Section 1

: Practice Questions

.155
PQ Whilst readinga histopathologyreport you come acrossthe term Breslow
.
thickness Youare aware that this determines the prognosisin cutaneousmelanoma
.

Breslow thickness is measured from

:

Stratumbasale
.
)
b Stratum corneum
.
)c Stratum granulosum
.
)
d Stratum lucidum
.
Stratum spinosum
.

.156 A70
PQ -year oldmanisadmittedwithweightlossandfatigue
. Heisnotedtohave
s.ichthyosi Acomputed
tomography scanshowed mediastinal
.
lymphadenopathyYou
makea diagnosisof acquiredichthyosis
.

h
Whic of thefollowingisnotarecognised
causeofacquiredichthyosis
?

.
Hypothyroidism
)b Multiple myeloma
.
)
c Nicotinic acid
.
.
Sarcoidosis
)
e .
Syphilis

.157
PQ A58
-year oldmanunderwent
excision
ofayellownoduleontheuppereyelid
t ishistologicall
tha y confirmed
assebaceous
.
adenoma
Hehasafamilyhistoryofco
-
lonic carcinoma
.

Which of thefollowing isthemost likelydiagnosis

?

)
a Hube
Brit
-D ogg .
syndrome
)b Cowden'ssyndrome
.
c) Gardner'ssyndrome
.
)
d Gorlin'ssyndrome
.
)
e -Torre
Muir .
syndrome

.158
PQ Whichof thefollowingbest representcorpsrondsin Darier'sdisease
?

Acantholytic cells
.
)
b Apoptotic keratinocytes
.
)
c Dyskeratotic melanocytes
.
)d Eosinophilicbasalcells
.
)
e Inclusion cysts
.

44
Section 1
: Practice Questions

.159
PQ Which of the following is a keycomponent of inner dense plaque
?

.
Desmocollin
)b .
Desmoplakin
)
c .
Envoplakin
)
d .
Plakoglobin
.
Plakophilin

.160
PQ Whichof the followingstatementsis incorrectregardingauto
-inflammatory
?
syndromes

Abdominal pain is common in acute attacks

.
)
b Arthralgiais common in acuteattacks
.
c) Feverisoften presentin acute attacks
.
Raisedinflammatory markers arealmost alwaysseenin acuteattacks
.
The predominant skin eruption during acute attacks consists of a maculo
-
papular exanthem
.

.161
PQ Whichof thefollowingdrugsis mostlikelyto causesystemicvasculitisdueto
the induction of ?
-ANCA
p

)
a -TNF
Anti .
agents
.
Minocycline
.
Penicillamine
.Propylthiouracil
.
Simvastatin

.162
PQ Which of the following isthe most important prognosticfactor in the diagnosis
of melanoma
?

Anatomical site of melanoma

.
Thepresence of lymphocyticinfiltrate
.
)c The presenceof mitoses
.
)
d Tumour thickness
.
.
Ulceration

45
Section 1
: Practice Questions

.163
PQ CD56is amarkerforwhichof thefollowingcells
?

-Cells
.B
.Macrophages
)
c .
Melanocytes
)
d Natural killer cells
.
-Cells
.T

.164
PQ A12
year
-o ld Pakistani
girlwasreferredwithalong
-standing historyofgeneral
g
stiffeninofthetongue
withthepresence
ofbeaded
papules
ontheeyelids
andonthe
-orbital
peri skinandhoarseness
of hervoice
. Therearealsoverrucous
- likeplaques
on
e elbow
th s andknuckle
s, inaddition
todentalanomalies
. Further
history
reveals
that
heroldersister
, aged16
, suffersfrom thesamecondition
.

The inheritance pattern of this condition ?

is

Anacquired condition therefore not inherited

.
Autosomal dominant
.
)
c Autosomal recessive
.
-linked dominant
X .
)
e -linked
X .
recessive

.165
PQ A -o
year
65ld manpresentswith photo
-distributed eczemathat isworseeach
e hework
tim s inhisgarden
. You
therefore
suspect
allergic
contact
dermatitis
andper
-
formpatc
h testingtoseries
whichinclude
chemicals
andplants
.
Whichof thefollowingchemicals
is foundpredominantly
inwood
?

)
a .
Dalbergiones
)
b .
Parthenoline
)
c .
Parthenoline
)
d .
Primin
Sesquiterpene lactone mix
.

46
Section 1
: Practice Questions

.166
PQ A -o
year
46ld woman hasbeen complainingof intractablevulval dermatitis
for the last five yearsfor which she hastried several prescribedand -over
the counter
,
ns
preparatiosomeofwhichaggravates
herdermatitis
. Yoususpect
allergic
contact
dermatitis and therefore advisepatch testing
.

Which of the following allergensis least likely to be relevant in this case

?

Balsamof Peru
.
.Neomycin
Caine mix
.
)
d NickelSulphate
.
)
e .
Parabens

.167
PQ -orbital
Peri oedemais mostlikely to occurin whichof the following
?
conditions

Actinic prurigo
.
Chronic actinic dermatitis
.
)
c Hydroa vacciniforme
.
-cPhoto
ontact .
allergy
Polymorphic light eruption
.

.168
PQ Whichofthefollowingisleastlikelyto resultingeneralized
pustular?
psoriasis

.
Pregnancy
Treatmentwith crudecoaltar
.
Treatment with infliximab
.
-A
Ultraviolet .
radiation
)
e Withdrawal of systemicsteroids
.

.169
PQ Sebaceousglandsare absent in which of the following
?

)a .
Nose
)
b .
Palms
.
Penis
Skin overlying the abdominal wall
.
Skinoverlyingthe shoulders
.

47
 Section 1
: Practice Questions

.170
PQ Which ofthe followingstatementsiscorrect
?

)
a Bothheparin and warfarin
-induced skin necrosisare related to the
productionofspecific
antibodies
againstthedrugs
.
-induced
Heparin skinnecrosis
isrelatedtoadropinproteinCleveis
.
)
C -induced
Heparin skinnecrosis
isrelatedto theproductionofantibodies
and
e
therefor
should
never
be.re
-challenged
)
d -iWarfarin
nduced skinnecrosisisrelatedto the productionof antibodies
andthereforeshouldneverbere
.-challenged
)
e -induced
Warfarin skinnecrosis
isalatemanifestation
ofwarfarin
,
therapy
oftenoccurringafterthefirst six weeks
.

.171
PQ A -o
mld
2 onth boypresentedwith targetoidlargeerythematousmaculeswith
a
purpur andoedema
onhislimbsandface
. History
reveals
thatthebabysuffered
an
upperrespiratory
tractinfectionten dayspriorto theappearance
ofthisrash
.

Whichof thefollowing statementsregardingthis conditionistrue

?

ANCAlevelmustbecheckedimmediately
.
Histologywill showleukocytoclasticvasculitisandthe conditionwill resolve
.
spontaneously
)
c y
Histolog
willshowmultiple
thrombiinthesuperficial
.
vessels
)
d Theconditionhasa very poorprognosisandrapidinitiation of corticosteroid
therapy is required
.
)
e Treatmentwith hyperoaricoxygenisrequired
.

.172 A60
PQ year
-o ld manpresented
witha relativelyrapidonsetofanerythema
-
-torange
tous
o coloured
,
eruption
whichstarted
initially
onhisface
. Itspread distally
toinvolv
e mostofhisskinwithsomeislands
ofnormalskinonhistrunkandlimbs
. His
palmsandsoleshavea shinyorangehueandsubungualhyperkeratosis
wasnoted
.
e
Ther isnopersonal
orfamilyhistory
ofpsoriasis
noristhereanyjointinvolvement
.
What isthe likely histological picture
?

Absenceof any hyperkeratosis

.
Denseinfiltrate of plasmacellsextendingdeepintothe reticulardermis
.
)
c Parakeratosis alternatingwithorthokeratosisin both the horizontaland
vertical plains
.
)d Superficialperi
-vascular eosinophilic
.infiltrate
)
e -shaped
Wedge is
hypergranulos
andthepresence
ofdyskeratotic
.
cells

48
Section 1
: Practice Questions

PQ
.1 73 Which of the following human papillomavirus serotypeis not associatedwith
epidermodysplasiaverruciformis
?

-12
.HPV
)b -16
.HPV
)
c .HPV
-3
)
d .
-5
HPV
)
e .
-8
HPV

.174
PQ A12
year
-o ld girlpresentswithapersistent
eczematous
eruptioncoveringher
,
face trunk andlimbs which isassociatedwith coarsefacialfeatures
, doughyskinand
broad nasalbridge
. Shealso has a history of recurrent fractures andpoor dentition
.
Shehasbeenfound to havepersistentlyraisedeosinophil,count significantlyraised
IgE levelsbut no demonstrable specific IgEsagainst any particular allergen
. On exami
-
,
nation you alsonotethat shehasa high
-arched .
palate

Mutation ofwhich geneisresponsiblefor this condition

?

.
ABCA12
-RAS
.B
c-k. it
)
d .
SPINK5
)
e .
STAT3

PQ
.1 75 Which of the following structural hair abnormalities can be seen in Neth
-
erton's syndrome
?

Loose anagen
.
)b Piliannulati
.
)
c Trichorrhexis invaginata
.
)
d Woollyhair
.
)
e .
Monilethrix

.176
PQ aeductase
-r5 lpha is responsiblefor which type of hair loss
?

Alopecia areata
.
)b Anageneffluvium
.
)
c Androgenetic alopecia
.
)
d Frontal fibrosing alopecia
.
)
e Telogen effluvium
.

49
 Section 1
: Practice Questions

.177 Whic
PQ h ofthefollowing
statements
regarding
thediagnosis
ofhidradenitis
-
sup
purativa is incorrect
?

