Dermatology 🧴

A 29 year old woman is seen in the GP surgery with a rash on her arms and legs. It have been worsening over the past few weeks. She has suffered from eczema since she was a child. She uses regular emollients and has bought over the counter topical steroids to use to manage her flare. She started using the over the counter topical steroid for the past week but she feels that it has not been improving her symptoms. She is unable to sleep well because of the intense itching. Below is a picture of her arms:

What is the SINGLE most appropriate medication to use?

A 25 year old man developed a papular rash which started on his thigh and spread around the chest, abdomen, arms and back over a period of several days. The rash started as a single 2 cm rash on his left thigh. The rash is not painful or itchy. He denies any fever. He does not take any regular medications. Below is the picture of the initial rash:

The following pictures are of different parts of his body showing the rash:

What is the SINGLE most likely diagnosis?

A 44 year old man complains of a solitary, shiny, red papule which has been growing on his nose for several months. It is firm with a central depression. It is 0.6 cm in size. What is the SINGLE most likely diagnosis?

A 9 year old boy presents with perioral blisters on the left side. It started as tiny pustules and vesicles that evolve rapidly into honey-coloured crusted plaques. What is the SINGLE most appropriate medication to use?

A 55 year old woman has fatigue and arthralgia. She has been feeling increasingly tired over the last few months with aches and pains especially in the morning. On examination, ring-shaped, raised scaly lesions are noticed on sun-exposed areas. Her past medical history includes chronic heart failure which is treated with isosorbide dinitrate and hydralazine. What is the SINGLE most likely positive antibody?

A 35 year old woman has a persistent fever, rash on her nose and cheeks and suffers from symmetrical joint pains in the hands, knee and elbow. She has also been feeling very fatigued over the past few months and has lost 10 kg in the span of 2 months. She recently went to Spain for a beach holiday and has returned with a skin rash over her whole body, worsening joint pains and more fatigue. Recent laboratory results show a normal CRP. What is the SINGLE most discriminative investigation?

A 33 year old woman with a maternal history of melanoma who grew up in Australia attends the GP surgery with concerns about a black mole on her back with hair growth on it. The mole has not grown since she noticed it 2 years ago. From the list below, which is the most worrisome feature of this lesion that should warrant a visit to a health care professional?

A 22 year old woman presents with a 4-week history of intense itching eruptions at her groin and between the fingers of her right hand. The itching is particularly worse at night. She also notices the itching and redness more after taking a shower. She has been using antihistamine for the past week but has not seen any benefit. She has been finding it difficult to study for her university exams because of her disturb sleep. She does not take any medication. She has a combination of erythematous papules, excoriations and linear lesions seen on her web-spaces of the fingers and on her genitalia. Which genus is responsible for her symptoms?

A 31 year old woman presented to her General Practitioner with an acute onset of rash on her legs, arms and trunk. It initially started on the back and palms of her hands and feet then within several hours spread to her limbs and trunk. The rash is absent on the genitalia and face. She was diagnosed with oral herpes 7 days ago. Pictures of the rash is seen below:

What is the SINGLE most likely cause of the rash?

A 39 year old woman is treated with amoxicillin for a community acquired pneumonia. Four days into her treatment, she develops targetoid lesions on palmar and dorsal aspects of hands and feet. Since the initial presentation of the rash, the flattish lesions have hence gotten bigger to form slightly raised patches. The patches have also started to spread toward her trunk. These lesions have a dusky red blistering centre with a surrounding pale area and the patient reports mild itching. What is the SINGLE most likely diagnosis?

A 4 year old child is brought to your GP practice by her mother. She has painful crusted lesions on her face and neck, mostly localized around her mouth. Her face feels hot to the touch. She also has a history of suspected asthma. What is the SINGLE most likely diagnosis?

A 28 year old woman presents with a 3-week history of intense itching around both her hands and under both her breasts. The itch is worse at night. She works in a nursing home. She has been using antihistamine for the past two weeks but has not seen any benefit. She does not take any medication. An image of her right hand can be seen here:

What is the SINGLE most appropriate management?

