mrcp gp question

1. Which one of the following steroid creams is the most potent?

Propaderm
Eumovate
Betnovate
Betnovate RD
Dermovate √
Mild
Moderate
Potent
Very potent

Hydrocortisone 0.5-2.5%
Betamethasone valerate 0.025% (Betnovate RD)
Clobetasone butyrate 0.05% (Eumovate)
Betamethasone dipropionate 0.025% (Propaderm)
Betamethasone valerate 0.1% (Betnovate)
Clobetasol propionate 0.05% (Dermovate)


2. A 25-year-old man presents with a widespread rash over his body. The torso and limbs are covered with multiple erythematous lesions less than 1 cm in diameter which in parts are covered by a fine scale. You note that two weeks earlier he was seen with to a sore throat when it was noted that he had exudative tonsillitis. Other than a history of asthma he is normally fit and well. What is the most likely diagnosis?

Pityriasis Rosea
Pityriasis versicolor
Syphilis
Discoid eczema
Guttate psoriasis √
Psoriasis: guttate
Guttate psoriasis is more common in children and adolescents. It may be precipitated by a Streptococcal infection 2-4 weeks prior to the lesions appearing. Features: Tear drop papules on the trunk and limbs

Management

· Most cases resolve spontaneously within 2-3 months

· There is no firm evidence to support the use of antibiotics to eradicate streptococcal infection

· Topical agents as per psoriasis

· UVB phototherapy

· Tonsillectomy may be necessary with recurrent episodes

3. A 19-year-old student presents with a 1 cm golden, crusted lesion on the border of her left lower lip. What is the most suitable management?

Oral co-amoxiclav
Oral penicillin
Oral flucloxacillin
Oral flucloxacillin + penicillin
Topical fusidic acid √
4. A 62-year-old man presents with a lesion on the right side of his nose. He is unsure how long it has been there. What is the most likely diagnosis?


A. Desmoplastic trichoepithelioma

B. Squamous cell carcinoma

C. Impetigo

D. Basal cell carcinoma √

E. Actinic keratosis



Basal cell carcinoma
Basal cell carcinoma (BCC) is one of the three main types of skin cancer. Lesions are also known as rodent ulcers and are characterised by slow-growth and local invasion. Metastases are extremely rare. BCC is the most common type of cancer in the Western world.
Features

· Many types of BCC are described. The most common type is nodular BCC, which is described here

· Sun-exposed sites, especially the head and neck account for the majority of lesions

· Initially a pearly, flesh-coloured papule with telangiectasia

· May later ulcerate leaving a central 'crater'

Management options:-------------------------------------------------------------------------



· Surgical removal

· Curettage

· Cryotherapy

· Topical cream: Imiquimod, Fluorouracil

· Radiotherapy



5. A 34-year-old man with a history of polyarthralgia, back pain and diarrhoea is found to have a 3 cm red lesion on his shin which is starting to ulcerate. What is the most likely diagnosis?

Systemic Shigella infection
Syphilis
Metastatic colon cancer
Erythema nodosum
Pyoderma gangrenosum √
6. A 67-year-old man with a history of Parkinson's disease presents due to the development of an itchy, red rash on his neck, behind his ears and around the nasolabial folds. He had a similar flare up last winter but did not seek medical attention. What is the most likely diagnosis?

Levodopa associated dermatitis
Seborrhoeic dermatitis √
Flexural psoriasis
Acne rosacea
Fixed drug reaction to ropinirole
7. A 23-year-old man presents as he is concerned about recent hair loss. Examination reveals the following: What is the most likely diagnosis?


A. Telogen effluvium

B. Alopecia areata √

C. Tinea capitis

D. Male-pattern baldness

E. Discoid lupus erythematous



8. 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?

Tinea corporis
Pityriasis versicolor √
Porphyria cutanea tarda
Lyme disease
Psoriasis
9. A 54-year-old man with a history of type 2 diabetes mellitus and benign prostatic hyperplasia is referred to dermatology due to a number of lesions over his shin. On examination symmetrical, erythematous, tender, nodules are found. The lesions have started to heal without scarring. What is the most likely diagnosis?

Necrobiosis lipoidica diabeticorum
Erythema nodosum √
Pyoderma gangrenosum
Syphilis
Pretibial myxoedema
10. A 43-year-old man comes for review. A few months ago he developed redness around his nose and cheeks. This is worse after drinking alcohol. He is concerned as one of his work colleagues asked him if he had a drink problem despite him drinking 14 units per week. On examination he has erythema as described above with some pustules on the nose and telangiectasia on the cheeks. What is the most likely diagnosis?

Mitral stenosis
Seborrhoeic dermatitis
Alcohol-related skin changes
Acne rosacea √
Systemic lupus erythematosus
11. A 54-year-old man presents with a two month history of a rapidly growing lesion on his right forearm. The lesion initially appeared as a red papule but in the last two weeks has become a crater filled centrally with yellow/brown material. On examination the man has skin type II, the lesion is 4 mm in diameter and is morphologically as described above. What is the most likely diagnosis?

Seborrhoeic keratosis
Keratoacanthoma √
Pyoderma gangrenosum
Basal cell carcinoma
Malignant melanoma
12. A 30-year-old female in her third trimester of pregnancy mentions during an antenatal appointment that she has noticed an itchy rash around her umbilicus. This is her second pregnancy and she had no similar problems in her first pregnancy. Examination reveals blistering lesions in the peri-umbilical region and on her arms. What is the likely diagnosis?

