general dermatology mcqs

8/11/2019 General Dermatology MCQs

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A pregnant woman presents with the following condition which is bothersome to her. Which of thefollowing is the most appropriate treatment option based on FDA classifications of medication in

pregnancy?

1 Topical erythromycin/benzoyl peroxide gel

2 Topical tretinoin

3 Tazarotene 0.1% cream4 Azelaic acid 20% cream

5 Bactrim DS

Q/Q(M)-482157 Report a Problem

A pregnant woman presents with the following condition which is bothersome to her. Which of thefollowing is the most appropriate treatment option based on FDA classifications of medication in

pregnancy?

4 Azelaic acid 20% cream

This patient has mild-moderate inflammatory acne. Azelaic acid is the only medication listed which fallsunder category B. The others listed are category C, except for tazarotene, which is category X


Pilomatricomas has been associated with which of the following conditions?

1 Acute myelogenous leukemia

2 Multiple sclerosis

3 Crohns Disease

4 Myotonic dystrophy

5 Pneumothorax


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Pilomatricomas has been associated with which of the following conditions?

4 Myotonic dystrophy

Answer D. Pilomatricomas are benign tumors that are derived from hair matrix cells. This tumor presentsmore frequently in children as a solitary asympotmatic purple red papule or nodule usually on the headand neck. Mutations in beta catenin is associated with the development of these tumors. Multiple

pilomatricomas may be a marker for the development of myotonic dystrophy. This rare disorder is AD,and is associated with difficulty relaxing muscles after contraction. In a review of patients with thisdisorder, patients tended to have mulitple pilomatricomas. Pilomatricomas can also be found with Turnersyndrome, Rubinstein-Taybi, and Churg Strauss syndromes.


Lacrimal gland involvement is characteristically seen in patients with:

1 Lymphoma

2 Sarcoid

3 Rosacea

4 Syphilis

5 Pemphigus


Lacrimal gland involvement is characteristically seen in patients with:

2 Sarcoid

Sarcoid is granulomatous autoimmune condition characterized by the formation of non-caseatinggranulomas which may affect any organ system. Lacrimal gland involvement occurs in 15-28% of

patients. Manifestation of lacrimal gland involvement includes bilateral painless swelling.


A patient presents requesting removal of a tattoo. Examination reveals a tattoo with red, orange, yellow,

and purple pigment. Which laser would be appropriate to treat this tattoo?1 Q switched Nd:YAG (532nm)

2 Q switched alexandrite (755nm)

3 Q switched ruby (694nm)

4 Nd:Yag (1064nm)

5 Alexandrite (755nm)



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A patient presents requesting removal of a tattoo. Examination reveals a tattoo with red, orange, yellow,and purple pigment. Which laser would be appropriate to treat this tattoo?

1 Q switched Nd:YAG (532nm)

The Q switched Nd:YAG can also be used to treat tan pigment. QS alexandrite and QS ruby can removegreen pigment. QS Nd:YAG is a good choice for patients with darker skin color.


A young man presents with explosive onset of severe cystic acne with acute, suppurative nodules andplaques that ulcerate and form a blackish eschar on the trunk as well as the face. Which of the followingis true regarding this entity?

1 Women are more often affected than men

2 P. acnes osteomyelitis presents with lytic changes on x-rays and bone scans

3 The sternoclavicular joint is often involved in this entity

4 Systemic corticosteroids are contraindicated given risk of sepsis

5 High-dose isotretinoin monotherapy is the treatment of choice


A young man presents with explosive onset of severe cystic acne with acute, suppurative nodules andplaques that ulcerate and form a blackish eschar on the trunk as well as the face. Which of the followingis true regarding this entity?

3 The sternoclavicular joint is often involved in this entity

Acne fulminans is a rare, explosive form of severe cystic acne affecting young males. Patients may besystemically ill, with leukocytosis, fever, arthralgias, and myalgias. Lytic changes, indicative of a sterileosteomyelitis, can be seen on x-ray and bone scans. The sternoclavicular joint and chest wall are mostfrequently affected. Treatment is with oral prednisone, intralesional steroids, antibiotics, and isotretinoin.


Which of the following is true regarding acquired C1 esterase inhibitor deficiency?

1 This condition generally occurs in the first or second decade of life

2 Serum C1q is normal

3 C2 and C4 are both decreased

4 C1 esterase inhibitor may be at normal levels with functional impairment

5 Positive family history is common


Which of the following is true regarding acquired C1 esterase inhibitor deficiency?

3 C2 and C4 are both decreasedC1 esterase inhibitor is a protease inhibitor that inhibits the catalytic subunits of the first components of


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the classical pathway. In the absence of C1 esterase inhibitor, activated C1 and plasmin generateactivated C2 kinin, which mediates angioedema. Acquired C1 esterase inhibitor deficiency generallyaffects adults or elderly individuals with no family history. Serum C1q is decreased. It occurs in thesetting of lymphoproliferative disease or rheumatologic illness, where idiotype/anti-idiotype immunecomplexes consume available C1q and functionally and quantitatively lower the amounts of C1 esteraseinhibitor. It can also occur in the setting of autoimmunity directed against the C1 esterase protein.Inherited C1 esterase inhibitor deficiency is detected in the first or second decade of life and is autosomaldominantly inherited. Serum C1q is normal in the inherited form, but there is a defect in the synthesisand/or function of C1 esterase inhibitor. In both the inherited and acquired forms levels of C2 and C4 aredecreased because of the uncontrolled actions of C1s.


A 2 year-old boy with crusted skin papules is found to have osteolytic defects and diabetes insipidus.These features are seen in:

1 Osteogenesis imperfecta

2 Conradi-Hunnerman disease

3 Metastatic small cell lung carcinoma

4 Hand-Schuller-Christian disease

5 Epidermal nevus syndrome


A 2 year-old boy with crusted skin papules is found to have osteolytic defects and diabetes insipidus.

These features are seen in:4 Hand-Schuller-Christian disease

Hand-Schuller-Christian disease is a chronic multifocal form of Langerhans cell histiocytosis.70% ofcases occur between the ages of 2 and 6. The four characteristic clinical findings are bone lesions,diabetes insipidus, exophthalmus, mucocutaneous lesions. Bones lesions are osteolytic and preferentiallyinvolve the calvarium.


