How to practise general dermatology viva questions
General dermatology viva questions test more than whether you can name a rash. You need to describe what you see, make a prioritised differential, recognise danger, and explain what you would do next. A sound answer is structured enough to follow but flexible enough to respond to new information from the examiner.
There is no single international “General Dermatology” viva format. Your exam may be part of a broader qualification or local assessment, so check the relevant examining body’s website for its actual format and published criteria. The stations below are practice cases, not claims about a particular exam.
Use this sequence when you meet a case:
- Clarify and assess urgency. Ask about onset, speed of spread, symptoms, systemic illness, medicines and relevant exposures. If the patient sounds acutely unwell, say so and address immediate safety first.
- Describe before naming. State the primary lesion, colour, surface, distribution and any mucosal or nail involvement. Avoid jumping straight to a diagnosis.
- Give a short, ranked differential. Name the most likely diagnosis, then one or two alternatives that would change your next step.
- Say what would distinguish them. Ask focused questions and choose examination or investigations that answer a specific clinical question.
- Manage and safety-net. State the immediate plan, appropriate referral or follow-up, and the change that should prompt urgent review.
In MySummaries, the examiner view for this practice set makes the answer priorities visible. It represents a general practice persona, not an official examiner or published marking scheme.
Choose a station and set a task
Practise aloud rather than only reading model answers. Give yourself a clear task: for example, “I will describe the eruption, name my leading diagnosis, and explain the immediate management.” If you have a study partner, ask them to interrupt with new findings after your opening answer. If you practise alone, pause after the opening question and answer before reading the feedback.
The following set moves from common inflammatory disease to a potentially life-threatening eruption and a suspicious pigmented lesion. The opening questions are prompts for practice, not scripts you must memorise.
In MySummaries, these stations sit together so you can repeat a difficult case and compare attempts over time.
Station 1: plaques on the elbows and scalp
Opening question: “A 34-year-old has well-demarcated scaly plaques on the elbows and scalp. How would you assess and manage them?”
Start with the description: sharply demarcated erythematous plaques with scale on extensor elbows and scalp are consistent with plaque psoriasis. Then check the history and distribution rather than assuming every scaly plaque is psoriasis. Ask about duration, itch or pain, previous episodes, treatments, triggers, family history and the effect on daily life. Examine the scalp, nails, flexures and other skin sites. Ask about joint pain, stiffness and swelling because possible psoriatic arthritis changes the plan.
Your opening should not get stuck in a long differential. Mention that eczema, seborrhoeic dermatitis or a fungal infection may be relevant if the morphology or distribution is atypical. Explain what would make you reconsider the diagnosis, such as an unusual pattern, treatment failure or diagnostic uncertainty.
In MySummaries, this recorded answer is marked against practice criteria for description, clinical reasoning, management and communication. Those are the platform’s feedback categories, not an official exam rubric.
Examiner
A 34-year-old has well-demarcated scaly plaques on the elbows and scalp. How would you assess and manage them?
You identified well-demarcated scaly plaques at typical sites.
ImproveSay explicitly whether the lesions are erythematous and whether nails or flexures are involved.
Psoriasis was your leading diagnosis and you gave reasonable alternatives.
ImproveExplain which atypical features would make you reconsider psoriasis.
You asked about itch and daily impact.
ImproveAsk specifically about joint pain, stiffness and swelling, and examine the nails.
You mentioned topical treatment but did not link treatment to site or severity.
ImproveDescribe an emollient and site-appropriate topical anti-inflammatory plan, review response, and consider specialist input for extensive or difficult disease.
A strong answerThe well-demarcated scaly plaques on the extensor elbows and scalp are typical of plaque psoriasis. I would ask about duration, itch, previous treatment, impact on daily life and joint symptoms, and examine the scalp, nails, flexures and other skin. If the appearance is atypical, I would reconsider diagnoses such as eczema or fungal infection and investigate only as indicated. I would discuss regular emollient use and a topical treatment appropriate to the site, with clear instructions and review of response. Extensive, difficult-to-control disease or suspected psoriatic arthritis would prompt appropriate specialist assessment.
That is a MySummaries station, filled with general dermatology material. Yours is written from your own notes. Start free
A useful improvement here is to make treatment site-specific without reciting a drug list. Scalp and facial skin do not necessarily call for the same preparation or potency as thick plaques on the elbows. State that the plan depends on location, extent, prior treatment and local guidance. In a real consultation, explain how to use the treatment and when to return if it is not working or the diagnosis is uncertain.
Station 2: painful rash with mucosal sores
Opening question: “A patient develops a painful spreading rash and mouth erosions after starting a new medicine. What is your immediate approach?”
This prompt tests whether you put safety before a polished differential. Painful skin, mucosal erosions and a recent medicine raise concern for a severe drug reaction, including Stevens–Johnson syndrome or toxic epidermal necrolysis. Do not diagnose from a short description alone; treat the presentation as urgent and arrange immediate hospital assessment. Ask about the medicine name, start date, dose changes and other recent medicines, but do not let the history delay escalation.
Your first response should mention general clinical stability and the need for urgent assessment by an appropriate hospital team. State that suspected culprit medicines need prompt review and that a possible severe drug reaction should not be rechallenged casually. Give a focused description of skin pain, blistering or detachment, mucosal sites and systemic symptoms. Further treatment decisions belong with the assessing clinical team and local protocols.
In MySummaries, the next recording shows how a concise safety-first answer can still explain the reasoning.
Examiner
A patient develops a painful spreading rash and mouth erosions after starting a new medicine. What is your immediate approach?
You recognised that painful skin and mucosal involvement are concerning.
ImproveState plainly that a severe drug reaction is possible and needs urgent hospital assessment.
You escalated rather than proposing routine outpatient review.
ImproveLead with escalation and assessment of the patient's overall clinical stability.
You asked about a new medicine but did not establish timing or other recent medicines.
ImproveAsk for medicine names, start dates, recent changes and associated symptoms without delaying referral.
You mentioned stopping a possible culprit but left the plan vague.
ImproveSay the suspected medicines need urgent review by the treating team and that rechallenge should be avoided unless specialists advise otherwise.
A strong answerI am concerned about a severe cutaneous drug reaction, including Stevens–Johnson syndrome or toxic epidermal necrolysis, because the rash is painful and there are mouth erosions after a new medicine. This needs immediate hospital assessment, and I would first consider the patient’s overall clinical stability and arrange urgent escalation. I would establish the names and start dates of all recent medicines, any dose changes, and whether the eyes or other mucosal sites are involved. The suspected culprit medicines need urgent review by the treating team, and I would not recommend an unsupervised rechallenge. I would document the suspected reaction and follow the local specialist pathway.
Notice the order: concern, escalation, focused history, safe handling of medicines. A common weak answer is to spend too long naming every possible rash before saying what should happen now. If an examiner adds that the patient is unwell or has eye involvement, respond to the new information directly and reinforce urgent assessment.
Station 3: a changing pigmented lesion
Opening question: “A 52-year-old says a mole has changed over several months. Talk me through your assessment and next steps.”
Ask what has changed and over what period: size, shape, colour, elevation, symptoms or bleeding. Ask about personal history of skin cancer and relevant risk factors, but do not let a risk-factor checklist replace examination. Describe the lesion and compare it with the patient’s other naevi. Look for asymmetry, an irregular border, variation in colour and evolution; no single feature should be used to dismiss a changing lesion.
Explain that a lesion suspicious for melanoma needs prompt assessment through the appropriate local pathway. The exact referral route and biopsy approach depend on the health system and clinical circumstances, so do not invent a deadline or universal procedure. If asked about investigations, say that dermoscopic assessment by a suitably trained clinician may help, while histology is required for diagnosis. Avoid reassurance based only on a patient’s age or the lesion’s small size.
In MySummaries, the third recording rewards a clear description and a definite next step rather than a confident guess about staging.
Examiner
A 52-year-old says a mole has changed over several months. Talk me through your assessment and next steps.
You asked about change and symptoms.
ImproveClarify the timing and type of change, and ask about personal skin-cancer history.
You covered asymmetry, border, colour and evolution.
ImproveCompare the lesion with the patient's other naevi and describe its site and appearance clearly.
You identified a changing lesion as requiring prompt assessment.
ImproveName the appropriate local urgent pathway rather than giving an unsupported universal deadline.
You mentioned specialist assessment but were unclear about confirmation.
ImproveSay that histology is needed for diagnosis and avoid guessing a stage from appearance alone.
A strong answerI would clarify what has changed, how quickly, and whether there has been growth, colour change, bleeding or itching. I would examine and describe the lesion, including asymmetry, border, colour and evolution, and compare it with the patient’s other naevi. A changing pigmented lesion suspicious for melanoma needs prompt assessment through the appropriate local pathway. Dermoscopy may assist assessment when performed by a trained clinician, but histology is needed to establish the diagnosis. I would not infer the stage or offer reassurance based only on one feature of the lesion.
After each station, review the actual words you used. Did you name the danger early? Did you describe what you saw before giving a diagnosis? Did you give a next step that a colleague could act on? Record one sentence you want to improve and repeat the answer with that change. The aim is not to memorise a paragraph; it is to make your reasoning audible.
In MySummaries, the transcript below highlights one phrase that sounded decisive but did not tell the examiner what action you would take.
This could be melanoma because the lesion has changed. I would refer them urgently. I would also ask about bleeding and previous skin cancer. I would confirm the stage from the dermoscopic appearance.
I would refer them urgently.
You communicated concern, but did not name the route or explain that the pathway depends on the local health system. The staging statement also goes beyond what appearance alone can establish.
Say: I would arrange prompt assessment through the appropriate local skin-cancer pathway; histology is needed to confirm the diagnosis, and I would not infer stage from appearance alone.Make each attempt useful
A simple review routine keeps practice specific:
- Before speaking: identify the station’s main risk and choose a structure. For the acute drug eruption, safety comes first; for the changing mole, describe and escalate; for psoriasis, assess extent, impact and joints as well as the plaques.
- After speaking: write down one omission, not a dozen. Choose the omission most likely to change safety or management.
- Repeat: answer again, adding the missing point without turning the response into a lecture.
- Transfer: practise the same structure on a different presentation. For example, with itchy widespread eczema, ask about sleep, infection and triggers, assess distribution and severity, and make a treatment and follow-up plan. Do not assume every itchy rash is eczema; consider alternatives such as contact dermatitis or scabies when the history and pattern suggest them.
If you are using a study partner, ask them to probe your reasoning with one new fact: “The rash is painful,” “the patient has eye symptoms,” or “the lesion has bled.” Practise changing your plan when the case changes. If you are working alone, record the answer and listen for vague phrases such as “I would investigate” or “I would refer”. Replace them with the question the investigation answers or the pathway you would use, while checking local guidance for details.
How MySummaries helps
Build a board from your own dermatology notes, then practise recorded viva stations based on that material. The examiner-style feedback can help you spot an omitted safety point, a thin explanation or a phrase to make more specific. Start at portal.mysummaries.app.