Ebook Handbook of PLAB (2nd edition): Part 2

412 Handbook of PLAB

thirteen

Dermatology
THEME: 1
DIAGNOSIS OF SKIN DISEASE
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Fungal infections.
Erythema multiforme.
Granuloma annulare.
Basal cell carcinoma.
Psoriasis.
Discoid eczema.
Pityriasis rosea.
Impetigo.
Pityriasis alba.
Freckles.

Seborrheic keratoses.
Pityriasis versicolor.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
1.
2.
3.
4.
5.

Herald patch, oval red lesions with scaly edge.
Superficial slightly scaly infection with the yeast M. furfur.
Posteczema hypopigmentation, often on children’s face.
Active erythematous scaly edge with central scarring.
Well defined red patches, covered with honey colored
crusts.
6. Pinkish papules forming a ring.
7. Brown macules, related to sun exposure.
8. Pearly papules with central ulcer.


Dermatology 413

THEME: 2
DIAGNOSIS OF SKIN DISORDERS
Options
a.
b.

c.
d.
e.

Multiple petechiae in both axillae.
Draining sinus on lateral chest wall.
Purplish submucosal lesion on the hard palate.
Exuberant violaceous nodules over the nose and malar areas.
Black pigmented nodules along folds of skin in axillary and
perineal areas.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
9. A 24-year-old homosexual man with fever, weightloss,
and diffuse alveolar infiltrates on chest roentgenogram.
10. A 31-year-old man with confusion and dyspnea 24 hours
after fracturing his femur at a skin resort.
11. A 52-year-old black woman with hypercalcemia and
interstitial fibrous of the lung.
12. A 69-year-old man with confusion, fever, dense
consolidation with cavitation in the right lower lobe.
13. A 74-year-old man with hemoptysis and right hilar mass
on chest roentgenogram.
THEME: 3
DIAGNOSIS OF SKIN CONDITION
Options
a.
b.
c.

d.
e.
f.
g.
h.

Lichen planus.
Seborrheic dermatitis.
Erythema chronicum migrans.
Pyoderma gangrenosum.
Vitiligo.
Acne.
Thrombophlebitis migrans.
Dermatitis herpetiformis.


414 Handbook of PLAB

i.
j.
k.
l.

Acanthosis nigricans.
Nerobiosis lipoidica.
Erythema marginatum.
Erythema multiforme.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.

Questions
14. Itchy grouped blisters on knees, elbows and scalp in a
patient with chronic diarrhea.
15. Successive crops of tender nodules along blood vessels
in a patient with pancreatic cancer.
16. Yellowish, shiny skin with telangiectasia, on the skin of a
diabetic.
17. Circular lesions with central blisters, widespread—
including palms and soles with ulcers in the mouth and
genitalia.
18. Pigmented, dark, rough, thickened skin in axillae and
groins.
THEME: 4
DIAGNOSIS OF SKIN LESIONS
Options
a. Vitiligo
b. Melanoma
c. Rodent ulcer
d. Benign naevus
e. Keratoacanthoma
f. Pyoderma gangrenosum
g. Erythema marginatum
h. Dermatitis herpetiformis
i. Tophi
j. Necrobiosis lipoidica
k. Granuloma annulare
l. Erythema migrans
m. Erythema nodosum
n. Erythema ab igne

Dermatology 415

For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
19. A young oil engineer complains of painful red lesions on
his thighs. Physical examination determines them to be
nodular. He has recently been vaccinated for travel to
Asia.
20. A young woman complains of mark on her abdomen.
Initially it was purple and then it enlarged and faded in
the centre. Over the past few weeks it has multiplied
outwards.
21. A middle-aged woman presents with a lesion on her calf.
It is an ulcerated nodule with a red and necrotic border.
It is very tender.
22. A 52-year-old man complains of a large white patch on
his back. It is geographic with a hyperpigmented border.
He has just come back from a beach holiday and it is
physically irritating him.
23. A 28-year-old woman with a heart condition has a rash
on her lower arms. It is pink or red and ring like. It moves
up and down her arms and she can’t get rid of it.
THEME: 5
DIAGNOSIS OF SKIN LESIONS
Options
a.
b.

c.
d.
e.
f.
g.
h.
i.
j.

