MCQ-Skin

MCQ 1 33 year old male printer complained of a 3 month history of hand dermatitis. Patch testing was negative. A biopsy showed spongiosis and lymphocytic exocytosis. No Munro’s microabcesses are seen.

Identify the most likely diagnosis.

A. Prebullous pemiphigoid B. Psoriasis vulgaris C. Irritant/contact eczematous dermatitis D. Mycosis fungoides E. Drug reaction

MCQ 2a Which statement is false.

Psoriasis: a. Can result in alopecia b. Sacrum affected c. Pustular form exists d. Histologically shows spongiform pustule of Kogoj e. Vascular ectasia is seen with margination of neutrophils

MCQ 2b

a. b. c. d. e.

A 34 year old patient presents with multiple silvery skin plaques. A skin biopsy is performed to confirm the diagnosis.

Identify the finding which would not be consistent with a diagnosis of psoriasis.

Can result in alopecia Sacrum affected Pustular form exists Histologically shows spongiform pustule of Kogoj Vascular ectasia is seen with margination of neutrophils

MCQ 2c

a.

b. c. d. e.

A 34 year old patient presents with multiple silvery skin plaques involving the extensor surface of the limbs, scalp and lower back. The condition is worse after periods of stress and localises to areas of trauma. A skin biopsy is performed to confirm the diagnosis.

Identify the finding which would not be expected in this condition.

Can result in alopecia Sacrum affected Pustular form exists Histologically shows spongiform pustule of Kogoj Vascular ectasia is seen with margination of neutrophils

MCQ 2d

a.

b. c. d. e.

A 34 year old patient presents with multiple silvery skin plaques involving the extensor surface of the limbs, scalp and lower back. The condition is worse after periods of stress and localises to areas of trauma. A skin biopsy is performed to confirm the diagnosis.

Identify the finding which would not be expected in this condition.

Fibrous replacement of hair follicles Parakeratosis Neutrophilic pustules in the epidermis Vascular ectasia is seen with margination of neutrophils Loss of the granular cell layer

MCQ 3 A 44 year old taxi-driver presents with an sudden eruption on the trunk and limbs. Target lesions are present on the hands and feet. His skin biopsy shows basal cell damage with apoptotic keratinocytes.

Identify the most likely diagnosis. a. Lichen planus b. Dermatomyositis c. Erythema multiforme d. Chronic graft versus host disease e. Lichen nitidus

MCQ 4a Which of the following conditions does not show a leukocytoclastic vasculitis?

A. Erythema nodosum B. Microscopic polyangiitis C. Wegeners granulomatosis D. Polyarteritis nodosa E. Urticarial vasculitis

MCQ 4b A 42 year old patient presents with purpuric lesions involving both limbs. Inflammatory markers are raised.

A skin biopsy is taken and shows features of a leukocytoclastic vasculitis.

Identify the condition which does not show this feature.

A. Erythema nodosum B. Churg Strauss syndrome C. Wegeners granulomatosis D. Polyarteritis nodosa E. Urticurial vasculitis

MCQ 4c A 42 year old patient presents with purpuric lesions involving both limbs. Inflammatory markers are raised.

A skin biopsy is taken and shows fibrinoid necrosis of vessel walls with leukocytoclasis and red blood cell extravasation.

Identify the most likely diagnosis.

A. Erythema nodosum B. Eczematous dermatitis C. Epidermolysis bullosa acquista D. Erythema multiforme E. Polyarteritis nodosa

MCQ 4d A 42 year old patient presents with purpuric lesions involving both limbs. Inflammatory markers are raised.

A skin biopsy is taken and shows fibrinoid necrosis of vessel walls with leukocytoclasis and red blood cell extravasation.

Identify the condition which would not show these features.

A. Erythema nodosum B. Churg Strauss syndrome C. Wegeners granulomatosis D. Polyarteritis nodosa E. Urticarial vasculitis

MCQ 5a Which of the following conditions is not associated with granulomatous inflammation.

A. Sarcoidosis B. Granuloma annulare C. Pemiphigus vulgaris D. Fungal infection E. Tuberculosis

MCQ 5b A 58 year year old woman presents with itchy annular skin lesions. She has a history of Crohn’s disease for which she is on systemic therapy. A skin biopsy show aggregates of histiocytes. A Grocott silver stain is positive.

Identify the most likely diagnosis.

A. Sarcoidosis B. Granuloma annulare C. Necrobiosis lipoidica D. Fungal infection E. Metastatic Crohn’s disease

MCQ 6 A 68 year old female has a 1/52 history of tense large blisters arising on erythematous skin. A skin biopsy shows a subepidermal blister containing eosinophils.

Identify the most likely diagnosis?

