Dermatology MCQs for NEET PG
963 worked Dermatology questions across 107 areas. Each one has its own page with the reasoning for every option.
What this set is
Dermatology rewards recognition: the lesion, its distribution and a classic sign. A compact subject with predictable high-yield areas such as leprosy, blistering disease and drug reactions.
This page lists the 963 Dermatology questions that have a full worked page: 672 application questions that put a fact to use on a patient or a finding, and 291 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Dermatology practice bank in the app is larger, with 3,878 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Dermatology test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Dermatology covers in the exam
- Infections: bacterial, viral, fungal, parasitic
- Papulosquamous disorders
- Vesiculobullous disorders
- Leprosy
- Sexually transmitted infections
- Pigmentary disorders
- Drug reactions
- Skin tumours
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Dermatology study guide.
Worked questions by area
107 areas, largest first. Open an area to see its questions.
Papulosquamous disorders91
- Papulosquamous disorders · ApplicationThe Auspitz sign (pinpoint bleeding on removing scales) is characteristic of:
- Papulosquamous disorders · ApplicationWickham's striae are seen in which condition?
- Papulosquamous disorders: psoriasis histology · ApplicationA skin biopsy of a plaque shows parakeratosis, absent granular layer, regular acanthosis, thinned suprapapillary plates and collections of neutrophils in the stratum co…
- Papulosquamous disorders: drugs aggravating psoriasis · ApplicationA man with stable plaque psoriasis flares after starting a new antihypertensive. Which drug is most likely responsible?
- Papulosquamous disorders: pustular psoriasis · ApplicationA patient with psoriasis who stopped prolonged oral prednisolone abruptly develops fever and generalised sterile pustules on red skin. What is the diagnosis?
- Papulosquamous disorders: psoriatic arthritis · ApplicationA patient with psoriasis has sausage-shaped swelling of a toe and arthritis of the distal interphalangeal joints. Radiographs show a pencil-in-cup deformity. Which stat…
- Papulosquamous disorders: biologics in psoriasis · ApplicationSecukinumab, used for moderate to severe plaque psoriasis, acts against which target?
- Papulosquamous disorders: methotrexate toxicity · ApplicationA psoriasis patient on weekly methotrexate develops mouth ulcers and pancytopenia after accidentally taking the dose daily. Which is the specific rescue agent?
- Papulosquamous disorders: acitretin · ApplicationA woman of childbearing age with palmoplantar pustulosis is prescribed acitretin. What is the most important counselling point?
- Papulosquamous disorders: lichen planus histology · ApplicationWhich combination of features is typical of lichen planus on biopsy?
- Papulosquamous disorders: oral lichen planus · ApplicationA woman with erosive oral lichen planus has persistent ulcers. Which investigation is important and why?
- Papulosquamous disorders: lichen sclerosus · ApplicationA postmenopausal woman has intense vulval itching with porcelain-white atrophic plaques in a figure-of-eight around the vulva and anus. What is the first-line treatment?
- Papulosquamous disorders: pityriasis rubra pilaris · Multi-stepA man has orange-red scaly plaques with follicular papules and well-demarcated islands of normal skin, plus waxy orange palmoplantar keratoderma. Which is the most like…
- Papulosquamous disorders: Hanifin and Rajka major criterion · ApplicationWhich of the following is a MAJOR criterion in the Hanifin and Rajka criteria for atopic dermatitis?
- Papulosquamous disorders: infantile atopic dermatitis pattern · ApplicationA 5-month-old has itchy, weepy, crusted erythema of both cheeks and the extensor surfaces of the knees and elbows. The napkin area is clear. What is the most likely dia…
- Papulosquamous disorders: nummular eczema · ApplicationAn elderly man in winter has several well-defined, coin-shaped, itchy, oozing plaques on both shins. KOH mount is negative. Which is the most appropriate treatment?
- Papulosquamous disorders: pompholyx · ApplicationA 28-year-old woman has recurrent, deep-seated, intensely itchy vesicles on the sides of the fingers and palms that look like tapioca grains. KOH of the roof is negativ…
- Papulosquamous disorders: Woronoff ring · ApplicationA pale halo that develops around resolving psoriatic plaques during phototherapy or topical treatment is known as:
- Papulosquamous disorders: palmoplantar pustulosis · ApplicationWhich lifestyle factor is most strongly associated with palmoplantar pustulosis?
- Papulosquamous disorders: causes of erythroderma · ApplicationIn adults, which group of causes accounts for the largest share of erythroderma?
- Papulosquamous disorders: lichen planus nail change · ApplicationWhich nail change is considered characteristic of lichen planus?
- Papulosquamous disorders: lichen striatus · ApplicationA 4-year-old girl has an asymptomatic band of small flat-topped pink papules running down the left leg along a line, appearing over a week. What is the best advice?
- Papulosquamous disorders: Grover disease · ApplicationAn elderly man confined to bed in a hot ward develops a sudden, itchy eruption of discrete red papules on the chest and back. Histology shows focal acantholysis. What i…
- Papulosquamous disorders: allergic versus irritant contact dermatitis · ApplicationWhich statement best distinguishes allergic contact dermatitis from irritant contact dermatitis?
- Papulosquamous disorders: paraphenylenediamine allergy · Multi-stepA woman develops severe oedematous dermatitis of the scalp margin, forehead and eyelids 2 days after using a black hair dye at home. Which allergen should be patch test…
- Papulosquamous disorders: latex allergy · Multi-stepA surgeon develops itchy wheals on the hands within 15 minutes of putting on latex gloves, and one episode included wheeze. Which mechanism and next step are correct?
- Papulosquamous disorders: chronic hand eczema · Multi-stepA mason with severe chronic hand eczema persisting for over a year fails potent topical steroids and avoidance advice. Which oral drug is specifically indicated for sev…
- Papulosquamous disorders: asteatotic eczema · ApplicationAn 80-year-old has itchy, dry, cracked skin on the shins in a pattern resembling a dried river bed during winter. What is the best first-line management?
- Papulosquamous disorders: prurigo nodularis · Multi-stepA 55-year-old has intensely itchy, firm, hyperkeratotic nodules with excoriation on the extensor forearms and legs, sparing the mid upper back. Which diagnosis fits?
- Papulosquamous disorders: notalgia paraesthetica · ApplicationA 50-year-old has a persistent itchy hyperpigmented patch below the left scapula without a primary rash. Which condition is suspected?
- Papulosquamous disorders: cholestatic pruritus · Multi-stepA woman with primary biliary cholangitis has severe generalised itching without rash. Which drug is first-line for the pruritus?
- Papulosquamous disorders: dermatitis artefacta · Multi-stepA 19-year-old woman presents with bizarre linear and geometric ulcers on the left forearm with sharp margins and healthy surrounding skin. She denies any cause. Which a…
- Papulosquamous disorders: delusional infestation · Multi-stepA 60-year-old brings a matchbox of skin debris to prove he is infested with worms. Examination shows only excoriations and no parasites. Which drug class is used if he…
- Papulosquamous disorders: paradoxical psoriasis with anti-TNF · Multi-stepA patient with Crohn disease on infliximab develops new palmoplantar pustular psoriasis. What is this phenomenon called and how is it managed?
- Papulosquamous disorders: porokeratosis · ApplicationA skin biopsy from an annular plaque with a thread-like raised keratotic border shows a column of parakeratosis. What is this histological feature called?
- Papulosquamous disorders: inverse psoriasis · ApplicationA man has well-demarcated, glistening red plaques with little scale in the axillae, inframammary folds and natal cleft, with a negative KOH mount. What is the diagnosis?
- Papulosquamous disorders: psoriasis comorbidities · ApplicationA 45-year-old with severe plaque psoriasis has a high waist circumference. Which statement is correct regarding comorbidities?
- Papulosquamous disorders: brachioradial pruritus · ApplicationA 52-year-old woman with cervical spondylosis has burning itch over the lateral forearms that worsens after sun exposure and is eased by an ice pack. Skin examination s…
- Papulosquamous disorders: nailfold capillaroscopy in Raynaud phenomenon · Multi-stepA 35-year-old woman with cold-induced digital colour change wants to know whether it is primary or secondary Raynaud phenomenon. Which finding favours a secondary proce…
- Papulosquamous disorders: dimethylglyoxime test · ApplicationA woman has an itchy eczematous patch under the clasp of her wristwatch and around her navel under a jeans button. Which bedside test would confirm that the metal is th…
- Papulosquamous disorders: eye protection after oral psoralen · ApplicationA patient receiving oral psoralen with UVA (PUVA) for psoriasis is advised to wear UVA-blocking glasses for the rest of the treatment day, including on the way home. Wh…
- Papulosquamous disorders: iron deficiency and generalised itch · ApplicationA 30-year-old woman has generalised itch for 3 months with no rash apart from scratch marks. She is pale and has koilonychia and angular stomatitis. What is the best in…
- Papulosquamous disorders: topical therapy for an infant with severe atopic dermatitis · ApplicationAn 8-month-old with atopic dermatitis has weeping, crusted flexural eczema with honey-coloured crusts and yellow pustules. Which approach addresses the complicating fac…
- Papulosquamous disorders: erythroderma complication · Multi-stepA 58-year-old man with erythroderma from long-standing psoriasis becomes tachycardic and breathless, has pitting leg oedema and a body temperature of 35.2 degrees Celsi…
- Papulosquamous disorders: sun-protected pityriasis rosea · ApplicationA 22-year-old has an oval pink scaly plaque on the chest, followed a week later by smaller oval lesions arranged along skin cleavage lines on the trunk. Palms and soles…
- Papulosquamous disorders: lichen planus hypertrophic variant · ApplicationA 48-year-old has intensely itchy, thick, warty violaceous plaques on both shins for two years. Biopsy shows irregular acanthosis, hypergranulosis and a band-like lymph…
- Papulosquamous disorders: lichen planus malignant potential · Multi-stepA 60-year-old with long-standing erosive oral lichen planus has a persistent firm, nonhealing ulcerated plaque on the lateral tongue. What is the most appropriate next…
- Papulosquamous disorders: polymorphic light eruption versus lupus · Multi-stepA 28-year-old woman develops itchy papules over the exposed forearms and V of the neck a few hours after the first sunny days of spring. They settle in a week without s…
- Papulosquamous disorders: pityriasis rubra pilaris versus psoriasis · Multi-stepA 45-year-old has orange-red scaly plaques with sharply demarcated islands of unaffected skin, thick yellow palmoplantar keratoderma and follicular papules on the backs…
- Papulosquamous disorders: pseudopelade of Brocq · ApplicationA 38-year-old woman has several small, smooth, ivory-white atrophic patches on the scalp. There is no erythema, scaling or follicular plugging, and the patches resemble…
- Papulosquamous disorders: epidermolytic hyperkeratosis · ApplicationA newborn has generalised erythema and blisters. Over years, warty corrugated hyperkeratosis develops in the flexures. Biopsy shows vacuolar degeneration of the supraba…
- Papulosquamous disorders: Löfgren syndrome · ApplicationA 28-year-old woman has painful red nodules on both shins, bilateral ankle arthritis and bilateral hilar lymphadenopathy on the chest radiograph. What is this syndrome?
- Papulosquamous disorders: aquagenic pruritus · ApplicationA 58-year-old man with a ruddy face develops intense prickling itch within minutes of a warm bath, with no rash. Which investigation is most useful?
- Papulosquamous disorders: eosinophilic fasciitis · ApplicationAfter strenuous exercise, a 40-year-old man has symmetric painful swelling, then woody induration with an orange-peel look of the forearms and legs. The fingers are spa…
- Papulosquamous disorders: granuloma faciale · ApplicationA 50-year-old man has an asymptomatic, well-demarcated, brownish-red plaque on the cheek with prominent follicular openings. Biopsy shows a dense infiltrate with many e…
- Papulosquamous disorders: juvenile plantar dermatosis · ApplicationA 9-year-old atopic boy has symmetrical shiny, glazed, fissured erythema over the forefoot and toe pulps, sparing the web spaces. It is worse in winter and with synthet…
- Papulosquamous disorders: pityriasis lichenoides et varioliformis acuta · ApplicationA 19-year-old has crops of reddish-brown papules in different stages. Some have haemorrhagic crusts, and they heal with varioliform scars. Biopsy shows a wedge-shaped i…
- Papulosquamous disorders: habit-tic nail deformity · ApplicationA young man has a longitudinal midline groove in the thumbnail with transverse parallel ridges stacked like a fir tree. He does not have psoriasis or lichen planus. Wha…
- Papulosquamous disorders: Favre-Racouchot syndrome · ApplicationAn elderly man with decades of sun exposure and smoking has open comedones and small cysts on yellowed, furrowed skin around both eyes and over the cheekbones. There is…
- Papulosquamous disorders: steatocystoma multiplex · ApplicationA teenage boy has dozens of firm, yellowish dome-shaped cysts on the chest and axillae, from the age of 12. When punctured they release an oily, clear fluid. Which gene…
- Papulosquamous disorders: Ludwig pattern hair loss · ApplicationA 40-year-old woman notices a widening central parting with diffuse thinning over the crown. The frontal hairline is preserved, there is no shedding of club hairs, and…
- Papulosquamous disorders: chronic actinic dermatitis · Multi-stepA 66-year-old farmer has had eczematous lichenified plaques on the face, V of the neck and backs of the hands for three years. They worsen in summer but never clear in…
- Papulosquamous disorders: erythema annulare centrifugum · Multi-stepA woman has a slowly enlarging annular erythematous ring on the thigh with a trailing scale on the inner edge. KOH is negative and the lesion is firm to palpate. What i…
- Papulosquamous disorders: ILVEN · Multi-stepA child has had a linear, itchy, psoriasiform and verrucous plaque on the left leg since infancy, along Blaschko lines, resistant to topical steroids. What is the expec…
- Papulosquamous disorders: pachyonychia congenita · Multi-stepA child has thick, yellow, dystrophic nails, painful plantar keratoderma, white oral plaques and multiple small cysts. Which keratin defect usually underlies this condi…
- Papulosquamous disorders: lipoid proteinosis · Multi-stepA child has had a hoarse cry since infancy. Now there are beaded papules along the eyelid margins and waxy thickened skin, and imaging shows bean-shaped intracranial ca…
- Papulosquamous disorders: Wells syndrome · Multi-stepA woman has recurrent itchy, burning cellulitis-like plaques on the limbs with no fever, no response to antibiotics and eosinophilia. Biopsy shows a dense dermal eosino…
- Papulosquamous disorders: Sjögren-Larsson syndrome · Multi-stepA child has generalised ichthyosis from infancy, spastic diplegia and intellectual disability, and the retina shows glistening white dots. Which enzyme is deficient?
- Papulosquamous disorders: Cronkhite-Canada syndrome · Multi-stepA 60-year-old man has chronic diarrhoea with protein-losing enteropathy, diffuse alopecia, nail atrophy and hyperpigmented macules on the palms. Endoscopy shows numerou…
- Papulosquamous disorders: scleromyxoedema · Multi-stepA middle-aged man has widespread firm, waxy, closely set papules on the face, neck and arms, producing a leonine look and stiff fingers. There is no thyroid disease and…
- Papulosquamous disorders: lichen planus pemphigoides · Multi-stepA man with itchy violaceous flat-topped papules on the wrists develops tense blisters both over the papules and on clinically normal skin of the limbs. Direct immunoflu…
- Papulosquamous disorders: anti-MDA5 dermatomyositis · Multi-stepA woman has Gottron papules, painful palmar papules that ulcerate, and minimal muscle weakness with a normal creatine kinase. Within weeks she develops rapidly progress…
- Papulosquamous disorders: IL36RN and generalised pustular psoriasis · ApplicationA young woman with no previous psoriasis has recurrent episodes of fever with sheets of sterile pustules on erythematous skin, and a sibling is similarly affected. Loss…
- Papulosquamous disorders: scleromyxedema paraprotein · Multi-stepA 55-year-old man has widespread firm, waxy, closely set papules in linear arrays on the hands, forearms and face with thickened glabellar furrows. Thyroid function is…
- Papulosquamous disorders: nephrogenic systemic fibrosis · ApplicationA patient with end-stage kidney disease on haemodialysis develops woody induration and tightening of the skin of the legs and forearms with joint contractures, a few we…
- Papulosquamous disorders: erythema elevatum diutinum · Multi-stepA man with an IgA paraprotein has symmetric, persistent red-purple-brown nodules and plaques over the knuckles, elbows and knees. Biopsy shows leukocytoclastic vasculit…
- Papulosquamous disorders: elastosis perforans serpiginosa · Multi-stepA young man with Down syndrome has an arciform ring of keratotic papules on the nape of the neck. Biopsy shows transepidermal elimination of altered elastic fibres thro…
- Papulosquamous disorders: trichoscopy in alopecia areata · ApplicationA child has a smooth round patch of hair loss without scarring. On trichoscopy, which finding is the most common in alopecia areata?
- Papulosquamous disorders: wet wrap therapy in atopic dermatitis · ApplicationA 4-year-old has a severe, widespread flare of atopic dermatitis with sleep loss that has not settled despite regular emollients and a moderate-potency topical steroid.…
- Papulosquamous disorders: IL-12/23 inhibition in psoriasis · ApplicationA patient with extensive plaque psoriasis is started on ustekinumab. Which cytokine subunit does this drug bind?
- Papulosquamous disorders: pellagra-like dermatitis in Hartnup disease · Multi-stepAn 8-year-old with an adequate diet has recurrent photosensitive, scaly, pellagra-like dermatitis of the face and hands with episodes of cerebellar ataxia. Urine chroma…
- Papulosquamous disorders: verrucous epidermal naevus and mosaicism · ApplicationA 3-year-old has linear brown warty plaques, S-shaped on the trunk and V-shaped on the back, present since infancy. Which concept best explains this distribution?
- Papulosquamous disorders: essential fatty acid deficiency · ApplicationA patient on prolonged total parenteral nutrition without lipid emulsion develops dry scaly dermatitis, diffuse hair thinning and delayed wound healing, with thrombocyt…
- Papulosquamous disorders: histology of pustular psoriasis · Multi-stepA biopsy from a pustule in generalised pustular psoriasis shows neutrophils collected within a network in the upper stratum spinosum rather than in the stratum corneum.…
- Papulosquamous disorders: lichen nitidus · ApplicationA boy has groups of 1 mm flesh-coloured, shiny, flat-topped papules on the penile shaft and forearms that appear along scratch lines. Histology shows a dense infiltrate…
- Papulosquamous disorders: trigger of generalised pustular psoriasis · Multi-stepA man with plaque psoriasis develops fever and widespread sterile pustules over red skin. Which event in the preceding fortnight most likely precipitated this?
- Papulosquamous disorders: adverse effect of coal tar · ApplicationA patient with chronic plaque psoriasis applies crude coal tar to the plaques on the legs daily. After a few weeks, follicular papulopustules appear in the treated area…
- Papulosquamous disorders: radiology of arthritis mutilans · ApplicationA patient with long-standing severe psoriasis has shortened, telescoping fingers. Radiographs show erosion of the proximal phalanx into a cup-shaped end with the distal…
- Papulosquamous disorders: mechanism of PUVA · ApplicationIn PUVA therapy for psoriasis, what is the molecular action of the oral psoralen once the skin is exposed to UVA?
- Papulosquamous disorders: bleach baths in atopic dermatitis · ApplicationA child with severe, recurrently infected atopic dermatitis has frequent flares despite emollients and topical steroids. A dilute sodium hypochlorite bath is advised. W…
- Papulosquamous disorders: pityriasis rotunda · ApplicationA dark-skinned adult has several sharply demarcated, perfectly round, hyperpigmented scaly patches on the trunk, measuring 5 to 15 cm. They are asymptomatic. Which cond…
Infections71
- Infections: tinea imbricata · ApplicationConcentric, overlapping rings of scaling that form a lamellar pattern on the trunk are produced by which dermatophyte?
- Infections: tinea nigra · Multi-stepA 20-year-old has a solitary, asymptomatic, non-scaly, brown-black macule on the palm after travel to the tropics. KOH shows brown septate hyphae. What is the most like…
- Infections: tinea barbae · ApplicationA farmer has painful boggy plaques with pustules and loosened hairs over the beard area. KOH shows endothrix and ectothrix spores. What is the most appropriate treatment?