Seborrhoeic dermatitis
Pompholyx
Polymorphic eruption of pregnancy
Lichen planus
Pemphigoid gestationis √
13. A 54-year-old man is referred by his GP to the dermatology outpatient department due to a facial rash which has persisted for the past 12 months. On examination there is a symmetrical rash consisting of extensive pustules and papules which affects his nose, cheeks and forehead. What is the most appropriate treatment?

Ciprofloxacin
Isotretinoin
Oxytetracycline √
Hydroxychloroquine
Prednisolone
14. A 17-year-old female presents with multiple comedones, pustules and papules on her face. Which one of the following is least likely to improve her condition?

Topical retinoids
Dietary advice √
Sunlight
Oral trimethoprim
Ethinylestradiol with cyproterone acetate
15. Which one of the following best describes the typical distribution of atopic eczema in a 10-month-old child?

Nappy area and flexor surfaces of arms and legs
Face and trunk √
Nappy area and trunk
Flexor surfaces of arms and legs
Scalp and arms
16. A 31-year-old woman develops painful, purple lesions on her shins. Which one of the following medications is most likely to be responsible?

Montelukast
Lansoprazole
Combined oral contraceptive pill √
Sodium valproate
Carbimazole
17. A 34-year-old man presents to his GP with an itchy rash on his genitals and palms. He has also noticed the rash around the site of a recent scar on his forearm. Examination reveals papules with a white-lace pattern on the surface. What is the diagnosis?

Lichen planus
Scabies
Lichen sclerosus √
Morphea
Pityriasis rosea
18. A 67-year-old man who is a retired builder presents following the development of a number of red, scaly lesions on his left temple. These were initially small and flat but are now erythematous and rough to touch. What is the most likely diagnosis?

Pityriasis versicolor
Seborrhoeic keratosis √
Polymorphous light eruption
Actinic keratoses
Malignant melanoma
19. A 30-year-old man presents with a two-week history of a productive cough. Whilst examining him you notice a large number of atypical naevi over his torso. On his back you count between 20-25 moles. He reports no change in any of his moles, no bleeding and no itch. One particular mole is noted due to the irregular border. It is 6 * 4 mm in size. What is the most appropriate action?

A. Refer to dermatology for photo mapping

B. Refer under the two-week rule to dermatology √

C. Advise about sun protection + arrange gene testing for xeroderma pigmentosum

D. Advise about sun protection + take a digital photo for his records + review in 1 month

E. Advise about sun protection + take a digital photo for his records



20. A 74-year-old lady with a history of hypothyroidism presents in January to her GP with a rash down the right side of her body. On examination an erythematous rash with patches of hyperpigmentation and telangiectasia is found. What is the likely diagnosis?

Erythema marginatum
Herpes zoster
Pretibial myxoedema
Erythema ab igne √
Xanthomata
21. A 85-year-old lady presents to her GP complaining of itchy white plaques affecting her vulva. There is no history of vaginal discharge or bleeding. A similar plaque is also seen on her inner thigh. What is the likely diagnosis?

Candida
Lichen planus
Lichen sclerosus √
Herpes simplex
Seborrhoeic dermatitis
22. You are teaching a mother about the use of topical steroids for her child with atopic eczema. She has heard about the use of Finger Tip Units (FTU) when determining how much steroid to use. What does 1 FTU equate to?

Sufficient to treat a skin area about that of a forearm
Sufficient to treat a skin area about twice that of the flat of an adult hand √
Sufficient to treat a skin area about 5 * 5 cm (2 * 2 inches)
Sufficient to treat a skin area about twice that of the forearm
Sufficient to treat a skin area about that of the flat of an adult hand
23. A 34-year-old man presents with unsightly toes: What is the most likely causative organism?


A. Microsporum gypseum

B. Trichophyton interdigitale

C. Candida

D. Non-dermatophytic moulds

E. Trichophyton rubrum √



24. A 26-year-old newly qualified nurse presents as she has developed a bilateral erythematous rash on both hands. She has recently emigrated from the Philippines and has no past medical history of note. A diagnosis of contact dermatitis is suspected. What is the most suitable to test to identify the underlying cause?

Radioallergosorbent test (RAST)
Latex IgM levels
Skin prick test
Urinary porphyrins
Skin patch test √
25. A 18-year-old man complains of an itchy sensation around his toes; What is the most appropriate first line treatment?

A. Topical nystatin

B. Topical miconazole √

C. Topical amorolfine

D. Topical steroid

E. Antiperspirant dusting powders

Most commonly, infection is due to Trichopyton rubrum, T. mentagrophytes and Epidermophyton floccosum





26. A 34-year-old man presents for the removal of a mole. Where on the body are keloid scars most likely to form?

Sternum √
Lower back
Abdomen
Flexor surfaces of limbs
Scalp
27. A 23-year-old man presents with a three day history of general malaise and low-grade temperature. Yesterday he developed extensive painful ulceration of his mouth and gums. On examination his temperature is 37.4ºC, pulse 84 / min and there is submandibular lymphadenopathy. What is the most likely diagnosis?

Epstein Barr virus
Lichen planus
HIV seroconversion illness
Herpes simplex virus infection √
Oral Candida
28. A 33-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. He has tried 'Head and Shoulders' and 'Neutrogen T-gel' but with poor results. Which one of the following is the most appropriate treatment for his scalp?

Topical hydrocortisone
Topical dermovate
Topical selenium sulphide
Oral Terbinafine
Topical ketoconazole √
29. A 34-year-old female presents to her GP due to a skin rash under her new wrist watch. An allergy to nickel is suspected. What is the best investigation?