An autosomal dominant variant exists

.
)
b Arthritiscanbeamanifestation
in severecases
.
)
c Obesity tendsto worsen the condition
.
Smokingtends to worsen the condition
.
Thereisincreased
riskof basalcellcarcinoma
.

. 17
PQ 8 Antibodiesaremostlikelyto beformedagainstwhichof thefollowingdrugs
?

.
Adalimumab
.Etanercept
.
Infliximab
.
Methotrexate
.
Ustekinumab

.179
PQ which of the followingsub
-types of morpheaisthecommonestin children
?

En coupde Sabre
.
Generalized type
.
)
c Linear type
.
-sclerotic
.Pan
Plaque type
.

.180
PQ -septal
Naso perforationcanbefoundin allof thefollowingexcept
?

Bevacizumabtherapy
.
)
b Cocaine use
.
c) Polyarteritisnodosa
.
)
d .
Trauma
Wegener'sgranulomatosis
.

.181
PQ The commonest site for intra
-oral squamous cell carcinoma is
?

Buccal mucosa
.
Dorsal tongue
.
c) Floor of the mouth
.
)
d Soft palate
.
Hardpalate
.

50
Section 1
: Practice Questions

.
PQ 182 Parakeratosis is not a feature of which of the following
?

Classical lichen planus

.
Hypertrophic lichen planus
.
)
c Lichenplanopilaris
.
Pityriasis rubra pilaris
.
)
e Plaque psoriasis
.

PQ
.1 83 Which of the following is not a treatment option in pruritus secondaryto end
-
stagerenal failure
?

.
Gabapentin
)b .
Mirtazapine
)
c .Rifampicin
)
d Topical anti
-pruritic .
therapy
)
e UVBphototherapy
.

.184
PQ Basedonavailable,evidencewhichof thefollowingis considered
the best
option for treating morphea
?

.
Ciclosporin
)
b .
Methotrexate
c) Mycophenolate mofetil
.
UVBphototherapy
.
.
PUVA

.185
PQ Whichofthefollowingisthemostcommonmanifestation
ofocularrosacea
?

.
Blepharitis
.
Conjunctivitis
.
Keratitis
)
d Meibomian
glanddysfunction
.
)
e .
Scleritis

51
 Section 1
: Practice Questions

.186
PQ Thecombinationof ciclosporinandstatintherapyleadsto increased
leveisof
n which
stati inturncanleadtostatin
-induced .
myopathy

h
Whic ofthefollowing
statinsishowever
safeto combine
withciclosporin
dueto a
differentmetabolicpathway
?

Atorvastatin
& Simvastatin
.
)
b .Atorvastatin
c) .
Pravastatin
.
Rosuvastatin
.Simvastatin

. 18
PQ7 Whichtypeofcryoglobulinaemi
a isleastlikelytobeassociated
withsmallves
-
sel vasculitis
?

-1
Types &2
.
)
b .Type
-1
c) -2
Types &3
.
-2
Type
.
-3
Type

.188 Whichofthefollowing
PQ nerves
isnotabranchofthetrigeminal
?
nerve
.
Infratrochlear
)
b .
Lacrimal
c) Marginal.mandibular
)
d .Supraorbital
.
Supratrochlear

.189
PQ Whichof thefollowingisthe mostcommonsiteforsebaceous
?
carcinoma

.
Extremities
)
b .
Eyelids
.
Ears
.
Lips
.
Genitalia

52
Section 1
: Practice Questions

.190
PQ A -o
year
52ld woman presented with a 3
-year history of multiple painful and
tendernodularlesionsinvolvingtheupperaspectsof herarmsand thighs
, whichwere
followed by atrophic scarring of the affected areas
. She alsosuffered from chronic ar
-
thralgia and myalgia
. Shehad positive ANA and weak double
- stranded DNAantibod
-
.
ies A biopsy showed evidence of atrophic epidermis with peri
-vascular lymphocytic
,
infiltrate lobularpanniculitiswith a lymphocyticinfiltrate
.

The most likely diagnosisis

?

)
a Discoid lupus erythematosus
.
)
b Erythema nodosum leprosum
.
Erythemanodosum
.
)d Lupus pernio
.
)
e Lupus profundus
.

.191
PQ Sarcoidal granulomas can be seen in all of the following except
?

)
a Crohn's disease
.
Granuloma annulare
.
)
c Granulomatous rosacea
.
.Sarcoidosis
)
e Silicaforeign body reaction
.

.192
PQ Epidermaldesmosomesserve to adhere the cells together due to the
presenceof various glycoproteins
.

Whichof the following componentsof the desmosomesis not targeted in para

-
neoplasticpemphigus
?

.
Corneodesmosin
.
Desmoglein
.
Desmoplakin
)
d .Periplakin
.
Plakoglobin

53
Section : Practice
1 Questions

.193
PQ A62
-year old manwhois seriouslyill in intensivecarewith neutropenia ona
d
backgrounof chronicmyeloidleukaemiadevelopedseveralerythematous
andpur
-
puricmaculesonhisthigh andlowerback
, whichrapidlydevelopedinto haemorrhagic
bullaewhichrupturedleavingulcerswith eschars
. Therewasasurroundingerythema
-
tous violaceous necrotic area of skin
.

d culture
Bloos willmostlikelyshowwhichofthefollowing
?
organisms
)
a Escherichia .
coli
Neisseria meningitides
.
)
c Pseudomonas aeruginosa
.
Staphylococcus aureus
.
Streptococcus pyogenes
.

.194
PQ Frusemideis aloop diureticthat iswidely used
.

Whichof thefollowingblisteringdisorderscanbecausedby thisdrug

?

Bullouspemphigoid& pseudoporphyria
.
Bullouspemphigoid
.
-induced
Drug .
pemphigus
Linear IgA disease
.
Pseudo porphyria
.

.195
PQ Allof the followingconditionscanincreasetherisk of developingbasalcell
carcinomasin children except
:

.Albinism
Giant congenital naevus
.
Gorlin's syndrome
.
Naevus sebaceous
.
Xerodermapigmentosum
.

.196
PQ Whichof thefollowingchemicalsisnot apreservative
?

.
Formaldehyde
.
Mercaptobenzothiazole
c) .
Methyldibromoglutaronitrile
.
Methylparaben
)
e .
Phenoxyethanol

54
Section 1
: Practice Questions

.197
PQ A -o
year
65ld Caucasianman
, who works for an international companyrecent
-
ly returnedfrom aforeigntrip wherehe wasworkingfor six months
. Herecalledbeing
bitten by an insect on his right cheek and gradually developed a small papule which
hasbecomeulcerated
. Yoususpectcutaneousleishmaniasisandhavetaken a biopsy
for both histology andculture
.

Which of the following leishmaniasis species causes visceral leishmanisis only with no
cutaneous ?
lesions

)
a .L.brasiliensis
.
L.donovani
)
C . major
L .
)
d .
L.mexicana
.
L.tropica

.198
PQ When differentiating between granuloma annulare and necrobiosis
lipoidica histologically
, which of the following statements is correct
?

)
a Abundant plasmacells maybe seenin granulomaannulare
.
Abundant plasma cells maybe seenin necrobiosislipoidica
.
)c Necrobiosis lipoidica often has increased mucin deposition in the dermis
.
)
d Subcutaneousinvolvement isonly afeature found in granuloma annulare
.
The type of granulomain granuloma annulareissarcoidal
.

.199
PQ Which of the following drugs is anabsolute contra
-indication in patients with
activehepatitisB
?

.Acitretin
.
Adalimumab
c) .
Ciclosporin
.
Hydroxychloroquine
.
Usetkinumab

55
 Section 1
: Practice Questions

.200
PQ Youpatchtesta36
-year oldladywhogaveahistoryofworsening
ofherecze
-
a wit
m h theuse
ofcertai
n topical
s
preparation
andyoufound
astrong
positive
-
reac
tion to benzalkonium chloride
.

Whichof thefollowingtopicalpreparationsissafeto use

?

®
Dermol 500lotion
.
®
Dermol .
cream
)c Emulsiderm emulsion
® .
)
d ®
Oilatum .
gel
®
Oilatum .
plus

.201
PQ Which of the following markersis a sensitivemarkerfor merkel cell
?
carcinoma

.CD1a
.
CD34
)c .
CK20
)
d Factor XIlla
.
.
5100

.202
PQ Whichof thefollowingconditionsis notanacantholytic
disorder
?

Bullous pemphigoid
.
Darier's disease
.
)
c Grover's disease
.
)d Hailey
-H ailey .
disease
)
e Pemphigusvulgaris
.

.203 Whic
PQ h ofthefollowin
g s
statement
regarding
poison
ivyiscorrect
?
on ivysensitiv
Pois e s
individual
candevelop
-oral dermatitis
peri fromeating
.
bananas
)
b Rubberglovesaresafeto usein sensitizedindividualswhen in contact with
the plant
.
)c Theallergen
responsible
followingcontactwiththeplantisurushiol
.
)
d Theallerge
n e
responsibl
forthedermatitis
following
contact
withtheplant
is primin
.
Thehighest
rateofsensitization
isfoundinSouthEast
.
Asia

56
Section 1
: Practice Questions

.204
PQ Whichof thefollowing statementsregardingcatscratchdiseaseisincorrect
?

)
a Bartonellosis is the disseminated form of the infection in the im
munocompromisedhost
.
)
b Bacillaryangiomatosisis thecutaneous
-limited manifestationof Bartonella
.
henselae
)
c Lymphadenopathy mayoccurin half of the cases
.
)
d The condition is self
-limiting in immunocompetents and therefore
conservative management is appropriate
.
)
e The responsibleorganismis Bartonella henselae
.

.205
PQ A53
year
-o ld mandevelopedanintenselypruriticeruptionconsisting
ofviola
-
ceous papules on histrunk and limbs with somefollicular accentuation
. He received a
-marrow
bone transplant four months prior to the onset of the eruption
.

Which of the following statements regarding this condition is incorrect

?

