How to use these questions
These general dermatology practice questions test decisions that come up across routine clinical work: recognising patterns, choosing an appropriate investigation and identifying when a presentation needs urgent action. They are not tied to one country’s guideline or a particular exam format. For local prescribing details and referral pathways, check current guidance from the relevant official body.
Answer each question in the browser before reading its explanation. Look for the feature that changes the decision, then check why the best distractor does not fit. A MySummaries question screen on this topic looks like this:
A 34-year-old has well-demarcated, erythematous plaques with silvery scale on both elbows and knees. The plaques are limited in area; there is no nail disease or joint pain. What is the most appropriate initial treatment?
A topical corticosteroid of suitable potency is a common first-line treatment for limited plaque psoriasis, with emollients used to reduce dryness and scale. Emollient alone may soothe but is unlikely to control active plaques. Systemic corticosteroids are not a routine treatment for plaque psoriasis and can cause problems when withdrawn.
Question 2: Atopic dermatitis
This tests flare management and the role of regular skin-barrier care.
A 7-year-old with a history of itchy eczema has a flare of red, dry patches in the elbow creases. There is no fever, weeping or crusting. What is the most appropriate management?
An active atopic dermatitis flare is treated with a topical corticosteroid chosen for the child’s age and affected site, alongside regular emollient use. Flexures need particular care with potency and duration. Oral antibiotics are not indicated without evidence of bacterial infection; emollient alone may not settle active inflammation.
The practical distinction is between maintenance and flare treatment: emollients are useful regularly, while an appropriate topical anti-inflammatory is needed for active inflammation. Reassess if the eruption is not improving, looks infected or the diagnosis is uncertain.
Question 3: Scabies
This tests both treatment of the affected person and control of household reinfestation.
A 22-year-old reports intense itching that is worse at night. Several people in the household are also itchy, and examination shows small burrows at the finger webs. What is the best next step?
The pattern is typical of scabies. Permethrin 5% is a commonly used treatment; it must be applied according to local instructions and repeated after 7 days. Close contacts should be treated at the same time to reduce reinfestation. An antihistamine may ease itch but does not eradicate mites.
A correct treatment plan includes contact management and clear application instructions, not just a prescription for the person in the consultation. Itching can persist for a time after successful treatment; new burrows or ongoing spread should prompt a check of treatment technique and contacts.
Question 4: Suspected melanoma
This tests the diagnostic biopsy approach for a suspicious, accessible pigmented lesion.
A 48-year-old has an accessible pigmented lesion that has recently changed in shape and colour. Melanoma is suspected. Which biopsy approach is preferred when feasible?
When feasible, complete full-thickness excision with a narrow clinical margin allows assessment of the lesion and Breslow thickness. A shave can transect the base and compromise depth measurement; cryotherapy provides no diagnostic specimen. If complete excision is impractical, the biopsy plan should be made with an appropriate specialist.
Do not confuse the narrow margin used to obtain a diagnostic specimen with the wider margin that may be recommended for definitive treatment after histology. The latter depends on the pathology and local guidance.
Question 5: Basal cell carcinoma
This tests recognition of a common keratinocyte cancer pattern.
A 67-year-old has a slowly enlarging, shiny pink papule on the upper trunk with a raised rolled edge and fine surface telangiectasia. Which diagnosis is most likely?
A pearly or shiny papule with a rolled edge and telangiectasia is a typical clinical pattern for basal cell carcinoma. Actinic keratoses are usually rough, scaly lesions; melanoma is generally a pigmented lesion with concerning change, though appearances vary. Clinical suspicion should be followed by assessment appropriate to the lesion and setting.
Recognition is not the same as confirming a diagnosis: atypical lesions, uncertainty or a high-risk site may change the need for biopsy, referral or treatment choice. Check local pathways rather than assuming every lesion can be managed in the same way.
Question 6: Tinea capitis
This tests the key difference between fungal infection of the scalp and infection of the skin surface.
A 9-year-old has a scaly patch on the scalp with broken hairs and a small area of hair loss. Tinea capitis is suspected. Which treatment principle is correct?