Eczema herpetiformis
Morbiliform rash
Erythema multiforme
Erthema marginatum
Dermatitis herpetiformis
Maculapapular rash
Generalized urticaria
Lichen planus
Erythema chronicum migrans
Erythema nodusum


416 Handbook of PLAB

For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
24. A 24-year-old man visited a forest area 2 weeks ago and
developed a flu like illness. He now has a stiff neck, sore
throat and arthralgia.

25. A 14-year-old boy has had a pyrexia, rash, raised ESR.
Subcutaneous nodules and a generalized rash is noted
on her trunk.
26. A 15-year-old girl has difficulty swallowing and large
circular lesions (target lesion) are noted around her
mouth, the inside of her mouth is swollen with crustation
of the gingival.
27. A 6-year-old girl presents with failure to thrive and a rash
is noted, the child dislikes gluten-based foods.
28. A 14-year-old boy has haematuria, hypertension,
abdominal pain and a rash is noted on the flexor surfaces
of his lower limbs.
THEME: 6
DIAGNOSIS OF SKIN INFECTIONS
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Cellulitis
Shingles
Pityriasis versicolor
Molluscum contagiosum

Ringworm
Necrotizing fascitis
Impetigo
Scabies
Leprosy
Seconday syphilis
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all


Dermatology 417

Questions
29. A 30-year-old man complains of a painless rash on his
trunk. He has 3 pale, pink, scaly circular lesions with central
clearing, which measure between 3 and 8cm in diameter.
30. A 60-year-old man complains of a 2-day history of pain
in the left side of his chest. He now has a blistering rash
in a vertical band of skin on his left side.
31. A 35-year-old woman from Nigeria has a number of
depigmented patches of skin on her legs. They are painless
with reduced skin sensation.
32. A 28-year-old businessman returned from a trip to
Thailand 2 months ago. He now has a faint paplar rash,
which includes is palms and soles. He did have a painless
ulcer on his penis but this resolved weeks ago.
33. A 25-year-old woman from Ghana has a painless rash on
her trunk of multiple scaly patches measuring between 1
and 3 cm in diameter.

34. A 38-year-old man presents with a 12 hour history of a
painful swollen right arm. He has parasthesiae in his
fingers. He is febrile and the arm is tender with dusky skin.
THEME: 7
DIAGNOSIS OF SKIN INFECTIONS
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Infected sebaceous cyst
Furunculosis
Cellulitis
Herpes zoster
Carbuncle
Erysipelas
Hidradenitis suppurativa
Infected sinus
Skin necrosis
Scrofula
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all

418 Handbook of PLAB

Questions
35. A 55-year-old non-insulin dependent diabetic man
presents with chronics recurrent tender swelling in his
groin. These red swellings eventually discharge pus.
36. A 45-year-old gardener presents with fever and swelling
over his left cheek. The left side of his face is red, hot and
tender with a raised border.
37. A 60-year-old obese insulin dependent diabetic woman
presents with red papules and vesicles along the left
preauricular region and mandible. It was preceded by
fever.
38. A 70-year-old man with peripheral vascular disease present
with a pinprick sized hole in the centre of his groin wound
following a aorto-bifemoral graft. The discharge is serous.
39. A 50-year-old woman presents with a tender 1.5 cm
swelling in the preauricular region. There is a puncture
seen in the centre. The swelling is tense and smooth and
attached to the skin.
THEME: 8
DIAGNOSIS OF SKIN LESIONS
Options
a.
b.
c.
d.
e.

f.
g.
h.
i.
j.
k.
l.

Lichen planus
Psoriasis
Pityriasis versicolor
Pityriasis rosea
Acne vulgaris
Allergic contact dermatitis
Acanthosis nigrans
Herpes zoster
Erythema nodosum
Dermatitis herpetiformis
Pemphigus vulgaris
Pemphigoid
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.


Dermatology 419

Questions
40. A 80-year-old man presents with itching followed by
large, tense bullae on the limbs that do not rupture easily.

