Prometric Exam Questions for Dermatology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the DER5421 Paper

The dermatology specialist paper (DER5421; consultants sit DER5762) tests diagnosis from a described or pictured lesion, first-line and systemic treatment, the monitoring that systemic drugs require, and the emergencies that must be recognised in minutes. Gulf dermatology has its own emphasis: pigmentary disorders in darker skin, fungal and parasitic infections, and aesthetic practice under tight regulation. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the dermatologist guide. For timed papers use the Dermatology specialist bank, about 3,000 questions.

Inflammatory dermatoses

Question 1

A 35-year-old has chronic plaque psoriasis covering 15% of body surface area, with a PASI of 14 and a DLQI of 16, failing topical therapy and phototherapy. The next step is:

1. Long-term oral corticosteroids
2. Systemic therapy such as methotrexate, or a biologic where criteria are met, with baseline screening for TB, hepatitis and HIV
3. More potent topical steroids only
4. Antihistamines

Answer: B. Moderate-to-severe psoriasis failing topical and light therapy warrants systemic treatment. Oral steroids are avoided because of rebound and pustular flares. Biologic screening includes TB, hepatitis B and C and HIV.

Question 2

A 6-month-old has an itchy, weeping, erythematous eruption on the cheeks and extensor limbs with a family history of asthma. First-line management is:

1. Oral prednisolone
2. Regular emollients, a mild-to-moderate topical corticosteroid for flares, and treatment of secondary infection if present
3. Antifungal cream
4. Elimination of all foods

Answer: B. Infantile atopic eczema is treated with emollients as the base and appropriate-potency topical steroids for flares. Food exclusion is only on allergist advice; systemic steroids are not used in infants.

Question 3

A 20-year-old woman has nodulocystic acne with scarring that has failed oral tetracyclines and topical retinoids. The treatment of choice and its essential safeguard are:

1. Long-term topical antibiotic
2. Oral isotretinoin, with a pregnancy prevention programme, baseline and follow-up lipids and liver function, and counselling on mood
3. Oral corticosteroids
4. Laser resurfacing first

Answer: B. Isotretinoin is the only treatment that alters the disease course in severe acne. It is highly teratogenic; contraception before, during and for one month after is mandatory, with monitoring for mood change.

Infections and infestations

Question 4

A 25-year-old labourer has an annular, scaly plaque with central clearing on the groin that worsened with a topical steroid. The diagnosis and treatment are:

1. Psoriasis; stronger steroid
2. Tinea cruris (tinea incognito after steroid); a topical azole or terbinafine, with oral terbinafine or itraconazole for extensive or resistant disease, and treat tinea pedis if present
3. Candida; nystatin only
4. Erythrasma; nothing

Answer: B. Dermatophyte infection is extremely common in hot, humid climates. Topical steroids mask and spread it. Confirm with KOH microscopy where available; recurrent and extensive cases need systemic antifungals.

Question 5

A family presents with intensely itchy papules in the finger webs, wrists and genitals, worse at night, with burrows. The treatment is:

1. Topical steroid alone
2. Permethrin 5% cream applied to the whole body from the neck down, left for 8 to 12 hours and repeated after one week, treating all household contacts simultaneously and laundering bedding
3. Oral antihistamine only
4. Antibiotics

Answer: B. Scabies is a household diagnosis. Oral ivermectin is an alternative for crusted scabies or outbreaks. Post-scabetic itch can persist for weeks and is not treatment failure.

Question 6

A child has honey-coloured crusted lesions around the nose and mouth. The likely organism and first-line treatment for localised disease are:

1. Herpes simplex; aciclovir
2. Staphylococcus aureus or Streptococcus pyogenes; topical antibiotic such as fusidic acid or mupirocin, with oral flucloxacillin for extensive disease
3. Candida; nystatin
4. Molluscum; cryotherapy

Answer: B. Non-bullous impetigo is treated topically when localised and orally when widespread; hygiene measures reduce spread in schools and households.

Pigmentary disorders and skin of colour

Question 7

A 30-year-old woman with Fitzpatrick type IV skin has symmetrical brown patches on the cheeks and forehead that worsened in pregnancy. First-line management is:

1. Deep chemical peel immediately
2. Strict broad-spectrum photoprotection and a triple combination cream (hydroquinone, tretinoin and a mild steroid) or hydroquinone for a limited course, with tranexamic acid considered for resistant cases
3. Oral steroids
4. Ablative laser

Answer: B. Melasma is chronic and relapsing. Sun protection is non-negotiable; aggressive procedures risk post-inflammatory hyperpigmentation in darker skin. Hydroquinone is used in courses to avoid ochronosis.

Question 8

A 12-year-old has depigmented, sharply demarcated macules on the hands and around the mouth that fluoresce bright white under Wood's lamp. The diagnosis and first-line treatment are:

1. Pityriasis versicolor; antifungal
2. Vitiligo; potent topical steroid or topical calcineurin inhibitor for limited disease, narrowband UVB for widespread disease, and screening for thyroid disease
3. Post-inflammatory hypopigmentation; nothing
4. Albinism; genetic counselling

Answer: B. Vitiligo carries a heavy psychosocial burden in darker-skinned populations. Topical JAK inhibitors are an emerging option for facial disease where available.

