Practice targeted AMC-style multiple-choice questions on skin lesion.
A 35-year-old male presents to his general practitioner with a lesion on his nose that has been present for approximately 3 months. He initially thought it was a persistent pimple but it has not resolved and seems to be slowly growing. He denies pain, itching, or bleeding from the lesion. He has no significant past medical history and takes no regular medications. He works outdoors but reports using sunscreen inconsistently. On examination, vital signs are stable. The lesion is as shown in the image. There are no other skin lesions noted elsewhere. Regional lymph nodes are not palpable. Based on the appearance of the lesion shown, what is the most appropriate next step in the management of this patient?
A 45-year-old male presents to his GP with a lesion on his nose that has been slowly enlarging over the past six months. He reports no pain, itching, or bleeding. He has no significant past medical history and takes no regular medications. On examination, vital signs are stable. The image shows the appearance of the lesion. Given the clinical presentation and morphology, what is the most appropriate initial step in management?
A 35-year-old male presents to his general practitioner complaining of a persistent, asymptomatic lesion on his nose that has been present for approximately 6 months. He denies any trauma to the area. He reports no other skin issues or systemic symptoms. Physical examination reveals the lesion shown. The patient is concerned about cosmetic appearance and potential for malignancy. What is the MOST appropriate initial management step?
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 35-year-old male presents with a painless lesion on his nose that has been present for several months. He denies any trauma or recent illness. Examination reveals the image shown. What is the most appropriate initial management?
A 62-year-old man presents with a lesion on his nose that has been slowly enlarging over the past 8 months. He reports occasional tenderness but no bleeding. He has a significant history of outdoor work and multiple previous sunburns. His medical history is otherwise clear. On examination, vital signs are stable. The lesion appears as shown in the image. Regional lymph nodes are not palpable. Considering the clinical presentation and the appearance of the lesion, which of the following is the most appropriate initial step in the management of this patient?
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 40-year-old man presents with a painless, slowly growing lesion on his nose for the past 8 months. He denies any trauma or previous skin conditions. Examination reveals the pictured lesion. What is the MOST appropriate next step in management?
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 70-year-old woman, post-mastectomy, presents with a chronic, pruritic lesion. What is the MOST likely underlying pathophysiology?
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 65-year-old woman presents with a chronic, non-healing lesion at the site of her mastectomy scar, performed 7 years ago. She denies pain but reports occasional itching. What is the MOST appropriate next investigation?
A 68-year-old woman presents to her GP with a 3-month history of a persistent, mildly pruritic skin lesion on her left chest wall. She had a left simple mastectomy for invasive ductal carcinoma 10 years ago, followed by adjuvant therapy. She denies fever, weight loss, or other systemic symptoms. Physical examination reveals the appearance shown. What is the most appropriate initial diagnostic investigation?
A 70-year-old woman presents with a lesion on her chest wall at the site of a mastectomy performed 10 years prior. She reports it started as a small area of redness and has slowly enlarged. What is the MOST likely diagnosis?
A 40-year-old man presents with a solitary, asymptomatic nodule on his nose. Biopsy reveals perivascular eosinophilic infiltrate. What is the MOST likely diagnosis?
A 35-year-old man presents with a painless lesion on his nose, present for 6 months. Examination reveals the image shown. What is the MOST likely diagnosis?
A 65-year-old lady weighing 70 kg has an enlarging papule on her right neck, measuring 8 mm, raised with a keratotic horn. A keratinocytic tumor is suspected. What is the maximum safe dose of 1% lidocaine with adrenaline for local anesthesia in this patient?
A 72-year-old female on warfarin for chronic atrial fibrillation presents with a 2-day history of increasing pain and a developing lesion on her right lower leg. She denies trauma. Her INR is therapeutic at 2.5. Vitals are stable. Considering the clinical presentation and the image provided, what is the most appropriate immediate management?
