A 25-year-old female presents with concerns regarding the unsightly appearance of her toe nails.
They have a whitish discolouration extending up the nail bed in a number of the toes of both feet.
They are entirely painless and she is otherwise well.
What is the most appropriate treatment?
(Please select 1 option)
Oral fluconazole
Oral terbinafine
Correct
Topical benzoic acid
Topical fluconazole
Topical terbinafine
This young woman has typical features of fungal nail infection- onychomycosis and the most
appropriate treatment is oral antifungals as topical antifungals may be effective for one or two nails
but not where there are a number affected
Which of the following determines the primary mechanical properties of skin?
(Please select 1 option)
Dermis
Stratum basale
Stratum corneum
Correct
Stratum granulosum
Subcutaneous tissue
The stratum corneum is the last layer and provides a mechanical barrier to the skin therefore
determines the mechanical functions of the skin. The hands and feet have thick stratum corneum as
compared to the lips and eyelids. The thicker the stratum corneum is the more protection there is
for the skin.
The dermis also has some factor to play with its elastic fibres and fibrous tissue.
The rest of the layers are also important but the mechanical properties are primarily determined by
the stratum corneum.
A 22-year-old man consults his GP complaining of redness and itching on his face and hands.
He has regularly visited another GP for similar complaints within the last two years and has been
signed off on sick leave from employment as a builder. He is in receipt of benefits and reports that
he is in the process of making an insurance claim for loss of earnings.
He says that there was one ointment that cured the problem but he had not been able to find any
proprietary medication that works. Examination showed no skin lesions and no apparent rash.
What is the most likely diagnosis?
(Please select 1 option)
Conversion disorder
Delusional disorder
Malingering
Correct
Munchausen syndrome
Obsessive compulsive disorder
In somatoform disorders, both illness production and motivation are unconscious drives.
In malingering, as suggested here, the patient consciously fakes or claims to have a disorder in order
to attain a specific gain (for example, financial).
Munchausen's syndrome is manifested by a chronic history of multiple hospital admissions and
willingness to receive invasive procedures.
Which of the following concerning leg ulcers is correct?
(Please select 1 option)
Diuretics have been shown to improve ulcer healing when associated with oedema.
In diabetic ulcers the dressing should be left in situ for no more than one week
the correct answer
This is
Large gravitational ulcers are always painful
Treating superficial infection with antibiotics has been shown to be beneficial
answer selected
Incorrect
Ulcers caused by arterial disease are typically treated by compression bandaging
Diuretics may reduce oedema but have not been demonstrated per se to reduce healing time.
Gravitational ulcers are not usually painful.
If there are no obvious features of surrounding cellulitis, antibiotic therapy is usually unnecessary
and has not been shown to improve healing in superficial infection which is common in ulceration.
During a follow-up visit at an asthma clinic a 38-year-old female complains of the appearance of a
mole.
Which of the following characteristics of the lesion would raise suspicion that it is a malignant
melanoma?
(Please select 1 option)
Lesion has irregular outline
Correct
Lesion is deeply pigmented
Lesion is present on face
Lesion is raised
Lesion is 6 mm in diameter
The mnemonic of ABCDE regarding characteristics of a melanoma are as follows:

A - Asymmetry - one half of the lesion does not match the other half

B - Border irregularity

C - Colour variegation - pigmentation is not uniform

D - Diameter- a diameter 7 mm warrants investigation although changes in size are also
important

E - Evolution - evolving size or changes in characteristics such as nodules.
A 59-year-old patient of South Asian origin presents with a widespread blistering rash.
Which of the following features would be consistent with a diagnosis of pemphigus?
(Please select 1 option)
Acanthosis
Blisters arising within the subepidermal area
IgA antibodies
Oral involvement
Correct
Treatment with methotrexate
Pemphigus is associated with loss of intercellular cohesion in the lower part of the epidermis,
leading to acantholysis (separation of keratinocytes).
Pemphigus is classically associated with flaccid blistering, and often with immunoglobulin (Ig)G
antibodies.
Treatment may be successful with azathioprine.
Pemphigoid is associated with subepidermal bullae.
A 26-year-old man is noted to have cyanosis of the lower limbs and clubbing of the toes but not the
fingers.
Which of the following statements is true?
(Please select 1 option)
He has coarctation of the aorta.
He has Eisenmenger's syndrome.
This is the correct answer
He has had a Blalock shunt operation.
He is likely to have a loud continuous 'machinery' murmur below the left clavicle.
Incorrect answer selected
He is likely to need urgent surgery.
This is the differential cyanosis of a reversed patent ductus arteriosus (PDA). There is a right-left
shunt from the pulmonary artery to the aorta just distal to the left subclavian artery.
Coarctation causes radiofemoral delay. It may be associated with PDA but there is no suggestion in
this patient.
Continuous machinery murmur is the classic murmur of PDA but when the shunt reverses (as in
patients with a large PDA and/or pulmonary disease) the murmur becomes softer and shorter.
When Eisenmenger's syndrome has developed surgery is associated with a very high mortality.
A Blalock shunt (anastamosis of subclavian artery to pulmonary artery) used to be performed for
Fallot's tetralogy and leads to a weak left radial pulse.
6315
A 16-year-old girl is seen in clinic as she is concerned due to areas of hair loss on the scalp. Past
medical history includes atopic eczema and she has a number of depigmented areas on her hands.
What is the most likely diagnosis?
(Please select 1 option)
Alopecia areata
Correct
Hypothyroidism
Seborrhoeic dermatitis
Systemic lupus erythematosus
Trichotillomania
This girl has a combination of vitiligo and alopecia areata which can co-exist and have similar
autoimmune aetiology. Discrete areas of hair loss and normal texture on the scalp are highly
suggestive of alopecia areata.
15 year-old boy was treated with permethrin cream for scabies infestation. On follow-up three
weeks later, he was found to have continuing infestation.
What is the most likely reason for this?
(Please select 1 option)
The treatment was not repeated as prescribed
Other household members were not treated
Correct
Facial skin was not treated
Non-disposal of underwear
The organism is resistant to permethrin
Scabies is an intensely pruritic and highly contagious infestation of the skin, acquired through close
personal contact. A delayed type IV hypersensitivity reaction to the mites, their eggs, or excreta
occurs approximately 30 days after infestation and is responsible for the intense pruritus that is the
hallmark of the disease. All household members and close personal contacts should be treated,
whether or not they are symptomatic, and patients should be re-examined 2 weeks after treatment
to evaluate effectiveness. Treatment failures are uncommon. Recurrence of the eruption usually
means re-infection has occurred.
Concerning neurofibromatosis Type 1 (NF1), which one of the following statements is true?
(Please select 1 option)
Bilateral acoustic neuromas are common
Incorrect answer selected
Clinical severity in individuals is similar in a given family
New mutations occur rarely
Pigmented spots on the iris are a characteristic feature
This is the correct answer
The diagnosis is likely if two café-au-lait patches are present
Lisch nodules of the iris are present in more than 90% of patients.
Bilateral acoustic neuromas are a hallmark feature of neurofibromatosis type 2.
Expressivity of the gene is highly variable and members of the same family usually show wide
differences in clinical symptoms.
NF1 is one of the most common autosomal dominant conditions. However almost half of all cases
give no family history and are new mutations. The mutation rate is estimated to be 1:10,000
gametes.
The diagnosis is suggested by six or more café-au-lait macules (spots), each over 5 mm in diameter in
prepubescent individuals and over 15 mm in postpubertal individuals.
A 60-year-old woman presents with raised, erythematous lesions on the limbs and blistering in the
mouth and eyes.
She had been taking a number of drugs prescribed by her GP.
Which may be responsible for her presentation?
(Please select 1 option)
Nifedipine
Paracetamol
Paroxetine
Prednisolone
Sulphasalazine
Correct
This is a typical case of Stevens-Johnson syndrome.
Stevens-Johnson syndrome (SJS) is an immune-complex-mediated hypersensitivity complex that is a
severe expression of erythema multiforme. It is now known also as erythema multiforme major.
SJS typically involves the skin and the mucous membranes. While minor presentations may occur,
significant involvement of:

