🤔 MEDIUM

Rashes are some of the most common presentation to GP practices, with most can be quite easy to identify. Have a go at some of these questions to test your knowledge – good luck!

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Approach to the patient with an acute rash

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Question 1

Stem 1, Question 1 of 5

Andrew, a 41 year old male, attends to the A&E department with a painful pruritic full body rash that has appeared over the last 36 hours. He said he feels generally unwell, and has taken paracetamol to treat the pain, which he score 6/10. He has a past medical history of asthma and psoriasis.
What is the most likely diagnosis?
A
Cellulitis
B
Erythroderma
C
Contact dermatitis
D
Seborrhoeic dermatitis
E
Steven-Johnson syndrome
Question 1 Explanation: 
The most likely diagnosis is erythroderma. Cellulitis, contact dermatitis and seborrhoeic dermatitis are normally localised to a specific area on the body, whilst Steven-Johnson syndrome presents with mucosal involvement and epidermal layers sloughing off.
Question 2

Stem 1, Question 2 of 5

Andrew tells you that he recently stopped taking his cream for his chronic psoriasis, as he left it in the hotel whilst he was on holiday 3 days ago, and hasn't had time to get a new prescription. His GP told him it is a "corticosteroid". Which of the following is not a corticosteroid? (Tick all that apply)
A
Amiodarone
B
Dexamethasone
C
Clobetasone
D
Tibolone
E
Fluocinonide
Question 2 Explanation: 
Amiodarone is a anti-arryhthmic, whilst tibolone is for treatment of oestrogen deficiency. The large majority of corticosteroids end in -one, but it's important to not assume when taking a drug history.
Question 3

Stem 1, Question 3 or 5

On examination of Andrew's skin you see some is scaling and peeling off. What are is the order of the 5 layers of epidermis, starting from the most superficial down.
A
Stratum corneum, stratum granulosum, stratum basale, stratum lucidum, stratum spinosum
B
Stratum granulosum, stratum basale, stratum lucidum, stratum spinosum, stratum corneum
C
Stratum granulosum, stratum corneum, stratum basale, stratum spinosum, stratum lucidum
D
Stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale
E
Stratum lucidum, stratum granulosum, stratum basale, stratum corneum, stratum spinosum
Question 3 Explanation: 
The correct order is: Stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale This can be remembered by the phrase "Come Lets Get Sun Burnt"
Question 4

Steam 1, Question 4 of 5

Upon referral to the dermatology registrar is is concluded that Andrew's presentation is caused by a reaction to the abrupt withdrawal of his medication. What is the most common type of psoriasis?
A
Psoriatic arthritis
B
Flexural psoriasis
C
Guttate psoriasis
D
Chronic plaque psoriasis
E
Localised pustular psoriasis
Question 4 Explanation: 
Chronic plaque psoriasis is the most common type, affecting 80-90% of people with psoriasis (according to NICE, 2020).
Question 5

Stem 1, Question 5 of 5

Whilst Andrew is still in the department he says he has also run out of his asthma medication. What is the treatment for patients who are waking twice a week due to their but are otherwise well managed?
A
short acting beta-2 agonist, an inhaled low-dose corticosteroid, and a long-acting beta-2 agonist
B
an inhaled low-dose corticosteroid and a long-acting beta-2 agonist
C
long-acting beta-2 agonist
D
short acting beta-2 agonist
E
short acting beta-2 agonist and a inhaled low-dose corticosteroid
Question 6

Stem 2, Question 1 of 5

Simon, a 26 year old male, presents to the GP with a pruritic rash of 3 days on his left upper arm. He does no know of anything recently that could have caused it with no change in his daily routine. He  has no past medical history, aside from breaking his leg 2 years ago. He has no allergies.
On examination the GP finds this rash. What is the most likely diagnosis?  
A
Chronic plaque psoriasis
B
Contact dermatitis
C
Ringworm
D
Urticaria
E
Seborrhoeic dermatitis
Question 6 Explanation: 
The rash is most likely ring worm with the customary circle scaling plaque with a clearer centre. Chronic plaque psoriasis presents as red and inflamed white scaly regions normally affecting the flexor regions and scalp. Contact dermatitis is most commonly caused by an external agent, and presents as an erythematous area resultant from where the agent has come in contact. Urticaria presents as raised oedematous regions that last less than 24 hours. Seborrhoeic dermatitis normally presents as erythematous and scaly regions of the scalp, nasolabial folds, glabella and occasional central face and chest.
Question 7

Stem 2, Question 2 of 5

What organism causes ringworm?  
A
Dermatophytes
B
Aspergillus
C
Candida albicans
D
Mucorales
E
Blastomyces
Question 7 Explanation: 
Is it caused my dermatophytes, a fungi that invade and grow in dead keratin, so is found the skin, hair and nails.
Question 8

Stem 2, Question 3 of 5

The GP advises Simon that he should make sure he keeps his skin clean and wear loose fitting clothes to keep moisture away from his skin. She also advises Simon not to share towels and to wash bed linen frequently. Alongside this lifestyle advise, what medications could be used to treat the infection? (Tick all that apply)
A
Miconazole
B
Terbinafine
C
Amoxicillin
D
Clotrimazole
E
Nystatin
Question 8 Explanation: 
Terbinafine, miconazole and clotrimazole are all topical medications that can be used to treat the infection. Amoxicillin is an antibiotic so is not suitable for a fungal infection. Nystatin is an oral solution use to treat oral candidiasis.
Question 9

Stem 2, Question 4 of 5

3 months later Simon comes back to his GP complaining of itchy spot down the side of his trunk, the GP diagnoses this as scabies. What  organism causes scabies?
A
Protozoa
B
Bacteria
C
Virus
D
Fungi
E
Parasite
Question 9 Explanation: 
Scabies is caused by a parasite - a mite called Sarcoptes scabiei
Question 10

Stem 2, Question 5 of 5

What is the first line treatment for Simon's scabies?  
A
Malathion
B
Permethrin
C
Benzyl benzoate
D
Dimeticone
E
Chlorphenamine
Question 10 Explanation: 
Permethrin is first line for scabies. Malathion can be used is permethrin is contraindicated. Benzyl benzoate is less effective than both malathion and permethrin. Dimeticone is used to treat head lice. Chlorphenamine can be used to treat pruritus, but is not used to directly treat the parasite.
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