- Infections: pityriasis amiantacea · ApplicationAn 8-year-old has thick, silvery, adherent scale in patches on the scalp that glues bundles of hair together. Hair loss is minimal and regrows. What is this called?
- Infections: herpetic whitlow · Multi-stepA dental nurse develops a painful, swollen fingertip with grouped clear vesicles on an erythematous base and no pus on aspiration. What should be avoided?
- Infections: papular purpuric gloves and socks syndrome · Multi-stepA 22-year-old has fever and painful, pruritic swelling with erythema and petechiae of both hands and feet, sharply bounded at the wrists and ankles. Which virus is the…
- Infections: cercarial dermatitis · ApplicationAfter wading in a freshwater pond, a boy develops intensely itchy red papules on the exposed legs within hours, resolving in a week. Which organism causes this?
- Infections: cutaneous leishmaniasis diagnosis · Multi-stepA 25-year-old from Rajasthan has a slowly enlarging painless ulcer with raised indurated edge on the face for 2 months. Which investigation gives rapid confirmation?
- Infections: milker's nodule · ApplicationA dairy worker develops one or two firm, red-purple, weeping nodules on the fingers a week after handling cows with teat lesions. Which virus is responsible?
- Infections: chikungunya skin signs · ApplicationWeeks after acute chikungunya fever, many patients show brown pigmentation over the nose and cheeks. This is called:
- Infections: rapidly growing mycobacteria · Multi-stepThree weeks after a cosmetic injection, a patient has multiple red, tender, discharging nodules at the injection sites. Routine bacterial cultures are sterile and there…
- Infections: Langerhans cell histiocytosis · Multi-stepA 10-month-old has a persistent seborrhoeic-like eruption of the scalp and flexures with petechial crusted papules, hepatosplenomegaly and anaemia. Which test is most u…
- Infections: juvenile xanthogranuloma · ApplicationA 1-year-old has a solitary, firm, yellow-orange dome-shaped papule on the scalp. Biopsy shows Touton giant cells. Lipid profile is normal. What is the usual course?
- Infections: papular urticaria · ApplicationA 4-year-old has recurrent crops of grouped, itchy, excoriated papules on the exposed legs and arms during the rainy season, and the family cat has fleas. What is the b…
- Infections: plantar wart versus corn · ApplicationParing a painful plantar lesion shows pinpoint black dots and interruption of skin lines. Which diagnosis is supported?
- Infections: tinea faciei · ApplicationA child has an annular scaly, mildly itchy plaque with a raised edge on the cheek that worsens after sun exposure. KOH is positive. What is the diagnosis and treatment?
- Infections: erythema induratum of Bazin · Multi-stepA 30-year-old woman has recurrent painful, deep violaceous nodules on the calves that ulcerate in cold weather. Biopsy shows lobular panniculitis with granulomas and va…
- Infections: tinea cruris versus candidal intertrigo · ApplicationA man has a red, sharply marginated, scaly plaque with an active edge in both groins. The scrotum looks normal. What is the most likely diagnosis?
- Infections: pityriasis versicolor signs · ApplicationA young man has multiple hypopigmented scaly macules on the upper trunk after sweating in summer. Scratching the surface with a fingernail produces fine scale. What is…
- Infections: tinea incognito · Multi-stepA man applied clobetasol for an itchy groin rash for months. The rash is now larger, less scaly, with pustules and little active edge. What best explains this?
- Infections: plane warts · Multi-stepA teenager has dozens of flat, skin-coloured to pale brown, slightly raised papules on the face and dorsal hands, which appear in lines along scratch marks. Which featu…
- Infections: pellagra · ApplicationA man on a maize-based diet with chronic alcohol use has a photosensitive, well-demarcated brown scaly rash around the neck, along with diarrhoea and confusion. What is…
- Infections: acrodermatitis enteropathica · Multi-stepAn infant soon after weaning from breast milk has erosive, psoriasiform dermatitis around the mouth and perineum, diarrhoea and alopecia. Which investigation and treatm…
- Infections: cutaneous anthrax · ApplicationA hide worker has a painless black necrotic ulcer with a rim of vesicles and marked surrounding oedema on the forearm. What is the diagnosis?
- Infections: herpes zoster ophthalmicus · Multi-stepA 70-year-old has painful vesicles on the forehead and a vesicle on the tip of the nose. Which nerve involvement does this predict, and what is its significance?
- Infections: rhinosporidiosis · ApplicationA farmer who bathes in a village pond has a friable, polypoid, strawberry-like bleeding mass in the nose. Histology shows large sporangia containing endospores. What is…
- Infections: scurvy · ApplicationA malnourished man has perifollicular haemorrhages with corkscrew hairs, swollen bleeding gums and poor wound healing. Which deficiency is responsible?
- Infections: hyper-IgE syndrome · Multi-stepA child has recurrent cold staphylococcal skin abscesses, eczema, pneumatoceles, retained primary teeth and very high serum IgE. What is the likely diagnosis?
- Infections: bacterial, viral, fungal, parasitic: rhinoscleroma · ApplicationA 32-year-old from a rural area has progressive nasal obstruction with a hard, painless, woody infiltrate of the nasal tip and upper lip. Biopsy shows large foamy macro…
- Infections: bacterial, viral, fungal, parasitic: intralesional immunotherapy for warts · ApplicationA 14-year-old has numerous plantar and periungual warts that have not cleared after months of salicylic acid and repeated cryotherapy. Which treatment works by provokin…
- Infections: bacterial, viral, fungal, parasitic: disseminated herpes zoster · ApplicationA 45-year-old woman receiving chemotherapy for lymphoma develops painful dermatomal vesicles over the chest. Four days later about 60 vesicles appear on the trunk and l…
- Infections: bacterial, viral, fungal, parasitic: trichomycosis axillaris · ApplicationA man with marked axillary sweating notices yellow, soft, waxy sheaths that coat the hair shafts, and his vests become stained yellow. Hair does not break and there is…
- Infections: bacterial, viral, fungal, parasitic: cutaneous cryptococcosis in HIV · Multi-stepA man with HIV and a CD4 count of 40 cells per cubic millimetre has several umbilicated skin-coloured papules on the face that resemble molluscum contagiosum. He also r…
- Infections: bacterial, viral, fungal, parasitic: Mycoplasma pneumoniae-induced rash and mucositis · Multi-stepAn 11-year-old has had cough and fever for five days. He now has severe painful oral, ocular and genital erosions with only a few vesiculobullous skin lesions. He has t…
- Infections: bacterial, viral, fungal, parasitic: perianal streptococcal dermatitis · ApplicationA 5-year-old has sharply demarcated, bright red perianal erythema with pain on defecation and some blood-streaked stool. A swab grows a Gram-positive coccus in chains.…
- Infections: bacterial, viral, fungal, parasitic: cutaneous leishmaniasis treatment · ApplicationA 24-year-old in a desert region of Rajasthan has a single 2 cm painless crusted ulcer with a raised indurated edge on the forearm for three months. Smear shows amastig…
- Infections: bacterial, viral, fungal, parasitic: actinomycetoma treatment · Multi-stepA farmer has a swollen foot with multiple sinuses discharging red grains. Microscopy shows thin branching filaments that are Gram positive and modified acid-fast, and f…
- Infections: bacterial, viral, fungal, parasitic: onset of itch in first scabies infestation · ApplicationA student sharing a hostel room develops intense nocturnal itch only 4 weeks after first exposure to a scabies carrier, although mites were present from the start. What…
- Infections: bacterial, viral, fungal, parasitic: cat-scratch disease · ApplicationA 10-year-old keeping a kitten has a small crusted papule on the hand, followed after two weeks by a tender, enlarged epitrochlear lymph node and mild fever. What is th…
- Infections: bacterial, viral, fungal, parasitic: bacillary angiomatosis · ApplicationA man with HIV and a CD4 count of 40 has multiple red friable papules like pyogenic granulomas. Biopsy shows lobular capillary proliferation with neutrophils, and Warth…
- Infections: bacterial, viral, fungal, parasitic: cutaneous cysticercosis · ApplicationA young man from rural North India has multiple painless firm subcutaneous nodules on the trunk, and has had a seizure. Radiographs of the thigh show rice-grain calcifi…
- Infections: bacterial, viral, fungal, parasitic: Fournier gangrene · ApplicationA diabetic man has severe scrotal pain, fever and hypotension. The scrotal skin is dusky with crepitus and foul-smelling discharge. What is the immediate treatment prio…
- Infections: bacterial, viral, fungal, parasitic: gram-negative folliculitis · Multi-stepA 22-year-old on long-term oral doxycycline for acne has a sudden crop of pustules and cysts around the nose and cheeks that do not respond to the antibiotic. Gram stai…
- Infections: bacterial, viral, fungal, parasitic: post-kala-azar dermal leishmaniasis · Multi-stepA man in Bihar treated for kala-azar three years ago now has hypopigmented macules and nodules on the face. Slit-skin smear shows Leishman-Donovan bodies. Why is this c…
- Infections: bacterial, viral, fungal, parasitic: Vibrio vulnificus infection · Multi-stepA 55-year-old man with alcoholic cirrhosis develops fever, hypotension and haemorrhagic bullae on the leg 24 hours after wading in seawater and eating raw oysters. Whic…
- Infections: bacterial, viral, fungal, parasitic: Paederus dermatitis · ApplicationDuring the monsoon a farmer wakes with linear streaks of erythema and vesicles on the neck, with a burning sensation and mirror-image lesions where two skin folds touch…
- Infections: bacterial, viral, fungal, parasitic: post-scabetic itch · ApplicationA man and his family were all treated correctly with permethrin 5 percent cream for scabies two weeks ago. He still itches, but there are no new burrows, no fresh nodul…
- Infections: bacterial, viral, fungal, parasitic: antifungals in pityriasis versicolor · ApplicationA 24-year-old has many well-defined hypopigmented scaly macules over the upper back, and a skin scraping in KOH shows short hyphae with round yeast forms. Extensive dis…
- Infections: bacterial, viral, fungal, parasitic: erythema marginatum · ApplicationA 9-year-old has fever, a swollen painful knee that improved as the ankle became swollen, and a new apical murmur. He also has evanescent pink rings with clear centres…
- Infections: bacterial, viral, fungal, parasitic: cutaneous diphtheria · ApplicationA homeless man has a chronic punched-out ulcer on the shin with a grey-brown adherent membrane that has not healed for weeks. A smear from the edge shows pleomorphic Gr…
- Infections: bacterial, viral, fungal, parasitic: HIV-associated eosinophilic folliculitis · Multi-stepA man with advanced HIV infection and a CD4 count of 80 per microlitre has intensely itchy follicular papules and sterile pustules on the face, upper trunk and extensor…
- Infections: bacterial, viral, fungal, parasitic: erysipeloid · ApplicationA fishmonger sustains a finger puncture from a fish bone. Two days later the finger shows a painful, well-demarcated violaceous plaque that spreads slowly outwards with…
- Infections: bacterial, viral, fungal, parasitic: danger triangle of the face · Multi-stepA young man squeezes a boil beside his nose. Two days later he has high fever and a swollen, proptosed eye with restricted eye movements, and within a day the other eye…
- Infections: bacterial, viral, fungal, parasitic: green nail syndrome · ApplicationA dishwasher with chronic paronychia has a green-black discolouration under a partly lifted nail plate. Which organism produces the pigment responsible?
- Infections: bacterial, viral, fungal, parasitic: cervicofacial actinomycosis · Multi-stepA man has a hard, woody swelling at the angle of the jaw for several weeks, with multiple sinuses discharging pus that contains yellow granules. Gram stain of a crushed…
- Infections: bacterial, viral, fungal, parasitic: purpura fulminans in a febrile child · Multi-stepA 6-year-old has had fever and vomiting for a few hours, and now has non-blanching purpuric spots spreading over the trunk and limbs, cold peripheries and a blood press…
- Infections: bacterial, viral, fungal, parasitic: recombinant zoster vaccine · ApplicationA 62-year-old who has had shingles asks about a vaccine that is not a live virus and can be offered to people on immunosuppressive treatment. What kind of zoster vaccin…
- Infections: bacterial, viral, fungal, parasitic: primary herpetic gingivostomatitis · ApplicationA 3-year-old has fever, drooling, refusal to feed, swollen bleeding gums and clusters of small vesicles around the lips. The hands and feet are normal. Which virus is t…
- Infections: bacterial, viral, fungal, parasitic: imiquimod in anogenital warts · ApplicationA topical immune response modifier is applied three nights a week for anogenital warts and clears them without being directly cytotoxic. What is its mechanism of action?
- Infections: bacterial, viral, fungal, parasitic: loiasis and its vector · ApplicationA man returns from the West African rain forest with recurrent, transient, non-pitting itchy swellings of the forearm, and once noticed a thread-like worm crossing his…
- Infections: bacterial, viral, fungal, parasitic: body louse infestation · ApplicationA homeless man has generalised itching with linear excoriations and thickened, hyperpigmented skin over the shoulders, back and waist. Skin examination reveals no mites…
- Infections: bacterial, viral, fungal, parasitic: bed bug bites · ApplicationA woman wakes with three itchy erythematous papules in a straight line on her exposed forearm, and her partner has similar lesions. There are no burrows, and nothing is…
- Infections: bacterial, viral, fungal, parasitic: nodular scabies · Multi-stepEight weeks after completing permethrin for scabies, a man still has intensely itchy firm red-brown nodules on the scrotum and in the axillae. Skin scrapings show no mi…
- Infections: bacterial, viral, fungal, parasitic: bullous scabies mimicking pemphigoid · Multi-stepAn 80-year-old man has tense blisters on the arms and thighs with severe nocturnal itch. His wife is also itchy, and small burrows are seen in the finger webs. What is…
- Infections: bacterial, viral, fungal, parasitic: cutaneous histoplasmosis · Multi-stepA man with advanced HIV infection has fever, hepatosplenomegaly and umbilicated papules and ulcers on the face. Biopsy shows 2 to 4 micron oval budding yeasts packed wi…
- Infections: bacterial, viral, fungal, parasitic: primary cutaneous aspergillosis · ApplicationA neutropenic patient develops an erythematous plaque with a black central eschar around an intravenous cannula site. Biopsy shows septate hyphae branching at acute ang…
- Infections: bacterial, viral, fungal, parasitic: paracoccidioidomycosis · ApplicationA rural farm worker from Latin America has painful, granular ulcers of the mouth and nose with enlarged cervical nodes. Biopsy shows a large round yeast with multiple n…
- Infections: bacterial, viral, fungal, parasitic: proximal subungual onychomycosis · ApplicationAn adult has white discolouration beginning beneath the proximal nail plate and spreading distally, with an intact nail surface. Which underlying condition should be ac…
- Infections: bacterial, viral, fungal, parasitic: candidal balanitis in diabetes · Multi-stepA man with type 2 diabetes recently started on an SGLT2 inhibitor develops an itchy red glans with white patches and satellite pustules. What is the underlying mechanism?
- Infections: bacterial, viral, fungal, parasitic: one hand two feet syndrome · ApplicationA farmer has dry scaling of the right palm accentuated in the palmar creases, along with diffuse scaling of both soles. The left hand is normal. What is the most likely…
- Infections: bacterial, viral, fungal, parasitic: varicella exposure in pregnancy · Multi-stepA pregnant woman at 20 weeks, who has no history of chickenpox and is seronegative, was in close contact with a child with chickenpox 3 days ago. What is the most appro…
Leprosy71
- Leprosy · ApplicationIn which type of leprosy is the lepromin test strongly positive?
- Leprosy · ApplicationWhich feature is typical of tuberculoid leprosy?
- Leprosy: predilection sites · ApplicationWhich of the following sites is characteristically spared by leprosy lesions because of its higher temperature?
- Leprosy: indeterminate leprosy · ApplicationA child has a single ill-defined hypopigmented macule with minimal sensory loss and no nerve thickening. Biopsy shows a nonspecific infiltrate around neurovascular bund…
- Leprosy: tuberculoid leprosy · ApplicationA man has a solitary, well-defined, dry, hairless, anaesthetic plaque with raised edges and a thickened nerve emerging from it. Slit skin smear is negative. Which is th…
- Leprosy: borderline leprosy · Multi-stepWhich lesion morphology is most characteristic of mid-borderline (BB) leprosy?
- Leprosy: lepromin test · ApplicationWhich statement about the lepromin (Mitsuda) test is correct?
- Leprosy: lepromatous histology · ApplicationA skin biopsy from a patient with symmetric nodules shows sheets of foamy macrophages filled with acid-fast bacilli in globi, separated from the epidermis by a clear zo…
- Leprosy: tuberculoid histology · ApplicationWhich histological finding best fits tuberculoid leprosy?
- Leprosy: histoid leprosy · Multi-stepA patient on dapsone monotherapy for years develops firm, shiny, cutaneous nodules and the biopsy shows spindle-shaped histiocytes teeming with bacilli. What is this va…
- Leprosy: Lucio phenomenon · Multi-stepA Mexican patient with diffuse, nonnodular lepromatous leprosy develops painful angular necrotic ulcers on the legs with endothelial invasion by bacilli. What is this r…
- Leprosy: pure neuritic leprosy · ApplicationA patient has thickened tender ulnar and common peroneal nerves with loss of sensation in their distribution, but no skin lesions. Which investigation confirms the diag…
- Leprosy: bacteriological index · ApplicationOn the Ridley logarithmic scale, a bacteriological index of 6+ corresponds to how many bacilli per oil immersion field?
- Leprosy: staining · ApplicationWhich stain is preferred for demonstrating M. leprae in tissue sections?
- Leprosy: lagophthalmos · ApplicationA patient cannot close the eye completely and develops corneal exposure. Which nerve branch is damaged?
- Leprosy: plantar ulcer care · ApplicationA patient has a painless ulcer on the plantar surface of the forefoot caused by repeated trauma on an insensitive foot. What is the key principle of management?
- Leprosy: histamine test · ApplicationWhen intradermal histamine is injected into an anaesthetic leprosy patch, which part of the triple response is absent?
- Leprosy: sensory loss · ApplicationIn a leprosy patch, which modality of sensation is usually the earliest to be impaired?
- Leprosy: paediatric MDT · Multi-stepWhat is the correct monthly rifampicin dose in the multibacillary blister pack for a child aged 10 to 14 years?
- Leprosy: chemoprophylaxis · ApplicationUnder leprosy post-exposure prophylaxis, what is given to household contacts of a newly diagnosed case?
- Leprosy: dapsone adverse effects · ApplicationBefore starting dapsone for leprosy, which enzyme deficiency should be considered because of the risk of haemolysis?
- Leprosy: clofazimine · ApplicationWhich adverse effect of clofazimine commonly worries patients on multibacillary therapy?
- Leprosy: rifampicin · ApplicationWhat is the mechanism of action of rifampicin against M. leprae?
- Leprosy: thalidomide in reactions · ApplicationA man with lepromatous leprosy has recurrent tender erythematous nodules with fever. Which drug is very effective but absolutely contraindicated in women of childbearin…
- Leprosy: management during reactions · ApplicationA patient on multidrug therapy develops painful nerve enlargement with new erythema over existing patches. What is the correct approach?
- Leprosy: elimination target · ApplicationLeprosy was declared eliminated as a public health problem in India in 2005. What does this target mean?
- Leprosy: disability grading · ApplicationAccording to the WHO disability grading, which finding corresponds to grade 2 disability in the hand?
- Leprosy: serology and molecular tests · Multi-stepWhich antigen is targeted in serological tests for leprosy, with high titres in multibacillary disease?
- Leprosy: Mycobacterium lepromatosis · Multi-stepWhich organism, described in 2008, has been implicated in diffuse lepromatous leprosy with Lucio phenomenon?
- Leprosy: nerve abscess · Multi-stepA patient with tuberculoid leprosy has a tender fluctuant swelling of the ulnar nerve with rapid loss of function. What is the next appropriate step?
- Leprosy: reconstructive surgery · Multi-stepWhich procedure is commonly used to correct foot drop in leprosy?
