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Rash and Non-Pigmented Skin Lesion OSCE Examination Quiz

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You have finished examining a patient's non-pigmented skin lesion. Which action is the most appropriate part of your plan?

A Perform dermoscopy and take skin scrapings at the bedside before asking any further questions about the lesion
B Take a brief history of sun exposure and family history, then reassure the patient and arrange no follow-up
C Start a potent topical corticosteroid for an itchy non-pigmented lesion before the cause has been established
D Take a full skin history, including when it started, symptoms, triggers, medications and the effect on quality of life ✓
E Ask about pain and itch, and arrange a review in two weeks if the lesion has not cleared spontaneously

The answer is D: Take a full skin history, including when it started, symptoms, triggers, medications and the effect on quality of life

Explanation

Why D is correct

See Configuration and Arrangement. Option D is correct because the examination tells you what the skin looks like, while the history tells you how it behaved and why. A full dermatological history covers the onset and evolution (when it started and how it has changed), symptoms such as itch, pain or burning, possible triggers (new products, plants, foods, sunlight or stress), the drug history (a new medicine can cause or worsen a rash) and the effect on quality of life, such as sleep, work and mood. This matters because a skin condition is frequently the visible part of a wider illness, so these details help you decide whether you are looking at inflammation, infection, an allergy, a drug reaction or a systemic disease. Saying you would also look at the rest of the skin, the nails and the scalp completes the plan, because the pattern across the body is one of the most useful diagnostic clues.

History: Onset and evolution, symptoms, triggers, drug history and effect on quality of life.
Why it matters: A skin condition is frequently the visible part of a wider illness.
Plan: Also look at the rest of the skin, the nails and the scalp, because the pattern across the body is a diagnostic clue.

Why the other options are incorrect

A. Perform dermoscopy and take skin scrapings at the bedside before asking any further questions about the lesion: Dermoscopy and scrapings can help, but they should follow a full history and are not always diagnostic. Performing them before further questioning puts tests before history.
B. Take a brief history of sun exposure and family history, then reassure the patient and arrange no follow-up: Sun exposure and family history are relevant to some skin lesions, but this history is too narrow for a non-pigmented lesion. Reassuring without follow-up may miss a treatable or serious disease.
C. Start a potent topical corticosteroid for an itchy non-pigmented lesion before the cause has been established: A potent topical corticosteroid can suppress the inflammation of a fungal infection and disguise it, so treatment should not start before the cause is clear.
E. Ask about pain and itch, and arrange a review in two weeks if the lesion has not cleared spontaneously: This asks only about symptoms and offers a delayed review, but it misses the triggers, drug history and quality-of-life impact that a full history should capture. A painless lesion still needs a complete assessment.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
After examining a non-pigmented skin lesion, which action best represents how to complete the examination?
2
A 24-year-old woman has several itchy, non-pigmented plaques on her upper chest after using shared gym showers. Each plaque is roughly circular, with a scaly, redder advancing edge and a paler centre. They have grown over the past week but remain separate. There are no clustered blisters, no wavy tracks and no mouth symptoms. Which term best describes the configuration of these lesions?

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