Alichenoid drug eruption is the differential diagnosisin this case

.
In grade 4 of the diseasethe histological appearancescanresemble those of
toxic epidermal necrolysis
.
The chronic variant always follows on from the acute setting
.
)
d The condition is primarily mediated by Tlymphocytes
.
)
e The incidence is highest in the setting of bone marrow transplantation
.

.206
PQ A -o
year
64ld manwith 3
-year historyof dermatomyositispresentedwith firm
,
l
painfunodulesonhisabdomen
andlimbs
. Histology
showedevidence
ofcalcification
in the dermis
.

The most likely mechanism here is

:

Dystrophiccalcinosiscutis
.
Idiopathic calcinosiscutis
.
Metastatic calcinosiscutis
.
Primary osteoma cutis
.
)
e Secondaryosteomacutis
.

57
 Section 1
: Practice Questions

.207
PQ A -o
year
40ld woman recently diagnosedwith acutemyeloidleukaemiapre
-
d
sente 3weeksfollowingtreatmentwiththechemotherapy
agentcytarabine
. -
Clinical
lyshehadpruritic andtenderpapulesonherforearmsand chestwith bilateralpalmar
.
erythema Thepapuleswere slightlyoedematousand somehavecoalescedto form
s.
plaque Abiopsytakenfromoneofthepapules
showedadenseneutrophilic
infiltrate
aroundeccrineglandswith associatednecrosis
.

Whichof the following statementsregardingthis conditionisincorrect

?

Acutemyeloidleukaemiaisthe mostcommonassociatedmalignancywith
this condition
.
ne
Cytarabi
isthecommones
t reported
chemotherapy
agent
responsible
for
this condition
.
)
c Thecondition is associatedwith a high mortalityrate and future
chemotherapy should be avoided
.
)
d Theconditionisself
-limiting andtreatmentis oftennotrequired
.
Theconditionusuallybeginswithin 3 weeksfollowing chemotherapy
.

.208
PQ Whichofthefollowingtattoopigments
shouldbeavoided
in apatientwitha
known contact allergyto cement
?

.
Chromium
)
b Ferric hydrate
.
)c Ferric oxide
.
)
d .Manganese
)
e .
Mercury

.209
PQ Whichof thefollowing delayedreactionsto tattoosisthe commonest
?

Allergic contact dermatitis

.
)
b .Granulomatous
c) .
Lichenoid
)d -induced
.Photo
)
e .
Pseudoplymphomatous

.210
PQ Inwhichofthefollowingsubtypesofvasculitisis thepresenceof granulomas
a feature
?

-Strauss
Churg .
syndrome
Cryoglobulinaemic .
vasculitis
)
c Erythema elevatum diutinum
.
)
d Granuloma faciale
.
)
e Microscopicpolyarteritis
.

58
Section 1
: Practice Questions

.211
PQ Spongiosisisleast likely to be presentin
:

"Id .
reaction
)
b Contact dermatitis
.
)
c Cutaneous B cell lymphoma
.
)d Pityriasis rosea
.
)
e Tinea corporis
.

.212
PQ CD30positivity can be seen in all of the following except
:

Anaplasticlarge cell lymphoma

.
)
b Lymphomatoid .
papulosis
)
c Marginal zone B cell lymphoma
.
)
d .
Scabies
)
e Transformedmycosisfungoides
.

.213
PQ A 36
-year old man has had a changing mole on his back removed
. This was
reportedhistologicallyto be asuperficialspreadingmelanoma
, Breslowthicknessof
3.4 mm with no ulceration
. Sentinelnode biopsydid not show any evidence ofpositive
lymph nodes andthere were no systemicfeatures to suggestdistant metastases
.

The pathologicalstaging of this tumour is

:

.
Ib
.
Ila
)
c .
Ilb
)
d .
IIc
.
IV

.214
PQ Thesensory innervation of the vertex of the scalp is predominantly by which
?
nerve

.
Auriculotemporal
Lesser occipital
.
)
c -orbital
.Supra
-trochlear
.Supra
.
Zygomaticotemporal

59
Section 1
: Practice Questions

.215
PQ A -o
year
17ld man presentedwith diffuseasymptomaticangiokeratomason
thetrunkandgenitaliawithbilaterallegoedema
. Inadditionhehasbeencomplain
-
ing of neuropathic
painsin hislimbsandhypohidrosis
. Urinalysis
showedevidenceof
.
proteinuria

h
Whic ofthefollowingstatements
regarding
thisconditionisincorrect
?

c
Cardia
s
arrhythmia
areapotential
complication
inthiscondition
.
Theangiokeratoma
s tendnotto respond
to enzyme
replacement
.
therapy
)
c Thedeficientenzymeis -A
galactosidase
.alpha
)
d Thediseaseis generallymilder in women
.
Thepatternof inheritanceis autosomal.dominant

.216
PQ A40
year
-o ld manwith a historyofthyroid carcinomaand multiplefacial
omas
tricholemmed
present
withcobblestoni
ng oftheoral
mucosa
and
-palmo
plantar
.
keratoses

Themostlikelydiagnosishereis
:

Bazexsyndrome
.
-Hube
Birt
D ogg .
syndrome
)
c Cowden's .syndrome
Gardner's syndrome
.
)
e -Torre
Muir .
syndrome

.217 Cobblestoni
PQ ng ofthegingiva
canoccur
withallofthefollowing
:
except
Cowden'ssyndrome
.
Crohn's disease
.
Darier's disease
.
Lipoid proteinosis
.
)
e -Jegher
Peutz .
syndrome

.218 Dent
PQ al anomali
es canbefound
inallofthefollowing
:
except
Dyskeratosiscongenita
.
r's
Gardne
.
e
syndrom
)
c Incontinentia pigmenti
.
Junctionalepidermolysis.bullosa
Netherton's .
syndrome

60
Section 1
: Practice Questions

.219
PQ Which of the following nerves is not a branch of the ophthalmic division of
trigeminal(.)
V1 nerve
?

)
a Infra
-o rbital .nerve
)
b -trochlear
Infra .
nerve
)
c Lacrimal .
nerve
)
d -orbital
Supra .
nerve
)
e -trochlear
Supra .
nerve

PQ
.2 20 A -o
year
40ld man with a history of excessivealcohol intake and self
- neglect
hasa 12
-month history of intermittent scaling of his hands andfeet associatedwith a
malarrashon hischeeksand a powderyscaleonhis nose
. Inaddition
, he hadmarked
erythema of his tongue and has been complaining of loose stools for several months
.
He scores low on mini mental state examination
.

Themost likely diagnosisis

:

.
Beriberi
.
Pellagra
)
c Porphyriacutaneatarda
.
.Scurvy
Systemic lupus erythematosus
.

.221
PQ A 50
-year old man presented with non
-tender papules and nodules with no
e
surfac s
changeontheback
. Hehadrecentlybeencomplaining
ofnightsweatsand
ht
weig .
loss Histology
ofthelesionshowed
a densedermalinfiltratewhichstained
e
negativ for CD3
, ,
CD20 ,
CD79a
,
-2
bc ,
-6
bc ,
CD4 CD30andCD5andwaspositivefor
CD43and myeloperoxidase
.

Whatis themostlikelydiagnosis
?

Anaplastic large cell lymphoma

.
Follicle centre B cell lymphoma
.
Leukaemia cutis
.
Marginal zone B cell lymphoma
.
)
e Mycosisfungoides
.

61
Section 1
: Practice Questions

.222
PQ Youremovea tumour from the right nasalala anddecideto reconstructthe
ct withafullthicknes
defe s skingraft
. One
ofthefollowing
factors
does
notreduce
the
survivalofthegraft
:

Cartilageat the base of the defect

.
Donorsitefromsun
-exposed .
skin
)
c Poorly controlled diabetesmellitus
.
.
Smoking
)
e Thepresenceof a fat layerat thebaseof thegraft
.

.223 Atumou
PQ r was
removefromtheconchal
d .
bowl
This
defect
measures
10x8mm
and isfairlysuperficialwith intact periosteum
.

ch ofthefollowin
Whi g ve
reconstructi
options
isthemostsuitable
inthiscase
:
Bilobed transposition flap
.
n
Paramedia
forehead
.flap
Primary closure
.
Rhombictransposition flap
.
)
e Secondaryintentionhealing
.

.224
PQ Whichof the followingis anablativelaser
?

.
Alexandrite
)
b Erbium YAG
.
)c Intensepulsedlight().
IPL
)
d Pulsed dye
.
-switched Nd
Q :YAG 532nm
.

.225 Whic
PQ h ofthefollowin
g isthemostcommonly
observed
side
effect
ofpulsed
dyelasertreatment
?

)
a .
Blistering
.
Bruising
.Dyschromia
Herpessimplexreactivation
.
)
e Keloidscarring
.

62
Section 1
: Practice Questions

PQ
.2 26 Youremovea suspiciousmole on the shoulderof a youngwoman who had
e
excessiv sun exposure
. Theresult showeda superficialspreadingmelanomawith a
w
Breslos
thicknes
of0.7mmwithnomitoses
orulceration
. Youarrange
forurgent
actionbut thepatient informsyou that sheisnow 8 weekspregnant
.

Which of thefollowing actionsshouldtakeplace

?

Deferanyfurther interventionuntil after deliveryof thebaby

.
Recommend radiotherapy .
only
)c Wide local excisionwith 1 cmmargin
.
)
d Wide localexcision with 2 cm margin
.
)
e Wide local excision with 5 mm
.

.227
PQ Yousee a 61
-year old Australian man with a3 cm ulcerated nodule below his
left eye that has been growing over the last 5 months
. Onfurther examination the
nodule appearstethered and attached the underlying structures
. A biopsy performed
aweek earlier showed apoorly
-differentiated squamouscell carcinoma
.

What should be the next action

?

