1. A 5-year-old boy presents with fever, cough, conjunctivitis, and a maculopapular rash starting on the face and spreading downward. Examination reveals Koplik spots on the buccal mucosa. What is the most likely diagnosis?

• Measles
• Rubella
• Roseola
• Scarlet fever

Answer: Measles

Koplik spots are pathognomonic for measles, along with the characteristic rash and the triad of cough, conjunctivitis, and coryza.

2. A 9-month-old infant develops a sudden high fever lasting 3 days, followed by a pink maculopapular rash as the fever subsides. What is the most likely complication of this condition?

• Febrile seizures
• Pneumonia
• Otitis media
• Encephalitis

Answer: Febrile seizures

Roseola (exanthem subitum) is known for high fever in infants, leading to febrile seizures before the rash appears.

3. A 30-year-old woman presents with recurrent painful nodules in her axillae that occasionally drain purulent fluid. She feels embarrassed and struggles with daily activities. What is the most appropriate initial management?

• Topical clindamycin
• Oral isotretinoin
• Wide surgical excision
• Start oral antibiotics immediately

Answer: Topical clindamycin

Mild hidradenitis suppurativa responds to topical clindamycin. More severe disease may need oral antibiotics or biologics.

4. What is the underlying mechanism of pompholyx (dyshidrotic eczema)?

• Dysfunction of the sweat glands leading to vesicle formation
• Allergic response to environmental allergens
• Idiopathic inflammatory response causing vesicles on palms and soles
• Fungal infection causing an eczematous reaction

Answer: Idiopathic inflammatory response causing vesicles on palms and soles

Pompholyx features recurrent, intensely itchy vesicles on hands/feet with an unknown exact cause (idiopathic).

5. A 45-year-old man presents with a dog bite on his forearm. The wound is superficial but erythematous. What is the most appropriate next step in management?

• Irrigate the wound and start co-amoxiclav
• Leave the wound open and monitor for infection
• Administer tetanus toxoid only
• Perform primary closure and prescribe antibiotics

Answer: Irrigate the wound and start co-amoxiclav

Thorough cleaning plus antibiotic prophylaxis is crucial for dog bites to prevent infection, typically using co-amoxiclav.

6. A 7-year-old girl presents with an itchy scalp. Examination reveals live lice and nits attached to the hair shafts. What is the most appropriate first-line treatment?

• Wet combing and topical permethrin
• Oral ivermectin
• Antibiotic therapy
• Shaving the scalp

Answer: Wet combing and topical permethrin

Head lice are effectively treated with mechanical removal (wet combing) and a pediculicide such as permethrin lotion.

7. A 60-year-old man with diabetes presents with severe pain, swelling, and dusky discoloration of his thigh. He is hypotensive and febrile. What is the most important initial management?

• Start broad-spectrum IV antibiotics and perform emergency surgical debridement
• Obtain MRI of the thigh and start IV fluids
• Start high-dose steroids and observe closely
• Perform fasciotomy under local anaesthesia

Answer: Start broad-spectrum IV antibiotics and perform emergency surgical debridement

Necrotising fasciitis demands urgent surgical exploration/debridement and empiric, broad-spectrum antibiotics to minimise mortality.

8. A 5-year-old boy presents with perianal itching, particularly at night. His mother observes small white worms in his stool. What is the most effective way to prevent reinfection?

• Treat the entire household with mebendazole
• Advise wearing gloves while sleeping
• Administer antihistamines for itching
• Disinfect all toys with alcohol-based cleansers

Answer: Treat the entire household with mebendazole

Pinworm infections spread easily within families. Household treatment plus hygiene measures prevent ongoing cycles.

9. A 6-year-old girl presents with fever, sore throat, and a sandpaper-like rash. A throat swab confirms Group A Streptococcus. What advice should be given to the parents regarding school attendance?

• The child can return to school 24 hours after starting antibiotics
• The child must remain at home until the rash resolves completely
• The child can return to school immediately as long as symptoms improve
• The child should remain at home for at least 7 days

Answer: The child can return to school 24 hours after starting antibiotics

After a full day of appropriate antibiotics, children with scarlet fever are generally no longer infectious and can return to school.

10. A 19-year-old man presents with fever, fatigue, and pharyngitis. Examination shows posterior cervical lymphadenopathy and hepatosplenomegaly. Monospot test is positive. What is the most likely complication?

• Splenic rupture
• Carditis
• Meningitis
• Guillain-Barré syndrome

Answer: Splenic rupture

Enlarged spleen is vulnerable to rupture in EBV mononucleosis, necessitating caution with contact sports or heavy lifting.