(BQ) Part 2 book Handbook of PLAB presents the following contents: Dermatology, surgery, radiology, biochemistry, pediatrics, orthopedics, ophthalmology, obstetrics, gynecology, renal diseases, miscellaneous,...
412 Handbook of PLAB thirteen Dermatology THEME: DIAGNOSIS OF SKIN DISEASE Options a b c d e f g h i j k l Fungal infections Erythema multiforme Granuloma annulare Basal cell carcinoma Psoriasis Discoid eczema Pityriasis rosea Impetigo Pityriasis alba Freckles Seborrheic keratoses Pityriasis versicolor For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions Herald patch, oval red lesions with scaly edge Superficial slightly scaly infection with the yeast M furfur Posteczema hypopigmentation, often on children’s face Active erythematous scaly edge with central scarring Well defined red patches, covered with honey colored crusts Pinkish papules forming a ring Brown macules, related to sun exposure Pearly papules with central ulcer Dermatology 413 THEME: DIAGNOSIS OF SKIN DISORDERS Options a b c d e Multiple petechiae in both axillae Draining sinus on lateral chest wall Purplish submucosal lesion on the hard palate Exuberant violaceous nodules over the nose and malar areas Black pigmented nodules along folds of skin in axillary and perineal areas For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions A 24-year-old homosexual man with fever, weightloss, and diffuse alveolar infiltrates on chest roentgenogram 10 A 31-year-old man with confusion and dyspnea 24 hours after fracturing his femur at a skin resort 11 A 52-year-old black woman with hypercalcemia and interstitial fibrous of the lung 12 A 69-year-old man with confusion, fever, dense consolidation with cavitation in the right lower lobe 13 A 74-year-old man with hemoptysis and right hilar mass on chest roentgenogram THEME: DIAGNOSIS OF SKIN CONDITION Options a b c d e f g h Lichen planus Seborrheic dermatitis Erythema chronicum migrans Pyoderma gangrenosum Vitiligo Acne Thrombophlebitis migrans Dermatitis herpetiformis 414 Handbook of PLAB i j k l Acanthosis nigricans Nerobiosis lipoidica Erythema marginatum Erythema multiforme For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 14 Itchy grouped blisters on knees, elbows and scalp in a patient with chronic diarrhea 15 Successive crops of tender nodules along blood vessels in a patient with pancreatic cancer 16 Yellowish, shiny skin with telangiectasia, on the skin of a diabetic 17 Circular lesions with central blisters, widespread— including palms and soles with ulcers in the mouth and genitalia 18 Pigmented, dark, rough, thickened skin in axillae and groins THEME: DIAGNOSIS OF SKIN LESIONS Options a Vitiligo b Melanoma c Rodent ulcer d Benign naevus e Keratoacanthoma f Pyoderma gangrenosum g Erythema marginatum h Dermatitis herpetiformis i Tophi j Necrobiosis lipoidica k Granuloma annulare l Erythema migrans m Erythema nodosum n Erythema ab igne Dermatology 415 For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 19 A young oil engineer complains of painful red lesions on his thighs Physical examination determines them to be nodular He has recently been vaccinated for travel to Asia 20 A young woman complains of mark on her abdomen Initially it was purple and then it enlarged and faded in the centre Over the past few weeks it has multiplied outwards 21 A middle-aged woman presents with a lesion on her calf It is an ulcerated nodule with a red and necrotic border It is very tender 22 A 52-year-old man complains of a large white patch on his back It is geographic with a hyperpigmented border He has just come back from a beach holiday and it is physically irritating him 23 A 28-year-old woman with a heart condition has a rash on her lower arms It is pink or red and ring like It moves up and down her arms and she can’t get rid of it THEME: DIAGNOSIS OF SKIN LESIONS Options a b c d e f g h i j Eczema herpetiformis Morbiliform rash Erythema multiforme Erthema marginatum Dermatitis herpetiformis Maculapapular rash Generalized urticaria Lichen planus Erythema chronicum migrans Erythema nodusum 416 Handbook of PLAB For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 24 A 24-year-old man visited a forest area weeks ago and developed a flu like illness He now has a stiff neck, sore throat and arthralgia 25 A 14-year-old boy has had a pyrexia, rash, raised ESR Subcutaneous nodules and a generalized rash is noted on her trunk 26 A 15-year-old girl has difficulty swallowing and large circular lesions (target lesion) are noted around her mouth, the inside of her mouth is swollen with crustation of the gingival 27 A 6-year-old girl presents with failure to thrive and a rash is noted, the child dislikes gluten-based foods 28 A 14-year-old boy has haematuria, hypertension, abdominal pain and a rash is noted on the flexor surfaces of his lower limbs THEME: DIAGNOSIS OF SKIN INFECTIONS Options a b c d e f g h i j Cellulitis Shingles Pityriasis versicolor Molluscum contagiosum Ringworm Necrotizing fascitis Impetigo Scabies Leprosy Seconday syphilis For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Dermatology 417 Questions 29 A 30-year-old man complains of a painless rash on his trunk He has pale, pink, scaly circular lesions with central clearing, which measure between and 8cm in diameter 30 A 60-year-old man complains of a 2-day history of pain in the left side of his chest He now has a blistering rash in a vertical band of skin on his left side 31 A 35-year-old woman from Nigeria has a number of depigmented patches of skin on her legs They are painless with reduced skin sensation 32 A 28-year-old businessman returned from a trip to Thailand months ago He now has a faint paplar rash, which includes is palms and soles He did have a painless ulcer on his penis but this resolved weeks ago 33 A 25-year-old woman from Ghana has a painless rash on her trunk of multiple scaly patches measuring between and cm in diameter 34 A 38-year-old man presents with a 12 