Arrange imaging
.
)
b Repeat the biopsy
.
)c Referfor radiotherapy
.
)
d Surgical excision with a margin of 1 cm
.
Surgicalexcisionwith a margin of 6mm
.

.228
PQ Perineuralinvasionis typically not observedin which of the following
:

Desmoplastic trichoepithelioma
.
Infiltrative type basalcell carcinoma
.
)
C Microcystic adnexal carcinoma
.
Morphoeic typebasal cell carcinoma
.
)
e -differentiated
Poorly squamous cell carcinoma
.

.229
PQ Which of the following is a sensorynerve
?

Buccal nerve
.
)
b Cervical nerve
.
)
c Marginalmandibular nerve
.
Temporal .
nerve
Zygomaticofacial.nerve

63
 Section 1
: Practice Questions

.230 Yo
PQ u diagnos
e apatientashaving
pemphigus
foliaceous
andsend
thehistology
specimento the pathologist
.

Ifyourclinicaldiagnosis
iscorrect
, heshouldidentifythesplitat
:

Basal layer
.
)
b Corneal layer
.
)
c Granular layer
.
Nosplit
.
. pidermal
-e
Sub

.231
PQ Thephenomenonby whichgentlepressureonanintactbullaforcesthefluid to
d
spreaundertheskinawayfromthesiteofpressure
inpemphigus
isknownas
:
)
a -Hansen's
Asboe .
sign
Darier'ssign
.
)
c Nikolsky's.sign
Turban's sign
.
Trucot's sign
.

.232 Apatientspresentwithscaly
PQ andcrusted
lesions
onthemalar
regionofthe
e an
fac d inothe
r c'seborrhoei
.
areas
Direct
ce
immunofluoresen
shows
invivo
IgGand
C3depositionon cell surfacesof keratinocytesas well asthe basementmembrane
.
e
zon y
Serolog
shows
presence
ofcirculating
antinuclear
.
antibodies
Whichof thefollowingisthemostlikelydiagnosis
?

)
a Bullouspemphigoid
.
Lupus erythematosus
.
c) Paraneoplastic
.
pemphigus
)
d Pemphiguserythematosus
.
Pemphigusvulgaris
.

64
Section 1
: Practice Questions

.233
PQ Useof antigen specific ELISAallowsfor diagnosisof pemphigus
.

Which of the following best describesELISAfor pemphigus

?

ELISAcannot predict diseaserelapse

.
)b ELISAscoresparallel diseaseactivity
.
c) Serumis positive againstDsg1but negative againstDsg3in mucosal
-
dominant type of pemphigus vulgaris
.
)
d Serum is positive against Dsg1 but negative against Dsg3 in pemphigus
.
vulgaris
)
e Serumis negativeagainstboth Dsg1andDsg3in mucocutaneous
type of
pemphigusvulgaris
.

.234
PQ A 45
-year oldpatient has severepemphigusvulgaris
.

Which one of the drugs used to treat pemphigus has sterility as a side effect
?

.
Azathioprine
.Corticosteroids
)c .
Cyclophosphamide
)
d .Immunoglobulins
)
e .
Rituximab

.235
PQ A 40
-year old man has been diagnosedwith IgApemphigus
.

Which of the following is the drug of choice in this condition

?

.
Ciclosporin
.
Colchicine
c) .
Dapsone
.
Methotrexate
)
e Oral Prednisolone
.

.236
PQ Which of the following virusis not beenknown to be associatedwithlichen
planus )?
(LP

HepatitisC().
HCV
)
b Human herpes virus
-6 (HHV 6
).
Human herpes virus
-7 (HHV 7
).
)d Humanherpesvirus
-8 (HHV 8
).
)
e -transmitted
Transfusion .
virus

65
Section 1
: Practice Questions

.237
PQ One of thefollowing is not usefulin differentiatinglichenstriatusfrom linear
lichen planus ):
(LP

Histologyshowslichenoidchangesin lichenplanus
.
)
b Hypopigmentationismoreoften asequlaeof lichenstriatus
.
)
c Lichenplanusoftenresultsin hyperpigmentation
.
)
d Pruritusis morecommonlya featureof lichen planus
.
Spontaneousresolutionoccurswithin a shortperiod of time in lichen
.
striatus

.238
PQ Eccrine
sweatglandsarepresentin whichoneof thefollowingsites
?

)
a .
Clitoris
)
b Externalauditory canal
.
)c Finger tips
.
)
d Labia minora
.
)
e .
Lips

.239
PQ Apatientissaidtohavechronicurticariaif theurticariasymptoms
occurfor
morethan 6 weeks
.

In addition
, which of thefollowing criteriashouldbe fulfilled for urticariato beclassi
-
fied as '?
'chronic

Urticariaoccurring at least once aweek off treatment

.
Urticariaoccurringatleasttwiceaweekoff treatment
.
)
c Urticariaoccurringatleasttwicea weekontreatment
.
Urticariaoccurringat leastthreetimesaweekofftreatment
.
)
e Urticariaoccurringat leastthreetimesa weekontreatment
.

.240
PQ Physical
urticariasareinducedbyanexogenous
physicalstimulus
.

Whichof the following isthemost commonphysical?

urticaria

)
a Cholinergic urticaria
.
Delayed dermographism
.
Delayed pressure urticaria
.
-induced
Exercise .
anaphylaxis
Immediate symptomatic dermographism
.

66
Section : Practice
1 Questions

.241
PQ A 36
-year old patient developsanexpandingrashon her left thigh after a tick
.
bite If untreated sheis has a highest risk of developing
:

)
a Cardiac block
.
Facial nerve paralysis
.
)
c Knee Arthritis
.
)
d Persistent .
headaches
)
e .
Pleurisy

.242
PQ Ofallthepregnanc
y associated
,
dermatoses
cholestasis
ofpregnancy
isassoci
-
ated with highest incidence of fetal distress
. Therisk of fetal distressishighest if levels
of maternal bile salts are higher than
:

)
a /l.
5umol
/l.
10umol
/I.
20umol
/l.
30umol
40 umol
/l.

. 243In which of the followingconditionscanyouseeacantholysisin a skinbiopsy

PQ ?

)
a Bullous pemphigoid
.
Dermatitis herpetiformis
.
Erythema Multiforme
.
)
d Grover's disease (benign papular acantholytic dermatosis
).
Lupus erythematosus
.

.244
PQ Which ofthe followingcystslacksa granularcell layer
?

)
a Dermoid cyst
.
)
b Epidermoid cyst
.
Eruptive vellus hair cyst
.
)
d Follicular .
cyst
)
e Pilar )(trichilemmal .
cyst

.245
PQ Microabscesses
areseenin whichof thefollowing conditions
?

Bullouspemphigoid
, ,
PLEVA.
urticaria
)
b Dermatitisherpetiformis
, mycosisfungoides
, .
psoriasis
)
c s
Dermatiti
,
herpetiformis
,
PLEVA
bullous.pemphigoid
)
d ,Lupus psoriasis
, .
PLEVA
)
e ,
Psoriasis,
urticaria lymphomatoidpapulosis
.

67
 Section 1
: Practice Questions

.246 Whic
PQ h ofthefollowin
g s
antibodie
isused
tohighlight
pagetoid
spread
insuper
-
ficialspreadingmalignantmelanoma
?

)
a AlphaSMA
.
.CD30
)
c .
CD31
)
d .
-A
Melan
)
e .
MNF116

.247 A50yearoldmalepresents
PQ withapapular
skinrash
. Histological
examination
s
reveal granulomatous
inflammationin thedermis
.

h
Whicofthefollowin
g s
marker
orspecial
stains
willhelp
inthediagnosis
:
)
a -EP4
.Ber
.
-A
Melan
-Alcian
PAS .
Blue
)
d Verhoeff
-V an GiesonStain
.
Zeiehl.Neelsen

.248
PQ Selectthe markermostusefulin differentiating
basalcellcarcinoma
fromba
-
saloidsquamouscell carcinoma
:

-EP4
.Ber
CarcinoEmbryonicAntigen).
(CEA
)
c -45
.HMB
MelanA
.
)
e 100 protein
$ .

PQ
.2 49 A45yea
r oldfemal
e d
presente
withanitchyerythematous
. Histological
rash
tion
examina ed aspongioti
reveal c s
dermatiti
withneutrophils
inthesuperficial
keratin
.
layer

ch ofthefollowin
Whi g s
marker
orspecial
stains
willhelpinthediagnosis
:
-EP4
.Ber
.Melan
-A
.
PASD
)
d -Van
Verhoeff GiesonStain
.
Zeiehl.Neelsen

68
Section 1
: Practice Questions

.250
PQ A 25 year old female presentsclinically with a changingmole
. Skin biopsy re
-
veals a lympho
-histiocytic infiltrate with residual bland melanocytes
.

Which of the following is the most likely diagnosis ?

Halo naevus
.
)
b Intradermal melanocytic .
naevus
)c Malignant melanoma
.
)
d Reed's naevus
.
)
e Spitz naevus
.

.251
PQ A44 yearold femalepresentswith papulesshowinginterfacechangeand Ci
-
vatte bodies on skin biopsy
.

What is your preferred diagnosis

?

Bowen's disease
.
)
b .
Eczema
)
C Lichen planus
.
.
Psoriasis
.
Sarcoidosis

.252
PQ Which of the following statements about psoriasisis false
:

Histologicallyshowsspongiform pustule of Kogoj

.
Pustular form exists
.
)
c Sacrum affected
.
Showsinterface change onskin biopsy
.
)
e Vascularectasiais seen with margination of neutrophils
.

.253
PQ Aninfant hasa focal areaof midlinealopecia
, overlyingablue
-tinged -
com
pressiblenodule
, surrounded by longdark coarsehair
. Whichof the following investi
-
gations would youinstigate
?

Serum testosterone
.
MRI head
.
Diagnosticbiopsy
.
)
d Serum folate
.
)
e Diagnosticaspiration
.

69
Section 1
: Practice Questions

.254
PQ A 31
-year old amateurrugbyplayerexperiencesconsiderabledistressduring
adentaie
procedurdespitereceiving
multiplelocalanaesthetic
.
injectionsWhatisthe
most likely underlying ?
diagnosis

)
a Marfan'ssyndrome
.
Pseudoxanthoma elasticum
.
)
c -Danlos
Ehlers .
Syndrome
)
d Ectodermal dysplasia
.
)
e Osteogenesisimperfecta
.

.255
PQ A7
-year oldgirlisnotedto haveexaggerated
wrinklingofthepalmsafter
briefimmersion
in water
. Whichof thefollowinginvestigations
wouldyouinstigate
?

Random glucose
.
Sweat test
.
)c Thyroid function tests
.
)
d Diagnostic skin biopsy
.
Nerve conduction .
studies

.256 A15
PQ -year oldboy
, whose
family
have
recently
moved
totheUK
, presents
with crops of reddish
-brown pigmented plaques and papillomatous lesions over his
,face trunk andlimbs
. Thesefirst appearedaged12 andhavesteadilygrownmore
.
extensive Adiagnosisof epidermodysplasiaverruciformisissuspected
. Thisdisorder
s
result frommutationinwhichgene
?

.
SPINK
.FLG
)c .
PTEN
)
d .
NEMO
)
e .
EVER

.257
PQ -Pumphrey
Bart syndromeresultsfrom mutationin the geneencodingcon
-
nexin 26
. The function of which structures will be affected
?

Intermediate .
filaments
Anchoring filaments
.
.
Hemidesmosomes
)
d Gap junctions
.
.
Tonofilaments

70
Section 1
: Practice Questions

.258
PQ A 10
-year old girl isseen in clinic with multiple lentigines andblue naevi
. -
Dur
ing examination
, youalsoelicitacardiacmurmurleadingyouto suspectanunderly
-
ingdiagnosisofLAMB
. Towhatdoesthe'A ' in this acronymrefer
?

)
a AV malformations
.
Atrial myxomas
.
)
c Aortic stenosis
.
Aortic regurgitation
.
)
e Any of the above
.

.259
PQ Youhavebeenreviewingan 18
-month yearoldboy withmultiple papules
over hischeeksand forehead
. Initially lesionsappearedsmooth andpink but lately
e developedayellowishappearance
hav . Diagnostic
skinbiopsyisconsistentwith
juvenilexanthogranuloma
. Whatactionmight youconsider
?

None of the above - this is a skin

-limited .
disorder
Full lipid profile
.
)
c Liver function tests
.
Cardiologyreview
.
)
e Ophthalmology review
.

.260
PQ Thesecondmember of afamily who have recently installed ahot
-tub in their
k gardenpresentstoyourclinicwithfollicular
bac -based papulesandpustulespre
-
y
dominantl
d
distributeoverthetorso
, buttocks
andlegs
. Whatisthemostprobable
causative agent
?

.Streptococcus
Pseudomonas aeroginosa
.
Hepatitis C
.
Staphylococcusaureus
.
)
e .
HIV

.261 Ahaematolo
PQ gy e
colleagu
asks
foryouropinion
ona38
-year oldfemale
, with
newly
-d iagnosed lupus
-related ,
leukopaenia
whonowpresents withpearly
-umbili
d papule
cate s overherbreasts
andhands
. Herotherwise
well-m
11onth oldchildhas
cropsofsimilarlesions
. Whatisthecausative?
agent

Human papilloma virus

.
.
Enterovirus
)
c DNA pox virus
.
Herpes simplex virus
.
)
e RNApox virus
.

71
 Section 1
: Practice Questions

.262
PQ Amiddle
-aged businessmanwhotravelsextensively
abroadhasamonomor
-
cphi follicul
ar n
eruptiooverthefaceandtrunk
. Diagnostic
skinbiopsydemonstrates
adens
e eosinophi
lic -follicular infiltrate
peri . Hedenies
taking
any,prescription
-
over
-counter orherbalremedies
the . Whatisthemostlikelyunderlying
?
diagnosis
Hepatitis C
.
)b Propionibacterium acnes
.
)
c Pseudomonas
.
aeroginosa
)
d Acneiform drug reaction
.
)
e .
HIV

.263 Th
PQ e caseofa23
-year oldfemalemedical,
studentwhohasrecently
returned
fro anelectiv
m e inBhutan
, isdiscusse
d atyourlocaldermato
-pathology .
meetingShe
d
presentewith scalyplaquesovertheshouldersandupperarmsalongside
systemic
t.
upse tic
Diagnos skinbiopsy
d
demonstratesarcoidal
,
granuloma
withnoplasmacell
.infiltrat Bothserum
e ACEandchestradiography
haveproved.
reassuring
Whatnext
-
stepinvestigationwill likelybesuggested
?

.
Quantiferon
al
Venere
e
Diseas
h
Researc
Laboratory
.
test
Fasting glucose
.
)
d .
Colonoscopy
Bone marrow trephine
.

.264 A38
PQ -year woman
isseeninclinicwithextensively
-damaged skin
sun . She
poin outwell
ts -demarcatedandentirely
c
asymptomati areas
offinepaper
-like -
wrin
g ove
klin r hertrunk
andupper
armsthatshefirstnoted
during
arecent .
pregnancy
o evidenc
N e oftransepithelial
elimination
ofelasticfibresorfibrosisareseenon
ic
diagnostskinbiopsy
. Whatisthemostlikelydiagnosis
?
)
a Cutaneous morphea
.
)
b Ehler'sDanlosSyndrome
.
)
c Acrodermatitis chronica atrophicans
.
)
d Pseudoxanthoma .
Elasticum
)
e -dermal
Mid .
elastolysis

72
Section 1
: Practice Questions

.265
PQ Which of the following structures is involved in the Lewis reaction (also
known as the hunter's reflex
)?

Pilosebaceous .
unit
Eccrineunit
.
)
c Glomusbody
.
Pacinian corpuscle
.
Meissner'scorpuscle
.

PQ
.2 66 Youwish to undertake aresearch study to assesscircadianvariation in
keratinocyteRNAlevels
. Which of the following researchtechniqueswould be most
?
appropriate

Westernblotting
.
Northern .
blotting
)c Southernblotting
.
)
d Eastern blotting
.
)
e Polymerasechain reaction
.

.267
PQ A 23
-year man presentswith severefacial dermatitis
. The problem appeared
duringarecentcampingholidayduringwhichtime heusedsafetymatcheson adaily
.
basis -4
Type hypersensitivity haslikely developed to which of the following agents
?

Phosphorus sesquisulfide
.
DMDM hydantoin
.
)
с Imidazolidinyl urea
.
Diazolidinyl urea
.
)
e Quaternium 15
.

PQ
.2 68 A44
-year old womanwith knownchronicplaquepsoriasisand metabolic
syndromeissuspectedto havevulvalpsoriasis
. Which of thefollowing anatomical
structures will most likely be involved
?

Monspubis
.
)
b .
Hymen
)c Labia minora
.
)
d Labia majora
.
)
e Urinary meatus
.

73
 Section 1
: Practice Questions

.269 Yo
PQ u seea2
-month oldchildwithscarring
blistering
oftheskin
. Other
-
rea
sture includ
e amittendeformity
withproximal
fusionorallhandandtoeswebsand
.
a
aphoni Which
ofthefollowing
combinations
concerning
) inheritance
1 ) protein
2 (s)
ed 3
affect ) cellula
r e
structur
affected
and4
) leveloftheblister
, forthiscondition
is
?
true

al
Autosom,
e
recessiv
collagen
7(),
COL7A1anchoring
,
fibril sublaminal
.
densa
al
Autosom
,
e
recessiv
laminin
, anchoring
332 ,
filament
-lucida
lamina .
split
al
Autosom,
dominant
collagen
7(),
COL7A1anchoring
,
fibril sublaminal
.
densa
al
Autosom
,
dominant
keratin
5&,14 intermediate
,
filament
-epithelial
intra
.
split
)
e None of the above
.

.270 A
PQ n8-yearoldgirlisreferre
d tothedepartment
ofpaediatric
dermatology
withaport
-wine stainoverlying
herright.-b
mack
id Sheisundertheneurology
team
for aradiculopath
.
y Yoususpectaunifying diagnosis
ofCobb.Syndrome

h
Whic ofthefollowingbestdescribes
theinheritance
patternofthiscondition
?
-linked
X .
recessive
Autosomal dominant
.
)
c Autosomalrecessive
.
-linked dominant
X .
.
Sporadic

PQ
.2 71 Yo
u ar
e aske
d torevie
w apatient whohasd
develope
highly
itchy
tense
rs arou
blistend hers.umbilicu
She
is5days
-partum and
post presented
withasimilar
m
probleafterydeliver
ofherfirstchild
. You
review
thehistology
report
askinbiopsy
n atthetime
take . What
directIMFpattern
doyouanticipate
?
LinearIgGat DEJ
.
GranularIgGat DEJ
.
)c Linear C3 at DEJ
.
)
d Granular C3 at DEJ
.
LinearIgGand C3at DEJ
.

74
Section 1
: Practice Questions

.272
PQ Whatpercentageof patientswith linearIgAdiseasehaveoral mucousmem
-
brane involvement
?

)a %.
100
)
b %.
25
)
c %.
0
50
%.
%.
75

PQ
.2 73 Blue
-grey ovoidnestsandspokewheeledpigmentation areevidentonder
-
c
moscopi examination
of alesion
. Towhichofthefollowingdothesefeaturesmost
likelyrelate
?

Malignant melanoma
.
Seborrhoeic keratosis
.
)
c Junctional melanocytic .
naevus
Pigmentedbasalcell carcinoma
.
)
e Blue naevus
.

.274
PQ Ophiasisisrecognisedto be apoor prognosticmarkerin alopeciaareata
.
What pattern of hair loss dosesit describe
?

Unilateral scalp involvement

.
Lateral and occipital scalp involvement
.
c) Multiple
3
/> .
patches
)
d Eyebrow .involvement
Beard involvement
.

.275
PQ A39
-year old patienthasanextremelyitchyglisteningorange
-red plaque
r theglanspenisandforeskin
ove . Yoususpect
adiagnosis
ofplasma
cell(or Zoon's
)
.
balanitisWhatisthemostdefinitivetreatmentforthiscondition
?

Imiquimod cream
.
)b .
Circumcision
c) Laser destruction
.
)
d Topicalsteroid
.
)
e Topicaltacrolimus
.

75
 Section 1
: Practice Questions

.276 Whatistheriskofdevelopin
PQ g complicating
squamous
cellcarcinoma
inpa
-
tients with vulval lichen sclerosus
?

%.
1
Less than %.
1
)
c 5.
%
%.
10
%.
50

.277
PQ Whichofthefollowingphotosensitive
disorders
istypicallyinheritedin a
-autosomal
non recessive pattern
?

Erythropoietic protoporphyria
.
Bloom's syndrome
.
Cockaynesyndrome
.
)
d Kindler syndrome
.
Congenitalerythropoieticporphyria
.

.278
PQ Whatis thetrans
-epidermal cycletime in normalskin
?

)
a 24 days
.
18 days
.
)
c 28 days
.
14 days
.
)
e 32 days
.

.279 A50
PQ -year oldwoman
develops
avesicular
eruption
overherlowerlipafter
startingPUVAfor vitiligo
. Whatisthe mostlikelycause
?

Photosensitivity
dueto anassociated
autoimmune
connective
tissue
.
disorder
Fixeddrugeruptiontoingested
.psoralen
)c .Photoburn
)
d HSVreaction
.
.
Coincidental

76
Section 1
: Practice Questions

.280
PQ Which of the following medications is contraindicated in patients with known
a allergy
soy ?

.
Isotretinoin
)
b .
Acitretin
.
Ciclosporin
)d .
Bexarotene
)
e .
Methotrexate

.281
PQ Which of the following would you not expect to see on dermatoscopic exami
-
nation of a seborrhoeic ?
keratosis

Cerebriform pattern
.
)
b Pigment network
.
)
с Fingerprint structures
.
)
d Hairpin vessels
.
)
e -eaten
Moth .
border

.282
PQ Howdoesthenoveloralanticoagulant
dabigatran
work
?

)
a Inhibition of activated vitamin Ksynthesis
.
)
b Inhibition of factor .
Xa
)
c Inhibition of thrombin (factor lla
).
Activation of antithrombin .
Ill
)
e None of the above
.

.283
PQ A 35
-year old man with skin phenotype 2 is to start narrow
-band UVB for
poorlycontrolled
, chronicplaquepsoriasis
. Whatisthe maximumnumberofsessions
he can have in a lifetime
?

.
350
.200
c) .
300
)d .
400
)
e .
500

77
Section 1
: Practice Questions

.284
PQ Which of the following absorbable and non
-absorbable suture combinations
will minimise the suturereaction andscarring
?

PDS)(polydioxanone and Ethilon

.
Monocryl and Ethion
.
)
c Vicryl and Prolene
.
)
d MonocrylandProlene
.
PDS )(polydioxanone and Prolene
.

.285
PQ Question 10
: A 55
-year patient with a history of self
-neglect and features of
n
malnutritioisadmittedwithaninfectiveexacerbation
ofchronicobstructive
-
pul
monarydiseasenecessitatingsystemicsteroids
. Onday7 of admissionhedevelops
haemorrhagicbullaeoverhis buttocks
, groinsand innerthighsthat breakdownto
leave deep purulent ulcers
.

Which causative agent would you expect to identify on blood culture

?

Escherichia coli
.
Pseudomonas aeriginosa
.
)c Neisseriameningitis
.
)
d Staphyloccus aureus
.
)
e Aeromonas hydrophila
.

.286
PQ Which of the following is the cardinalfeature of -R
Mosen
Miescher
elkersson
thal Syndrome
?

.Cheilitis
Lingua plicata
.
)
c Mucosal tags.
)
d Facial nerve paralysis
.
)
e Cutaneous lesions
.

.287
PQ A65
-year oldladyattendsyourclinicforreviewof anitchyerythematous
e
plaqur herrightupperchest
ove . n
Examinatio
underdermoscopy
reveals
ascattered
grey granular pattern
. What isthe most likely diagnosis
?

)
a Lichenoid keratosis
.
Pigmentedbasal cellcarcinoma
.
c) Lichen simplex
.
)
d Malignant melanoma .in
-situ
Squamous cell carcinoma .in
-situ

78
Section 1
: Practice Questions

.288
PQ A GPrefers a17
-year old veterinary nursetrainee with suspectedCatch
ScratchDisease
. If her suspicionis correct
, whatis the likelihoodthat the patientwith
have lympadenopathy
?

%.
0
)
b %.
75
%.
50
%.
25
)
e %.
100

.289
PQ A 19
-year oldpatient is referred for review of alesion overlying her poste
-
rior shoulder
. Herattentionwasfirst drawnto this whenplanningatattoo of two
intertwined serpents at the site
. Examinationunder dermoscopy revealsstreaks
of pigmentationforminga peripheralstarburstpattern
. Whatisthe mostprobable
?
diagnosis

Naevus of Ito
.
Blue naevus
.
c) Spitz naevus
.
Superficialspreadingmalignantmelanoma
.
Naevusof Oto
.

.290
PQ Whichof thefollowing vascularpatternswouldyouexpectondermoscopic
examination of a clear cell acanthoma
?

Polymorphousvessels
.
)
b Uniform .
lacunes
)
c Arborizing telangiectasia
.
Dot vesselslined up in a string of pearls
.
Glomerular vessels
.

.291
PQ A patient is carrying aCTLA
-4 gene mutation
. Which of the following diseases
would you wish to exclude
?

Tuberous sclerosis
.
Atopic dermatitis
.
Coeliacdisease
.
Desmoid tumours
.
.
Amyloidosis

79
 Section 1
: Practice Questions

.292 You
PQ suspedrug
ct -related Churg
-Strauss syndrome
inapatient
younave
oeen
g
treatinforchronic
.
urticaria
Which
class
ofdrugislikely?
implicated
-rH1eceptor .
inhibitor
Calcineurin inhibitor
.
)c Leukotriene receptor inhibitor
.
)
d -receptor
H2 .
inhibitor
)
e -IgE
Anti monoclonal antibody
.

.293 Skinprick
PQ testing
ina21
-year oldfemale
nurse
confirms
theclinical
suspicion
oflate
x allerg
y. h ofthefollowing
Whic factors
carries
thegreatest
riskofmortality
during anyfuture anaphylacticattack
?

-controlled
Poorly .
asthma
Poorconcordance
withprescribed
-histamines
.anti
Levelof anti
-latex serum IgE
.
)
d Strengthof skinprickresponse
to latex
.
)
e Familyhistory of death during anaphylaxis
.

.294 Yo
PQ u arelookin
g after
apatient
withcutaneous
-celllymphoma
T . Atwhat
stage
oftheire
diseaswould
youconsider
introducing
?
Bexarotene
Stage 3or above
.
)b Stage 2a or above
.
c) Stage 1b or above
.
Stage 2b or above
.
)
e Stage4
.

.295 A29
PQ -year oldpregnant
woman isseeninclinicwithherfourthskinmalignan
-
.cy Ther
e isstrong family
history
ofcancer
withherfatherandpaternal grandmother
ng suffer
havied medulloblas
toma andovaria
n ,
cancer
.
y
respectivel
She
andherpart
-
, whohasnopersonal
ner orfamilyofskincancer
, wishtoknowthelikelihood
that
r child
thei, whic
h theyknow
tobeadaughter
, willalso
beaffected
bythecondition
.
Which of the following isthe correct answer
?

75
%.
)
b %.
25
)
c %.
0
%.
50
%.
100

80
Section :
1 Practice Questions

.295
PQ Whichofthefollowingstatements
regarding
Vismodegib
istrue
?

)
a Itinhibit
s thehedgeho
g receptor
anditsmostcommon
sideeffect
ismuscle
.
cramps
)
b It inhibits the smoothened receptor andits mostcommon sideeffect is
.
nausea

It inhibits thesmoothenedreceptorandits mostcommonsideeffectis

muscle cramps
.
)
d It inhibits the hedgehogreceptor andits most common side effect isnausea
.
)
e None of the above
.

.297
PQ Which HPVserotype is most commonly associatedwith subungualsquamous
cell carcinoma
?

HPV 16
.
)
b HPV18
.
c) HPV26
.
HPV31
.
HPV56
.

.298
PQ Whatis the secondmostcommonsite for melanomain BritishCaucasian
?
men

Upperlimbs
.
)b .
Trunk
c) Headand neck
.
Lower.limbs
Acral sites
.

PQ
.2 99 A14-year oldboywithredhairandfreckledskinis referredbyhisGPdueto
n
concer regardinganumberof atypical.moles Ontakingafamilyhistoryyouestab
-
lishthathisfather
, oldersisterandpaternal,uncle allof asimilarcomplexion
, had
malignant melanomabefore the ageof 40 . Mutation inwhich gene is mostlikely to
underliethe strong family history of malignant melanoma
?

.
CDKN2A
. AF
-R
B
)c .
BRACA
)
d .
PTEN
.
MC1R

81
Section 1
: Practice Questions

.300 A31
PQ -year oldwoman
hasBRAF
-positive stage4malignant
.
melanoma
Which
of the following treatmentsoffersher the bestprognosis
?

Vemurafenib - IV.
)
b Ipilimumab - orally
.
Vemurafenib - orally
.
)
d Rituximab - IV
.
)
e Ipilimumab - IV
.

.301
PQ A53
-year manhasBRAF
-negative stage4 malignant
.
melanoma
Whichofthe
followingtreatmentswouldafford himthebest prognosis
?

Ipilimumab - orally
.
Ipilimumab - .IV
Vemurafenib - IV
.
Vemurafenib- orally
.
Rituximab - IV
.

.302
PQ A 31
-year oldwomanisto start Ipilimumabfor BRAF
-negative stage4 malig
-
nant melanoma
. What isthe most common complicatingautoimmune reaction seen
with this monoclonal antibody
?

.Pneumonitis
.
Dermatitis
c) .
Uveitis
.Hepatitis
)
e .
Colitis

.303
PQ Apatient with stage4 melanomapresentswith her secondsquamouscell
ma
carcino since
starting
anewmedication
. Which
ofthefollowing
therapies
isshe
mostlikelyto bereceiving
?

.
Dacarbazine
.
Ipilimumab
)c .
Interferon
)
d .Dabrafenib
.
Radiotherapy

82
Section 1
: Practice Questions

.304
PQ Which of the following statements regards Naxos syndrome is most accurate
?

It isautosomal,recessiveinvolvesadefectin the desmoplakingene

, and
presents with woolly hair
, arrhythmogenic left ventricular cardiomyopathy
and striate PPK
.
)
b It isautosomalrecessive
, involvesadefectin theplakoglobingene
, and
presentswith woolly hair
, arrhythmogenicleft ventricularcardiomyopathy
and diffuse PPK
.
)
c Itisautosomal
,
recessive
involves
a defectin theplakoglobin
,
geneandpre
sents with woolly hair
, arrhythmogenic right ventricular cardiomyopathy and
striate PPK
.
It isautosomaldominant
, involvesa defectin theplakoglobingene
, and
presentswith woolly hair
, arrhythmogenicleft ventricularcardiomyopathy
and striate PPK
.
)
e It is autosomal recessive
, involves adefect in the plakoglobin gene
, and
presentswith woolly hair
, arrhythmogenicright ventricularcardiomyopathy
and diffuse PPK
.

.305
PQ What is the protein target of local anaesthetics
?

Sodium channels
.
)
b Calcium channels
.
)c Gap junctions
.
)
d Potassium channels
.
)
e Chloride channels
.

.306
PQ A 60 yearold man
, with skinphenotype3
, isreferredfor urgentreview ofa
solitary plaque on his left shin which he first noticed after aweekend gardening
. -
Der
moscopyshows acentral thrombosed lacune
. Surroundingthis are multiple smaller
thrombosedandpurplelacunes
, overwhichthere isa blue
-white .
veil

What is the most likely diagnosis

?

)
a .
Haemangioma
Malignant .
melanoma
.
Angiokeratoma
.
a
Lymphangiom
Ink spotlentigo
.

83
Section 1
: Practice Questions

.307
PQ Whichofthefollowingmedications
wouldyouwishto avoidin a patientwith
urticarial pigmentosa
?

.Propranolol
.
Hydroxychloroquine
.
Lithium
.Atropine
.
Terbinafine

84
Section 1
: Answers & Comments

n
Sectio : Answers
1 &Comments

.1
PQ :
Answer a

Comments

~ PUPPwhich is alsocalled polymorphic eruption of pregnancy occursinthe first preg

-
nancy and seldom recurs in subsequent pregnancies
.
~ Both pemphigoid gestationis and intrahepatic cholestasisof pregnancy can recur
with subsequent pregnanciesor with the use of oral contraceptives
.
~ Atopic eruption of pregnancycanbe the first manifestationof atopic diseasein a
susceptibleperson
.

.2
PQ :
Answer e

Comments
~ The type of cell infiltrate together with the direct immunofluoresence canbe very
helpful in establishing a histological differential
.
~ Subepidermal bullae with a predominantly neutrophilic infiltrate :
include linear gA
,
diseasedermatitisherpetiformis
, mucousmembranepemphigoid
, bullouslupusery
-
thematosus and Sweet's syndrome
.
~ Bullousmastocytosishassubepidermal bullae with mastcells
.
~ Bullouspemphigoidhas a predominantlyeosinophilicinfiltrate although a neu
-
trophilic infiltrate may occur
.
~ Erythemamultiformehasapredominantly
lymphocytic.infiltrate
~ Epidermolysisbullosa acquisitatypically is cell
-poor but somecasesmayhave aneu
-
trophilic .
infiltrate

87
Section 1
: Answers & Comments

.3
PQ :
Answer c

Comments
~ Neonatalacneconsistsof both inflammatorylesionsand comedones
.
~ It presents in the first three months oflife
.
~ Thisoccurs dueto the presenceof the maternal hormoneswhich stimulate the seba
-
ceous glands in the neonate
.
~ The condition resolvesspontaneously without treatment in the first three months
of life
.
~Neonat
al cephalicpustulosis
isapustularcondition
mainlyaffecting
theheadofne
-
,
onateswithoutcomedones
. Thisis maybe dueto overgrowthof variousMalassezia
.
species
~ Infantileacneappears
aftertheageofthreemonthsandis morecommoninboys
dueto higherlevelsoftestosteroneinthefirst 6
-12 monthsoflife
.
~Ther
e maybeapositive
familyhistory
, andthecondition
includes
bothinflammatory
and comedonal,lesions howeveroften inflammatorylesionspredominateand in se
-
verecases
, cysticacnemayoccur
.
~ Childr
en withinfantile
acneshould
beevaluated
withanendocrinological
screening
forunderlyin
g ,
s
abnormalitie
andtheremaybeariskforsevere
acnelaterinlife
.
~ Staphylococcalpustulosispresentswith diffuse pustulesin the absenceof come
-
,
dones on the trunkandlimbs
.

88
Section 1
: Answers & Comments

.4
PQ :
Answer d

Comments
~Staphylococc
al scalded
skinsyndrome
ischaracterized
bygeneralized
tendermacu
-
lar erythemawhichdesquamateswithin few days
, particularlyon theskin aroundthe
,
mouth nose andflexural areas
.
~Typicall
y, e superficia
larg l flaccid
bullae
mayappear
onthebackground
oftheerythe
-
ma and leave painful denuded .
areas
~ Thechildis oftenlethargicandfebrileandthe conditionis dueto staphylococcal
exfoliating toxin
.
~ Promp
t treatmentwithanti
-staphylococcal antibiotics
results
infullrecovery
andthe
prognosis is generally very good
.
~Toxi
c epiderma
l s
necrolysi
wouldcertainly
beinthedifferential
, ,
however
thiscon
-
dition is oftensecondaryto drugsand occursmorein adultsthan children
, and often
involves the mucous membranes
.
~ Diagnosticbiopsyissometimesrequiredto differentiatethetwo conditions
.
~ Intoxicepidermalnecrolysis
, full epidermal
necrosis
is seenwith minimaldermal
.
infiltrate
~ The defect )(split in staphylococcalscaldedskin syndromeis in the subcorneallayer
.
~ Kawasaki'sdiseasemaygive rise to desquamation in the flexural area
; ,
however the
diagnosisrequiresthe presenceof high feverlastingfor at least five daysand four of
thefollowing criteria
: conjunctival,injection mucousmembranechanges(particularly
strawberrytongueappearance
), erythemaoroedemaof the palmsandsoles , and cer
-
vical lymphadenopathy
.
~Coronaryartery aneurysmisone of the main andfatal complicationsof Kawasaki's
,
diseaseand patientsthereforerequire anechocardiogram
.

.5
PQ :
Answer b

Comments
~ Erythrasma canbe treated with topical or oral erythromycin
.
~ Epidermophytonfloccosummayaffectthe axillae
, althoughit is commonlypresent
in the groins
.
~It isafungusthatdoesnotfluoresce
; scrapings
canbepositive
formicroscopy
and
.
culture
~ Trichophytonverrucosumis a zoophilic dermatophytefound in cattle and usually
results in a severe inflammatory dermatomycosis
.

89
Section 1
: Answers & Comments

.6
PQ :
Answer e

Comments
~ Hirsutismisdefinedas excessive
terminalhairgrowthin womenin the androgen
-
sensitive .
areas

~Polycysticovariansyndromeisthe commonestendocrinologicalcausefor hirsutism

.
~ Diagnosi
s ofpolycysticovariansyndrome
requirestwo out ofthreeof thefoliowing
:
e
positiv,
imaging
menstrual
abnormalities
andsignsofhyperandrogenism
, whichcan
b remembere
e d bytheacronym
,
SAHA thatstandsfor Seborrohea
, ,
AcneHirsutism
and Androgenetic alopecia
.

.7
PQ :
Answer c

Comments
~Althoug
h y
generallsystemic
treatments
should
beavoided in pregnancy
if possible
,
allth
e above
, withtheexception
ofmycophenolate
,
mofetil
canbeusedinpregnancy
.
.8
PQ :
Answer e

Comments

~Vancomyc
in isthemostcommon
causeofdruginducedlinearIgAdisease
.
~ Penicillaminecancauseboth drug
-induced pemphigusand mucousmembranepem
-
,phigoidandlong
-term usecanresultinelastosisperforansserpiginosa
, in whichelas
-
ticfibresextrudethroughtheepidermis
.

.9
PQ :
Answer a

Comments
~ Althoughimmunosuppressive
therapiescan certainlybeused with somedegreeof
s
succesin patientswithsolarurticaria
, antihistamines
remainfirstchoicetreatment
.
~UV
B desensitisat
ion canalso
beused
inthiscondition
provided
thatpatients
donot
show sensitivityto that particularwavelength
.
~Erythe
ma andwheals
insolarurticaria
develop
withinseconds
tominutes
following
exposure to sunlight and almost always subside within 24 hours
.

