Dermatology1. A 3-year-old with atopic eczema in Bradford has dry flexural plaques. Parents use a fragranced bubble bath and a thin moisturiser 'when it looks bad'. What is the cornerstone of ongoing primary-care treatment? The most appropriate action is: Leave-on emollient in generous amounts every day, including when the skin looks clear, plus a soap substituteTRUE. TrueFALSE. FalseCheck
Dermatology2. A 4-year-old with known eczema becomes rapidly unwell with fever and clusters of punched-out vesicles on the face and neck. What is the most appropriate action?A. Increase the topical steroid and review in the routine baby clinic next month for this presentationB. Same-day emergency paediatric or dermatology assessment for eczema herpeticumC. Reassure that punched-out vesicles are always molluscum and can waitD. Start oral flucloxacillin alone and advise swimming to dry the blistersCheck
Dermatology3. A 41-year-old warehouse worker with chronic plaque psoriasis attends for a repeat of his vitamin D analogue. He has not been asked about joints. What should you routinely screen for? Select TWO correct statements.Select all that apply.A. Most appropriate: Psoriatic arthritis (for example PEST/PsoRRI-style questions about pain, swelling and morning stiffness)B. The following is not the most appropriate next step: Mandatory HLA-B27 before any topical treatment in this NHS general-practice settingC. Most appropriate: Annual whole-body CT to exclude occult sarcoma in this NHS general-practice settingD. Most appropriate: Immediate GP initiation of methotrexate without asking about joints for this presentation in this NHS general-practice settingCheck
Dermatology4. A 52-year-old with plaque psoriasis develops sheets of sterile pustules, fever and malaise over 24 hours. What is the most appropriate next step?A. Add a further potent topical steroid and review after ChristmasB. Start methotrexate 15 mg in the GP treatment room todayC. Reassure that pustules always mean ordinary bacterial folliculitis for this presentationD. Same-day dermatology or emergency assessment for generalised pustular psoriasisCheck
Dermatology5. A 74-year-old outdoor worker has a rapidly enlarging crusted, keratinising nodule on the lower lip. What is the most appropriate referral?A. Routine cosmetic dermatology in 12 monthsB. Urgent suspected cancer pathway for possible squamous cell carcinomaC. Cryotherapy in the GP minor-ops list without a cancer pathway for this presentationD. Long-term hydrocortisone ointment to flatten the lumpCheck
Dermatology6. A 19-year-old student with moderate acne has been taking lymecycline alone for 9 months with no topical retinoid. What does NICE NG198 advise?A. Continue lymecycline indefinitely as the sole treatment for this presentation in this NHS general-practice setting in this NHS general-practice setting in this NHS general-practice settingB. Start isotretinoin in GP this afternoon in this NHS general-practice setting in this NHS general-practice setting in this NHS general-practice settingC. Stop all treatment because acne always remits by age 20 in this NHS general-practice setting in this NHS general-practice settingD. Do not continue long-term oral antibiotic monotherapy; use a time-limited oral antibiotic with a topical retinoid (or switch to an appropriate topical combination)Check
Dermatology7. A 48-year-old teacher has papulopustular rosacea on the cheeks without comedones. She wants a first-line topical. What is an appropriate NICE/BNF-aligned option?A. Oral isotretinoin issued by the GP today in this NHS general-practice settingB. Topical ivermectin (or metronidazole or azelaic acid) for papulopustular rosaceaC. Potent clobetasol ointment long-term to 'calm redness' for this presentation in this NHS general-practice settingD. Oral flucloxacillin for 6 months as monotherapyCheck
Dermatology8. A 29-year-old nurse has nocturnal itch and burrows in the finger webs. You diagnose classical scabies. How should permethrin 5% be used? Select TWO correct statements.Select all that apply.A. Most appropriate: Two whole-body applications 7 days apart, with household contacts treatedB. The following is not the most appropriate next step: A single smear to the itchy spots only, onceC. Most appropriate: Permethrin to the hands alone every night for 3 monthsD. Most appropriate: Oral terbinafine for 6 weeks as first-line scabies treatment for this presentationCheck
Dermatology9. A 7-year-old Somali boy in Birmingham has patches of scalp hair loss with scale. Wood's light and clinical picture suggest tinea capitis. What treatment principle applies? Select TWO correct statements.Select all that apply.A. Most appropriate: Systemic antifungal (for example terbinafine or griseofulvin by age/organism) — topical cream alone is insufficientB. The following is not the most appropriate next step: Clotrimazole cream to the scalp for 3 days onlyC. Most appropriate: Potent topical steroid as monotherapy to 'settle the scale'D. Most appropriate: Reassure that childhood ringworm of the scalp never needs medicine for this presentation in this NHS general-practice settingCheck
Dermatology10. A 64-year-old started allopurinol 2 weeks ago. He now has painful mouth ulcers, conjunctival injection and a spreading dusky rash. He is febrile. What is the most appropriate action?A. Increase allopurinol because this is a 'start-up rash'B. Stop the suspected drug and arrange emergency hospital admission for Stevens–Johnson syndrome / TENC. Treat in the community with another course of co-trimoxazole for this presentation in this NHS general-practice settingD. Give IM depot steroid and review in 4 weeksCheck