- Leprosy: eye involvement · ApplicationWhich ocular complication in lepromatous leprosy results from invasion of the anterior segment by bacilli and may flare during erythema nodosum leprosum?
- Leprosy: pregnancy · ApplicationA pregnant woman is diagnosed with multibacillary leprosy. What is the appropriate management?
- Leprosy: dapsone hypersensitivity · Multi-stepFour weeks after starting dapsone, a patient develops fever, exfoliative dermatitis, hepatitis and eosinophilia. What is this called?
- Leprosy: morphological index · ApplicationWhat does the morphological index (MI) measure in leprosy?
- Leprosy: silent neuropathy · Multi-stepA multibacillary leprosy patient on MDT has gradually developed weakness of finger abduction and reduced sensation in the little finger over 6 weeks, without pain, tend…
- Leprosy: downgrading reaction · Multi-stepA patient with untreated borderline tuberculoid leprosy develops many new, smaller lesions with increasing bacillary load on smear. Which term describes this immunologi…
- Leprosy: mild ENL management · ApplicationA lepromatous patient has a few painful nodules and mild fever for 2 days, with normal nerve function and no eye, testis or joint involvement. What is the suitable appr…
- Leprosy: nerve tropism · Multi-stepBy which mechanism does Mycobacterium leprae attach to peripheral nerves?
- Leprosy: endocrine involvement in lepromatous disease · ApplicationA man with long-standing lepromatous leprosy has small soft testes, reduced libido and gynaecomastia. What explains this?
- Leprosy: HIV-associated immune reconstitution · Multi-stepA 35-year-old man with HIV starts antiretroviral therapy. Eight weeks later he develops new anaesthetic erythematous plaques and a thickened ulnar nerve. What is the be…
- Leprosy: bone changes · ApplicationNeuropathic bone resorption of the toes and metatarsals in leprosy produces which radiological appearance?
- Leprosy: ultrasound of nerves · ApplicationWhich imaging method is useful to detect nerve thickening and increased vascularity in suspected neural leprosy?
- Leprosy: risk factors for ENL · Multi-stepWhich patient is at highest risk of developing erythema nodosum leprosum?
- Leprosy: rifampicin counselling · ApplicationA man with multibacillary leprosy starts multidrug therapy and returns alarmed that his urine is red-orange. What is the correct response?
- Leprosy: management of type 1 reaction · Multi-stepA woman with borderline tuberculoid leprosy develops swollen erythematous existing plaques and a tender, thickened ulnar nerve with new weakness of finger abduction. Wh…
- Leprosy: trophic ulcer care · ApplicationA man with leprosy has a painless, punched-out ulcer on the sole under the first metatarsal head. What is the key step to achieve healing?
- Leprosy: contact screening and self-care · ApplicationA newly detected leprosy patient has five household members. What is the appropriate public health action?
- Leprosy: ENL histology · Multi-stepA skin biopsy from a tender erythematous nodule in a patient with lepromatous leprosy shows a dense neutrophilic infiltrate with vasculitis and fragmented bacilli in fo…
- Leprosy: reversal reaction spectrum · ApplicationWhich group of patients is most prone to type 1 (reversal) lepra reaction?
- Leprosy: monofilament testing · ApplicationAt a leprosy clinic, a health worker wants a reproducible way to document early loss of light touch on the sole before ulcers develop. Which tool is best suited to this…
- Leprosy: release from treatment · Multi-stepA multibacillary leprosy patient completes the prescribed course of multidrug therapy. Skin patches are still faintly visible and the smear remains positive but with a…
- Leprosy: hepatitis during multidrug therapy · Multi-stepA multibacillary leprosy patient on rifampicin, clofazimine and dapsone develops jaundice and markedly raised transaminases in the second month. After stopping the drug…
- Leprosy: pure neuritic leprosy with absent skin lesions · Multi-stepA farmer has an enlarged, tender ulnar nerve and a patch of anaesthesia on the hypothenar eminence, but no skin lesion and a negative skin smear. Which test most direct…
- Leprosy: leprosy mimic with fungal hyphae · Multi-stepA boy has an annular, scaly, hypopigmented patch with a raised edge on the trunk. Touch and pain sensation within the patch are normal, no nerve is thickened, and KOH s…
- Leprosy: leprosy and diabetic neuropathy · Multi-stepA diabetic man has painless plantar ulcers and a stocking pattern of sensory loss, but also a thickened, tender posterior tibial nerve and a hypopigmented anaesthetic p…
- Leprosy: necrotising erythema nodosum leprosum · Multi-stepA lepromatous leprosy patient on multidrug therapy develops fever and tender red nodules over the limbs, some of which turn pustular, ulcerate and form necrotic scars.…
- Leprosy: median nerve involvement · ApplicationA leprosy patient cannot oppose the thumb to the little finger. The thenar eminence is wasted and sensation is reduced over the radial three and a half digits of the pa…
- Leprosy: posterior tibial nerve involvement · ApplicationA man with long-standing leprosy has an anaesthetic, dry sole and clawing of the toes from paralysis of the small muscles of the foot. Which nerve is mainly involved?
- Leprosy: Fernandez reaction · ApplicationAfter an intradermal injection of lepromin, which reaction is read at 48 to 72 hours and reflects delayed hypersensitivity to antigens of the bacillus?
- Leprosy: steroid-sparing drug in chronic ENL · Multi-stepA lepromatous patient has recurrent erythema nodosum leprosum that returns every time prednisolone is tapered, and thalidomide cannot be used. Which antileprosy drug wi…
- Leprosy: mechanism of thalidomide in ENL · ApplicationThalidomide is very effective in severe erythema nodosum leprosum mainly because it suppresses which mediator that is raised in the lesions and the serum?
- Leprosy: histology of a reversal reaction · Multi-stepA biopsy from an inflamed existing plaque in a patient with borderline leprosy shows epithelioid granulomas with oedema between and within them, swollen epithelioid cel…
- Leprosy: relapse versus reaction · Multi-stepThree years after completing 12 months of multibacillary therapy, a man develops a few new skin lesions that appeared slowly, without redness, pain or nerve tenderness.…
- Leprosy: dapsone-induced methaemoglobinaemia · Multi-stepA leprosy patient on dapsone becomes cyanosed. His blood is chocolate brown, pulse oximetry reads about 85 percent, and arterial oxygen tension is normal. Which antidot…
- Leprosy: rifampicin and oral contraceptives · ApplicationA young woman on multibacillary therapy for leprosy is using combined oral contraceptive pills. What advice is correct?
- Leprosy: secondary amyloidosis · Multi-stepA man with lepromatous leprosy of 20 years and repeated ENL has oedema and heavy proteinuria. Renal biopsy shows amorphous deposits that stain with Congo red, and the a…
- Leprosy: borderline tuberculoid lesions · ApplicationA patient has a few large, well-defined, hypoaesthetic dry plaques, with several small lesions near the edge of the largest one. Smear is negative. Which type of lepros…
- Leprosy: Lucio phenomenon versus necrotic ENL · Multi-stepWhich feature distinguishes Lucio phenomenon from necrotising erythema nodosum leprosum?
- Leprosy: nerve involvement across the spectrum · ApplicationHow does the pattern of peripheral nerve damage differ between the tuberculoid and lepromatous poles of leprosy?
- Leprosy: cytokine profile at the lepromatous pole · ApplicationA patient has widespread symmetric skin infiltration with a bacteriological index of 5+ and a negative lepromin test. Which cytokine profile is expected in the lesions?
Skin tumours67
- Skin tumours: Marjolin ulcer · ApplicationA non-healing, everted-edge ulcer develops in a 30-year-old burn scar on the leg. Which malignancy is it most likely to be?
- Skin tumours: melanoma prognosis · ApplicationWhich histological parameter is the most important prognostic factor for primary cutaneous melanoma?
- Skin tumours: Kaposi sarcoma · ApplicationA man with HIV has violaceous plaques on the legs and palate. Biopsy shows spindle cells forming slit-like vascular spaces with extravasated red cells. Which virus is t…
- Skin tumours: acral melanoma · ApplicationA 55-year-old Indian man has a darkly pigmented, irregular, enlarging macule on the sole. Which melanoma subtype is the most common in dark-skinned populations such as…
- Skin tumours: dermatofibrosarcoma protuberans · Multi-stepA young adult has a slowly growing, indurated plaque on the trunk that recurs after simple excision. Biopsy shows spindle cells in a storiform pattern infiltrating fat…
- Skin tumours: seborrhoeic keratosis · ApplicationAn elderly man suddenly develops numerous itchy seborrhoeic keratoses over the trunk. Which diagnosis should be excluded?
- Skin tumours: infantile haemangioma · ApplicationA 3-month-old has a rapidly enlarging, bright red, raised vascular lesion over the face that is threatening the eye. Which drug is first line?
- Skin tumours: Kasabach-Merritt phenomenon · Multi-stepAn infant has a rapidly enlarging, firm, purple vascular tumour on the thigh with thrombocytopenia of 12,000 per microlitre, low fibrinogen and raised D-dimer. Which tu…
- Skin tumours: keratoacanthoma · ApplicationA 65-year-old farmer has a 1.5 cm dome-shaped nodule on the cheek with a central keratin-filled crater that appeared and enlarged over 5 weeks. What is the appropriate…
- Skin tumours: melanoma immunohistochemistry · ApplicationWhich immunohistochemical marker is the most sensitive, but least specific, for melanoma?
- Skin tumours: BRAF mutation in melanoma · Multi-stepA patient with unresectable stage IV melanoma is found to have a BRAF V600E mutation. Which treatment combination is appropriate?
- Skin tumours: sentinel lymph node biopsy · Multi-stepA 48-year-old has a wide excision of a back melanoma with Breslow thickness 1.8 mm, no ulceration, and no palpable nodes or distant disease. Which staging procedure is…
- Skin tumours: familial atypical mole syndrome · ApplicationA family has multiple members with more than 50 atypical moles, melanoma and pancreatic cancer. Which gene is commonly mutated?
- Skin tumours: extramammary Paget disease · Multi-stepA 68-year-old man has a chronic, well-demarcated, red scaly weeping patch on the scrotum unresponsive to antifungals and steroids for a year. Biopsy shows large pale ce…
- Skin tumours: hedgehog pathway inhibitors · ApplicationVismodegib is used in advanced basal cell carcinoma. Which molecule does it inhibit?
- Skin tumours: Muir-Torre syndrome · Multi-stepA 55-year-old man with a colorectal carcinoma has multiple sebaceous adenomas and a sebaceous carcinoma of the eyelid. Which genetic defect is expected?
- Skin tumours: Birt-Hogg-Dube syndrome · Multi-stepA 40-year-old has multiple small dome-shaped skin-coloured papules on the face and neck, and had a spontaneous pneumothorax. CT shows basal lung cysts and a renal mass.…
- Skin tumours: naevus sebaceus · Multi-stepA teenager has a yellow-orange hairless warty plaque on the scalp present since birth that has thickened at puberty. What is the concern in later life?
- Skin tumours: giant congenital melanocytic naevus · Multi-stepA newborn has a large bathing-trunk pigmented hairy naevus with multiple satellite lesions. At 4 months he has seizures. Which complication and investigation are releva…
- Skin tumours: Brooke-Spiegler syndrome · ApplicationMultiple scalp cylindromas forming a turban tumour and trichoepitheliomas on the face with autosomal dominant inheritance are due to a mutation in:
- Skin tumours: pilomatricoma · ApplicationAn 8-year-old has a firm, stony-hard, skin-coloured nodule on the cheek that shows angular edges when the skin is stretched (tent sign). Histology would show:
- Skin tumours: glomus tumour · Multi-stepA 35-year-old woman has severe paroxysmal pain under a nail, triggered by cold and light touch, with a small bluish spot beneath the nail plate. Which diagnosis fits?
- Skin tumours: Stewart-Treves syndrome · Multi-stepA woman who had a mastectomy with axillary clearance and radiotherapy 10 years ago develops purple nodules on the chronically swollen arm. Biopsy shows malignant vascul…
- Skin tumours: morpheaform basal cell carcinoma · ApplicationA waxy, ivory-coloured, scar-like plaque with ill-defined margins on the nose of an older man recurs after simple excision. Which technique gives the lowest recurrence?
- Skin tumours: skin cancer in transplant recipients · Multi-stepA renal transplant recipient on azathioprine and prednisolone for 12 years develops multiple warty keratotic lesions on the hands. Which statement is correct about skin…
- Skin tumours: lymphomatoid papulosis · Multi-stepA 30-year-old has recurrent crops of red-brown papules that become necrotic and heal spontaneously over 6 weeks with small scars. Biopsy shows large atypical CD30-posit…
- Skin tumours: actinic cheilitis · ApplicationA 65-year-old outdoor worker has a persistently scaly, dry lower lip with loss of the vermilion border and a firm indurated area. What is the next step?
- Skin tumours: dermoscopic blue-white veil · Multi-stepDermoscopy of a pigmented lesion on the back shows an irregular blue-white veil, atypical network and irregular streaks. Which diagnosis is most worrying?
- Skin tumours: nodular melanoma · ApplicationWhich melanoma subtype has an early vertical growth phase, appears as a rapidly enlarging dome-shaped dark or pink nodule, and often has no radial growth phase?
- Skin tumours: kangri cancer · Multi-stepA 60-year-old Kashmiri man who keeps a kangri (firepot) under his clothes has a non-healing ulcerated nodule on the thigh with hyperpigmented reticulate skin around it.…
- Skin tumours: Gorlin syndrome · Multi-stepA 20-year-old has multiple basal cell carcinomas, palmar pits and odontogenic keratocysts of the jaw. Which gene is mutated?
- Skin tumours: Sezary syndrome · Multi-stepA 65-year-old has diffuse erythroderma, severe itch, generalised lymphadenopathy and cells with cerebriform nuclei in peripheral blood. What is the diagnosis?
- Skin tumours: Merkel cell carcinoma · Multi-stepA 78-year-old has a rapidly growing, painless, firm violaceous nodule on the sun-exposed cheek. Biopsy shows small blue cells with perinuclear dot-like cytokeratin 20 s…
- Skin tumours: DFSP histology · Multi-stepA firm plaque on the trunk of a young adult recurs after excision with narrow margins. Histology shows spindle cells in a storiform pattern infiltrating fat in a honeyc…
- Skin tumours: Leser-Trelat sign · Multi-stepA 68-year-old man develops many seborrhoeic keratoses over a few months, with itching and weight loss. What does this suggest?
- Skin tumours: lentigo maligna · Multi-stepA 75-year-old has a slowly enlarging irregular brown macule with variegated pigment on the cheek for 8 years. Biopsy shows atypical melanocytes along the basal layer wi…
- Skin tumours: cutaneous angiosarcoma · Multi-stepAn elderly man has a spreading bruise-like violaceous plaque with nodules and oedema on the scalp and forehead. What is the likely diagnosis?
- Skin tumours: basal cell carcinoma behaviour · ApplicationA 60-year-old has a pearly papule with rolled edge and telangiectasia on the nose. Which statement about this tumour is correct?
- Skin tumours: dermoscopic pigment network · ApplicationOn dermoscopy of a pigmented lesion in a 45-year-old, the network is thick and irregular with abrupt cut-off at the periphery and several different colours. What does t…
- Skin tumours: PD-1 inhibitors in melanoma · ApplicationA 55-year-old has metastatic melanoma without a BRAF mutation. Which class of drug acts by releasing the brake on T cells and is a standard immunotherapy?
- Skin tumours: Bowen disease treatment · ApplicationA 70-year-old has a well-demarcated, red, scaly, slowly enlarging plaque on the lower leg. Biopsy shows full-thickness epidermal atypia without invasion. Which is a sui…
- Skin tumours: xanthelasma · ApplicationA 45-year-old woman has soft, flat, yellowish plaques symmetrically on the inner aspects of both upper eyelids. What is the most appropriate first investigation?
- Skin tumours: dermoscopy of basal cell carcinoma · ApplicationA pearly nodule on the nose of an elderly farmer is examined by dermoscopy. Which finding supports a diagnosis of basal cell carcinoma?
- Skin tumours: Bazex syndrome · Multi-stepA 60-year-old smoker has violaceous psoriasiform plaques on the fingers, toes, ears and nose, with nail dystrophy, resistant to treatment. What further evaluation is mo…
- Skin tumours: atypical fibroxanthoma · Multi-stepA 78-year-old man has a rapidly enlarging, ulcerated 1.5 cm nodule on the bald scalp. Histology shows pleomorphic spindle cells with atypical mitoses. Cytokeratin, S100…
- Skin tumours: Maffucci syndrome · Multi-stepA young man has multiple soft blue-purple spindle-cell haemangiomas on the hands and multiple enchondromas causing deformity of the fingers. Which malignancy carries th…
- Skin tumours: blue rubber bleb naevus syndrome · Multi-stepA young adult has multiple soft, compressible blue nodules on the skin with a nipple-like appearance, along with iron deficiency anaemia and episodes of melaena. Which…
- Skin tumours: Sister Mary Joseph nodule · ApplicationA 62-year-old man with weight loss and abdominal distension has a firm, hard nodule in the umbilicus. Biopsy shows adenocarcinoma. What is the significance of this find…
- Skin tumours: cutaneous metastases · ApplicationWhich statement about the primary site of cutaneous metastases is correct?
- Skin tumours: biopsy of suspected melanoma · ApplicationA 1 cm irregular pigmented lesion on the back is clinically suspicious for melanoma. Which biopsy technique is preferred for diagnosis?
- Skin tumours: mammary Paget disease · ApplicationA 58-year-old woman has a unilateral, scaly, eczematous patch of the nipple and areola that has not responded to topical steroids over several months. Which step is mos…
- Skin tumours: perineural invasion in squamous cell carcinoma · Multi-stepA 70-year-old man has a recurrent cutaneous squamous cell carcinoma of the cheek with numbness and tingling over the lip. Biopsy shows tumour cells tracking around a ne…
- Skin tumours: eccrine porocarcinoma · Multi-stepAn elderly man has a slowly enlarging, ulcerated, friable nodule on the lower leg that arose in a long-standing small papule. Histology shows ductal differentiation wit…
- Skin tumours: desmoplastic melanoma · Multi-stepA 72-year-old has a scar-like, firm, amelanotic plaque on the sun-damaged cheek that recurred locally after excision. Histology shows spindle cells in a fibrous stroma…
- Skin tumours: granular cell tumour · Multi-stepA 35-year-old woman has a firm painless nodule on the tongue. Histology shows polygonal cells with abundant eosinophilic granular cytoplasm containing PAS-positive, dia…
- Skin tumours: topical therapy of superficial basal cell carcinoma · ApplicationA 55-year-old man has a 1.5 cm pink scaly patch on the trunk, and biopsy shows superficial basal cell carcinoma. He declines surgery. Which topical agent is appropriate?
- Skin tumours: Cowden syndrome · ApplicationA woman has multiple facial trichilemmomas, cobblestone papules of the oral mucosa, macrocephaly, thyroid goitre and fibrocystic breast disease. Which gene is mutated?
- Skin tumours: plexiform neurofibroma · ApplicationA child with NF1 has a soft, ropey, bag-of-worms swelling of the eyelid and temple with overlying hyperpigmentation. Which lesion is this, and what is its main risk?
- Skin tumours: hereditary leiomyomatosis and renal cell cancer · Multi-stepA woman with multiple painful grouped red-brown cutaneous papules (leiomyomas) also has early-onset uterine fibroids. Which screening is most important?
- Skin tumours: ultraviolet carcinogenesis · ApplicationChronic sun exposure is the main cause of cutaneous squamous cell carcinoma. Which DNA lesion is the characteristic signature of UV damage?
- Skin tumours: systemic mastocytosis mutation · ApplicationAn adult has persistent red-brown macules that become urticarial on stroking and a raised serum tryptase. Which mutation is found in most adults with systemic disease?
- Skin tumours: Kaposi sarcoma in AIDS · Multi-stepAn HIV positive man with CD4 count of 60 per microlitre has a few cutaneous Kaposi sarcoma plaques and no visceral disease. What is the first step in management?
