Dermatology --- Best Answer

.A 2-year-old child develops a scaly macular diffuse rash and is diagnosed with psoriasis Which of the following is true of this diagnosis?
(Please select 1 option)
A common cause of alopecia totalis
Associated with cows' milk protein intolerance
Best treated initially with steroid creams
Sometimes a sequel to staphylococcal infection
Typically not itchy
Eczema is associated with cows' milk intolerance and itchiness, rather than psoriasis. Coal tar is
commonly used initially.
Small patches of alopecia are associated with psoriasis, rather than complete alopecia. Telogen effluvium
is the typical form of hair loss that psoriasis induces, but sometimes psoriasis can cause a scarring
alopecia.
There is a rather loose association between streptococcal throat infections and psoriasis.
.A young child is brought to clinic with severe eczema Which of the following statements concerning his treatment is correct?
(Please select 1 option)
Might benefit from a diet free of cows' milk
Should be given a course of oral steroids
Should be treated with the aim of complete cure
Should not be immunised against measles
Should not be immunised against pertussis
Cows' milk allergy may precipitate severe eczema, and trial of soy based formula may have beneficial
effects on the infant's condition.
Complete cure is not always a practical aim of treatment.
Amelioration of symptoms, using appropriate preventative measures and topical preparations, may
minimise, but not totally eradicate the condition.
Most infants grow out of the condition by the time they are 2-3 years old.
There is no current evidence to suggest that infants with eczema should not receive measles or pertussis
immunisation, but they should not be immunised if there is a concurrent skin infection.
Oral steroids are a last resort of treatment and are only rarely used in infants with severe eczema.
.A 4-month-old child is diagnosed with napkin rash 1

Dermatology --- Best Answer

Which of the following is the most appropriate treatment of mild napkin rash?
(Please select 1 option)
Bactroban cream
Exposure to air
Oral flucloxacillin
Topical betamethasone
Topical iodine
Causes of napkin rash include contact dermatitis, which may produce ammonia and this may burn the
skin.
Infection with bacteria and candida yeasts may cause nappy rash, as can psoriasis and atopic dermatitis
affecting the nappy area.
Nappy rash is not an indicator of infantile eczema, and it is not more common in boys, nor is it less
common in soy fed infants.
Treatment is best achieved by prevention with frequent (disposable absorbent) nappy changing, and fluid
feeding early in the day to lessen night time urination.
Anti-fungal lotions may also be useful.
A 5-month-old boy presents with florid red rash over his scalp, nappy area and trunk. Despite this he seems well in himself and feeding well. He was born at term weighing 3.1 kg and there were no neonatal
.problems. He is fully immunised and there is no FH/SH of note
On examination he is apyrexial and well. The rash is florid red and confluent over his nappy area. He has
a crusty confluent covering over his scalp, extending onto his forehead. Smaller 0.5-1 cm greasy lesions
are present over his trunk.
What is the most likely diagnosis?
(Please select 1 option)
Acrodermatitis enteropathica
Ammoniacal dermatitis
Histiocytosis
Infantile eczema
Seborrhoeic dermatitis
The picture is of extensive greasy scaly rash especially over the head (cradle cap) and nappy area without
systemic upset.
This is highly characteristic of seborrhoeic dermatitis.
Selenium shampoo and topical steroids usually result in rapid resolution.