A 35 year old renal transplant recipient attends your clinic for a routine skin examination. A suspicious lesion is detected on his trunk which is fully excised and sent for pathohistological analysis. What is the SINGLE most important prognostic indicator for malignant melanoma?

A 19 year old woman has severe acne and has been prescribed medications that she has been taking over the past few months. She has started having dry eyes, dry throat, dry nose and frequent nose bleeds which she believes may be related to the medications she was started on. Which medication is most likely to have caused the side effects?

A 5 year old child is seen with his mom in the GP surgery with a rash on his flexures of the arms and behind his knee and neck. It has been progressively worsening over months. His mother has been applying regular emollients to his skin. He is unable to sleep at night due to the intense itching even while on antihistamines. He also has a reduced appetite for the past week. Both his parents suffer from hay fever. There is a widespread area of dry skin, crackling, redness and bleeding with excoriation marks at his flexures and neck. What is the SINGLE most appropriate medication to use?

A 20 month old child is seen with his mom in the GP surgery with a rash on his ankles and behind his knees on both sides that have been progressively worsening over weeks. His mother has been applying regular emollients on his skin. His father suffered from asthma as a child. There are small areas of dry skin with redness. There is no fever. Below is the picture of the rash:

What is the SINGLE most appropriate medication to use?

A 19 year old girl presents with an itchy and scaly rash over her face, scalp, extensor surfaces of her arm. Her grandmother also suffers from a similar skin disease. Her mom is worried that the rash is contagious. She has been helping out in the hair salon for her summer holidays. Below is a pictures of her elbows:

Which of the following is the best advice that you can give her?

A 32 year old woman has malaise, fatigue, weight loss and fever. On examination, a malar rash with sparing of nasolabial fold can be seen. She also complains of joint stiffness and pain in her hands and wrist. Her hands are very sensitive to cold and her fingers often turn pale when exposed to cold for a period of time. What is the SINGLE most likely positive antibody?

A 39 year old man presents with numerous pink itchy umbilicated papules on his genitals, thighs, and lower abdomen. They are small measuring 1-3 mm. White material can be expressed when pinching the papules. He is a known HIV positive patient. What is the SINGLE most likely diagnosis?

A 45 year old Australian man attends the GP surgery as a partner noticed a lesion at the back of his ear. He is a professional cyclist. He is of caucasian in origin. An 8 mm asymmetrical pigmented lesion is seen on his left ear. What is the SINGLE most important prognostic indicator for malignant melanoma?

A 58 year old man attends the GP surgery with complaints of severe itching on his upper arm and trunk for the past 2 weeks. There are obvious excoriations on his upper arms and burrows seen on the wrist. He was told by his vet to come in to see his GP as his vet is treating his dog for scabies. His wife and pregnant daughter who live with him are asymptomatic. What is the most appropriate advice?

A 49 year old man has been having pink patches with a fine yellow greasy scale on his head and face for the past 6 months. It also affects his eyebrows. He complains of a mild itch. He does not have any other rashes on his body aside from his face and head. A picture of his forehead can be seen below:

What is the SINGLE most likely diagnosis?

A 65 year old man develops a blistering rash which is widespread on his trunk over the past 2 days. It started with sore, itchy red patches that evolved into blisters after several days. He complains of a severe itch near the blisters. His wife says that he has been becoming confused over the past day and cannot remember where he is. On examination, there are numerous tense blisters around 1 to 3 cm in diameter on inflamed skin on the lower trunk. There are no rashes on the face and neck. He has a temperature of 38.9°C and a heart rate of 80 beats/minute. What is the SINGLE most likely diagnosis?

A 7 year old girl presents to the GP surgery with clusters of a small round papules on the underarm. Each individual papule measures around 2-4 mm. She is afebrile. She denies any pain. She is afebrile. Below is the image of the rash

What is the most appropriate management?

A 33 year old woman developed painful sores on her lips and around her mouth 24 hours ago. Several hours before the sores appeared, she felt tingling and a burning sensation around her mouth. She has no sores inside of her mouth. She has had a similar episode like this 4 years ago. She has no significant medical history. A picture of her lesions can be seen below:

What is the SINGLE most appropriate management?