- Skin tumours: sebaceous carcinoma of the eyelid · Multi-stepA 68-year-old woman has had a firm eyelid nodule diagnosed as chalazion that recurred twice at the same site after curettage, with madarosis of the adjacent lashes. Wha…
- Skin tumours: dermoscopy of seborrhoeic keratosis · ApplicationDermoscopy of a brown stuck-on plaque on the back shows milia-like cysts, comedo-like openings and brain-like fissures and ridges. What is the diagnosis?
- Skin tumours: infantile haemangioma marker · ApplicationAn infant has a bright red raised lesion that appeared at 3 weeks and is growing. Which immunohistochemical marker distinguishes this tumour from vascular malformations?
- Skin tumours: cutaneous T-cell lymphoma staging therapy · Multi-stepA 50-year-old has scaly erythematous patches on the buttocks and thighs for years, and biopsy shows epidermotropic atypical T cells. There are no plaques, tumours or no…
- Skin tumours: squamous cell carcinoma prevention in transplant recipients · Multi-stepA renal transplant recipient on tacrolimus, azathioprine and prednisolone develops multiple actinic keratoses and a second squamous cell carcinoma. Which change in mana…
STI62
- STI: NACO syndromic care, urethral discharge · ApplicationA man presents with urethral discharge and dysuria. Under NACO syndromic management, which colour-coded kit is issued?
- STI: NACO syndromic care, vaginal discharge · ApplicationA woman presents with vaginal discharge and risk factors for cervicitis. Which kit is used under NACO syndromic care, covering gonorrhoea, chlamydia, trichomonas, bacte…
- STI: NACO syndromic care, genital ulcer · ApplicationA man has a painless genital ulcer with no vesicles. Which kit is used for non-herpetic genital ulcer disease, covering syphilis and chancroid?
- STI: NACO syndromic care, herpetic ulcer · ApplicationA woman has grouped painful vesicles and shallow ulcers on the vulva. Which drug regimen is used in the NACO kit for herpetic genital ulcers?
- STI: biological false positive VDRL · ApplicationA woman with recurrent miscarriages and venous thrombosis has a reactive VDRL, but the TPHA is nonreactive. Which condition explains this?
- STI: prozone phenomenon · Multi-stepA patient has a generalised rash with palmar lesions typical of secondary syphilis, yet the undiluted VDRL is nonreactive. What is the explanation?
- STI: syphilis serology after treatment · ApplicationWhich statement about serological tests for syphilis is correct?
- STI: tertiary syphilis · ApplicationA patient has a painless, punched-out ulcer with a wash-leather base on the leg and a positive treponemal test, some years after untreated infection. What is the lesion?
- STI: neurosyphilis · ApplicationA man with lightning pains, ataxia with loss of position sense and small pupils that accommodate but do not react to light has a reactive CSF-VDRL. What is the diagnosis?
- STI: congenital syphilis · ApplicationWhich triad is characteristic of late congenital syphilis?
- STI: early congenital syphilis · ApplicationA 3-week-old infant has persistent bloody nasal discharge, vesicobullous lesions on the palms and soles and hepatosplenomegaly. What is the likely diagnosis?
- STI: treatment of syphilis · ApplicationWhat is the recommended treatment of early (primary) syphilis in a nonpregnant adult?
- STI: treatment of neurosyphilis · Multi-stepWhich regimen is appropriate for neurosyphilis?
- STI: Jarisch-Herxheimer reaction · ApplicationWithin hours of the first penicillin injection for secondary syphilis, a patient develops fever, chills, myalgia and exacerbation of the rash. What is this reaction?
- STI: syphilis in pregnancy · ApplicationA pregnant woman with early syphilis reports penicillin allergy. What is the recommended management?
- STI: lymphogranuloma venereum · ApplicationA man has tender unilateral inguinal lymph nodes separated by the inguinal ligament, forming a groove, several weeks after a painless transient genital papule. Which tr…
- STI: genital herpes · ApplicationA man with genital herpes has had 7 recurrences in the last year, which are distressing. What is the recommended management?
- STI: anogenital warts in pregnancy · ApplicationA pregnant woman has extensive genital warts. Which treatment option is appropriate?
- STI: bowenoid papulosis · Multi-stepA young sexually active man has multiple small, pigmented, flat-topped papules on the penile shaft. Biopsy shows full-thickness atypia resembling carcinoma in situ, but…
- STI: giant condyloma · Multi-stepAn uncircumcised man has a large, locally destructive, cauliflower-like penile tumour caused by HPV 6 and 11, with deep invasion but no metastasis. What is the diagnosis?
- STI: treatment of gonorrhoea · ApplicationWhich regimen is the preferred treatment of uncomplicated gonococcal urethritis in most guidelines because of widespread quinolone resistance?
- STI: disseminated gonococcal infection · Multi-stepA sexually active woman has fever, migratory polyarthralgia, tenosynovitis of the wrist and a few acral pustules on an erythematous base. Which statement is correct?
- STI: ophthalmia neonatorum · ApplicationA neonate develops copious purulent conjunctival discharge on day 3 of life. Which organism is most likely?
- STI: nongonococcal urethritis · ApplicationA man has mucoid urethral discharge with mild dysuria and no gonococci on Gram stain. What is the first-line treatment of this nongonococcal urethritis?
- STI: reactive arthritis · ApplicationA young man develops asymmetric knee arthritis, conjunctivitis and urethritis three weeks after a genital infection. Which HLA antigen is associated?
- STI: Mycoplasma genitalium · Multi-stepA man has persistent urethritis after a course of doxycycline for presumed chlamydia, and tests for gonorrhoea and chlamydia are negative. Which organism, lacking a cel…
- STI: pelvic inflammatory disease · Multi-stepA woman with PID develops right upper quadrant pain with pleuritic features, and laparoscopy shows violin-string adhesions between the liver capsule and the anterior ab…
- STI: epididymo-orchitis · ApplicationA 24-year-old sexually active man has acute unilateral scrotal pain and swelling with urethral discharge. Which organisms are most likely?
- STI: erythroplasia of Queyrat · Multi-stepAn uncircumcised man has a persistent, well-demarcated, velvety red plaque on the glans penis unresponsive to antifungals. Biopsy shows full-thickness epidermal dysplas…
- STI: HIV skin manifestations · Multi-stepAn HIV positive patient with a CD4 count of 120 has intensely itchy, urticarial follicular papules on the face, neck and upper trunk, with peripheral eosinophilia and r…
- STI: HPV vaccine types · ApplicationWhich HPV types are covered by the nonavalent vaccine?
- STI: scope of HPV vaccination · ApplicationA 24-year-old woman with genital warts asks whether HPV vaccination will remove them. What is correct?
- STI: Bartholin abscess · ApplicationA woman has a tender, fluctuant swelling at the 5 o'clock position of the vaginal introitus and fever. What is the most appropriate treatment?
- STI: malignant syphilis · Multi-stepAn HIV-positive man has fever and widespread necrotic ulcerated nodules with rupioid crusts. VDRL is strongly reactive at high titre. Which diagnosis fits?
- STI: Clutton joints · ApplicationA 10-year-old with interstitial keratitis and saddle nose has painless symmetrical knee effusions. These are called:
- STI: phthiriasis palpebrarum · Multi-stepA 6-year-old has itchy eyelid margins with tiny brown crawling insects and nits on the eyelashes. What is the best treatment?
- STI: neonatal herpes prevention · Multi-stepA woman at 38 weeks has a first episode of genital herpes with active lesions at the onset of labour. What is the best obstetric management to reduce neonatal infection?
- STI: monitoring response to syphilis treatment · Multi-stepA patient treated for early syphilis returns at 6 months. Which finding indicates an adequate serological response?
- STI: HIV and seborrhoeic dermatitis · ApplicationA young man has severe, extensive seborrhoeic dermatitis resistant to usual therapy and recurrent oral thrush. Which test is most appropriate?
- STI: HIV post-exposure prophylaxis timing · ApplicationA healthcare worker has a needle-stick injury from a known HIV-positive patient. Within what time should post-exposure prophylaxis ideally be started?
- STI: reactive arthritis skin signs · Multi-stepA young man with recent urethritis develops asymmetric knee arthritis, conjunctivitis and hyperkeratotic pustular plaques on the soles. What are the sole lesions called?
- STI: early latent syphilis · ApplicationA blood donor has reactive VDRL and TPHA with no symptoms. A negative test was documented 8 months ago. How is the stage classified?
- STI: pseudobubo of donovanosis · ApplicationA man with a chronic painless, beefy-red genital ulcer develops a fluctuant swelling in the groin, but the swelling is subcutaneous granulation tissue and not an enlarg…
- STI: treatment of chancroid · ApplicationA man has multiple soft, painful genital ulcers with a tender inguinal bubo. Which single-dose regimen treats chancroid?
- STI: management of a chancroid bubo · Multi-stepA man with chancroid has a tender, fluctuant inguinal bubo that threatens to rupture despite antibiotics. Which approach is preferred?
- STI: mucous patches of secondary syphilis · ApplicationA young adult has a symmetric coppery rash on the trunk and palms and painless greyish-white superficial erosions on the tongue and buccal mucosa. What are the oral les…
- STI: radiological sign of congenital syphilis · ApplicationA radiograph of a neonate born to an untreated mother shows bilateral symmetric destruction of the medial upper tibial metaphyses. What is this sign called?
- STI: treatment of late latent syphilis · ApplicationA patient has reactive treponemal and non-treponemal tests, no symptoms, and no documentation of when the infection was acquired. How is he treated?
- STI: meningovascular syphilis · Multi-stepA 38-year-old man treated inadequately for a genital sore years ago develops sudden hemiparesis. CSF shows lymphocytic pleocytosis, raised protein and a reactive VDRL.…
- STI: general paresis · ApplicationA 50-year-old man with untreated syphilis has progressive memory loss, grandiose delusions, tremors of the lips and tongue, and Argyll Robertson pupils. What is the dia…
- STI: histology of syphilis · Multi-stepA biopsy from a firm, painless genital ulcer shows a dense perivascular infiltrate of plasma cells and lymphocytes with swelling of the endothelium and narrowing of sma…
- STI: recurrent versus primary genital herpes · ApplicationHow does a recurrent episode of genital herpes differ from the first primary episode?
- STI: urinary retention in primary genital herpes · Multi-stepA woman with a first episode of genital herpes develops difficulty in passing urine, perineal numbness and constipation. What is the mechanism?
- STI: oncoproteins of high-risk HPV · ApplicationBy which mechanism do the oncoproteins of high-risk HPV types contribute to cervical and anogenital cancer?
- STI: koilocytes in condyloma · ApplicationA biopsy of a cauliflower-like perianal growth shows acanthosis, papillomatosis and keratinocytes with perinuclear clearing and wrinkled, hyperchromatic nuclei. What ar…
- STI: post-gonococcal urethral stricture · Multi-stepA man treated inadequately for a purulent urethral discharge years ago now has a thin, deflected urinary stream and incomplete emptying. A urethrogram shows a fixed nar…
- STI: neonatal chlamydial conjunctivitis · Multi-stepA 10-day-old neonate has mucopurulent conjunctivitis. Gram stain shows no organisms, and Giemsa stain shows basophilic intracytoplasmic inclusions in epithelial cells.…
- STI: chlamydia in pregnancy · ApplicationA woman at 20 weeks of pregnancy has chlamydial cervicitis. Which drug is preferred?
- STI: Amsel criteria · ApplicationWhich finding is not part of the Amsel criteria for diagnosing bacterial vaginosis?
- STI: vaginal pH in common vaginitis · ApplicationWhich pair of vaginal infections characteristically raises the vaginal pH above 4.5?
- STI: HIV diagnosis in an exposed infant · ApplicationAn asymptomatic 8-month-old infant born to a mother with HIV has a reactive HIV antibody test. Which test confirms infection in the infant?
- STI: mode of delivery with genital warts · Multi-stepA woman at 38 weeks has extensive but non-obstructing genital warts. What is the appropriate mode of delivery?
Pigmentary disorders55
- Pigmentary disorders · ApplicationA man has well-demarcated chalk-white macules on his hands and around his mouth. A skin biopsy shows an absence of melanocytes. What is the diagnosis?
- Pigmentary disorders · ApplicationA woman has symmetrical brown patches over the cheeks and forehead. Under Wood's lamp, which finding indicates that the pigment is mainly epidermal?
- Pigmentary disorders: vitiligo surgery · Multi-stepWhich condition is essential before offering melanocyte transplantation surgery for vitiligo?
- Pigmentary disorders: phototherapy · ApplicationWhich wavelength of phototherapy is the preferred modality for generalised vitiligo?
- Pigmentary disorders: albinism · ApplicationA child has white hair, pink skin, nystagmus and photophobia, with a normal number of melanocytes. Which enzyme defect underlies the commonest type, OCA1?
- Pigmentary disorders: piebaldism · Multi-stepA boy has a white forelock and symmetric depigmented patches on the abdomen and limbs since birth, with islands of normal pigment inside them. Which gene is mutated?
- Pigmentary disorders: nevus of Ota · ApplicationAn Asian woman has a unilateral blue-grey patch over the periorbital area and cheek with pigmentation of the sclera. Which treatment is effective?
- Pigmentary disorders: Addison disease · ApplicationA woman with fatigue, hypotension and hyperpigmentation of the palmar creases, buccal mucosa and scars has low cortisol. What explains the pigmentation?
- Pigmentary disorders: ochronosis · Multi-stepA man has blue-black pigmentation of the ear cartilage and sclerae, dark urine on standing and early degenerative spinal arthritis. Which metabolite accumulates?
- Pigmentary disorders: Peutz-Jeghers syndrome · ApplicationA child has dark brown macules on the lips and buccal mucosa with recurrent intussusception from intestinal polyps. Which gene is mutated?
- Pigmentary disorders: lichen planus pigmentosus · Multi-stepA 35-year-old Indian woman has slowly progressive, asymptomatic, ill-defined slate-brown macules on the face and neck, with no preceding scaling or blisters. Biopsy sho…
- Pigmentary disorders: naevus depigmentosus · Multi-stepA 3-year-old has a well-defined, stable, hypopigmented patch on the trunk present since birth, with normal sensation and no leukotrichia. Its size has grown only in pro…
- Pigmentary disorders: tranexamic acid in melasma · ApplicationWhich patient should NOT receive oral tranexamic acid for refractory melasma?
- Pigmentary disorders: Becker naevus · Multi-stepA 15-year-old boy notices a unilateral, irregular brown patch with coarse dark hair on the shoulder and upper chest that became prominent after puberty. What is it?
- Pigmentary disorders: Riehl melanosis · ApplicationA woman using a fragrance-containing facial cream develops slowly progressive, reticulated grey-brown pigmentation on the forehead and temples, with minimal itching. Wh…
- Pigmentary disorders: erythema dyschromicum perstans · Multi-stepA 28-year-old has multiple oval ash-grey macules on the trunk and limbs, some with a thin erythematous raised rim in early lesions, over 8 months with no itch. Which dr…
- Pigmentary disorders: halo naevus · ApplicationA 14-year-old has a brown mole on the back surrounded by a symmetrical ring of depigmented skin. What should be done?
- Pigmentary disorders: monobenzone · ApplicationFor which situation is monobenzyl ether of hydroquinone (monobenzone) used in vitiligo?
- Pigmentary disorders: topical calcineurin inhibitors in vitiligo · ApplicationAn alternative to topical steroids for facial and neck vitiligo, which avoids skin atrophy, is:
- Pigmentary disorders: targeted excimer phototherapy · ApplicationWhich phototherapy modality delivers 308 nm light selectively to small localised vitiligo patches?
- Pigmentary disorders: Chediak-Higashi syndrome · Multi-stepA child has silvery-grey hair, partial oculocutaneous albinism, recurrent pyogenic infections and giant cytoplasmic granules in leukocytes. Which gene is defective?
- Pigmentary disorders: Hermansky-Pudlak syndrome · Multi-stepAn albino patient reports easy bruising and prolonged bleeding after dental extraction. Platelet count is normal and platelet aggregation shows a storage pool defect. W…
- Pigmentary disorders: naevus spilus · ApplicationA tan background patch speckled with darker small macules and papules on the trunk, present since childhood, is called:
- Pigmentary disorders: naevus anaemicus · Multi-stepA child has a pale patch on the chest that becomes indistinct when the skin is rubbed, and the surrounding skin flushes but the patch stays pale. Diascopy erases the bo…
- Pigmentary disorders: Kligman formula in melasma · ApplicationA 35-year-old woman has symmetrical centrofacial melasma. A triple combination cream containing a depigmenting agent, a retinoid and a mild steroid is prescribed. What…
- Pigmentary disorders: oral mini-pulse in vitiligo · ApplicationA 25-year-old has rapidly spreading vitiligo over the trunk and limbs, with new patches appearing every week. Which treatment can help to arrest rapid progression?
- Pigmentary disorders: Hori naevus · ApplicationA 35-year-old Asian woman has bilateral blue-grey-brown speckled macules over the cheeks, with no mucosal involvement and onset in adult life. What is the likely diagno…
- Pigmentary disorders: trichrome vitiligo · ApplicationA patient with vitiligo has patches with three colours: white, tan and normal brown skin in between. What does this pattern signify?
- Pigmentary disorders: albinism and skin cancer · Multi-stepA 25-year-old farm worker in India with oculocutaneous albinism has a scaly crusted ulcerated nodule on the sun-exposed scalp. What is the most likely diagnosis?
- Pigmentary disorders: Rothmund-Thomson syndrome · Multi-stepAn infant develops facial erythema that evolves into poikiloderma on the face and limbs. Later there are sparse hair, juvenile cataracts, short stature and an osteosarc…
- Pigmentary disorders: Cockayne syndrome · Multi-stepA child with cachectic dwarfism, deafness, pigmentary retinopathy and intellectual disability has severe sunburn on minimal exposure. Skin cancers have not developed. W…
- Pigmentary disorders: Dowling-Degos disease · Multi-stepA woman has had progressive reticulate brown hyperpigmentation of the axillae, groins and neck folds since adolescence, with comedo-like pitted scars on the back. Sever…
- Pigmentary disorders: confluent and reticulated papillomatosis · Multi-stepAn overweight young adult has asymptomatic brown reticulated papules coalescing into plaques on the chest and between the shoulder blades. KOH is negative and antifunga…
- Pigmentary disorders: congenital erythropoietic porphyria · Multi-stepA newborn has red-stained urine in the diaper and, over months, blistering of sun-exposed skin with mutilating scarring. The teeth fluoresce red under Wood lamp, and he…
- Pigmentary disorders: Carney complex · Multi-stepA young woman has facial lentigines, epithelioid blue naevi, an atrial myxoma and primary pigmented nodular adrenocortical disease. Which gene is most often mutated?
- Pigmentary disorders: McCune-Albright syndrome · Multi-stepA 7-year-old girl has vaginal bleeding with breast development, a large café-au-lait macule with a jagged border that stops at the midline, and a polyostotic bone lesio…
- Pigmentary disorders: Laugier-Hunziker syndrome · ApplicationA 45-year-old woman has multiple asymptomatic brown macules on the lips and buccal mucosa, with longitudinal brown streaks in several nails. She has no gastrointestinal…
- Pigmentary disorders: haemochromatosis pigmentation · ApplicationA 50-year-old man has a diffuse bronze-grey skin colour, diabetes mellitus and a firm enlarged liver. Which statement about the pigmentation is correct?
- Pigmentary disorders: Waardenburg syndrome · ApplicationA newborn has a white forelock, irides of two different colours, a broad nasal root with lateral displacement of the inner canthi, and fails the hearing screen. Which g…
- Pigmentary disorders: Griscelli syndrome · Multi-stepA child with a silvery-grey sheen of the hair has recurrent pyogenic infections and an episode of fever with pancytopenia and haemophagocytosis. Hair shaft microscopy s…
- Pigmentary disorders: phytophotodermatitis · ApplicationA bartender squeezes limes outdoors in bright sun. A day later he has linear streaky erythema and blisters on the hands that heal with brown streaky pigmentation. Which…
- Pigmentary disorders: berloque dermatitis · ApplicationAfter dabbing perfume on her neck and sitting in the sun, a woman develops mild erythema followed by a pendant-shaped band of brown pigmentation on the side of the neck…
- Pigmentary disorders: LEOPARD syndrome · ApplicationA child has numerous flat dark-brown lentigines over the face and trunk, widely spaced eyes, pulmonary valve stenosis and sensorineural deafness. Which gene is most com…
- Pigmentary disorders: MC1R and pheomelanin · ApplicationA man with red hair and fair freckled skin that burns and never tans has a higher lifetime melanoma risk. Which change in melanin synthesis underlies this phenotype?
