disease

correct answer
SLE 
Tuberculosis 
Psoriasis 
Granuloma annulare 
Explanation:
The rash described is characteristic of erythema chronicum migrans which is caused by Borrelia burgdorferi, a spirochaete leading to Lyme disease and is transmitted by the ixodid tick. It can lead to arthralgia and can lead to cardiac abnormalities such as heart block and can lead to neurological features such as cranial nerve palsies. For diagnosis, serology is required either in serum or CSF. 
 
A five year old boy is brought to the GP after noticing lesions on his neck and trunk. On examination there are several smooth, elevated, reddish papules with a central punctum. What is the most likely diagnosis?
Molluscum Contagiosum
correct answer
Warts 
Lichen Planus 
Herpes Simplex virus 
Spitz Naevus 
Explanation:
The most likely diagnosis is molluscum contagiosum. It is caused by the pox virus and is spread by direct contact. It is more common in children. It commonly affects the face, neck and trunk. The key to the diagnosis is the central punctum. This differentiates it from warts. Lichen planus tends to occur on wrists and mucous membranes and has a fine white reticulate layer.
 
A 52 year old female has developed a rash on her hands, feet which is gradually spreading centrally, predominantly on the extensor surfaces. She has been unwell for a few days before with a cold and the rash developed suddenly. On examination there is numerous circular lesions approximately 2cm in diameter which have a purpuric or pale centre. She states that new lesions develop whenever if there is any trauma to a site. Which of the following is most commonly associated with the development of these skin lesions?
Herpes simplex virus
correct answer
Herpes Zoster virus 
Mycoplasma pneumoniae 
Tuberculosis 
Lymphoma 
Explanation:
The classical target lesions described are most likely to be due to erythema multiforme. This can often be preceded by URTI symptoms and people can be very unwell with high fever. When the mucosa is severely involved this is known as Steven's Johnson Syndrome. It is associated most commonly with herpes simplex infection and also with drug reactions, other infective organisms such as mycoplasma infection and some connective tissue diseases. It is also associated with certain haematological malignancies such as leukaemia, Myeloma and non-Hodgkin's Lymphoma. 
 
A 32 year old gentleman has been undergoing topical treatment for psoriasis for some time. He presents as he has noticed patches of skin which appear thin and lax and which are hypopigmented and shiny with prominent blood vessels. What is the most likely cause of this?
Topical steroid use
correct answer
Topical tar based cream 
Advanced psoriatic plaques 
Topical vitamin A analogue 
Dithranol 
Explanation:
The lesions described are typical of skin atrophy secondary to repeated topical steroid use. Dithranol is more difficult to use and is often only applied in a hospital setting. Dithranol, topical vitamin A and tar based creams can be irritant but do not lead to atrophy.
 
A 16 year old female presents with a purpuric rash on her buttocks, arms and back of legs. The lesions began as erythematous macules. She is complaining of arthralgia and abdominal pain with some bloody diarrhoea. She had a cold about one week ago. On dipstick of urine there is evidence of proteinuria and microscopic haematuria. Given the most likely diagnosis, what is the likeliest outcome?
 
Full recovery
correct answer
Recurring episodes 
Chronic kidney disease 
Acute renal failure without full recovery 
Steroids required for full recovery 
Explanation:
Henoch Schonlein purpura is the most likely diagnosis. It is a vasculitis and presents in children with a higher incidence in males. It leads to a purpuric rash on ulnar side of arms, buttocks and back of legs which begin as erythematous macules. A URTI can precede it's development. Arthralgia, abdominal pain and diarrhoea are common features. It leas to eosinophilia and raised IgA. There is evidence of glomerulonephritis and sometimes a nephrotic syndrome can develop. In the majority of cases HSP is self limiting and there is full recovery. In a minority there is recurring episodes. It is rare in children for end stage renal failure to develop. It is rare in adults but when is does it is more likely to be severe and cause permanent kidney damage. Steroids are useful in severe disease and are useful for relief of arthralgia and GI symptoms.
 