Nikolsky’s sign is negative.
41. A 50-year-old man presents with brownish scaly lesions
of varying size on his trunk. Depigmentation after
treatment lasts for several months.
42. A 30-year-old female presents with an itch painful rash
over the lobes of both pinna. Her earlobes are pierced.
43. A 50-year-old man presents with a rash consisting of
discrete purple shiny polygonal papules with fine white
lines in previous scratch marks on his forearm. He is also
noted to have a white lacy network of lesions on the buccal
mucosa.
44. A 60-year-old man presents with brown pigmented
plaques in the axilla. He underwent prostatectomy recently.
THEME: 9
DIAGNOSIS OF SKIN LESIONS
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.

Erythema nodosum
Erythema multiforme

Henoch-schonlein purpura
Eczema
Psoriasis
Necrobiosis lipoidica
Ringworm
Shingles
Urticaria
Pemphigus
Pemphigoid
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
45. A 65-year-old woman has a 3-day history of painful
blistering rash on her left outer thigh. She has recently
been diagnosed with breast cancer.


420 Handbook of PLAB

46. A 25-year-old woman was recently started on Cotrimoxazole for a UTI. She is now complaining of painful.
Red, raised lesions on both shins.
47. A 30-year-old builder has developed pink scaly patches
on both knees. He has similar lesions on his elbows and
scalp.
48. A 65-year-old woman has developed extensive blistering
particularly involving her legs. The blisters are fragile and
seem to spread under the skin surface when pressed. She
feels generally unwell but has no other symptoms.
49. A 16-year-old girl presents with small purple lesions on

her buttocks and shins. She also has painful joints and
abdomen. Urinalysis reveals proteinuria.
50. A 60-year-old man who has had diabetes for several years,
has developed a waxy yellow patch on his left shin, which
is showing signs of inflammation and ulceration.
THEME: 10
DIAGNOSIS OF SKIN LESIONS
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.

Seborrhoeic Keratosis
Malignant melanoma
Café au lait parch
Haemangioma
Cambell de Morgan spor
Keratpecanthoma
Solar keratosis
Basal cell carcinoma
Squamous cell carcinoma
Bowen’s disease

Marjolin’s ulcer
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
51. A 60-year-old man presents with a persistent itchy ulcer
on his right cheek. He has had this ulcer for years. The


Dermatology 421

52.
53.

54.
55.

edges are rolled with a central scab that falls off and
reforms. The local lymph nodes are not enlarged.
A 65-year-old farmer presents with a grey thickened patch
of skin on the rim of his left ear. The 1 cm lesion is painless,
raised, firm and has not changed in size over many years.
A 40-year-old woman presents with a rapidly growing
1cm lump in the skin of her wrist. The lump is the same
colour as her skin but the centre is necrotic. It is freely
mobile and rubbery in consistency with a hard core.
A newborn baby presents with several, 2cm pale brown
macules on the back.
A 20-year-old man presents with a chronic paronychia.
On examination, there is an expanding brown pigmentation present beneath the toe-nail with enlargement of

the local lymph nodes.
THEME: 11
SKIN DISEASE IN CHILDREN

Options
a.
b.
c.
d.
e.
f.
g.

Erythema chronicum migrans
Erythema infectiosum
Erythema multiforme
Erythema nodosum
Exanthema subitum
Purpura fulminans
Tinea corporis
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
56. A nine-months old child is nonspecifically unwell for three
days with a fever. The rash subsides and the child breaks
out in maculopapular rash over its body.
57. Following a course of Septrin for a bacterial infection, a
five-year-old child breaks out in a widespread macular
rash with target lesions.

422 Handbook of PLAB

58. A four-year old boy has a runny nose and mild fever and
develops bright red cheeks and reticular rash on forearms.
59. Following a tick bite on holiday in a forested area, a sevenyear-old boy develops an erythematous macule at the site
of the bite which then spreads into an annular lesion with
a clear central area.
THEME: 12
INVESTIGATION OF SKIN LESIONS
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Full blood count
Kveim test
ANCA
ESR
Antibodies to double stranded DNA

Skin biopsy
Skin biopsy for Ziehl Neelsen straining for acid-fast bacilli
Fasting cholesterol and triglyceride levels
Anti-Ro antibodies
Serum pancreativ gluganon
Muscle biopsy
Serum glucose
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
60. A 38-year-old man presents with malaise and arthralgia.
He is noted to have various skin lesions, including a
purple bulbous nose and tender red raised nodules on
his anterior shin.
61. A 70-year-old woman presents with mid-facial
disfigurement. The nose appears to have been gnawed
off by a condition. The cutaneous lesion shows
grandulomas with central caseation.
62. A 50-year-old woman presents with fleshy co loured
papules over the right distal interphalangeal joint of her
thumb and a brown waxy plaque over her right shin.