Skin prick test
Skin patch test √
Skin biopsy
Serum IgE
Serum nickel antibodies
30. A 62-year-old female is referred due to a long-standing ulcer above the right medial malleolus. Ankle-brachial pressure index readings are as follows:

Right = 0.95 Left = 0.95

To date it has been managed by the District Nurse with standard dressings. What is the most appropriate management to maximize the likelihood of the ulcer healing?

Compression bandaging √
Intermittent pneumatic compression
Hydrocolloid dressings
Refer to vascular surgeon
Topical flucloxacillin
31. An 18-year-old man presents due a number of itchy skin lesions on his arms and trunk. On examination the lesions are coppery brown in colour and scaly. A diagnosis of pityriasis versicolor is suspected. Which one of the following is the most appropriate treatment?

Topical dapsone
Topical fusidic acid
Topical selenium sulphide √
Topical hydrocortisone
Phototherapy with UVB
32. Which one of the following complications is most associated with Psoralen + ultraviolet A light (PUVA) therapy?

Squamous cell cancer √
Osteoporosis
Basal cell cancer
Dermoid cysts
Malignant melanoma
33. Which one of the following types of rash is most often seen in early Lyme disease?

Erythema nodosum
Psoriasis
Erythema marginatum
Erythema ab igne
Erythema chronicum migrans √
34. A 4-year-old boy develops multiple tear-drop papules on his trunk and limbs. He is otherwise well. A diagnosis of guttate psoriasis is suspected. What is the most appropriate management?

Oral penicillin for 14 days
Reassurance + topical treatment if lesions are symptomatic √
Oral penicillin for 14 days + topical treatment if lesions are symptomatic
Referral to secondary care
Oral corticosteroids
35. A 24-year-old woman presents due to a rash on her neck and forehead. She returned from a holiday in Cyprus 1 week ago and had her hair dyed 2 days ago. On examination there is a weepy, vesicular rash around her hairline although the scalp itself is not badly affected. What is the most likely diagnosis?

Cutaneous leishmaniasis
Irritant contact dermatitis √
Allergic contact dermatitis
Syphilis
Photocontact dermatitis
36. A 64-year-old woman presents with severe mucosal ulceration associated with the development of blistering lesions over her torso and arms. On examination the blisters are flaccid and easily ruptured when touched. What is the most likely diagnosis?

Pemphigus vulgaris √
Pemphigoid
Dermatitis herpetiformis
Psoriasis
Epidermolysis bullosa
37. A 26-year-old male presents with a rash. Examination reveals erythematous oval lesions on his back and upper arms which have a slight scale just inside the edge. They vary in size from 1 to 5 cm in diameter. What is the most likely diagnosis?

Lichen planus
Guttate psoriasis
Lichen sclerosus
Pityriasis rosea
Pityriasis versicolor √
38. A 54-year-old woman presents with an unsightly toenail. Nail scrapings demonstrate dermatophyte infection. What is the treatment of choice?

Oral Terbinafine For 12 Weeks √
Oral Itraconazole For 4 Weeks
Topical Itraconazole For 2 Weeks
Topical Amorolfine For 6 Weeks
Oral Itraconazole For 1 Weeks
39. A 19-year-old man presents as he has developed a number of skin lesions similar to the one below: What is the most appropriate first-line management?



A. Emollients

B. Emollients + topical steroid

C. Emollients + combined topical steroid/calcipotriol

D. Emollients + topical calcipotriol

E. Any of the above √





40. A 34-year-old man presents with a three week history of an intensely itchy rash on the back of his elbows. On examination he has a symmetrical vesicular rash on the extensor aspects of his arms. Which one of the following antibodies is most likely to be positive?

Anti-mitochondrial antibody
Anti-gliadin antibody
Anti-nuclear antibody
Anti-neutrophil cytoplasmic antibody
Anti-Jo-1 antibody
41. A 34-year-old who has recently returned from a business trip to New York presents with a one-day history of a painful rash on his neck:What is the most appropriate management?







A. Topical fusidic acid

B. Topical clotrimazole + hydrocortisone

C. Oral aciclovir + prednisolone

D. Oral acyclovir √

E. Send blood for antibodies to Borrelia burgdorferi





42. A 26-year-old man who is HIV positive is noted to have developed seborrhoeic dermatitis. Which of the following two complications are most associated with this condition?

Alopecia and otitis externa
Blepharitis and otitis externa √
Photosensitivity and alopecia
Photosensitivity and blepharitis
Blepharitis and alopecia
43. A 15-year-old male returns to the dermatology clinic for review. He has a past history of acne and is currently treated with oral lymecycline. There has been no response to treatment and examination reveals evidence of scarring on his face. What is the most suitable treatment?

Oral doxycycline
Oral cyproterone acetate
Oral retinoin √
IV retinoin
Topical retinoids
Theme: Acne vulgaris: managementi



A. Oral trimethoprim

B. Oral oxytetracycline

C. Oral doxycycline

D. Topical zinc + erythromycin

E. Oral isotretinoin

F. Oral lymecycline

G. Oral minocycline

H. Oral erythromycin



For each one of the following questions please select the correct answer from the options listed above:

44. Should be avoided due to an increased risk of drug-induced lupus and hyperpigmentation Oral minocycline

45. Should be taken twice a day on an empty stomach Oral oxytetracycline

46. Patients should be warned about photosensitivity Oral doxycycline

47. An 84-year-old woman with a history of ischaemic heart disease is reviewed in a nursing home. She has developed tense blistering lesions on her legs. Each lesion is around 1 to 3 cm in diameter and she reports that they are slightly pruritic. Examination of her mouth and vulva is unremarkable. What is the most likely diagnosis?

