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Put your knowledge of skin pathology to the test with this dermatology quiz. Check out our guide to taking a dermatological history here.

Dermatology quiz

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Question 1
What type of melanoma is often seen in dark skinned individuals?
A
Superficial spreading
B
Lentigo maligna melanoma
C
Nodular
D
Acral lentiginous
Question 1 Explanation: 
The acral lentiginous variant of melanoma arises in dark skinned individuals on their palms or soles. It is not linked to UVB induced DNA damage unlike the other types (this was the disease that caused the death of Bob Marley).
Question 2
What condition is associated with this presentation? – A pink pearly nodule with telangiectasias, ulceration and rolled borders on the upper lip.
A
Squamous cell carcinoma
B
Basal cell carcinoma
C
Melanoma
D
Eczema
Question 2 Explanation: 
This is a classical presentation of basal cell carcinoma, a malignant proliferation of basal cells and the most common skin cancer. Risk factors include excessive sunlight exposure, xeroderma pigmentosum and albinism. Treatment is surgical excision.
Question 3
What disease is associated with dermatitis herpetiformis?
A
Herpes
B
Coeliac disease
C
Atopic dermatitis
D
Melanoma
Question 3 Explanation: 
In coeliac disease, there are IgA antibodies against gluten that cross react with reticulin fibres that anchor the basement membrane to the dermis. Thus, IgA is deposited at the tips of dermal papillae, presenting as grouped pruritic vesicles, papules or bullae. Usually found on elbows.
Question 4
What is the pathogenesis of pemphigus vulgaris?
A
IgG antibody against desmoglein
B
IgG antibody against hemidesmosome components
C
Autoimmune deposition of IgA at tips of dermal papillae
D
Enzyme defect in tyrosinase
Question 4 Explanation: 
Desmosomes are located in the stratum spinosum between keratinocytes. Antibodies against the desmoglein component result in painful flaccid bullae or blisters that rupture easily on both skin and oral mucosa. It is treated with corticosteroids.
Question 5
What childhood infection is associated with Koplik spots?
A
Measles
B
Rubella
C
Varicella
D
Fifth disease
Question 5 Explanation: 
Measles is a paramyxovirus. Koplik spots are small bright red spots with a white centre on the buccal mucosa that precede the measles rash by 1-2 days and are pathognomonic for measles. Measles present initially with cough, coryza and conjunctivitis then the Koplik spots. Eventually a maculopapular rash develops, beginning at the head/neck and spreading downwards.
Question 6
What skin condition is caused by poxvirus?
A
Verruca
B
Molluscum contagiosum
C
Impetigo
D
Cellulitis
Question 6 Explanation: 
Molluscum contagiosum is an umbilicated papule. It is commonly seen in children and sexually transmitted in adults.
Question 7
How does lichen planus present clinically?
A
Salmon coloured plaques with silvery scale
B
Pruritic, red, oozing rash with edema
C
Golden coloured crusts
D
Pruritic, purple, polygonal, planar papules and plaques
Question 7 Explanation: 
Learn the 6 P’s of lichen planus. It also often occurs with reticular white lines on the mucosal surfaces (Wickham striae). There is an association with hepatitis C.
Question 8
What is the most common mole found in adults?
A
Junctional nevus
B
Compound nevus
C
Intradermal nevus
D
Congenital nevus
Question 8 Explanation: 
A mole/nevus is a benign neoplasm of melanocytes. It can be congenital or acquired. If acquired, it progresses from a junctional nevus (most common in children) to a compound nevus and eventually to an intradermal nevus. Note that the mole can undergo dysplasia and the dysplastic nevus is a precursor to melanoma.
Question 9
An elderly lady presents to her doctor with a raised, round discoloured plaque, ‘stuck on appearance’ on her face. What skin condition is this?
A
Rubella
B
Seborrheic keratosis
C
Basal cell carcinoma
D
Melasma
Question 9 Explanation: 
Seborrheic keratosis is a benign squamous proliferation and is seen frequently in the elderly.
Question 10
What is the best indicator of prognosis for a melanoma?
A
Asymmetry
B
Colour
C
Diameter
D
Invasion of the dermis
Question 10 Explanation: 
Invasion/ depth of extension measured by Breslow thickness is the most significant prognostic factor in predicting metastasis. Asymmetry, border irregularity, colour variation and diameter (>6mm) are known as the ‘ABCD’ criteria for describing melanomas.