Dermatology 423

63. A 50-year-old woman present with weakness in her upper
arms. She has difficulty combing her hair. On examination
she is noted to have ragged cuticles and nail fold capillary
dilatation.

64. A 60-year-old woman presents with crops of yellow
papules on her elbows and knees. Her serum glucose is
normal.
THEME: 13
INVESTIGATION OF DERMATOLOGICAL LESIONS
Options
a. Skin scrapings
b. Skin biopsy
c. Wood’s light
d. Patch test
e. Urine testing for glucose
f. Full blood count
g. Immunoflourescent staining of skin sample
h. Antinuclear antibodies
i. Clotting screen
j. Chest X-ray
k. Kveim test
l. Mantoux test
m. ESR
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
65. A 7-year-old girl presents with an itchy rash in her elbow
creases and behind her knees. Lichenification is seen in
both the elbow and knee flexures.
66. A 10-year-old boy presents with areas of scaling and hair
loss. On examination, there are areas of crusting on the
scalp and matting of the hair.
67. A 33-year-old female presents with a facial rash and a

rash on the back of her hands. She is notes to have a


424 Handbook of PLAB

maculopapilar rash over her forehead, nose and cheeks
and a blue-red discolouration of the back of her hands.
68. A 40-year-old man presents with areas of erythema and
scaling of the skin of the groin and perianal region.
69. A 65-year-old man presents with irritation and erythema
of the skin and blister formation. The blisters are over the
legs and are tense.
THEME: 14
INVESTIGATION OF ALLERGIES
Options
a.
b.
c.
d.
e.
f.
g.
h.

Skin prick testing
Patch testing
Serum IgE levels
RAST
Oral challenge testing
Measure C1 and C4 levels

IM adrenaline 1:1000+piriton treatment
Inspect for nasal polyps.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
70. A 30-year-old man presents with nasal blockage and
watery nasal discharge. He states that symptoms are
worse at work. The floors are carpeted, and there is central
heating. On examination, he has oedematous and pale
nasal inferior turbinates.
71. A 20-year-old female is started on penicillin for acute
tonsillitis. She develops stridor and generalised rash.
72. A 10-year-old boy presents with abdominal pain and
bloating after eating shellfish.
73. A 12-year-old boy with cystic fibrosis complains of
bilateral nasal blockage and mouth breathing.
74. A 30-year-old woman presents with recurrent attacks of
cutaneous swelling of her face. These episodes seem to
be triggered by stress. There is no associated urticaria or
pruritis.


Dermatology 425

THEME: 15
THE TREATMENT OF SKIN CONDITIONS
Options
a.
b.

c.
d.
e.
f.
g.
h.
i.
j.
k.

Topical coal tar
Topical steroids
Clotrimazole
Erythromycin
Adrenaline
Oral prednisolone
Dapsone
Oxytetracycline
Cetrimide
Acyclovir
Oral nystatin
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
75. A 24-year-old man presents with multiple silver-scaly
lesions over the extensor surfaces of his elbows and knees.
He also has nail pitting and arthropathy of the terminal
interphalangeal joints.
76. An 18-year-old female presents with an itch rash along

the flexor surfaces of her elbows and knees. Scaling and
weeping vesicles are features.
77. A 23-year-old female with Hodgkin’s disease presents
with small, white mucosal flecks in the mouth that can be
wiped off.
78. A 50-year-old man presents with flaccid bullae over the
limbs and trunk following a course of pencillamine for
his rheumatoid arthritis.
79. A 20-year-old hairdresser presents with itchy vesicles on
her palms.