oral

nasal

eye

vaginal

urethral

gastrointestinal (GI) and

lower respiratory tract mucous membranes
may develop in the course of the illness.
GI and respiratory involvement may progress to necrosis.
SJS is a serious systemic disorder with the potential for severe morbidity and even death.
The drugs most closely associated with causing Stevens-Johnson syndrome are:

antibacterials

sulfonamides

anticonvulsants (oxicam)

non-steroidal anti-inflammatory agents (piroxicam and tenoxicam)

chlormezanone and

allopurinol.
A 50-year-old man presented in the summer complaining of itching and blistering of his hands and
forehead. On examination there were small areas of excoriation on the backs of his hands. What is
the most likely diagnosis?
(Please select 1 option)
dermatitis herpetiformis
lupus erythematosus
pemphigoid
pemphigus
porphyria cutanea tarda
Correct
The distribution of the lesions suggests a photosensitive element. Both lupus erythematosus and
PCT are associated with a photosensitive elements, however this is more typical of PCT. PCT
causes blistering of the hands and the forehead which usually heal with small scar and milia
formation. It is also associated with an excessive alcohol intake.
Which of the following is a feature of hereditary haemorrhagic telangiectasia?
(Please select 1 option)
A good response to oestrogen therapy
Cerebral arteriovenous malformations
Correct
GI haemorrhage is the usual presenting feature
Telangiectasia of the mucous membranes, but not the skin
Tendency of lesions to become less obvious with age
In hereditary haemorrhagic telangiectasia there may also be pulmonary aortic valve (AV)
malformations.
Epistaxis, not gastrointestinal (GI) haemorrhage, is the usual presenting feature.
Lesions become more obvious with age and affect mucuous membranes as well as skin.
Oestrogen therapy is sometimes advocated but the effect, if any, is small.
A 33-year-old female attends her GP concerned regarding a mole.
Which of the following characteristics of the lesion would raise suspicion that it is a malignant
melanoma?
(Please select 1 option)
Lesion has irregular edge
Correct
Lesion is 5 mm in diameter
Lesion is pigmented uniformly
Lesion is present on face
Lesion is smoothly raised
The mnemonic of ABCDE regarding characteristics of a melanoma are as follows:

A - Asymmetry - one half of the lesion does not match the other half

B - Border irregularity

C - Colour variegation - pigmentation is not uniform

D - Diameter- a diameter 7 mm warrants investigation although changes in size are also
important