A.Pemphigus vulgaris B.Pemphigus foliaceus C.Darier’s disease D.Bullous pemphigoid E.Grover’ Disease

MCQ 7a Predisposing factors for squamous cell carcinoma are all the following except: a. UVB exposure

b. HPV Infection c. Immunosuppression

d. Scarring e. HHV-8 Infection

MCQ 7b A 35 year old presents with an invasive poorly differentiated squamous cell carcinoma of the scalp.

Identify the most likely aetiological factor.

A- Solar damage/sun exposure B- Immunosuppression C- HHV8 infection D- Previous radiotherapy E- Idiopathic

MCQ 8 A 72 year old presents with a squamous cell carcinoma of the scalp. An excision biopsy is performed and reported as per the RCPath dataset.

Identify which feature would upstage the tumour to pT3.

A- Perineural invasion –subcutis nerves B- Location in head and neck C- Depth of invasion 5.5mm D- Clinical diameter >20mm E- Lymphovascular invasion

MCQ 9 A 72 year old presents with an ulcerating tumour of the scalp. He has had androgenetic alopecia for many years. A biopsy shows basaloid nests of atypical cells infiltrating the dermis.

Identify the most likely predisposing factor in this case.

A- Solar damage B- Immunosuppression C- Gorlins syndrome D- Xeroderma pigmentosum E- Underlying lichen planopilaris

MCQ 10 All the following lesions are benign except A. Spitz naevus B. Lentigo maligna C. Cellular blue naevus D. Naevus of ota E. Freckles

MCQ 11 A 27 year old man presents with a pigmented lesion on the upper arm. An excision biopsy is performed. The lesion is compound in nature with prominent Pagetoid ascent in the epidermis and multiple dermal mitoses (3 per mm2).

Identify the most important prognostic factor.

A- Depth of invasion B- Macroscopic diameter C- Presence of dermal mitoses D- Pagetoid ascent E- Absence of tumour infiltrating lymphocytes

MCQ 12 A 23 year old woman presents with a changing melanocytic lesion. An excision biopsy shows malignant melanoma.

Identify the most likely genetic mutation.

A- cKIT B- BRAF C- ALK D- k-RAS E- Tyrosine kinase

Question EMQ 1 Options A. Trichoepithelioma B. Basal cell carcinoma C. Halo naevus D. Compound melanocytic naevus E. Intradermal melanocytic naevus F. Blue naevus G. Keratoacanthoma H. Lichen planus I. Malignant melanoma J. Trichilemmoma K. Seborrhoeic keratosis L. Simple lentigo M. Squamous cell carcinoma

Question 1 A 55 year old female present with a pigmented lesion on the hand.

Histology shows naevus cells in the dermis with pigmented dendiritic processes with overlying normal epidermis.

Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.

Question EMQ 1 Options A. Trichoepithelioma B. Basal cell carcinoma C. Halo naevus D. Compound melanocytic naevus E. Intradermal melanocytic naevus F. Blue naevus G. Keratoacanthoma H. Lichen planus I. Malignant melanoma J. Trichilemmoma K. Seborrhoeic keratosis L. Simple lentigo M. Squamous cell carcinoma

Question 2 A 35 year old man present with a pigmented lesion on the arm with an outer hypo-pigmented area. Biopsy shows a band of inflammatory cells at the dermo-epidermal junction with scattered bland nests of naevus cells.

Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.

Question EMQ 1 Options A. Trichoepithelioma B. Basal cell carcinoma C. Halo naevus D. Compound melanocytic naevus E. Intradermal melanocytic naevus F. Blue naevus G. Keratoacanthoma H. Lichen planus I. Malignant melanoma J. Trichilemmoma K. Seborrhoeic keratosis L. Simple lentigo M. Squamous cell carcinoma

Question 3 A 28 year old female with a papule on the nose. Histology shows islands of basaloid cells with occasional mitotic activity and papillary mesenchymal bodies.

Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.

Question EMQ 1 Options A. Trichoepithelioma B. Basal cell carcinoma C. Halo naevus D. Compound melanocytic naevus E. Intradermal melanocytic naevus F. Blue naevus G. Keratoacanthoma H. Lichen planus I. Malignant melanoma J. Trichillemmoma K. Seborrhoeic keratosis L. Simple lentigo M. Squamous cell carcinoma

Question 4 A 70 year old man presents with a ulcerated lesion on the face. Skin biopsy shows squamous islands in the dermis with atypia and dyskeratosis.

Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.

Question EMQ 1 Options A. Trichoepithelioma B. Basal cell carcinoma C. Halo naevus D. Compound melanocytic naevus E. Intradermal melanocytic naevus F. Blue naevus G. Keratoacanthoma H. Lichen planus I. Malignant melanoma J. Trichilemmoma K. Seborrhoeic keratosis L. Simple lentigo M. Squamous cell carcinoma

Question 5 A 68 year old man with multiple papules on the face. Histology shows epidermal proliferation with glycogenated keratinocytes, peripheral palisade and thickened basement membrane. No atypia or mitoses are seen.

Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.