Tinea capitis involves hair follicles and usually requires an oral antifungal; topical treatment alone does not reliably clear infection within the hair. An antifungal shampoo may be used as an adjunct to reduce transmission. The preferred oral drug can depend on the likely organism and local guidance, so confirm testing and prescribing choices locally.
Where available, fungal microscopy or culture can help identify the organism and guide treatment. Check local advice on treating contacts and reducing spread, particularly when there are other affected people in a household or community.
Question 7: Acne in pregnancy
This tests safe treatment selection when pregnancy changes the options.
A patient who is pregnant asks for treatment for mild facial acne with comedones and a few inflammatory papules. Which option is the most appropriate from those listed?
Topical azelaic acid is a commonly used option for acne in pregnancy. Topical retinoids such as adapalene are generally avoided during pregnancy, and oral isotretinoin is contraindicated because of serious fetal risk. Tetracyclines such as doxycycline are also avoided in pregnancy. Confirm treatment choices against local pregnancy and medicines guidance.
Always ask about pregnancy or pregnancy plans before choosing acne therapy. The important exam skill is not only naming an effective drug, but excluding treatments with significant pregnancy risk.
Question 8: Severe drug eruption
This tests the immediate priority in a potentially life-threatening skin reaction.
A patient develops widespread tender dusky patches, blistering and erosions of the mouth and eyes after starting a new medicine. What is the most appropriate immediate action?
Painful widespread dusky skin with blistering and mucosal involvement raises concern for a severe cutaneous adverse reaction, including Stevens–Johnson syndrome or toxic epidermal necrolysis. Stop the suspected culprit and arrange urgent hospital assessment. Waiting for routine review risks delay in a potentially life-threatening illness.
When the skin findings suggest severe drug toxicity, stabilisation and urgent specialist assessment take priority over refining the outpatient differential. Record the suspected medicine and timing, and use the local pathway for severe drug reactions.
Question 9: Bullous pemphigoid
This tests the most useful immunopathology test in a patient with tense blisters.
An older adult has intensely itchy, tense blisters on the trunk and limbs, with no oral erosions. Bullous pemphigoid is suspected. Which biopsy is most useful for direct immunofluorescence?
Direct immunofluorescence is performed on a perilesional skin sample, using the correct transport medium rather than routine formalin. Bullous pemphigoid typically shows linear IgG and/or C3 along the basement membrane zone. A separate lesional biopsy for routine histology may also be needed; follow the laboratory’s specimen instructions.
The specimen site and handling matter as much as ordering the test. If a biopsy is planned, check the receiving laboratory’s instructions so that tissue for routine histology and direct immunofluorescence is collected and sent appropriately.
Question 10: Necrotising soft-tissue infection
This tests whether a concerning feature should prompt urgent surgical assessment rather than delayed testing.
A patient with rapidly spreading erythema and swelling has severe pain out of proportion to the visible skin changes, systemic toxicity and crepitus. What is the most appropriate next step?
Pain out of proportion, rapid progression, systemic toxicity and crepitus are red flags for a necrotising soft-tissue infection. Urgent hospital and surgical assessment is required; imaging must not delay escalation when clinical concern is high. Routine outpatient review or oral treatment alone is unsafe in this presentation.
The common thread is prioritisation: recognise when an apparently dermatological problem is time-critical, and do not let a confirmatory test delay urgent assessment.
Review what you missed
After answering, sort errors by the decision they involved: diagnosis, investigation, treatment or urgency. A low score across several questions may reflect uncertainty about a core principle; a single error may instead point to one missed exception. The review panel might look like this:
Return to the source notes for the weakest section, then practise stating the decision and its reason in one or two sentences. For a repeated missed mark, a focused reminder can bring the exact distinction back into your next review:
You lost this mark twice: for a suspected melanoma, what diagnostic biopsy is preferred when feasible, and why should the margin be narrow?
How MySummaries helps
Build a General Dermatology board from your own notes, then use it to generate practice questions and review repeated errors. Open MySummaries to work from your course material.