E - Evolution - evolving size or changes in characteristics such as nodules.
A 17-year-old pregnant female attends antenatal clinic and is noted to have scattered small, raised
lesions on her trunk and axillary freckles.
She was not aware of any of her family members having these lesions.
What is the likely mode of inheritance of this condition?
(Please select 1 option)
Autosomal dominant
Correct
Autosomal recessive
Trinucleotide repeating
X-linked dominant
X-linked recessive
This patient has neurofibromatosis with axillary freckling and neurofibromas.
This is usually inherited as autosomal dominant although it may arise from a sporadic new mutation
of the NF1 gene.
A 45-year-old teacher presents six weeks after he returns from a hiking holiday in South America
with a shallow, painless ulcer of the nose.
What is the likely diagnosis?
(Please select 1 option)
Fusobacterium ulcerans
Leishmaniasis
Correct
Squamous cell carcinoma
Trichomoniasis
Trypanosomiasis
The likely diagnosis given the history is cutaneous leishmaniasis.
Lesion pain and pruritis may be present in cutaneous leishmaniasis, but is not typical.
Diagnosis is by histologic section with staining for amastigotes.
Leishmania braziliensis is the likely pathogen which is spread by sandfly bites in endemic areas.
Fusobacterium causes the tropical ulcer, an intensely painful, shallow ulcer.
In the treatment of psoriasis, which of the following statements is correct?
(Please select 1 option)
Etanercept is not effective in psoriatic arthritis
Infliximab is associated with tuberculosis
Correct
PUVA is ineffective
Retinoids are the most useful monotherapy in psoriatic patients
Vitamin D analogues are associated with cutaneous atrophy
Psoralen and ultraviolet light (PUVA) is an effective treatment for psoriasis, but has been related to
increased risk of squamous cell carcinoma, and possibly malignant melanoma.
Retinoids are most effective in combination therapy, especially with ultraviolet B (UVB)
phototherapy and PUVA.
Part of the attraction of vitamin D analogues over steroids is that they do not cause cutaneous
atrophy, whereas steroids do.
The recombinant tumour necrosis factor and receptor fusion protein, etanercept, has demonstrated
considerable beneficial effects on psoriatic arthropathy in placebo controlled, double blind studies.
Infliximab is associated with tuberculosis, by reactivation of latent disease. Thus it is advised that
patients who are to be treated with infliximab are tuberculin tested, and if required, receive chest
radiography
A 69-year-old woman presented with an ulcer over the left ankle, which had developed over the
previous nine months. She had a history of right deep vein thrombosis (DVT) five years previously.
On examination she had a superficial slough-based ulcer, 6 cms in diameter, over the medial
malleolus with no evidence of cellulitis.
Which one of the following is the most appropriate next investigation?
(Please select 1 option)
Ankle-brachial pressure index
This is the correct answer
Bacteriological swab of the ulcer
Bilateral lower limb arteriogram
Right leg venogram
Incorrect answer selected
Venous duplex ultrasound scan
It has been reported that venous ulcerations are the most common type of ulcer affecting the lower
extremities.
The probable underlying cause of venous congestion, which may promote ulceration, is venous
insufficiency.
The treatment of venous ulceration is control of oedema, treating any infection, and compression.
However, compressive dressings or devices should not be applied if the arterial circulation is
impaired.
It is thus important to identify any arterial disease, and ankle-brachial pressure index is a simple way
of doing this. One may then progress to lower limb arteriogram if indicated.
There is no clinical sign of infection, and although a bacterial swab would help to rule out pathogens
within the ulcer, arterial insufficiency is the more important issue.
If there is a clinical suspicion of DVT then duplex (or rarely a venogram) is indicated to decide on the
indication for warfarin.
A 24-year-old female presents with vague frontal headaches and visual disturbance.
She has a past history of acne for which she is receiving treatment. Examination reveals her to be
obese with a blood pressure of 110/70 mmHg. There is absence of the central retinal vein pulsation
on fundoscopic examination.
Which of the following drugs account for these findings?
(Please select 1 option)
Ampicillin
Dianette
This is the correct answer
Erythromycin
Isotretinoin
Incorrect answer selected
Topical tetracycline
Dianette, like any oral contraceptive, may be associated with benign intracranial hypertension (BIH).
Topical tetracycline is not associated with BIH.
Rarely BIH has been associated with isotretinoin but usually in combination with a tetracycline.
A 23-year-old obese female with known tuberculosis presents with ulcerating nodules on the back of
her legs.
Which of the following is the most likely diagnosis?
(Please select 1 option)
Erythema induratum (EI)
Correct
Erythema marginatum
Erythema nodosum
Lupus pernio
Lupus vulgaris
EI is a form of panniculitis characterised by chronic, recurrent, tender, subcutaneous, and sometimes
ulcerated nodules on the lower legs that may also appear elsewhere.
Females are more frequently affected, with a female:male ratio of 7:1 and it is more frequent in
younger females.
It is found in association with tuberculosis.
Another possibility although not provided in the stems is pyoderma gangrenosum.
On the other hand, lupus vulgaris is a chronic, progressive and destructive form of cutaneous
tuberculosis in patients with a moderate or high degree of immunity. It occurs more commonly in
females than in males.
The classical lesions consist of reddish-brown plaques not nodules. The lesions progress by
peripheral extension and central healing, atrophy and scarring. The areas of predilection are head
and neck (80%), followed by arms, legs, then trunk.
This rash is not the typical description of erythema marginatum (finer rash) or multiforme (blisters,
targets).
Lupus pernio occurs in association with sarcoid.
A 38-year-old female presents with red target lesions confined to the hands and is diagnosed with
erythema multiforme.
Which of the following could be the cause?
(Please select 1 option)
Cytomegalovirus infection
Group B streptococci
Incorrect answer selected
Langerhan's cells histiocytosis
Penicillin V
This is the correct answer
Ureaplasma urealyticum
Potential causes of erythema multiforme include:
1. Infections

Viruses: herpes simplex 1 and 2, hepatitis B, Epstein-Barr virus (EBV), enteroviruses

Small agents: Mycoplasma pneumoniae

Bacteria: Group A Streptococcus, eosinia

Other: Mycobacterium tuberculosis, histoplasma, coccidioides.
2. Neoplasia

Leukaemia

Lymphoma.
3. Antiboitics

Penicillins, sulphonamides, isoniazid, tetracycline.
4. Anticonvulsants

Phenytoin, phenobarbitone, carbamazepine.
5. Other

Aspirin, radiation therapy, etoposide, NSAIDs, sunlight, pregnancy.
Which of the following is true regarding diabetic foot ulceration?
(Please select 1 option)
Autonomic neuropathy results in increased resting blood flow
selected
Incorrect answer
Callus formation at pressure areas is an important predictor of ulceration
correct answer
This is the
Plantar ulceration is most commonly due to atherosclerosis.
Skin infection is the most common initiating event in ulceration.
Radiography can readily distinguish between Charcot’s joint and osteomyelitis.
Callus formation at pressure areas is an important predictor of potential ulceration.
Plantar ulceration is usually a consequence of neuropathy.
Minor skin trauma is probably the most common initiating event.
Blood flow is often decreased with autonomic neuropathy hence sympathectomy may be performed
to improve skin blood flow.
It is difficult to distinguish radiographically between Charcot's joint and osteomyelitis.
Exposure to sunlight aggravates which of the following?
(Please select 1 option)
Acne vulgaris
Acute intermittent porphyria
Pellagra
Incorrect answer selected
This is the correct answer
Pseudoxanthoma elasticum
Psoriasis
Exacerbation or localisation of other dermatoses is characteristic of:

Pellagra

Hartnup's disease

Lupus erythematosus

Darier's disease

Rosacea

Scleroderma

Actinic lichen planus and

Lymphocytoma.
A nurse presents with severe swelling around the mouth following her lunch.
She was treated for suspected anaphylaxis and on further questioning she says that previously she
has had an itchy rash on her hands after wearing latex gloves.
Which of the following fruit is the most likely to have been in her lunch to explain this reaction?
(Please select 1 option)
Apple
Banana
Correct
Gooseberry
Pineapple
Star fruit
"Latex allergy represents an increasing occupational problem, mainly among healthcare workers. An
association between latex allergy and hypersensitivity to some plant foods, particularly fruits (the
latex-fruit syndrome), has been established. Class I chitinases with an N-terminal hevein-like domain
from avocado, chestnut, banana and other foods, and latex hevein seem to be the allergens
responsible for the cross-reactions involved in the latex-fruit syndrome." Salcedo G, Diaz-Perales A,
Sanchez-Monge R. The role of plant panallergens in sensitization to natural rubber latex. Curr Opin
Allergy Clin Immunol. 2001 Apr;1(2):177-83.
Deficiency of which one of the following trace elements is implicated as a cause of cardiomyopathy?
(Please select 1 option)
Chromium
Copper
Manganese
Selenium
Correct
Zinc
Selenium deficiency is one of the reversible causes of dilated cardiomyopathy.
A 43-year-old woman with atopic dermatitis (atopic eczema) presented with an acute generalised
exacerbation of her disease.
She was admitted to hospital but failed to improve with emollients, topical betamethasone-17valerate and oral antihistamine.
Which one of the following drugs is the most appropriate treatment?
(Please select 1 option)
Acitretin
Amoxicillin
Ciclosporin
Correct
Colchicine
Dapsone
Cyclosporin is a well used drug in the treatment of atopic dermatitis (AD). It is usually at doses of 2-5
mg/kg.
The pathophysiology of AD is complex but the T lymphocytes are involved and it is known that there
is an increased production of cytokines particularly IL-4.
Ciclosporin is a suppressor of T cells and in that respect works very well in atopic dermatitis and
psoriasis. The side effects of hypertension and renal toxicity limit its use.
These patients are seen monthly to have their blood pressure and urea and electrolytes (U+Es)
checked.
A 16-year-old boy presents with erythema nodusum.
Which of the following should be considered?
(Please select 1 option)
Cytomegalovirus infection
Kawasaki disease
Reiter's disease
Incorrect answer selected
Toxoplasmosis
Ulcerative colitis
This is the correct answer
Erythema nodosum is characterised by painful, indurated, shiny, red, hot, elevated nodules 1-3 cm
diameter particularly on the shins.
There may be associated fever, malaise, and arthralgia ± hilar adenopathy.
Over a period of days they become violaceous, then dull purple then fade like a large bruise without
residual ulceration or scar. There may be crops over three to six weeks.
They are uncommon under the age of six, and are commoner in females than males.
Causes include:
1. INFECTIONS:
1.
Bacteria: Streptococci, leptospirosis, cat-scratch disease, psittacosis, yersinia.
2.
Viruses: EBV.
OTHER:
0. TB, tularaemia, histoplasmosis, coccidiodomycosis.
DRUGS:
0. Sulphonamides, oral contraceptive pill.
SYSTEMIC DISEASES:
0. SLE, vasculitis, regional enteritis, ulcerative colitis, Behçet syndrome.
A 75-year-old female presents with chronic leg ulceration which is a consequence of venous
insufficiency.
Which one of the following is the most appropriate management?
(Please select 1 option)
Appropriate systemic antibiotic in preparation for skin grafting
Compression bandaging
This is the correct answer
Improve the venous return by limb elevation
Skin biopsy to exclude neoplasm
Incorrect answer selected
Vein surgery exclusion of neoplasm by skin biopsy
Venous ulcers are secondary to venous stasis and chronic stretching vessel of the vein walls of the
superficial veins.
These eventually become thinner and ulcerate.
The only treatment shown in studies to be beneficial for this condition would be to compress the
superficial venous using a four layer compression bandage.
The patient should always have their Doppler's and ABPI (ankle brachial pulse index) prior to
compression. This should be greater than 1.
A 40-year-old female presents with a six month history of pruritic papules, vesicles and excoriations
on the elbows, knees, buttocks and scalp.
Her GP has prescribed topical betamethasone therapy which has been unhelpful.
What is the most likely diagnosis?
(Please select 1 option)
Atopic dermatitis (eczema)
Dermatitis herpetiformis (DH)
Correct
Hennoch-Schonlein purpura (HSP)
Psoriasis
Scabies
The question describes the characteristic distribution of the lesions of dermatitis herpetiformis.
DH is one of the immunobullous conditions and characteristically has very intensely pruritic vesicles.
It is not usually responsive to topical steroids, but would respond well to dapsone.
It is associated with gluten sensitivity and coeliac disease.
Atopic eczema is non-vesicular and would respond to potent topical steroids.
HSP is a purpuric rash and is non-pruritic.
Scabies usually affect the extremities and rarely affect above the neck line. It does not cause papules
and vesicles.
A previously fit 30-year-old female presents with a four day history of intractable pruritus and
urticaria.
What is the most appropriate initial management?
(Please select 1 option)
Chlorpheniramine
Prednisolone
This is the correct answer
Incorrect answer selected
Ranitidine
Topical hydrocortisone
Topical mepyramine
Urticaria is a common condition and usually responds very well to systemic antihistamines which are
the correct first line treatment.
Oral steroids can be given for severe cases but only as a last resort.
Topical steroids/ topical antihistamines have no effect.
A 51-year-old male presents with a rash that has been present intermittently over the last two years.
On examination there is a symmetrical rash over the cheeks, nose and chin, with multiple papules
and pustules.
What is the most appropriate therapy for this patient?
(Please select 1 option)
Flucloxacillin
Hydroxychloroquine
Isotretinoin
Oxytetracycline
Correct
Prednisolone
The description is that of acne rosacea particularly in view of the distribution, duration and absence
of any other features. The most appropriate treatment is a tetracycline.
A 58-year-old man has a history of obesity, gastro-oesophageal reflux disease, low back pain and
IHD.
He presents with large, itchy weals over the trunk and limbs and a sensation of tightness in the
throat.
Which one of the following drugs is the most likely to have triggered this skin eruption?
(Please select 1 option)
Aspirin
Correct
GTN (nitrate) spray
Omeprazole
Paracetamol
Simvastatin
In hypersensitive patients aspirin can cause angioedema, bronchospasm and urticaria (skin rashes).
A young woman has acne and is taking oral medication.
She develops polyarthritis and has raised liver enzyme tests.
Investigations show:
AST
95 U/L (1-31)
ALT
170 U/L (5-35)
Bilirubin
16 µmol/L (1-22)
Antinuclear antibodies
strongly positive at 1/20, negative at 1/640
Which of the following drugs is she most likely to have been prescribed?
(Please select 1 option)
Erythromycin
Isotretinoin
Minocycline
Incorrect answer selected
This is the correct answer
Oxytetracycline
Trimethoprim
Except trimethoprim all other drugs listed above are used in the treatment of acne. All of these
can cause hepatotoxicity.
Erythromycin usually causes cholestasis.
Minocycline can cause drug induced systemic lupus erythematosus (SLE).
A 68-year-old woman presents with a two month history of a widespread pruritic rash.
Examination reveals widespread erythema with several small blisters containing straw-coloured fluid
and one or two larger serosanguineous blisters.
What is the most likely diagnosis?
(Please select 1 option)
Bullous impetigo
Incorrect answer selected
Bullous pemphigoid
This is the correct answer
Insect bite
Scabies
Urticarial vasculitis