Pemphigus
Drug reaction to aspirin
Epidermolysis bullosa
Scabies
Bullous pemphigoid √
48. Which one of the following factors would predispose a patient to forming keloid scars?

Having white skin
Incisions along relaxed skin tension lines
Being aged 20-40 years √
Being female
Having a wound on the lower back
49. A 72-year-old man complains of a skin lesion on his trunk. On examination it has the typical appearance of a seborrhoeic keratosis. Which one of the following management options is least suitable?

Cryosurgery
Reassurance about benign nature
Shave biopsy
Currettage
Excision √
50. A 5-week-old girl is brought to the surgery due to a rash on her scalp: What is the most appropriate management?




A. Referral to paediatric dermatologist

B. Swab rash and prescribe topical fusidic acid

C. Baby shampoo and baby oil √

D. Topical hydrocortisone

E. Topical ketoconazole





51. A 50-year-old man with a history of ulcerative colitis comes for review. Six years ago he had an ileostomy formed which has been functioning well until now. Unfortunately he is currently suffering significant pain around the stoma site. On examination a deep erythematous ulcer is noted with a ragged edge. The surrounding skin is erythematous and swollen. What is the most likely diagnosis?

Munchausen's syndrome
Irritant contact dermatitis
Pyoderma gangrenosum √
Dermatitis artefacta
Stomal granuloma
52. A 35-year-old female presents tender, erythematous nodules over her forearms. Blood tests reveal: Calcium = 2.78 mmol/l; What is the most likely diagnosis?

Granuloma annulare
Erythema nodosum √
Erythema multiforme
Lupus pernio
Necrobiosis lipoidica
53. A 62-year-old with a history of acne rosacea presents for advice regarding treatment. Which one of the following interventions has the least role in management?

Camouflage creams
Topical metronidazole
Low-dose topical corticosteroids √
Laser therapy
Use of high-factor sun block
54. A 19-year-old female who has just started work as a cleaner presents with a rash on her hands. On examination there is a generalised erythematous rash on the dorsum of both hands. There is no evidence of scaling or vesicles. What is the most likely diagnosis?

Tinea manuum
Irritant contact dermatitis √
Allergic contact dermatitis
Ichthyosis vulgaris
Pustular psoriasis
55. A 47-year-old man who is known to have dermatomyositis secondary to small cell lung cancer is noted to have roughened red papules over the extensor surfaces of the fingers. What are these lesions called?

Heberden's node
Aschoff nodules
Gottron's papules √
Bouchard's nodes
Muehrcke's lines
56. Which one of the following conditions causes non-scarring alopecia?

Discoid lupus
Radiotherapy
Lichen planus
Tinea capitis
Alopecia areata √
57. A 7-year-old girl is brought to surgery due to the development of several small, umbilicated lesions on the thigh of her left leg. There has been no similar lesions in the past, and she is otherwise well apart from a history of asthma. What is the most appropriate management?

Reassure √
Trial of hydrocortisone
Make discreet enquiries about possible sexual abuse
Refer to secondary care
Topical salicylic acid
58. A 54-year-old woman is prescribed topical fusidic acid for a small patch of impetigo around her nose. She has recently been discharged from hospital following varicose vein surgery. Seven days after starting treatment there has been no change in her symptoms. Examination reveals a persistent small, crusted area around the right nostril. Whilst awaiting the results of swabs, what is the most appropriate management?

Oral vancomycin
Oral erythromycin
Topical metronidazole
Topical mupirocin √
Oral flucloxacillin
59. A 22-year-old male presents to surgery due to a longstanding problem of bilateral excessive axillary sweating. He is otherwise well but the condition is affecting his confidence and limiting his social life. What is the most appropriate management?

Non-sedating antihistamine
Topical hydrocortisone 1%
Perform thyroid function tests
Topical aluminium chloride √
Refer to dermatology
60. A 45-year-old woman is presents with itchy, violaceous papules on the flexor aspects of her wrists. She is normally fit and well and has not had a similar rash previously. Given the likely diagnosis, what other feature is she most likely to have?

Onycholysis
Raised ESR
Mucous membrane involvement √
Pain in small joints
Microscopic haematuria
61. A 17-year-old female originally from Nigeria presents due to a swelling around her earlobe. She had her ears pierced around three months ago and has noticed the gradual development of an erythematous swelling since. On examination a keloid scar is seen. What is the most appropriate management?

Refer for intralesional diclofenac
Advise no treatment is available
Refer for intralesional triamcinolone √
Advise will spontaneously regress within 4-6 months
Refer for intralesional sclerotherapy
62. A 31-year-old female with polycystic ovarian syndrome consults you as she is troubled with excessive facial hair. Switching her combined oral contraceptive pill to co-cyprindiol has had no effect. On examination she has hirsuitism affecting her moustache, beard, and temple areas. What is the most appropriate treatment?

Topical salicylic acid
Topical adapalene
Oral clomifene
Topical eflornithine √
Topical tazarotene
63. A 19-year-old man is started on isotretinoin for severe nodulo-cystic acne. Which one of the following side-effects is most likely to occur?

Low mood
Thrombocytopaenia
Raised plasma triglycerides
Reversible alopecia
Dry skin √
64. A 19-year-old man presents with the following lesions on his leg. They are mildly pruritic.

Two weeks later he develops numerous other lesions on his body. What is the most likely diagnosis?





