KFP – Dermatological presentations

Felicity Roberts, aged 45, presents with a 2-week history of a worsening rash on her lower legs. She reports that it started as small red spots but has become increasingly painful and raised. She denies any recent insect bites or trauma. She has a history of type 2 diabetes and hypertension.

Medications: Metformin, perindopril

Allergies: Nil known

Past history: Type 2 diabetes (HbA1c 7.9%), hypertension

Family history: Father with coronary artery disease

Social history: Office worker, non-smoker

Examination findings: Bilateral lower legs with erythematous, tender, raised plaques with central clearing and areas of scaling. No systemic signs such as fever. No ulceration noted. Distal pulses present bilaterally. No peripheral neuropathy on monofilament testing. [Insert Image Here]

What are the most likely diagnoses? Select three (3) from the following list:

Jason McAllister, a 17-year-old high school student, presents with a 6-month history of persistent facial acne. He is distressed about his appearance and reports worsening of lesions, especially around exam periods. He has trialled over-the-counter benzoyl peroxide and a topical antibiotic cream from the pharmacy, with limited effect.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with parents, no smoking or alcohol. Reports increased stress and lack of sleep due to school exams. Not sexually active.

Examination findings: Multiple inflamed papules and pustules over the face, particularly the cheeks and jawline. Several closed comedones. No nodules or cysts. No scarring. No involvement of the chest or back. No features of virilisation. [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Helen Lawson, a 66-year-old retired farmer, presents for review of a lesion on her left cheek that she noticed three months ago. It began as a small red patch but has slowly grown and now bleeds intermittently. She has a history of basal cell carcinoma excision on her upper back five years ago.

Medications: Rosuvastatin

Allergies: Nil known

Past history: Hypercholesterolaemia, basal cell carcinoma

Social history: Lives alone in a rural area. Longstanding sun exposure due to farming. Non-smoker, drinks wine occasionally. No travel overseas.

Examination findings: 1.2 cm pearly papule with a rolled edge and telangiectasia on the left cheek. Slight central ulceration. No regional lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Natalie Singh, a 28-year-old kindergarten teacher, presents with a 3-day history of intensely itchy rash on her hands and wrists. Several children at her workplace have recently had similar complaints. Natalie notes that the rash is worse at night. She has tried moisturiser and an over-the-counter hydrocortisone cream, which has not helped.

Medications: Ethinyloestradiol/norgestimate (COCP)

Allergies: Nil known

Past history: Atopic dermatitis as a child

Social history: Lives with her partner. No recent travel. No pets.

Examination findings: Multiple erythematous papules and excoriations over the interdigital spaces, lateral aspects of fingers, and flexor surfaces of wrists. A few burrows are visible. No systemic symptoms. [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Stephen Tran, a 36-year-old FIFO worker, presents with a painful, rapidly enlarging lesion on his left thigh. He first noticed a small red pimple 3 days ago which has since grown in size and become fluctuant. He denies any systemic symptoms but is concerned due to increasing pain and difficulty walking.

Medications: Nil

Allergies: Nil known

Past history: Recurrent boils; otherwise well

Social history: Lives with wife and two children. Works in mining with 2-week-on/1-week-off roster. No recent travel. No pets.

Examination findings: 3 cm erythematous, fluctuant, tender nodule with central purulent point on the left anterolateral thigh. Surrounding cellulitis extending 1–2 cm. No regional lymphadenopathy. Afebrile. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Margaret Devlin, a 72-year-old woman, presents with a slowly enlarging rough patch on her right temple. She reports that it has been there for several months and occasionally feels itchy or slightly tender. She has a long history of sun exposure from years working in her garden and has had multiple previous actinic keratoses treated with cryotherapy.

Medications: Aspirin, amlodipine

Allergies: Nil known

Past history: Hypertension, previous actinic keratoses

Social history: Lives independently. Non-smoker. No alcohol use.

Examination findings: 1.5 cm hyperkeratotic, erythematous plaque with a rough surface and indistinct border on the right temple. No ulceration. No lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Aliyah Chowdhury, a 6-year-old girl, presents with her mother due to a spreading rash on her scalp over the past two weeks. Her mother reports associated mild itching and a patch of hair loss. No other family members are affected, but Aliyah recently started at a new primary school. Her mother has tried an anti-dandruff shampoo without improvement.