A 35-year-old man presents to his general practitioner reporting a lesion on his nose that he first noticed approximately three months ago. He describes it as initially resembling a persistent pimple, but notes it has not resolved and appears to be slowly increasing in size. He denies any associated pain, itching, or bleeding from the site. His past medical history is unremarkable, and he is not currently taking any regular medications. He works outdoors in a role involving significant sun exposure but admits to inconsistent use of sun protection measures. On physical examination, his vital signs are within normal limits. The lesion in question is located on his nose and has the appearance shown in the accompanying image. No other suspicious skin lesions are identified elsewhere on his body, and regional lymph nodes are not palpable. Considering the clinical presentation and the appearance of the lesion depicted, what is the most appropriate initial step in the management of this patient?
A 35-year-old male presents to his general practitioner with a lesion on his nose that has been present for approximately 3 months. He initially thought it was a persistent pimple but it has not resolved and seems to be slowly growing. He denies pain, itching, or bleeding from the lesion. He has no significant past medical history and takes no regular medications. He works outdoors but reports using sunscreen inconsistently. On examination, vital signs are stable. The lesion is as shown in the image. There are no other skin lesions noted elsewhere. Regional lymph nodes are not palpable. Based on the appearance of the lesion shown, what is the most appropriate next step in the management of this patient?
A 55-year-old man presents to his GP with a lesion on his nose that he first noticed about 6 months ago. It has gradually increased in size but is not painful or itchy. He has no significant past medical history and takes no regular medications. On examination, vital signs are stable. The image shows the lesion. Based on the appearance of this lesion, what is the most appropriate next step in management?
A 55-year-old man presents with a slowly growing lesion on his nose that he first noticed about 6 months ago. He reports occasional mild discomfort but no bleeding. He has a history of significant sun exposure due to his occupation. His medical history is otherwise unremarkable. On examination, vital signs are normal. The lesion appears as shown in the image. Regional lymph nodes are not enlarged. Considering the patient's history, risk factors, and the appearance of the lesion, what is the most appropriate initial step in the management of this patient?
A 65-year-old patient recently started on warfarin for deep vein thrombosis presents with a painful, expanding skin lesion on their leg. They report the lesion appeared suddenly and has worsened over the past 24 hours. INR is 2.8. Considering the clinical presentation and the appearance of the lesion, what is the most appropriate immediate management step?
A 45-year-old man presents to his GP with a lesion on his nose that has been present for several months and seems to be slowly enlarging. He denies pain, itching, or bleeding. He works outdoors but reports using sunscreen inconsistently. His past medical history is unremarkable, and he takes no regular medications. On examination, vital signs are stable. Regional lymph nodes are not palpable. The lesion is as shown in the image. Considering the clinical presentation, risk factors, and the appearance of the lesion, which of the following represents the most appropriate initial step in establishing a definitive diagnosis and guiding management?
A 55-year-old man presents to his GP with a persistent lesion on his nose that has been present for several months and has not changed significantly in size or appearance. He reports it is occasionally itchy but otherwise asymptomatic. His medical history is unremarkable, and vital signs are within normal limits. On examination, you observe the lesion shown in the image. Considering the appearance of this lesion, what is the most appropriate initial step in the management of this patient?
A 68-year-old woman recently started on warfarin for a pulmonary embolism presents with a painful, rapidly expanding purpuric lesion on her thigh, which developed two days ago. Her INR is 2.5. She has no history of trauma to the area. Considering the clinical presentation and the appearance of the lesion, what is the most likely underlying pathophysiological process?
A 65-year-old woman presents with a several-month history of a slowly enlarging, mildly pruritic skin lesion on her left chest wall. She underwent a simple mastectomy on the left side for invasive ductal carcinoma 8 years ago. She denies systemic symptoms. Physical examination reveals the appearance shown. What is the most appropriate next step in management?