Dermatology --- Best Answer

An 18-month-old boy presents with fever for six days and large neck glands. He has begun to develop an .erythematous rash
Full term normal delivery, no neonatal problems. Immunisations up to date. No family or social history of
note.
On examination the temperature is 38.9C and he is miserable. He has bilateral non-purulent
conjunctivitis, massive tender cervical lymphadenopathy, swollen hands and a strawberry tongue.
What is the most likely diagnosis?
(Please select 1 option)
Infectious mononucleosis
Kawasaki disease
Measles
Parvovirus infection
Scarlet fever
Fever for more than five days, cervical nodes, rash, strawberry tongue, and conjunctivitis make Kawasaki
disease the likely diagnosis. The criteria for diagnosis are clinical.
Treatment with IVIG (2 g/kg) and high dose aspirin (100 mg/kg/d) within 10 days of disease onset reduces
the risk of coronary artery aneurysm.
.A 10-month-old child presents acutely with non-blanching, purple skin lesions In these circumstances, which of the following statements is true?
(Please select 1 option)
A haemoglobin of 7.3 g/dl, with a white cell count of 12 x 109/l and platelets of 86 suggests acute
leukaemia
If the haemoglobin is 12.3 g/dl, the white cell count is 12 x 109/l, and the platelets are 97, this suggests
Henoch-Schnlein purpura
Microscopic haematuria suggests infective endocarditis
Splenomegaly suggests idiopathic thrombocytopaenic purpura
The likeliest cause is meningococcal disease
Causes of purpura in children include:
Thrombocytopaenic:

Impaired production: leukaemia, aplastic anaemia

Excessive destruction: immune (ITP), secondary (systemic lupus erythematosus [SLE], drugs, viral
infections), alloimmune neonatal thrombocytopaenia

Consumptive coagulopathy: disseminated intravascular coagulation (DIC), haemolytic uraemic

syndrome, thrombotic thrombocytopaenic purpura
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Dermatology --- Best Answer

Congenital: giant haemangioma, Wiskott-Aldrich syndrome.

Vascular disorders:

Congenital: connective tissues disorders (osteogenesis imperfecta, Ehlers-Danlos, Marfan's)

Acquired: meningococcal and other severe infections

Immune: Henoch-Schnlein purpura (HSP), connective tissue disorders (SLE)

Drugs.

Although meningococcal disease is an important differential in all children with purpura, it is not the most
likely cause. Even in febrile children, only 7% will have meningococcal disease.
The platelet count in HSP is normal.
In idiopathic thrombocytopaenic purpura there is an absence of hepatosplenomegaly.
Acute leukaemia is an important differential in anybody with pancytopaenia; 2/3 cell lines affected also
make this most likely.
Microscopic haematuria plus purpura may occur in infective endocarditis, but may also be related to HSP
or SLE.
?Which of the following therapies is NOT appropriate for the associated condition (Please select 1 option)
1% hydrocortisone for infantile eczema
Coal tar for psoriasis
Cortisone cream for alopecia areata
Permethrin for scabies
Surgical excision for a cavernous haemangioma 3 cm x 4 cm on the arm
Cavernous haemangiomas are usually not present at birth but appear in the first two weeks of life. Lesions
are usually on the face, neck or trunk and are well-circumscribed and lobulated.
Treatment options do not include surgical excision. Treatment may be indicated if there is inhibition of
normal development - for example impairing normal binocular visual development by obstructing the vision
from one eye.
It may involve systemic or local steroids, sclerosants, interferon, or laser treatment.
Alopecia areata is an autoimmune condition causing discrete areas of hair loss.
Treatment options include cortisone injections into the affected areas, and the use of topical cortisone
creams.
?Which of the following is true of atopic eczema (Please select 1 option)
Does not have a genetic basis
Does not respond to dietary measures
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Dermatology --- Best Answer

