February practice questions

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All answers with explanations can be found at the end of the page!

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1. A 45-year-old man presents to his GP with a rash on his face, upper chest and hands. He states that it has been getting worse for the last few weeks. He doesn't remember changing his diet or starting any new medication in this time. On further questioning, he also reveals that he has been feeling weaker and finding it more difficult at work to move heavy boxes. On examination, he has a purplish rash on his eyelids. He has red papules on the proximal joints of his fingers. Excoriations and evidence that some of the lesions have bled is also noted.

Given the history and examination findings, what is the most likely diagnosis?

A. Scleroderma 

B. Polymyositis 

C. Dermatomyositis 

D. Psoriasis 

E. SLE

2. A 72-year-old man presents to his General Practitioner with a rash. The rash in question is warty plaque across his back. What is the usual first-line treatment for this condition?

A. Topical 5-fluorouracil 

B. Cryotherapy 

C. Dapsone

D. Topical Steroids 

E. Oral Prednisolone

3. A 6-year-old girl is brought into the general practice by her father. He is concerned about a new rash that has developed around his daughter's mouth. Apart from this rash, she is well in herself. The lesion is a superficial, erythematous macule with some erosion and a golden crust.

Given the likely diagnosis, when can she return to school?

A. After 24 hours of commencing antibiotic therapy 

B. She must not return until she is seen by a dermatologist 

C. 7 days after onset of rash 

D. After all lesions crusted over 

E. Immediately 

4. A 47 year old woman attends the GP with a new rash. On examination, there are a number of purple, flat-topped, papules across her trunk. The rash is intensely itchy. 2 months ago she was started on a new medication.

Which of the following medications is most likely responsible for the rash?

A. Paracetamol 

B. Bisoprolol 

C. Amoxicillin 

D. Silver Nitrate

E. Hydralazine

5. A 15 year old teenager has presented to the GP with his mother. His mother is concerned that her son has developed signs of acne on his forehead and cheeks. Following examination, the GP concludes the teenager does have evidence of mild Acne Vulgaris. Which of the following skin changes has the GP most likely identified in order to reach this conclusion?

A. Furuncle

B. Macule

C. Patch 

D. Plaque

E. Comedones

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We hope you found these questions useful. For the answers, please refer below

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Q1: C 

Explanation: Dermatomyositis is a rare condition that causes muscle inflammation. It presents with symmetric proximal muscle weakness, skin rash, and extramacular manifestations. It is thought to be the result of a humoral mediated attack directed against the muscle capillaries and the endothelium of arterioles.

Skin changes may precede or may coincide with the onset of muscular symptoms. Patients can present with several types of skin rashes, photosensitivity, changes in pigmentation, and pruritis. Dermatomyositis can also cause nail changes and alopecia.

Pathognomonic findings of dermatomyositis include the following:

• Gottron papules: dorsal metacarpophalangeal and interphalangeal joints may show the presence of overlying erythematous or violaceous papules with or without scaling or ulceration.

• Heliotrope rash: This is a characteristic skin finding of dermatomyositis and presents with a violaceous, or an erythematous rash affecting the upper eyelids with or without periorbital edema. This finding may not be apparent in patients with dark skin patients.

Q2: B

Explanation: Treatment options for non-facial warts in adults and older children include topical salicylic acid, cryotherapy, or a combination of both (cryotherapy is not recommended for younger children). As topical salicylic acid is not an option here, cryotherapy is the next best option.

Q3: D

Explanation: Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed. It’s important to stay away from work, school, nursery or playgroup until this point.

Q4: B

Explanation: Anti-hypertensives such as B-blockers, thiazides and ACE-i are causes of a lichenoid eruption

Q5: E

Explanation: Comedones are dilated sebaceous follicles in the skin (also called pores). They can be open (blackheads) or closed (whiteheads) due to the accumulation of bacterial and cellular debris. Both open and closed comedones are non-inflammatory lesions associated with mild Acne Vulgaris.

References:

1. Medical question banks [Internet]. Available from: https://quesmed.com/