A 20 year old male presents with a rash to his GP. It is predominantly over his trunk and there is multiple papules and red scaly plaques with some looking like rain drops. These are itchy. He has recently been unwell with presumed strep. throat. He has recently had sex with a new partner. What is the most likely diagnosis?

Guttate psoriasis

correct answer
Secondary syphilis 
Toxic Epidermal Necrolysis 
Pityriasis 
Reiters syndrome 
Explanation:
The history and clinical findings are indicative of Guttate Psoriasis. Secondary syphilis can lead to a similar rash however there is no evidence of primary infection. Reiters Syndrome is a triad of arthritis, urethritis and conjunctivis and a rash which classically affects the palms and soles. It is often secondary to gonococcal infection.
 
 
A 35 year old male presents with bald patches. These are well defined and there is no evidence of scarring. There is some broken hairs surrounding these areas. What is the most likely diagnosis?

Alopecia areata

correct answer
Discoid lupus 
Telogen effluvium 
Psoriasis 
Tinea capitis 
Explanation:
Alopecia areata leads to well defined areas of baldness with no scarring. Broken hairs may be seen at the edge which can be depigmented. Nail dystrophy in the form of pitting may be observed. It is autoimmune and associated with other autoimmune disorders. There may be a genetic component. Discoid Lupus leads to baldness but there is evidence of inflammation and scarring, scaling and follicular plugging and hair does not regrow unlike in alopecia where is usually fully recover in about 18 months. Telogen effluvium is a generalised, diffuse hair loss often seen in pregnancy but also in stress and malnutrition. Tinea capitis would show scaling and microscopic examination should be done to exclude this.
 
 A 22 year old presents with a rash. On examination there are small salmon pink papules with a fine scale which are drop like on her trunk and proximal arm and legs. She had suffered from tonsillitis two weeks previously. What is the most likely diagnosis?
Guttate Psoriasis
correct answer
Dermatitis 
Lichen Planus 
Secondary Syphillis 
Pityriasis Rosea 
Explanation:
The history and clinical features are highly suggestive of Guttate psoriasis. It is mostly associated with streptococcal infection but is also associated with stress, trauma and drugs such as antimalarials, lithium, NSAIDs and betablockers. Lichen planus tends to affect flexor surfaces and mucous membranes, is intensely itchy and more violaceous in colour. Secondary syphillis would typically be associated with other features and affects the palms and soles. Pityriasis rosea classically has a "Christmas tree distribution" and has a ring of scale and is itchy.
  
A70 year old presents with a lesion on his cheek. The lesion has a raised, pearly border and there is telangiectasia on the surface of the lesion. What is the most likely diagnosis?

Basal Cell Carcinoma

correct answer
Squamous Cell Carcinoma 
Actinic Keratosis 
Wart 
Melanoma 
Explanation:
The lesion described is typical of a nodular basal cell carcinoma. These present on sun exposed skin. Superficial BCCs more often present on the body but differ in that instead of telangiectasia they appear scaling black with a pearly white raised border. Excision surgery is the treatment of choice.
 
A 29 year old female presents to her GP. She has noticed dandruff and a rash on her face. On examination there is evidence of areas of erythema with fine scaling over her nasal bridge, around her nasolabial fold and eyebrows and ears and there is evidence of fine scaling on the scalp. What is the most likely diagnosis?

Seborrhoeic Dermatitis

correct answer
Psosriasis 
Rosacea 
Eczema 
Pityriasis Capitis 
 
 Which of the following is the most appropriate initial treatment?
Topical Ketoconazole
correct answer
Topical steroids 
Oral Fluconazole 
Oral Steroids 
PUVA 
Explanation:
The clinical features described are characteristic of Seborrhoeic dermatitis. It is thought to be caused by an inflammatory reaction to the yeast Malassezia. Typically the face and scalps is affected as described here however other areas which can be involved include the sternum and upper back and the skin flexures. Treatment includes topical ketoconazole including shampoo and topical steroids intermittently. More severe disease may be treated with oral antifungals and UV light treatment.