A. Guttate psoriasis

B. Pityriasis versicolor

C. Chronic plaque psoriasis

D. Dermatitis herpetiformis

E. Pityriasis rosea √









65. Which one of the following antibiotics is most associated with the development of Stevens-Johnson syndrome?

Co-trimoxazole √
Ethambutol
Chloramphenicol
Ciprofloxacin
Gentamicin
66. A 30-year-old man presents with painful, purple coloured lesions on his shins. Some of these lesions have started to heal and no evidence of scarring is seen. These have been present for the past 2 weeks. There is no past medical history of note and he takes no regular medications. What is the most useful next investigation?

Liver function tests
Anti-nuclear antibody
ECG
HIV test
Chest x-ray √
67. A 65-year-old woman with blistering lesions on her leg is suspected of having bullous pemphigoid. What is the most appropriate management?

Trial of topical corticosteroids and review in 2 weeks
Refer to secondary care √
Blood tests + chest x-ray + breast exam and refer to district nurse for dressings
Reassurance and refer to district nurse for dressings
Topical Permethrin 5%




68. A 48-year-old man with a history of psoriasis develops plaques on his face. Of the following options, which one is the most appropriate treatment?

Hydrocortisone 1%i √
Calcipotriol
Coal tar
Dithranol
Tacrolimus
69. A 62-year-old woman presents with a 'volcano' like spot on her left arm, which has appeared over the past 3 months. She initially thought it may be a simple spot but it has not gone away. On examination she has a 5 mm red, raised lesion with a central keratin filled crater. A clinical diagnosis of probable keratoacanthoma is made. What is the most suitable management?

Reassure will spontaneously involute within 3 months
Urgent referral to dermatology √
Topical 5-FU
Non-urgent to dermatology
Topical hydrocortisone
70. A 62-year-old female is referred to dermatology by her GP due to a lesion over her shin. It initially started as a small red papule which later became a deep, red, necrotic ulcers with a violaceous border. What is the likely diagnosis?

Necrobiosis lipoidica diabeticorum √
Syphilis
Erythema nodosum
Pretibial myxoedema
Pyoderma gangrenosum
71. A 45-year-old man with a history of seborrhoeic dermatitis presents in late winter due a flare in his symptoms, affecting both his face and scalp. Which one of the following agents is least likely to be beneficial?

Topical ketoconazole
Selenium sulphide shampoo
Topical hydrocortisone
Tar shampoo
Aqueous cream √
72. Which one of the following statements regarding strawberry naevi is incorrect?

Cavernous haemangioma is a deep capillary haemangioma
Chorionic villous sampling is a risk factor
Around 65% resolve before 10 years of age √
Typically they increase in size for around 6-9 months before regressing
Are usually not present at birth
73. A 15-year-old girl presents with an urticarial rash, angioedema and wheezing. Her mother states that she has just come from her younger sister's party where she had been helping to blow up balloons. What is the most likely diagnosis?

C1-esterase deficiency (hereditary angioedema)
Allergic contact dermatitis
Peanut allergy
Latex allergy √
Irritant contact dermatitis
74. Which one of the following steroid creams is classified as moderately potent?

Eumovate √
Propaderm
Betnovate
Hydrocortisone 1%
Dermovate
75. A 72-year-old woman is diagnosed with a number of erythematous, rough lesions on the back of her hands. A diagnosis of actinic keratoses is made. What is the most appropriate management?

Reassurance
Urgent referral to a dermatologist
Topical fluorouracil cream √
Review in 3 months
Topical Betnovate




76. A 62-year-old male is referred to dermatology by his GP due to a lesion over his shin. On examination shiny, painless areas of yellow skin over the shin are found with abundant telangiectasia. What is the most likely diagnosis?

Pretibial myxoedema
Necrobiosis lipoidica diabeticorum √
Erythema nodosum
Pyoderma gangrenosum
Syphilis
77. A 43-year-old presents with itchy lesions on the instep of both feet. These have been present for the past two months. On examination small blisters are seen with surrounding dry and cracked skin. What is the most likely diagnosis?

Porphyria cutanea tarda
Pustular psoriasis
Pompholyx √
Bullous pemphigoid
Pemphigus
78. Which one of the following is least likely to cause a bullous rash?

Frusemide
Friction
Lichen planus √
Insect bite
Epidermolysis bullosa
79. A 78-year-old nursing home resident is reviewed due to the development of an intensely itchy rash. On examination white linear lesions are seen on the wrists and elbows, and red papules are present on the penis. What is the most appropriate management?

Topical permethrin √
Referral to GUM clinic
Topical betnovate
Topical ketoconazole
Topical selenium sulphide
80. A 33-year-old woman presents to her GP with patchy, well demarcated hair loss on the scalp. This is affecting around 20% of her total scalp, and causing significant psychological distress. A diagnosis of alopecia areata is suspected. Which one of the following is an appropriate management plan?

Topical 5-FU cream + referral to dermatologist
Autoimmune screen + topical corticosteroid
Topical ketoconazole + referral to dermatologist
Topical corticosteroid + referral to dermatologist √
Autoimmune screen + topical ketoconazole
81. A 21-year-old woman who is 16 weeks pregnant present with worsening acne which she is finding distressing. She is currently using topical benzyl peroxide with limited effect. On examination there is widespread non-inflammatory lesions and pustules on her face. What is the most appropriate next management step?

Oral trimethoprim
Oral lymecycline
Oral erythromycin
Topical retinoid
Oral doxycycline
82. A 27-year-old female presents with spots around her left eye: What is the most likely diagnosis?