426 Handbook of PLAB

THEME: 16
SKIN AND SYSTEMIC DISEASES
Options
a.
b.
c.
d.
e
f.
g.
h.
i.
j.
k.
l.

Generalised vitiligo.
Localized vitiligo.
Telangiectasia.
Erythroderma.
Papulosquamous lesions of palms and soles.
Scarring alopecia.
Yellow coloured papules.
Acanthosis nigricans.
Folliculitis.
Pyderma gangrenosum.
Photosensitivity.
Cutaneous vasculitis.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.

SLE.
Diabetes mellitus.
Tuberculoid leprosy.

Scleroderma.
Sulfa drugs.
Hyperlipoproteinemia.
Secondary syphilis.
Obesity.
Rheumatoid arthritis.
Henoch-Schonlein purpura.
THEME: 17
ASSOCIATION OF SYSTEMIC DISEASE
AND SKIN LESIONS

Options
a. Erythema chronicum migrans
b. Erythema multiforme


Dermatology 427

c. Pretibial myxoedema
d. Dermatitis herpetiformis
e. Livedo (a cutaneous vasculitis)
f. Dermatomyositis
g. Bazin‘s disease
h. Dermatitis artefacta
i. Alopecia areata
j. Mycosis Fungoids
k. Bowen‘s disease
l. Paget‘s disease
m. Rodent ulcer
n. Café au lait spots

Questions
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.

Addison‘s disease
Cutaneous T-cell lymphoma
Coeliac disease
Hyperthyroidism
Tuberculosis
Polyarteritis nodosa
Mycoplasma pneumonia
Lyme disease
Von Recklinghausen disease
Bronchial carcinoma
THEME: 18
DIAGNOSIS OF SKIN MANIFESTATIONS OF
SYSTEMIC DISEASES

Options
a.
b.
c.

d.
e.
f.
g.
h.

Erythema nodosum
Erythema multiforme
Erythema marginatum
Erythema chronicum migrans
Vitiligo
Pyoderma gangrenosum
Acquired icthyosis
Necobiosis lipoidica


428 Handbook of PLAB

i. Dermatitis herpetiformis
j. Acanthosis nigricans
k. Pretibial muxoedema
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
100. A 53-year-old female presents with proptosis, heat
intolerance and red oedematous swellings over the lateral
malleoli which progress to thickened oedema.
101. A 45-year-old man presents with a shiny area on his shins
with yellowish skin and telangiectasia. He also suffers

from areas of fat necrosis.
102. A 55-year-old female who is advised to eat a gluten free
diet presents with itchy blisters in groups on her knees,
elbows and scalp.
103. A 30-year-old man suffering from Crohn’s disease
presents with a pustule on his leg with a tender red-blue
necrotic edge.
104. A 15-year-old female presents with fever and mouth
ulcers. She is also noted to have target lesions with a
central blister on her palms and soles.
THEME: 19
ASSOCIATION OF SKIN LESIONS
AND SPECIFIC DISEASE
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.

Hyperthyroidism
Diabetes Mellitus
Liver disease
Ceoliac disease
Hypogonadism
Carcinoma of tail of pancreas

Measles
Deep vein thrombosis
Psoriasis


Dermatology 429

j. Leptospirosis
k. Borrelia duttoni infection
Questions
105. A fit 55-year-old gentleman complains of recurrent
episodes of seeing visible veins on his body which are
tender. He has started to loose weight and attributes this
to his diarrhoea. The consultant dermatologist thinks he
has thrombophlebitis migrans.
106. A 49-year-old woman complains of itchy blisters .which
are occurring in groups on her knees and elbows.The itch
is becoming unbearable and she is contemplating suicide.
She responds to 180 mg Dapsone within 48 hours of
treatment.
107. A Welsh farmer with malaise and arthralgia is
increasingly anxious about a skin lesion which started as
a paule (Diameter approx 1 mm)which has progressed
to a red ring(Diameter approx 50 mm) with central fading.
108. A 42-year-old man who reports a loss in weight presents
with a shiny erythematous lesion on her shin. Its edges
appear yellowish and are beginning to ulcerate with
undermining. She says it started as a pustule sometime
ago. Her blood glucose is 5.3 mmol/l.
109. A 32-year-old woman complains of palpitations and is

found to have red oedematous swellings above both
lateral malleoli which are beginning to affect her feet. She
is found to have digital cluubing and periorbital puffiness.
THEME: 20
CUTANEOUS LESIONS ASSOCIATED WITH
GASTROINTESTINAL CONDITION
Options
a.
b.
c.
d.
e

Carcinoid.
Glucagonoma.
Crohn’s disease.
Gluten enteropathy.
Ulcerative colitis.


