Specialty Certificate in Dermatology Sample Questions

Question: 1 A 40-year-old man presented with a 12-month history of an eruption affecting both hands. It improved when he went on holiday, but did not go away. He had worked as a bricklayer for 20 years. On examination, he had a chronic dermatitis affecting the back and front of both hands. He was referred for patch testing. Which relevant allergen is most likely to prove positive on patch testing? A B C D E cobalt chloride fragrance mix II nickel sulphate potassium dichromate thiuram mix

Revised-Apr-2012

Question: 2 A 50-year-old woman presented with a solitary asymptomatic lesion on her left thigh. On examination, the lesion was pink, dome-shaped and measured 1 1 cm. The lesion demonstrated a fine collarette of scale. The lesion was excised and sent for histopathological analysis. The pathologist reported that there were some psoriasiform features in the epidermis. What is the most likely diagnosis? A B C D E clear-cell acanthoma keratoacanthoma pilomatricoma seborrhoeic keratosis trichilemmoma

Revised-Apr-2012

Question: 3 A 53-year-old woman was referred with a lesion on her lower leg. She had noted the rapid development of a very painful ulcer during the previous 3 weeks. Before the ulceration appeared, she recalled a small blister following minor trauma. On examination, there was a discrete deep ulcer with undermined borders on the lateral aspect of the mid-left calf that measured 8 10 cm. There was surrounding erythema and regional lymphadenopathy. She had no signs of arterial or venous insufficiency. A skin biopsy taken from the ulcer margin demonstrated a dense diffuse neutrophilic infiltrate with a mixture of lymphocytes, plasma cells, histiocytes and occasional foreign body giant cells, extending to the subcutis. Investigations: haemoglobin white cell count platelet count antinuclear antibodies anti-neutrophil cytoplasmic antibodies syphilis serology urinalysis colonoscopy culture for bacteria, mycobacteria What is the most appropriate therapeutic option? A B C D E dapsone flucloxacillin infliximab minocycline prednisolone 146 g/L (115165) 14.2 109/L (411) 450 109/L (150400) negative negative negative normal normal negative and fungi

Revised-Apr-2012

Question: 4 A 53-year-old man presented with a 3-month history of sore areas in the mouth and on the scalp. He was otherwise well and on no regular medication. On examination, there were erosions on the buccal mucosae and crusted lesions on his scalp and upper back. Skin biopsy demonstrated epidermal acantholysis and a mixed inflammatory cell infiltrate in the dermis. Direct immunofluorescence showed intercellular deposition of immunoglobulin G and C3 in the epidermis. What is the most likely autoantigen? A B C D E collagen VII desmocollin 1 desmoglein 3 desmoplakin laminin V

Revised-Apr-2012

Question: 5 A 17-year-old girl presented with acne. She had been taking co-cyprindiol (cyproterone acetate 2 mg, ethinylestradiol 35 g) for contraception and acne management for the last 2 years. On examination, she had facial papules, cysts, comedones and scarring. Her fasting lipids and liver function tests were within the normal range. What is the most important issue to discuss if considering treatment with systemic isotretinoin? A B C D E alcohol consumption cheilitis drug interaction keloid risk teratogenic risk

Revised-Apr-2012

Question: 6 A 23-year-old man was referred for genetic counselling because of non-itchy dryness of his skin, present since birth. He was otherwise well. His maternal grandfather had a similar skin condition. His wife was pregnant with their first child. On examination, he had pronounced light brown scaling of his skin, most prominent on the extensor surfaces of the upper arms and legs with less marked changes in the flexures. What is the probability that the child will express ichthyosis? A B C D E 0% 25% 50% 75% 100%

Revised-Apr-2012

Question: 7 A 27-year-old man presented with a 2-month history of an enlarging, red nodule on the left great toe. The lesion was uncomfortable when he walked. On examination, there was an inflamed nodule 8 mm in diameter. The lesion was excised and the histology was examined (see image).

What is the most likely diagnosis? A B C D E abscess amelanotic melanoma eccrine poroma myxoid cyst pyogenic granuloma

Revised-Apr-2012

Question: 8 A 55-year-old woman presented with a 3-month history of an eruption on her hands and feet. She worked as a cleaner and had a past history of hypothyroidism and reflux oesophagitis, which had been treated with thyroxine and omeprazole. She consumed 12 units of alcohol per week and smoked 20 cigarettes per day. On examination, there were pustules and brown scaly lesions over the palms and the insteps. What is the most likely diagnosis? A B C D E allergic contact dermatitis asteatotic eczema drug-induced lichen planus irritant contact dermatitis palmo-plantar pustulosis

Revised-Apr-2012

Question: 9 A 75-year-old woman presented with an enlarging lesion on the upper back of 3 years duration. She had multiple co-morbidities. On examination, there was a 4-cm diameter erythematous, shiny plaque. A punch biopsy showed superficial basal cell carcinoma. It was decided to treat her with imiquimod. What is the recommended treatment regimen? A B C D E 3 times per week for 8 weeks 5 times per week for 6 weeks alternate days for 4 weeks daily for 3 weeks daily for 6 weeks

Revised-Apr-2012

Question: 10 A 62-year-old man presented with a rapidly enlarging nodule on his scalp. He had undergone a renal transplant 15 years previously. He was taking prednisolone, azathioprine and ciclosporin. On examination, there was a purple lesion measuring 2 cm in diameter that was tender, but not ulcerated. There was no lymphadenopathy. Skin biopsy showed features of Merkel cell carcinoma. What virus is most likely to be associated with this tumour? A B C D E herpesvirus papillomavirus polyomavirus poxvirus retrovirus

Revised-Apr-2012

Question 11 A 5-year-old boy presented with a history of recurrent blistering on his feet, which had begun in early infancy as soon as he had started to walk, and was worse in the summer. There was a similar history of blistering in his mother and maternal grandfather. A diagnosis of epidermolysis bullosa was suspected. In what molecule is the most likely primary structural defect? A B C D E -4 integrin bullous pemphigoid antigen 180 desmoglein 1 keratin 5 laminin 332

Revised-Apr-2012

Question 12 An 82-year-old man presented with a 3-month history of an enlarging crusted area on the vertex of his scalp, from which the crust was removed (see image). The area had been exudative. The scalp was not painful but was tender to touch. In the past, he had had treatment for actinic keratoses.