Medications: Nil

Allergies: Nil known

Past history: No significant medical history

Social history: Lives with parents and younger sibling. Family recently adopted a kitten from a shelter.

Examination findings: A 3 cm annular patch of hair loss with overlying erythema and scaling is noted on the occipital scalp. Broken hairs and black dots are visible within the patch. No cervical lymphadenopathy. No other lesions noted. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

George Papadopoulos, a 60-year-old man, presents with a recurrent itchy rash in both axillae over the past month. He describes redness, scaling, and occasional fissuring. He denies any systemic symptoms, fever, or new personal care products. He has recently started going to the gym and notes increased sweating. His diabetes has been stable on metformin.

Medications: Metformin

Allergies: Nil known

Past history: Type 2 diabetes

Social history: Lives with partner, non-smoker, works as a delivery driver

Examination findings: Bilateral erythematous plaques with scaling and maceration in the axillae, with some satellite papules at the periphery. No systemic signs. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Emily Waters, a 32-year-old woman, presents with an outbreak of painful blisters on her lips and surrounding skin. She reports a tingling sensation 24 hours before the appearance of grouped vesicles. She has had similar episodes before, particularly during periods of stress or illness. She is otherwise well.

Medications: Occasional paracetamol

Allergies: Nil known

Past history: Recurrent herpes labialis

Social history: Works as a nurse. Non-smoker. No recent travel.

Examination findings: Grouped vesicles on an erythematous base at the right vermilion border of the lip, some crusting present. No oral ulceration. No systemic symptoms. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Michael Robinson, a 52-year-old office worker, presents with a non-itchy pigmented lesion on his upper back that his partner noticed had changed in size and colour over the past 3 months. He has a history of significant sun exposure from years of surfing and has never had a skin check before.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Non-smoker, occasional alcohol use. Lives with partner.

Examination findings: Asymmetrical pigmented lesion, 9 mm in diameter with irregular borders and variegated colours (tan, brown, black) on the upper back. No ulceration or bleeding. No palpable regional lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Chloe Fraser, a 24-year-old university student, presents with a 5-day history of a painful, red area on her right lower leg. She recalls nicking her leg while shaving the week prior. The area has progressively worsened with increasing pain, swelling, and redness. She reports feeling feverish but has not checked her temperature.

Medications: Nil

Allergies: Nil known

Past history: Atopic dermatitis as a child

Social history: Lives in a student apartment, no pets, non-smoker

Examination findings: 6 x 8 cm erythematous, warm, tender, swollen plaque on the right anterior shin with poorly defined borders. No fluctuance. Small abrasion noted centrally. No crepitus. Temperature 38.2°C. No lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Jacob Elwood, a 10-year-old boy, presents with a 2-day history of rapidly spreading crusty lesions around his nose and mouth. His mother reports that he recently had a cold and was frequently rubbing his nose. The lesions began as red spots and quickly developed into golden, oozing crusts. He is otherwise well and afebrile.

Medications: Nil

Allergies: Nil known

Past history: Mild asthma

Social history: Attends primary school, lives with parents and two siblings

Examination findings: Several erythematous plaques with thick golden-yellow crusts around the nares and perioral region. No lymphadenopathy. No systemic signs. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Thomas Bell, a 40-year-old man, presents with an intensely itchy rash on his arms and legs that began 4 days ago after hiking through bushland in northern Queensland. He describes red, raised lines that appeared suddenly and have since spread. He denies any systemic symptoms. He has no prior history of eczema or allergies.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as an electrician, recently returned from a camping trip. No recent travel overseas.

Examination findings: Excoriated linear erythematous papules and burrow-like tracks on wrists, between fingers, ankles and lower abdomen. No lymphadenopathy. No signs of secondary infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Angela Martin, a 48-year-old woman, presents with a 2-month history of a persistent, scaly red rash on the lateral aspects of both elbows and knees. She reports mild itchiness but is mostly concerned about the cosmetic appearance. The rash has not improved with moisturisers. There is no joint pain or nail involvement.

