Image-Based Questions in Dermatology (MRCP Part 1)

TL;DR: 

Image-based questions in dermatology (mrcp part 1) reward pattern recognition over rare facts. In MRCP Part 1, candidates are expected to identify classic rashes, lesions, nails, and mucosal findings, then link them to diagnosis, associations, or first-line management. With targeted practice and awareness of common traps, these questions can become reliable scoring opportunities.

Why this matters

Dermatology is one of the few MRCP Part 1 subjects where a single image can replace a long clinical stem. A photograph of skin, nails, or hair can test diagnosis, systemic associations, complications, and management within seconds. Many candidates struggle because image interpretation feels less concrete than text-based revision.

However, the images used in MRCP Part 1 are deliberately high-yield and classic, not obscure. They focus on common conditions with recognisable appearances. Once you train your eye to spot these patterns, image-based questions often become some of the fastest and safest marks in the exam.

For context on how dermatology fits into the wider exam, see the official MRCP Part 1 overview from MRCP(UK):https://www.mrcpuk.org/mrcpuk-examinations/part-1

What MRCP Part 1 image-based questions actually test

Image questions are rarely about naming a rash alone. Examiners usually test one (or more) of the following:

1. Pattern recognition – identifying a classic visual diagnosis

2. Key association – linking the image to a systemic condition

3. Complication or prognosis – understanding what the appearance implies

4. First-line management – particularly in common inflammatory or infective dermatoses

If you recognise which domain is being tested, you avoid overthinking the image.

Most tested dermatology image themes

Below is a numbered high-yield list of dermatology themes that repeatedly appear in MRCP Part 1 image-based questions.

1. Psoriasis Well-demarcated erythematous plaques with silvery scale, typically on extensor surfaces. Nail pitting and onycholysis are frequent visual clues. Questions often test associations such as psoriatic arthritis.

2. Eczema and dermatitis Flexural involvement, excoriations, and lichenification. Images are commonly paired with a history of atopy or contact exposure.

3. Skin cancer and premalignant lesions Basal cell carcinoma (pearly rolled edge, telangiectasia), squamous cell carcinoma (crusted or ulcerated lesions), and actinic keratoses. Melanoma images usually emphasise asymmetry and colour variation.

4. Infective dermatoses Tinea (annular lesions with central clearing), herpes zoster (dermatomal vesicles), impetigo (honey-coloured crusts). Infection control or first-line treatment is frequently tested.

5. Blistering disorders Pemphigus vulgaris versus bullous pemphigoid. Images are interpreted alongside age, mucosal involvement, and clinical context rather than detailed immunology.

Classic image clues and what they mean

Image feature	Likely diagnosis	High-yield association
Silvery scale on extensor plaques	Psoriasis	Psoriatic arthritis
Annular lesion with central clearing	Tinea corporis	Dermatophyte infection
Honey-coloured crusts	Impetigo	Staphylococcus aureus
Pearly papule with rolled edge	Basal cell carcinoma	Chronic sun exposure
Flaccid blisters with erosions	Pemphigus vulgaris	Autoimmune disease

This “visual cue → diagnosis → association” pathway reflects how examiners expect candidates to reason.

Practical examples / mini-cases

Mini-case

A photograph shows well-defined erythematous plaques with thick silvery scale over the elbows and knees. The fingernails show multiple small pits. The question asks which associated condition is most likely.

Answer and explanation

This is classic chronic plaque psoriasis. Nail pitting strongly supports the diagnosis. In MRCP Part 1, the most likely associated condition tested is psoriatic arthritis, rather than less commonly emphasised associations.

The key exam skill is recognising the pattern first, then identifying what the examiner is asking about that diagnosis.

How to practise image-based questions effectively

Image interpretation improves only with repeated exposure. A structured approach is most effective:

• Practise regularly using image-based MCQs from reputable MRCP resources

• Attempt questions under timed conditions to simulate exam pressure

• After each question, note which visual feature led to the diagnosis

• Revisit incorrect images after a few days to reinforce visual memory

• In the final weeks, attempt full mock papers with mixed image questions

Using question banks that mirror exam style is particularly helpful. The MRCP(UK) examiners themselves emphasise testing “common presentations of common conditions”.

Common pitfalls (5)

• Over-diagnosing rare dermatological conditions instead of recognising common ones

• Ignoring lesion distribution (flexural vs extensor)

• Missing nail or mucosal clues shown subtly in images

• Jumping to management without confirming the diagnosis

• Relying only on text-based revision and under-practising images

FAQs

Are image-based questions common in MRCP Part 1 dermatology?

Yes. Dermatology frequently uses images to test recognition of common conditions and their associations.

Do I need to memorise rare skin diseases?

No. MRCP Part 1 focuses on common conditions with classic appearances rather than rare diagnoses.

Are management questions asked from images?

Sometimes. More often, the image confirms the diagnosis and the question tests first-line management or complications.

How can I improve quickly at dermatology images?

Regular exposure is key. Practising image-based MCQs and reviewing mistakes systematically is more effective than passive reading.

Sources

• MRCP(UK). Examination format and syllabus.https://www.mrcpuk.org/mrcpuk-examinations/part-1

• British Association of Dermatologists. Patient information and clinical images.https://www.bad.org.uk/patient-information/

• NICE Clinical Knowledge Summaries – Dermatology.https://cks.nice.org.uk/topics/dermatology/