A punch biopsy showed evidence of solar elastosis, mild dysplasia and a marked inflammatory reaction. What is the most likely diagnosis of the ulcerated area? A B C D E basal cell carcinoma erosive pustular dermatosis pemphigus foliaceus pemphigus vulgaris squamous cell carcinoma in situ

Revised-Apr-2012

Question 13 A 45-year-old man of Afro-Caribbean descent presented to the outpatient clinic complaining of itchy pigmented lesions on the extensor surfaces of his limbs and abdomen. He had a history of diabetic nephropathy and was approaching end-stage renal failure. On examination, there were numerous 0.51.0-cm hyperpigmented papulonodular lesions, many with central ulceration and some with keratin plugs discernible. What is the most likely diagnosis? A B C D E acquired reactive perforating collagenosis calcific uraemic arteriolopathy diabetic dermopathy nephrogenic systemic fibrosis nodular prurigo

Revised-Apr-2012

Question 14 A 17-year-old boy presented with a 9-month history of an increasingly severe rash affecting the dorsal aspects of his feet. His mother had noticed that the rash was worse if he wore trainer-type footwear and improved if he wore brown or black shoes with leather uppers. He underwent patch testing. What is the most likely relevant positive allergen? A B C D E 4-tert-butylphenol formaldehyde resin formaldehyde N-isopropyl-N-phenyl-4-phenylenediamine potassium dichromate tetramethylthiuram disulfide

Revised-Apr-2012

Question 15 A 72-year-old woman, who had had chronic hand dermatitis for many years, presented with a deterioration of her condition over the summer months. She was a keen gardener. Examination showed vesicular palmar eczema with several fissures. She was patch tested to the standard series of the British Society for Cutaneous Allergy. What is the most likely positive, relevant patch test reaction? A B C D E compositae mix methyldibromo glutaronitrile potassium dichromate thiuram mix wool alcohols

Revised-Apr-2012

Question 16 A 76-year-old man attended for curettage and cautery of a 15-mm irritated keratosis of the left chest. He had a permanent cardiac pacemaker, which had been inserted 10 years previously, and was taking warfarin. The control box lay just below the keratosis on the chest. The surgeon wished to avoid damage or malfunction of the pacemaker during surgery. What form of haemostasis is most appropriate? A B C D E calcium alginate electrocautery electrodessication electrofulguration trichloroacetic acid solution

Revised-Apr-2012

Question 17 A 27-year-old man presented with 4-week history of a rash on his trunk and limbs. He described the rash as gradually changing from pale pink spots to becoming raised. It was not itchy. He had had some general malaise with aching joints and headaches, but had not been off work. On examination, there was a widespread eruption affecting his chest, back and limbs. The individual lesions were up to 1.5 cm in diameter and slightly raised, with a coppery pink colour. In his mouth, there were a few ill-defined erosions on his palate. Skin biopsy showed an epidermis of normal thickness with a dermal perivascular inflammatory cell infiltrate. The infiltrate comprised lymphocytes and plasma cells. Vessel walls showed endothelial swelling. What is the most appropriate investigation? A B C D E antinuclear antibodies antistreptolysin O titre EpsteinBarr virus serology erythrovirus B19 serology syphilis serology

Revised-Apr-2012

Question 18 A 34-year-old man had an excision biopsy of an irregular pigmented lesion on his back. Histology showed a malignant melanoma, of Breslow thickness 0.8 mm, nonulcerated and completely excised. His case was discussed at the local skin cancer multidisciplinary team meeting. According to current UK Melanoma Guidelines, what further management is recommended? A B C D E 1-cm margin wide local excision 2-cm margin wide local excision 3-cm margin wide local excision no further excision and observation sentinel node biopsy

Revised-Apr-2012

Question 19 A 62-year-old woman presented with a 6-month history of itching around a longstanding area of ulceration above her medial malleolus. She had no previous history of skin disorders. Despite recent changes of ulcer dressing, the lesion had deteriorated, with an increase in adjacent eczema. On examination, there was an area of ulceration with a maximum diameter of 2.5 cm over the left medial malleolus. There was evidence of brownish discolouration and subacute eczema in the adjacent skin. What is most likely to offer an explanation for the deterioration? A B C D E angiography patch testing pulse oximetry skin biopsy venography

Revised-Apr-2012

Question 20 A 39-year-old man presented with a 6-month history of hand eczema. Patch testing showed a positive reaction to cetostearyl alcohol. What preparation would be safe for him to use? A B C D E aqueous cream Betnovate cream Betnovate ointment emulsifying ointment Hydromol cream

Revised-Apr-2012

Answers :

1. 2. 3. 4. 5. 6. 7. 8. 9.

D A E C E A E E B

10. C 11. D 12. B 13. A 14. A 15. A 16. B 17. E 18. A 19. B 20. C

Revised-Apr-2012