430 Handbook of PLAB

f. Acute pancreatitis.
g. Malabsorption syndrome.
h. Gastric adenocarcinoma.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
110.

111.
112.
113.
114.

Erythema nodosum.
Pyoderma gangrenosum.
Acanthosis nigricans.
Nodular fat necrosis.
Dermatitis herpetiformis.
THEME: 21
SIDE EFFECTS OF DRUGS ON SKIN

Options
a.
b.
c.
d.
e.
f.
g.

Dystrophic nail changes.
Gram-negative folliculitis.
Black pigmentation of face.
Erythema nodosum.
Morbilliform eruption in patients with AIDS.
Gingival hyperplasia.
Reactions in patients with nasal polyps.
For each of the situations/conditions given below, choose

the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
115.
116.
117.
118.
119.

Bleomycin.
Chloroquine.
Birth control pills.
Tetracycline.
Sulfamethoxazole and trimethoprim.


Dermatology 431

THEME: 22
DIAGNOSIS OF ERYTHEMA
Options
a.
b.
c.
d.
e.
f.

Erythema ab igne.
Rosacea.

Erythema annulare centrifugum.
Erythema nodosum.
Dermato myositis.
Erythema induratum.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
120. Associated with tuberculosis and present symmetrical
deep seated painless red nodules on the legs.
121. Appears on extensor surfaces of legs/arms and
Streptococcal infection, barbiturate and sulphonamide
ingestion are some of the causes.
122. Appears on legs of women due to prolonged exposure to
heat.
123. Follows bite by Ixodes.
124. Commonly associated over telangiectasia.
THEME: 23
DIAGNOSIS OF BLISTERING
Options
a.
b.
c.
d.
e.
f.
g.
h.

Trauma

Impetigo
Herpes zoster
Erythema multiforme
Insect bites
Fixed drug eruption
Dermatitis herpetiformis
Porphyria cutanea tarda


432 Handbook of PLAB

i.
j.
k.
l.

Epidermolysis bullosa
Pemphigoid
Pemphigus
Steven-Johnson syndrome
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
125. A 65-year-old woman has multiple tense blisters with
underlying erythema, which started on her arms and legs
and now involves her trunk. Skin biopsy shows a split at
the level of the basement membrane.
126. A 25-year-old man with a history of diarrhoea and weight
loss has a blistering rash on his buttocks and elbows with

marked pruitus.
127. A 55-year-old woman was recently diagnosed with breast
cancer. She now has a 2-day history of painful blistering
eruption, which effects a band of skin on the left side of
her back.
128. An 18-year-old man with diabetes has a 2-day history of
painful blisters on his left cheek. When the blisters heal
they leave a yellow crust on the skin.
129. A 25-year-old man has had a recent sore throat for which
he was given a course of antibiotics. He now has multiple
blisters on his limbs. The blisters have central pallor and
there is pruritus. His mouth is unaffected.
130. A 68-year-old Asian woman has multiple blisters on her
trunk and a few on her limbs. The blisters are fragile and
most have ruptured, leaving erthematous scaly patches.
Pressure on an intact blister seems to cause it to spread.
THEME: 24
FACIAL APPEARANCE
Options
a. Acne rosacea
b. Addison’s disease


Dermatology 433

c.
d.
e.
f.
g.

h.
i.
j.
k.
l.

Chloasma
Discoid lupus erythamatosus
Lupus pernio
Lupus vulgaris
Mitral stenosis
Peutz-Jeghers syndrome
Rhinophyma
Sarcoidosis
Seborrhoeic determatitis
Systemic lupus erythematosus
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all
Questions
131. A 25-year-old man with excessive dandruff and a pruritic
erythematous rash affecting his eyebrows, ears scalp and
lateral margins of the nose.
132. A 35-year-old woman with a malar butterfly rash
complains of a dry mouth and joint pains.
133. A 40-year-old woman with a diffuse, purple-red
infiltration if the nose and cheeks. She has had a persistent
dry cough, mild dyspnoea, weight loss and malaise for
over a year. Chest examination appears normal.
134. A patient presents to the A&E department with recurrent

colicky abdominal pain. There are a number of small
brownish-black macules affecting the perioral skin and
oral mucosa.
135. A 45-year-old man presents with a persistent reddish
papulopustular rash affecting the cheeks, nose, forehead
and chin. The nose appears bulbous and craggy.
THEME : 25
DIAGNOSIS OF SCALES AND PLAQUES
Options
a. Psoriasis.
b. Eczema.


434 Handbook of PLAB

c.
d.
e
f.
g.

Fungal.
Seborrhoeic dermatitis.
Seborrhoeic keratosis.
Erythema multiforme.
None of the above.
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions

136. A 29-year-old develops multiple plaques, which are not
well demarcated. The lesions are markedly itchy and
symmetrical.
137. A 54-year-old woman develops generalised plaques. The
lesions are well demarcated and symmetrical. There is
no itch.
138. Active erythematous scaly edge with central scarring.
THEME: 26
PRURITUS
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Chronic renal failure
Dermatitis herpetiformis
Eczema
Iron deficiency
Lichen planus
Liver disease
Lymphoma

Old age
Polycythaemia
Pregnancy
Scabies
Thyroid disease
For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.


Dermatology 435

Questions
139. A 55-year-old woman presents complaining of oral
soreness exacerbated by spicy foods and a pruritic,
cutaneous rash principally affecting her shins and the
flexor surfaces of her wrists.
140. A 30-year-old man presents with groups of small intensely
itchy vesicles affecting the skin on his knees, elbows,
buttocks and scalp.
141. A 55-year-old woman presents with recurrent headaches,
intermittent visual disturbances, angina and Raynaud’s
phenomenon. She has been troubled by a generalized itch
that is worse after a hot bath. Examination reveals
splenomegaly and bruises.
142. A 19-year-old man is seen in clinic with painless cervical
lymphadenopathy initially noticed by his girlfriend. He
has been feeling lethargic for some time with nigh sweats
and itchy skin.
143. A 70-year-old woman complains of generalized itch,

tiredness and shortness of breath on exercise. On
examination she appears pale, and thin with brittle, spoon
shaped nails.
THEME: 27
HAIR LOSS
Options
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Alopecia areata
Androgentic alopecia
Colchicine
Hypothyroidism
Iron deficiency
Lichen planus
Lupus erythematosus
Malnutrition
Scalp ringworm
Secondary syphilis
Telofen effluvium

Traumatic


436 Handbook of PLAB

For each of the situations/conditions given below, choose
the one most appropriate/discriminatory option from above.
The options may be used once, more than once, or not at all.
Questions
144. A 55-year-old woman is complaining about patchy hair
loss with localised areas of erythema scaling and scarring
affecting the scalp. She has a sore mouth and a skin rash
affecting the flexor surfaces of her wrists and shins.
145. A 20-year-old man presents with sharply defined nonerythematous patches of baldness on his scalp. His
eyebrows and beard are all affected and examination of
the individual hairs show that they taper towards the
scalp.
146. Three months after experiencing a severe illness with high
fevers an 18-year-old man notices excessive numbers of
hair in hairbrush and on his pillow.
147. A 50-year-old woman notices some diffuse thinning of
her hair with bitemporal recession.
148. A 65-year-old woman presents with thinning hair, loss of
the outer third of her eyebrows and lethargy.
THEME: 28
DIAGNOSIS OF PREMALIGNANT DISEASE
Options
a.
b.
c.

d.
e.
f.
g.
h.
i.
j.
k.
l.

Erythroplasia of querat
Marjolins ulcer
Malignant melanoma
Pytriasis versicolor
Dermatofibroma
Lentigo maligna
Basal cell carcinoma
Porokeratosis
Squamous cell carcinoma
Solar keratosis
Pyogenic granuloma
Lupus vulgaris