A 2 month old infant presented with his mother complaining of red itchy dry skin over the left side of the baby’s scalp, face, neck and elbows. He is afebrile. He is not currently on any medications. An image of the infant is seen below:

What is the SINGLE most likely diagnosis?

A 71 year old man attends the GP surgery as he has small rough scaly lesions on his left arm. He has noticed these lesions over the past 4 months. They are slightly itchy. A picture of it is seen below:

On examination, the surface feels rough. What is the SINGLE most likely diagnosis?

A 48 year old man presents to his general practitioner with the complaint of multiple yellow plaques on his eyelids. He says that the plaques have been developing over the past two years and that they are painless. They do not affect his vision however he is concerned as they appear to be increasing in size. The patient’s past medical history is significant for hypertension. He is on an antihypertensive and a statin and he claims full compliance with his medications. Examination reveals multiple soft yellowish raised plaques ranging in size from 0.3 cm to 0.5 cm on the patient’s upper eyelids bilaterally, near the medial canthus. What is the SINGLE best diagnosis for this patient’s condition?

A 33 year old woman attends the GP surgery with a rash on her hand that started 3 days ago. She complains of a flu-like illness with chills and joint pain. She has recently travelled around Europe hiking and returned back to the UK 7 days ago. She was also started on antibiotics a few days ago for acute tonsillitis. Below is a picture of her rash:

What is the SINGLE most likely diagnosis?

An 8 year old girl has had itching on both the flexors of his knees for the past 8 months. Her father suffers from asthma and her mother suffers from hay fever. An image of the flexures is seen below.

What is the SINGLE most likely diagnosis?

A 4 year old child is seen with his mom in the GP surgery with a rash on his arms, legs, trunk and neck. It has been progressively worsening over months. His mother has been applying regular emollients to his skin. He is unable to sleep at night due to the intense itching. He is scratching throughout the day. There is a widespread area of dry skin, crackling, redness and bleeding with excoriation marks at his flexures and neck. There is extensive skin thickening. What is the SINGLE most appropriate medication to use?

A 31 week primiparous pregnant woman presents to the dermatology clinic with complains of an itchy rash across her abdomen. On examination, there are raised papules and plaques across her abdomen and lower limbs with sparing of the umbilicus. There are no blisters seen. What is the SINGLE most likely diagnosis?

A 24 year old pregnant woman complains of recent onset of severe itching and wheals which followed a viral infection. She first noticed the rash 2 weeks ago. She is unable to sleep at night due to the itch. On inspection, numerous wheals of all sizes are noticed on her skin. The wheals tend to come and go within hours. Eyelids, lips and tongue appear normal with no swelling. What is the SINGLE most appropriate management?

A 57 year old woman with a history of hepatitis C presents to her GP complaining of a three month history of itchy shin lesions. She has tried various over the counter creams including hydrocortisone which has not helped. She also reports a white patch at the sides of her tongue and cheek. She is a non smoker and does not drink any alcohol. On examination, she has multiple purplish flat topped papules and plaques on her shins with evident excoriations. Examination of her mouth reveals white lacy lines on both sides of the buccal mucosa and the sides of the tongue. What is the SINGLE most likely diagnosis?

A 54 year old cab driver presents with an urticarial rash that is very pruritic. The wheals last for less than 6 hours usually. He has suffered from these symptoms for the past 3 weeks. Due to his job, he has requested for any medication to help with the itch which will not make him drowsy. He takes atorvastatin once a day. What is the SINGLE most appropriate medication to prescribe?

A 29 year old man has developed a red, raised rash on his trunk after playing football. The rash is becoming increasingly itchy over the past few hours and has now spread to his arms. His past medical history includes asthma which was diagnosed when he was 7 years old. What is the SINGLE most appropriate management?

A 13 month old baby is seen with his mom in the GP surgery with a rash on his trunk and legs. It has been progressively worsening over months. There is a widespread area of dry skin, crackling, redness at his trunk. A picture of his legs is seen below.

His mother would like to know which would be the best medication to use to reduce his symptoms. Which medication would be the most beneficial to reduce his symptoms?