Skin cancer and drug reactions

Question 9

A 55-year-old has a changing 8 mm asymmetric pigmented lesion with irregular borders and multiple colours on the back. The next step is:

1. Shave biopsy
2. Full-thickness excisional biopsy with a narrow 2 mm margin, then wide local excision guided by Breslow thickness, with sentinel node biopsy considered above 0.8 mm
3. Cryotherapy
4. Observe for six months

Answer: B. Suspected melanoma is excised completely for histology; shave and partial biopsies compromise staging. Margins and sentinel node biopsy follow Breslow thickness.

Question 10

Ten days after starting allopurinol, a patient develops a painful rash with mucosal erosions, skin tenderness and a positive Nikolsky sign, involving about 35% of body surface area. The diagnosis and immediate management are:

1. Urticaria; antihistamines
2. Toxic epidermal necrolysis; stop the culprit drug immediately, transfer to a burns or intensive care unit, supportive care with fluids, wound care, ophthalmology review, and consider ciclosporin or other systemic therapy per protocol
3. Erythema multiforme; aciclovir
4. Psoriasis flare; methotrexate

Answer: B. SJS/TEN is a dermatological emergency with high mortality. Drug withdrawal and supportive care in a specialised unit are the mainstays; SCORTEN estimates prognosis. Allopurinol, anticonvulsants and sulfonamides are common culprits.

Question 11

Which clinical description best fits a basal cell carcinoma?

1. A rapidly growing crusted nodule on the lip of a smoker
2. A slow-growing pearly papule with telangiectasia and rolled edge on the face, which may ulcerate centrally
3. A pigmented lesion with irregular colours on the back
4. A flat scaly patch on the shin

Answer: B. BCC is the most common skin cancer, locally invasive and rarely metastatic. Treatment is excision with a 4 mm margin for most, Mohs surgery for high-risk sites, and topical or photodynamic therapy for superficial lesions.

Hair, nails and paediatrics

Question 12

A 28-year-old woman has diffuse hair shedding three months after a febrile illness, with a positive pull test and no scarring. The diagnosis and management are:

1. Alopecia areata; intralesional steroid
2. Telogen effluvium; reassurance, treat any iron, thyroid or vitamin D deficiency, and expect recovery within six to twelve months
3. Female pattern hair loss; oral finasteride
4. Tinea capitis; griseofulvin

Answer: B. Telogen effluvium follows a trigger by about three months and resolves spontaneously. Check ferritin, thyroid function and vitamin D, which is commonly low in the Gulf.

Question 13

A 7-year-old has patchy scalp hair loss with scale and broken hairs, and an occipital lymph node. The treatment is:

1. Topical antifungal shampoo alone
2. Oral terbinafine or griseofulvin for several weeks, with antifungal shampoo to reduce spread and examination of household contacts
3. Topical steroid
4. No treatment

Answer: B. Tinea capitis requires systemic therapy because the fungus is within the hair shaft. A boggy, tender kerion may need additional short-course steroids.

Question 14

Which nail finding is most characteristic of psoriasis?

1. Koilonychia
2. Pitting, onycholysis with a salmon-coloured "oil drop" sign and subungual hyperkeratosis
3. Clubbing
4. Beau's lines

Answer: B. Nail psoriasis affects up to half of patients and predicts psoriatic arthritis. Koilonychia suggests iron deficiency, clubbing suggests cardiopulmonary disease, and Beau's lines follow systemic illness.

Regulation and aesthetic practice

Question 15

A patient requests high-strength hydroquinone and a topical steroid combination for "skin lightening" with no diagnosis of melasma. The appropriate response is:

1. Prescribe it as requested
2. Decline cosmetic bleaching, explain the risks of steroid atrophy, ochronosis and systemic absorption, and offer evidence-based treatment only where a pigmentary disorder is diagnosed
3. Refer for laser bleaching
4. Recommend an over-the-counter mercury-containing cream

Answer: B. Gulf regulators restrict steroid and hydroquinone bleaching products, and mercury-containing creams are banned. The exam tests professional and regulatory judgement alongside clinical knowledge.

How to use these questions

• Learn first-line treatments and their monitoring: isotretinoin, methotrexate, biologics, systemic antifungals.
• Know the emergencies: SJS/TEN, erythroderma, necrotising fasciitis, angioedema.
• Practise skin of colour: pigmentary disorders and the risks of aggressive procedures.
• Practise under time in the Dermatology bank with the error-log method.

Aesthetic practitioners such as beauty therapists and laser technicians sit separate papers (guide). Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the dermatology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and about 70% for consultants.

Does the paper include aesthetic dermatology?

At the level of indications, complications and regulation of lasers, fillers, peels and bleaching agents.

Can an MD dermatology holder skip the exam?

Sometimes, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.