FMGE Dermatology questions with answers

1. Q1. A young adult on a prolonged fat-restricted diet develops dry, rough skin with keratotic papules at the hair follicles, and separately reports difficulty seeing at dusk. Which single deficiency explains both?

   • A. Vitamin B2
   • B. Vitamin C
   • C. Vitamin A
   • D. Vitamin K

   Answer: C. Vitamin A

2. Q2. A man with chronic alcohol dependence has a symmetrical pigmented scaly rash confined to the neck and the backs of the hands, with diarrhoea and impaired memory. Which vitamin should be replaced?

   • A. Niacin
   • B. Thiamine
   • C. Riboflavin
   • D. Cobalamin

   Answer: A. Niacin

1. Q1. A man develops several deep, painful genital ulcers with ragged undermined edges two weeks after unprotected intercourse, with tender suppurative inguinal nodes. Which organism is responsible?

   • A. Treponema pallidum
   • B. Haemophilus ducreyi
   • C. Klebsiella granulomatis
   • D. Chlamydia trachomatis serovar L2

   Answer: B. Haemophilus ducreyi

1. Q1. A young man has well-demarcated plaques with silvery scale on both elbows and knees, and fine pits in several fingernails. Scraping the scale away produces pinpoint bleeding. What is that sign called?

   • A. Nikolsky sign
   • B. Auspitz sign
   • C. Darier sign
   • D. Koebner phenomenon

   Answer: B. Auspitz sign

1. Q1. A teenager develops abrupt, severely inflamed ulcerating acne nodules with fever, arthralgia and a raised ESR. Which organism drives the underlying acne, and what does the systemic upset represent?

   • A. Cutibacterium (Propionibacterium) acnes, with an exaggerated immune response to it
   • B. Staphylococcus aureus, with secondary bacteraemia
   • C. Malassezia furfur, with follicular invasion
   • D. Demodex folliculorum, with mite hypersensitivity

   Answer: A. Cutibacterium (Propionibacterium) acnes, with an exaggerated immune response to it

2. Q2. A patient with plaque psoriasis develops new lesions in a line along a recent surgical scar. What is this called, and what does it signify?

   • A. The Auspitz sign, indicating thinned suprapapillary plates
   • B. The Koebner phenomenon, indicating active disease
   • C. The Nikolsky sign, indicating an intraepidermal split
   • D. The Darier sign, indicating mast cell degranulation

   Answer: B. The Koebner phenomenon, indicating active disease

1. Q1. Histology of a scaly plaque shows parakeratosis, elongated rete ridges, thinning of the suprapapillary plate and collections of neutrophils within the stratum corneum. What are those neutrophil collections called, and what is the diagnosis?

   • A. Civatte bodies, in lichen planus
   • B. Munro microabscesses, in psoriasis
   • C. Pautrier microabscesses, in mycosis fungoides
   • D. Kamino bodies, in Spitz naevus

   Answer: B. Munro microabscesses, in psoriasis

2. Q2. An institutionalised child with intellectual disability has thick warty crusts on the hands, feet and trunk with intense scaling, and several contacts have developed itch. Which variant of scabies is this, and why is it so infectious?

   • A. Nodular scabies, with a hypersensitivity reaction
   • B. Animal scabies, which is self-limiting
   • C. Crusted (Norwegian) scabies, because the crusts carry an enormous mite burden
   • D. Scabies incognito, masked by topical steroid

   Answer: C. Crusted (Norwegian) scabies, because the crusts carry an enormous mite burden

1. Q1. A man develops a well-defined dusky red plaque on the same patch of forearm skin each time he takes an NSAID, healing with pigmentation. What is this reaction called, and what is the mechanism?

   • A. Fixed drug eruption, from memory T cells resident in that patch of skin
   • B. Urticaria, from IgE-mediated mast cell degranulation
   • C. Erythema multiforme, from immune complex deposition
   • D. Post-inflammatory hyperpigmentation, from melanin incontinence alone

   Answer: A. Fixed drug eruption, from memory T cells resident in that patch of skin

2. Q2. Which nail change is regarded as most specific for psoriasis, produced by parakeratosis of the nail bed showing through the plate?

   • A. Nail pitting
   • B. Onycholysis
   • C. The salmon patch or oil-drop sign
   • D. Beau's lines

   Answer: C. The salmon patch or oil-drop sign

1. Q1. Removing the scale from a psoriatic plaque produces pinpoint bleeding. Which histological features explain this?

   • A. Subepidermal blistering with eosinophils
   • B. Acantholysis within the epidermis
   • C. Dermal mucin deposition
   • D. Thinned suprapapillary plates over dilated, tortuous dermal papillary capillaries

   Answer: D. Thinned suprapapillary plates over dilated, tortuous dermal papillary capillaries

1. Q1. An infant weaned from breast milk develops a sharply demarcated erosive rash around the mouth, anus and fingertips, with diarrhoea and hair loss. Which deficiency, and what is the treatment?

   • A. Zinc deficiency (acrodermatitis enteropathica), treated with oral elemental zinc
   • B. Iron deficiency, treated with ferrous sulphate
   • C. Vitamin A deficiency, treated with retinol
   • D. Calcium deficiency, treated with supplementation

   Answer: A. Zinc deficiency (acrodermatitis enteropathica), treated with oral elemental zinc

2. Q2. A child burns severely after minutes of sun exposure, with freckling on exposed skin and several skin cancers by adolescence. Which repair pathway is defective?

   • A. Mismatch repair
   • B. Nucleotide excision repair of ultraviolet-induced pyrimidine dimers
   • C. Base excision repair of oxidised bases
   • D. Homologous recombination repair

   Answer: B. Nucleotide excision repair of ultraviolet-induced pyrimidine dimers

1. Q1. A young woman has fever, painless oral ulcers and a photosensitive erythematous rash across the cheeks and bridge of the nose that spares the nasolabial folds. What is the diagnosis?

   • A. Systemic lupus erythematosus
   • B. Dermatomyositis
   • C. Rosacea
   • D. Melasma

   Answer: A. Systemic lupus erythematosus

2. Q2. A man with recent unexplained weight loss develops sudden widespread eruptive seborrhoeic keratoses. What is this sign, and what does it demand?

   • A. Acanthosis nigricans, demanding a glucose tolerance test
   • B. Actinic keratosis, demanding cryotherapy
   • C. Cutaneous candidiasis, demanding topical antifungals
   • D. The sign of Leser-Trelat, demanding a search for internal malignancy, typically gastrointestinal

   Answer: D. The sign of Leser-Trelat, demanding a search for internal malignancy, typically gastrointestinal

1. Q1. Which of the following is NOT a feature of congenital syphilis?

   • A. Hutchinson incisors
   • B. Higoumenakis sign
   • C. Painful genital ulceration acquired at birth
   • D. Interstitial keratitis

   Answer: C. Painful genital ulceration acquired at birth

2. Q2. Which treatment repigments vitiligo by combining a photosensitiser with ultraviolet A?

   • A. Topical retinoids
   • B. Systemic corticosteroids
   • C. Psoralen with UVA phototherapy
   • D. Nd-YAG laser

   Answer: C. Psoralen with UVA phototherapy

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.