A 49 year old woman has a growing painless ulcer on her left axilla which she has noticed over the past few months. She has had a left mastectomy followed by radiotherapy 8 months ago for breast cancer. On examination, there is a central depression surrounded by rolled edges. There are blood vessels crossing the surface. The lesion is 5 mm in diameter and has pigmentation. What is the SINGLE most likely diagnosis?

A 4 year old boy presents to the GP surgery with the complaint of a rash. His mother, who accompanies him, complains of a rash that occurs on her son’s creases of his elbows, behind his knees and on his hands. This rash has been worsening over the past few weeks. She reports that her son tries to scratch the aforementioned areas and that the itching causes him distress. He has no other medical conditions and is not on any medication. His mother reports the pregnancy and birth to have had no complications. On examination, there is dryness of the skin and redness at the flexures of the elbows and knees. What is the first-line most appropriate treatment for this patient’s condition?

A 35 year old woman has tiredness and joint pain. She has been undergoing treatment for tuberculosis. On examination, erythematous macules and papules are seen on face, upper chest, and arms in photodistribution. What is the SINGLE most likely positive antibody?

A 33 year old woman who recently came from India has a nodular patch on both her shins which is reddish brown. The nodules are slightly raised above the surrounding skin. She also has a fever and feels unwell. What is the SINGLE most probable diagnosis?

A 4 year old girl has a 6 day history of high grade fever, 2 day history of a generalized rash and a 1 day history of swelling of the hands and feet. She has no relevant medical history. Her vaccinations are up to date. On examination, her hands and feet are oedematous. She has erythematous cracked lips and redness of the eyes. She has palpable cervical lymphadenopathy. She has a maculopapular rash on her trunk. Her temperature is 39.1°C. A few days later, the skin around her fingers started to peel. What is the most likely complication associated with this condition?

A 2 month old infant presented with his mother complaining of red itchy dry skin over the left side of the baby’s scalp, face, neck and elbows. He is afebrile. He is not currently on any medications. An image of the infant is seen below:

What is the SINGLE most appropriate treatment?

A 33 year old man presents with hypopigmentation of his chest and back. It has been present for several months and causes mild itching. Below is a picture of it

What is the SINGLE most appropriate diagnosis?

A 17 year old complains of a rash on both her knees and elbows. On further questioning. he has noticed unintentional weight loss of 5kg and a change in his bowel habits, including increased flatulence and offensive-smelling stools. A recent tissue transglutaminase IgA is positive. On examination, you note multiple papules and vesicles over the extensor surfaces of the knees and elbows, with associated excoriations. What is the most likely diagnosis?

A 5 year old child has painful vesicles around her mouth and neck which started 2 days ago. Some of the vesicles around her mouth are crusted. She continues to develop some papules on her trunk and her head. The lesions are itchy. She has a temperature of 38.9°C. What is the SINGLE most likely diagnosis?

A 33 year old woman developed a papular rash which is widespread around the chest, abdomen and the back. The rash started as a single 3 cm rash on the back. This was followed by numerous oval rashes throughout the chest, abdomen and back which occurred a week later. She is well and afebrile although she had a mild headache and a fever a few days before the first rash started. The rash is not itchy. She does not take any regular medications. Below is a picture of her back:

What is the SINGLE most likely diagnosis?

A 33 year old man has red itchy plaques with silver scaling over her back and extensor surface of her arms. The rash started several weeks ago and has worsened. A picture of his back and elbows can be seen below:

What is the SINGLE most likely diagnosis?

A bluish discolouration is seen over the sacrum of a 2 year old baby. It is flat and irregular in shape. His mother says that it has been there since birth. What is the SINGLE most appropriate action?

A 58 year old caucasian man was referred to the dermatology clinic by his GP for a growth on his chest. It measures 25 mm in maximum diameter. The patient denies itch or pain associated with the growth. He noticed the growth 4 weeks ago but is not sure how long it has been there. He has a few other moles on his back but smaller than 2 mm. A picture of the lesions was taken and seen below:

From the list below, which is the most worrisome feature of this lesion that should warrant a visit to a health care professional?

