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rash

Practice targeted AMC-style multiple-choice questions on rash.

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A 32-year-old male presents to his GP complaining of a new, intensely itchy rash on his wrists and ankles. On examination, there are multiple small, flat-topped, polygonal, violaceous papules. Some of the papules have fine white lines on their surface. What is the most likely diagnosis?

A. Lichen planus
B. Psoriasis
C. Tinea corporis
D. Contact dermatitis
E. Atopic dermatitis
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A 10-year-old boy presents to the pediatric clinic with a history of fever, a rash characterized by erythema marginatum, and migratory arthralgia. His mother reports that he had a sore throat about three weeks ago, which resolved without treatment. On examination, he has a temperature of 38.5°C, a heart rate of 110 bpm, and a faint erythematous rash on his trunk. His joints are tender but not swollen. Given the suspicion of acute rheumatic fever, which of the following is the most appropriate next step in management?

A. Perform an anti-streptolysin O (ASO) titer test
B. Echocardiogram
C. Start aspirin therapy
D. Throat swab culture
E. Initiate corticosteroid treatment
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A 10-year-old boy presents to his GP with a chronic, intensely itchy rash affecting the flexural areas of his elbows and knees, as well as his neck. His parents report that he has had this condition on and off since infancy, with periods of remission and exacerbation. He also has a history of allergic rhinitis and asthma. On examination, the skin in the affected areas is dry, lichenified, and excoriated. There are also scattered papules and plaques. The patient reports significant sleep disturbance due to the itch. Topical corticosteroids have provided temporary relief in the past, but the rash flares up again soon after stopping treatment. Which of the following is the MOST appropriate next step in managing this patient's atopic dermatitis?

A. Refer the patient to a dermatologist for systemic immunosuppressant therapy without attempting further topical treatments.
B. Initiate treatment with a topical calcineurin inhibitor such as tacrolimus or pimecrolimus.
C. Recommend oral antihistamines as the sole treatment for the itch.
D. Advise strict avoidance of all potential allergens based on unproven allergy testing.
E. Prescribe a potent topical corticosteroid for long-term daily use.
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A 32-year-old woman presents to her general practitioner with a 2-week history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling of the small joints in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) and anti-double-stranded DNA antibodies. What is the most likely diagnosis?

A. Psoriatic arthritis
B. Dermatomyositis
C. Systemic lupus erythematosus (SLE)
D. Rheumatoid arthritis
E. Sjogren's syndrome
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A 45-year-old woman presents with a 3-month history of an intensely itchy rash on her wrists and ankles. On examination, you note violaceous, flat-topped papules. What is the most likely diagnosis?

A. Tinea corporis
B. Contact dermatitis
C. Psoriasis
D. Lichen planus
E. Atopic dermatitis
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 68-year-old woman presents with a persistent, pruritic rash on her chest wall at the site of a previous mastectomy performed 8 years ago for invasive ductal carcinoma. She completed adjuvant chemotherapy and radiation. Examination reveals the area shown. What is the MOST appropriate next step in management?

A. Initiation of systemic chemotherapy
B. Reassurance and observation
C. Referral for wide local excision
D. Skin biopsy of the affected area
E. Topical corticosteroid application
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 72-year-old woman presents with a 6-month history of a non-healing rash on her chest wall at the site of a previous mastectomy performed 10 years prior for invasive ductal carcinoma. She completed adjuvant chemotherapy and radiation. Examination reveals the findings shown. What is the MOST appropriate next step in management?

A. Skin biopsy of the affected area
B. Empiric antibiotic therapy
C. Reassurance and observation
D. Referral for wide local excision
E. Topical corticosteroid application
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A 32-year-old woman presents to her GP complaining of a new, intensely itchy rash on her elbows, knees, and scalp. On examination, the GP notes symmetrical, erythematous papules and plaques with overlying silvery scales. The patient reports a family history of similar skin conditions. What is the most likely diagnosis?

A. Contact Dermatitis
B. Tinea Corporis
C. Pityriasis Rosea
D. Eczema (Atopic Dermatitis)
E. Psoriasis
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A 6-year-old child presents with intensely itchy, small, fluid-filled blisters on their hands and feet. The blisters are most prominent on the palms and soles. The child has a history of atopic dermatitis. What is the most likely diagnosis?

A. Pompholyx eczema
B. Contact dermatitis
C. Scabies
D. Bullous impetigo
E. Hand, foot, and mouth disease
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 68-year-old woman presents with a persistent rash on her chest wall at the site of a previous mastectomy performed 8 years ago. She denies pain or itching. What is the MOST appropriate next step in management?

A. Reassurance and observation
B. Topical corticosteroid application
C. Skin biopsy
D. Referral to dermatology for cryotherapy
E. Excisional biopsy with wide margins
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A 32-year-old woman presents to her GP with a 3-month history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling of the small joints of her hands. Laboratory tests reveal a positive ANA and anti-dsDNA antibodies. What is the most likely diagnosis?

A. Dermatomyositis
B. Systemic lupus erythematosus (SLE)
C. Psoriatic arthritis
D. Sjogren's syndrome
E. Rheumatoid arthritis
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A 6-month-old infant is brought to the general practitioner by his parents, who are concerned about a persistent, itchy rash. The rash initially appeared on his cheeks and scalp a few weeks ago and has now spread to his trunk and extensor surfaces of his arms and legs. The parents report that the infant is constantly scratching, which disrupts his sleep. He has no known allergies, and there is no family history of asthma or allergic rhinitis. On examination, the infant is alert and active. There are erythematous, papular lesions with areas of weeping and crusting on his cheeks, scalp, trunk, and extensor surfaces. The skin is dry and flaky in other areas. Which of the following is the MOST appropriate initial management strategy for this infant's condition?

A. Systemic corticosteroids
B. Referral to a dermatologist for allergy testing
C. Oral antihistamines and topical antibiotics
D. Emollients and topical corticosteroids
E. Elimination diet for the mother (if breastfeeding)
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A 32-year-old woman presents to her general practitioner complaining of a persistent, intensely itchy rash that started a few weeks ago. She reports that it began on her wrists and ankles and has now spread to her elbows and knees. She denies any new medications, travel, or changes in personal care products. On examination, you observe symmetrical, excoriated papules and plaques on her wrists, elbows, knees, and upper back. Some of the papules have small blisters. Which of the following is the most appropriate initial investigation?

A. Patch testing with a standard allergen series
B. Potassium hydroxide (KOH) examination of skin scraping
C. Serum IgE level
D. Skin biopsy for direct immunofluorescence
E. Viral culture of blister fluid
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A 32-year-old woman, G1P1, presents to her general practitioner at 34 weeks gestation complaining of a new, intensely itchy rash. The rash started on her abdomen around the umbilicus and has now spread to her thighs and buttocks. On examination, there are erythematous papules and plaques, some with vesicles, located within the striae distensae of her abdomen. She denies any personal or family history of eczema or other skin conditions. She is otherwise well, with normal blood pressure and no proteinuria. Fetal movements are normal. Which of the following is the most appropriate initial management?

A. Oral corticosteroids
B. Topical corticosteroids and emollients
C. Referral to a dermatologist for biopsy
D. Induction of labour
E. Oral antihistamines alone
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A 24-year-old woman presents to the emergency department with a 3-day history of fever, sore throat, and fatigue. She also reports a rash that developed after taking amoxicillin prescribed by her GP for a presumed bacterial throat infection. On examination, she has cervical lymphadenopathy, a diffuse maculopapular rash, and mild splenomegaly. Her vital signs are stable. A monospot test is positive. Which of the following is the most likely explanation for the rash?

A. Scarlet fever
B. Allergic reaction to amoxicillin
C. Amoxicillin-induced rash in the context of infectious mononucleosis
D. Drug-induced lupus erythematosus
E. Stevens-Johnson syndrome
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A 3-year-old boy is brought to the emergency department with a high fever, irritability, and a rash. The rash started on his face and has now spread to his trunk and limbs. On examination, he has conjunctivitis and Koplik spots are noted on the buccal mucosa. What is the most likely diagnosis?

A. Scarlet fever
B. Roseola
C. Rubella
D. Measles
E. Chickenpox
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A 4-year-old boy is brought to the clinic by his parents due to a persistent itchy rash on his arms and legs. The rash has been present for several weeks and seems to worsen at night. The child has a history of asthma and allergic rhinitis. On examination, there are erythematous, scaly patches with excoriations on the flexural surfaces of his arms and legs. What is the most likely diagnosis?

A. Scabies
B. Psoriasis
C. Contact dermatitis
D. Atopic dermatitis
E. Tinea corporis
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A 32-year-old woman presents to her general practitioner complaining of a persistent, intensely itchy rash on her elbows, knees, and scalp for the past 6 months. She reports that the itching is worse at night and after hot showers. She has tried over-the-counter hydrocortisone cream without relief. On examination, the GP notes symmetrical, excoriated papules and plaques on the extensor surfaces of her elbows and knees, as well as some scaling on her scalp. The patient also mentions a history of recurrent mouth ulcers. Which of the following is the MOST appropriate initial investigation to confirm the suspected diagnosis?

A. Skin biopsy for histopathology and direct immunofluorescence
B. Allergy testing (skin prick or RAST) for common environmental allergens
C. Full blood count (FBC) and liver function tests (LFTs)
D. Potassium hydroxide (KOH) examination of skin scrapings
E. IgA anti-endomysial antibody (EMA) and IgA tissue transglutaminase (tTG) antibody testing
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A 32-year-old woman presents to her general practitioner with a 2-week history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. Laboratory tests reveal anemia, leukopenia, and positive antinuclear antibodies (ANA). What is the most likely diagnosis?

A. Systemic lupus erythematosus (SLE)
B. Sjogren's syndrome
C. Psoriatic arthritis
D. Rheumatoid arthritis
E. Dermatomyositis
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 68-year-old woman presents to her general practitioner with a persistent, pruritic rash on her chest wall. She reports a history of left mastectomy for invasive ductal carcinoma 8 years ago, followed by adjuvant chemotherapy and radiation therapy. She denies any recent trauma or changes in soaps or detergents. Physical examination reveals the findings shown. A punch biopsy is performed. Which of the following immunohistochemical stains would most likely be positive in this patient's biopsy sample, supporting the suspected diagnosis?

A. Vimentin
B. Cytokeratin 7 (CK7)
C. Smooth muscle actin (SMA)
D. S-100
E. Human epidermal growth factor receptor 2 (HER2)
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A 6-year-old child presents with intensely itchy, small, fluid-filled blisters on their hands and feet, especially between the fingers and toes. The lesions are linear and excoriated. Multiple family members have similar symptoms. What is the most likely diagnosis?

A. Scabies
B. Chickenpox
C. Hand, foot, and mouth disease
D. Atopic dermatitis
E. Contact dermatitis
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A 30-year-old woman presents to the emergency department with a 2-day history of fever, sore throat, and a diffuse rash. She recently started taking a new medication for her epilepsy. On examination, she is febrile at 38.2°C, with a heart rate of 100 bpm and blood pressure of 110/70 mmHg. The rash is erythematous and involves the trunk and extremities, with some areas of desquamation. Laboratory tests reveal leukocytosis with eosinophilia and elevated liver enzymes. Which of the following is the most likely diagnosis?

A. Stevens-Johnson syndrome
B. Scarlet fever
C. Toxic shock syndrome
D. Kawasaki disease
E. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
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A 32-year-old woman presents to her general practitioner with a 3-month history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash, mild synovitis in her hands, and no signs of organomegaly. Laboratory tests reveal anemia, leukopenia, and positive antinuclear antibodies (ANA) with a high titer. Which of the following is the most appropriate initial management for this patient?

A. Hydroxychloroquine
B. Azathioprine
C. Methotrexate
D. Cyclophosphamide
E. Prednisone
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 68-year-old woman presents with a persistent, pruritic rash on her chest wall at the site of a previous mastectomy performed 8 years ago for invasive ductal carcinoma. She completed adjuvant chemotherapy and radiation at that time. Examination reveals the area shown. What is the MOST appropriate next step in management?

A. Topical corticosteroid application
B. Referral for excisional re-resection
C. Mammogram of the contralateral breast
D. Empiric antifungal treatment
E. Skin biopsy of the affected area
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 68-year-old woman presents with a persistent rash following a mastectomy 5 years prior. What is the MOST appropriate next step in management?

A. Skin biopsy
B. Reassurance and observation
C. Topical corticosteroids
D. Mammogram of the contralateral breast
E. Excisional biopsy with wide margins
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A 32-year-old woman presents to the emergency department with a 2-day history of fever, headache, and a rash that started on her wrists and ankles and has now spread to her trunk. She recently returned from a camping trip in the Northern Territory. On examination, she is febrile at 38.5°C, with a heart rate of 110 bpm and blood pressure of 100/70 mmHg. The rash is maculopapular and blanching. Laboratory tests reveal thrombocytopenia and elevated liver enzymes. Which of the following is the most likely diagnosis?

A. Systemic lupus erythematosus
B. Drug reaction
C. Rickettsial infection
D. Viral exanthem
E. Meningococcal infection
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A 32-year-old woman presents to her general practitioner complaining of a persistent, intensely itchy rash that started a few weeks ago. She reports that it began on her wrists and ankles and has now spread to her elbows and knees. She denies any new medications, travel, or changes in personal care products. On examination, you observe symmetrical, intensely pruritic, violaceous, flat-topped papules and plaques on her wrists, ankles, and shins. Some of the lesions show fine, white lines on the surface. There are also a few small, similar lesions on her buccal mucosa. Which of the following is the most appropriate initial management?

A. Systemic corticosteroids and antifungal cream
B. Topical corticosteroids and antihistamines
C. Oral antibiotics and topical emollients
D. Referral to a rheumatologist for autoimmune workup
E. Cryotherapy to the affected areas
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A 5-year-old boy is brought to the clinic by his parents due to a 3-day history of fever, irritability, and refusal to eat. On examination, he has a temperature of 39°C, erythematous oropharynx, and tender cervical lymphadenopathy. There are also vesicular lesions on his hands and feet. What is the most likely diagnosis?

A. Varicella (chickenpox)
B. Scarlet fever
C. Hand, foot, and mouth disease
D. Kawasaki disease
E. Herpangina
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 72-year-old woman presents with a 6-month history of a non-healing rash on her chest wall at the site of a previous mastectomy performed 10 years prior for invasive ductal carcinoma. She has completed adjuvant chemotherapy and radiation. Examination reveals the findings shown. What is the MOST appropriate next step in management?

A. Skin biopsy of the affected area
B. Topical corticosteroid application
C. Referral for wide local excision
D. Empiric antibiotic therapy
E. Fungal culture of the lesion
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A 28-year-old woman presents to her general practitioner with a 2-week history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-double-stranded DNA antibodies. What is the most likely diagnosis?

A. Systemic lupus erythematosus (SLE)
B. Dermatomyositis
C. Rheumatoid arthritis
D. Psoriatic arthritis
E. Sjögren's syndrome
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