A. Meibomian cysts

B. Milia √

C. Hordeolum externum

D. Molluscum contagiosum

E. Acne conglobata













83. Which one of the following statements regarding fungal nail infections is incorrect?

Candida accounts for less than 10% of cases
Diagnosis should be confirmed by microbiology before starting treatment
Treatment is successful in around 90-95% of people X
Thickened, rough, opaque nails are typical
Suitable investigations include nail clippings
84. A 36-year-old woman is reviewed. She presented 4 weeks ago with itchy dry skin on her arms and was diagnosed as having atopic eczema. She was prescribed hydrocortisone 1% cream with an emollient. Unfortunately there has been no improvement in her symptoms. What is the next step in management, alongside continued regular use of an emollient?

Betamethasone valerate 0.1%
Clobetasone butyrate 0.05% √
Clobetasol propionate 0.05%
Topical tetracycline
Regular wet wraps
85. Which of the following is least associated with acanthosis nigricans?

Gastric adenocarcinoma
Cushing's disease
Polycystic ovarian syndrome
Anorexia nervosa √
Acromegaly
Acanthosis nigricans: Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.

Causes



· Internal malignancy (esp. Gastrointestinal)

· Insulin-resistant diabetes mellitus

· Obesity

· Acromegaly

· Cushing's disease

· Hypothyroidism

· Polycystic ovarian syndrome

· Familial

· Prader-willi syndrome

· Drugs: oral contraceptive pill, nicotinic acid



86. A 29-year-old man consults you regarding a rash he has noticed around his groin. It has been present for the past 3 months and is asymptomatic. On examination there is a symmetrical well-demarcated, brown-red macular rash around the groin. What is the most likely diagnosis?

Erythrasma √
Pityriasis versicolor
Secondary syphilis
Acanthosis nigricans
Candidal intertrigo
Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum. Examination with Wood's light reveals a Coral-red fluorescence. Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection

87. A 19-year-old asks for help with a long-standing problem of spots, particularly around his forehead:
Which one of the following is the best descriptive term for the skin lesions?

Moderate acne vulgaris √
Severe acne vulgaris
Acne conglobata
Acne fulminans
Mild acne vulgaris
88. Venous ulceration is most characteristically seen above the:

Lateral malleolus
Greater trochanter
Sacrum
Medial malleolus √
Pre-tibial area
89. A 58-year-old woman presents with a persistent erythematous rash on her cheeks and a 'red nose'. She describes occasional episodes of facial flushing. On examination erythematous skin is noted on the nose and cheeks associated with occasional papules. What is the most appropriate management?

Topical metronidazole √
Oral oxytetracycline
Benzyl peroxide
Daktacort
Topical hydrocortisone




Acne rosacea

Acne rosacea is a chronic skin disease of unknown aetiology.

Features

· Typically affects nose, cheeks and forehead

· Flushing is often first symptom

· Telangiectasia are common

· Later develops into persistent erythema with papules and pustules

· Rhinophyma

· Ocular involvement: blepharitis

Management

· Topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)

· More severe disease is treated with systemic antibiotics e.g. Oxytetracycline

· Recommend daily application of a high-factor sunscreen

· Camouflage creams may help conceal redness

· Laser therapy may be appropriate for patients with prominent telangiectasia

Theme: Skin disorders affecting the soles of the feet



A. Pitted keratolysis

B. Mosaic wart

C. Acquired keratoderma

D. Juvenile plantar dermatosis

E. Palmoplantar pustulosis

F. Tinea pedis

G. Callus

H. Idiopathic plantar hidradenitis

I. Exfoliative keratolysis

J. Contact dermatitis



For each one of the following scenarios please select the most likely diagnosis:

90. A 23-year-old female presents with red, thickened skin on the soles. On closer inspection a crop of raised lesions are seen. Palmoplantar pustulosis

91. A 22-year-old man presents with a 3 cm area of hyperkeratotic skin on the heel of his right foot. A number of pinpoint petechiae are seen in the lesion. Mosaic wart

92. A 15-year-old complains of excessively smelly feet. On examination he has white skin over the sole of the forefoot bilaterally. Small holes can be seen on the surface of the affected skin. Pitted keratolysis

93. A 53-year-old diabetic woman presents with a four month history of bilateral erythematous lesions on her shins surrounded by telangiectasia. What is the most likely diagnosis?

Erythema nodosum
Neuropathic ulcer
Candidiasis
Necrobiosis lipoidica √
Granuloma annulare
94. A 47-year-old lorry driver presents following the development of a widespread urticarial rash. This is associated with pruritus. What is the most appropriate medication to help relieve the itch?

Cetirizine
Loratadine √
Chlorphenamine
Ranitidine
Alimemazine
95. Each one of the following is associated with hirsuitism, except:

Porphyria cutanea tarda √
Congenital adrenal hyperplasia
Polycystic ovarian syndrome
Adrenal tumour
Cushing's syndrome
96. A 64-year-old female is referred to dermatology due to a non-healing skin ulcer on her lower leg. This has been present for around 6 weeks and the appearance didn't improve following a course of oral flucloxacillin. What is the most important investigation to perform first?

MRI
Rheumatoid factor titres
Ankle-brachial pressure index √
Swab of ulcer for culture and sensitivity
X-ray
97. Which of the following skin conditions is not associated with diabetes mellitus?

Necrobiosis lipoidica
Sweet's syndrome √
Granuloma annulare
Vitiligo
Lipoatrophy
98. A 29-year-old man presents due to the development of 'hard skin' on his scalp. On examination he has a 4cm circular, white, hyperkeratotic lesion on the crown of his head. He has no past history of any skin or scalp disorder. Skin scrapings are reported as: No fungal elements seen

What is the most likely diagnosis?