Pemphigoid, erythema multiforme and herpes are the commonest causes of a blistering rash.
The history above is a classic description of bullous pemphigoid (BP).
Immunoglobulin (Ig)G autoantibodies bind to the skin basement membrane in patients with BP. The
binding of antibodies at the basement membrane activates complement and inflammatory
mediators.
Activation of the complement system is thought to play a critical role in attracting inflammatory cells
to the basement membrane. These inflammatory cells are postulated to release proteases, which
degrade hemidesmosomal proteins and lead to blister formation.
Eosinophils are characteristically present in blisters as demonstrated by histopathologic analysis,
although their presence is not an absolute diagnostic criterion.
An 18-year-old woman presents with red, tender lumps on her shins and arthralgia.
Chest X-ray shows bilateral hilar lymphadenopathy and clear lung fields. A clinical diagnosis of
sarcoidosis is made.
Which one of the following is the most appropriate management plan?
(Please select 1 option)
24 hour urinary calcium measurement
Follow up appointment with chest X-ray in three months
This is the correct answer
Mediastinoscopy and lymph node biopsy
Skin biopsy
Thoracic CT scan
Incorrect answer selected
This is also known as Lofgren's syndrome (a benign form of sarcoidosis).
The presentation of erythema nodosum-arthropathy-bilateral hilar lymphadenopathy syndrome is so
chracteristic that histological diagnosis is not necessary.
The prognosis is excellent with less than 10% having persistent disease.
With less characteristic presentations, positive biopsies are needed.
Mediastinoscopy is the method of choice for anterior mediastinal nodes.
A 63-year-old man presents with recurrent gradually increasing shortness of breath over the last
few weeks.
His chest x ray is shown: Lt pleural effusin
On examination his hands showed the following: yellow nails, thickned
What is the diagnosis?
(Please select 1 option)
Chronic mucocutaneous candidiasis
Iron deficiency
Ochronosis
Polychondritis
Yellow nail syndrome
Correct
This is yellow nail syndrome where the nails are yellow, thickened, curved, stop growing and may
become detached from the nailbed.
Associated findings include lymphoedema, bronchiectasis and pleural effusions
A 20-year-old male presents with extensive, coalescing, hypopigmented, slightly scaly lesions on his
back and chest.
The rash had been present for two years and had gradually become more extensive. He had
otherwise been in good health. The lesions were not symptomatic but he was concerned about their
appearance.
What is the most appropriate treatment for his condition?
(Please select 1 option)
Aciclovir cream
Ketoconazole cream
This is the correct answer
Nystatin cream
Oral itraconazole
Incorrect answer selected
Oral terbinafine
The patient presents with an asymptomatic eruption on his trunk.
The lesions are scaly, hypopigmented and are not associated with any systemic disease.
This is characteristic of pityriasis versicolor, which is caused by the unicellular yeast Pityrosporum
ovale and Pityrosporum orbiculare. The yeast is lipophilic and is encouraged by an increase in
environmental temperature, thus many patients notice that the condition begins after a summer
vacation.
It is a disorder of the healthy but the immunocompromised are at risk.
The condition is asymptomatic and appears pale in comparison to the normal skin. The fungus
affects the melanocytes hence the hypo- pigmentation.
The treatment options include topical imidazole creams, selenium sulphide shampoo and if not
responding to topical treatment oral itraconazole 200 mg once a day for seven days.
In this patient the topical treatment should be tried first.
Which of the following concerning pityriasis rosea is correct?
(Please select 1 option)
It is characterised by flat scaly patches
It is due to a fungal infection
This is the correct answer
Incorrect answer selected
It is frequently associated with oro-genital itching
May be preceded by intense itching
Tends to recur after apparent cure
Pityriasis rosea is a rash that can occur at any age but it occurs most commonly in people between
the ages of 10 and 35 years.
It is not caused by a fungus.
The condition often begins as a large single pink patch on the chest or back. This patch may be scaly
and is called a "herald" or "mother" patch.
Within a week or two, more pink patches, sometimes hundreds of them, appear on the body and on
the arms and legs. Patches may also occur on the neck, and though rare, the face.
A 26-year-old male epileptic is admitted with temperature and rash.
Over the last one week a rash has developed and he has become increasingly ill. Recently he has had
some problems with epileptic control and has commenced carbamazepine with valproate.
Examination reveals an unwell patient with a temperature of 39°C, a diffuse erythematous, painful
rash with evidence of some lateral sliding of these erythematous areas on palpation.
There is also blistering and inflammation of the oral cavity.
What is the likely diagnosis?
(Please select 1 option)
Erythema elevatum diutinum
Exfoliative dermatitis
Pustular psoriasis
Toxic epidermal necrolysis
Correct
Toxic shock syndrome
This patient's presentation and clinical description suggests a diagnosis of toxic epidermal necrolysis
(TEN) due to carbamazepine therapy.
TEN is a severe mucocutaneous exfoliative disease with an uncertain pathogenesis and a high
mortality rate.
It is difficult to say whether it is another variant of Stevens-Johnson syndrome and treatment of both
are similar.
It is often idiopathic but may be associated with:
- viral infections
- leukaemia
- lymphoma and
- drugs (in particular sulphonamides and anticonvulsants).
The suggested association with carbamazipine in this case makes toxic shock syndrome due to
Staph. aureus remote, which like pustular psoriasis would not be expected to affect the mucous
membranes.
A 30-year-old woman presents with a skin rash. On applying pressure to an unaffected area of
skin it was relatively easy to induce trauma.
Increased fragility of the skin is characteristic of which of the following conditions?
(Please select 1 option)
Acute intermittent porphyria
Epidermolysis bullosa
Incorrect answer selected
This is the correct answer
Neurofibromatosis
Pseudo-xanthoma elasticum
Tuberous sclerosis
Increased skin fragility is seen in a number of disorders and is used as a clinical test in bullous
disorders (Nikolsky's sign).
Other causes include pemphigus vulgaris, porphyria cutanea tarda and drug reactions (especially
pseudoporphyria).
Other causes of increased skin fragility (not associated with bullae) include long term
corticosteroid therapy, Ehlers-Danlos syndrome and scurvy (vitamin C deficiency).
Which of the following suggests a diagnosis of molluscum contagiosum rather than chickenpox?
(Please select 1 option)
Absence of erythema surrounding lesions
Correct
Lesions disappearing within a month
Positive contact history
Presence of macules and papules
Presence of pruritis
Molluscum contagiosum is caused by a deoxyribonucleic acid (DNA) pox virus.
The lesions are small, skin coloured papules with central umbilication. There is little surrounding
inflammation and they may be spread following scratching to other sites.
Chickenpox lesions in the early stages may be mistaken for molluscum. However, the presence of
associated macules and later vesicles and pustules help to differentiate them.
These lesions also affect the mucus membranes, and usually disappear within a few weeks, while
molluscum can persist for up to a year.
Which statement regarding tinea capitis is correct?
(Please select 1 option)
It causes patches that fluoresce dull green under Wood's lamp.
answer
This is the correct
It is effectively treated with topical nystatin ointment.
It is most commonly caused by the fungus Microsporum canis.
It often results in permanent alopecia.
Incorrect answer selected
Its presence should suggest immunological deficiency.
Tinea capitus is a dermatophyte infection of the scalp most often caused by Trichophyton
tonsurans, and occasionally by Microsporum canis.
It is commonest in areas of socio-economic deprivation.
