quiz 5 mrcpa 15.docx

7/17/2019 QUIZ 5 MRCPA 15.docx

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QUIZ 5 MRCPA 15-year-old girl presents with an itchy rash around her umilicus at

the site o! her "eans stud# $he is patch tested and !ound to e allergic to nic%el#

&hich o! the !ollowing is '() true*

$he is li%ely to ecome desensitised to nic%el i! she a+oids it !or a long time

)opical steroids will impro+e the rash

$he has a type-, allergy to nic%el

Painting the stud with nail +arnish may impro+e the rash

'ic%el allergy is the most common patch test nding in women

Incorrect

Contact dermatitis is a type-, allergy that can e treated with topical steroids# 'ail

+arnish can reduce contact o! studs with the s%in and impro+e this prolem

.although suse/uent allergy to the nail +arnish has een reported0#

(nce type-, allergy to a sustance has de+eloped it is usually li!e-long e+en i! the

allergen is strictly a+oided#

An 2,-year-old woman with a history o! ischaemic heart disease is re+iewed in the

dermatology clinic# 3er current medication includes aspirin sim+astatin isoprolol

ramipril and isosoride mononitrate#

$he has de+eloped tense listering lesions on her legs# 4ach lesion is around 1 to

cm in diameter and she reports that they are slightly pruritic# 46amination o! her

mouth and +ul+a is unremar%ale#

&hat is the most li%ely diagnosis*

7ullous pemphigoid



Pemphigus

8rug reaction to aspirin

4pidermolysis ullosa

$caies

Correct

7ullous pemphigoid is an autoimmune condition causing su-epidermal listering o!

the s%in# )his is secondary to the de+elopment o! antiodies against

hemidesmosomal proteins 7P129 and 7P:9 #

;eatures include itchy tense listers typically around <e6ures the listers usually

heal without scarring#

A :=-year-old newly /ualied nurse presents as she has de+eloped a ilateral

erythematous rash on oth hands# $he has recently emigrated !rom the Philippines

and has no past medical history o! note# A diagnosis o! contact dermatitis is

suspected#

&hat is the most suitale to test to identi!y the underlying cause*

$%in patch test

Radioallergosorent test .RA$)0

>ate6 IgM le+els

$%in pric% test

Urinary porphyrins

Correct

$%in patch testing Use!ul !or contact dermatitis# Around 9-,9 allergens are placed

on the ac%# Irritants may also e tested !or# )he patches are remo+ed ,2 hours

later with the results eing read y a dermatolois ugist a!ter a !urther ,2 hours#



A =:-year-old hea+y smo%er with a long history o! sel!neglect presents to his ?P

with se+ere leg pain# (n e6amination there are multiple small punched-out ulcers

situated on the lower third o! oth legs# 7oth dorsalis paedis and posterior tiial

pulses appear asent#

&hat diagnosis ts est with this clinical picture*

)raumatic s%in damage

Multiple arterial ulcers

;lea in!estation

@asculitis

Multiple +enous ulcers

Correct

)his is the typical picture o! arterial ulceration in a smo%er# Associated ischaemic leg

pain may e particularly intense on ele+ating the legs and cause sleep inter!erence#

As well as peripheral +ascular disease as e+idenced y the asent !oot pulses

ilaterally#

An 12-year-old woman attends antenatal clinic 1: wee%s into her pregnancy where

the doctor incidentally notes numerous small lumps o+er her trun% and !rec%les in

her a6illae# $he reported that none o! her relati+es had any similar !eatures#


'euroromatosis

)uerous sclerosis

Acanthosis nigricans

8ysplastic nae+us syndrome

Mastocytosis



Correct

)he patient is li%ely to ha+e neuroromatosis .';10 with two or more

neuroromas or a ple6i!orm neuroroma and !rec%les under the arm or in the

groin region#

A =,-year-old woman presents with se+ere mucosal ulceration associated with the

de+elopment o! listering lesions o+er her torso and arms#

(n e6amination the listers are <accid and easily ruptured when touched#


8ermatitis herpeti!ormis

Pemphigoid

Pemphigus +ulgaris


Psoriasis

Correct

Pemphigus +ulgaris is an autoimmune disease caused y antiodies directed

against desmoglein a cadherintype epithelial cell adhesion molecule# It is more

common in the Ash%enai Bewish population #

Mucosal ulceration is common and o!ten the presenting symptom# (ral in+ol+ement

is seen in 59-9D o! patients # $%in listering E <accid easily ruptured +esicles and

ullae# >esions are typically pain!ul ut not itchy# )hese may de+elop months a!ter

the initial mucosal symptoms#

'i%ols%yFs descries the spread o! ullae !ollowing application o! horiontal

tangential pressure to the s%in



A =:-year-old woman has recently een diagnosed as suGering !rom lentigo maligna

on her !ace#

&hich !actor is most important in determining her prognosis*

Initial sie o! the lesion

Colour o! the lesion

)hic%ness o! the lesion

PatientFs age

(ther comoridities

Correct

>entigo maligna represents an increased numer o! melanocytes at the

epidermodermal "unction# It egins as a <at !rec%le-li%e lesion which can change

into a malignant melanoma# It occurs on the !acial or sune6posed s%in o! patients in

their si6ties or older#

Malignant change should e suspected with a change in sie outline colour

sur!ace or ele+ation o! the lesion# It spreads +ia the lymphatics and satellite lesions

are commonly seen#

)he prognosis is directly related to the thic%ness o! the tumour assessed at

histological e6amination# )he prognosis is also related to the site#

A 1H-year-old student presents !or re+iew# 3e has "ust returned to uni+ersity !or the

start o! the $pring term#

3e gi+es a history o! a red patch o! s%in on his chest surrounded y an area o! s%in

scaling which was !ollowed aout days later y the de+elopment o! o+al macules

o+er the rest o! his trun% arms and thighs# 3e is otherwise well#




>i%ely drug reaction

8arierFs disease

Pityriasis rosea

Pityriasis rura pilaris

Pityriasis +ersicolor

Correct

)he rst clinical lesion to appear in pityriasis rosea is the so-called herald patchF an

isolated erythematous patch appearing on the trun% surrounded y a ring o!

scaling s%in# A numer o! o+al macules appear on the upper arms remainder o! thetrun% and upper thighs some :E, days later#

In+ol+ement o! the hands !eet or scalp is rare# $e+ere itching is uncommon#

Pityriasis rosea normally remits within ,E 2 wee%s#

$ystemic antihistamines or calamine lotion may e use!ul to relie+e itching# )opical

steroids do not shorten the duration o! the disease and systemic steroids ha+e no

+alue in disease modication#

&hich o! the !ollowing is true regarding psoriasis*

)he main anormality is increased epidermal proli!eration due to e6cessi+e

di+ision o! cells in the asal layers and a shorter cell-cycle time

It suggests underlying adominal malignancy

It may commonly e the presenting !eature o! 3odg%inFs lymphoma

It aGects 15-:9D o! the population

Psoriatic arthropathy occurs in o+er 9D o! people with psoriasis

Correct



Psoriasis may e associated with an increased ris% o! certain malignacies notaly

non-3odg%inFs lymphoma# 3owe+er the treatments o! psoriasis .e#g# methotre6ate

)'; alpha inhiitors0 pose a greater ris% o! associated malignancy than the

condition itsel!#

Psoriasis aGects 1- D o! the population and an arthropathy occurs in aout 5D o!

patients# )rauma eta-haemolytic streptococcal throat in!ections U@ rays

antimalarials and lithium can cause <are-ups#

&hich o! the !ollowing is true o! cutaneous anthra6*

>esions are associated with mar%ed oedema

>esions are usually pain!ul and tender

Mortality is appro6imately :9D despite antiiotic therapy

Is +ery li%ely to occur in su"ects e6posed to anthra6 spores

Causes a lac% eschar which o+erlies pus

Incorrect

Anthra6 is caused y 7acillus anthracis a ?ram positi+e rod# Cutaneous anthra6 is

caused y direct contact o! the acteria into an open wound .usually touching an

in!ected animal0#

Cutaneous anthra6 is associated with a lac% eschar without pus tends to e

painless and to ha+e widespread oedema#

&ithout antiiotics mortality is o! the order o! :9D ut with antiiotics mortality is

low which contrasts with pulmonary anthra6#

A patient with psoriatic arthritis has acti+e "oints and troulesome pla/ue psoriasis#

&hich o! the !ollowing will impro+e oth the "oint and s%in prolems*



Methotre6ate

Penicillamine

$ulphasalaine

3ydro6ychloro/uine

?old

Correct

3ydro6ychloro/uine can e6acerate psoriasis# $ulphasalaine tends to only impro+e

"oint symptoms and not impro+e the psoriasis# ?old and penicillamine are not

commonly used to treat this condition#

A 9-year-old woman presents with an intermittent pruritic eruption which has eenoccurring !or se+eral months# >esions last a !ew hours only and disappear lea+ing no

mar% suggesting a diagnosis o! urticaria# $he is atopic and had a nut allergy as a

child#

&hich one o! the !ollowing is true*

Most patients with chronic urticaria do not ha+e an e6ogenous trigger

$%in pric% tests are not use!ul in diagnosis o! the causes o! urticaria

Acute urticaria typically responds to topical steroids

In!ant nut allergy persists into adult li!e in most patients

Chronic urticaria is strongly associated with atopy

Incorrect

Most indi+iduals with chronic long-term urticaria do not ha+e an e6ogenous trigger#

Ig4-mediated urticarial reactions to !oods usually !ollow a clear pattern and can ein+estigated y s%in-pric% tests or serum Ig4 /uantication#

A :,-year-old theatre nurse presents !or re+iew# $he has red scaling pla/ues that

are worse on her hands ut are also present on the <e6or sur!aces o! her arms and

legs#



3er past history o! note includes coeliac disease# )here is a mildly raised lood

eosinophil count# &

hat diagnosis ts est with this clinical picture*

Atopic ecema


Psoriasis

Photosensiti+ity

3istiocytosis-J

Incorrect

4cema characteristically occur on the <e6ural sur!aces# Chronic in<ammation may

result in s%in lichenication constant scratching in hypopigmentation# In this case

late6 sensitisation may ha+e played a role in worsening the clinical picture#

A 15-year-old oy was treated with permethrin cream !or scaies in!estation# (n

!ollow-up three wee%s later he was !ound to ha+e continuing in!estation#

&hat is the most li%ely reason !or this*

'on-disposal o! underwear

(ther household memers were not treated

)he treatment was not repeated as prescried

)he organism is resistant to permethrin

;acial s%in was not treated

Correct



)reatment !ailures are uncommon# Recurrence o! the eruption usually means re-

in!ection has occurred#

A :-year-old man presents with a , day history o! an itchy and sore right ear# 3e

has recently returned !rom holiday in $pain# (n e6amination the right ear canal is

in<amed ut no deris is seen# )he tympanic memrane is clearly +isile and is

unremar%ale#

&hat is the most appropriate management*

(ral <uclo6acillin

Re!er to 4')

)opical corticosteroid K clotrimaole

)opical corticosteroid

)opical corticosteroid K aminoglycoside

Incorrect

)his patient has otitis e6terna which commonly de+elops a!ter swimming on

holiday# )he rst line management is either a topical antiiotic or a comined

topical antiiotic and steroid#

A ,5-year-old woman presents !or re+iew# $he has noticed a numer o! patches o!

pale s%inF on her hands o+er the past !ew wee%s# )he patient has tried using an

emollient and topical hydrocortisone with no result#

(n e6amination you note a numer o! hypopigmented patches on the dorsum o!

oth hands# 3er past medical history includes thyroto6icosis !or which she ta%escarimaole and thyro6ine#

&hat is the most li%ely causes o! her symptoms*



Carimaole-induced hypopigmentation

Addison disease

@itiligo

>eu%opaenia-induced !ungal in!ection

Idiopathic guttate hypomelanosis

Correct

@itiligo is more common in patients with %nown autoimmune conditions such as

thyroto6icosis#

A =9-year-old lady presents with a ,-wee% history o! generalised rash# $he

complains o! areas o! erythema and listering although only e6coriations are +isiletoday# (n !urther /uestioning she also admits to diLculty swallowing and pain on

passing urine#

3er past medical history includes angina and coeliac disease# 3er medication

includes aspirin atenolol and hydralaine#

$he is suse/uently re+iewed y the dermatologists who per!orm a s%in iopsy# )he

immuno<uorescence results show immunogloulin ? .Ig?0 staining in the

intercellular sustance#


Pemphigus

Pemphigoid


Allergic reaction


Correct



Pemphigus occurs in middle age etween the ages o! ,9 and =9 years# It is common

in eastern countries and also in Bewish populations# It is characterised y <accid

listers that rupture easily as compared with the tense listers seen in pemphigoid#

Pemphigus also tends to in+ol+e the mucus memranes and patients may complain

o! pain on eating#

)he diagnosis is conrmed with immuno<uorescence which shows antiodies to the

cells in the epidermis while pemphigoid will show antiodies directed at the

asement memrane#

A 5-year-old woman is admitted to the 4mergency 8epartment at 95#99h with

oro!acial angio-oedema ha+ing eaten a prawn curry the pre+ious e+ening# $he has

a past history o! hypertension and hypothyroidism and has recently een treated

!or a chest in!ection# 3er regular medications include endro<umethiaide lisinopril

and le+othyro6ine# $he has a history o! penicillin allergy#

(n admission she is com!ortale at rest and has no urticaria# (ser+ations are as

!ollows temperature NC pulse 29 pm respiratory rate 1=Ominute and 7P

19O199 mm3g#


Idiopathic anaphyla6is

Penicillin allergy

Angiotensin-con+erting enyme inhiitor-induced angio-oedema

Anaphyla6is due to prawns

8iuretic allergy

Incorrect

Angio-oedema may e related to use o! an angiotensin-con+erting enyme inhiitor

and may occur e+en a!ter apparent tolerance o! the drug !or many months# In this

case the drug should e stopped or sustituted#



Allergic angio-oedema is usually o+ious y its !ast onset typically within a !ew

minutes o! contact with the allergen#

A ,-year-old woman who is a recent immigrant !rom Moami/ue is re!erred to the

dermatology outpatient clinic# $he has de+eloped a numer o! hypopigmented o+al

shaped lesions on her ody which are associated with reduced sensation#

)hese are mainly located on the e6tensor sur!aces o! her lims# $he has no past

medical history o! note other than suGering !rom malaria as a child#


Chagas disease

3I@

>eprosy

Pityriasis +ersicolor

)uerculosis

Correct

>eprosy causes patches o! hypopigmented s%in typically aGecting the uttoc%s

!ace and e6tensor sur!aces o! lims and sensory loss#

A ,-year-old patient who is %nown to ha+e psoriasis presents with erythematous

s%in in the groin and genital area# 3e also has erythematous s%in in the a6illa# In the

past he has e6pressed a disli%e o! messy or cumersome creams#

&hat is the most appropriate treatment*

)opical clotrimaole

)opical steroid



)opical calcipotriol

)opical dithranol

Coal tar

Incorrect

)his patient has <e6ural psoriasis which responds well to topical steroids# )opical

calcipotriol is usually irritant in <e6ures# Mild tar preparations are an option ut may

e messy and cumersome#

&hich one o! the !ollowing conditions is least li%ely to e associated with pyoderma

gangrenosum*

>ymphoma

Ulcerati+e colitis

$yphilis

Rheumatoid arthritis

IgA monoclonal gammopathy

Incorrect

Pyoderma gangrenosum causes include

idiopathic in 59D

in<ammatory owel disease ulcerati+e colitis CrohnFs

rheumatoid arthritis $>4

myeloproli!erati+e disorders

lymphoma myeloid leu%aemias

monoclonal gammopathy .IgA0

primary iliary cirrhosis

&hich is true regarding ecema herpeticum*



(nly a single crop o! +esicles usually appear

Is more se+ere in reacti+ation disease

Is in+arialy !atal i! untreated

Usually has an indolent onset

Is typically associated with a high !e+er !or o+er a wee%

Incorrect

4cema herpeticum is the result o! primary in!ection o! ecematous s%in with

3erpes simple6 +irus .3$@0# )he se+erity +aries !rom mild to !atal#

)here is usually an arupt onset with crops appearing o+er se+en to nine days#

)hese may ecome coalesced# )ypically the child has a high !e+er !or se+en days

and recurrent attac%s can occur#

8eath can result !rom physiological disturances .loss o! <uid electrolytes and

protein through the s%in0 or dissemination o! the +irus to rain and other organs or

!rom secondary acterial sepsis#

A -year-old woman is re+iewed in the dermatology clinic with patchy well

demarcated hair loss on the scalp# )his is aGecting around :9D o! her total scalp

and causing signicant psychological distress# A diagnosis o! alopecia areata is

suspected#

&hich one o! the !ollowing is an appropriate management plan*

Autoimmune screen

)opical corticosteroid

)opical 5-;U cream

Autoimmune screen K topical %etoconaole



)opical %etoconaole

Correct

3air will regrow in 59D o! patients y 1 year and in 29-H9D e+entually# Care!ul

e6planation is there!ore suLcient in many patients# )opical or intralesional

corticosteroids is the management o! choice#

A :5-year-old male presents with e6tensi+e patches o! altered pigmentation on his

!ront ac% !ace and thighs# )here is mild pruritus# A diagnosis o! e6tensi+e

pityriasis +ersicolor is made#

&hat is the most appropriate management*

(ral itraconaole

)opical terinane

(ral metronidaole

(ral terinane

)opical selenium sulphide

Incorrect

Pityriasis +ersicolor management y topical anti!ungal e#g# terinane or selenium

sulphide i! e6tensi+e disease or !ailure to respond to topical treatment then

consider oral itraconaole#

A 5,-year-old Bewish woman consults her ?P ecause o! recurrent oral ulceration

and the appearance o! listers on her trun%#

$%in iopsy re+eals a supercial intraepidermal split "ust ao+e the asal layer with

e+idence o! acantholysis#






Pemphigus +ulgaris

>inear IgA disease

7ullous pemphigoid

Correct

Pemphigus +ulgaris is characterised y mucosal in+ol+ement with ulceration

.presenting sign in up to 59D0 this is then !ollowed y the appearance o! <accid

listers on the trun% in particular#

Patients tend to complain o! soreness !rom the listers as these rapidly denude the

appearance is o!ten one o! weeping erosions#

)he listers can e e6tended with gentle pressure .'i%ols%yFs sign0# )he s%in iopsy

is o! the typical appearance descried in the clinical scenario#

A =5-year-old !emale who has a history o! long-standing psoriasis and hea+y alcoholinta%e presents with a se+ere e6aceration o! psoriasis# $he was admitted and

recei+ed topical therapy and o+er the month o! her admission her gamma-?)

concentration had !allen !rom ,99 UO> to 159 UO> .,-50#

$i6 wee%s a!ter discharge she was seen in outpatients where her psoriasis remained

under control ut she complained o! generalised hair loss#

&hat is the most li%ely cause !or her hair loss*

Iron deciency

)elogen eu+ium



Alopecia areata

)hiamine deciency

)richotillomania

Correct

In a normal healthy personFs scalp aout 25D o! the hair !ollicles are acti+ely

growing hair and 15D are resting# I! there is some shoc% to the system as many as

9D o! the scalp hairs can e precipitated into a resting state thus re+ersing the

usual ratio# )ypical precipitants include illnesses operations accidents and

childirth#

A 5,-year-old man is re!erred to the dermatology outpatient department due to a

!acial rash which has persisted !or the past 1: months#

(n e6amination there is a symmetrical rash consisting o! e6tensi+e pustules and

papules which aGects his nose chee%s and !orehead#

&hat is the most appropriate treatment*

3ydro6ychloro/uine

Cipro<o6acin

(6ytetracycline

Isotretinoin

Prednisolone

Incorrect

)his case o! acne rosacea # As there is e6tensi+e in+ol+ement oral o6ytetracyclineshould proaly e used rather than topical metronidaole#

A =:-year-old !emale is re!erred due to a long-standing ulcer ao+e the right medial

malleolus# An%le-rachial pressure inde6 readings are as !ollows



Right 9#H5

>e!t 9#H5

)o date it has een managed y the 8istrict 'urse with standard dressings#

&hat is the most appropriate management to ma6imie the li%elihood o! the ulcer

healing*

Intermittent pneumatic compression

Re!er to +ascular surgeon

Compression andaging

3ydrocolloid dressings

)opical <uclo6acillin

Correct

)he an%le-rachial pressure inde6 readings indicate a reasonale arterial supply and

suggest the ulcers are +enous in nature#

Compression andaging usually !our layer .only treatment shown to e o! real

enet0 oral pento6i!ylline a peripheral +asodilator impro+es healing rate#

A :1-year-old woman who is 1= wee%s pregnant present with worsening acne which

she is nding distressing# $he is currently using topical enyl pero6ide with limited

eGect# (n e6amination there is widespread nonin<ammatory lesions and pustules

on her !ace#

&hat is the most appropriate ne6t management step*

(ral erythromycin

)opical retinoid



(ral do6ycycline

(ral trimethoprim

(ral lymecycline

Correct

(ral erythromycin may e used !or acne in pregnancy# )he other drugs are

contraindicated#

A 9-year-old man gi+es a history o! recurrent ullous eruption on his hands

!orearms and trun% whene+er he is on holiday and mentions that these lesions

de+elop whene+er he +isits sunny places# 3e has numerous scars on his hands

!orearms and chest wall#

&hat is the diagnosis*

Pemphigous

$unurn

Pemphigoid

Porphyria cutanea tarda

Polymorphic light eruption

Correct

Porphyria cutanea tarda presents with ullous eruptions on e6posure to sunlight#

)he eruptions heal with scarring#

8iagnosis depends on the presence o! increased le+els o! urinary uroporphyrin#

Remission can e induced y +enesection# Chloro/uine promotes the urinarye6cretion o! uroporphyrin#

A ,-year-old presents with itchy lesions on the soles o! oth !eet# )hese ha+e een

present !or the past two months# (n e6amination small listers are seen with

surrounding dry and crac%ed s%in#




Pompholy6

7ullous pemphigoid

Porphyria cutanea tarda

Pustular psoriasis

Pemphigus

Incorrect

Pompholy6 is a type o! ecema which aGects oth the hands .cheiropompholy60 andthe !eet .pedopompholy60# It is also %nown as dyshidrotic ecema #