A 62-year-old man presents with a painless lesion on his nose, present for 8 months. He denies trauma or fever. Examination reveals the image shown. Histopathology is MOST likely to show which of the following?
A 35-year-old man presents with a painless lesion on his nose that has been present for several months. He denies any trauma or recent illness. Examination reveals the image shown. What is the most appropriate initial management?
A 45-year-old man presents with the finding shown. He denies pain but is concerned about its appearance. What is the MOST appropriate initial step?
A 50-year-old man presents with a slowly growing, asymptomatic nasal lesion. He reports no trauma or fever. Examination reveals the image shown. What is the MOST likely long-term outcome if left untreated?
A 40-year-old patient presents with a persistent, slightly raised lesion on their nose that has been present for several months. It is asymptomatic except for occasional mild itching. There is no history of trauma or recent changes in size or colour. The patient is otherwise healthy. Considering the appearance of the lesion shown and the clinical presentation, which of the following represents the most appropriate initial approach?
A 62-year-old woman presents for a routine follow-up appointment several years after undergoing a simple mastectomy for pT1N0M0 invasive ductal carcinoma of the left breast. She completed adjuvant endocrine therapy and has been well since. During the consultation, she mentions that she has noticed a persistent area of skin change on her left chest wall, near the mastectomy scar, over the past few months. She describes it as occasionally itchy and slightly raised, but denies pain, discharge, or systemic symptoms such as weight loss or fever. Her vital signs are stable, and physical examination reveals no palpable axillary or supraclavicular lymphadenopathy. The appearance of the affected area is shown in the image. Considering the patient's history and the clinical presentation, what is the most appropriate initial diagnostic step?
A 55-year-old man presents to his GP with a lesion on his nose that has been slowly enlarging over the past 4 months. He reports no associated pain, itching, or bleeding. He is otherwise well, with no significant past medical history. On examination, vital signs are within normal limits. The lesion is as shown in the image. Considering the clinical presentation and the appearance of the lesion, what is the most appropriate initial step in the management of this patient?
A 50-year-old man presents with a slowly growing nasal lesion. Examination reveals the image shown. What is the MOST appropriate initial management?
A 35-year-old male presents with a painless lesion on his nose that has been present for several months. He denies any trauma or previous skin conditions. Examination reveals the image shown. What is the MOST appropriate initial management step?
A 45-year-old male presents with a painless lesion on his nose that has been present for 6 months. He denies any trauma or previous skin conditions. Examination reveals the lesion seen in the image. What is the MOST appropriate next step in management?
A 72-year-old woman presents with a persistent, slowly expanding skin lesion on her right chest wall, present for several months. She underwent a right mastectomy for invasive ductal carcinoma 12 years ago. She denies pain, discharge, or systemic symptoms. Physical examination reveals the appearance shown. Considering the patient's history and the clinical finding, which of the following investigations is most appropriate to assess for potential underlying malignancy or systemic involvement?
A 45-year-old male presents with a painless lesion on his nose that has been present for several months. He denies any trauma or recent illness. Examination reveals the image shown. What is the MOST appropriate initial management?
An 82-year-old woman with a history of paroxysmal atrial fibrillation was recently discharged from hospital following treatment for community-acquired pneumonia. Five days ago, she was commenced on warfarin 5mg daily for stroke prevention. She presents to the emergency department today complaining of severe, rapidly worsening pain and a dark, blistering lesion on her right lower leg that developed over the past 48 hours. She denies any recent trauma to the leg. Her vital signs are stable: blood pressure 132/82 mmHg, heart rate 76 bpm, respiratory rate 18/min, temperature 37.0°C. Physical examination reveals the appearance shown in the image on her right anterior lower leg. Laboratory results show an INR of 4.8, haemoglobin 125 g/L, white cell count 8.5 x 10^9/L, and platelets 250 x 10^9/L. She has no known personal or family history of thrombophilia. Considering the clinical presentation, recent medication changes, and the appearance depicted, which of the following is the most appropriate immediate management strategy?