M. canis is a zoophilic species acquired from cats and dogs. There is initially a small papule at the
base of the hair follicle which spreads peripherally forming a scaly circular plaque (ringworm)
within which there are brittle, broken infected hairs (exclamation mark hairs).
Confluent patches of alopecia develop and there may be pruritis.
Sometimes a severe inflammatory response produces an elevated boggy granulomatous mass
(kerion), studded with sterile pustules.
There may be fever and regional lymphadenopathy, and occasionally permanent scarring and
alopecia may result.
The crusted patches fluoresce dull green under Wood's light. Microscopic examination of a
potassium hydroxide (KOH) preparation shows tiny spores and the fungi may be grown in
Sabouraud medium with antibiotics.
Oral griseofulvin for two to three months is required, or ketoconazole for resistant cases
Which is true regarding eczema herpeticum?
(Please select 1 option)
Is invariably fatal if untreated.
Incorrect answer selected
Is more severe in reactivation disease.
Is typically associated with a high fever for over a week.
Only a single crop of vesicles usually appear.
This is the correct answer
Usually has an indolent onset.
Eczema herpeticum is the result of primary infection of eczematous skin with Herpes simplex virus
(HSV). The severity varies from mild to fatal.
There is usually an abrupt onset with crops appearing over seven to nine days. These may become
coalesced. Typically, the child has a high fever for seven days, and recurrent attacks can occur.
Death can result from physiological disturbances (loss of fluid electrolytes and protein through the
skin) or dissemination of the virus to brain and other organs or from secondary bacterial sepsis
Which of the following is true of cutaneous anthrax?
(Please select 1 option)
Causes a black eschar which overlies pus
Is very likely to occur in subjects exposed to anthrax spores
selected
Lesions are associated with marked oedema
Incorrect answer
This is the correct answer
Lesions are usually painful and tender
Mortality is approximately 20% despite antibiotic therapy
Anthrax is caused by Bacillus anthracis a Gram-positive rod.
Cutaneous anthrax is caused by direct contact of the bacteria into an open wound (usually
touching an infected animal).
Cutaneous anthrax is associated with a black eschar without pus, tends to be painless and to have
widespread oedema.
Without antibiotics mortality is of the order of 20%, but with antibiotics, mortality is low, which
contrasts with pulmonary anthrax.
A 17-year-old boy is diagnosed with scabies.
Which of the following statements regarding scabies is correct?
(Please select 1 option)
Is best treated by salicylate emulsion
It can be spread by a droplet infection
It causes itchiness in the skin even where there is no obvious lesion to be seen
Correct
It is caused by Staphylococcus aureus
Typically affects the face
Scabies is an infestation of the skin with the microscopic mite Sarcoptes scabei. Infestation is
common, found worldwide, and affects people of all races and social classes.
Scabies spreads rapidly under crowded conditions where there is frequent skin-to-skin contact
between people, such as in hospitals, institutions, child-care facilities, and nursing homes.
Scabies can spread by direct, prolonged, skin-to-skin contact, with a person already infested with
scabies. Contact must be prolonged (a quick handshake or hug will usually not spread infestation).
Infestation is easily spread to sexual partners and household members. Infestation may also occur by
sharing clothing, towels, and bedding.
Scabies is characterised by papular-like irritations, burrows or rash of the skin, especially:
- the webbing between the fingers
- the skin folds on the wrist, elbow, or knee
- the penis
- the breast or
- shoulder blades.
A number of treatments are available for scabies, including:
- permethrin ointment
- benzyl benzoate and
- oral ivermectin for resistant cases.
Antihistamines and calamine lotion may be used to alleviate itching.
A 65-year-old female who has a history of long-standing psoriasis and heavy alcohol intake, presents
with a severe exacerbation of psoriasis.
She was admitted and received topical therapy and over the month of her admission, her gamma-GT
concentration had fallen from 400 U/L to 150 U/L (4 - 35).
Six weeks after discharge she was seen in outpatients where her psoriasis remained under control,
but she complained of generalised hair loss.
What is the most likely cause for her hair loss?
(Please select 1 option)
Alopecia areata
Iron deficiency
Telogen effluvium
Correct
Thiamine deficiency
Trichotillomania
In a normal healthy person's scalp about 85% of the hair follicles are actively growing hair and 15%
are resting.
If there is some shock to the system, as many as 70% of the scalp hairs can be precipitated into a
resting state, thus reversing the usual ratio. Typical precipitants include illnesses, operations,
accidents and childbirth.
The resting scalp hairs, now in the form of club hairs, remain firmly attached to the hair follicles at
first. It is only about two months after the shock that the new hairs coming up through the scalp
push out the "dead" club hairs and increased hair fall is noticed. Thus, paradoxically, with this type of
hair loss, hair fall is a sign of hair regrowth.
As the new hair first comes up through the scalp and pushes out the dead hair a fine fringe of new
hair is often evident along the forehead hairline. At first the fall of club hairs is profuse and a general
thinning of the scalp hair may become evident but after several months a peak is reached and hair
fall begins to lessen, gradually tapering back to normal over six to nine months.
As the hair fall tapers off the scalp thickens back up to normal, but recovery may be incomplete in
some cases
A 70-year-old woman complained of a rash that had developed over a month. She had otherwise
been fit and well.
On examination, there were numerous tense, fluid filled blisters over the trunk and limbs, but no
mucosal involvement was evident.
What is the most likely diagnosis?
(Please select 1 option)
Dermatitis herpetiformis
Erythema multiforme
Herpes simplex
Pemphigoid
Correct
Pemphigus vulgaris
The patient presents with tense blisters on her arms, trunk and legs. She is otherwise well and there
is no mucosal involvement.
This is typical of bullous pemphigoid.
Dermatitis herpetiformis presents with itchy excoriated areas in the elbows knees and buttocks.
Erythema multiforme presents with characteristic target lesions.
Herpes simplex is vesicular and in generalised cases the patient is likely to be unwell.
Pemphigus presents with superficial erosions and usually there is mucosal involvement
A 55-year-old woman presents with a non-pruritic rash that had developed over the last two
months.
Examination revealed several, circular, erythematous, raised, smooth-surfaced lesions of variable
size from 1-5 cms in diameter on the elbows, extensor aspects of the forearms and knuckles.
What is the most likely diagnosis?
(Please select 1 option)
Eczema
Granuloma annulare
Psoriasis
Tinea corporis
Correct
Urticaria
The history of non-itchy, circular, raised, smooth-surfaced lesions on the elbows, extensor aspects of
the forearms and knuckles and the raised borders are suggestive of granuloma annulare.
Discoid eczema tends to be scaly and pruritic in nature.
Psoriasis typically has a silvery scale and can be pruritic.
Urticaria lasts a few hours and is pruritic.
Tinea corporis is a fungal infection and is typically scaly and pruritic in nature.
The most likely answer is therefore granuloma annulare.
This can be associated with diabetes.
A 24-year-old female attends clinic complaining of numerous depigmented areas on the arms and
legs.
Which of the following diseases is most likely to accompany this skin condition?
(Please select 1 option)
Addison's disease
Hypoparathyroidism
Pernicious anaemia
Correct
Systemic lupus erythematosus
Tuberous sclerosis
The suggested diagnosis is vitiligo which is associated with numerous autoimmune conditions
including, in order of frequency:

Autoimmune hypothyroidism

Pernicious anaemia

Alopecia areata and

Addison's disease.
It is associated with both type 1 and 2 autoimmune polyendocrine syndromes but these are much
rarer than the former diagnoses.
A 35-year-old woman presents with a facial rash which had been present for one year.
On examination she had erythematous, scaly, indurated plaques on both cheeks with areas of
scarring alopecia. Hyperkeratosis over dilated hair follicles was also seen.
What is the diagnosis?
(Please select 1 option)
Acne rosacea
Discoid lupus erythematosus
Correct
Impetigo
Lupus pernio
Psoriasis
The patient has discoid lupus as suggested by the indurated plaques on cheeks, the scarring alopecia
and hyperkeratosis over the hair follicles.
Which of the following statements regarding psoriasis is correct?
(Please select 1 option)
1% of patients have associated psoriatic arthropathy
Guttate psoriasis is the most common form of the disease
Psoriasis is more common at lower geographical altitudes
Psoriatic arthropathy precedes cutaneous lesions in roughly 20% of cases
Correct
The prevalence in the United Kingdom is 10%
The prevalence of psoriasis is reported as between 0.5 and 4.6%.
For reasons which may be explained by the filtering of ultraviolet B (UVB) light, psoriasis is more
common at higher altitudes.
The commonest form of psoriasis is plaque psoriasis, making up approximately 80% of cases (guttate
-10%, erythrodermic - 3%, pustular - 3%).
Studies report:

A 5-42% prevalence of psoriatic arthropathy in patients with cutaneous psoriasis and

Arthropathy precedes cutaneous lesions in 20%

Cutaneous lesions precede joint disease in 60-70% and

They occur simultaneously in 10-20%
Which of the following statements regarding psoriasis is most true?
(Please select 1 option)
Ciclosporin is ineffective in the treatment of psoriasis
Diagnosis requires histological confirmation
Guttate psoriasis often arises after staphylococcal infection
T-cells play a prominent role in the pathogenesis of psoriasis
Correct
Twin studies have identified no genetic basis for psoriasis
Diagnosis of psoriasis is based on clinical observation of sharply demarcated, erythematous,
scaling plaques, and rarely requires biopsy.
Streptococcal infection is associated with precipitation and recurrence of guttate psoriasis.
Ciclosporin is a major inhibitor of T cell activation, and given that T cells are central to the
pathogenesis of psoriasis, is very effective treatment in psoriasis.
Genetic studies have led most experts to believe that psoriasis is the result of multiple genetic
factors interacting with environmental stimuli.
Genetic factors also seem to contribute to the clinical manifestations of the disease, for example,
age of onset and severity of disease.
A 41-year-old female presents with a six month history of a pruritic vesicular-papular rash on the
elbows, knees and buttocks associated with numerous blistering eruptions and excoriations.
Her GP has prescribed topical steroid therapy but this has not helped.
What is the most likely diagnosis?
(Please select 1 option)
Atopic eczema (dermatitis)
Dermatitis herpetiformis (DH)
Correct
Lichen planus
Psoriasis
Scabies
This patient presents with pruritic vesicles on her elbows, knees and buttocks which have not
responded to topical steroids.
This is the classical presentation of DH.
Atopic dermatitis usually is flexural and responds to topical steroids.
Henoch-Schonlein purpura is a form of vasculitis.
In scabies there are burrows and in psoriasis the rash consists of plaques with silvery scales.
A 36-year-old female presents with raised erythematous tender lesions on both legs which have
developed since she had a throat infection two weeks ago.
Which one of the following investigations is most likely to establish the diagnosis?
(Please select 1 option)
Anti-streptolysin-O titre (ASOT)
Correct
Chest x ray
Throat swab cultured for bacteria
Mantoux test
Throat swab cultured for viruses
This lady presents with tender lesions two weeks after a sore throat.
This is most likely to be post-streptococcal erythema nodosum and ASOT is most likely to confirm
this
A 33-year-old female is admitted with erythema multiforme (EM) and erythematous lesions of the
mouth and eyes.
Which one of the following drugs may account for her presentation?
(Please select 1 option)
Diazepam
Fluoxetine
Mebeverine
Oral contraceptive
Sulfasalazine
Correct
Any drug or infection can trigger EM but sulfasalazine and sulpha- group drugs are well reported
as causes of EM and Stevens-Johnson syndrome.
A 52-year-old female presents with blistering of the hands and arms which deteriorates during the
summer.
She was otherwise well and drinks approximately 20 units of alcohol weekly.
Examination of her skin revealed erosions and scarring on the backs of her hands and forearms and
some mild hirsutes.
Which one of the following is the most likely diagnosis?
(Please select 1 option)
Acute intermittent porphyria
Erythropoietic protoporphyria
Pemphigoid
Porphyria cutanea tarda (PCT)
Correct
Subacute lupus erythematous (LE)
The history of photosensitive eruption, hypertrichosis and milia formation (keratin-containing cysts)
are characteristic of PCT.
Acute intermittent porphyria usually causes intermittent neurological and abdominal problems.
Subacute LE can cause erythema and scarring but in a patient with increased alcohol intake and
hypertrichosis the most likely diagnosis is PCT.
Erythropoietic protoporphyria patients get pain and erythema on exposure to sunlight
A 22-year-old female returns from a fortnight holiday in Cyprus with a tan and numerous scaly
hypopigmented lesions on the neck and upper trunk.
What is the most likely diagnosis?
(Please select 1 option)
Chronic plaque psoriasis
Discoid eczema
Pityriasis rosea
Incorrect answer selected
Pityriasis versicolor
This is the correct answer
Seborrhoeic dermatitis
Pityriasis versicolor is caused by a superficial fungal infection with Pityrosporum ovale.
It usually presents as slightly scaly hypopigmented lesions. Growth is encouraged by an increase in
temperature and suntan oils and most commonly is seen after a sun holiday.
Chronic plaque psoriasis, discoid eczema and seborrhoeic dermatitis have distinct appearance and
distribution.
Pityriasis rosea usually starts with a herald patch followed by small scaly lesions following the rib
lines
A sixteen-year-old girl who is known to be allergic to bee stings, presents after suffering a bee sting.
Which of the following is the most likely clinical outcome?
(Please select 1 option)
Anaphylaxis
Facial rash
Correct
Local irritation at site of sting only
Stridor
Widespread urticaria
A patient with an allergy to bee stings is likely to develop a type I reaction to a bee sting and
therefore anaphylactic shock.
Generalised urticaria, loss of consiousness, facial rash and stridor may be part of anaphylaxis.
In this patient the correct answer would be anaphylaxis
A 22-year-old female is referred with symmetrical, depigmented areas on the arms and legs but has
been otherwise quite well.
Which one of the following diseases is most likely to be associated with her skin disease?
(Please select 1 option)
Diabetes mellitus
Hypoparathyroidism
Pernicious anaemia
Correct
Scleroderma
Systemic lupus erythematosus (SLE)
She has vitiligo and consequently is 15 times more likely to be suffering from an additional
autoimmune condition. Although hypoparathyroidism may be an associated autoimmune condition,
pernicious anaemia occurs more frequently.
Vitiligo may be a component of the polyglandular autoimmune syndrome which includes type 1
diabetes, autoimmune adrenal insufficiency and autoimmune thyroid disease.
SLE causes post-inflammatory hypopigmentation and scleroderma is not associated.
An 82-year-old lady had a history of a red facial rash and has suffered with venous eczema of the
legs. She was treated for acne rosacea.
On examination, she was noted to have blue-grey discolouration of both legs.
What drug is most likely to have caused this?
(Please select 1 option)
Amiodarone
Incorrect answer selected
Ciprofloxacin
Doxycycline
Minocycline
This is the correct answer
Oxytetracycline
This patient has developed skin pigmentation in her venous eczema due to treatment of her acne
rosacea.
Tetracyclines are the most appropriate treatment of acne rosacea and the most likely of these to
cause this bluish grey skin pigmentation in the legs is minocycline
A 20-year-old female with a history of systemic lupus erythematosis (SLE) presents with symmetrical
reticulated violaceous patches, which become more prominent in cold weather and involving both
lower limbs.
Which of the following is the likely diagnosis?
(Please select 1 option)
Erythema ab igne
Erythema marginatum
Erythema nodosum
Livedo reticularis
Correct
Pyoderma gangrenosum
Livedo reticularis is due to dilation of capillary blood vessels and stagnation of blood within these
vessels producing a mottled discolouration of the skin.
It is described as being reticular (net-like) cyanotic cutaneous discolouration surrounding pale
central areas.
It occurs mostly on the legs, arms and trunk and is more pronounced in cold weather.
Mostly it is idiopathic, or secondary to:

Malignancy

Vasculitis

SLE

Cancer

Cholesterol embolisation
A 40-year-old female presents with a long history of excessive localised armpit sweating.
She finds the problem embarrassing and has problems staining clothes. She has tried antiperspirants without relief.
Which is the most appropriate treatment that you would offer this patient?
(Please select 1 option)
Amitriptyline
Axillary surgery
Botulinum toxin injection
Correct
Propantheline
Topical aluminium salts
This woman has primary hyperhidrosis which can be quite psychologically disabling.
In this case the most appropriate treatment would be botulinum toxin injection to each axilla. This
treatment is licensed for use and would be the preferred treatment before aluminium salts as antiperspirants have failed.
Similarly, anti-muscarinics are associated with systemic side effects that may prove intolerable and
their efficacy is really not proven.
Pharmacological approaches should be tried before surgery.
A 45-year-old teacher presents six weeks after he returns from a hiking holiday in South America
with a shallow, painless ulcer of the nose.
What is the likely diagnosis?
(Please select 1 option)
Fusobacterium ulcerans
Leishmaniasis
Correct
Squamous cell carcinoma
Trichomoniasis
Trypanosomiasis
The likely diagnosis given the history is cutaneous leishmaniasis.
Lesion pain and pruritis may be present in cutaneous leishmaniasis, but is not typical.
Diagnosis is by histologic section with staining for amastigotes. Leishamania braziliensis is the likely
pathogen which is spread by sandfly bites in endemic areas.
Fusobacteria cause the tropical ulcer, an intensely painful, shallow ulcer
A 16-year-old boy presents with scaly patches on his scalp.
Examination reveals well-circumscribed, circular areas of hair loss, 2-5 cm in diameter with scaling
and raised margins. There is no scarring.
What is the most likely cause in this patient?
(Please select 1 option)
Discoid lupus erythematosus
Lichen planus
Morphoea
Systemic lupus erythematosus
Tinea capitis
Correct
This patient has non-scarring alopecia due to invasion of hairs by dermatophytes, most commonly
Trichophyton tonsurans.
The most common causes of nonscarring alopecia include:

Telogen effluvium

Androgenetic alopecia

Alopecia areata

Tinea capitis, and

Traumatic alopecia.
Less commonly, non-scarring alopecia is associated with lupus erythematosus and secondary
syphilis.
Scarring alopecia is more frequently the result of a primary cutaneous disorder such as:

Lichen planus

Folliculitis decalvans

Cutaneous lupus, or

Linear scleroderma (morphoea)
A 43-year-old female presents with a weepy, erythematous rash mainly affecting the forehead,
scalp, neck and upper back.
Three days earlier she had used red hair dye at home to self-administer "highlights".
What is the likely diagnosis?
(Please select 1 option)
Acne rosacea
Contact allergic dermatitis
Correct
Eczema
Psoriasis
Seborrhoeic dermatitis
Hair dye contains substances which may induce contact allergic dermatitis.
This type of reaction is typical for this sort of timescale, and is an example of a type IV, or delayed,
hypersensitivity reaction.
Sensitisation occurs on initial exposure to the allergen and "memory" T-cells proliferate in lymphoid
tissue. Subsequent exposure to allergen induces activation of the T-lymphocytes and an
inflammatory response.
Hairdressing chemicals are a very common cause of contact allergic dermatitis, a disorder which is
very common amongst the hairdressing community.
A lady at this age is unlikely to present with a new, previously undiagnosed case of eczema.
Acne rosacea is usually a disorder of the skin on the cheeks and nose