PLAB 1 Dermatology Questions: 10 Free Practice MCQs

Ten PLAB 1-style dermatology questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 170 dermatology questions and many more across every topic.

1. 1 / 10

   A 13 year old is diagnosed with limited plaque psoriasis during a primary care visit and is otherwise well.

   What does NICE recommend about specialist care?

   • A. Refer the child to a specialist at presentation
   • B. Use the adult topical pathway without specialist assessment
   • C. Refer only if more than 10 percent of body surface area is affected
   • D. Wait until a systemic medicine is being considered
   Show answer

   Answer: A. Refer the child to a specialist at presentation

   Why: Refer the child to a specialist at presentation. NICE CG153 makes this recommendation for children and young people with any type of psoriasis, including limited disease.

   • B. A child with psoriasis should receive specialist input at presentation rather than only follow the adult primary care pathway.
   • C. The referral recommendation applies to any type of psoriasis in children, not only extensive disease.
   • D. Referral is advised at presentation, so it should not be delayed until systemic treatment is discussed.

   Sources: NICE CG153 recommendation 1.2.1.12

2. 2 / 10

   A 16-year-old has severe nodulocystic acne with new permanent scars and substantial distress.

   What is the appropriate next step?

   • A. Continue over-the-counter treatment for a year
   • B. Prescribe oral isotretinoin without specialist input
   • C. Use topical antibiotic alone indefinitely
   • D. Refer to a consultant dermatologist led team
   Show answer

   Answer: D. Refer to a consultant dermatologist led team

   Why: NICE NG198 recommends referral to a consultant dermatologist led team for acne conglobata, acne fulminans, nodulocystic acne, or acne causing scarring. Assess psychological distress and provide timely specialist care.

   • A. Severe nodulocystic acne and scarring warrant prompt specialist assessment.
   • B. NICE places isotretinoin within specialist care and safety controls.
   • C. Topical antibiotic monotherapy is discouraged and is inadequate for this severe presentation.

   Sources: NICE NG198 recommendation 1.6.1

3. 3 / 10

   A 16 year old has severe nodulocystic acne with scarring despite adequate courses of topical treatment and systemic antibiotics.

   When may oral isotretinoin be considered?

   • A. For any acne that has lasted longer than one month
   • B. For severe acne resistant to adequate standard therapy, through the appropriate specialist pathway
   • C. As first line treatment in primary care before any topical or antibiotic course has been tried
   • D. For mild comedonal acne without distress
   Show answer

   Answer: B. For severe acne resistant to adequate standard therapy, through the appropriate specialist pathway

   Why: Isotretinoin may be considered for people older than 12 with severe acne resistant to adequate courses of standard topical treatment and systemic antibiotics. NICE NG198 links prescribing to MHRA safety requirements and an appropriate specialist led pathway.

   • A. NICE NG198 restricts isotretinoin consideration to severe acne resistant to adequate standard therapy.
   • C. NICE NG198 requires adequate standard therapy before considering isotretinoin for severe resistant acne.
   • D. Mild acne without treatment resistance does not meet the NICE criteria for isotretinoin consideration.

   Sources: NICE NG198 recommendations 1.5.18 to 1.5.20

4. Like these? UK.med has 1645 more, plus timed mock exams. Free to start: App Store · Google Play

5. 4 / 10

   A 20-year-old with treatment-resistant severe acne is planning pregnancy and asks about the safety of starting oral isotretinoin with a specialist.

   What is the safest response?

   • A. Prescribe isotretinoin in primary care without additional precautions
   • B. Recommend isotretinoin during pregnancy because acne is severe and scarring is permanent
   • C. Use isotretinoin only as a short course without pregnancy assessment
   • D. Explain it is contraindicated in pregnancy and requires specialist-led pregnancy prevention measures
   Show answer

   Answer: D. Explain it is contraindicated in pregnancy and requires specialist-led pregnancy prevention measures

   Why: NICE NG198 states oral isotretinoin is contraindicated in pregnancy and subject to the MHRA pregnancy prevention programme. It is reserved for severe acne resistant to adequate standard treatment and prescribed under specialist oversight. Do not start it in primary care.

   • A. Isotretinoin is a specialist treatment and has strict pregnancy prevention requirements.
   • B. Isotretinoin exposure in pregnancy is unsafe and the medicine is contraindicated.
   • C. A short course does not remove the teratogenic risk or pregnancy prevention requirements.

   Sources: NICE NG198 recommendations 1.5.20 to 1.5.24

6. 5 / 10

   A 22-year-old who may become pregnant is considering a topical retinoid for acne.

   What safety advice is appropriate before prescribing?

   • A. Topical retinoids are suitable during pregnancy if used on small areas
   • B. Use a topical retinoid with oral isotretinoin during pregnancy
   • C. No counselling is required for topical treatment
   • D. Avoid topical retinoids during pregnancy and when planning pregnancy
   Show answer

   Answer: D. Avoid topical retinoids during pregnancy and when planning pregnancy

   Why: NICE NG198 advises that topical retinoids are contraindicated during pregnancy and when planning pregnancy. Check pregnancy possibility, discuss suitable alternatives and provide clear advice before prescribing.

   • A. NICE advises avoiding topical retinoids during pregnancy and when planning pregnancy.
   • B. Both retinoid options raise pregnancy safety concerns and this combination is unsuitable.
   • C. Topical retinoids have pregnancy precautions that should be discussed before prescribing.