Medications: Nil

Allergies: Nil known

Past history: Mild seasonal hay fever

Family history: Father with psoriasis and type 2 diabetes

Social history: Office worker, no recent travel

Examination findings: Well-demarcated erythematous plaques with silvery scale over both extensor elbows and knees. No excoriations. No signs of infection. Nails appear normal. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Brian O’Leary, a 72-year-old retired farmer, presents with a slowly enlarging lesion on his lower lip. He reports that it began as a scaly patch several months ago and has since become thicker and occasionally bleeds after eating. He is a lifelong smoker and has significant sun exposure history.

Medications: Aspirin, atorvastatin

Allergies: Nil known

Past history: Hypertension, previous actinic keratoses

Social history: Former sheep grazier, extensive outdoor work history, ex-smoker (40 pack-year history)

Examination findings: 1.2 cm indurated, scaly, crusted lesion with slight ulceration on the lower vermilion border. The lesion is firm to palpation. No palpable regional lymph nodes. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Sarah Khalil, a 19-year-old university student, presents with sudden onset of multiple red, scaly spots on her trunk and proximal limbs. She reports having had a sore throat two weeks ago which resolved without antibiotics. The rash is slightly itchy. She has no significant past medical history and is not on any medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives in student accommodation, no recent travel, non-smoker

Examination findings: Numerous small erythematous scaly papules with fine collarette of scale, distributed over the trunk and proximal extremities. A larger herald patch is noted on the right flank. Face, palms, and soles are spared. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Linda Hughes, a 62-year-old woman, presents with a longstanding itchy rash under her breasts, which flares intermittently. She describes redness, mild discomfort, and occasional fissuring, particularly in warmer weather. She has tried moisturisers and talcum powder without sustained benefit. She has a BMI of 32.

Medications: Atorvastatin, perindopril

Allergies: Nil known

Past history: Hypertension, hyperlipidaemia

Social history: Retired, lives with husband, no smoking or alcohol use

Examination findings: Bilateral erythematous plaques with maceration and satellite pustules under both inframammary folds. No systemic signs. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Dominic Wu, a 33-year-old man, presents with a painful, blistering rash on the right side of his chest. He reports a tingling and burning sensation for two days before the rash appeared yesterday. The rash has been progressively worsening and is very tender to touch. He is otherwise well with no significant medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: IT worker, lives alone, non-smoker

Examination findings: Clusters of vesicles on an erythematous base following a dermatomal pattern along the right T5 distribution. No midline crossover. No signs of bacterial superinfection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Eva Dimitriou, a 9-month-old girl, is brought in by her mother due to a persistent rash in the nappy area. The rash has been present for the past week and has not responded to barrier creams. The mother reports the rash worsens after bowel motions. Eva is otherwise well, feeding and growing normally.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with parents, attends day care three days a week

Examination findings: Erythematous rash with confluent plaques and satellite pustules involving the perianal area, buttocks, and extending into the inguinal folds. No systemic symptoms. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Joshua Reid, a 29-year-old builder, presents with an intensely itchy rash between his toes, present for the past two weeks. He reports excessive sweating and wearing work boots all day. The rash started as peeling skin and is now red, scaly, and macerated. He denies systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with partner, no pets, non-smoker

Examination findings: Interdigital erythema, maceration, and scaling between the fourth and fifth toes bilaterally. No vesicles, ulceration, or signs of bacterial infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Laura Nguyen, a 26-year-old woman, presents with a single, firm, round lesion on her right forearm that has slowly enlarged over the past 6 months. It is asymptomatic, but she is concerned about the appearance. She denies any trauma to the area. There are no other skin lesions and she is otherwise well.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works in retail, no smoking or alcohol, no recent travel

Examination findings: A 1.5 cm dome-shaped, firm, hyperpigmented nodule with a central dimple on lateral pressure (‘dimple sign’) on the right forearm. No surrounding inflammation. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Kevin Liu, a 36-year-old man, presents with a chronic rash on his hands that has been present for over 3 months. He works as a hairdresser and reports dryness, cracking, and itching of both hands, worse after washing hair or cleaning. He has used moisturisers with minimal relief. He has no relevant medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with partner, non-smoker, uses latex gloves at work