Is a generalised rash over the whole body
Should be treated in its early stages with topical corticosteroids
Usually starts in the first year of life
The typical distribution is face, ears, elbows and knees.
Cow's milk is a common cause and switching to a milk hydrolysate may assist.
It is more common in those with a family history of asthma, hay fever and eczema.
Topical steroids should be applied sparingly only if symptoms cannot be controlled.
Often it develops in the first year of life.
A 5-month-old boy presents with florid red rash over his scalp, nappy area and trunk. Despite this he .seems well in himself and feeding well
He was born at term weighing 3.1 kg and there were no neonatal problems. He is fully immunised and
there is no FH/SH of note.
On examination he is apyrexial and well. The rash is florid red and confluent over his nappy area. He has
a crusty confluent covering over his scalp, extending onto his forehead. Smaller 0.5-1 cm greasy lesions
are present over his trunk.
What is the most likely diagnosis?
(Please select 1 option)
Contact dermatitis
Erythema multiforme
Impetigo
Seborrhoeic dermatitis
Stevens-Johnson syndrome
The picture is of extensive greasy scaly rash especially over the head (cradle cap) and nappy area without
systemic upset.
This is highly characteristic of seborrhoeic dermatitis.
Selenium shampoo and topical steroids usually result in rapid resolution.
.A 3-month-old infant boy is brought to you by his mother who is concerned about a rash on his body Which of the following supports a diagnosis of eczema?
(Please select 1 option)
Cold weather relieves the symptoms
Dermographism excludes the diagnosis
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Dermatology --- Best Answer

The rash has been present from birth
The rash is fluctuant
The rash is pruritic
It is unusual for the rash of infantile eczema to be present at birth and usually occurs around 3 months
after birth.
Pruritus is a typical feature and relief with warmer conditions may occur.
Dermographism is also a feature.
The rash tends to be fluctuant and usually resolves by aged 10.
Treatment is usually with emollients, though steroid creams may be required for more severe cases.
A family history of atopy, hay fever, asthma or eczema is found in the vast majority of cases.
.A young child is seen with peeling of the palms of the hands and the soles of the feet Which of the following is a potential explanation for this presentation?
(Please select 1 option)
Chickenpox
Kawasaki disease.
Measles
Mumps
Urticaria
The secondary viraemia of varicella, featuring viral particles being spread to the skin 14-16 days after
initial exposure, causes the typical vesicular rash. Skin peeling is not a feature.
The histopathologic pattern in papular urticaria consists of

Mild subepidermal oedema

Extravasation of erythrocytes

Interstitial eosinophils, and

Exocytosis of lymphocytes.

The reaction is thought to be caused by a haematogenously disseminated antigen deposited by an

arthropod bite in a patient who is sensitive.
In Kawasaki's disease, desquamation of the fingers and toes begins in the periungual region, may involve
the palms and soles, and usually is observed one to two weeks after the onset of fever.
Tinea infection is associated with peeling of the skin in the affected area, and in scarlet fever, the skin rash
is associated with streptococcal Group A infection; the skin begins to peel usually around the sixth day of
the rash.
Atopic eczema is frequently associated with ichthyosis and desquamation.
Kawasaki disease is associated with desquamation and mucous membrane involvement.
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Dermatology --- Best Answer

.A 3-year-old child is noted to have a lesion on the left cheek and a diagnosis of impetigo is considered Which one of the following statements is true regarding impetigo?
(Please select 1 option)
Characterised by scab-covered weeping lesions
Highly infectious requiring isolation
Restricted to the face
Usually caused by Candida albicans
With dry, itchy and scaly lesions
Impetigo is a skin infection, caused by Staphylococcus aureus, Streptococcus pyogenes, or both.
It leads to the formation of scabby, yellow-crusted sores and, sometimes, small blisters filled with yellow
fluid.
It can occur anywhere in the body, but commonly occurs in the face, arms or legs.
It is a highly contagious, but does not require isolation.
?Which one of the following statements is true regarding scabies (Please select 1 option)
Is best treated by salicylate emulsion.
It can be spread by a droplet infection
It causes generalised pruritus
It is caused by Staphlococcus aureus
Typically it affects the face
Scabies typically affects the interdigital webs and skin folds of the arms and legs. The itch may persist for
2-3 weeks after successful treatment.
It is caused by the mite Sarcoptes scabiei. Permethrin-containing lotions are the treatment. It is spread by
skin contact and sharing clothes and bedding.
.An 18-year-old male presents with small pruritic scabs in his pubic region What is the most likely diagnosis?
(Please select 1 option)
Atopic eczema
Lice infestation
Pityrosporum folliculitis
Scabies
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Dermatology --- Best Answer