- Pigmentary disorders: vitiligo and thyroid disease · ApplicationA 30-year-old woman with generalized vitiligo reports fatigue, cold intolerance and weight gain. Which associated disorder should be looked for first?
- Pigmentary disorders: immune pathway in vitiligo · Multi-stepTopical ruxolitinib can repigment active nonsegmental vitiligo. Which pathway in the disease does it block?
- Pigmentary disorders: exogenous ochronosis · ApplicationA woman applied 4 percent hydroquinone to melasma continuously for several years. She now has blue-black sooty macules and papules over the cheeks. Alkaptonuria is excl…
- Pigmentary disorders: hypomelanosis of Ito · Multi-stepA 2-year-old has whorled and streaky hypopigmented macules along Blaschko lines on the trunk and limbs, together with seizures and developmental delay. Which explanatio…
- Pigmentary disorders: poikiloderma of Civatte · ApplicationA fair-skinned 62-year-old woman has reticulate red-brown pigmentation with telangiectasia and fine atrophy on the lateral neck and upper chest, but the skin under the…
- Pigmentary disorders: dyskeratosis congenita · Multi-stepA boy has reticulate grey-brown pigmentation of the neck and chest, dystrophic nails and oral leukoplakia, and later develops bone marrow failure. Which mechanism under…
- Pigmentary disorders: chemical leukoderma · ApplicationA rubber factory worker has depigmented patches on the hands and forearms, then new satellite macules at distant sites, resembling vitiligo. Exposure to which compounds…
- Pigmentary disorders: cobalamin deficiency · ApplicationA strict vegetarian has fatigue, sore red tongue and bluish-brown hyperpigmentation of the knuckles and palmar creases. Blood film shows macrocytosis and hypersegmented…
- Pigmentary disorders: Vogt-Koyanagi-Harada disease · Multi-stepA 35-year-old develops bilateral uveitis with headache, tinnitus and neck stiffness. Weeks later she has patchy poliosis of the eyelashes and depigmented patches on the…
- Pigmentary disorders · ApplicationWhich disorder causes sharply demarcated depigmented patches that fluoresce under Wood lamp?
- Pigmentary disorders · ApplicationWhat is a common trigger for post-inflammatory hyperpigmentation?
Drug reactions47
- Drug reactions · ApplicationWhich of the following drugs is a well-recognised trigger of Stevens–Johnson syndrome and toxic epidermal necrolysis?
- Drug reactions · Multi-stepOn the fourth day after starting warfarin for a deep vein thrombosis without heparin cover, an obese woman develops painful red-purple patches on her breasts and thighs…
- Drug reactions: severe cutaneous reactions · ApplicationTwo weeks after starting allopurinol, a woman has fever, painful skin and widespread blistering with mucosal erosions. Skin detachment involves about 40% of the body su…
- Drug reactions: AGEP · ApplicationTwo days after starting amoxicillin, a patient has fever, neutrophilia and numerous tiny non-follicular sterile pustules on an erythematous base in the flexures. What i…
- Drug reactions: HLA association with carbamazepine · ApplicationBefore starting carbamazepine in an Asian patient, which HLA allele is screened for to reduce the risk of Stevens-Johnson syndrome?
- Drug reactions: allopurinol hypersensitivity · Multi-stepWhich HLA allele is linked to severe cutaneous reactions with allopurinol, especially in Han Chinese, Thai and Korean patients with renal impairment?
- Drug reactions: warfarin necrosis · Multi-stepOn day 4 of warfarin initiation without heparin cover, a woman has painful red patches on the breasts and thighs that turn into haemorrhagic necrosis. What is the mecha…
- Drug reactions: EGFR inhibitors · ApplicationA lung cancer patient on erlotinib develops papulopustular lesions on the face and upper trunk without comedones. What is the explanation and management?
- Drug reactions: amiodarone · ApplicationA patient on long-term amiodarone has slate-grey discolouration of sun-exposed skin. Which statement is correct?
- Drug reactions: toxic epidermal necrolysis · ApplicationHow is toxic epidermal necrolysis distinguished from Stevens-Johnson syndrome by extent of body surface area detachment?
- Drug reactions: hand-foot syndrome · ApplicationA patient on capecitabine has painful erythema, swelling and peeling of the palms and soles. What is this reaction called?
- Drug reactions: morbilliform drug eruption · Multi-stepA boy is started on amoxicillin for sore throat and 8 days later develops a symmetrical blanching erythematous macular and papular rash on the trunk with no fever, muco…
- Drug reactions: doxycycline photo-onycholysis · ApplicationA woman on doxycycline for acne notices painless separation of several nails from the distal nail bed after a holiday in the sun. What is this reaction?
- Drug reactions: drug-induced lupus · ApplicationA man on hydralazine for hypertension develops arthralgia, fever and a positive ANA with antibodies to histones, but anti-dsDNA is negative. What is expected after stop…
- Drug reactions: minocycline pigmentation · ApplicationA woman treated with minocycline for acne for 3 years has blue-grey discolouration of the shins and old acne scars. Which statement is correct?
- Drug reactions: BRAF inhibitor cutaneous effects · Multi-stepA patient with metastatic melanoma on vemurafenib develops multiple rapidly growing crateriform keratotic lesions and a cutaneous squamous cell carcinoma. What is the m…
- Drug reactions: argyria · ApplicationA man who has taken a colloidal silver preparation for years develops slate-grey pigmentation of the face and hands, accentuated in sun-exposed areas. Which is the diag…
- Drug reactions: serum sickness-like reaction · Multi-stepA 4-year-old develops fever, an urticarial rash and joint pains 8 days after starting cefaclor. Urine and complement levels are normal. What is the diagnosis?
- Drug reactions: drug-induced urticaria mechanism · ApplicationMinutes after an intramuscular penicillin injection a patient develops itchy wheals and lip swelling. What type of hypersensitivity is this?
- Drug reactions: hydroxychloroquine retinal screening · Multi-stepA woman with discoid lupus has taken hydroxychloroquine for 6 years. Which routine monitoring is most important?
- Drug reactions: SCORTEN · Multi-stepA clinician wants to estimate mortality in a patient with toxic epidermal necrolysis at admission. Which tool is used?
- Drug reactions: bleomycin pigmentation · ApplicationA patient on chemotherapy develops linear, whip-like hyperpigmented streaks on the trunk after scratching. Which drug is the likely cause?
- Drug reactions: chronic arsenic exposure · Multi-stepA farmer from an arsenic-contaminated groundwater region has punctate palmar keratoses, raindrop pigmentation on the trunk and a non-healing scaly plaque. What is the g…
- Drug reactions: fluorouracil supravenous pigmentation · ApplicationA woman receiving an infusional regimen of fluorouracil develops dark linear bands over the veins used for the infusion. What is this called?
- Drug reactions: neomycin contact allergy · ApplicationA man applies a neomycin-containing ointment to a leg ulcer. The surrounding skin becomes red, weeping and itchy and the ulcer worsens despite the ointment. What is the…
- Drug reactions: hydroxychloroquine pigmentation · ApplicationA woman with lupus on long-term hydroxychloroquine has blue-grey patches on the shins and the hard palate. Which is the likely cause?
- Drug reactions: propylene glycol in topical minoxidil · Multi-stepA man on 5 percent topical minoxidil develops an itchy, red, scaly scalp. Patch testing shows allergy to the vehicle and not to minoxidil itself. Which component is the…
- Drug reactions: hydroxyurea cutaneous effects · ApplicationA 60-year-old man with polycythaemia vera has taken a cytoreductive antimetabolite for six years. He now has painful ulcers around both ankles, atrophic skin and violac…
- Drug reactions: Nicolau syndrome · ApplicationMinutes after an intramuscular diclofenac injection in the buttock, a patient has severe pain. A livedoid violaceous patch appears and over days becomes a necrotic ulce…
- Drug reactions: levamisole-adulterated cocaine · Multi-stepA young man who uses cocaine presents with painful purpuric plaques with a retiform pattern on the ears and cheeks, with neutropenia and positive p-ANCA. Which adultera…
- Drug reactions: lamotrigine and valproate · Multi-stepA 12-year-old with epilepsy on sodium valproate has lamotrigine added at a standard adult starting dose and rapid increases. Ten days later she has fever, mucosal erosi…
- Drug reactions: imatinib cutaneous effects · ApplicationA patient with chronic myeloid leukaemia on imatinib develops periorbital oedema, a mild generalised rash and patches of hypopigmentation of the skin. Which pathway inh…
- Drug reactions: corticosteroid-induced acne · ApplicationA man started on high-dose oral prednisolone for nephrotic syndrome develops, within two weeks, an abrupt crop of uniform red papules and pustules on the chest and back…
- Drug reactions: voriconazole photosensitivity · Multi-stepA lung transplant recipient on long-term voriconazole develops severe sunburn-like reactions and, over the years, multiple scaly keratotic lesions on the face and hands…
- Drug reactions: granulysin in SJS/TEN · Multi-stepWidespread keratinocyte death occurs in Stevens-Johnson syndrome and toxic epidermal necrolysis. Which mediator released by cytotoxic T cells and NK cells is largely re…
- Drug reactions: nevirapine rash · ApplicationA woman with HIV is to start a nevirapine-based regimen. Which approach reduces the risk of severe rash and hepatotoxicity?
- Drug reactions: checkpoint inhibitor depigmentation · Multi-stepA patient with metastatic melanoma on pembrolizumab develops symmetric depigmented patches on the trunk and hands. What does this finding usually imply?
- Drug reactions: NSAID-exacerbated cutaneous disease · Multi-stepA man with chronic rhinosinusitis, nasal polyps and asthma develops urticaria and wheeze after taking an NSAID. Which mechanism underlies this?
- Drug reactions: allopurinol hypersensitivity prevention · Multi-stepA 70-year-old with stage 4 chronic kidney disease is started on allopurinol at a standard full dose. Five weeks later he has fever, rash, eosinophilia and hepatitis. Wh…
- Drug reactions: cross-reactivity of antiepileptics · ApplicationA patient had DRESS syndrome on carbamazepine. Which antiepileptic is most likely to cross-react and should be avoided?
- Drug reactions: hypersensitivity vasculitis · ApplicationEight days after starting a beta-lactam antibiotic, a man has palpable purpura on the legs. Biopsy shows neutrophil infiltration with nuclear dust and fibrinoid change…
- Drug reactions: heparin-induced skin necrosis · Multi-stepOn day 7 of subcutaneous heparin, a patient develops painful erythematous plaques at the injection sites that turn necrotic, and the platelet count falls from 250,000 t…
- Drug reactions: drug-induced subacute cutaneous lupus · Multi-stepA 62-year-old woman on hydrochlorothiazide develops annular scaly photodistributed plaques on the upper trunk and arms. Anti-Ro (SSA) antibodies are positive and anti-d…
- Drug reactions: chemotherapy-induced alopecia · ApplicationTwo weeks after the first cycle of doxorubicin-based chemotherapy, a woman has diffuse hair loss, with tapered broken hairs. Which type of hair loss is this?
- Drug reactions: toxic epidermal necrolysis eye care · Multi-stepA patient with toxic epidermal necrolysis has conjunctival erosions and early pseudomembrane formation. Which measure best reduces long-term ocular sequelae?
- Drug reactions · ApplicationWhat life-threatening blistering skin reaction requires immediate specialist care?
- Drug reactions · ApplicationWhat feature is a red flag for severe cutaneous drug reaction?
Vesiculobullous disorders34
- Vesiculobullous disorders · ApplicationA middle-aged man has flaccid blisters and painful oral erosions. A biopsy shows suprabasal acantholysis. What is the expected direct immunofluorescence finding on peri…
- Vesiculobullous disorders: pemphigus vegetans · ApplicationA patient has vegetating, papillomatous plaques with pustules in the axillae and groins that evolved from flaccid erosions. DIF shows intercellular IgG. Which variant o…
- Vesiculobullous disorders: paraneoplastic pemphigus antigens · Multi-stepA 62-year-old with non-Hodgkin lymphoma has intractable painful stomatitis and polymorphic skin lesions with blisters and target-like lesions. Indirect immunofluorescen…
- Vesiculobullous disorders: drug-induced pemphigus · ApplicationWhich drug is the classic cause of drug-induced pemphigus, typically pemphigus foliaceus-like, via its thiol group?
- Vesiculobullous disorders: gliptin-associated pemphigoid · Multi-stepA 72-year-old man with diabetes has taken vildagliptin for 8 months. He now has tense bullae on the trunk and limbs with itching. Biopsy shows a subepidermal split and…
- Vesiculobullous disorders: bullosis diabeticorum · Multi-stepA man with long-standing diabetes develops several tense, non-inflamed blisters on the dorsum of the feet overnight without trauma. The blister fluid is sterile. What i…
- Vesiculobullous disorders: bullous systemic lupus erythematosus · Multi-stepA woman with SLE develops tense subepidermal blisters on sun-exposed skin that respond dramatically to dapsone. Which antigen is the main target?
- Vesiculobullous disorders: dystrophic epidermolysis bullosa protein · ApplicationA 3-year-old has blisters on the hands and knees that heal with scarring, milia and loss of nails, and the fingers are starting to fuse together. Which structural prote…
- Vesiculobullous disorders: complication of recessive dystrophic epidermolysis bullosa · Multi-stepA 28-year-old man with severe recessive dystrophic epidermolysis bullosa since childhood develops a nonhealing, indurated, ulcerated nodule on a chronically scarred for…
- Vesiculobullous disorders: azathioprine and TPMT · Multi-stepA patient with pemphigus vulgaris is to start azathioprine as a steroid-sparing agent. Which test should be done first to reduce the risk of severe myelosuppression?
- Vesiculobullous disorders: hepatitis B screening before rituximab · Multi-stepA 40-year-old with refractory pemphigus vulgaris is planned for rituximab. Which check is essential beforehand because of a risk of fulminant reactivation?
- Vesiculobullous disorders: BP180 NC16A ELISA in bullous pemphigoid · ApplicationA 75-year-old with bullous pemphigoid on treatment has anti-BP180 NC16A antibodies measured serially. What does a falling titre indicate?
- Vesiculobullous disorders: fluid management in toxic epidermal necrolysis · Multi-stepA 40-year-old with toxic epidermal necrolysis involving 60 percent of the body surface is transferred to a burn unit. Compared with a patient with a thermal burn of sim…
- Vesiculobullous disorders: hydroa vacciniforme · ApplicationA 7-year-old boy develops tense, umbilicated vesicles on the cheeks, nose and ears after each sunny season. They crust and heal with pock-like scars. Porphyrin levels a…
- Vesiculobullous disorders: localised epidermolysis bullosa simplex · ApplicationA recruit has tense blisters on the soles after long route marches in summer. He has had the same problem since childhood and his father is affected. There is no mucosa…
- Vesiculobullous disorders: Kindler syndrome · Multi-stepAn infant has acral blistering that heals into poikiloderma over the years, with photosensitivity, fragile gums and webbing of the fingers. Which gene is mutated?
- Vesiculobullous disorders: IgA pemphigus · Multi-stepA 50-year-old has flaccid pustules arranged in rings on the trunk and flexures. Biopsy shows subcorneal neutrophils with little acantholysis. Direct immunofluorescence…
- Vesiculobullous disorders: HLA association in dermatitis herpetiformis · ApplicationA 30-year-old has intensely itchy grouped vesicles and excoriations over the elbows, knees and buttocks. Biopsy of perilesional skin shows granular IgA deposits at the…
- Vesiculobullous disorders: dressings in epidermolysis bullosa · ApplicationA newborn with recessive dystrophic epidermolysis bullosa has widespread erosions at friction sites. Which dressing approach is most appropriate for the open wounds?
- Vesiculobullous disorders: coma blisters · Multi-stepA young man is found unconscious after a drug overdose and later develops tense bullae over the ankles, wrists and buttocks, which were in contact with the floor. Biops…
- Vesiculobullous disorders: lymphangioma circumscriptum · ApplicationA child has had clusters of clear, frogspawn-like vesicles on the shoulder since infancy, some turning dark red or black from bleeding into them. Which pathology underl…
- Vesiculobullous disorders: pemphigus erythematosus · Multi-stepA woman has crusted, scaly erythematous plaques over the malar area and seborrhoeic zones of the chest and scalp, with a few superficial erosions. DIF shows intercellul…
- Vesiculobullous disorders: polymorphic eruption of pregnancy · ApplicationA primigravida in the third trimester develops intensely itchy urticarial papules that start within abdominal striae and spare the periumbilical skin, with no blisters.…
- Vesiculobullous disorders: desmoglein compensation theory · Multi-stepA patient has painful oral erosions for months without skin blisters. Serum contains autoantibodies against desmoglein 3 only. Which explanation best accounts for the a…
- Vesiculobullous disorders: neonatal pemphigus · ApplicationA newborn of a mother with active pemphigus vulgaris has a few flaccid blisters and erosions that heal without treatment over a few weeks. What is the mechanism?
- Vesiculobullous disorders: autoantigen in dermatitis herpetiformis · ApplicationGranular IgA deposits at the tips of dermal papillae are found in a man with intensely itchy grouped vesicles over the elbows and knees. Which is the main target antige…
- Vesiculobullous disorders: monitoring pemphigus by ELISA · ApplicationA man with pemphigus vulgaris in remission is followed in clinic. Which laboratory test best tracks disease activity and may predict relapse?
- Vesiculobullous disorders: rituximab in pemphigus · ApplicationA man with severe pemphigus vulgaris relapses repeatedly on high-dose prednisolone and azathioprine. A monoclonal antibody that depletes B cells is added. Which target…
- Vesiculobullous disorders: infantile acropustulosis · Multi-stepA 9-month-old has recurrent crops of intensely itchy vesicopustules on the palms and soles every few weeks. He was treated for scabies, but skin scrapings are negative,…
- Vesiculobullous disorders: epidermolysis bullosa simplex with muscular dystrophy · ApplicationA child has blistering of the skin from friction since infancy and later develops progressive muscle weakness. Biopsy shows a split within the basal keratinocytes. A mu…
- Vesiculobullous disorders: junctional epidermolysis bullosa with pyloric atresia · ApplicationA newborn has widespread skin erosions and persistent projectile non-bilious vomiting, and imaging shows pyloric atresia. Which hemidesmosomal protein defect is the lik…
- Vesiculobullous disorders: erythropoietic protoporphyria · ApplicationA child cries within minutes of sun exposure because of burning and stinging of the face and hands, with only mild swelling and later waxy scarring. Which enzyme is def…
- Vesiculobullous disorders: long-term risk in dermatitis herpetiformis · ApplicationA man with dermatitis herpetiformis never follows a gluten-free diet and relies on dapsone for 15 years. He develops weight loss and abdominal pain. Which malignancy is…
- Vesiculobullous disorders: IVIG in refractory pemphigus · Multi-stepA patient with extensive pemphigus vulgaris develops recurrent sepsis on immunosuppressants. Intravenous immunoglobulin is added. What is the proposed mechanism of its…
Fungal infections23
- Fungal infections: tinea capitis · ApplicationA child has patchy alopecia with broken hairs seen as black dots on the scalp, with scaling. Trichophyton tonsurans is isolated. What is the pattern of hair invasion?
- Fungal infections: Wood's lamp fluorescence · ApplicationA child with scaly patchy alopecia shows bright green fluorescence of hairs under Wood's lamp. Which organism is most likely?
- Fungal infections: favus · ApplicationA boy has yellow cup-shaped crusts around hair follicles, a mousy odour and permanent scarring alopecia. Which organism is responsible?
- Fungal infections: terbinafine resistance · Multi-stepIn India, many patients with extensive tinea corporis and cruris show poor response to terbinafine. What is the main mechanism of resistance in these dermatophytes?
