Dermatology Postgraduate MCQs and Revision Notes

James Halpern

• Editorial: CRC Press
• Año: 2022
• ISBN:
  9781000515404
• Edición: 1
• Categoría: Medizin
• Categoría: Medizinische Theorie, Praxis & Referenz

Postgraduates studying dermatology can face a lack of appropriate revision aids: reference books are often too exhaustive or out-of-date, while undergraduate and introductory texts lack the necessary detail and depth. This book is specifically designed for postgraduate examinations, and is the perfect accompaniment for the diploma in dermatology.

Chapter 1

Eczematous and papulosquamous disorders

QUESTIONS

1 A six-month-old child presents with a symmetrical eczematous eruption on the cheeks, elbows and anterior aspects of the knees. The rash responds to a mild topical steroid cream but flares whenever the cream is stopped. What is the most likely cause of the rash:

1. A seborrhoeic dermatitis
2. B contact dermatitis to steroid cream
3. C atopic eczema
4. D food intolerance
5. E acrodermatitis enteropathica.

2 An eight-year-old boy of Indian descent presents to your clinic with ill-defined hypopigmented patches on his cheeks. He has a history of moderate atopic eczema controlled with 1% hydrocortisone ointment and a simple emollient. What is the most likely diagnosis:

1. A melasma
2. B pityriasis alba
3. C steroid induced hypopigmentation
4. D vitiligo
5. E lepromatous leprosy.

3 A 26-year-old man with a recent diagnosis of HIV infection presents with a rash and dandruff. The rash consists of small, scaly red patches and is prominent on the ears, face and trunk. What organism is most likely to have precipitated the rash:

1. A malassezia furfur
2. B streptococcus
3. C tinea mentagrophytes
4. D trichophyton rubrum
5. E tinea versicolor.

4 You are asked to see an 88-year-old lady who has recently become resident in a nursing home. She gives a worsening history of a moderately itchy rash on her lower legs. On examination she has an eczematous rash with extreme xerosis and ‘riverbed’ cracking over the shins. Despite advice on using copious amounts of greasy emollients the rash does not improve. Which of these tests is likely to be the most useful for this lady:

1. A patch testing to emollients
2. B a full blood count with a blood film examination
3. C a skin biopsy
4. D skin scrapings for mycology
5. E thyroid function tests.

5 A 55-year-old man presents with a new onset very itchy rash. On examination he has slightly weepy, eczematous, well defined annular patches worse on the limbs in an extensor distribution. He has had little benefit from regular clobetasone butyrate (Eumovate). Which treatment is the most appropriate:

1. A refined coal tar +/− dithranol
2. B 1% hydrocortisone ointment + aqueous cream
3. C oral prednisolone 40 mg/day for 5 days
4. D betamethasone/clioquinol (Betnovate-C) + antiseptic emollient
5. E PUVA phototherapy.

6 An 82-year-old lady has been under your care for some time with a rash on her legs. She presented with a bilateral itchy, red, eczematous rash associated with haemosiderin deposition and varicosities. The rash was controlled with a combination of regular emollients, support stockings and betamethasone/neomycin ointment (Betnovate-N). Two years later she presents to you with a widespread eczematous eruption covering much of her body. What is most likely to have happened:

1. A disseminated eczema with allergic contact dermatitis to neomycin
2. B disseminated eczema with allergic contact dermatitis to betamethasone
3. C secondary asteatotic eczema
4. D superimposed zoster infection with koebnerization
5. E development of nummular eczema.

7 You review an eight-year-old boy with known behavioural problems and asthma who presents in shabby sportswear. His mum gives a six month history of worsening rash on the soles of his feet. The rash has not responded to a number of topical steroid preparations prescribed by his general practitioner. On examination over the balls and toepads of the feet the skin is dry, scaly and fissured with a glazed appearance. What treatment is most appropriate:

1. A regular emollients only
2. B a super-potent topical steroid
3. C wear shoes less and use leather shoes rather than trainers
4. D a short course of oral terbinafine
5. E topical miconazole.