Psoriasis
Dissecting cellulitis
Kerion
Systemic lupus erythematous
Seborrhoeic dermatitis
99. A 14-year-old male is reviewed by his GP due to a patch of scaling and hair loss on the right side of his head. A skin scraping is sent which confirms a diagnosis of tinea capitis. Which organism is most likely to be responsible?

Trichophyton tonsurans √
Microsporum distortum
Trichophyton verrucosum
Microsporum audouinii
Candida
100. Which of the following statements regarding psoriasis is incorrect?

Often occurs on extensor surfaces
Psoriatic arthropathy may occur prior to the development of skin lesions
Mediated by type 2 helper T cells √
Abnormal T cell activity stimulates keratinocyte proliferation
Nail signs include pitting and onycholysis
101. You are teaching the parent of a 4-year-old child with eczema on the correct use of emollients. Which one of the following statements is correct?

Emollients should be applied against the direction of hair growth
Around 100g / week should be used `
The ratio of emollient to topical steroid should be about 50:1
If a topical steroid is used then emollients should be applied about 30 minutes after the steroid
Emollients should be rubbed in to the skin until they 'disappear'
102. A 36-year-old female with a history of ulcerative colitis is diagnosed as having pyoderma gangrenosum. She presented 4 days ago with a 1 cm lesion on her right shin which rapidly ulcerated and is now painful. What is the most appropriate management?

Topical hydrocortisone
Oral prednisolone √
Surgical debridement
Topical tacrolimus
Intravenous pulsed methylprednisolone
103. A 30-year-old man who is an immigrant from Albania presents to surgery with a translator. He has been unwell for a number of months and describes losing 8 kgs in weight and having chronic diarrhoea. On examination of his skin the following is seen:

= Kaposi’s Sarcoma.

Inside his mouth similar lesions can be seen on his hard palate and there is some bleeding around his gums. What is the most appropriate action?

Give IM benzylpenicillin + phone 999
Order a chest x-ray
Order a HIV test √
Start vitamin C supplements
Order hepatitis C test + cryoglobulin screen
104. Which one of the following causes of pneumonia is most associated with the development of Stevens-Johnson syndrome?

Legionella
Mycoplasma
Coxiella
Staphylococcus
Klebsiella
105. A 54-year-old man presents with a brown velvety rash on the back of his neck around his axilla. A clinical diagnosis of acanthosis nigricans is made. Which one of the following conditions is most associated with this kind of rash?

Hypothyroidism √
Psoriasis
Non-alcoholic steatohepatitis
Ulcerative colitis
Chronic pancreatitis
106. A 65-year-old woman presents with bullae on her forearms following a recent holiday in Spain. She also notes that the skin on her hands is extremely fragile and tears easily. In the past the patient has been referred to dermatology due to troublesome hypertrichosis. What is the most likely diagnosis?

Pellagra
Pemphigus vulgaris
Epidermolysis bullosa
Bullous pemphigoid
Porphyria cutanea tarda √
107. An 80-year-old woman presents due a 'sore' on the medial aspect of her right eye:

What is the most likely diagnosis?

Basal cell carcinoma √
Squamous cell carcinoma
Chalazion
Stye
Indurated dacryocystitis
108. A 17-year-old male is reviewed six weeks after starting an oral antibiotic for acne vulgaris. He stopped taking the drug two weeks ago due to perceived alteration in his skin colour, and denies been exposed to strong sunlight for the past six months. On examination he has generalised increased skin pigmentation, including around the buttocks. Which one of the following antibiotics was he likely to be taking?

Doxycycline
Oxytetracycline
Tetracycline
Erythromycin
Minocycline √
109. A 23-year-old man presents with an itchy skin condition. Which one of the following is least relevant when deciding whether a patient has atopic eczema?

History of asthma
Responds to topical steroids √
History of flexural involvement
Onset below age 2 years
History of generally dry skin
110. A 25-year-old male presents with extensive patches of altered pigmentation on his front, back, face and thighs. There is mild pruritus. A diagnosis of extensive pityriasis versicolor is made. What is the most appropriate management?

Oral metronidazole
Topical terbinafine
Oral itraconazole √
Topical selenium sulphide
Oral terbinafine
111. A 55-year-old female is referred to dermatology by her GP due to a lesions over both shins. On examination symmetrical erythematous lesions are found with an orange peel texture. What is the likely diagnosis?

Pretibial myxoedema √
Pyoderma gangrenosum
Necrobiosis lipoidica diabeticorum
Erythema nodosum
Syphilis
112. A 45-year-old man who presented with itchy lesions on his hands is diagnosed with scabies. It is decided to treat him with permethrin 5%. You have explained the need to treat all members of the household and hot wash all bedding and clothes. What advice should be given about applying the cream?

From the neck down + leave for 12 hours
All skin including scalp + leave for 12 hours + retreat in 2 days
All skin including scalp + leave for 12 hours + retreat in 7 days √
From the neck down + leave for 4 hours
From the neck down + leave for 12 hours + retreat in 7 days
113. A 72-year-old woman who is known to have type 2 diabetes mellitus and heart failure is reviewed. One week ago she was treated with oral flucloxacillin and penicillin V for a right lower limb cellulitis. Unfortunately there has been no response to treatment. What is the most appropriate next line antibiotic?

Co-amoxiclav
Erythromycin
Clindamycin √
Vancomycin
Gentamicin
114. A 43-year-old man presents to his GP due to skin lesions on the back of his hands and the extensor aspects of his arms. On examination there are a number of smooth, firm, papules as shown below:


What is the most likely diagnosis?