Question 11
What disorder is characterised by an initial ‘herald patch’ which is then followed by scaly erythematous plaques usually in a ‘Christmas tree’ distribution?
A
Pityriasis rosea
B
Herpes
C
Varicella zoster virus
D
Erysipelas
Question 11 Explanation: 
Pityriasis rosea classically presents with a salmon coloured solitary patch ‘herald patch’ which enlarges over a few days followed by generalised bilateral and symmetric macules with collarette scale. Pruritus is sometimes present. It self resolves within 6 – 8 weeks.
Question 12
How does impetigo present?
A
Golden honey coloured crust over an erythematous base
B
Salmon coloured plaque with silvery scale
C
Comedones, pustules and nodules
D
Flesh coloured papule with a rough surface
Question 12 Explanation: 
Impetigo is a superficial skin infection caused by Staph aureus or Strep pyogenes. It frequently affects children. It is treated with penicillin and topical preparations e.g. mupirocin.
Question 13
What is a precursor to squamous cell carcinoma (SCC)?
A
Keratoacanthoma
B
Actinic keratosis
C
Leser-Trélat sign
D
Measles
Question 13 Explanation: 
Actinic keratosis is a premalignant lesion to SCC, caused by prolonged sun exposure. It presents as scaly, rough, erythematous and small plaques, most commonly on the face, back or neck.
Question 14
What is the infective agent implicated in acne?
A
Staphylococcus aureus
B
Streptococcus pyogenes
C
Staphylococcus epidermidis
D
Propionibacterium acnes
Question 14 Explanation: 
Propionibacterium acnes infection produces lipases resulting in inflammation and breakdown of sebum, leading to pustule formation.
Question 15
What is the pathogenesis of vitiligo?
A
Congenital lack of pigmentation
B
Increase in the number of melanosomes
C
Autoimmune destruction of melanocytes
D
Benign proliferation of melanocytes
Question 15 Explanation: 
Vitiligo is the localised loss of skin pigmentation due to the autoimmune destruction of melanocytes. Melanocytes synthesise melanin in melanosomes. Thus, if melanocytes are destroyed, melanin cannot be produced.
Question 16
What condition is associated with acanthosis nigricans?
A
Type 2 diabetes and gastric adenocarcinoma
B
Rubella
C
Varicella zoster
D
Basal cell carcinoma
Question 16 Explanation: 
Acanthosis nigricans is epidermal hyperplasia with darkening of the skin, especially in the axilla, neck or groin. It is associated with malignancy especially GIT adenocarcinoma or insulin resistance as seen in type 2 diabetes and metabolic syndrome.
Question 17
What is the most common causative agent of erythema multiforme (EM)?
A
Penicillin and sulphonamides
B
Systemic lupus erythematosus
C
HSV infection
D
Malignancy
Question 17 Explanation: 
HSV is the most common etiologic agent of EM, which presents as a targetoid rash and bullae. All the other options are also associated with the disorder, but less commonly.
Question 18
Do people with albinism have an increased risk of skin cancer?
A
True
B
False
Question 18 Explanation: 
Albinism is the congenital lack of pigmentation. Melanin is protective against UVB, thus persons afflicted with the disorder would be more susceptible to UVB induced DNA damage, increasing the risk of basal cell carcinoma, squamous cell carcinoma and melanoma.
Question 19
What are the histological findings of psoriasis?
A
Inflammation of the dermal-epidermal junction
B
Peripheral palisading of basal cells
C
Acanthosis, Parakeratosis and Munro microabscesses
D
Keratin pseudocysts
Question 19 Explanation: 
Psoriasis is as a result of increased keratinocyte proliferation. It presents as salmon coloured papules and plaques with silvery scaling, especially on extensor surfaces and scalp. On histology, there is epidermal hyperplasia (acanthosis), hyperkeratosis with retention of nuclei in stratum corneum (parakeratosis) and groups of neutrophils in the stratum corneum (Munro microabscesses).
Question 20
What is Leser-Trélat sign?
A
Sudden appearance of multiple seborrheic keratosis and is an indicator of a gastrointestinal tract carcinoma.
B
A left supraclavicular node associated with gastric carcinoma
C
Metastasis of gastric carcinoma to the periumbilical region
D
Metastasis of gastric carcinoma to the bilateral ovaries
Question 20 Explanation: 
Note that the presentation of gastric carcinoma can include Leser-Trélat sign, Virchow node, Sister Mary Joseph nodule and Krukenberg tumour.
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