A 3 year old male patient presents to the clinic with his mother. His mother complains that he has developed a rash localized at his flexures particularly at the popliteal and antecubital fossae, which manifested this morning. Upon further questioning, it was revealed that the patient had been ill because of an upper respiratory tract infection two days ago. He was diagnosed with eczema a year ago and has been using emollients. He was delivered via uncomplicated vaginal delivery and appears to be healthy and well nourished. He has no other medical history of note and is taking no other chronic medications. What is the SINGLE most appropriate management for this patient?

A 14 year old girl has developed an itchy, scaly patch on her scalp and extensor aspects of her elbows and knees after she recently switched schools. She had a similar patch that cleared away spontaneously 2 years ago after she went on a beach holiday in Spain with her family. What is the SINGLE most likely diagnosis?

A 69 year old man attends the GP surgery as he has small rough scaly spots that can be felt like rubbing sandpaper on his forehead. He is a retired gardener. He has noticed these lesions over the past 4 months. They are not itchy or painful. A picture of it is seen below:

On examination, the surface feels rough. What is the SINGLE most appropriate management?

A 9 year old Syrian child who lives in a refugee camp with his family, presents with an itchy rash over his buttocks. The itching increases at night and disturbs the boy’s sleep. A picture of the rash is shown below

What is the SINGLE most likely diagnosis?

An 9 year old girl presents with a 3-day history of an intensely itchy rash on the flexor surfaces of the legs and arms. The rash is painful. There is clear yellow fluid within the vesicles. Her parents reported that she has a previous history of atopic dermatitis. She had eczematous lesions that had previously occurred in these locations. She is afebrile, and no lymphadenopathy is present. A picture of the rash can be seen below:

What is the SINGLE most likely diagnosis?

A 7 year old girl has been treated with penicillin for a sore throat, fever and cough. 3 days later she develops a skin rash and complains of burning sensation and pruritus. The skin rash initially started at the dorsum of her hands and feet and spread towards her torso. There are hundreds of lesions seen which are concentric target shaped with raised patches. What is the SINGLE most probable diagnosis?

A 25 year old woman presented to her General Practitioner with an acute onset of rash on her legs, arms and trunk. It initially started on the back and palms of her hands and feet then within several hours spread to her limbs and trunk. The rash is absent on the genitalia and face. They are quite painful with weeping and crusting. She started on antibiotics for tonsillitis 7 days ago. On examination, her pulse rate is 89 beats/minute and her blood pressure is 134/70 mmHg. What is the SINGLE most likely cause of the rash?

A 19 year old girl has developed a bright red itchy well-demarcated plaques with silver scaling over the extensor surface of her body. She also complains of a dry itchy scalp. Her mother suffers from a similar rash that often comes and goes. What is the SINGLE most likely diagnosis?

A 39 year old man who has a background of Crohn’s disease attends the GP surgery with a rash seen in both his axilla. The rash has been present for the past two months and it is seen as a pink scaly rash. A picture of the rash can be seen below:

What is the most likely diagnosis?

A 25 year old woman attends for acne review. She has used systemic isotretinoin for 6 months. Her pregnancy test today is negative. She mentions that she has pruritic purple papules on the flexor surface of her wrist which has been present for the past 5 years. A white lacy pattern is identified on her buccal mucosa. What is the SINGLE most likely diagnosis?

A 30 year old man has depigmented lesions on his elbows and his hands. They occurred gradually over the period of 2 years. It does not cause him any discomfort or itch. He has a history of hypothyroidism. His father had a similar condition. Pictures of the condition can be seen below:

What is the SINGLE most likely diagnosis?

A 41 year old woman attends the GP surgery with a 6 month history of soft tissue swelling on her left shoulder. The lump is not painful. She has no other abnormal lumps on her body. The picture below shows the mass.

The mass is soft, mobile and non-tender. What is the most likely diagnosis?

A 24 year old woman suffers with moderate acne. The acne tends to flare up on the first few days of her menstrual cycles. She has been prescribed benzoyl peroxide and a retinoids cream for treatment. Which group of bacteria does these group of medications aim to reduce?

