Psoriasis — KFP-style written assessment

KFP 1 (10 marks)

A 19-year-old student presents two weeks after a severe sore throat with dozens of drop-like scaly papules across trunk and proximal limbs. This is her first episode. She is otherwise well; throat still mildly sore. ^[4]

1. State the diagnosis, its trigger and the investigation you would order. (3) ^[4]
2. Outline management and prognosis counselling. (4) ^[4]
3. She asks whether she will develop chronic plaque disease or arthritis. Answer honestly. (3) ^[4]

Model answers

1. Guttate psoriasis — widespread drop-like scaly papules on trunk/proximal limbs appearing one to three weeks after streptococcal pharyngitis. Order throat swab ± ASO titre to document streptococcal trigger. ^[4]
2. Many episodes resolve spontaneously over weeks–months; treat symptomatically with emollients and topical corticosteroids ± vitamin D analogue. For extensive or persistent eruptions, NB-UVB phototherapy clears most cases. Treat documented streptococcal infection; discuss tonsillectomy only for recurrent streptococcal-triggered flares. Prognosis counselling: guttate may resolve completely, persist, or transition to chronic plaque disease — follow-up until pattern declares itself. ^[4]
3. A proportion develop chronic plaque psoriasis; some develop psoriatic arthritis. Honest answer: neither is inevitable, but psoriasis is a lifelong tendency — counsel on triggers (streptococcal infection, skin trauma/Koebner, smoking, alcohol, stress) and give explicit advice to return if joints become painful or stiff, since psoriatic arthritis screening belongs at every future review. Family history strengthens both risks. ^{[4] [2]}