Examination findings: Bilateral dry, erythematous, lichenified plaques on the dorsal and palmar surfaces of the hands, with some fissuring. No vesicles or pustules noted. No signs of secondary infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Emily Grant, a 15-year-old girl, presents with a 3-month history of multiple rough, skin-coloured papules on her fingers and around her nails. They are not painful but she finds them embarrassing and reports that they’ve been slowly increasing in number. She is otherwise well.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Attends high school, plays netball, no smoking or alcohol

Examination findings: Several verrucous papules with a rough surface over the dorsal fingers and periungual area. No signs of inflammation, ulceration, or pain. No lesions elsewhere. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Helen Forsyth, a 58-year-old woman, presents with multiple rough, scaly patches on the dorsum of both hands. She reports they have been present for several months and occasionally feel tender or itch. She has a history of high sun exposure due to gardening and beach walking. She is concerned about skin cancer.

Medications: HCTZ, calcium carbonate

Allergies: Nil known

Past history: Hypertension, osteoporosis

Social history: Retired, lives with husband, non-smoker

Examination findings: Multiple 4–8 mm erythematous, rough, sandpaper-like macules and papules scattered across the dorsal hands. No ulceration or induration. No lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Sophia Richards, a 4-year-old girl, is brought in by her father due to the sudden appearance of multiple, small, dome-shaped lesions on her torso and upper arms over the past few weeks. The lesions are asymptomatic and not painful or itchy. She attends day care regularly and is otherwise well.

Medications: Nil

Allergies: Nil known

Past history: Atopic dermatitis in infancy

Social history: Lives with parents and younger brother. No pets. Up-to-date with immunisations.

Examination findings: Multiple 2–4 mm pearly, umbilicated papules on the trunk and proximal upper limbs. No surrounding erythema or signs of infection. No mucosal involvement. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Anthony Russo, a 44-year-old man, presents with a pigmented lesion on the plantar aspect of his left foot. He reports that it has been present for a few years but has recently changed in shape and become darker. He works as a chef and is on his feet most of the day. No other symptoms are reported.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Non-smoker, lives with wife and two children

Examination findings: A 7 mm asymmetrical, irregularly pigmented macule with irregular borders on the plantar arch. No ulceration, but darker pigmentation at the periphery. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

James Hill, a 72-year-old man, presents with a persistent, scaly lesion on his left temple. He reports that it occasionally bleeds when he shaves and has slowly increased in size over the past 6 months. He has a history of sun damage and several previous actinic keratoses treated with cryotherapy.

Medications: Aspirin, perindopril

Allergies: Nil known

Past history: Hypertension, previous non-melanoma skin cancers

Social history: Retired builder, extensive outdoor exposure, non-smoker

Examination findings: A 1.2 cm erythematous, scaly plaque with central erosion and rolled border on the left temple. Telangiectasia visible within the lesion. No regional lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Olivia Brown, a 22-year-old woman, presents with a painful red rash in the groin area. She reports it developed over the past week and is getting worse. It started as redness and burning after shaving and now includes a few small pustules. She denies systemic symptoms or vaginal discharge.

Medications: COCP (ethinylestradiol/levonorgestrel)

Allergies: Nil known

Past history: Mild acne, no history of STI

Social history: Sexually active with one partner, uses condoms inconsistently

Examination findings: Bilateral erythema in the inguinal folds with scattered follicular pustules and papules. No fluctuance. No ulceration. No lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

David Youssef, a 38-year-old man, presents with a well-demarcated, red, scaly rash on the soles of both feet. He reports mild itching and occasional fissuring, especially after work. He wears steel-capped boots all day and often has sweaty feet. No other body areas are affected. He has tried moisturisers with minimal improvement.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as a mechanic, lives with partner, non-smoker

Examination findings: Bilateral plantar scaling with erythema and fine fissures. No vesicles or maceration between the toes. Nails appear normal. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Amira Hassan, a 30-year-old woman, presents with a persistent red rash around her mouth and chin for the past 3 weeks. She reports mild burning and tightness, especially after using her facial moisturiser. The rash worsened after she applied a topical steroid cream that had previously been prescribed for eczema. She is otherwise well and denies systemic symptoms.

