March 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 23-year-old woman is seen in the dermatology clinic with a 3-month history of an intensely itchy rash over her hands and feet. She has been working as a veterinarian's assistant for the last 9 months and there is no clear trigger for her symptoms. She finds the itching is exacerbated on hot days, particularly during her holiday to Spain 4 weeks ago. There is no past medical history of note and she has no known allergies. There is a family history of atopic eczema.

On examination, she has sweaty palms. There is a vesicular rash over her plantar and palmar surfaces. The surrounding skin is erythematous.

What is the most likely diagnosis?

A. Allergic contact dermatitis

B. Atopic Eczema

C. Hand foot and mouth disease

D. Irritant contact dermatitis

E. Pompholyx

2. A 25-year-old man of black African-Caribbean origin with a history of eczema presents to the GP with a flare of red, itchy, dry skin behind his knees. As well as advising about emollients, the GP prescribes a course of betamethasone. They advise the patient to follow the instructions carefully and not to apply the betamethasone for more than one week.

What adverse effect is the patient most likely to experience from his treatment?

A. Dry Skin

B. Hyperglycaemia

C. Reduced Hair growth at site of application

D. Skin depigmentation

E. Skin hypertrophy

3. A 5-year-old boy with eczema is brought to the GP with his mother with a patch of itchy, erythematous skin on his right cheek that has been worsening despite using emollients and topical hydrocortisone. Overnight, the patch has become extremely painful and has spread to the temple.

On examination, another dry, erythematous patch is noted on his chin. The skin on the right cheek is more erythematous and extends 3 cm towards the temple. It is hot and tender on palpation. His observations are normal and he is otherwise well. He has an allergy to penicillin.

What is the most appropriate action for the GP to take?

A. Arrange immediate hospital admission

B. Prescribe a more potent topical corticosteroid

C. Prescribe oral aciclovir

D. Prescribe oral clarithromycin

E. Prescribe oral flucloxacillin

4. Which one of the following best describes the typical distribution of atopic eczema in a 10-month-old child?

A. Nappy area and flexor surfaces of arms and legs

B. Face and trunk

C. Nappy area and trunk

D. Flexor surfaces of arms and legs

E. Scalp and arms

5. A 2-year-old boy is brought to the GP by his mother. She has noticed a red rash on the flexor aspects of his elbows and on the abdomen and reports he is constantly trying to scratch. On examination the child appears well. There is evidence of excoriation over red patches of dry skin but there is no crusting or evidence of infection. A diagnosis of eczema is made. What is the first line treatment in a child of this age?

A. Topical corticosteroids

B. Topical calcineurin inhibitors

C. Topical emollients

D. Phototherapy

E. Bandages and dressings

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

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Q1: E

Explanation: This woman has a diagnosis of pompholyx. It is a dermatological condition that is more common in young adults and more often in females compared to males. It is characterised as an itchy vesicular rash over the palms and soles of feet and is associated with sweating. Heat often exacerbating the rash.

Q2: D

Explanation: Topical corticosteroids may cause patchy depigmentation in patients with darker skin. Betamethasone is an example of a corticosteroid. Corticosteroids are applied topically to reduce inflammation in skin conditions such as eczema or psoriasis. When applied appropriately (i.e. appropriate strength and lowest possible dose for lowest possible time), topical corticosteroids are associated with few adverse effects. However, if applied for a long period to the same area or in high doses, topical corticosteroids can cause local adverse effects, including skin depigmentation (particularly in patients with darker skin), skin atrophy (thinning), and excessive hair growth.

Q3: A

Explanation: Rapidly worsening and painful eczema that is unresponsive to usual treatment should raise suspicion of eczema herpeticum, which is a medical emergency requiring immediate hospital admission. This is because it can rapidly worsen and lead to systemic complications such as the involvement of the eyes, brain, meninges, lungs, and liver. It requires treatment with urgent intravenous antivirals. Rapidly worsening painful eczema is an early sign of eczema herpeticum and as time goes on, clustered blisters and punched-out erosions may appear.

Q4: B

Explanation: Atopic eczema, also known as atopic dermatitis, typically affects the face and trunk in infants. This distribution is due to the fact that these areas are more exposed to environmental allergens and irritants. The cheeks, forehead, and extensor surfaces of the limbs are common sites. The nappy area is usually spared because it is covered and protected from these factors.

Q5: C

Explanation: This question focuses on the stepwise management of eczema in children. The child in this scenario has a new diagnosis and has not tried any treatment. The first-line treatment is topical emollients. If necessary, topical steroids can be used alongside the emollients, but emollients must be used before steroids can be added.

Bandages and dressings may help to prevent excoriation but will not treat the eczema.

Calcineurin inhibitors and phototherapy are not suitable in this scenario.

References:

1. Passmedicine [Internet]. Available from: https://www.passmedicine.com/