Probiotics, which are cultures of potentially beneficial gut microflora bacteria, have been studied in theprimary prevention of which of the following diseases?

1 Celiac disease

2 Atopic dermatitis

3 Psoriasis

4 Cutaneous T-cell lymphoma

5 Asthma



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Probiotics, which are cultures of potentially beneficial gut microflora bacteria, have been studied in theprimary prevention of which of the following diseases?

2 Atopic dermatitis

Probiotics have been studied in the primary prevention of atopic dermatitis by Kalliomaki et al.Lactobacillus GG cultures were given to pregnant women with a history of atopy to assess the effect of

potentially beneficial gut flora on the prevention of atopic disease in their children. The frequency of

atopic dermatitis in the children in the probiotic group was half that in the placebo group at two years oflife.


Mutations in which of the following genes has been implicated in the pathogenesis of disseminatedsuperficial actinic porokeratosis?

1 BRAF

2 K-RAS

3 PTCH

4 PTEN

5 SART3


Mutations in which of the following genes has been implicated in the pathogenesis of disseminatedsuperficial actinic porokeratosis?

5 SART3Disseminated superficial actinic porokeratosis (DSAP) is a disorder characterized by numerous keratoticmacules and papules often localized in a photodistribution. Clinically, they are distinguished by a rim ofkeratotic scale and often may have an atropic appearance centrally. Histologically, they often display alichenoid infiltrate flanked by characteristic cornoid lamella (inward-bending tiers of parakeratosis withunderlying hypogranulosis and dyskeratosis). Recently, mutations in SART3 (squamous cell carcinomaantigen recognized by T-cells 3) have been implicated in a Taiwainese patient cohort affected by DSAP.Of note, while all varieties of porokeratoses have the potential for malignant degeneration anddevelopment of squamous cell carcinoma, lesions of DSAP have the lowest risk.


Which contact allergen is found in Krazy glue?

1 Formaldehyde

2 Lanolin alchohol

3 Ethyl cyanoacrylate

4 Octyl-dimethyl-paba

5 Mercaptobenzothiazole



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Which contact allergen is found in Krazy glue?

3 Ethyl cyanoacrylate

Ethyl cyanoacrylate is a chemical found in Krazy Glue. It can also be found in nail adhesives causing adermatitis on the face and fingers, nail dystrophy, and a generalized rash. Formaldehyde is a widely used

chemical found in a variety of applications and is a common allergen. It can be found in paper, skin andhair products, cosmetics, and permanent press textiles. Lanolin alcohol is found in wool fat, wool wax,adhesives, cosmetics and pharmaceuticals. Octyl-dimethyl-paba is a chemical found in sunscreens and isthe most frequently used PABA group sunscreen. Mercaptobenzothiazole is a rubber accelerant and is themost common allergen found in dermatitis to shoes. It is also found in veterinarian products such as fleaand tick sprays and powders. Mercapotbenzothiazole can also be found in cutting oil, antifreeze,fungicides and photographic film emulsions.


In the setting of the lupus erythematosus-associated complement deficiency syndrome, which of thefollowing would most often be observed?

1 low C3 and C4

2 low C2 and C3

3 low C2 and C4

4 low C2 only

5 low C3 only


In the setting of the lupus erythematosus-associated complement deficiency syndrome, which of thefollowing would most often be observed?

3 low C2 and C4

In the complement deficiency syndrome, low C2 and C4 are most commonly seen. Photosensitivity,annular SCLE lesions, and Ro antibody formation are commonly observed.


Which of the following is a feature of Schnitzler's Syndrome?

1 Monoclonal IgG gammopathy

2 Thromboembolic events

3 Bronchospasm

4 Hematuria

5 Sensorimotor neuropathy


Which of the following is a feature of Schnitzler's Syndrome?


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5 Sensorimotor neuropathy

Schnitzler's syndrome presents as episodes of urticarial vasculitis that occur in association with amonoclonal IgM M component. Fever, lymphadenopathy, hepatosplenomegaly, bone pain, andsensorimotor neuropathy also occur.


Which of the following is a manifestation of psoriasis of the nail matrix?

1 Splinter hemorrhages

2 Oil spots

3 Subungual hyperkeratosis

4 Pits

5 Onycholysis


Which of the following is a manifestation of psoriasis of the nail matrix?

4 Pits

Psoriatic nail changes may be of nail matrix or nail bed origin. Pits are the common finding; splinterhemorrhages the least. Psoriatic nail changes of matrix origin include: pits (representing focal psoriasis ofthe proximal matrix) and leukonychia. Psoriatic nails changes of nail bed origin include: salmon spots,oil spots,onycholysis, subungual hyperkeratosis, and splinter hemorrhages.


Which of the following leukodermas has a normal number of epidermal melanocytes?

1 Albinism

2 Vitiligo

3 Piebaldism

4 Waardenburg's syndrome

5 Ziprowski-Margolis syndrome


Which of the following leukodermas has a normal number of epidermal melanocytes?

1 Albinism

Patients with albinism have a normal number of epidermal melanocytes, however, these melanocytessynthesize inadequate amounts of melanin. Vitiligo, piebaldism, Waardenburg's syndrome andZiprowski-Margolis syndrome all feature a decreased number or total absence of epidermal melanocytes.


After being treated for several months with doxycycline, this patient develops a gram negativefolliculitis. What is the next appropriate therapy?


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1 Tetracycline

2 Bactrim

3 Isotretinoin

4 Ceftriaxone

5 CefepimeQ/Q(M)-476722 Report a Problem

After being treated for several months with doxycycline, this patient develops a gram negativefolliculitis. What is the next appropriate therapy?

3 Isotretinoin

Gram negative folliculitis may occur after prolonged antibiotic therapy for acne vulgaris. It should besuspected in patients who are well controlled and then suddenly flare. The treatment of choice is

isotretinoin.Q/Q(M)-476722 Report a Problem

You are consulted to evaluate this patient with tender, warm plaques on his shins. What other physicalsigns should you look for?

1 Exophthalmos

2 Uveitis

3 Tachycardia4 Clubbing of the fingers


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5 Cough


You are consulted to evaluate this patient with tender, warm plaques on his shins. What other physicalsigns should you look for?

2 Uveitis

Erythema Nodosum (EN) is represented by tender, warm,nodules and plaques, often but not exclusivleylocated on the anterior shin. It represents a reactive panniculitis. Causes include, infections(Streptococcal, tuberculosis, yersina, mycoplasma, campylobacter,salmonella, histoplasmosis,

blastomycosis, coccidiomycosis), drugs (sulfonamides, gold, and OCP's), enteropathies, pregnancy,hodgkin's disease and lymphoma and sarcoidosis. Loefgren's disease is a varient of sarcoidosis with EN,hilar adenopathy, fever, uveitis and arthritis. Differential diagnosis includes: pretibial myxedema anderythema induratum.


TH2 immune responses:

1 Are associated with cell-mediated immunity

2 Produce IL-6

3 Produce IFN-gamma

4 Produce TNF-beta

5 Produce IL-2


TH2 immune responses:

2 Produce IL-6

TH1 cells produce IL-2, IFN-gamma, and TNF-beta, and are associated with cell-mediated immunity.TH2 cells produce IL-4, IL-5, IL-6, IL-10, and IL-13, and are associated with antibody-mediated immuneresponses.


Monotherapy for acne with topical antibiotics is discouraged because of:


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1 Slow onset of comedolytic action

2 Potential for irritation

3 Lack of anti-inflammatory action

4 Potential for bacterial resistance

5 Poor patient complianceQ/Q(M)-474321 Report a Problem

Monotherapy for acne with topical antibiotics is discouraged because of:

4 Potential for bacterial resistance

Topical antibiotics reduce the population of P. acnes on the skin, and thus are indirectly anti-inflammatory. In contrast to topical retinoids, topical antibiotics are not comedolytic. They are generallywell tolerated by patients.


The first site in body that shows yellowish pigmentation in carotenoderma is

1 Face

2 Trunk

3 Palms and soles

4 Nails

5 ScleraQ/Q(M)-482111 Report a Problem

The first site in body that shows yellowish pigmentation in carotenoderma is

1 Face

Carotenoderma is yellowish discoloration of the skin secondary to carotenemia. Carotene is excreted bysebaceous glands and in sweat, so the yellow pigmentation appears first on the face (especially nasolabialfolds and forehead) and then becomes diffusely distributed with accentuation in palms and soles. Incontrast to jaundice, carotenoderma spares mucous membranes and sclera

Q/Q(M)-482111 Report a ProblemIn addition to the lesions seen on the feet of this young man he also had geographic tongue, erythematous

plaques on his penis and arthritis, what HLA type is associated with this syndrome?

1 HLA-B27

2 HLA-B51

3 HLA-DR1

4 HLA-DR3

5 HLA-DQW2


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In addition to the lesions seen on the feet of this young man he also had geographic tongue, erythematousplaques on his penis and arthritis, what HLA type is associated with this syndrome?

1 HLA-B27

Reiter syndrome, now referred to as reactive arthritis (ReA), is a condition that most often occurs

following enteric or urogenital infections. Reactive arthritis is associated with human leukocyte antigen(HLA)B27, although HLA-B27 is not always present in individuals who are HIV+. Bacteriaassociated with reactive arthritis are generally enteric or venereal and include the following: Shigellaflexneri, Salmonella typhimurium, Salmonella enteritidis, Streptococcus viridans, Mycoplasma

pneumonia, Cyclospora, Chlamydia trachomatis, Yersinia enterocolitica, and Yersiniapseudotuberculosis.


What is the most common variant of morphea in children?

1 Plaque2 Generalized

3 Bullous

4 Deep (morphea profunda)

5 Linear


What is the most common variant of morphea in children?5 Linear

Linear morphea is the most common presentation in children, comprising between 40% to 70% ofchildren with morphea. This subtype includes linear morphea of the extremity, en coup de sabre, or

progressive facial hemiatrophy, all of which may be accompanied by underlying tissue atrophy.


Presence of which of the following autoantibodies is diagnostic of SLE and not reported in patients withother connective tissue diseases?

1 anti-U1RNP


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2 anti-dsDNA

3 anti-Ro

4 anti-La

5 anti-Sm


Presence of which of the following autoantibodies is diagnostic of SLE and not reported in patients withother connective tissue diseases?

5 anti-Sm

Anti-Sm is diagnostic of SLE and not reported in patients with other connective tissue diseases. It isfound in 15-40% of patients with SLE. Most patients with anti-Sm also have antibodies to U1RNP, butthe converse is not true. anti-U1RNP is found in 100% of patients with MCTD and in 30% of patientswith SLE (the majority of patients with positive U1RNP have SLE rather than MCTD). Anti-dsDNA

correlates with renal involvement in SLE. Anti-Ro and anti-La antibodies are found in LE and Sjogren's,and strongly associated with photosensitivity.


Perifolicular depigmentation is a characteristic cutaneous manifestation of:

1 Dermatomyositis

2 Secondary syphilis

3 Scleroderma

4 Discoid lupus

5 Sarcoidosis

Q/Q(M)-477175 Report a ProblemPerifolicular depigmentation is a characteristic cutaneous manifestation of:

3 Scleroderma

Scleroderma is a systemic disease which may affect almost any organ in the body. Cutaneous findings arecharacterized by symmetric, thickening of the skin. Dyspigmentation may occur with salt and

pepper appearance due to perifollicular depigmentation.Q/Q(M)-477175 Report a Problem

Which of the following hormones bind the androgen receptor?

1 Dehydroepiandrosterone

2 Androstenedione

3 Dihydrotestosterone

4 Dehydroepiandrosterone and dihydrotestosterone

5 Dehydroepiandrosterone, androstenedione, and dihydrotestosterone


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Which of the following hormones bind the androgen receptor?

3 Dihydrotestosterone

Only testosterone and dihydrotestosterone bind the androgen receptor, thus adrenal androgens(androstenedione and dehydroepiandrosterone) virilize only in so far as they serve as precursors fortestosterone and dihydrotestosterone.


A patient presents with hemorrhagic onycholysis. The drug class most commonly associated with thisfinding is:

1 Quinolone antibiotics

2 Systemic retinoids

3 Calcineurin inhibitors

4 Taxanes

5 Tetracyclines


A patient presents with hemorrhagic onycholysis. The drug class most commonly associated with thisfinding is:

4 TaxanesTaxane probably cause nail changes more commonly than other drugs. Cutaneous toxicity has beenreported with taxanes and includes erythema and desquamation, involving primarily the hands. Taxanesexert their cytotoxic effect by reversibly binding the -subunit of tubulin, thereby inducing tubulin

polymerization and inhibiting microtubule depolymerization. A balance between polymerization anddepolymerization is needed for normal microtubule function. Taxanes disrupt this balance, leading toarrest at the G2/M phase of the cell cycle.


Diarrhea, Dementia and a photosensitive dermatitis are associated with a deficiency of which vitamin?1 Niacin

2 Biotin

3 Thiamine

4 Riboflavin

5 Pyridoxine



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Diarrhea, Dementia and a photosensitive dermatitis are associated with a deficiency of which vitamin?

1 Niacin

Niacin (Vitamin B3) deficiency is associated with a photosensitive dermatitis, diarrhea and dimentia. Thephotosensitive dermatitis classically involves the face, neck and upper chest (Casal's necklace) andforearms (as pictured). Other findings may include angular cheilitis and thickening andhyperpigmentation of skin overlying bony prominences.


What is the most common presentation of psoriatic arthritis?

1 Asymmetric oligo- or polyarthritis

2 Symmetric polyarthritis

3 Spondylitis (axial)

4 Distal interphalangeal joint (DIP) disease

5 Arthritis mutilans


What is the most common presentation of psoriatic arthritis?

1 Asymmetric oligo- or polyarthritis

Psoriatic arthritis affects 20-40% of patients with psoriasis. Most (~80%) of psoriatic arthritis patients arerheumatoid factor negative. All of the answer choices represent possible presentations of psoriaticarthritis, but asymmetric oligo- or polyarthritis is the most common presentation.



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In this patient with an autoimmune disorder, which autoantibody would be indicative of increased risk ofpulmonary disease?

1 U1RNP

2 DsDNA

3 anti-Jo-1 antibody

4 Mi-2 antibody

5 Scl-70 antibody


In this patient with an autoimmune disorder, which autoantibody would be indicative of increased risk ofpulmonary disease?

3 anti-Jo-1 antibody

The patient depicted has dermatomyositis. Autoantibodies to anti-Jo-1 antibody targets histidyl transferRNA synthetase. In dermatomyositis correlates with the development of pulmonary disease.


All of the following drugs have been reported to cause rash similar to the attached image except

1 Hydroxyurea

2 D-penicillamine

3 Statins

4 Phenytoin

5 Captopril



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All of the following drugs have been reported to cause rash similar to the attached image except

5 Captopril

The image shows symmetrical erthematous to violaceous plaque on dorsal hands with some periungualerythema and telangiectasia. Skin biopsy was consistent with interface dermatitis and mucin. Many drugshave been reported to cause dermatomyositis-like picture, which include hydroxyurea, D-penicillamine,statins, phenytoin and alfuzosin (alpha antagonist for BPH). Captopril is not associated with DM-likerash.


This woman has restricted ability to open her mouth with tight bound down skin of her hands andpulmonary fibrosis. In addition to a positive ANA with a nucleolar pattern, what is the most commonautoimmune antibody that is associated with pulmonary fibrosis?

1 Topoisomerase I antibodies (formerly Scl-70)

2 Fibrillarin antibodies

3 Anti-U3RNP antibodies

4 Anti-PM-Scl antibodies

5 Anti-thyroglobulin antibodies


This woman has restricted ability to open her mouth with tight bound down skin of her hands and

pulmonary fibrosis. In addition to a positive ANA with a nucleolar pattern, what is the most commonautoimmune antibody that is associated with pulmonary fibrosis?


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1 Topoisomerase I antibodies (formerly Scl-70)

This woman has scleroderma which is a systemic disease characterized by skin induration andthickening. The cutaneous findings are accompanied by various degrees of tissue fibrosis and chronicinflammatory infiltration in numerous visceral organs, prominent fibroproliferative vasculopathy, andhumoral and cellular immune alterations. Antinuclear antibodies are present in about 95% of the patients,usually with a speckled or homogenous pattern. A nucleolar pattern, although less common, is more

specific for systemic sclerosis. Topoisomerase I antibodies (formerly Scl-70) are present inapproximately 30% of patients with diffuse disease (absent in limited disease) and are associated with

pulmonary fibrosis. Anticentromere antibodies are present in about 60-90% of patients with limiteddisease and are rare in patients with diffuse disease. Fibrillarin antibodies and antibodies to U3ribonucleoprotein (RNP) may also be present but are more common in patients with skeletal muscleinvolvement. Anti-U3RNP is present mostly in patients with diffuse disease with overlap syndromes.Anti-ThRNP is present mostly in limited disease and is associated with more extensive visceral disease.Anti-PM-Scl is present in limited and overlap states and is associated with myositis and renalinvolvement.


Increased chylomicrons are a feature of which type of hyperlipoproteinemia?

1 Type I

2 Type IIa

3 Type IIb

4 Type III

5 Type IVQ/Q(M)-480549 Report a Problem

Increased chylomicrons are a feature of which type of hyperlipoproteinemia?

1 Type I

Type I (familial lipoprotein lipase deficiency or apoprotein CII deficiency) hyperlipoproteinemia hasincreased chylomicrons as a feature, and presents with eruptive xanthomas and lipemia retinalis. For theother hyperlipoproteinemias, the associated lipid abnormalities are as follows: Type IIa -- increased LDL;Type IIb -- increased LDL and VLDL; Type III -- increased IDL; Type IV -- increased VLDL. Type V

has increased chylomicrons and increased VLDL.Q/Q(M)-480549 Report a Problem

A patient presents with cutaneous lesions suggestive of sarcoidosis. You consider ordering a serum ACElevel to help with the diagnosis. What is the sensitivity and specificity of checking an ace level in this pt?

1 Sensitivity: 60 Specificity: 80





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A patient presents with cutaneous lesions suggestive of sarcoidosis. You consider ordering a serum ACElevel to help with the diagnosis. What is the sensitivity and specificity of checking an ace level in this pt?


Serum ACE levels are positive in only approximately 60% of patients with sarcoidosis. However thespecificity is only 80%. Therefore, serum ace levels are less helpful in diagnosis (they can be helpful infollowing treatment response.) For example, if your pretest clinical suspicion of sarcoidosis is 25% (i.e. 1of 4 likely possible etiologies based on differential diagnosis), then of a 1000 patients tested, 250 willhave sarcoidosis. 160 of these will be detected by an abnormal serum ace level, but 150 of the non-sarcoidosis patients will also have an abnormal ace level giving you a positive predictive value of justover 50% making it a poor diagnositic test.


Pyostomatitis vegetans is characteristically associated with which systemic disease?

1 Pemphigus vulgaris

2 Ulcerative colitis

3 Lichen planus

4 Lymphoma

5 Rheumatoid arthritis


Pyostomatitis vegetans is characteristically associated with which systemic disease?

2 Ulcerative colitis

Pyostomatitis vegetans is a pustular, vegetative variant of pyoderma gangrenosum, found in the oralmucous membranes. It is most frequently associated with inflammatory bowel disease.


Best treatment option for this stable type of vitiligo is

1 Phototherapy with narrow band UVB

2 Excimer laser

3 Oral prednisone

4 20% monobenzyl ether of hydroquinone

5 Nitrogen mustard



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Best treatment option for this stable type of vitiligo is

4 20% monobenzyl ether of hydroquinone

The picture shows generalized type of vitiligo or vitiligo universalis. Patients who have widespreaddisease with only a few areas of normally pigmented skin in exposed sites can be treated withdepigmenting agents. The patients must be carefully chosen, i.e. adults who recognize that theirappearance will be altered significantly and who understand that depigmentation requires lifelong care of

the skin (sunscreens, protective clothing, etc.). The most commonly used agent is monobenzyl ether ofhydroquinone (MBEH) 20% applied twice daily to the affected areas for 9-12 months or longer.Monobenzyl ether of hydroquinone is a potent irritant and/or allergen, and an open use test should be

performed before more widespread application. It normally takes 1-3 months to initiate a response, and aloss of pigment can occur at distant sites. Although depigmentation from MBEH is considered

permanent, repigmentation (especially perifollicular) can be seen following a sunburn or even intense sunexposure. Monomethyl ether of hydroquinone in a 20% cream can be used as an alternative to MBEH.Side effects include contact dermatitis, exogenous ochronosis and leukomelanoderma en confetti.Phototherapy and excimer laser are not good or practical choices for this type of vitiligo. Nitrogenmustard is not used in vitiligo.


What is the most common malignancy associated with this condition in this female?

1 Brain cancer

2 Thyroid cancer

3 Breast cancer

4 Ovarian cancer

5 Liver cancerQ/Q(M)-476818 Report a Problem


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What is the most common malignancy associated with this condition in this female?

4 Ovarian cancer

Dermatomyositis is an autoimmune polymyositis with characteristic cutaneous findings. Patients withdermatomyositis should be screened for a underlying malignancy. Risk factors for having an underlyingmalignancy include a negative ANA, adult age, and female gender. Ovarian cancer is one of the most

frequently associated dermatomyositis.Q/Q(M)-476818 Report a Problem

What is the treatment of choice for this condition?

1 Nystatin

2 Fluconazole

3 Better oral hygiene

4 Penicillin

5 Acyclovir


What is the treatment of choice for this condition?

3 Better oral hygiene

Black tongue is associated with poor oral hygiene, the use of medications, and radiation to the head and


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neck region. In many cases, simply brushing the tongue with a toothbrush or using a commerciallyavailable tongue scraper is sufficient improve the condition.


Patients with Dermatitis Herpetiformis are most likely to have:

1 Antibodies to BPAg2

2 Antibodies to transglutaminase 3

3 Mutations in transglutaminase I

4 Mutations in laminin 5

5 Mutations in plectin


Patients with Dermatitis Herpetiformis are most likely to have:

2 Antibodies to transglutaminase 3

In dermatitis herpetiformis, antibodies are found to transglutaminase 3, and the direct immunofluorescentstudies show granular IgA and C3 in the dermal papillae. Antibodies to BPag2 are found in bullous

pemphigoid. Mutations in plectin are found in EBS with muscular dystrophy. Mutations in laminin 5 arefound in patients with JEB,Herlitz type. Mutations in transglutaminase I are found in pateints withlamellar ichthyosis and non bullous congenital ichthyosiform erythroderma.


Histologic examination of this chronic pruritic plaque on the back, which of the following stains wouldNOT be positive?

1 Von Kossa

2 Cotton dyes

3 Crystal violet

4 PAS5 Thioflavin T


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Histologic examination of this chronic pruritic plaque on the back, which of the following stains wouldNOT be positive?

1 Von Kossa

Macular amyloid is a form of keratin derived amyloid, which is typically located between the shoulderblades. Many stains are used to identify amyloid in the skin including Congo red, cotton dyes, crystalviolet, PAS and thioflavin T.


The differential diagnosis for the attached image should include all of the followings except

1 Candidiasis

2 Lichen planus

3 Contact dermatitis

4 Inverse psoriasis

5 Erythrasma


The differential diagnosis for the attached image should include all of the followings except


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5 Erythrasma

The image shown is inverse type of psoriasis. Although psoriatic lesions are classically distributed on theextensor surfaces (the elbows, knees, and lumbosacral regions), lesions may also be found in a flexuraldistribution with involvement of the axillae, groin, perineum, central chest, and umbilical region.Differential diagnosis include all other choices in question. Although erythrasma might be included indifferentials in case of groin involvement only, it is unlikly for eryhrasma to presnt on penis with well

demarctaed erythamtos plaques. Erythrasma is a superficial bacterial infection of the skin caused by C.minutissimum. It is characterized by asymptomatic, well-demarcated, reddish brown, slightly scaly

patches in the groin, axillae, gluteal crease, or inframammary regions, and less often the interdigitalspaces of the feet. Erythrasma is frequently confused with a dermatophyte infection, it can bedifferentiated from tinea infection by the characteristic coral red fluorescence seen when viewed underWood's lamp illumination (due to the production of porphyrins by the corynebacteria.


This 10 year-old girl presents to your office. These lesions have been present for months. She denies any

other systemic complaints. What will you tell her parents?1 They should expect her to get more lesions in non sun-exposed areas

2 She is more likely to develop systemic lupus erythematosus than an adult with these lesions

3 She is less likely than an adult to develop renal disease

4 She is more likely than an adult to develop cardiovascular disease

5 No hematologic labs are required for evaluation


This 10 year-old girl presents to your office. These lesions have been present for months. She denies anyother systemic complaints. What will you tell her parents?

1 They should expect her to get more lesions in non sun-exposed areas


3 She is less likely than an adult to develop renal disease

4 She is more likely than an adult to develop cardiovascular disease


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5 No hematologic labs are required for evaluation


This 10 year-old girl presents to your office. These lesions have been present for months. She denies anyother systemic complaints. What will you tell her parents?


Discoid lupus erythematosus (DLE) presents with plaques characterized by scarring, atrophy, follicularplugging, and scale and photosensitivity. Children presenting with DLE have a higher incident ofdeveloping systemic lupus (SLE) than adults. Because of progression from DLE to SLE, children should

be screened and followed with antinuclear antibodies and anti- DNA antibodies. Children andadolescents have a higher incidence of renal involvement. Treatment for DLE includes topical steroids,oral steroids, and hydroxychloroquine.


You are suspicious for a new diagnosis of lupus in a patient recently treated with penicillamine. Whichantibodies would you expect to have been induced by this medication?

1 anti-dsDNA

2 anti-histone

3 anti-SSA

4 anti-SSB5 anti-Mi-2


You are suspicious for a new diagnosis of lupus in a patient recently treated with penicillamine. Whichantibodies would you expect to have been induced by this medication?

1 anti-dsDNA

Penicillamine induces native systemic lupus erythematosus, associated with anti-dsDNA antibodies, in

contrast to drug-induced lupus erythematosus which has been associated with exposure to hydralazine,procainamide, sulfonamides, penicillin, anticonvulsants, minocycline, and INH and is associated withanti-histone antibodies.


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What autoimmune disease is associated with a PRP-like eruption?

1 Systemic lupus

2 Rheumatoid arthritis3 Dermatomyositis

4 Scleroderma

5 Pemphigus erythematosus


What autoimmune disease is associated with a PRP-like eruption?

3 Dermatomyositis

The Wong type of dermatomyositis is characterized by erythematous, hyperkeratotic, follicular papules .It can have a limited or generalized distribution. It can evolve into full-blown dermatomyositis withclassic cutaneous features. This rare variant bears a striking clinical resemblance to PRP. It can bedistinguished on skin biopsy. It has been reported in both adults and children. Some reports suggest thefollicular papules are confined to the skin overlying the extensor knees and elbows and this variant may

be more common in Asian patients.


What is the treatment of choice for neurotic excoriations?

1 Risperidone

2 Doxepin

3 Olanzapine

4 Gabapentin

5 Diphenhydramine


What is the treatment of choice for neurotic excoriations?

2 Doxepin

Doxepin is the treatment of choice for patients with neurotic excoriations. It has both antidepressant andantipruritic effects. Combined psychiatric and pharmacologic intervention is recommended. Other agentssuch as risperidone, olanzapine, gabapentin, and diphenhydramine are not drugs of choice for thisdisorder.


The "flag sign" is seen in which of the following conditions?


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1 psoriasis

2 sarcoidosis

3 hidradenitis suppurativa

4 kwashiorkor

5 telogen effluviumQ/Q(M)-480485 Report a Problem

The "flag sign" is seen in which of the following conditions?

4 kwashiorkor

The "flag sign" is a striking physical finding most readily seen in long and dark hair. Hair that has grownduring periods of inadequate nutrition is pale so alternating bands of light and dark can be seen along asingle strand (reflecting periods of adequate and inadequate nutrition). The "flag sign" can be seen with

other nutritional disorders as well.Q/Q(M)-480485 Report a Problem

A young man treated with minocycline developed blue-black discoloration with acne scars at his cheeks.A Perls stain would show:

1 Increased melanin at the basal layer of the epidermis

2 Black staining granules within macrophages

3 Blue staining granules within macrophages

4 Muddy brownpigment granules

5 Giant melanosomes

Q/Q(M)-474305 Report a ProblemA young man treated with minocycline developed blue-black discoloration with acne scars at his cheeks.A Perls stain would show:

3 Blue staining granules within macrophages

Perls stain stains hemosiderin (iron) blue. Fontana Masson stains melanin black. Minocyclinehyperpigmentation often shows positive staining for both iron and melanin.


Which of the following is true regarding topical therapies for psoriasis?

1 Vitamin D3 analogues deactivate salicylic acid

2 Retinoids are effective in decreasing lesional erythema

3 Anthralin can cause irreversible staining of peri-lesional skin4 Calcipotriol is deactivated by UV light


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5 Anthralin inhibits PMNs and monocytes


Which of the following is true regarding topical therapies for psoriasis?

5 Anthralin inhibits PMNs and monocytesAnthralin, in addition to possessing antiproliferative activity on human keratinocytes, has strong anti-inflammatory effects by inhibiting PMNs and monocytes. Vitamin D3 analogues are inactivated bysalicylic acid and should be used after UV light (calcipotriol absorbs UV). Retinoids reduce scaling and

plaque thickness, but do not generally decrease lesional erythema. Anthralin can stain hair purple andcause reversible brownish discoloration of surrounding skin.

Q/Q(M)-480389 Report a ProblemWhat is the diagnosis?

1 Psoriasis

2 Lichen planus

3 Balanitis circinata

4 Candida

5 Syphilis


What is the diagnosis?

3 Balanitis circinataBalanitis circinata presents as sharply demarcated, serpiginous ulcers or plaques on the penile head.Balanitis circinata is usually seen in Reiter's syndrome which has a classic triad of arthritis, urethritis, andconjunctivitis. The syndrome typically occurs post-infection of the GI or urinary tract.