Medications: Occasionally uses over-the-counter hydrocortisone cream

Allergies: Nil known

Past history: Atopic dermatitis in childhood

Social history: Works as a receptionist, no recent travel, non-smoker

Examination findings: Perioral erythema with small papules and pustules around the mouth and chin, sparing the vermilion border. No comedones. No crusting or ulceration. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Ravi Prasad, a 42-year-old man, presents with several new skin lesions on his upper back and shoulders. He reports that the patches are lighter than the surrounding skin and have become more noticeable after returning from a beach holiday. He denies any itch or pain. He has no known skin conditions and is otherwise well.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Office worker, recently returned from Queensland

Examination findings: Multiple hypopigmented, scaly macules coalescing into patches over the upper back and shoulders. KOH test from skin scraping reveals hyphae and spores (spaghetti and meatballs appearance). [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Michael Chan, a 65-year-old man, presents with a slowly enlarging lesion on the left helix of his ear. He reports it began as a small nodule about 8 months ago and has gradually grown. It occasionally bleeds after he wears a hat or uses headphones. He has a long history of sun exposure due to working outdoors in construction.

Medications: Atorvastatin, aspirin

Allergies: Nil known

Past history: Hypertension, solar keratoses

Social history: Retired builder, ex-smoker, lives with partner

Examination findings: A 1.1 cm firm, pearly nodule with telangiectasia and a central ulcer on the upper part of the left ear. No palpable lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Leah Anderson, a 7-year-old girl, is brought in by her mother due to a persistent scaly patch on her scalp. It began as a small area of redness and hair thinning two weeks ago and has since enlarged. Leah complains of mild itching but is otherwise well. No other family members are affected, but the family recently adopted a puppy from a shelter.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with parents and two siblings, attends primary school

Examination findings: A 3 cm circular, scaly, alopecic patch on the occipital scalp with broken hairs and black dots. No lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Natalie Brooks, a 34-year-old woman, presents with a persistent, non-healing sore on her right lower leg. She first noticed it after bumping her shin on a bedframe two months ago. The lesion occasionally bleeds and forms a crust but never completely heals. She has a long history of varicose veins and chronic lower limb swelling.

Medications: Compression stockings, paracetamol as needed

Allergies: Nil known

Past history: Chronic venous insufficiency

Social history: Office worker, lives alone, non-smoker

Examination findings: A 1.4 cm ulcerated lesion with a rolled, pearly edge and visible telangiectasia on the anterior right lower leg. Surrounding skin shows signs of venous stasis (hyperpigmentation, oedema). No lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Isabelle Tran, a 2-year-old girl, is brought in by her parents with a widespread, itchy rash that developed over the past week. It started on her abdomen and has now spread to her arms, legs, and groin. Her older brother had a similar rash two weeks ago and was treated by their GP. The parents have noticed increased scratching at night.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Attends day care, lives with parents and two siblings

Examination findings: Multiple erythematous papules and excoriations on the trunk, wrists, interdigital spaces, and groin. Burrows are visible on the palms. No signs of secondary infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Greg Thompson, a 68-year-old man, presents with a persistent sore on his lower lip that bleeds easily and has not healed over the past 3 months. He is a retired farmer with a significant history of sun exposure and reports smoking for 40 years. He denies pain but notes that the lesion has recently increased in size.

Medications: Perindopril, atorvastatin

Allergies: Nil known

Past history: Hypertension, actinic keratoses

Social history: Lives with wife, retired, 40 pack-year smoking history

Examination findings: A 1.5 cm ulcerated, indurated lesion with raised edges on the lower vermilion border of the lip. No cervical lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Eliza Cartwright, a 27-year-old woman, presents with a painful, red lesion on her left axilla that has developed over the past 3 days. She reports similar episodes over the past year in both axillae and groin, often after menstruation. The current lesion is tender, has no visible pus, and has not responded to warm compresses. She is otherwise well.

