1.A 5yo boy was brought to GP with high temp and many vesicles on his back. What is the most
appropriate management?
a. Topic acyclovir
b. Oral acyclovir
c. Oral antibiotics
d. Topical steroids
e. None
answer: E
Generalized vesicles = chicken pox
Symptomatic management
2.A 14yo girl has developed an itchy, scaly patch on her scalp. She had a similar patch that cleared
spontaneously 2yrs ago. Her aunt has a similar undiagnosed rash on the extensor aspects of her
elbows and knees. What is the single most likely dx?
a. Eczema
b. Fungal infection
c. Impetigo
d. Lichen planus
e. Psoriasis
answer: E
Psoriasis : Plaques red silvery scales
distribution: extensor surfaces, palms, soles, scalp, sacral area
3.A pt presents with purple papular lesions on his face and upper trunk measuring 1-2 cm across.
They aren’t painful or itchy. What is the single most likely dx?
a. Kaposi’s sarcoma
b. Hairy leukoplakia
c. Cryptosporidium
d. CMV infection
e. Cryptococcal infection
4.A 35yo woman has had bruising and petechiae for a week. She has also had recent menorrhagia
but is otherwise well. Blood: Hgb=11.1, WBC=6.3, Plt=14. What is the single most likely dx?
a. Acute leukemia
b. Aplastic anemia
c. HIV infection
d. ITP
e. SLE
answer: D
Acute immune thrombocytopenia
ITP is caused by IgG autoimmune antibody to platelet cell membrane antigens leading to platelet destruction in the spleen and liver.
Presentation
• Most present between ages of 2 and 5yrs, but can occur at any age.
• 60% have preceding viral infection, e.g. upper respiratory tract infection
(URTI).
• Bruising, purpura, petechiae, mucosal bleeding, menorrhagia.
• Intracranial bleeds very rare (< 0.5%); often associated with trauma.
• Physical examination otherwise usually normal, e.g. no splenomegaly.
Investigation
• FBC: platelet count low, commonly platelet size increased due to compensatory megakaryocytosis. Otherwise FBC is usually normal.
• Testing for platelet antibodies is not clinically useful.
• Bone marrow in ITP normal, but striking increase in megakaryocytes.
Generally, bone marrow aspirate not indicated if the child is otherwise well, unless concurrent pancytopenia, hepatosplenomegaly, lymphadenopathy, or abnormally-increased blasts on FBC suggesting alternative diagnosis, e.g. aplastic anaemia, acute leukaemia, SLE (adolescent girls) or bone marrow failure syndrome.
5.A pt from Africa comes with nodular patch on the shin which is reddish brown. What is the most
probable dx?
a. Lupus vulgaris
b. Erythema nodosum
c. Pyoderma gangrenosum
d. Erythema marginatum
e. Solar keratosis
answer: B
Lofgrens syndrome of Sarcoidosis is more prevalent in Africans
(erythema nodosum, bilateral hilar lymphadenopathy, arthropathy)
other causes include TB which is also prevalent in parts of Africa.
N.b.
Lupus vulgaris = cutaneous TB
Pyoderma gangrenosum = ulcer associated with RA, IBD, Wegeners
Erythema marginatum = rheumatic fever
solar keratosis = form of skin damage by sun