Almost all patients with SLE have positive ANAs. A patient can have ANA-negative SLE if they onlymake antibodies to:

1 ssDNA

2 Sm


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3 U1RNP

4 Ro

5 dsDNA


Almost all patients with SLE have positive ANAs. A patient can have ANA-negative SLE if they onlymake antibodies to:

1 ssDNA

ANA-negative SLE is uncommon. The ANA has a high negative predictive value and low positivepredictive value. ANA-negative SLE can result if a patient only makes antibodies to ssDNA, which is notdetected by most tests.


A 62 year-old man with chronic renal failure on hemodialysis presents with carpal tunnel syndrome, bonecysts, and spondyloarthropathy. A diagnosis of amyloidosis is suspected. Which of the following is trueregarding his most likely diagnosis?

1 AA amyloid is likely causative

2 AL amyloid is likely causative

3 beta 2-microglobulin is likely causative

4 keratin-derived amyloid is likely causative

5 Amyloid P component will not be found in affected tissues


A 62 year-old man with chronic renal failure on hemodialysis presents with carpal tunnel syndrome, bonecysts, and spondyloarthropathy. A diagnosis of amyloidosis is suspected. Which of the following is trueregarding his most likely diagnosis?

3 beta 2-microglobulin is likely causative

The patient likely has dialysis-related amyloidosis. In this condition, beta 2-microglobulin is the proteincomponent altered by uremia. Carpal tunnel syndrome, bone cysts, and spondyloarthropathy commonlyresult. Amyloid P component and ground substance are found in all forms of amyloidosis; the protein-derived amyloid fibers differ among the various forms.


Which of the following is true regarding atopic dermatitis?

1 Over 80% of affected individuals present in the first year of life

2 Natural measles infection has been noted to improve atopic dermatitis

3 Most children develop worsening of atopic dermatitis if they develop asthma later in childhood


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4 Staphylococcus aureus is found in ~25% of atopic dermatitis skin lesions

5 Increased expression of cathelicidins such as LL 37 has been noted in atopic dermatitis


Which of the following is true regarding atopic dermatitis?

2 Natural measles infection has been noted to improve atopic dermatitis

Natural measles infection has been noted to improve atopic dermatitis. Atopic dermatitis typically beginsin infancy, with ~50% in the first year of life and an additional 30% between 1 and 5 years. Most childrenwith AD eventually develop allergic rhinitis or asthma later in childhood. Many outgrow AD asrespiratory allergy develops. S. aureus is found in over 90% of AD skin lesions. Decreased expression ofinnate antimicrobial peptides, such as human beta-defensin and cathelicidins, such as LL 37, may explainthe increased susceptibility to colonization and skin infection with S. aureus in patients with atopicdermatitis.


Sarcoidosis presenting as uveitis, facial nerve palsy, fever and parotid gland swelling is referred to as:

1 Heerfordt's syndrome

2 Lofgren's syndrome

3 Lupus pernio

4 Darier-Roussy disease

5 Schaumann syndrome


Sarcoidosis presenting as uveitis, facial nerve palsy, fever and parotid gland swelling is referred to as:


Heerfordt's syndrome is the name given to sarcoidosis presenting with uveitis, facial nerve palsy, feverand parotid gland swelling. Lofgren's syndrome is an acute presentation of sarcoidosis that presents wthfever, arthritis, erythema nodosum and hilar adenopathy. Darier-Roussy disease is sarcoidosis presentingas painless firm subcutaneous nodules. Lupus pernio refers to sarcoidosis presenting as papulonodules

and plaques involving the nose (especially the alar rim), ears and cheeks. Schaumann syndrome was adistractor as Shaumann bodies are seen in sarcoidosis on histopathology.


Which of the following is important in the pathogenesis of acne vulgaris?

1 Activation of toll-like receptor-3 by P. acnes

2 Activation of toll-like receptor-2 by M. furfur

3 Activation of toll-like receptor-2 by P. acnes

4 P. acnes produces lipase which cleaves cholesterol into triglycerides


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5 Demodex activates complement


Which of the following is important in the pathogenesis of acne vulgaris?

3 Activation of toll-like receptor-2 by P. acnesAcne vulgaris is a disease of follicular hyperkeratosis and the microcomedone is thought to be the

precursor lesion. P. acnes has lipase that cleaves triglycerides into free fatty acids. P. acnes can activatecomplement and PMN chemotaxis. Toll-like receptors (TLR) recognize bacterial patterns and P. acnesactivates TLR-2.


A child has a cutaneous ossification disorder characterized by endochondral bone formation, deafness,baldness, and mental retardation. Which form of osteoma cutis does this patient have?

1 Fibrodysplasia ossificans progressiva2 Progressive osseous heteroplasia

3 Plate-like osteoma cutis

4 Albright's hereditary osteodystrophy

5 Calcinosis cutis


A child has a cutaneous ossification disorder characterized by endochondral bone formation, deafness,baldness, and mental retardation. Which form of osteoma cutis does this patient have?

1 Fibrodysplasia ossificans progressiva

This patient has fibrodysplasia ossificans progressiva characterized by endochondral bone formation (theother types have intramembranous bone formation), noggin gene defects and other systemic symptoms aslisted. This is a progressive and potentially fatal condition. Progressive osseous heteroplasia is also

progressive, seen in mostly females, and demonstrates increased alkaline phosphatase, LDH and CPKwith normal calcium, phosphate, and PTH. Plate-like osteoma cutis is limited and seen in children andnewborns. Albright's hereditary osteodystrophy is due to a mutation in GNAS-1. This disorder is

characterized by a lack of responsiveness to parathyroid hormone, resulting in low serum calcium, highserum phosphate, and appropriately high serum parathyroid hormone. Individuals with Albright'shereditary osteodystrophy have short stature, characteristically shortened fourth and fifth metacarpals,rounded facies, and often mild mental retardation. Calcinosis cutis is not a form of osteoma cutis.