;eatures include small listers on the palms and soles pruritic sometimes urning

sensation once listers urst s%in may ecome dry and crac%#

A 9-year-old male presents with a =-month history o! a recurring itchy rash#

Clinically you suspect chronic idiopathic urticaria#

&hich o! the !ollowing is '() appropriate management !or him*

Ad+ising %eeping cool and a+oiding e6cess alcohol when the rash is present

Prescriing oral antihistamines

Re!erring !or patch testing

Ad+ising a+oidance o! aspirin and '$AI8$

Reassuring patient that it should e sel!-limiting

Incorrect



)hose cases o! urticaria which are allergic in aetiology are thought to e type 1

hypersensiti+ity reactions ut patch testing identies type , delayed

hypersensiti+ity reactions#

A :-year-old woman de+elops diLculty reathing and her lips and tongue swell

aout +e minutes a!ter starting to eat a curry# $he is rought to the accident and

emergency department y amulance# $he is cyanosed and wheeing#

Aside !rom high <ow o6ygen +ia a reser+oir ag which o! the !ollowing treatments

would e your top priority*

4pinephrine .adrenaline0 - 9#5 ml o! 1O1999 solution intramuscularly

$alutamol 5 mg neulied

3ydrocortisone :99 mg intra+enously

Chlorpheniramine 19 mg intra+enously

4pinephrine .adrenaline0 - 9#5 ml o! 1O1999 solution intra+enously

Incorrect

)he history clearly suggests anaphyla6is and treatment with intramuscular

epinephrine .9#5 ml o! 1O19990 is re/uired#

A :9-year-old woman %nown to suGer !rom acne +ulgaris has een started on

isotretinoin#

&hich o! the !ollowing statements est applies to treatment with isotretinoin*

It can cause hirsutism

Pregnancy should e a+oided during and 1 month a!ter treatment

It may cause haemoptysis

It is contraindicated in patients with renal artery stenosis



It can cause hyper%alaemia and hence electrolytes should e chec%ed e+ery month

Correct

Isotretinoin is indicated !or the treatment o! se+ere in<ammatory acne# 3owe+er it

causes mar%ed dryness o! the s%in and mucous memranes especially the lips and

can result in minor noseleeds#

8ue to its teratogenicity pregnancy must e e6cluded prior to its initiation and

during treatment as well as !or 1 month a!ter treatment#

Anormalities o! serum lipids and li+er !unction tests should e e6cluded e!ore

treatment

A 1H-year-old student presents with a three day history o! a 1 cm golden crusted

lesion on the order o! her lower lip#

&hat is the most suitale management*

(ral penicillin

(ral co-amo6icla+

)opical !usidic acid

(ral <uclo6acillin

(ral <uclo6acillin K penicillin

Correct

)his history is typical o! impetigo# As the lesion is small and localised topical !usidic

acid is recommended#

&hich o! the !ollowing is true regarding diaetic !oot ulceration*

$%in in!ection is the most common initiating e+ent in ulceration



Callus !ormation at pressure areas is an important predictor o! ulceration

Autonomic neuropathy results in reduced peripheral lood <ow

Plantar ulceration is most commonly due to atherosclerosis

Radiography can readily distinguish etween Charcots "oint and osteomyelitis

Correct

Callus !ormation at pressure areas is an important predictor o! potential ulceration#

Plantar ulceration is usually a conse/uence o! neuropathy# Minor s%in trauma is

proaly the most common initiating e+ent#

It is diLcult to distinguish radiographically etween CharcotFs "oint and

osteomyelitis as neither ha+e specic signs in their early stages#

A ,:-year-old man with a history o! ulcerati+e colitis attends the gastroenterology

clinic !or re+iew# 3e has noticed a deep ulcerating lesion on his leg and is concerned

as to what it may e#

(n e6amination he has a deep ulcer on the le!t lower leg which has a +iolet order#

In+estigations show

3 1:#9 gOdl

&CC 5#1 619HOl

P>) :, 619HOl

'aK 1,1 mmolOl

K ,# mmolOl

Creatinine 195 SmolOl

4$R 15 mmOhr

&hich o! the !ollowing would e the most appropriate in+estigation to conrm the

diagnosis*



Angiography and +enous 8oppler studies

7iopsy and culture !rom the ulcerated tissue

Chest 6-ray

;asting plasma glucose

Autoimmune prole

Incorrect

)his patient has a clinical history which is suggesti+e o! pyoderma granulosum a

condition which may e associated with +asculitis haematological malignancy or

in<ammatory owel disease as seen here#

7iopsy o! the ulcerated tissue re+eals intense neutrophilic inltration haemorrhage

and necrosis o! the o+erlying epidermis# Culture is important to rule out in!ection as

a cause o! the presentation#

An elderly man presented with a lump on his temple that is shiny and is gradually