Lupus vulgaris
Livedo reticularis
Guttate psoriasis
Granuloma annulare √
Pyoderma gangrenosum
115. A 34-year-old man comes to surgery. He has been generally unwell since an episode of diarrhoea four weeks ago, with joint pains, pain on passing water and a rash on the soles of his feet:


What does this rash likely represent?

Pompholyx
HIV-associated dermopathy
Plantar pustular psoriasis
Mosaic warts
Keratoderma blennorrhagica √
116. A woman presents with painful erythematous lesions on her shins. Which one of the following is least associated with this presentation?

Pregnancy √
Ulcerative colitis
Syphilis
Sarcoidosis
Tuberculosis




117. A 49-year-old man presents to his GP complaining of losing hair. Examination reveals generalised scalp hair loss that does not follow the typical male-pattern distribution. Which one of the following medications is least likely to be responsible?

Colchicine
Cyclophosphamide
Heparin
Carbimazole
Phenytoin √
118. A 24-year-old female in her third trimester of pregnancy mentions during a routine antenatal appointment that she has noticed an itchy rash around her umbilicus.


What is the most likely diagnosis?

Polymorphic eruption of pregnancy √
Pompholyx
Herpes gestationis
Lichen planus
Seborrhoeic dermatitis
119. A 78-year-old woman asks you for cream to treat a lesion on her left cheek. It has been present for the past nine months and is asymptomatic.


What is the most likely diagnosis?

Solar lentigo
Dermatofibroma
Lentigo maligna √
Bowen's disease
Seborrhoeic keratosis
120. A 67-year-old man with recurrent actinic keratoses on his scalp is reviewed. Which one of the following is not a treatment option for the management of this condition?

Topical diclofenac
Topical betnovate √
Topical fluorouracil
Topical imiquimod
Cryotherapy
121. A farmer presents with a tender lesion on his finger:


What is the most likely diagnosis?

Paronychia
Orf √
Tetanus
Anthrax
Hand, foot and mouth disease




122. Which one of the following conditions is most strongly associated with erythema multiforme?

Crohn's disease
Tuberculosis
Sarcoidosis
Herpes simplex virus √
Streptococcal infections
123. An 18-year-old female presents to her GP complaining of scalp hair loss. Which one of the following conditions is least likely to be responsible?

Porphyria cutanea tarda √
Discoid lupus
Tinea capitis
Alopecia areata
Telogen effluvium
124. A 67-year-old man is diagnosed with actinic keratoses on his right temple and prescribed fluorouracil cream. One week later he presents as the skin where he is applying treatment has become red and sore. On examination there is no sign of weeping or blistering. What is the most appropriate action?

Continue fluorouracil cream + review in 1 week √
Complete a 'Yellow Card'
Stop fluorouracil cream + prescribe topical hydrocortisone
Switch to topical diclofenac
Stop fluorouracil cream
125. Which one of the following is not a management option for patients with hyperhidrosis?

Endoscopic transthoracic sympathectomy
Iontophoresis
Topical aluminium chloride
Botulinum toxin
Topical atropine √
126. Which one of the following is least recognised as a cause of erythroderma in the UK?

Lymphoma
Drug eruption
Lichen planus √
Psoriasis
Eczema
127. A 43-year-old man is admitted to the Emergency Department with a rash and feeling generally unwell. He is known to have epilepsy and his medication was recently changed to phenytoin three weeks ago. Around one week ago he started to develop mouth ulcers associated with malaise and a cough. Two days ago he started to develop a widespread red rash which has now coalesced to form large fluid-filled blisters, covering around 30% of his body area. The lesions separate when slight pressure is applied. On examination his temperature is 38.3ºC and pulse 126 / min. Blood results show:

Na+144 mmol/l K+4.2 mmol/l Bicarbonate19 mmol/l Urea13.4 mmol/l

Creatinine121 µmol/l What is the most likely diagnosis?

Phenytoin-induced neutropaenia
Drug-induced lupus
Kawasaki disease
Toxic epidermal necrolysis √
Staphylococcal Scalded Skin syndrome
128. Which one of the following skin disorders is not commonly seen with systemic lupus erythematous?

Keratoderma blenorrhagica √
Alopecia
Livedo reticularis
Photosensitivity
Butterfly rash
129. Which of the following conditions is most associated with onycholysis?

Bullous pemphigoid
Raynaud's disease √
Osteogenesis imperfecta
Oesophageal cancer
Scabies




130. Which of the following skin disorders is most associated with antiphospholipid syndrome?

Lichen sclerosis
Lichen planus
Livedo reticularis √
Lupus vulgaris
Psoriasis
131. A man presents with an area of dermatitis on his left wrist. He thinks he may be allergic to nickel. Which one of the following is the best test to investigate this possibility?

Skin patch test √
Radioallergosorbent test (RAST)
Nickel IgG levels
Skin prick test
Nickel IgM levels
Theme: Skin disorders associated with malignancy



F. Oesophageal cancer

G. Lymphoma

H. Prostate cancer

I. Lung cancer

J. Head and neck cancers

K. Gastric cancer

L. Malignant melanoma

M. Colorectal cacner

N. Glucagonoma



For each one of the following rashes please select the malignancy that is most associated with it:

132. Tylosis Oesophageal cancer

133. Acanthosis nigricans Gastric cancer

134. Acquired ichthyosis Lymphoma

135. Which one of the following features is least associated with acne rosacea?

Pruritus √
Blepharitis
Flushing
Pustules
Rhinophyma