hour history of a painful swollen right arm He has parasthesiae in his fingers He is febrile and the arm is tender with dusky skin THEME: DIAGNOSIS OF SKIN INFECTIONS Options a b c d e f g h i j Infected sebaceous cyst Furunculosis Cellulitis Herpes zoster Carbuncle Erysipelas Hidradenitis suppurativa Infected sinus Skin necrosis Scrofula For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all 418 Handbook of PLAB Questions 35 A 55-year-old non-insulin dependent diabetic man presents with chronics recurrent tender swelling in his groin These red swellings eventually discharge pus 36 A 45-year-old gardener presents with fever and swelling over his left cheek The left side of his face is red, hot and tender with a raised border 37 A 60-year-old obese insulin dependent diabetic woman presents with red papules and vesicles along the left preauricular region and mandible It was preceded by fever 38 A 70-year-old man with peripheral vascular disease present with a pinprick sized hole in the centre of his groin wound following a aorto-bifemoral graft The discharge is serous 39 A 50-year-old woman presents with a tender 1.5 cm swelling in the preauricular region There is a puncture seen in the centre The swelling is tense and smooth and attached to the skin THEME: DIAGNOSIS OF SKIN LESIONS Options a b c d e f g h i j k l Lichen planus Psoriasis Pityriasis versicolor Pityriasis rosea Acne vulgaris Allergic contact dermatitis Acanthosis nigrans Herpes zoster Erythema nodosum Dermatitis herpetiformis Pemphigus vulgaris Pemphigoid For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Dermatology 419 Questions 40 A 80-year-old man presents with itching followed by large, tense bullae on the limbs that not rupture easily Nikolsky’s sign is negative 41 A 50-year-old man presents with brownish scaly lesions of varying size on his trunk Depigmentation after treatment lasts for several months 42 A 30-year-old female presents with an itch painful rash over the lobes of both pinna Her earlobes are pierced 43 A 50-year-old man presents with a rash consisting of discrete purple shiny polygonal papules with fine white lines in previous scratch marks on his forearm He is also noted to have a white lacy network of lesions on the buccal mucosa 44 A 60-year-old man presents with brown pigmented plaques in the axilla He underwent prostatectomy recently THEME: DIAGNOSIS OF SKIN LESIONS Options a b c d e f g h i j k Erythema nodosum Erythema multiforme Henoch-schonlein purpura Eczema Psoriasis Necrobiosis lipoidica Ringworm Shingles Urticaria Pemphigus Pemphigoid For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 45 A 65-year-old woman has a 3-day history of painful blistering rash on her left outer thigh She has recently been diagnosed with breast cancer 420 Handbook of PLAB 46 A 25-year-old woman was recently started on Cotrimoxazole for a UTI She is now complaining of painful Red, raised lesions on both shins 47 A 30-year-old builder has developed pink scaly patches on both knees He has similar lesions on his elbows and scalp 48 A 65-year-old woman has developed extensive blistering particularly involving her legs The blisters are fragile and seem to spread under the skin surface when pressed She feels generally unwell but has no other symptoms 49 A 16-year-old girl presents with small purple lesions on her buttocks and shins She also has painful joints and abdomen Urinalysis reveals proteinuria 50 A 60-year-old man who has had diabetes for several years, has developed a waxy yellow patch on his left shin, which is showing signs of inflammation and ulceration THEME: 10 DIAGNOSIS OF SKIN LESIONS Options a b c d e f g h i j k Seborrhoeic Keratosis Malignant melanoma Café au lait parch Haemangioma Cambell de Morgan spor Keratpecanthoma Solar keratosis Basal cell carcinoma Squamous cell carcinoma Bowen’s disease Marjolin’s ulcer For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 51 A 60-year-old man presents with a persistent itchy ulcer on his right cheek He has had this ulcer for years The Dermatology 421 52 53 54 55 edges are rolled with a central scab that falls off and reforms The local lymph nodes are not enlarged A 65-year-old farmer presents with a grey thickened patch of skin on the rim of his left ear The cm lesion is painless, raised, firm and has not changed in size over many years A 40-year-old woman presents with a rapidly growing 1cm lump in the skin of her wrist The lump is the same colour as her skin but the centre is necrotic It is freely mobile and rubbery in consistency with a hard core A newborn baby presents with several, 2cm pale brown macules on the back A 20-year-old man presents with a chronic paronychia On examination, there is an expanding brown pigmentation present beneath the toe-nail with enlargement of the local lymph nodes THEME: 11 SKIN DISEASE IN CHILDREN Options a b c d e f g Erythema chronicum migrans Erythema infectiosum Erythema multiforme Erythema nodosum Exanthema subitum Purpura fulminans Tinea corporis For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 56 A nine-months old child is nonspecifically unwell for three days with a fever The rash subsides and the child breaks out in maculopapular rash over its body 57 Following a course of Septrin for a bacterial infection, a five-year-old child breaks out in a widespread macular rash with target lesions ... ingestion are some of the causes 122 Appears on legs of women due to prolonged exposure to heat 123 Follows bite by Ixodes 124 Commonly associated over telangiectasia THEME: 23 DIAGNOSIS OF BLISTERING... to have a 424 Handbook of PLAB maculopapilar rash over her forehead, nose and cheeks and a blue-red discolouration of the back of her hands 68 A 40-year-old man presents with areas of erythema... cancer She now has a 2- day history of painful blistering eruption, which effects a band of skin on the left side of her back 128 An 18-year-old man with diabetes has a 2- day history of painful blisters