Tinea cruris
The diagnosis is likely to be infestation with pubic lice.
Eczema is unusual in the pubic region and the only other possibility is scabies, but there is usually no
evidence of infestation except for burrows in the finger webs and generalised pruritus.
.A 12-year-old boy presents with a florid rash on the hands and feet He became ill three days before, when he developed painful mouth ulcers. Yesterday he developed a rash
on the hands and feet.
He was a full term normal delivery, and previously has been very healthy. He is on no medications, is fully
immunised, and there is no family history of note.
On examination he has a temperature of 38.5C, RR 15/min and HR 85/min. He has profuse oral ulcers
on his tongue and buccal mucous membrances. He has many circular raised pinky red lesions over the
hands and feet with darker centres. He has tender cervical lymphadenopathy.
What is the most likely diagnosis?
(Please select 1 option)
Contact dermatitis
Erythema multiforme
Impetigo
Stevens-Johnson syndrome
Viral exanthems
The history suggests an attack of oral ulceration, followed by the development of target lesions over the
extremities.
The likely diagnosis is primary herpes simplex type 1 infection, complicated by erythema multiforme.
Treatment is supportive, though acyclovir may be given to control the herpes.
.A 7-month-old girl presents with fever and a rash She was completely well till five days ago, when she developed a slight cold. The next day she developed
fever to 39.7C, which has persisted despite antipyretics.
Despite this she has remained relatively well and continues to drink, though her appetite is poor. Today
she has developed a rash over the face and trunk.
She was born at term weighing 3.8 kg and there were no neonatal problems. She is fully immunised to
date and there is no FH/SH of note.
On examination she has a temperature of 36.8C, RR 25/min and HR 100/min. The rash is macular,
profuse, pink and blanching. It is most prominent over the face and trunk. She has shotty cervical
lymphadenopathy.
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Dermatology --- Best Answer

What is the most likely diagnosis?
(Please select 1 option)
Contact dermatitis
Erythema multiforme
Impetigo
Stevens-Johnson syndrome
Viral exanthems
The history of a well child with high fever for a few days followed by resolution of fever at around the time
of appearance of a rose-coloured rash is characteristic of roseola infantum.
Since the introduction of measles, mumps, rubella vaccine (MMR), this is by far the commonest cause of a
measles-like rash.
The peak incidence is 6-18 months. 5% develop febrile seizures.
It is caused by human herpes virus 6 and 7.
?Which of the following dermatological disorders is correctly matched to its treatment (Please select 1 option)
Acne and steroids
Erythema nodosum and topical tetracycline
Lipoma and laser therapy
Psoriasis and vitamin D analogues
Stevens-Johnson syndrome and retinoids
Stevens-Johnson syndrome is a condition associated with erythema multiforme and ulceration of the
mucous membranes. Treatment includes steroids and treating the underlying disorder.
Erythema nodosum is appropriately treated through treating the underlying condition - causes include
sarcoid, mycoplasma pneumonia and drugs.
Sebaceous cysts, lipomas and dermatofibromas are appropriately treated with surgery and do not respond
to topical therapies.
A 16-year-old girl is seen in clinic as she is concerned due to areas of hair loss on the scalp. Past medical history includes atopic eczema and she has a number of depigmented areas on her hands. What
?is the most likely diagnosis
(Please select 1 option)
Alopecia areata
Hypothyroidism
Seborrhoeic dermatitis
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Dermatology --- Best Answer

Systemic lupus erythematosus

Trichotillomania
This girl has a combination of vitiligo and alopecia areata which can co-exist and have similar autoimmune
aetiology. Discrete areas of hair loss and normal texture on the scalp are highly suggestive of alopecia
areata.
Azad Abdul Jabar Haleem

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