A 53 year old man went on a backpacking holiday to Europe for three months. Twelve days after his return to the United Kingdom, he presented to his general practitioner with a patch of alopecia over his parietal and temporal scalp area. The area of alopecia has an erythematous, scaly rash with crusting which the patient complains itches. What is the SINGLE best management for this patient?

A mother of a 6-week baby is concerned about a blue discolouration on her right buttock. It has been present since birth. Her cousin had the same condition. The mother is concerned about von Willebrand disease. Below is a picture of the discolouration.

What is the SINGLE most appropriate action?

A 6 year old boy has a golden-brown crust on the left perioral area. It started off as thin- walled vesicles which ruptured a few days ago. He complains of mild itch. He does not have a fever. He is drinking and eating well. His mother has been applying a topical antiseptic on the lesion over the past few days. What is the SINGLE most appropriate medication to use?

A 67 year old builder has a persistent nodular lesion on the upper part of his right pinna. On examination, there is a central depression and raised areas with telangiectasia around the lesion. It is 1 cm in size. What is the SINGLE most likely diagnosis?

A 38 year old man presents with an acute infection of the skin on his leg. A diagnosis of cellulitis has been made. He has no known allergies. He has type 2 diabetes mellitus. He has been travelling from Beijing to London by plane. He has a temperature of 38°C, heart rate of 80 beats/minute, respiratory rate of 18 breaths/minute and blood pressure of 120/90 mmHg. What is the SINGLE best choice of antibiotic to be prescribed?

A 19 year old who was suffering from eczema as a child complains of severe itching at the site of an insect bite which he noticed earlier today while camping. As he was asymptomatic for the past 3 years, he is currently on no treatment for eczema. What is the SINGLE most appropriate management?

A 44 year old woman has red itchy plaques with silver scaling over her back and extensor surface of her arms. She has suffered with them for many years. The rashes improve and they relapse a few months later. A picture of the condition can be seen below:

What is the SINGLE most likely diagnosis? 

A 9 year old boy is brought to the Urgent Care Centre by his mother as he has developed a rash around his mouth and a fever which started 2 days ago. The blistering rash started around his mouth and has spread towards his cheek. It is very painful and itchy. He has not been eating well for the past 24 hours. His medical history includes eczema which he applies emollients a few times a day On examination, clusters of vesicles with punched out ulcers and crusting are seen around his mouth and cheek. A few of the vesicles are filled with clear yellow fluid. He has a temperature of 39°C. What is the SINGLE most appropriate management?

A 19 year old hairdresser complains of shortness of breath, wheeze, and cough. She also has dry scaly skin with rashes that are itchy on her flexures of arms and knees. Recently she also started developing an itchy dry rash on her hands. Her brother suffers from similar symptoms. Attached is a photo of her hands:

What is the single SINGLE most likely diagnosis?

A 34 year old woman has fatigue, oral ulcers and a facial rash that is worse in the summer. She complains of having joint pains and stiffness, especially in the morning. Urea and creatinine are slightly elevated with urinalysis demonstrating red cell casts. What is the SINGLE most sensitive investigation for her condition?

A 2 year old boy is accompanied to the Emergency Department. According to his parents, he has been irritable and lethargic for the past 2 days with a rash and fever. The rash began 2 days ago as red patches on which blisters developed. These patches were painful and distressing and coalesced to become widespread. A fever of 38.2°C preceded the rash. He does not have a significant past medical history and was not on any form of medication. On examination, the patient appears grossly unwell and apprehensive. His temperature is 38.8°C with a heart rate of 160 beats/minute. He has a generalised, tender rash with blisters involving his trunk, limbs and face. The epidermis overlying the blisters slip on applying a lateral force to expose pink skin beneath. Additionally, the skin at the creases of his neck and elbows appear desquamated. Below is a picture of the boy.

Which of the following is the SINGLE most likely diagnosis?

A 58 year old man complains of nose disfigurement. He has a history of facial erythema particularly of the cheeks and nose. Red papules and pustules have been erupting at intervals over the last 10 years. He notices that his face becomes flushed commonly after consumption of alcohol. On examination, he is noted to have rhinophyma. What is the SINGLE most likely diagnosis?