8 A 52-year-old Englishman is admitted to coronary care after suffering an anterior myocardial infarction. After thrombolysis with streptokinase the patient is started on aspirin, clopidogrel, metoprolol, ramipril and simvastatin. During his recovery you are asked to see the patient as he has developed a rash. On examination he has multiple small beefy red plaques with silvery scale most prominent on the extensor surfaces. The patient’s identical twin brother has psoriasis. What is the most likely diagnosis:

1. A he has caught psoriasis from another patient on the ward
2. B latent psoriasis precipitated by beta-blocker
3. C psoriasiform drug reaction to aspirin
4. D latent psoriasis precipitated by ACE inhibitor
5. E latent psoriasis precipitated by streptokinase.

9 A 12-year-old boy attends your clinic as an emergency. The previous week shortly after a sore throat and coryzal illness, he has developed a rash. On examination he has a widespread rash consisting of multiple, small, deep red papules and plaques with some overlying scale. What initial treatment is most appropriate:

1. A admission to hospital and treatment with a potent topical steroid
2. B start on 1 mg/kg/day oral prednisolone
3. C work up for ciclosporin
4. D topical dithranol
5. E a coal tar preparation/mild topical steroid and consideration of UVB phototherapy.

10 You are called to the antenatal ward to see a pregnant lady who has become quite unwell. On examination she has extensive areas of confluent erythema and numerous pustules. Despite being pyrexial initial swabs from a pustule grow no organisms. What is the likely diagnosis:

1. A generalised pustular psoriasis
2. B staphylococcal scalded skin syndrome
3. C toxic epidermal necrolysis
4. D eczema herpeticum
5. E gestational pemphigoid.

11 A recently married 24-year-old nurse presents to you with a flare of palmo-plantar pustular psoriasis. She has previously maintained reasonable control of her condition with super potent topical steroids and vitamin D analogues. What would be the next reasonable step in treatment:

1. A methotrexate
2. B infliximab
3. C acitretin
4. D hand and foot PUVA
5. E hydroxycarbamide.

12 A 26-year-old woman presents with a rash. She describes the rash as occurring in crops with lesions tending to self resolve within a few weeks. On examination she has multiple erythematous to purple crusty papules with some small ulcers, vesicles and pustules. In some areas where lesions have resolved varioliform scarring has been left behind. A biopsy is taken that shows an interface dermatitis with necrotic keratinocytes, T-cell clonality studies show a predominantly CD8+ monoclonal infiltrate. What is the most likely diagnosis:

1. A pityriasis lichenoides et varioliformis acuta (PLEVA)
2. B pityriasis lichenoides chronic (PLC)
3. C mycosis fungoides
4. D guttate psoriasis
5. E small plaque parapsoriasis.

13 A 62-year-old man presents with diffuse erythroderma of gradual onset. He is systemically well. On examination follicular hyperkeratosis is seen on an erythematous base and there are large orange-red patches with distinctive islands of sparing. The palms and soles show an orange-red waxy keratoderma and there is fine diffuse scale on the scalp. The nails show a yellow-brown thickened nail plate with subungual debris. Which of the following treatments would you not consider for this patient:

1. A hydroxychloroquine
2. B methotrexate
3. C acitretin
4. D isotretinoin
5. E combination methotrexate and acitretin.

14 A 15-year-old girl presents with a two week history of a rash. She describes a single lesion appearing on her back that gradually enlarged over a few days, then multiple lesions appeared over the trunk and upper arms. The lesions are oval shaped, skin coloured and have a slightly raised margin. They vary from 2–4 cm in size, have central fine scale and a collarette of scale at the free edge. The lesions are asymptomatic and the patient is not unduly distressed by the rash. What is the appropriate course of action:

1. A book the patient for UVB phototherapy
2. B start a course of erythromycin
3. C reassure the patient and advise a little sun exposure
4. D start a topical steroid
5. E give a course of oral prednisolone.

15 A 52-year-old man is seen in clinic as an urgent referral. He gives a 2-week history of a spreading rash that now covers his whole body. The patient feels generally unwell, lethargic and thirsty. When you examine him he is shivering and has difficulty standing. He is erythrodermic with over 95% of his skin showing a non-specific confluent erythema. He has no history of skin disease and there are no clues to aetiology ...