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Q1: Definition and clinical presentation (2 min)
What is lichen sclerosus, and how does it classically present in an adult woman? Name the pathognomonic physical signs and the typical "figure-of-eight" anatomical distribution.
Q2: Differential diagnosis (3 min)
A 6-year-old girl presents with perianal soreness, constipation, and skin splitting on micturition. The paediatric registrar suspects sexual abuse. What is the most important dermatological differential, what features distinguish it, and what investigation is required?
Q3: Histopathology (2 min)
A punch biopsy shows the "red-white-blue" pattern. Describe the histological correlate of each colour, and state one direct immunofluorescence finding that would shift the diagnosis away from lichen sclerosus.
Q4: First-line management (3 min)
Outline the first-line pharmacological management of genital lichen sclerosus in an adult woman, including agent, formulation, dose, frequency, the 12-week tapering schedule, and the rationale for using an ultra-potent topical corticosteroid despite the disease being atrophic. What is the long-term maintenance strategy?
Q5: Complications and surveillance (2 min)
What is the lifetime risk of vulvar squamous cell carcinoma in genital lichen sclerosus, and what surveillance strategy should be instituted? Name three clinical features that mandate urgent biopsy.
Q6: Male genital LS / BXO (2 min)
A 35-year-old uncircumcised man presents with progressive phimosis and a sclerotic white ring at the prepuce. Name the condition, state the histological features, and outline the definitive surgical treatment. Why is surgery not curative of the underlying disease?
Q7: Pathophysiology and associations (2 min)
What are the proposed mechanisms in the immunopathogenesis of lichen sclerosus, and what systemic autoimmune diseases should be actively screened for at diagnosis?