- Fungal infections: chronic mucocutaneous candidiasis · Multi-stepA child has persistent candidiasis of nails, skin and mouth, with hypoparathyroidism and Addison disease. Which gene is mutated?
- Fungal infections: sporotrichosis · ApplicationA gardener pricked by a rose thorn develops a nodule on the finger followed by nodules along the lymphatics of the forearm. Which drug is the usual treatment of choice?
- Fungal infections: chromoblastomycosis · Multi-stepA farmer has a verrucous plaque on the leg for years. Histology shows brownish, thick-walled round cells arranged in clusters. What are these called?
- Fungal infections: mycetoma · ApplicationA barefoot farmer has a painless swollen foot with multiple draining sinuses discharging black grains. Which statement is correct?
- Fungal infections: talaromycosis · Multi-stepAn HIV patient from northeast India has fever and umbilicated papules on the face resembling molluscum. Biopsy shows intracellular yeasts that divide by fission with a…
- Fungal infections: id reaction · ApplicationA patient with an inflamed tinea pedis develops itchy vesicles on the palms and sides of the fingers. A KOH smear from the palms is negative. What is the explanation?
- Fungal infections: onychomycosis · ApplicationWhat is the usual continuous oral terbinafine regimen for toenail onychomycosis in an adult?
- Fungal infections: terbinafine · ApplicationWhat is the mechanism of action of terbinafine?
- Fungal infections: griseofulvin · ApplicationWhich statement about griseofulvin is correct?
- Fungal infections: itraconazole · Multi-stepWhich advice is correct for a patient taking itraconazole capsules for tinea?
- Fungal infections: Malassezia folliculitis · ApplicationA young man has monomorphic itchy follicular papules and pustules over the back and chest that worsened after oral antibiotics for acne. Which treatment is likely to he…
- Fungal infections: Majocchi granuloma · Multi-stepA woman applied a potent steroid-antifungal cream to a groin rash. It spread with follicular pustules and papules and KOH of hair shows fungal elements. Why do topical…
- Fungal infections: Candida paronychia · ApplicationA dishwasher has a swollen, tender nail fold with loss of the cuticle and transverse nail ridging. Which measure is most important in management?
- Fungal infections: mucormycosis · ApplicationA patient with uncontrolled diabetic ketoacidosis has facial pain, nasal black eschar and orbital swelling. Biopsy shows broad ribbon-like aseptate hyphae branching at…
- Fungal infections: culture medium · ApplicationWhich medium is commonly used to culture dermatophytes from skin and nail specimens?
- Fungal infections · ApplicationWhat is tinea versicolor caused by?
- Fungal infections · ApplicationWhat is a common feature of candidal intertrigo?
- Fungal infections · ApplicationWhich feature favors candidal intertrigo?
- Fungal infections · ApplicationWhat is the appropriate caution before prescribing topical steroid for a suspected ring-shaped fungal rash?
Hair disorders23
- Hair disorders: telogen effluvium · ApplicationA 29-year-old woman notices heavy diffuse hair shedding three months after childbirth. The scalp looks normal without scarring, and a gentle pull test removes more than…
- Hair disorders: JAK inhibitors · Multi-stepWhich oral drug class has been approved for severe alopecia areata through inhibition of interferon gamma signalling?
- Hair disorders: androgenetic alopecia · ApplicationA 28-year-old man has progressive frontotemporal recession and vertex thinning with miniaturised hairs. Which drug acts by inhibiting type 2 5-alpha reductase?
- Hair disorders: trichotillomania · ApplicationA teenager has irregularly shaped scalp patches with hairs broken at varying lengths, no scaling or inflammation, and a negative pull test. What is the diagnosis?
- Hair disorders: pseudofolliculitis barbae · ApplicationA man with tightly curled hair has recurrent inflamed papules and pustules in the beard area after close shaving, with curved hairs re-entering the skin. What is the be…
- Hair disorders: intralesional triamcinolone · ApplicationA 25-year-old has two patches of alopecia areata on the scalp. Which local therapy is commonly used, and what is its main local adverse effect?
- Hair disorders: lichen planopilaris · Multi-stepA 45-year-old woman has burning, itchy scalp patches with perifollicular erythema and scale at the margins and loss of follicular openings. Biopsy shows lichenoid inter…
- Hair disorders: frontal fibrosing alopecia · Multi-stepA 60-year-old postmenopausal woman has progressive band-like recession of the frontal hairline and complete loss of the eyebrows, with a few isolated hairs left in the…
- Hair disorders: central centrifugal cicatricial alopecia · ApplicationA 40-year-old woman of African descent has slowly spreading scarring hair loss starting at the vertex with a smooth shiny scalp. Which condition is most likely?
- Hair disorders: folliculitis decalvans · Multi-stepA 35-year-old man has a scalp vertex patch of scarring alopecia with pustules, crusts and tufts of 5 to 10 hairs emerging from single follicles. Cultures grow Staphyloc…
- Hair disorders: dissecting cellulitis of the scalp · ApplicationA young man has painful, boggy, interconnected nodules with sinus tracts discharging pus on the scalp and scarring alopecia. Which drug is most useful in recalcitrant d…
- Hair disorders: acne keloidalis nuchae · ApplicationA young man has firm dome-shaped papules and keloid-like plaques on the nape of the neck, with pustules and tufted hairs, aggravated by close haircuts and shirt collars…
- Hair disorders: trichorrhexis nodosa · ApplicationMicroscopy of fragile hair shafts shows nodes where the cortex splits into fibres, resembling two paintbrushes pushed together. What is the diagnosis?
- Hair disorders · ApplicationWhat is alopecia areata characterized by?
- Hair disorders · ApplicationWhat pattern is typical of androgenetic alopecia?
- Hair disorders · ApplicationWhat is trichotillomania?
- Hair disorders · ApplicationWhat is characteristic of alopecia areata?
- Hair disorders · ApplicationWhat pattern is typical of alopecia areata?
- Hair disorders · ApplicationWhich description best fits alopecia areata?
- Hair disorders · ApplicationA child has patchy hair loss with scalp scale and broken hairs. What diagnosis is most likely?
- Hair disorders · ApplicationWhich trichoscopic feature supports alopecia areata at the edge of a smooth patch of hair loss?
- Hair disorders · ApplicationWhat is telogen effluvium?
- Hair disorders: alopecia areata · ApplicationA patient develops a smooth round patch of nonscarring hair loss with exclamation-mark hairs at the margin. What is the diagnosis?
Viral infections22
- Viral infections · ApplicationA 6-year-old child has multiple small, pearly, dome-shaped papules with central umbilication on the trunk and in the axillae. What is the causative agent?
- Viral infections: herpes zoster · ApplicationA 68-year-old man has severe burning pain followed by grouped vesicles on an erythematous base confined to the right T5 dermatome, appearing 36 hours ago. What is the b…
- Viral infections: HPV types · ApplicationWhich pair of HPV types is mainly responsible for anogenital warts (condylomata acuminata)?
- Viral infections: eczema herpeticum · ApplicationA child with severe atopic dermatitis develops fever and sudden clusters of uniform, punched-out vesicles and erosions over eczematous skin. What is the best next step?
- Viral infections: erythema infectiosum · ApplicationA child with bright red cheeks followed by a lacy reticular rash on the limbs has a sibling with hereditary spherocytosis. Which complication is that sibling at risk of?
- Viral infections: roseola infantum · ApplicationA 14-month-old has three days of high fever, after which the fever abruptly settles and a pink maculopapular rash appears on the trunk. Which virus is responsible?
- Viral infections: Gianotti-Crosti syndrome · Multi-stepA child has symmetric, monomorphic, skin-coloured papules over the cheeks, buttocks and extensor limbs, sparing the trunk. With which virus was this condition first des…
- Viral infections: Ramsay Hunt syndrome · ApplicationA 55-year-old has severe ear pain with vesicles in the external auditory canal, ipsilateral facial weakness and hearing loss. What is the underlying cause?
- Viral infections: orf · ApplicationA shepherd handling lambs develops a solitary, firm, violaceous nodule with a central umbilication on the hand. What is the appropriate management?
- Viral infections: mpox · ApplicationA patient has fever followed by synchronous vesiculopustular lesions that all look the same age. Which feature best distinguishes mpox from smallpox?
- Viral infections: acyclovir-resistant herpes · Multi-stepAn HIV positive patient has persistent perianal herpetic ulcers despite adequate oral acyclovir, and the virus is thymidine kinase deficient. Which drug is appropriate?
- Viral infections: postherpetic neuralgia · ApplicationA 70-year-old has burning pain persisting in a thoracic dermatome 3 months after healed herpes zoster. Which drug is a first-line option?
- Viral infections: ampicillin rash in infectious mononucleosis · ApplicationA teenager with sore throat and lymphadenopathy takes amoxicillin and develops a diffuse maculopapular rash. What does this most likely indicate?
- Viral infections: wart cryotherapy · ApplicationA child has a common wart treated with liquid nitrogen cryotherapy. What is the approximate temperature of liquid nitrogen?
- Viral infections: epidermodysplasia verruciformis · Multi-stepA patient with an autosomal recessive mutation in EVER1/EVER2 has widespread flat warts and pityriasis versicolor-like plaques, with squamous carcinomas on sun-exposed…
- Viral infections: Hutchinson sign in zoster ophthalmicus · Multi-stepA 70-year-old has painful vesicles over the left forehead and a vesicle on the tip of the nose. What is the most important management step in addition to oral valacyclo…
- Viral infections · ApplicationWhat lesion is commonly caused by human papillomavirus?
- Viral infections · ApplicationWhat is molluscum contagiosum typically characterized by?
- Viral infections · ApplicationWhat pattern is most typical of herpes zoster?
- Viral infections · ApplicationWhy is ophthalmic herpes zoster particularly urgent?
- Viral infections · ApplicationWhich lesion morphology is typical of molluscum contagiosum?
- Viral infections · ApplicationWhat is the typical appearance of a common wart?
Bacterial infections21
- Bacterial infections · ApplicationA middle-aged diabetic man has well-defined, dry, brown-red, finely scaly patches in the groin and axillae. Under a Wood's lamp they glow coral red. What is the causati…
- Bacterial infections · ApplicationA 2-week-old neonate has fever, a tender red perioral rash and sheets of superficial skin that peel with gentle rubbing, though the mucous membranes are spared. Which t…
- Bacterial infections: erysipelas · ApplicationA 60-year-old has fever and a sharply demarcated, raised, tender red plaque over one cheek with a palpable edge. Which organism is the usual cause?
- Bacterial infections: hot tub folliculitis · ApplicationTwo days after using a poorly chlorinated hot tub, a young man develops itchy follicular papulopustules on the trunk and buttocks, sparing the face. Which organism is r…
- Bacterial infections: pitted keratolysis · ApplicationA soldier who wears closed boots all day has malodorous soles with shallow crateriform pits over the pressure areas. Which is the most appropriate management?
- Bacterial infections: necrotising fasciitis · Multi-stepA diabetic woman has a rapidly spreading red leg with pain out of proportion, dusky skin, bullae and fever with hypotension. What is the most important immediate step?
- Bacterial infections: cutaneous anthrax · ApplicationA farmer who skins dead cattle has a painless ulcer on the forearm with a black central eschar surrounded by marked oedema. Which organism is most likely?
- Bacterial infections: Mycobacterium marinum · ApplicationAn aquarium cleaner has a violaceous nodule on the hand that gradually spreads up the arm in a line of nodules. Biopsy culture grows organisms at 30 degrees C. What is…
- Bacterial infections: Buruli ulcer · Multi-stepA child from a swampy tropical region has a painless, undermined ulcer with surrounding oedema. The causative organism produces a polyketide toxin that destroys tissue.…
- Bacterial infections: Lyme disease · ApplicationA hiker returns with an expanding annular red patch with central clearing at the site of a tick bite, along with mild fever. What is the treatment of choice in an adult?
- Bacterial infections: scrub typhus · ApplicationA trekker in the Himalayan foothills has fever, headache and a painless black eschar in the axilla with tender regional lymph nodes. Which drug is best for this illness?
- Bacterial infections: yaws · ApplicationA child from a remote tribal area has a papillomatous 'mother yaw' on the leg and a positive treponemal test. What is the oral treatment used in the eradication strategy?
- Bacterial infections: ecthyma gangrenosum · Multi-stepA neutropenic leukaemia patient has painless, round, punched-out ulcers with black necrotic centres surrounded by an erythematous halo and signs of sepsis. Which organi…
- Bacterial infections: topical antibiotics · Multi-stepWhat is the mechanism of action of topical mupirocin used for impetigo and nasal carriage of Staphylococcus aureus?
- Bacterial infections: toxic shock syndrome · ApplicationA young woman using a tampon has fever, hypotension, diffuse macular erythroderma and later desquamation of the palms and soles. What is the pathogenic mechanism?
- Bacterial infections: bacillary angiomatosis · Multi-stepAn HIV positive patient with a CD4 count of 80 has multiple friable red vascular papules. Biopsy shows lobular capillary proliferation with neutrophils and granular pur…
- Bacterial infections: recurrent cellulitis · ApplicationA man has had three episodes of cellulitis of the same leg in one year, with chronic lymphoedema and tinea pedis. Which measure reduces recurrence?
- Bacterial infections: recurrent furunculosis · Multi-stepMultiple family members have recurrent furuncles with necrotising pneumonia in one case. Which staphylococcal toxin is implicated?
- Bacterial infections: bejel · ApplicationMucous patches in the mouth and condylomata lata in children living in hot, dry rural regions, with no genital chancre, suggest which non-venereal treponematosis?
- Bacterial infections · ApplicationWhich infection produces painful follicular nodules and sinus tracts in axilla or groin?
- Bacterial infections · ApplicationWhat is the most appropriate concern with rapidly spreading red skin and severe pain out of proportion?
Skin cancer18
- Skin cancer · ApplicationPearly telangiectatic papule suggests what?
- Skin cancer · ApplicationChanging asymmetric multicolored mole suggests what?
- Skin cancer · ApplicationWhat has pearly rolled edges?
- Skin cancer · ApplicationWhat has ABCDE warning features?
- Skin cancer · ApplicationWhat is a keratotic sun-exposed ulcer concerning for?
- Skin cancer · ApplicationWhat feature in a pigmented lesion raises concern for melanoma?
- Skin cancer · ApplicationWhat is the most common skin cancer?
- Skin cancer · ApplicationWhat is a common appearance of basal cell carcinoma?
- Skin cancer · ApplicationWhat is a warning feature of squamous cell carcinoma of skin?
- Skin cancer · ApplicationWhat is a common predisposing exposure for cutaneous squamous cell carcinoma?
- Skin cancer · ApplicationWhich feature in a pigmented lesion raises concern for melanoma?
- Skin cancer · ApplicationA slowly enlarging lesion on sun-exposed facial skin has a rolled translucent edge and surface telangiectasia; what morphology best describes it?
- Skin cancer · ApplicationWhat change in a pigmented lesion raises concern for melanoma?
- Skin cancer · ApplicationWhat is the common appearance of basal cell carcinoma?
- Skin cancer · ApplicationWhich change in a pigmented lesion is concerning for melanoma?
- Skin cancer · ApplicationWhich skin cancer is most likely to metastasize if untreated?
- Skin cancer · ApplicationWhich lesion feature is most concerning for squamous cell carcinoma?
- Skin cancer · ApplicationWhy does a non-healing ulcer on the lower lip require urgent assessment?
Bullous disorders14
- Bullous disorders · ApplicationA positive Nikolsky sign is characteristic of:
- Bullous disorders · ApplicationA young man has intensely itchy, grouped vesicles and excoriations over the elbows, knees and buttocks, and he also has gluten-sensitive enteropathy. What would direct…
- Bullous disorders: pemphigus histology · ApplicationA Tzanck smear from a flaccid blister base shows rounded keratinocytes separated from each other. Histology shows a suprabasal cleft with basal cells attached to the de…
- Bullous disorders: pemphigus immunofluorescence · ApplicationDirect immunofluorescence of perilesional skin in pemphigus vulgaris shows which pattern?
- Bullous disorders: pemphigus treatment · ApplicationWhich drug is an established first-line adjuvant to systemic corticosteroids in moderate to severe pemphigus vulgaris?
- Bullous disorders: pemphigus foliaceus · ApplicationA patient has scaly crusted erosions over the face, chest and back without oral lesions. Biopsy shows a split just beneath the stratum corneum. Which antigen is targeted?
- Bullous disorders: bullous pemphigoid · ApplicationAn 80-year-old has tense blisters on flexural surfaces after preceding itchy urticated plaques, and biopsy shows a subepidermal blister with eosinophils. Which antigens…
- Bullous disorders: dermatitis herpetiformis · ApplicationA young man has intensely itchy grouped vesicles on the elbows, knees and buttocks. Biopsy shows neutrophil microabscesses at dermal papillary tips with granular IgA. W…
- Bullous disorders: linear IgA bullous disease · Multi-stepA child has annular blisters forming a rosette, described as a string of pearls, with linear IgA at the basement membrane. Which drug is a well-known cause of the adult…
- Bullous disorders: epidermolysis bullosa acquisita · Multi-stepBlisters heal with scarring and milia at trauma-prone sites in an adult. Salt-split skin immunofluorescence shows IgG on the dermal side. Which is the target antigen?
- Bullous disorders: mucous membrane pemphigoid · Multi-stepAn elderly woman has desquamative gingivitis and recurrent conjunctivitis with adhesions between the eyelid and eyeball. Which complication is most feared?
- Bullous disorders: epidermolysis bullosa simplex · ApplicationA newborn has blisters on the hands and feet developing after friction, healing without scarring. Intraepidermal cleavage through basal keratinocytes is shown. Which ge…
- Bullous disorders: porphyria cutanea tarda · ApplicationA man with chronic alcohol use and hepatitis C has fragile skin, blisters and milia on the dorsum of the hands, with hypertrichosis on the face. Urine fluoresces coral…
- Bullous disorders: pemphigoid gestationis · ApplicationA woman in her third trimester has intensely itchy urticarial plaques around the umbilicus that become tense blisters. Which statement is correct?
Infestations14
- Infestations: scabies treatment · ApplicationWhich scabies treatment is appropriate for a pregnant woman and for infants?
- Infestations: crusted scabies · ApplicationA patient on long-term oral steroids has thick warty crusts on the hands and feet with thousands of mites and highly contagious spread. What is this form called?
- Infestations: pediculosis corporis · ApplicationA homeless man has itchy excoriated lesions on the back and waist with lice found in the seams of his clothes. Which serious infection can this louse transmit?
- Infestations: post kala-azar dermal leishmaniasis · ApplicationA man treated for visceral leishmaniasis 2 years earlier in Bihar now has hypopigmented macules and nodules on the face. Which statement about this condition is correct?
- Infestations: tungiasis · ApplicationA child from a rural area has a white nodule with a central black dot on the sole, with surrounding itching. What is the cause?
- Infestations: onchocerciasis · Multi-stepA patient from an endemic African region has subcutaneous nodules, severe itching with lichenified skin, depigmentation over the shins and visual impairment. Which drug…
- Infestations: dermoscopy of scabies · Multi-stepDermoscopy of a scabies burrow shows a dark triangular structure with a linear track behind it. How is this sign described?
- Infestations: myiasis · ApplicationA farmer has a boil-like nodule with a central pore from which the movement of a larva is sometimes seen. What is the best method of management?
- Infestations: larva currens · Multi-stepA patient with chronic strongyloidiasis has rapidly migrating, linear urticarial tracks over the buttocks that move several centimetres per hour. What is the best treat…
- Infestations · ApplicationWhat topical agent is commonly used for pediculosis when indicated?
- Infestations · ApplicationWhat symptom is typical of scabies?
- Infestations · ApplicationWhere are scabies burrows commonly found in adults?
- Infestations · ApplicationWhich finding supports scabies infestation?
- Infestations · ApplicationWhat management step is essential when treating confirmed scabies?
Vascular disorders14
- Vascular disorders: hereditary angioedema · ApplicationA man has recurrent non-itchy facial and laryngeal swelling without urticaria, unresponsive to adrenaline and antihistamines, and low C4. Which is the underlying defect?