   Sources: NICE NG198 recommendation 1.5.6

7. 6 / 10

   A 19-year-old has moderate facial acne with inflammatory papules and comedones. They have not tried prescription treatment, have no relevant allergies, and want to know which initial regimen follows current NICE guidance.

   Which option is an appropriate 12-week first-line treatment for acne of any severity under NICE guidance?

   • A. Topical clindamycin alone
   • B. Oral doxycycline alone
   • C. A fixed combination of topical adapalene and benzoyl peroxide
   • D. Topical clindamycin together with oral doxycycline
   Show answer

   Answer: C. A fixed combination of topical adapalene and benzoyl peroxide

   Why: NICE NG198 recommends offering a 12-week course of an appropriate first-line option, taking acne severity and the person's preferences into account. A fixed combination of topical adapalene and benzoyl peroxide is listed for any acne severity. NICE advises against topical-antibiotic monotherapy, oral-antibiotic monotherapy, and combining a topical with an oral antibiotic. This supports antimicrobial stewardship while providing an evidence-based topical regimen.

   • A. Topical antibiotic monotherapy is specifically not recommended; acne treatment should avoid antibiotic-only exposure because it promotes antimicrobial resistance.
   • B. Oral antibiotic monotherapy is not recommended for acne; when an oral antibiotic is selected it is combined with an appropriate topical treatment.
   • D. Combining a topical antibiotic with an oral antibiotic is on NICE's list of treatments not to use; select a non-antibiotic topical partner instead.

   Sources: NICE NG198 recommendations 1.5.1 and 1.5.11

8. 7 / 10

   A 17-year-old has started a first-line acne regimen. They ask when the response should be assessed.

   When should the initial treatment usually be reviewed?

   • A. After 1 week
   • B. After 4 weeks
   • C. Only after 12 months
   • D. After 12 weeks
   Show answer

   Answer: D. After 12 weeks

   Why: NICE NG198 recommends a 12-week course of first-line treatment and review at 12 weeks. At review, assess response, adverse effects, adherence and whether to continue, change or escalate treatment.

   • A. NICE recommends a 12-week course before routine review, unless there is a reason to assess sooner.
   • B. Four weeks is earlier than the usual review point for the initial acne regimen in NICE NG198.
   • C. Waiting a year misses the recommended 12-week review and opportunity to adjust treatment.

   Sources: NICE NG198 recommendations 1.5.1 and 1.5.12

9. 8 / 10

   A 16 year old with psoriasis is referred for treatment and a clinician proposes PUVA.

   What does NICE advise?

   • A. Avoid PUVA when another appropriate treatment is available
   • B. Use PUVA as first-line treatment for children
   • C. Start PUVA without specialist review
   • D. Use PUVA only if topical treatment has never been tried, regardless of age or other suitable options
   Show answer

   Answer: A. Avoid PUVA when another appropriate treatment is available

   Why: Avoid PUVA when another appropriate treatment is available and refer this young person for specialist psoriasis care. NICE advises against PUVA in children and young people in that circumstance. A previous trial of topical treatment does not remove the age-related safety consideration.

   • B. PUVA is not first line in children; topical options and specialist assessment are appropriate before considering later treatment steps.
   • C. A 16-year-old with psoriasis should receive specialist assessment, and PUVA should be avoided when another appropriate option is available.
   • D. Prior failure of topical treatment does not override NICE's advice to avoid PUVA in a young person when another appropriate treatment is available.

   Sources: NICE CG153 recommendations 1.2.1.12, 1.3.1.1 and 1.4.2.2

10. 9 / 10

    A 48-year-old notices a mole that has become larger, changed colour and developed an irregular outline over several months.

    What is the next appropriate action?

    • A. Reassure without follow-up
    • B. Prescribe topical antibiotic
    • C. Review only after several years, with photographs
    • D. Refer urgently using the suspected cancer pathway
    Show answer

    Answer: D. Refer urgently using the suspected cancer pathway

    Why: NICE NG12 recommends using the weighted 7-point checklist for pigmented lesions. A score of 3 or more supports referral using the suspected cancer pathway. Change in size, irregular shape and irregular colour are major features, each scoring 2 points.

    • A. Progressive change in a pigmented lesion needs assessment rather than reassurance alone.
    • B. An antibiotic does not assess a changing pigmented lesion for melanoma.
    • C. This delays assessment of a lesion with concerning changes.

    Sources: NICE NG12

11. 10 / 10

    A 19-year-old with mild to moderate facial acne asks for an initial treatment. They are not pregnant and have no relevant contraindications.

    Which approach is recommended as a first-line option?

    • A. Oral isotretinoin started in primary care
    • B. Topical antibiotic alone for 12 weeks
    • C. Oral antibiotic alone, such as lymecycline, for 12 weeks
    • D. A topical combination containing a retinoid and benzoyl peroxide
    Show answer

    Answer: D. A topical combination containing a retinoid and benzoyl peroxide

    Why: For people with acne of any severity, NICE NG198 recommends a 12-week course of a first-line option selected with the person. Options include fixed topical combinations, including adapalene with benzoyl peroxide. Consider contraindications, adverse effects, acne severity and patient preference.

    • A. Isotretinoin is reserved for severe acne resistant to adequate standard treatment and requires specialist oversight.
    • B. NICE advises against topical antibiotic monotherapy because it promotes antimicrobial resistance.
    • C. Oral antibiotic monotherapy is not recommended; combine it with an appropriate topical treatment.

    Sources: NICE NG198 recommendations 1.5.1 to 1.5.4

Exam-style questions written by MedHub for practice. They are not official exam questions.