Module 7: Quiz

Question 1

A patient presents with erythema, papules, and telangiectasia on the cheeks and nose. What is the probable diagnosis?

Answer 1

Rosacea (erythema and papules, often steroid-induced if history of topical steroid use)

Question 2

What is the most likely cause of her condition?
Rosacea

Answer 2

Use of betamethasone ointment (prolonged topical steroid use can trigger steroid-induced rosacea)

Question 3

How would you treat this patient?
Rosacea

Answer 3

Discontinue topical steroid immediately

Start topical metronidazole (0.75–1% cream or gel)

Systemic antibiotics (e.g., doxycycline) for severe cases

Sunscreen and avoidance of triggers

Question 4

A patient has diffuse facial erythema. Cellulitis is unlikely. What is the probable diagnosis?

Answer 4

Viral infection, such as measles

Question 5

A patient presents with unilateral facial swelling and erythema, sudden onset, high temperature, and rigors, with no epidermal changes. What is the diagnosis?

Answer 5

Cellulitis

Question 6

A patient has marked epidermal changes with crusting. What is the most likely condition?

Answer 6

Infected eczema

Question 7

A patient presents with symmetrical lesions on the malar areas and nose, with pigmentary changes. What is the diagnosis?

Answer 7

Cutaneous lupus erythematosus

Question 8

What are the common features of rosacea?

Answer 8

Red face, often the commonest cause of facial erythema

Flushing or burning sensation

Telangiectasia, erythema, follicular papules, and pustules

Question 9

What is a frequent trigger for rosacea?

Answer 9

Potent topical steroids applied to the face

Question 10

How is rosacea treated?

Answer 10

Topical metronidazole or azelaic acid cream

Oral doxycycline for more severe cases

Avoid triggers and practice gentle skincare

Question 11

Which of the following terms could be used to describe the predominant morphology seen in a patient with pale facial patches?

Answer 11

Patches (areas of altered skin colour, not raised)

Question 12

What is the most likely diagnosis for hypopigmented patches on the face of a child, sometimes with fine scaling?

Answer 12

Pityriasis alba

Question 13

What is the probable pathogenesis/association in a child with hypopigmented, scaly patches on the cheeks?

Answer 13

Atopy (associated with a history of atopic dermatitis, asthma, or allergic rhinitis)

Question 14

What is the most appropriate management for this patient with PA

Answer 14

Emollient applied regularly to maintain skin hydration

Avoid use of soaps that can dry the skin

Sunscreen to prevent tanning that accentuates the lesions

Incorrect options:
- Hydrocortisone 1% ointment: Not routinely needed
- Selenium sulphide shampoo: Used for tinea versicolor, not pityriasis alba

Question 15

Which of the following terms could be used to describe the predominant morphology seen in patients with raised, itchy, red lesions that blanch on pressure?

Answer 15

Wheals

Question 16

What is the most likely diagnosis for sudden-onset, itchy, blanching wheals, possibly triggered by allergens?

Answer 16

Acute urticaria

Question 17

Which of the following actions are appropriate in managing acute urticaria?

*
Increase the dose of cetirizine up to 4x standard dosing if response is poor.
*Increase the patient’s dose of enalapril.
*Initiate high dose systemic steroids with a slow taper in all patients.
*Stop the aspirin.
*Initiate a non-sedating 2nd generation antihistamine such as cetirizine.

Answer 17

Initiate a non-sedating 2nd generation antihistamine such as cetirizine

Increase the dose of cetirizine up to 4x standard dosing if response is poor

Stop any potential trigger medications (e.g., aspirin if suspected)

Incorrect options:

Increase enalapril: Could worsen urticaria if drug-related

Initiate high-dose systemic steroids in all patients: Not routinely indicated, only in severe or refractory cases

Question 18

Which investigations are most appropriate for a patient presenting with chronic urticaria?

Answer 18

TSH (to screen for thyroid disease, which can be associated)

ANA (if autoimmune features suspected)

Chest X-ray only if clinically indicated (e.g., systemic symptoms)

Not routinely indicated:
- Skin biopsy in all patients
- Immediate patch testing for allergies

Question 19

How is chronic urticaria defined?

Answer 19

Urticaria, with or without angioedema, occurring at least 2x a week for > 6 weeks

Question 20

Is chronic urticaria typically associated with life-threatening complications?

Answer 20

No. Unlike acute urticaria, chronic urticaria is rarely associated with anaphylaxis

Question 21

What are common aggravating factors for chronic urticaria?

Answer 21

ACE inhibitors

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)

Question 22

What is the first-line treatment for chronic urticaria?

Answer 22

Non-sedating 2nd-generation antihistamines

Can be titrated up to 4x standard dosing depending on response

Patients should not skip doses during the first month of treatment

Question 23

Which term best describes the predominant morphology of inflamed, red, raised lesions around hair follicles?

Answer 23

Papule (small, raised, inflamed lesion)

Question 24

What is the most likely diagnosis for painful, red, raised lesions around hair follicles that may discharge pus?

Answer 24

Boil (furuncle) or folliculitis (if multiple small pustular lesions)

Question 25

The patient reports recurrence at different sites with discharge. Which investigations are most appropriate?

Answer 25

HIV test (immunosuppression predisposes to recurrent infections) Blood glucose (diabetes increases infection risk) Culture from discharge (identify causative organism and antibiotic sensitivity) Not routinely needed: - Nasal swab - Biopsy (unless atypical lesion or suspicion of malignancy)

Question 26

How would you manage recurrent boils/folliculitis?

Answer 26

Flucloxacillin or clindamycin (oral antibiotics targeting Staphylococcus aureus) Nasal antiseptic *Antiseptic wash *Topical povidone iodine Supportive care: Warm compresses, hygiene Not appropriate: - Betamethasone ointment (steroids worsen infection) - Penicillin G IV or IM (not first-line for uncomplicated skin infection)