Medications: COCP (ethinylestradiol/levonorgestrel)

Allergies: Nil known

Past history: Recurrent boils, mild acne

Social history: Works in hospitality, non-smoker, no alcohol

Examination findings: A 2 cm firm, tender, subcutaneous nodule in the left axilla with overlying erythema. No fluctuation. No systemic signs. Several post-inflammatory hyperpigmented scars noted in both axillae and groin. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Stephen Marks, a 52-year-old man, presents with a rash on his upper chest and back that has worsened over the past few months. He describes it as greasy, flaky, and sometimes itchy. It improves slightly in summer and worsens in winter. He has a history of mild Parkinson’s disease diagnosed 1 year ago and is taking levodopa-carbidopa.

Medications: Levodopa-carbidopa, perindopril

Allergies: Nil known

Past history: Parkinson’s disease, hypertension

Social history: Retired schoolteacher, lives with wife, non-smoker

Examination findings: Well-demarcated erythematous plaques with yellowish greasy scale over the central chest, nasolabial folds, eyebrows, and postauricular area. No pustules or signs of secondary infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Emma D’Souza, a 45-year-old woman, presents with several skin-coloured bumps on her face that have gradually increased in number over the past year. She is concerned about their cosmetic appearance. The lesions are asymptomatic and she denies any bleeding or irritation. She has oily skin but no history of acne or other dermatological conditions.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as an accountant, wears makeup daily, non-smoker

Examination findings: Multiple 1–2 mm smooth, firm, dome-shaped, skin-coloured papules clustered around the cheeks and periorbital area. No erythema, scaling, or central punctum. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Andre Lewis, a 59-year-old man, presents with a painful, expanding lesion on his left calf that developed rapidly over the past 3 days. He first noticed a small red area which has now become swollen and hot, with surrounding erythema and tenderness. He denies any trauma or insect bite but recalls gardening recently. He has a fever of 38.2°C.

Medications: Amlodipine

Allergies: Nil known

Past history: Type 2 diabetes (diet-controlled)

Social history: Lives alone, retired, no recent travel, non-smoker

Examination findings: A 10 x 7 cm erythematous, warm, tender, and indurated plaque on the left calf with poorly defined borders. No purulent discharge or necrosis. No lymphadenopathy. Capillary refill and pulses intact. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Melissa Huang, a 32-year-old woman, presents with a sudden onset of widespread urticarial rash over her torso and limbs. The rash appeared approximately two hours after she ate prawns at a restaurant. She reports intense itchiness but no difficulty breathing, wheezing, tongue swelling, or light-headedness. She has a history of mild hay fever and eczema.

Medications: Nil

Allergies: Nil known

Past history: Atopic dermatitis, allergic rhinitis

Social history: Non-smoker, no recent travel, works as a teacher

Examination findings: Diffuse raised erythematous wheals across the chest, back, arms, and thighs. No facial swelling or signs of airway compromise. Vitals: HR 84 bpm, BP 118/76 mmHg, RR 16, SpO2 99% RA, Temp 36.8°C. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Samuel Li, a 61-year-old man, presents with a persistent, red scaly plaque on his left cheek that has been slowly enlarging over the past year. He reports occasional itching and flaking but no bleeding or pain. He has fair skin and a history of outdoor work as a landscaper.

Medications: Simvastatin

Allergies: Nil known

Past history: Actinic keratoses, hypertension

Social history: Retired landscaper, ex-smoker, extensive sun exposure

Examination findings: A 1.8 cm erythematous, well-demarcated, scaly plaque on the left malar region. The lesion is not indurated or ulcerated. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Ayesha Patel, a 40-year-old woman, presents with small vesicles and intense itching on the lateral aspects of her fingers. The rash flares intermittently, often during periods of stress or warmer weather. She has a history of atopic eczema and uses hand moisturisers regularly. There is no systemic involvement.