A 7 year old girl presents to the GP surgery with a papular rash on her thigh and abdomen. Each individual papule measures around 2 mm. She is afebrile. Upon question, the child says that it does not cause any discomfort.

Below is the image of her thigh.

Below is a closer look at the papules.

What is the most appropriate management?

A 43 year old woman is seen in the GP surgery as she has concerns about the growth of a black lesion on her back. She feels it has grown over the past year. She has had it since she was 20 years old and was asked to have an annual check-up by her dermatologist in her home country, Peru. Since moving to the UK 5 years ago, she has forgotten to have it checked. A picture of the lesions was taken and seen below:

It measures 10mm. A close up can be seen below:

What is the SINGLE most appropriate action?

A 36 year old woman complains of redness on her right cheek for nearly a year. She notices that her face becomes flushed commonly after consumption of alcohol. It is aggravated when she is exposed to the sun. She occasionally has papules and pustules. Below is an image of her right cheek:

What is the SINGLE most appropriate treatment?

A 54 year old woman who suffers from plaque psoriasis has recently had a rash on her abdomen which is itchy. She started a new medication 4 weeks ago to treat hypertension. A picture of the condition can be seen below:

What is the SINGLE most likely medication she has started?

A 22 year old woman complains of a 2 week history of severe itching and wheal formation. This is followed by a viral infection for which she took aspirin for her headache. The wheals are evanescent and disappear within 24 hours. On inspection, multiple wheals of all sizes are noticed on most of her skin. Below is a picture of her back:

What is the SINGLE most likely diagnosis?

A 29 year old health care worker in an elderly care home has developed an itchy scaly rash, particularly over her wrist with fine white streaks overlying the lesion. All her nails have ridges and thickened in the middle. Her buccal mucosa is lined with a lacy white pattern. What is the SINGLE most likely diagnosis?

A 33 year old man attends the GP clinic with a small mole on his upper chest. The mole looks benign and has not grown. He would like it removed as it is unsightly. It does not bleed or interfere with his daily life. What is the SINGLE most appropriate action?

A 60 year old white-British man was referred to the dermatology clinic by his GP for a growth on his back. It measures 20 mm in maximum diameter. The patient denies itch or pain associated with the growth. He noticed the growth 2 weeks ago but is not sure how long it has been there. A picture of the lesions was taken.

What is the SINGLE most likely diagnosis?

A 10 month old infant is brought to the GP surgery by his mother. His mother complains that he has developed a rash on his cheek, arms, legs, back and abdomen which has been worsening over the past few weeks. He is always seen scratching. He is fully breastfed and is growing well. He was delivered via uncomplicated vaginal delivery. He has no fever and looks alert. Below is a picture of his rash on his thighs. A similar rash is seen throughout his body.

What is the most appropriate medication to prescribe?

A 22 year old man presents to the Accident and Emergency department with pain on his left lower leg. On examination, the area is diffusely tender, slightly swollen and shows signs of inflammation. He has a temperature of 38.6°C. His blood results show:

Haemoglobin 138 g/L (130-180)

White cell count 23 x 10^9 /L (4-11)

CRP 58 mg/L (<10)

The patient has no known allergies and takes no other regular medications. What is the SINGLE most appropriate first line antibiotic to be prescribed?

A 16 year old boy has pain on his right toe with discharge over the past 5 days. There was no history of trauma. He has no significant medical history. Below is an image of his toe:

What is the SINGLE most appropriate management?

A 59 year old woman has white streaks on the side of her tongue and buccal mucosa. She also has painful and persisting ulcers of her tongue which have been present for the past 6 weeks. The ulcers cause discomfort when eating. The white streaks are adherent and cannot be removed easily with a spatula. The streaks show an irregular pattern. She does not smoke. She drinks alcohol socially with an average of 1 unit of alcohol a week. What is the SINGLE most likely diagnosis?