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 62-year-old woman presents for a routine follow-up appointment several years after undergoing a simple mastectomy for pT1N0M0 invasive ductal carcinoma of the left breast. She completed adjuvant endocrine therapy and has been well since, reporting no new systemic symptoms such as unexplained weight loss, fatigue, or bone pain. Her last mammogram of the contralateral breast and clinical examination at her previous visit six months ago were unremarkable. During the current consultation, she mentions that she has noticed a persistent area of skin change on her left chest wall, near the mastectomy scar, over the past few months. She describes it as occasionally itchy and slightly raised, but denies pain, discharge, or significant discomfort. Her vital signs are stable (BP 130/80 mmHg, HR 72 bpm, RR 16/min, Temp 36.8°C). Physical examination reveals no palpable axillary or supraclavicular lymphadenopathy. The appearance of the affected area is shown in the image. Considering the patient's history, the duration and nature of the symptoms, and the clinical presentation, what is the most appropriate initial diagnostic step to investigate this new finding?
A 70-year-old woman presents with a persistent, slowly enlarging skin lesion on her left chest wall, which she first noticed several months ago. She underwent a left simple mastectomy for invasive ductal carcinoma 12 years prior. Physical examination reveals the findings depicted. A recent biopsy of the lesion confirmed the presence of Paget cells. She has no other new symptoms. Her vital signs are stable. Considering the patient's history and the biopsy findings, which of the following investigations is the most appropriate next step in her management?
A 45-year-old man presents to his GP with a lesion on his nose that he first noticed about 6 months ago. It has slowly increased in size but is not painful or itchy. He has no significant past medical history and takes no regular medications. On examination, vital signs are stable. The image shows the appearance of the lesion. Considering the clinical presentation and the appearance of the lesion shown, what is the most appropriate initial management step?
A 68-year-old patient on warfarin for a recent DVT presents with a painful, rapidly expanding skin lesion on their leg that started 48 hours ago. Their INR is 2.9. Given the clinical context and the appearance of the lesion, what is the most appropriate immediate management step?
A 62-year-old woman presents for a routine follow-up appointment several years after undergoing a simple mastectomy for pT1N0M0 invasive ductal carcinoma of the left breast. She completed adjuvant endocrine therapy and has been well since. During the consultation, she mentions that she has noticed a persistent area of skin change on her left chest wall, near the mastectomy scar, over the past few months. She describes it as occasionally itchy and slightly raised, but denies pain, discharge, or systemic symptoms such as weight loss or fever. Her vital signs are stable, and physical examination reveals no palpable axillary or supraclavicular lymphadenopathy. The appearance of the affected area is shown in the image. Considering the patient's history and the clinical presentation, what is the most appropriate initial diagnostic step?
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 72-year-old woman on warfarin for chronic atrial fibrillation presents with a painful, rapidly expanding lesion on her right lower leg that began two days ago, shortly after her warfarin dose was increased. Her vital signs are stable, and her INR is within the therapeutic range. Considering the clinical presentation and the appearance of the lesion shown, what is the most appropriate immediate management?
An 82-year-old woman with a history of paroxysmal atrial fibrillation and a recent hospitalisation for pneumonia was discharged 5 days ago on warfarin 5mg daily. She presents to the emergency department complaining of increasing pain and a rapidly evolving lesion on her right lower leg over the past 48 hours. She denies trauma. Her vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, Temp 36.8°C. Physical examination reveals the appearance shown in the image on her right anterior lower leg. Her INR today is 4.5. She has no known history of protein C or S deficiency. Considering the patient's history, current medication, laboratory result, and the clinical appearance depicted, which of the following represents the most appropriate immediate management strategy?
A 50-year-old man with multiple cutaneous lesions presents with recurrent episodes of abdominal pain and iron deficiency anemia. The provided image was obtained. What is the MOST appropriate next step in management?