AIM • KMU EXAM PRACTICE

Question:
A 34-year-old woman presents with a widespread erythematous eruption of uncertain cause. She is afebrile and haemodynamically stable. Which examination approach is most useful for identifying clues that may immediately change the differential diagnosis and assessment of severity?

Correct Answer:
Assess mucosae, palms, soles, nails and overall distribution

Explanation:
A systematic skin examination includes morphology, distribution and special sites; mucosal, palm and sole involvement may provide major diagnostic and severity clues.

Question:
An 18-year-old student has acne affecting the face, chest and back. Examination shows open and closed comedones together with inflammatory papules. Which combination of processes best explains the development of these lesions?

Correct Answer:
Sebaceous activity, follicular plugging, bacterial colonization and inflammation

Explanation:
Acne results from increased sebum, abnormal follicular keratinization, Cutibacterium involvement and inflammation acting together within the pilosebaceous unit.

Question:
A patient presents with an intensely pruritic eruption consisting of erythema, small vesicles and areas of serous ooze. Which stage of eczema is best represented by this morphology?

Correct Answer:
Acute eczema

Explanation:
Acute eczema commonly produces erythema, vesiculation, weeping and crusting, while chronic disease becomes dry, thickened and lichenified.

Question:
A 12-year-old boy develops multiple small scaly erythematous lesions over the trunk two weeks after a sore throat. He has no pustules or blisters. Which clinical form of psoriasis is most likely?

Correct Answer:
Guttate psoriasis

Explanation:
Guttate psoriasis presents with an acute eruption of numerous small scaly lesions and may follow a streptococcal throat infection.

Question:
A patient has a few stable psoriatic plaques on the elbows and knees without joint symptoms or systemic illness. Which treatment principle is most appropriate for this limited disease?

Correct Answer:
Topical anti-inflammatory treatment with appropriate skin care

Explanation:
Localized plaque psoriasis is generally managed initially with topical therapy such as corticosteroids or vitamin D analogues together with emollient skin care.

Question:
A 40-year-old woman has symptomatic lichen planus limited to the wrists and ankles. There is no extensive mucosal involvement. Which management option is most appropriate initially?

Correct Answer:
Topical corticosteroid therapy

Explanation:
Localized symptomatic lichen planus is commonly treated initially with topical corticosteroids to suppress inflammation and pruritus.

Question:
A 30-year-old man has recurrent greasy scaling over the scalp and nasolabial folds without systemic symptoms. Which treatment is most directly directed at an important contributing factor in this condition?

Correct Answer:
Antifungal shampoo or cream

Explanation:
Malassezia contributes to seborrheic dermatitis, so topical antifungal preparations are useful particularly for scalp and facial disease.

Question:
A 24-year-old woman develops painful red nodules over both shins. She recently recovered from a febrile pharyngitis. Which investigation is most appropriately guided by the suspected underlying association?

Correct Answer:
Assessment for a recent streptococcal infection

Explanation:
Erythema nodosum may follow streptococcal infection; investigation should be targeted to the clinical history rather than using indiscriminate testing.

Question:
A woman develops swelling of the lips and eyelids during an episode of urticaria. Unlike the superficial wheals, the swelling is deeper and persists longer. Which process best explains the difference?

Correct Answer:
Edema involving deeper dermal and subcutaneous tissues

Explanation:
Angioedema involves deeper dermis and subcutaneous tissue, whereas ordinary urticarial wheals are primarily superficial dermal edema.

Question:
A 62-year-old woman with limited bullous pemphigoid has several tense pruritic blisters but is systemically well. Which therapeutic approach is reasonable for localized disease?

Correct Answer:
Potent topical corticosteroid therapy

Explanation:
Potent topical corticosteroids can control localized bullous pemphigoid; more extensive disease may require systemic treatment under specialist care.

Question:
A 46-year-old woman with pemphigus vulgaris has extensive mucocutaneous disease requiring systemic therapy. Which treatment principle most directly targets the inflammatory autoimmune process?