A 48 year old man presents with a red scaly plaque on his left-back and elbows which has been worsening over the past month. He also has scaly small lessons throughout his back. He had a sore throat 3 weeks ago. A picture of his back and elbows is seen below:

What is the SINGLE most appropriate treatment?

A 28 year old woman is seen in the GP surgery as she has concerns of a black lesion on her neck. She feels it has grown over the past few months. She has normal amounts of sun exposure. She denies any pain or bleeding. The lesion is not itchy. A picture of the lesions was taken and seen below:

A close up can be seen below:

What is the SINGLE most appropriate action?

A 6 year old child has multiple brown crusted lesions around his mouth and sides of the nose. The lesions initially started as thin-walled vesicles before they crusted. There are satellite lesions that have been spreading to his chin and neck over the past 2 days. They form annular lesions. He does not have a fever. The lesions are mildly itchy. What is the SINGLE most likely diagnosis?

A 14 year old boy has had itching on both the flexors of his elbows for the past 6 months. He has a history of asthma. An image of the flexure is seen below:

What is the SINGLE most likely diagnosis?

A 12 year old boy presents with pruritus especially around the wrists and palms of his hands. On examination, his skin is dry and red. His mother is asthmatic and older brother has hay fever. He owns a dog which sleeps in his bed. What is the SINGLE most likely diagnosis?

An 84 year old woman has tenderness and a tingling sensation that started 2 days ago along the 6th and 7th left rib from the front to the back. She has breathlessness and a 20-year smoking history. Her medical history includes COPD. She reports no injuries over the past few days. On examination, there is a bilateral wheeze on auscultation. There are no rashes seen. What is the SINGLE most likely diagnosis?

A 3 year old boy has been having scaly patches on his head over the past 3 months. He has dispersed flaking on the scalp when he scratches. It is mildly itchy. A picture of his head can be seen below:

A zoomed-in picture can be seen below:

What is the SINGLE most likely diagnosis?

An 8 year old child presented to her GP with an itchy rash, asthma and allergic rhinitis. The itchy rash is in the flexures of her arms and knees. All food allergy tests were negative. She was given emollient cream and topical steroids ointment by the GP. What SINGLE most appropriate advice should be given to her regarding the application of the ointments and cream?

A 3 year old boy has a sore rash on the left side of his mouth which started 4 days ago. There are fluid-filled blisters ranging from 1cm to 2 cm in diameter at the corner of his mouth. There is no history of trauma. What is the SINGLE most likely diagnosis?

A 30 year old woman attends the GP surgery complaining of a 6 month history of fatigue, bloating and loose stools. She describes occasional generalised abdominal pain. She gives a history of developing a rash that is intensely itchy especially at night. On examination, a widespread symmetrical rash composed papules and vesicles around her elbows, knees, scalp and sacrum are seen. Her blood test shows the following:

Haemoglobin 95 g/L (115-160 g/L)

Mean cell volume (MCV) 79 fL (76-96 FL)

Folate 1.2 mcg/L (2.0 – 11.0 mcg/L)

Ferritin 15 ng/ml (20-300 ng/ml)

Tissue transglutaminase IgA positive

What is the SINGLE most likely diagnosis?

A 9 year old child known with atopic eczema and asthma presents with multiple, discrete, pearly white, 2 to 5 mm dome-shaped smooth papules on the face and inner thighs with central umbilication. The lesions appear in clusters. He has tried topical steroids which he was prescribed for eczema but it had no effect. Below is a picture of his inner thighs.

A zoomed picture of the lesion can be seen here:

What is the SINGLE most likely diagnosis?

A 6 year old boy is seen brought to the GP surgery by his parents with complaints of frequent itching, redness and dry skin at the flexures of his arms and legs. His symptoms have been slowly worsening over a period of 3 months. The itch disturbs his sleep frequently. He uses regular emollients. His parents both have had a history of eczema as a child. What is the SINGLE most appropriate management?

A 45 year old woman is seen in the GP surgery as she has concerns of a black lesion on her back which she feels has grown over the past few months. She feels there is a change in sensation of the mole. The patient denies itch or pain associated with the growth. A picture of the lesions was taken and seen below:

What is the SINGLE most appropriate action?