- Vascular disorders: IgA vasculitis · ApplicationA 7-year-old has palpable purpura on the legs and buttocks, abdominal pain, arthralgia and haematuria after an upper respiratory infection. What is the diagnosis?
- Vascular disorders: Behcet disease · ApplicationA young man from the Silk Route region has recurrent oral aphthae, genital ulcers and uveitis. A needle prick on the forearm produces a pustule after 48 hours. What is…
- Vascular disorders: cutaneous polyarteritis nodosa · ApplicationA young woman has tender subcutaneous nodules and livedo reticularis on the legs for several months, with no renal, neurological or visceral involvement. Biopsy shows m…
- Vascular disorders: Sneddon syndrome · ApplicationA 35-year-old woman has livedo racemosa of the trunk and limbs and has had two ischaemic strokes. Which antibody should be sought?
- Vascular disorders: livedoid vasculopathy · Multi-stepA 30-year-old woman has recurrent painful ulcers on the ankles each summer that heal leaving porcelain-white stellate scars with surrounding telangiectasia. Biopsy show…
- Vascular disorders: cryoglobulinaemic vasculitis · Multi-stepA woman with chronic hepatitis C has palpable purpura on the legs, arthralgia and low C4 with positive rheumatoid factor. Which condition is most likely?
- Vascular disorders: granulomatosis with polyangiitis · ApplicationWhich antibody pattern is characteristic of granulomatosis with polyangiitis?
- Vascular disorders: pressure ulcer staging · ApplicationA bedridden patient has a shallow open sacral ulcer with a pink wound bed and loss of partial-thickness dermis, with no slough or visible fat. Which stage is this?
- Vascular disorders: ankle-brachial pressure index before compression · Multi-stepA 68-year-old woman has a painless shallow ulcer above the medial malleolus with surrounding haemosiderin staining and oedema. Before applying high-compression bandagin…
- Vascular disorders: spider naevus · ApplicationA pregnant woman develops a small red lesion on the cheek with a central punctum and radiating fine vessels that blanches when pressed centrally. What is it?
- Vascular disorders: erythromelalgia · Multi-stepA 50-year-old with essential thrombocythaemia has episodic burning pain, redness and warmth of both feet that are relieved by cooling and worsened by heat. Which drug d…
- Vascular disorders: acrocyanosis · ApplicationA thin young woman has persistent, painless, symmetrical bluish discolouration of the hands that is worse in the cold and does not cause ulceration. What is this?
- Vascular disorders: cutis marmorata telangiectatica congenita · ApplicationA newborn has a persistent, fixed, net-like violaceous pattern on one leg that does not fade on warming, with slight limb atrophy. What is this?
Genodermatoses13
- Genodermatoses · Multi-stepA 4-year-old child had infantile spasms in infancy and now has several hypopigmented lance-shaped macules on the trunk and new red papules over the cheeks and nose. The…
- Genodermatoses: xeroderma pigmentosum · ApplicationA child has severe sunburn on minimal exposure, freckling and early skin cancers. What is the underlying defect?
- Genodermatoses: Hailey-Hailey disease · Multi-stepA man has recurrent painful, malodorous, macerated erosions of the axillae and groin from childhood, with family history, and histology shows widespread acantholysis gi…
- Genodermatoses: Darier disease · Multi-stepA young adult has greasy, keratotic brown papules over the seborrhoeic areas, V-shaped nail nicking and worsening in summer. Histology shows corps ronds and grains. Whi…
- Genodermatoses: X-linked ichthyosis · ApplicationA boy has dark, large, adherent scales on the neck and trunk beginning in infancy, with comma-shaped corneal opacities, and his maternal uncle is affected. Which enzyme…
- Genodermatoses: pseudoxanthoma elasticum · Multi-stepA young woman has yellowish papules in a cobblestone pattern on the neck and axillae with angioid streaks on fundoscopy and gastrointestinal bleeding. What is the patho…
- Genodermatoses: harlequin ichthyosis · Multi-stepA newborn is born with thick, plate-like armour scales with fissures, ectropion and eclabium. Which gene is defective?
- Genodermatoses: Netherton syndrome · Multi-stepA newborn has erythroderma and later develops migratory polycyclic scaling plaques with a double-edged scale, sparse brittle hair that shows bamboo-like nodes under the…
- Genodermatoses: incontinentia pigmenti · Multi-stepA newborn girl has linear vesicles and blisters along Blaschko lines on the limbs, with peripheral eosinophilia. Her mother has patchy hypodontia. Which statement is tr…
- Genodermatoses: Fabry disease · Multi-stepA 16-year-old boy has burning pain in the hands and feet, hypohidrosis and clusters of small dark red non-blanching papules in the bathing-trunk area. His maternal uncl…
- Genodermatoses: Papillon-Lefevre syndrome · ApplicationA child has thick red-yellow keratoderma of palms and soles and has lost primary teeth early because of severe periodontitis. Which gene is mutated?
- Genodermatoses: Mal de Meleda · ApplicationWhich feature distinguishes Mal de Meleda from other palmoplantar keratodermas?
- Genodermatoses: ataxia telangiectasia · ApplicationA 6-year-old has progressive gait ataxia, recurrent sinopulmonary infections and conjunctival telangiectasia. Which laboratory finding is typical?
Acne12
- Acne: isotretinoin · ApplicationA man with nodulocystic acne unresponsive to antibiotics is started on oral isotretinoin. Which mechanism and caution are correct?
- Acne: monitoring isotretinoin · ApplicationWhich baseline and follow-up laboratory tests are advised in a patient on oral isotretinoin?
- Acne: hidradenitis suppurativa · ApplicationA young obese smoker has recurrent painful nodules, abscesses and sinus tracts in the axillae and groin with double-ended comedones. Which biologic is approved?
- Acne: acne fulminans · Multi-stepA 16-year-old boy with nodulocystic acne suddenly develops fever, joint pain, raised ESR and painful ulcerating crusted nodules on the chest and back. What is the best…
- Acne: polycystic ovary syndrome · ApplicationA 22-year-old woman has persistent jawline acne, hirsutism and oligomenorrhoea. Which condition should be investigated?
- Acne · ApplicationNodules and scarring acne may need what?
- Acne · ApplicationWhat is a primary lesion of acne vulgaris?
- Acne · ApplicationWhat topical medication can help reduce comedonal acne?
- Acne · ApplicationWhat lesion is characteristic of comedonal acne?
- Acne · ApplicationWhat topical therapy helps prevent comedone formation?
- Acne · ApplicationWhat primary lesion occurs in acne vulgaris?
- Acne · ApplicationA teenager has comedones, papules, pustules, and nodules on the face and back. Which lesion is most specific for acne vulgaris?
Fungal infection12
- Fungal infection · ApplicationAnnular scaly lesion with central clearing suggests what?
- Fungal infection · ApplicationBoggy scalp swelling with broken hairs in child suggests what?
- Fungal infection · ApplicationWhat is a common appearance of tinea corporis?
- Fungal infection · ApplicationWhat is a useful bedside test for superficial dermatophyte infection?
- Fungal infection · ApplicationWhat is a classic appearance of tinea corporis?
- Fungal infection · ApplicationWhat bedside test supports diagnosis of a superficial dermatophyte infection?
- Fungal infection · ApplicationWhat appearance is typical of tinea corporis?
- Fungal infection · ApplicationWhat bedside preparation can reveal dermatophyte hyphae?
- Fungal infection · ApplicationWhich bedside test can help confirm tinea corporis?
- Fungal infection · ApplicationWhich description best fits tinea corporis?
- Fungal infection: tinea corporis · ApplicationA patient has an itchy annular plaque with a scaly advancing edge and central clearing on the trunk. What is the most likely diagnosis?
- Fungal infection: tinea capitis · ApplicationA child has patchy alopecia, scalp scaling, and posterior cervical lymphadenopathy. What is the most likely diagnosis?
Dermatology11
- Dermatology: frostbite management · ApplicationA trekker arrives with frozen, waxy, numb toes. What is the correct initial treatment?
- Dermatology: Fox-Fordyce disease · ApplicationA 25-year-old woman has intensely itchy, skin-coloured follicular papules confined to the axillae and areolae, which worsen with sweating and emotion. What is the diagn…
- Dermatology: hyperhidrosis treatment · ApplicationA 22-year-old has severe axillary hyperhidrosis not controlled by 20 percent aluminium chloride hexahydrate. Which next treatment is appropriate?
- Dermatology: recurrent aphthous stomatitis · ApplicationA 28-year-old has recurrent painful round oral ulcers with a yellow base and red halo, each healing in 10 days without scarring, and no genital ulcers or eye symptoms.…
- Dermatology: Melkersson-Rosenthal syndrome · Multi-stepA 25-year-old has recurrent episodes of lip and facial swelling, a fissured tongue and an episode of lower motor neuron facial palsy. Biopsy of the lip shows non-caseat…
- Dermatology: transient neonatal pustular melanosis · ApplicationA newborn has pustules present at birth that rupture, leaving collarettes of scale and hyperpigmented macules. Smear shows neutrophils. What is the course?
- Dermatology: aplasia cutis congenita · Multi-stepA newborn has a 2 cm well-demarcated, ulcerated, hairless scalp defect at the vertex surrounded by a ring of darker, longer hair. What does this ring suggest, and what…
- Dermatology: miliaria types · ApplicationTiny clear, non-inflamed, fragile vesicles without erythema appear on the trunk of a feverish infant. What type of miliaria is this?
- Dermatology: erythema ab igne · ApplicationAn elderly woman who sits by a charcoal brazier has a net-like, brown, telangiectatic pigmentation on the shins. What is the diagnosis?
- Dermatology: striae distensae · ApplicationA 17-year-old boy who grew rapidly has multiple linear red-purple bands on the lower back that later became pale and atrophic. What is the underlying mechanism?
- Dermatology: terra firma-forme dermatosis · ApplicationA child has brown, velvety, dirt-like plaques on the neck that do not wash off with soap but disappear on a single wipe with isopropyl alcohol. What is the diagnosis?
Papulosquamous11
- Papulosquamous: large plaque parapsoriasis · Multi-stepA 55-year-old man has persistent, slightly atrophic, fine-wrinkled patches over 10 cm on the buttocks and thighs for years. What is the clinical concern?
- Papulosquamous: long-term PUVA adverse effect · Multi-stepA man with severe psoriasis has had more than 200 PUVA sessions over many years. Which malignancy is he at particular risk of developing?
- Papulosquamous: drugs that aggravate psoriasis · ApplicationA man with stable plaque psoriasis develops widespread worsening after starting treatment for bipolar disorder. Which drug is the likely culprit?
- Papulosquamous: collodion baby · ApplicationA newborn is covered by a taut, shiny, parchment-like membrane with ectropion and eclabium. What does this presentation commonly evolve into?
- Papulosquamous: reading patch tests · Multi-stepA nickel allergy is suspected and a patch test is applied on the back. When should the patches be read for a reliable result?
- Papulosquamous: stasis dermatitis · Multi-stepA 60-year-old woman with varicose veins has itchy, scaly, brown-pigmented skin on the lower legs with pitting oedema. Which measure is the cornerstone of management?
- Papulosquamous: impetigo herpetiformis · Multi-stepA pregnant woman in the third trimester has fever, hypocalcaemia and grouped sterile pustules at the margins of erythematous flexural plaques. What is the diagnosis?
- Papulosquamous: Ehlers-Danlos syndrome · ApplicationA young man has hyperextensible skin, wide atrophic scars, joint hypermobility and easy bruising. What is the underlying defect?
- Papulosquamous: acquired perforating dermatosis · Multi-stepA diabetic man on dialysis has intensely itchy umbilicated hyperkeratotic papules and nodules with a central keratotic plug on the limbs, appearing at sites of scratchi…
- Papulosquamous: Wiskott-Aldrich syndrome · Multi-stepA male infant has eczema, recurrent infections and bleeding with petechiae. The platelets are small and low in number. What is the pattern of inheritance?
- Papulosquamous: phrynoderma · ApplicationA child with chronic fat malabsorption has dry, rough, horny follicular papules on the extensor limbs and difficulty seeing in dim light. Which deficiency explains both?
Psoriasis11
- Psoriasis · ApplicationWhat scale is characteristic of plaque psoriasis?
- Psoriasis · ApplicationWhat phenomenon may occur after skin trauma in psoriasis?
- Psoriasis · ApplicationWhat nail finding can occur in psoriasis?
- Psoriasis · ApplicationWhat joint condition may accompany psoriasis?
- Psoriasis · ApplicationWhat skin finding is typical of plaque psoriasis?
- Psoriasis · ApplicationWhat is the Koebner phenomenon?
- Psoriasis · ApplicationWhich nail finding supports a diagnosis of psoriasis in a patient with scaly extensor plaques?
- Psoriasis · ApplicationWhat phenomenon describes psoriatic lesions appearing at skin trauma sites?
- Psoriasis · ApplicationWhich morphology is typical of chronic plaque psoriasis?
- Psoriasis · ApplicationA patient has sharply demarcated erythematous plaques with silvery scale on the extensor elbows and scalp, plus nail pitting. What is the diagnosis?
- Psoriasis: erythroderma · Multi-stepA patient with known psoriasis develops generalized erythema and scaling over most of the body with fever and fluid loss. What is the correct assessment?
Urticaria10
- Urticaria · ApplicationA 30-year-old woman has recurrent itchy raised red wheals that appear at different body sites. Which feature best supports ordinary urticaria rather than urticarial vas…
- Urticaria: refractory chronic spontaneous urticaria · Multi-stepA woman has daily wheals for 5 months. They persist despite cetirizine at four times the standard dose, and routine tests are normal. Which add-on drug is recommended n…
- Urticaria: urticarial vasculitis · Multi-stepA 40-year-old woman has burning wheals lasting 2 to 3 days each, which fade leaving bruise-like hyperpigmentation. ESR is raised and C3 and C4 are low. Which investigat…
- Urticaria: cholinergic urticaria · ApplicationA 19-year-old develops tiny 1 to 3 mm itchy wheals with surrounding flare on the trunk after running and hot showers, resolving within an hour. What is the diagnosis?
- Urticaria: cold urticaria · Multi-stepA young woman develops wheals and facial swelling after swimming in cold water, and an ice cube applied to the forearm for 5 minutes produces a wheal on rewarming. What…
- Urticaria · ApplicationHow long does an individual urticarial wheal usually persist?
- Urticaria · ApplicationWhat is the primary lesion in urticaria?
- Urticaria · ApplicationWhat is a common treatment class for uncomplicated urticaria?
- Urticaria · ApplicationWhat is the primary skin lesion of urticaria?
- Urticaria · ApplicationWhat is the primary lesion of urticaria?
Eczema9
- Eczema · ApplicationWhat is a typical symptom of eczema?
- Eczema · ApplicationWhat is a key first-line measure in chronic eczema care?
- Eczema · ApplicationWhat pattern is common in atopic eczema?
- Eczema · ApplicationWhat topical treatment is used for an acute inflammatory eczema flare when appropriate?
- Eczema · ApplicationWhat is a cardinal symptom of eczema?
- Eczema · ApplicationWhat is a foundation of chronic eczema management?
- Eczema · ApplicationWhich feature is most consistent with atopic eczema?
- Eczema: atopic dermatitis · ApplicationA child has chronic pruritic flexural eczema, dry skin, and a personal history of wheeze. What is the most likely diagnosis?
- Eczema: contact dermatitis · ApplicationA nurse develops itchy erythematous fissured hands after frequent glove use and handwashing. Which diagnosis is most likely?
HIV9
- HIV: acute retroviral syndrome · ApplicationThree weeks after unprotected sex, a man has fever, sore throat, lymphadenopathy and a maculopapular rash on the trunk. HIV antibody is negative. Which test is most lik…
- HIV: oral hairy leukoplakia · ApplicationAn HIV positive patient has white corrugated plaques on the lateral border of the tongue that cannot be scraped off. Which virus is implicated?
- HIV: first-line antiretroviral therapy · ApplicationWhich fixed-dose combination is the preferred first-line antiretroviral regimen under the Indian national programme?
- HIV: post-exposure prophylaxis · ApplicationA nurse suffers a needle-stick injury from an HIV positive patient. What is the recommended post-exposure prophylaxis?
- HIV: prevention of mother to child transmission · ApplicationUnder the Indian programme, what is the recommended approach for a newly diagnosed HIV positive pregnant woman?
- HIV: pruritic papular eruption · Multi-stepA man with advanced HIV (CD4 count 90 per microlitre) has intensely itchy, symmetrical, discrete skin-coloured and excoriated papules on the extremities and trunk, with…
- HIV: giant molluscum contagiosum · Multi-stepA 30-year-old man has dozens of large, umbilicated papules up to 1 cm on the face and neck, some coalescing. What should be done in addition to treating the lesions?
- HIV: herpes zoster in a young adult · Multi-stepA 26-year-old man with no known illness develops herpes zoster involving two non-contiguous dermatomes. Which step is most important?
- HIV: chronic herpes simplex ulcer · Multi-stepA patient has a persistent, enlarging anogenital herpetic ulcer for 6 weeks despite no immunosuppressive drugs. What does this signify?
Nail disorders9
- Nail disorders: Beau lines · ApplicationTwo months after a severe febrile illness, a patient has transverse grooves across all fingernails at the same level. What are these called?
- Nail disorders: subungual melanoma · ApplicationA 60-year-old has a longitudinal dark band in the thumbnail that has widened, with pigment extending onto the proximal nail fold. What is this sign?
- Nail disorders: yellow nail syndrome · Multi-stepA patient has thickened, slow-growing, yellow-green curved nails with lymphoedema and recurrent pleural effusions. What is the diagnosis?
- Nail disorders: trachyonychia · ApplicationA child has roughened, sandpaper-like, brittle nails on all twenty nails. Which conditions are associated?
- Nail disorders · ApplicationWhat finding is common in onychomycosis?
- Nail disorders · ApplicationWhat finding is typical of onychomycosis?
- Nail disorders · ApplicationWhich office test can support a clinical suspicion of onychomycosis before systemic antifungal treatment?
- Nail disorders · ApplicationWhich nail feature suggests iron deficiency or chronic trauma rather than fungal infection?
- Nail disorders · ApplicationWhat does clubbing of the nails represent?
Sexually transmitted infections9
- Sexually transmitted infections · Multi-stepA 28-year-old man has a non-itchy coppery macular rash that involves the palms and soles, and moist flat-topped plaques in the groin. Serum VDRL is non-reactive. What i…
- Sexually transmitted infections · Multi-stepA man has a painless, indurated, clean-based genital ulcer with firm, non-tender bilateral inguinal lymph nodes three weeks after unprotected sex. A VDRL test is non-re…
- Sexually transmitted infections: donovanosis · ApplicationA man has a painless, beefy-red, easily bleeding genital ulcer that slowly enlarges, with no inguinal lymphadenopathy. A smear stained with Giemsa shows intracellular e…
- Sexually transmitted infections: lymphogranuloma venereum proctitis · Multi-stepA man who has sex with men has anorectal pain, mucopurulent rectal discharge and tenesmus. Years later he develops difficulty passing stool and a narrowed rectum. Which…
- Sexually transmitted infections: zidovudine nail pigmentation · ApplicationA man with HIV on a zidovudine-containing regimen has developed blue-black longitudinal bands on several nails and a macrocytic anaemia. What is the likely cause of the…
- Sexually transmitted infections: serofast state · ApplicationA man treated with benzathine penicillin for secondary syphilis 12 months ago had an RPR titre fall from 1:64 to 1:4, and it has remained at 1:4 on repeat testing. He h…
- Sexually transmitted infections: early congenital syphilis and Parrot pseudoparalysis · ApplicationA 6-week-old infant of an untreated mother lies with one arm limp and cries when it is moved. He also has persistent blood-stained nasal discharge and hepatosplenomegal…
- Sexually transmitted infections: diagnosis of genital herpes · ApplicationA woman has painful grouped vesicles and shallow ulcers on the vulva. The clinician unroofs a vesicle and swabs the base. Which test has the highest sensitivity to conf…
- Sexually transmitted infections: cardiovascular syphilis · Multi-stepA 55-year-old man treated inadequately for syphilis in youth has chest discomfort and a diastolic murmur. The chest radiograph shows a dilated ascending aorta with thin…
Dermatitis8
- Dermatitis · ApplicationA 3-year-old with dry skin has an itchy, lichenified rash in the flexures of the elbows and knees. His father has asthma. Loss-of-function mutations in which gene are s…
- Dermatitis: atopic dermatitis pathogenesis · ApplicationA child has chronic itchy flexural eczema, dry skin, asthma and a family history of atopy. Loss-of-function mutations in which gene are strongly associated?