increasing in sie#


$eorrhoeic wart

7asal cell carcinoma

>entigo maligna

$/uamous cell carcinoma

Amelanotic melanoma

Incorrect

7asal cell carcinomas are the most common malignant s%in tumour and are related

to e6cessi+e sun e6posure# )hey are common later in li!e and may present as a



slow-growing nodule or papule# 7asal cell carcinomas grow slowly and may cause

local erosion ut they almost ne+er metastasise#

)reatment is with surgical e6cision although radiotherapy may e used !or large

supercial lesions# @ery supercial small asal cell carcinomas may e managed

with cryotherapy although regular !ollow-up to e6amine !or recurrence is

recommended#

A =-year-old man who is %nown to ha+e type : diaetes mellitus presents with a

numer o! lesions o+er his shins#

(n e6amination there are a numer o! -, mm smooth rm papules which arehyperpigmented and centrally depressed#


>upus +ulgaris

Pyoderma gangrenosum

?uttate psoriasis

?ranuloma annulare

'ecroiosis lipoidica diaeticorum

Incorrect

?ranuloma annulare is papular lesions that are o!ten slightly hyperpigmented and

depressed centrally # It is typically occur on the dorsal sur!aces o! the hands and

!eet and on the e6tensor aspects o! the arms and legs#

A =-year-old !emale presents with raised erythematous tender lesions on oth legs

which ha+e de+eloped since she had a throat in!ection two wee%s ago#

&hich one o! the !ollowing in+estigations is most li%ely to estalish the diagnosis*



Anti-streptolysin-( titre .A$()0

Mantou6 test

Chest 6 ray

)hroat swa cultured !or +iruses

)hroat swa cultured !or acteria

Correct

)his lady presents with tender lesions two wee%s a!ter a sore throat# )his is most

li%ely to e post-streptococcal erythema nodosum and A$() is most li%ely to

conrm this#

A =:-year-old with a history o! acne rosacea presents !or ad+ice regarding

treatment#

&hich one o! the !ollowing inter+entions has the least role in management*

>ow-dose topical corticosteroids

Camou<age creams

Use o! high-!actor sun loc%

>aser therapy

)opical metronidaole

Incorrect

)opical metronidaole may e used !or mild symptoms .i#e# >imited numer o!

papules and pustules no pla/ues0 more se+ere disease is treated with systemicantiiotics e#g# (6ytetracycline

Recommend daily application o! a high-!actor sunscreen camou<age creams may

help conceal redness laser therapy may e appropriate !or patients with prominent

telangiectasia#



A 9-year-old woman de+elops a systemic reaction characteried y hypotension

ronchospasm and widespread urticaria soon a!ter induction o! anaesthesia !or

cholecystectomy#

&hich o! the !ollowing lood test results would suggest that her reaction was

associated with mast cell degranulation*

3ypernatraemia

4le+ated plasma tryptase

3ypo%alaemia

3ypocomplementaemia

3ypergammagloulinaemia

Incorrect

)he constellation o! acute symptoms in this case is highly suggesti+e o! a systemic

allergic reaction either anaphyla6is .i! Ig4 mediated0 or an anaphylactoid reaction

.i! non-Ig4 mediated0# 7oth o! these reactions are due to e6tensi+e mast cell

degranulation leading to release o! large amounts o! tryptase in to the circulation#

A =H-year-old woman with a history o! learning diLculties is re+iewed in clinic# $he

is %nown to ha+e erythema a igne on her legs ut according to her carer still

spends long hours in !ront o! her electric re#

&hich one o! the !ollowing s%in lesions is she at ris% o! de+eloping*

Cutaneous )-cell lymphoma o! the s%in

$/uamous cell carcinoma

8ermatorosarcoma protuerans

7asal cell carcinoma



Malignant melanoma

Correct

I! 4rythema a igne is not treated then patients may go on to de+elop s/uamous

cell s%in cancer#

A ,5-year-old man who presented with itchy lesions on his hands is diagnosed with

scaies# It is decided to treat him with permethrin 5D# Tou ha+e e6plained the need

to treat all memers o! the household and hot wash all edding and clothes#

&hat ad+ice should e gi+en aout applying the cream*

;rom nec% down K lea+e !or 1: hours

;rom nec% down K lea+e !or , hours

;rom nec% down K lea+e !or 1: hours K retreat in days

All s%in including scalp K lea+e !or 1: hours K retreat in days

All s%in including scalp K lea+e !or 1: hours K retreat in : days

Incorrect

)he 7'; ad+ises to apply the insecticide to all areas including the !ace and scalp

contrary to the manu!acturerFs recommendation# Allow to dry and lea+e on the s%in

!or 2-1: hours !or permethrin or !or :, hours !or malathion e!ore washing oG #

Repeat treatment days later#

A :2-year-old ;rench woman presents complaining o! increasingly dar% areas o!

