Dermatology question paper

Dermatology

Dermatology is a specialized medical field that focuses on the diagnosis and treatment of diseases and conditions related to the skin, scalp, hair, and nails. Dermatologists are highly trained doctors who have completed additional training in this area. They use their knowledge to diagnose illnesses like acne, eczema, psoriasis, skin cancer, moles and other skin-related issues.

In order to treat patients with these ailments, dermatologists may suggest options such as topical creams or ointments to reduce inflammation or antibiotics if there is an infection present. Other treatments include laser therapies for more severe cases or injectables such as Botox for wrinkles. Dermatologists also specialize in cosmetic surgery procedures like chemical peels or liposuction to improve aesthetic appearance of the patient’s skin.

Are you ready to test your dermatology knowledge? Our dermatology quiz with multiple choice questions will help you see how much you know about the subject. Whether you’re a student studying for an upcoming exam or a medical professional looking for some extra practice, our questions will provide valuable insight into the world of dermatology.

Our collection of questions are carefully crafted by experts in the field who understand the complexities of dermatology. Each has been designed to challenge even those with advanced understanding of the subject, so don’t be discouraged if some prove difficult. Regardless, we believe these tests can help build your confidence in this ever-evolving field. So why wait? Take our dermatology multiple choice questions and see where your knowledge stands! Just click “reveal” to show the answer.

Skin lesion on ear

A farmer presents with a skin lesion over his ear. It is pearly white in colour and has a rolled edge. there is no pigmentation. there is a small area of ulceration at the tip of the lesion. What is the most likely diagnosis?

  • Basal Cell Carcinoma
  • Malignant Melanoma
  • Actinic Keratosis
  • Herpes Simplex
  • Herpes Zoster

The answer here is a BCC (basal cell carcinoma) The description of the rolled edge is classical. These lesions rarely metastasise but left untreated can become large and disfiguring. They are the commonest form of skin cancer. Treatment: Surgery/laser/cryotherapy/topical chemotherapy/ radiotherapy.

Continued from previous question: [A farmer presents with a skin lesion over his ear. It is pearly white in colour and has a rolled edge. there is no pigmentation. there is a small area of ulceration at the tip of the lesion. ]

He believes the lesion may have been caused by his long hours working in the fields. Is he correct?

  • True
  • False

True

UV light plays a role in the aetiology of both basal cell carcinoma and actinic (solar) keratosis. They are rarely seen in people under the age of 50. As with any unusual skin lesion in an exam the correct and safe approach is to consider biopsying any lesions which is concerning. A biopsy will help to shed some light on the identify almost any skin rash!

Vasculitic rash

A 36 year old man presents with fatigue and breathlessness.

On examination he appears to have a vasculitic type rash on his feet, which has been present for 6 weeks. Which of the following is likely to be true about the rash?

  • It will not blanche on pressure
  • The rash is characterised by ecchymoses
  • The rash is characterised by telangiectasia
  • The rash is painful
  • The rash is very itchy

It will not blanche on pressure

Vasculitic type rashes are petichial non blanching rashes: a petichiae is a non blanching bruising cause by intra dermal bleeding and is the same type of rash as seen in meningococcal septicaemia. Its not a characteristically itchy or painful rash.

An ecchymoses is a simple bruise (non blanching)
Telangectasia are prominent cutaneous blood vessels (e.g. those seen in systemic sclerosis (CREST syndrome: calcinosis, raynaudss, sclerodactly, eosophageal dysmotility (American), and telangectasia.

If it was english (Oesophagus) we could have called it STORC which has a nicer ring.

Continied from previous question:

[A 36 year old man presents with fatigue and breathlessness.
On examination he appears to have a vasulitic type rash on his feet, which has been present for 6 weeks. ]


He has a history of nosebleeds.


Which of the following blood tests may you suspect to be positive?

  • ANA
  • DsDNA
  • ENA
  • ANCA
  • Anti DNAse B
  • ASO titre

ANCA

This rash means you have to link the symptoms (nasal discharge/ fatigue/ malaise/ vasculitic rash) and come up with the most likely diagnosis: in this case its Wegener’s granulomatosis.

Wegener’s should be considered with the following features:
urinay sediment/glomerular inflammation/nephritis (i.e. dipstic + blood and protein)
CXR showing nodules/ cavities/ inflitrates
Vasculitic rash/ other features of vasculitis
Nasal Discharge.

A key investigation is a biopsy (e.g. nose/lung) which shows the characteristic granulomatous inflammation seen in WG.

Cause of cellulitis

Which bacteria is the commonest cause of cellulitis from the following list?

  • Neisseria
  • E Coli
  • Other Gram negative rod
  • Other gram negative cocci
  • Staphlococcal

Staphlococcal

Streptococci and staphylococci are the commonest gram positive organisms that cause cellulitis. In patients who are not immunocompramised it is rare to have infections with a gram negative rod like E-coli.

Remember neisseria meningitis is the”meningococci” that causes menigitis. Its a classic exam question. remember that this is one of the 2 main gram negative cocci groups: along with neisseria gonorrhoea (the gonococcus which causes gonorrhoea.

Bruised lump

A 26 year old backpacker returns from holiday from India where he has been living for the past 6 months.

He has lost 2 stone in weight.

He tells you he has a painful big bruised lump on the front of his shin, but that he cant recall injuring his leg. What is the most likely diagnosis relating to the rash?

  • Rash associated with Malaria
  • Kala Azar
  • Pyoderma Gangrenosum
  • Ecchymoses
  • Erythema Nodosum

Erythema Nodosum

This sounds like

1) he’s probably got TB (cough/ weight loss/ recent long spell in endemic area)

2) His rash is not related to trauma

A painful lump you say: this sounds like the classic description of EN, palpable tender areas over the fronts of the shins..

Continuing question from previous stem:

[A 26 year old backpacker returns from holiday from India where he has been living for the past 6 months.
He has lost 2 stone in weight.
He tells you he has a painful big bruised lump on the front of his shin, but that he cant recall injuring his leg.]

You’re amazed that in fact his chest x-ray was clear at the time of his return to the UK. He has had no cough, fever or nightsweats and when back eating home cooking he has returned to complete health.

A more detailed medical history reveals that he was otherwise well in India, however he did have an HIV test, Hep B booster and treatment for a chlamydia sexually transmitted infection following a contact with a prostitute. (This was undertaken in a private hospital in India).

He has had a repeat HIV test from his GP which was negative.

What do you think has most likely caused his rash?

  • It was probably not erythema nodosum but erythema multiforme
  • Tetracycline treatment

Tetracycline treatment

Drugs are another common cause of EN principally the following

Oral contraceptive pill
Penicillin
Tetracyclines
Sulphonamides (e.g. bumetanide, frusemide, sulphasalazine)
Sulphonylureas (e.g. gliclazide)
Tetracyclines: Doxycycline is one of the drugs used to treat chlamydia.

He’s very unlikely to have HIV with 2 negative tests 3 months apart.

Although a Reiters syndrome is associated with a sexually transmitted infection, his symptoms are of erythema nodosum, not arthritis (uveitis/arthritis/urethritis=Reiters)

The Hep B vaccine is NOT a live vaccine.

Erythema nodosum symptom

Which of the following systemic diseases is not a common cause of erythema nodosum?

  • Systemic Lupus Erythematosis
  • Behcet’s
  • Inflammatory Bowel disease
  • Sarcoidosis
  • Leukaemia

Systemic Lupus Erythematosis

Erythema nodosum is so common in exams you should just “know” it.

It’s about the only time SLE isn’t the culprit for the symptoms and signs!

This is something you just have to know…

Guttate Psoriasis

Guttate psoriasis typically occurs following:

  • Post Infective streptococcal infection
  • Postive infective diarrhoea
  • Post staphylococcal infection
  • Hereditary inferitance
  • Antimicrobial therapy

Post Infective streptococcal infection

Guttate psoriasis is one of 3 main forms of skin psoriasis: guttate, pustular and plaque (plaque psoriasis being the most common form with approx 1 in 10 of these patients going on to suffer with psoriatic arthritis.

Guttate psoriasis is often described as a teardrop appearance of papules occuring over the trunk and limbs.

Treatment: penicillin orally.

Hairy leucoplakia

A dentist has referred a 17 year old student to your clinic with hairy leucoplakia. He is concerned about an underlying diagnosis. What is it most likely to be concerning him?

  • HIV
  • Lymphoma
  • Leukamia
  • Connective tissue disease

HIV

OHL is one of a number of skin manifestations of HIV including:

Kaposi sarcoma (associated with human herpes virus 8, pre malignant, occurs in the skin but also in the gut etc.)
Tinea infections (ringworm)
Molluscum Contageosum
Herpes simplex reactivation
Mucosal candidiasis (especially oesophageal)

Joint pain diagnosis

A 54 year old woman presents with a history of wrist and metacarpo-phalangeal joint pain. She has been found to have an elevated CRP at 18.

On examination there is no skin rash. There are small pits over the nails with some minor synovitis across the MCP joints.

The X-rays are normal.

What is the most likely diagnosis?

  • Rheumatoid Arthritis
  • Reactive arthritis
  • Ankylosing Spondylitis
  • Psoriatic arthritis
  • Systemic Lupus Erythematosis

Psoriatic arthritis

Good grey case.

In favour of RA: symmetrical, female, MCP joints. However for exam purposes when you’re given a clue like nail pitting this is what you need to home in on.

Common causes of nail pitting are:
1) Psoriasis
2) Eczema<
3) Lichen Planus.

Pitting occurs as tiny little pocks in the nail fold which may be 1mm in diameter. They can be subtle. Their presence is a strong predictor towards Psoriatic Arthritis (PsA).

The fact that PsA is normally asymmetrical in distribution and more commonly affects the PIP and DIP joints should not put you off.