- Dermatitis: dupilumab · ApplicationA teenager with severe atopic dermatitis is started on dupilumab. Which cytokine pathways does it block, and which adverse effect is common?
- Dermatitis: patch testing · ApplicationWhich condition is confirmed by patch testing?
- Dermatitis: Parthenium dermatitis · ApplicationA farmer in India develops itchy eczema on the face, neck V and flexures every monsoon, worse on exposure to a roadside weed. Which plant is most likely responsible?
- Dermatitis: stasis dermatitis · ApplicationA 65-year-old with varicose veins has scaly, itchy, brownish skin and oedema over the medial malleolus. What is the cause of the pigmentation?
- Dermatitis: polymorphic light eruption · ApplicationA young woman has itchy papules and vesicles on the arms and V of the neck appearing 1 to 2 days after the first sunny days of spring, clearing in a week. What is the d…
- Dermatitis: photopatch testing · Multi-stepA woman develops a recurrent eczematous eruption on her face and neck after sun exposure while using a sunscreen. Routine patch tests are negative. Which test is indica…
Drug eruptions8
- Drug eruptions · ApplicationA man repeatedly develops a round, sharply demarcated dusky-red patch on the glans penis within hours of taking a particular antibiotic tablet. Each episode heals with…
- Drug eruptions · Multi-stepThree weeks after starting carbamazepine, a man develops fever, facial oedema, a widespread morbilliform rash, tender lymphadenopathy, marked eosinophilia and raised li…
- Drug eruptions · ApplicationWhat is a red-flag feature in a severe drug-related skin reaction?
- Drug eruptions · ApplicationWhat red flag suggests a severe cutaneous drug reaction?
- Drug eruptions · ApplicationWhich symptom accompanying a new widespread rash should prompt urgent assessment for a severe drug reaction?
- Drug eruptions · ApplicationWhich medication eruption requires urgent withdrawal assessment because of skin pain, mucosal involvement, and epidermal detachment?
- Drug eruptions: Stevens-Johnson syndrome · Multi-stepAfter starting a new high-risk medication, a patient has fever, painful targetoid rash, mucosal erosions, and epidermal detachment. What is the immediate action?
- Drug eruptions: DRESS · Multi-stepSeveral weeks after starting an anticonvulsant, a patient develops fever, facial edema, widespread rash, eosinophilia, and hepatitis. Which drug reaction is most likely?
Metabolic skin signs8
- Metabolic skin signs · ApplicationAn obese adolescent has velvety, thickened, dark skin over the nape of the neck and in the axillae. Which underlying abnormality is the most likely?
- Metabolic skin signs: necrobiosis lipoidica · ApplicationA diabetic woman has a yellowish-brown, atrophic, shiny plaque with prominent telangiectasia over the shin that sometimes ulcerates. What is the diagnosis?
- Metabolic skin signs: calciphylaxis · Multi-stepA dialysis patient has intensely painful retiform purpura progressing to black necrotic ulcers on the thighs and abdomen, with raised calcium-phosphate product. Which t…
- Metabolic skin signs: scleredema adultorum · ApplicationA man with long-standing poorly controlled diabetes and obesity has diffuse woody, non-pitting thickening of the skin of the upper back and posterior neck. What is the…
- Metabolic skin signs: eruptive xanthomas · Multi-stepA man with poorly controlled diabetes develops crops of 2 to 4 mm yellow papules with erythematous halos on the buttocks and extensor limbs over 2 weeks. Which test is…
- Metabolic skin signs: lichen amyloidosis · ApplicationA 40-year-old man has intensely itchy, hyperkeratotic, rippled brown papules on the shins. Biopsy shows apple-green birefringence with Congo red under polarised light i…
- Metabolic skin signs: friction melanosis · Multi-stepA young Indian woman has a symmetric, rippled brown pigmentation over the interscapular region that appeared after years of vigorous scrubbing with a nylon bath towel.…
- Metabolic skin signs: calcinosis cutis · Multi-stepA woman with limited systemic sclerosis has firm white chalky nodules on the fingertips that discharge a chalky material, with normal serum calcium and phosphate. Which…
Therapeutics8
- Therapeutics: topical corticosteroids · ApplicationWhich statement about topical corticosteroids is correct?
- Therapeutics: sunscreens · ApplicationThe sun protection factor (SPF) printed on a sunscreen primarily indicates protection against which radiation?
- Therapeutics: photodynamic therapy · ApplicationPhotodynamic therapy for actinic keratosis uses which combination?
- Therapeutics: dithranol in psoriasis · ApplicationA patient with stable chronic plaque psoriasis is prescribed short-contact dithranol therapy. Which advice is correct?
- Therapeutics: Whitfield ointment · ApplicationWhitfield ointment, used for hyperkeratotic tinea pedis, contains which two agents?
- Therapeutics: topical calcineurin inhibitors · ApplicationA mother is worried about the burning sensation and the boxed warning on topical tacrolimus for her child's facial eczema. What is the correct counselling?
- Therapeutics: pre-biologic screening · Multi-stepA man with severe plaque psoriasis is to start adalimumab. Which pre-treatment evaluation is most important?
- Therapeutics: JAK inhibitor safety · Multi-stepA 45-year-old woman with a history of deep vein thrombosis and smoking has severe atopic dermatitis. Why is caution needed before choosing upadacitinib?
Viral infection8
- Viral infection · ApplicationPainful unilateral dermatomal vesicles suggest what?
- Viral infection · ApplicationUmbilicated papules suggest what?
- Viral infection · ApplicationWhat is characteristic of herpes zoster?
- Viral infection · ApplicationWhat virus causes varicella and herpes zoster?
- Viral infection · ApplicationWhat is typical of herpes zoster?
- Viral infection · ApplicationWhat lesion is caused by molluscum contagiosum?
- Viral infection · ApplicationWhat rash pattern is typical of herpes zoster?
- Viral infection: herpes zoster · ApplicationA patient has severe burning pain followed by grouped vesicles on an erythematous base in a unilateral dermatomal distribution. What is the diagnosis?
Connective tissue disease7
- Connective tissue disease · ApplicationA 50-year-old woman has a violaceous rash over the upper eyelids, scaly erythematous papules over the knuckles and progressive difficulty climbing stairs. What should b…
- Connective tissue disease: dermatomyositis antibodies · Multi-stepIn an adult with dermatomyositis, which myositis-specific antibody is most strongly associated with underlying malignancy?
- Connective tissue disease: subacute cutaneous lupus · Multi-stepA photosensitive woman has annular, psoriasiform lesions on the shoulders and upper back, and her newborn later has congenital heart block. Which antibody is most likel…
- Connective tissue disease: discoid lupus · ApplicationA woman has well-defined erythematous plaques on the face and scalp with adherent scale, follicular plugging and atrophic scarring. The ANA is negative. Which investiga…
- Connective tissue disease: morphea · ApplicationA girl has a depressed, firm, hairless linear band of sclerotic skin extending across the forehead into the scalp. She has no Raynaud phenomenon or internal organ invol…
- Connective tissue disease: sarcoidosis of the skin · ApplicationA woman has violaceous, indurated plaques on the nose and cheeks with biopsy showing noncaseating naked epithelioid granulomas. Which name is given to this presentation?
- Connective tissue disease: limited cutaneous systemic sclerosis · Multi-stepA 48-year-old woman has long-standing Raynaud phenomenon, tight skin of the fingers, telangiectasia on the face, subcutaneous calcinosis and dysphagia. Which antibody i…
Cutaneous tuberculosis6
- Cutaneous tuberculosis · ApplicationA 20-year-old woman has a slowly enlarging reddish-brown plaque on her cheek for several years. On diascopy with a glass slide, the lesion shows an apple-jelly colour.…
- Cutaneous tuberculosis: lupus vulgaris · ApplicationA woman has a slowly enlarging red-brown plaque on the face with soft nodules that look yellowish-brown, like apple jelly, when pressed with a glass slide. What is the…
- Cutaneous tuberculosis: scrofuloderma · ApplicationA child has a bluish-red swelling in the neck that breaks down into ulcers and sinuses overlying a tuberculous lymph node. Which type of cutaneous tuberculosis is this?
- Cutaneous tuberculosis: tuberculosis verrucosa cutis · ApplicationA butcher has a warty plaque on the dorsum of his hand with an expanding annular border that heals centrally. How was this infection acquired?
- Cutaneous tuberculosis: lichen scrofulosorum · Multi-stepA child with tuberculous lymphadenitis develops asymptomatic, grouped, tiny skin-coloured follicular papules on the trunk. Smears and cultures are negative and the lesi…
- Cutaneous tuberculosis: papulonecrotic tuberculid · Multi-stepA young adult with pulmonary tuberculosis has symmetric crops of dusky papules with central necrosis on the extensors of the limbs, healing with varioloform scars. Biop…
Inflammatory6
- Inflammatory · ApplicationPurple polygonal pruritic papules suggest what?
- Inflammatory · ApplicationFlexural itchy eczema in child suggests what?
- Inflammatory · ApplicationExtensor silvery plaques suggest what?
- Inflammatory · ApplicationWhat causes flexural itchy dermatitis?
- Inflammatory · ApplicationWhat causes extensor silvery plaques?
- Inflammatory · ApplicationWhat sign is pinpoint bleeding after psoriasis scale removal?
Pigment disorders6
- Pigment disorders · ApplicationA patient has sharply demarcated milky-white patches without scale due to loss of epidermal melanocytes. Which diagnosis is most likely?
- Pigment disorders · ApplicationWhat may trigger melasma to become more visible?
- Pigment disorders · ApplicationA patient has sharply demarcated milk-white patches caused by loss of functional melanocytes; which diagnosis best fits?
- Pigment disorders · ApplicationA patient has sharply bordered milk-white patches without scale, caused by loss of functional melanocytes rather than inflammation. Which diagnosis best fits this prese…
- Pigment disorders · ApplicationA patient develops sharply demarcated white patches because melanocytes are lost; which pigment disorder is most likely?
- Pigment disorders · ApplicationWhich feature favors melasma rather than vitiligo?
Bacterial skin infection5
- Bacterial skin infection · ApplicationWhat is a typical feature of cellulitis?
- Bacterial skin infection · ApplicationWhat lesion is typical of impetigo?
- Bacterial skin infection · ApplicationWhat finding is typical of cellulitis?
- Bacterial skin infection · ApplicationWhich organism is a common cause of nonbullous impetigo?
- Bacterial skin infection: cellulitis · ApplicationA patient has a warm, tender, expanding erythematous lower leg with fever but no sharply raised border. What is the most likely diagnosis?
Cutaneous markers of malignancy5
- Cutaneous markers of malignancy · ApplicationA 65-year-old man develops a sudden eruption of numerous itchy seborrhoeic keratoses over his trunk, along with weight loss. This sign suggests which internal condition?
- Cutaneous markers of malignancy: necrolytic migratory erythema · Multi-stepA 58-year-old woman has weight loss, new diabetes, anaemia and a migratory erythematous eruption with erosions and crusting around the groin and perineum. Which diagnos…
- Cutaneous markers of malignancy: erythema gyratum repens · Multi-stepA 65-year-old smoker has a rapidly migrating, concentric wood-grain pattern of erythematous bands over the trunk with intense itching. Which underlying disease should b…
- Cutaneous markers of malignancy: acquired ichthyosis · ApplicationA 40-year-old man develops new generalised fish-scale dryness of the skin with cervical lymphadenopathy and weight loss. Which malignancy is the classic association of…
- Cutaneous markers of malignancy: hypertrichosis lanuginosa acquisita · Multi-stepA 58-year-old woman develops sudden growth of fine, soft, unpigmented lanugo-type hair over the face and trunk with weight loss and a smooth red tongue. What should be…
Vesiculobullous5
- Vesiculobullous: junctional epidermolysis bullosa · Multi-stepA neonate has widespread blisters, nail dystrophy and granulation tissue around the mouth. Electron microscopy shows a split in the lamina lucida. A defect in which pro…
- Vesiculobullous: pseudoporphyria · Multi-stepA teenager taking naproxen for arthritis develops tense blisters and fragility on sun-exposed dorsal hands. Plasma and urine porphyrins are normal. What is the diagnosis?
- Vesiculobullous: SSSS versus TEN level of split · Multi-stepA 2-year-old has fever, perioral crusting and widespread tender erythema with superficial peeling and sparing of the mouth. A skin biopsy would most likely show cleavag…
- Vesiculobullous: salt-split skin in pemphigoid · Multi-stepDirect immunofluorescence of perilesional skin in a patient with tense bullae shows linear IgG and C3 along the basement membrane. On salt-split skin, the deposits loca…
- Vesiculobullous: topical therapy for bullous pemphigoid · Multi-stepAn 80-year-old man has localised tense bullae on the flexures and limbs with positive linear IgG and C3 at the basement membrane. Which first-line therapy is supported…
Bacterial infection4
- Bacterial infection · ApplicationHoney-colored crusts suggest what?
- Bacterial infection · ApplicationRaised sharply demarcated red plaque with fever suggests what?
- Bacterial infection · ApplicationWhat is a typical clinical feature of cellulitis?
- Bacterial infection · ApplicationWhat lesion is characteristic of impetigo?
Contact dermatitis4
- Contact dermatitis · ApplicationA rash limited to nickel jewelry contact is what mechanism?
- Contact dermatitis · ApplicationWhat is the mechanism of allergic contact dermatitis?
- Contact dermatitis · ApplicationWhat is a central management step for irritant contact dermatitis?
- Contact dermatitis · ApplicationWhat is the first practical management step for suspected allergic contact dermatitis?
Pigment4
Rosacea4
- Rosacea · ApplicationA 40-year-old woman has episodic flushing with persistent central facial erythema, telangiectasia and papules and pustules, but no comedones. Symptoms worsen with alcoh…
- Rosacea: sub-antimicrobial doxycycline · ApplicationA patient with papulopustular rosacea is prescribed doxycycline 40 mg modified-release daily. Why is this dose used?
- Rosacea: ocular rosacea · ApplicationA woman with papulopustular rosacea complains of grittiness, red eyelid margins and recurrent styes. What is the likely cause and treatment?
- Rosacea · ApplicationA middle-aged adult has recurrent central facial flushing, persistent erythema, telangiectasia, and papules but no comedones. What is the diagnosis?
Scabies4
- Scabies · ApplicationWhat is a classic symptom of scabies?
- Scabies · ApplicationWhat is a typical site for scabies burrows in adults?
- Scabies · ApplicationWhat symptom is most characteristic of scabies?
- Scabies · ApplicationWhich topical treatment is commonly first-line for uncomplicated scabies in adults and children older than two months?
Blistering disorders3
- Blistering disorders · ApplicationA patient has flaccid blisters that rupture easily and a positive Nikolsky sign. Which condition is most likely?
- Blistering disorders · ApplicationWhich finding is typical of bullous pemphigoid?
- Blistering disorders · ApplicationWhy is pemphigus vulgaris clinically serious?
Drug reaction3
Hair3
Infection3
Infestation3
- Infestation · ApplicationNight itch with finger-web burrows suggests what?
- Infestation · ApplicationWhat causes nocturnal itch and burrows?
- Infestation: scabies · ApplicationA household has intense nocturnal itch with papules and burrows in the finger webs and wrists. What is the correct management principle?
Leg ulcers3
Neurocutaneous syndromes3
- Neurocutaneous syndromes · ApplicationA 10-year-old has six light-brown macules larger than 5 mm on the trunk, axillary freckling and two cutaneous neurofibromas. Which ocular finding is most characteristic…
- Neurocutaneous syndromes: Sturge-Weber syndrome · Multi-stepA newborn has a unilateral port-wine stain over the forehead and upper eyelid. At 6 months she has focal seizures. What additional complication should be screened for?
- Neurocutaneous syndromes: PHACE syndrome · Multi-stepA large segmental haemangioma of the face in an infant should prompt screening for which association?
Skin lesions3
- Skin lesions · ApplicationWhich primary skin lesion is a flat, circumscribed area of altered skin color without elevation?
- Skin lesions · ApplicationWhich primary skin lesion is a small, raised collection of clear fluid within or beneath the epidermis?
- Skin lesions · ApplicationOn examination, a patient has a small sharply circumscribed change in skin color that is completely flat and cannot be felt above the surrounding surface. What is this…
Sun protection3
Wound care3
Arterial disease2
Atopic eczema2
Autoimmune blistering2
Autoimmune blistering disease2
- Autoimmune blistering disease · ApplicationAn older adult has widespread tense itchy bullae on normal or erythematous skin, with no significant mucosal involvement. Which diagnosis is most likely?
- Autoimmune blistering disease · ApplicationA patient has painful oral erosions and flaccid bullae that rupture easily, with positive Nikolsky sign. Which diagnosis is most likely?
Bacterial skin infections2
Blistering2
Dermatologic emergencies2
- Dermatologic emergencies · ApplicationWhich presentation should trigger urgent evaluation for possible necrotizing soft tissue infection?
- Dermatologic emergencies: erythroderma · Multi-stepA patient has diffuse erythema and scale over more than 90% of body surface area, tachycardia, and chills. What is the appropriate level of concern?
Inflammatory dermatoses2
Leprosy reactions2
- Leprosy reactions · ApplicationA patient with lepromatous leprosy on multidrug therapy develops fever, painful tender erythematous nodules over the limbs, joint pains and neuritis. What is the underl…
- Leprosy reactions · ApplicationA patient with borderline tuberculoid leprosy, a few weeks into treatment, develops erythema and swelling of his existing skin patches and a sudden foot drop and a tend…
Lesion morphology2
Neutrophilic dermatoses2
- Neutrophilic dermatoses · Multi-stepA woman with ulcerative colitis develops a painful pustule on her shin after minor trauma. It rapidly expands into a deep ulcer with a violaceous, undermined border. Cu…
- Neutrophilic dermatoses: Sweet syndrome · Multi-stepA 55-year-old woman has fever, neutrophilia and tender, juicy erythematous plaques on the arms for 5 days. Biopsy shows a dense dermal neutrophilic infiltrate without v…
Nonmelanoma skin cancer2
- Nonmelanoma skin cancer: basal cell carcinoma · ApplicationA patient has a slowly enlarging pearly papule with rolled edge, surface telangiectasia, and occasional bleeding on the nose. What is the likely diagnosis?
- Nonmelanoma skin cancer: squamous cell carcinoma · ApplicationA patient has a tender enlarging hyperkeratotic indurated nodule on the lower lip. Which malignancy is most likely?
Pressure injury2
Skin anatomy2
Ulcers2
Venous disease2
Viral2
Androgenetic alopecia1
Atopic dermatitis1
Bacterial skin disease1
Basal cell carcinoma1
Drug eruption1
Emergency infection1
Necrotizing infection1
Necrotizing soft-tissue infection1
Nutritional skin disease1
Occupational dermatology1
Papulosquamous disease1
Photodermatoses1
Pigmented lesions1
Seborrheic dermatitis1
Skin examination1
Skin infections1
Squamous cell carcinoma1
Tinea versicolor1
Common questions
How many Dermatology questions are there?
963 original questions across 805 topics, and the bank grows over time.
Which Dermatology topics are covered?
Blistering disorders, Leprosy, Pigmentary disorders, Drug reactions, Papulosquamous disorders, Bullous disorders, Viral infections, Urticaria, Panniculitis, Sexually transmitted infections, Metabolic skin signs, Bacterial infections, and more.
How difficult are these Dermatology questions?
0 are recall, 672 are application and 291 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Dermatology questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Dermatology for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Dermatology test?
Yes. The Dermatology subject test is included with a paid term, with a countdown and a question palette.
How should I use these Dermatology questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Dermatology questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.