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.