Correct Answer:
Systemic corticosteroid-based immunosuppression

Explanation:
Pemphigus vulgaris is an autoimmune blistering disease and generally requires systemic immunosuppression, often with additional steroid-sparing therapy.

Question:
A patient notices a sharply demarcated dusky-red patch on the same area of the forearm each time a particular analgesic is taken. The lesion fades leaving residual pigmentation. Which drug eruption is most likely?

Correct Answer:
Fixed drug eruption

Explanation:
A fixed drug eruption characteristically recurs at the same site after re-exposure and commonly heals with residual hyperpigmentation.

Question:
A 28-year-old man develops a symmetrical maculopapular eruption over the trunk and proximal limbs several days after beginning an antibiotic. He has no skin pain, mucosal erosions, blistering or systemic instability. Which type of reaction is most likely?

Correct Answer:
Morbilliform drug eruption

Explanation:
A symmetrical maculopapular eruption arising after drug exposure without mucosal involvement or epidermal detachment is typical of a morbilliform drug eruption.

Question:
Two patients develop severe epidermal necrolysis after medication exposure. Both have mucosal erosions and epidermal detachment, but the second patient has much more extensive skin loss. What feature is principally used to distinguish Stevens–Johnson syndrome from toxic epidermal necrolysis within this spectrum?

Correct Answer:
Extent of epidermal detachment

Explanation:
SJS and TEN form a spectrum of severe epidermal necrolysis and are principally classified according to the extent of epidermal detachment.

Question:
A patient with a widespread rash is taking several medications. Examination shows pruritic wheals without epidermal detachment or mucosal ulceration. Which category of drug reaction best matches this morphology?

Correct Answer:
Urticarial drug eruption

Explanation:
Drug reactions may present with urticaria; wheals indicate dermal edema rather than the epidermal necrosis seen in severe blistering drug reactions.

Question:
A 58-year-old man develops generalized erythema and scaling while taking several recently introduced medications. Initial stabilization has been started. Which additional management step is most appropriate while the underlying cause is being established?

Correct Answer:
Review and withdraw possible offending nonessential drugs

Explanation:
Drugs are an important cause of erythroderma; medication review and withdrawal of suspected nonessential agents are part of identifying and treating the cause.

Question:
A patient with known psoriasis develops almost universal erythema and scaling after abruptly altering treatment. He has malaise and peripheral edema. Which interpretation best links the current presentation with his previous skin disorder?

Correct Answer:
Psoriasis can progress to erythrodermic disease

Explanation:
Psoriasis is an important underlying cause of erythroderma, in which widespread inflammatory skin involvement may produce significant systemic effects.

Question:
A 40-year-old woman has progressive fatigue, weight loss and diffuse hyperpigmentation that is particularly noticeable over palmar creases and pressure areas. Which systemic category should be considered when interpreting this cutaneous finding?

Correct Answer:
Endocrine disease

Explanation:
Diffuse hyperpigmentation involving creases can be a cutaneous clue to endocrine disease such as adrenal insufficiency and should prompt systemic assessment.

Question:
A young woman presents with photosensitive facial erythema, oral ulcers and intermittent joint pains. Which interpretation of the skin findings is most appropriate?

Correct Answer:
They may represent a cutaneous manifestation of systemic autoimmune disease

Explanation:
Photosensitivity and characteristic facial changes occurring with oral and joint symptoms should raise suspicion of a systemic autoimmune disorder rather than isolated skin disease.

Question:
A 63-year-old patient presents with a new widespread rash, generalized lymphadenopathy and unexplained weight loss. Initial symptomatic treatment has not improved the eruption. Which clinical principle is most appropriate?

Correct Answer:
Consider an underlying systemic or neoplastic process

Explanation:
Generalized rash accompanied by lymphadenopathy, weight loss or other constitutional features should prompt assessment for underlying systemic or neoplastic disease.