A 27 year old soldier has just returned from Afghanistan. He has been sent to the dermatology due to a lesion on his right forearm. He states that this began as a small red patch which them increased in size. On examination there is an erythematous raised lesion on his right forearm which has ulcerated and has crusted over. He is otherwise well. Which of the following is the most likely diagnosis?

Cutaneous Leishmaniasis

correct answer
Mucocutaneous Leishmaniasis 
Psoriasis 
Eczema 
Squamous Cell Carcinoma 
Explanation:
Given where the patient has travelled to and the description of the lesion, the most likely diagnosis is cutaneous leishmaniasis. Cutaneous Leishmaniasis is caused by old world protozoa such as L. tropica or Infantum or new world protozoa such as L. Mexicana. This leads to the lesion described. Mucocutaneous leishmaniasis is a risk in new world leishmaniasis. Visceral leishmaniasis is caused by L. Donovani or Chagasi and affects the reticuloendothelial system and leads to anaemia and hepatosplenomegaly.
 
What disorder would you most commonly associate with Stevens Johnson syndrome?

Herpes simplex infection

correct answer
Sarcoidosis 
Infective Endocarditis 
Streptococcal infection 
Penicillin Use 
Explanation:
Herpes simplex infection is most commonly associated with Stevens Johnson syndrome. It is also associated with mycoplasma pneumoniae, certain drugs such as penicillin and anticonvulsants and with haematological malignancies.
 
 A 28 year old soldier presents with an itchy rash. He is itchy in his finger webs, wrists and groin and there is evidence of excoriation in these areas. What is the most likely diagnosis?
  
Sarcoptes scabiei infection
correct answer
Psoriasis 
Lichen Planus 
Tinea Corporis
Contact dermatitis
 
Explanation:
 The history is indicative of scabies. AS well as the wrist, finger webs and groin other areas commonly affected are elbows and perineum. Sometimes burrow holes can be observed and mites extracted with a needle. The whole body must be treated with topical preparations such as gamma benzene hexachloride or benzyl benzoate. Due to the lack of the classical rashes in the other diagnoses and the areas affected the other diagnoses are less likely.
 
A 60 year old gentleman presents with a mole on the sole of his foot. On examination there is evidence of a 1.5cm mole with border irregularity and a halo surrounding it. What is the most likely diagnosis?
Acral lentiginous melanoma
correct answer
Periungual melanoma 
Lentigo maligna melanoma 
Nodular melanoma 
Superficial spreading melanoma 
Explanation:
The most likely diagnosis is acral lentiginous melanoma which is observed on the sole of the foot. It is often surrounded by a halo of paler skin. Periungual melanoma is not the diagnosis as it occurs in the nail bed. Lentigo maligna melanoma is a large flat area of pigmentation. Nodular melanoma is very aggressive and is nodular and can be depigmented and does not occur on the sole.
 
 A patient with ulcerative colitis develops several necrotic ulcers on her legs. How do you manage these?

Prednisolone

correct answer
Antibiotics 
Angiogram 
Local application of silver nitrate 
Dressings alone 
Explanation:
 The likely diagnosis is pyoderma gangrenosum and prednisolone is the most appropriate from this list for management.
 
A 14 year old girl presents with moderate acne and pustules affecting the face, back and chest. How would you manage this case?

Oral tetracycline for three months

correct answer
Topical tretinoin 
Topical erythromycin 
Roaccutane 
Dianette 
Explanation:
Due to the fact this patient has features of moderate acne then oral tetracycline for three months is the most appropriate treatment. Erythromycin is an alternative. This is a second line treatment and mild acne is normally treated with topical agents such as topical antibiotics, keratolytics or topical retinoids. Dianette is another option but is also used as a contraceptive and has other implications. Roaccutane is an oral retinoid and is a third line therapy only prescribed by dermatologists and with certain inclusion criteria due to the teratogenicity.
 
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