pigmentation on her !ace which ha+e appeared o+er the past !ew wee%s#

$he has noticed weight increase o+er the past !ew months and has not had a period

!or 5 months#

&hat is the diagnosis that ts est with this clinical picture*



Chloasma

@itiligo

Prolactinoma

>upus

4cema

Incorrect

Chloasma is a hormonally stimulated increase in melanogenesis that mainly

appears on the !ace it aGects oth pregnant women and those who are ta%ing the

comined oral contracepti+e pill# )he pigment is augmented y sunlight hence the

more pronounced appearance on the !ace# )he pigmentation may ta%e many

months to resol+e a!ter parturition or pill discontinuation#

&hich o! the !ollowing s%in conditions is not associated with diaetes mellitus*

$weets syndrome

?ranuloma annulare

>ipoatrophy

@itiligo

'ecroiosis lipoidica

Incorrect

$weetFs syndrome is also %nown as acute !erile neutrophilic dermatosis has a

strong association with acute myeloid leu%aemia# It is not associated with diaetes

mellitus#

A 55-year-old man %nown to suGer !rom alcohol-induced li+er disease gi+es a history

o! a listering rash on his hands a!ter a holiday in ?reece#



46amination shows estalished listers as well as scar mar%s# 3e says he de+eloped

a similar rash last year !ollowing a holiday in Ma"orca which healed with the

!ormation o! scars# 3e also has patches o! scarring alopecia#

&hich o! the !ollowing in+estigations might est estalish the diagnosis*

$%in iopsy

Plasma and urinary uroporphyrins

C) scan o! the li+er

>i+er !unction tests

>i+er iopsy

Correct

)his patient has porphyria cutanea tarda# )his is due to a deciency o!

uroporphyrinogen decaro6ylase which leads to the accumulation o!

uroporphyrinogen III# )he anormality can e ac/uired as a result o! alcoholinduced

li+er disease or it may e inherited#

46posure to sun results in lister !ormation which heal with scarring# 3ypertrichosis

may occur especially o+er temporal and malar !acial areas and sometimes in+ol+es

arms and legs#

&hich is not a poor prognostic !actor !or outcome in patients with malignant

melanoma*

$ur!ace ulceration

8iameter o! melanoma = mm

Microsatellite metastasis

7reslow thic%ness mm

Clar%eFs le+el I@



Incorrect

Malignant melanoma is staged according to the 7reslow thic%ness which is

measured in millimetres !rom the dermoepidermal "unction# )he deeper the 7reslow

thic%ness the poorer the prognosis#

)he Clar%eFs le+el is measured !rom I to I@ and re<ects the le+el o! in+asion through

the dermis#

Clar%eFs le+el I represents melanomas that ha+e not in+aded past the asement

memrane

Clar%eFs le+el II represents in+ol+ement o! the supercial dermis

Clar%eFs le+el III in+ol+ement o! the deep dermis

Clar%eFs le+el I@ in+ol+ement o! the sucutis# An increasing

Clar%eFs le+el is associated with a poorer prognosis#

Malignant melanoma tends to grow radially e!ore entering a +ertical growth phase#

)he diameter it reaches has not een !ound to e a prognostic !actor#

Microsatellite metastases are cutaneous metastases around the primary melanoma

and are a poor prognostic !eature# $ur!ace ulceration is also a poor prognostic

!eature#

A si6-month-old ay is re!erred with a recurrent itchy eruption aGecting his trun%

and soles# 46amination shows a diGuse ecema on the trun% and pin%-red papules

on oth soles#

&hich o! the !ollowing is the most li%ely diagnosis*

)inea pedis

$caies



@iral warts

Atopic dermatitis

Pustular psoriasis

Incorrect

$caies can present with an itchy dermatitic-loo%ing rash on the ody ut the clues

are at certain sites .soles genitalia uttoc%s0#

It is unli%ely that the child has pustular psoriasis as there are no pustules in the

history# )inea pedis and +iral warts do not generally gi+e rise to dermatitis on the

trun%# Atopic dermatitis presents with a dermatitis aGecting the <e6ures or the !ace

in aies without papules on the soles#

A 1,-year-old male is re+iewed due to a patch o! scaling and hair loss on the right

side o! his head# A s%in scraping is sent which conrms a diagnosis o! tinea capitis#

&hich organism is most li%ely to e responsile*

Microsporum distortum

)richophyton tonsurans

Microsporum audouinii

Microsporum canis

)richophyton +errucosum

Correct

Most common cause o! )inea capitis is )richophyton tonsurans in the U and the

U$A # It may also e caused y Microsporum canis ac/uired !rom cats or dogs#

quiz 5 mrcpa 15.docx

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