90
Section 1
: Answers & Comments

.10
PQ :
Answer c

Comments
~DRE
SS isaserious
drugeruptionthattypicallypresents
withanexanthematous
-
erup
n withfever
tio , ,
y
lymphadenopath
oedema
oftheface
, peripheral
,
eosinophilia
-
atypi
callymphocytes and visceralinvolvement
.
~ Liver andkidney involvement maybe seen
.
~Th
e latenc
y periodmaytakeanywhere
between
-8 weeks
1 , although
thismaybe
much earlier with re
-exposure to the drug
.
~ Apustulareruptionis not afeatureofDRESS
syndromeandis seenin acutegeneral
-
ized exanthematouspustulosis
.

.11
PQ :
Answerd

Comments
~ Incontinenti
a pigmentiisagenodermatosis
thatprimarilyaffectsfemalesasmalesdo
notsurvivethis X
-linked dominantdisorder
, unlessthey aremosaic
. Thecommonest
mutation involves adeletion in the NEMOgene onthe long arm of the X chromosome
.
~Theconditionhasfour stages
; inflammatoryvesicularstagewhichtendsto be along
s
Blaschko'
,
lines a verrucous
,stage hyperpigmented
, andfinallyhypopigmented
stage
in whic
h whorl
s andswirls
p
develo
inacharacteristi
c "Chinese
"
letter.
pattern
~ Thereis associatedectodermaldysplasiaand nail changesmay occurincluding
s,
onycholysi
y
onychodystroph
andsubungual
.
hyperkeratosis
~ Systemicdefects canoccur
, and in particular
, brain and eye involvement
.
~ Patientswith incontinentiapigmentishouldhaveneurologicalandophthalmicas
-
.
sessment

.12
PQ :
Answer b

Comments
~ Acneconglobata
is aspecificvariantof acnecharacterised
bylargecomedones
with
multiple openings
, predominantlyonthefaceand back
.
~ Apositivefamilyhistoryis oftenfoundandthisshouldnot beconfused
withacne
fulminans which is a severeform of acne that tends to affect youngmalesand presents
with malaise
, ,
fever arthralgiaandliverinvolvement
.
~Unli
ke acn
e congloba
,
ta gic
haemorrha
crusted
ulcerative
lesion
can
befound
inacne
.
fulminans

91
Section 1
: Answers & Comments

.13
PQ :
Answer b

Comments
~ -D
Hube
Birt
ogg syndrome
manifests
asfibrofolliculomas
, trichodiscomas
andacro
-
.
chordons
~Thi
s is anautosomal
dominant
disorderandcanbeassociated
withrenalandpulmo
-
nary cysts
; and can presentwith pneumothoraces
.
~ Romb
o e
syndrom
presents
withbasalcell,carcinomas
,
trichoepitheliomas
-
hypo
,
trichosis atrophoderma andtelangiectasia
.
~Bazex
Dhristol
-C upre e
syndrom
presents
withbasal
cellcarcinomas
, follicular
-
atro
,
ma
phoder pilitorti
, scrotal
,
tongue
spiny,hyperkeratosis
andneuropsychiatric
-
symp
.
toms It is an X
-linked dominant .
disorder
~Gorlin'
s e
syndrompresents
withbasalcell,carcinomas
-plantar
palmo , odonto
pits -
c jawcysts
geni , frontal,bossingovariancarcinoma
/ fibroma
, ,
medulloblastomas
-
lipo
,
mas and epidermal cysts
.
~ It isanautosomaldominantdisorderdueto PTCH1
genedefect
.

.14
PQ :
Answer c

Comments
~5m
m isthemargin
isemployed
formelanoma
-situ andlentigomaligna
in -(melano
ma in situ in sun
-damaged ).
skin
~Th
e guideline
s t
sugges
thatinthinmelanomas
(lessthan1 mmindepth
), these
uld b
sho e excis
ed withamargi
n ofatleast
1cmand
formelanoma
s, between
-2
1.01
mm a margin of 2 cm when possible
.
~2m
m marginistheinitialmargin
usedforatypical
naeviaswasthecasehere
.

92
Section : Answers
1 & Comments

.15
PQ :
Answer a

Comments
~ Conradi
-Hünermann syndrome isinherited in anX
-linked dominant pattern
.
~ Patients are often born with acollodion
-like membrane followed by an ichthyosiform
erythroderma in Blaschko's lines
.
~ Theremayalso befollicular atrophoderma
, scarringalopecia
, scoliosisand cataracts
.
~ Sjögren
-Larsson syndromeis an autosomal recessivedisorder presentswith ichthyo
-
sis at birth with spastic paralysis and mental retardation
.
~ Netherton's syndrome is an autosomal recessive disorder that presents with an ex
-
foliative erythroderma with ichthyosis linearis circumflexa
; the typical double edged
migratory scale
.
~ Th
e typicalfeatureisthe so-called "bamboo hairsshowingmicroscopically
thetyp
-
icaltrichorrhexis.invaginata
~ Lamellarichthyosis presentswith a collodion baby at birth
. It is an autosomal reces
-
sive disorder
.
~ Most patients develop later in life features of ectropion
, inverted ears
, -like
plate
,
scale whichis often"dirty brown
", andpalmo
-plantar .
keratoderma
~ Xeroderma pigmentosum is an autosomal recessive .
disorder

.16
PQ :
Answer e

Comments
~ In systemic lupus erythematosus )(SLE anti
-nuclear antibody is positive in the ma
-
jority of patients
. Immunological abnormalities including the finding of anti
-Sm and
-dsDNA
anti antibodiesform one of the criteria for diagnosisof SLE
.
~ Anti
-Sm antibodies are specific to SLE and are found in around %
-30
20 of patients
.
~ -D
dsNA
Anti antibodiesarealsospecificto this condition(also in "lupoid hepatitis
)
and the titres may correlate with both renal involvement and diseaseactivity (unlike
the anti
-Sm ).
antibody

.17
PQ :
Answer e

Comments
~ Although the incidence of cutaneous tumours and dysplastic lesions is greatly in
-
creasedin patients with organtransplantationdue to immunesuppression
, the risk
of squamous cellcarcinoma )(SCC in particular is greatly increased(x )60
-250 and the
usual basal cell carcinoma
: SCCincidence ratio of 4
:1 is reversed
.
~ The risk of basal cell carcinoma and melanomais also increased but to a lesser de
-
greecompared to SCCs
.

93
Section 1
: Answers & Comments

.18
PQ :
Answer b

Comments
~Thecurrentconsensus isthat dermatologicalsurgicalproceduresconferalow riskfor
,
endocarditis andtherefore
, no prophylacticantibioticsarerequired
.
~ Anassessmentshouldhowever
, stilltakeplacebasedonindividualcircumstances
.

.19
PQ :
Answer b

Comments
~ Dermatofibromasarefirm
, ,
indurated but mobilecommonmesenchymallesions
.
~Later
al n
compressio
of dermatofibroma
produces
adimple
-like depression
inthe
overlyingskin("
").
buttonholing

.20
PQ :
Answer c

Comments

* Apredominantlyneutrophilicinfiltrate isfoundin folliculitisdecalvansanddissecting

cellulitis of the scalp
.
~Alymphocyt
ic infiltrate
isfound
inlichenplanopilaris
, alopecia
,
mucinosa
cutaneous
lupuserythematosus
, alopeciaareataandpseudopelade
of Brocq
, thoughinthelatter
there may be little inflammation .
present
~Earl
y acnenecrotica
anderosivepustulardermatosis
canhaveamixedneutrophilic
and lymphocytic .
infiltrate

.21
PQ :
Answer e

Comments
~Nodula
r s
amyloidosi
isarareprimarycutaneous
amyloidosis
caused
bythedepo
-
sition of the AL amyloidsproducedby infiltrate of plasmacells
. It is thereforeoften
regarded as a plasmacytoma
.
~ Theothertwotypesofcutaneous amyloidosis(macularandlichenoid
) resultfrom
d
damage ;
keratinocytes
thereforetheystainpositively
forcytokeratins
.
~Carcin
oma encuiras
se iscutaneo
us s
metastasi
frombreast
,
carcinoma
thislikeother
epithelialtumoursstainpositivelyfor cytokeratins
.

94
Section 1
: Answers & Comments

.22
PQ :
Answer a

Comments
~ With the exceptionof xanthomatadisseminatum
, and verucciformxanthomas
, all
other types of xanthomasare associatedwith anabnormal lipid profile
.
~ Eruptive xanthomata are often associatedwith elevatedtriglycerides asopposed to
increased cholesterol levels in the other forms of xanthomata
.
~ Xanthomatadisseminatum isa histiocytic disorder
.

.23
PQ :
Answer a

Comments
~Cutaneouslarvamigransisa pruritic eruptionthat iscausedby thenematodehook
-
wormAnkylostoma
brazilense
(and in someoccasionsAnkylostoma
),
caninum which
is depositedin dogsand catsfaeces
.
~ It clinically presentswith serpiginousvesicularburrows that migrate slowly
. The
worm cannot penetrate the basement membrane
.
~ Stronglyoide
s ,
stercoralisanothernematode
, causes
cutaneouslarvacurrenswhich
presents similarly with serpiginous urticarial burrows on the buttocks or trunk
. This
worm howevercanpenetratethebasementmembraneand canaffectthe lungsand
thegastrointestinal.tract Whenit doesinvolvethe lungsit maycauseLoeffler'ssyn
-
drome (pulmonary eosinophilia
).
~ Schistosomes
maycauseschistosomiasis
and""swimmer's itch
.
~ Mycobacterium marinum causesfish tank granuloma presentingwith red to purple
coloured nodules andplaques with sporotrichoid spread
.
~ A further difference between Stronglyoides and Ankylostoma is that the latter mi
-
gratesslowly and Stronglyoidestypically migratefast
.