Medications: Cetirizine PRN

Allergies: Nil known

Past history: Atopic dermatitis

Social history: Works as a nurse, washes hands frequently, non-smoker

Examination findings: Clusters of small, clear vesicles on the lateral edges of several fingers and palms. Skin is erythematous with some areas of lichenification. No pustules or signs of infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Victor Kowalski, a 47-year-old man, presents with a single, scaly, erythematous plaque on his left elbow that has persisted for several months. It is well-demarcated and occasionally itchy but not painful. He has a similar but smaller lesion on his right knee. He reports that his father had similar skin issues in the past.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Builder, daily sun exposure, non-smoker

Examination findings: A 3 cm well-demarcated, erythematous plaque with silvery scale on the extensor surface of the left elbow. Smaller similar lesion noted on right knee. No nail pitting or joint swelling. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Leo Adams, a 14-year-old boy, presents with multiple small, brown, flat lesions on his trunk that have gradually increased in number over the past year. They are asymptomatic and were first noticed during a school swimming carnival. His parents are concerned about possible skin cancer. He has no other symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with parents and two siblings, attends high school

Examination findings: Numerous 2–5 mm uniform, flat, hyperpigmented macules scattered over the chest and back. All lesions are well circumscribed, with even pigmentation and no surface change. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Gina Marquez, a 62-year-old woman, presents with a painful rash on the right side of her chest that developed 3 days ago. She initially experienced a burning sensation in the area followed by the appearance of red patches and grouped blisters. The rash has not crossed the midline. She is otherwise well but describes moderate pain that is interfering with sleep.

Medications: Ramipril, atorvastatin

Allergies: Nil known

Past history: Hypertension, chickenpox as a child

Social history: Lives alone, retired, non-smoker

Examination findings: Unilateral, dermatomal vesicular rash with grouped vesicles on an erythematous base along the right T6 dermatome. No signs of secondary infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Thomas Nguyen, a 25-year-old man, presents with a sudden outbreak of painful pustules and inflamed nodules on his back and chest. He has a history of moderate acne and started a new gym supplement regimen including whey protein and anabolic steroids two months ago. He denies systemic symptoms but is distressed about the appearance of the lesions.

Medications: Nil prescribed

Allergies: Nil known

Past history: Acne vulgaris, mild asthma

Social history: Works as a personal trainer, non-smoker, uses anabolic steroids intermittently

Examination findings: Numerous inflammatory papules, pustules, and nodules on the chest, shoulders, and back. No cysts or scarring. Face is minimally affected. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Sandra Matthews, a 74-year-old woman, presents with a slowly growing lesion on her scalp that has become tender and intermittently bleeds. It has been present for over a year but has noticeably increased in size over the past 2 months. She has a history of actinic keratoses and extensive sun exposure from working outdoors.

Medications: Calcium carbonate, bisoprolol

Allergies: Nil known

Past history: Osteoporosis, hypertension, multiple actinic keratoses

Social history: Retired farmer, lives alone, non-smoker

Examination findings: A 2.2 cm ulcerated, indurated lesion with raised everted edges on the vertex of the scalp. Scattered solar keratoses noted on the forehead and temples. No regional lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Nathan Ross, a 34-year-old Aboriginal man, presents with an itchy, dry rash in both antecubital fossae that has persisted for months. He reports it flares with stress and hot weather. He uses soap frequently at work as a chef and has recently started using a new scented body wash. He has no systemic symptoms and no family history of psoriasis.

Medications: Nil

Allergies: Nil known

Past history: Childhood eczema

Social history: Lives with partner and children, drinks socially, non-smoker

Examination findings: Bilateral, poorly demarcated erythematous patches with lichenification and excoriations in the antecubital fossae. No vesicles or pustules. No signs of secondary infection. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Brenda O’Neill, a 66-year-old woman, presents with a pearly papule on her right lower eyelid that has been slowly enlarging over the past 8 months. It occasionally crusts but is not painful. She has a history of extensive sun exposure and previously had a basal cell carcinoma removed from her cheek five years ago.

Medications: Hydrochlorothiazide, calcium carbonate

Allergies: Nil known

Past history: Basal cell carcinoma, osteopenia

Social history: Retired teacher, enjoys gardening, non-smoker

Examination findings: A 6 mm pearly nodule with central ulceration and telangiectasia on the right lower eyelid margin. No conjunctival involvement or lymphadenopathy. [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list: