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Question 1
Correct
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Which one of these features is typical of dermatomyositis?
Your Answer: Gottron's papules over knuckles of fingers
Explanation:Dermatomyositis is a long-term inflammatory disorder which affects muscles. Its symptoms are generally a skin rash and worsening muscle weakness in the proximal muscles (for example, the shoulders and thighs) over time. These may occur suddenly or develop over months. Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity. Complications may include calcium deposits in muscles or skin.The skin rash may manifest as aheliotrope (a purplish color) or lilac, but may also be red. It can occur around the eyes along with swelling, as well as the upper chest or back ( shawl sign) or V-sign above the breasts and may also occur on the face, upper arms, thighs, or hands. Another form the rash takes is called Gottron’s sign which are red or violet, sometimes scaly, slightly raised papules that erupt on any of the finger joints (the metacarpophalangeal joints or the interphalangeal joints)
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 2
Correct
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Which of the following statements regarding psoriasis is incorrect?
Your Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease which is characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly commonly on the extensor surfaces. Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression. Psoriatic arthritis affects up to 30% of individuals with psoriasis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response, rather than type 2 helper T cells
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 3
Correct
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All of the following features may suggest malignant changes in a melanocytic naevi, EXCEPT?
Your Answer: Decrease in size
Explanation:Melanocytic naevi are skin tumours produced by melanocytes. They usually present in childhood but increase during puberty. The mnemonic A-B-C-D, is used by institutions to assess for suspicion of malignancy. The letters stand for asymmetry, border, colour, and diameter. If a mole starts changing in size, colour, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include if it begins to crust over, bleed, itch, or become inflamed.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 4
Correct
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A 32 year old man presents with blistering and hyperpigmentation on his face and hands, after a beach holiday with friends. Tests reveal high levels of uroporphyrinogen in the urine. The most likely diagnosis is:
Your Answer: Porphyria cutanea tarda
Explanation:Porphyria cutanea tarda (PCT) is the most common of the porphyries. It is characterised by fragility and blistering of exposed skin. Typically, patients who are ultimately diagnosed with PCT first seek treatment following the development photosensitivities in the form of blisters and erosions on commonly exposed areas of the skin. This is usually observed in the face, hands, forearms, and lower legs. It heals slowly and with scarring. Though blisters are the most common skin manifestations of PCT, other skin manifestations like hyperpigmentation (as if they are getting a tan) and hypertrichosis (mainly on top of the cheeks) also occur. Risk factors for the development of PCT include alcohol and sun.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 5
Correct
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Which one of the following conditions is least likely to be associated with pyoderma gangrenosum?
Your Answer: Syphilis
Explanation:The following are conditions commonly associated with pyoderma gangrenosum:
Inflammatory bowel disease:
- Ulcerative colitis
- Crohn’s disease
Arthritides:
- Rheumatoid arthritis
- Seronegative arthritis
Haematological disease:
- Myelocytic leukaemia
- Hairy cell leukaemia
- Myelofibrosis
- Myeloid metaplasia
- Monoclonal gammopathy
Autoinflammatory disease:
- Pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome)
- Granulomatosis with polyangiitis
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 6
Correct
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Which of the following statements regarding psoriasis is incorrect?
Your Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease characterized by patches of skin typically red, dry, itchy, and scaly. Psoriasis can affect the nails and produces a variety of changes in the appearance of finger and toe nails including pitting and onycholysis. Nail psoriasis occurs in 40–45% of people with psoriasis affecting the skin and has a lifetime incidence of 80–90% in those with psoriatic arthritis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 7
Incorrect
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Café-au-lait spots are seen in each of the following, except:
Your Answer: Hunter syndrome
Correct Answer: Friedreich's ataxia
Explanation:Café-au-lait spots are hyperpigmented lesions that vary in colour from light brown to dark brown, with borders that may be smooth or irregular.
Causes include:
- Neurofibromatosis type I
- McCune–Albright syndrome
- Legius syndrome
- Tuberous sclerosis
- Fanconi anaemia
- Idiopathic
- Ataxia-telangiectasia
- Basal cell nevus syndrome
- Benign congenital skin lesion
- Bloom syndrome
- Chediak-Higashi syndrome
- Congenital nevus
- Gaucher disease
- Hunter syndrome
- Maffucci syndrome
- Multiple mucosal neuroma syndrome
- Noonan syndrome
- Pulmonary Stenosis
- Silver–Russell syndrome
- Watson syndrome
- Wiskott–Aldrich syndrome
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 8
Correct
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Which is NOT true of vitiligo?
Your Answer: A positive family history is not a risk factor
Explanation:The cause of Vitiligo is typically unknown. It is believed to be due to genetic susceptibility that is triggered by an environmental factor such that an autoimmune disease occurs. This results in the destruction of skin pigment cells. Risk factors include a family history of the condition or other autoimmune diseases, such as hyperthyroidism, alopecia areata, and pernicious anaemia. Vitiligo is classified into two main types: segmental and non-segmental. Most cases are non-segmental meaning they affect both sides and typically get worse with time. The prevalence of vitiligo is 0.5-1% of populations worldwide. Typical sites include backs of hands, wrists, knees, neck and around body orifices. The Koebner phenomenon refers to skin lesions appearing on lines of trauma. This occurs in vitiligo secondary to scratching.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 9
Correct
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Which of the following skin conditions is not associated with diabetes mellitus?
Your Answer: Sweet's syndrome
Explanation:Diabetic dermadromes constitute a group of cutaneous conditions commonly seen in people with diabetes with longstanding disease. Conditions included in this group are:- Acral dry gangrene- Carotenosis- Diabetic dermopathy- Diabetic bulla- Diabetic cheiroarthropathy- Malum perforans- Necrobiosis lipoidica- Limited joint mobility- Scleroderma- Waxy skin is observed in roughly 50%. Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia. It is not associated with diabetes mellitus.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 10
Correct
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Which of the following conditions is least likely to exhibit the Koebner phenomenon?
Your Answer: Lupus vulgaris
Explanation:The Koebner phenomenon refers to skin lesions appearing on lines of trauma, exposure to a causative agents including: molluscum contagiosum, warts and toxicodendron dermatitis or secondary to scratching rather than an infective or chemical cause include vitiligo, psoriasis, lichen planus, lichen nitidus, pityriasis rubra pilaris, and keratosis follicularis (Darier disease).
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 11
Correct
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A 38-year-old woman has a melanocytic naevi on her left forearm.Which of the following features do not suggest malignant change?
Your Answer: Decrease in size
Explanation:Melanocytic nevi are benign neoplasms or hamartomas composed of melanocytes. Melanocytes are derived from the neural crest and migrate during embryogenesis to selected ectodermal sites (primarily the skin and the CNS), but also to the eyes and the ears.They tend to appear during early childhood and during the first 30 years of life. They may change slowly, becoming raised, changing color or gradually fading.. Pregnancy can increase the number of naevi as well as the degree of hyperpigmentation.They may become malignant and this should be suspected if the naevus increases in size, develops an irregular surface or becomes darker, itches or bleeds.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 12
Incorrect
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A 72-year-old with varicose veins complains of swollen, red, itchy legs. Which is the most likely diagnosis?
Your Answer: Lipodermatosclerosis
Correct Answer: Varicose eczema
Explanation:Varicose eczema is a common problem, particularly in elderly patients due to stasis or blood pooling from insufficient venous return; the alternative name of varicose eczema comes from a common cause of this being varicose veins. It is often mistaken for cellulitis, but cellulitis is rarely bilateral and is painful rather than itchy.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 13
Correct
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A 52-year-old man has squamous-cell carcinoma of his lower lip. Which of the following is most likely to be a feature of this type of carcinoma?
Your Answer: It is capable of metastasising via the lymphatics
Explanation:Squamous-cell skin cancer usually presents as a hard lump with a scaly top but can also form an ulcer. Onset is often over months and it is more likely to spread to distant areas than basal cell cancer vie the lymphatics. The greatest risk factor is high total exposure to ultraviolet radiation from the Sun. Other risks include prior scars, chronic wounds, actinic keratosis, lighter skin, Bowen’s disease, arsenic exposure, radiation therapy, poor immune system function, previous basal cell carcinoma, and HPV infection. While prognosis is usually good, if distant spread occurs five-year survival is ,34%
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 14
Correct
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Which one of these features is typical of dermatomyositis?
Your Answer: Gottron's papules over knuckles of fingers
Explanation:The main symptom of dermatomyositis include skin rash and symmetric proximal muscle weakness (in over 90% of patients) which may be accompanied by pain and tenderness. It occurs more commonly in females. Skin findings include:Gottron’s sign – an erythematous, scaly eruption occurring in symmetric fashion over the MCP and interphalangeal jointsHeliotrope or lilac rash – a violaceous eruption on the upper eyelids and in rare cases on the lower eyelids as well, often with itching and swellingShawl (or V-) sign is a diffuse, flat, erythematous lesion over the back and shoulders or in a V over the posterior neck and back or neck and upper chest, which worsens with UV light. Erythroderma is a flat, erythematous lesion similar to the shawl sign but located in other areas, such as the malar region and the forehead. Periungual telangiectasias and erythema occur.
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This question is part of the following fields:
- Dermatology
- Medicine
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