The mechanism of action of azithromycin is:

1 Inhibition of bacterial cell wall synthesis

2 Inhibition of RNA-dependent protein synthesis by binding to the 30s ribosomal subunit3 Inhibition of RNA-dependent protein synthesis by binding to the 50s ribosomal subunit


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4 Inhibition of DNA-dependent RNA polymerase

5 Inhibition of bacterial topoisomerase


The mechanism of action of azithromycin is:

3 Inhibition of RNA-dependent protein synthesis by binding to the 50s ribosomal subunit

Azithromycin is a macrolide antibiotic. It binds the bacterial 50s ribosomal subunit and inhibits RNA-dependent protein synthesis.


A pregnant woman in her third trimester presents with nonpruritic erythematous plaques and pustules inthe intertriginous regions, the trunk, and the extremities as well as systemic symptoms of malaise andfever. Which complication is most associated with this condition?

1 Premature labor

2 Placental insufficiency

3 No risk to fetus or mother

4 Small for gestational age

5 Microcephaly


A pregnant woman in her third trimester presents with nonpruritic erythematous plaques and pustules inthe intertriginous regions, the trunk, and the extremities as well as systemic symptoms of malaise andfever. Which complication is most associated with this condition?

2 Placental insufficiency

This patient has pustular psoriasis of pregnancy which is also called "impetigo herpetiformis." It ischaracterized by red plaques with a peripheral ring of pustules that are distributed symmetrically inflexural areas and trunk and extremities. Patients can have elevated ESR and leukocytosis as well ashypocalcemia. There is a risk of fetal morbidity and mortality secondary to placental insufficiency and

maternal mortality secondary to cardiac or renal failure. Premature labor may be associated withcholestasis or pregnancy. Patients with herpes gestationis may have a risk of premature labor and smallfor gestational age. Microcephaly may occur with isotretinoin taken during pregnancy.


Acrokeratosis paraneoplastica is most commonly associated with which of the following malignancies:

1 Squamous cell carcinoma

2 Adenocarcinoma

3 Transitional cell carcinoma4 T-cell lymphoma


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5 Breast cancer


Acrokeratosis paraneoplastica is most commonly associated with which of the following malignancies:

1 Squamous cell carcinomaAcrokeratosis paraneoplastica, also known as Bazexs syndrome, is a rare paraneoplastic syndrome.Clinically, it appears as symmetric, hyperkeratotic lesions on red base, in an acral distribution, nose andhelices of the ears. Most commonly associated with upper aerodigestive tract tumors. Treatment of thetumor leads to disappearance of lesions.


Which of the following is an example of a large vessel vasculitis?

1 Takayasu arteritis

2 Wegener's granulomatosis

3 Chrug-Strauss syndrome

4 Polyarteritis nodosa

5 Henoch-Schonlein purpura


Which of the following is an example of a large vessel vasculitis?

1 Takayasu arteritis

Takayasu arteritis is a large vessel vasculitis that manifests as progressive granulomatous inflammationof the aorta and its major branches. The systemic vasculitidies are classified into three categories: largevessel, medium-sized vessel and small vessel vasculitis. Takayasu arteritis and Giant cell (temporal)arteritis are the two large vessel vasculitidies. Polyarteritis nodosa and Kawasaki disease are medium-sized vasculitidies. Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis,Henoch-Schonlein purpura and cutaneous leukocytoclastic vasculitis are examples of small vesselvasculitidies.


What mast cell mediators are preformed, rather than synthesized upon exposure to a trigger?

1 tryptase

2 leukotriene C4

3 thromboxane

4 prostaglandin D2

5 platelet activating factor



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What mast cell mediators are preformed, rather than synthesized upon exposure to a trigger?

1 tryptase

Mast cell mediators can be grouped into two classes: preformed and newly formed. Preformed mediatorsinclude tryptase, histamine, serotonin, and heparin. Newly formed mediators include prostaglandin D2,leukotriene C4, and platelet activating factor.


What is the treatment of choice for this condition:

1 Topical antifungal medication

2 High potency topical steroid

3 Topical antibiotic cream

4 Oral antibiotic

5 Excision


What is the treatment of choice for this condition:

2 High potency topical steroid

The condition depicted is lichen sclerosus et atrophicus which most commonly affects the genital region.High potency topical steroids are the treatment of choice.


RNP antibodies include:

1 anti-SSA, anti-centromere, anti-SSB

2 anti-SSA, anti-SSB, anti-Sm, anti-U1RNP

3 anti-SSA, anti-SSB, anti-Sm, anti-dsDNA

4 ANA, anti-dsDNA

5 anti-SSA, anti-U1RNP, anti-centromere



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RNP antibodies include:

2 anti-SSA, anti-SSB, anti-Sm, anti-U1RNP

RNP antibodies target small ribonucleoproteins. These include SS-A (Ro), SS-B (La), Sm, and U1RNP.The total amount of antibody has more diagnostic value than the mere presence of antibody.


Which systemic anesthetic can be safely used in mastocytosis?

1 Lidocaine

2 Succinylcholine

3 D-tubocurarine

4 Thiopental

5 Propofol


Which systemic anesthetic can be safely used in mastocytosis?

5 Propofol

Local lidocaine can be safely used but systemic lidocaine can precipitate anaphylaxis in patients withmastocytosis. Other systemic analgesics that are counter-indicated in mastocytosis includesuccinylcholine, d-tubocurarine, thiopental, metocurine, enflurane, isoflurane, and etomidate. Propofol,vecuronium bromide, and fentanly are safe options for systemic anesthesia in patients with mastocytosis.


A 48 year old woman was recently diagnosed with dermatomyositis. Which examination would be mostimportant in a work up for malignancy?

1 Breast exam

2 Chest xray

3 Thyroid exam

4 Pelvic exam5 Stool guiac


A 48 year old woman was recently diagnosed with dermatomyositis. Which examination would be mostimportant in a work up for malignancy?

4 Pelvic exam

Dermatomyositis is an idiopathic inflammatory disease with myositis and characteristic cutaneous

manifestations. There is an increased incidence of malignancy in these patients which may precede, occurwith or follow the diagnosis of dermatomyositis. The most common form of malignancy in adult women


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is ovarian cancer. Other malignancies that have been associated include testicular cancer, gastrointestinal,lung and nasopharyngeal carcinomas.


A 17 year old high school cheerleader returns to clinic for follow up of her acne and management of herisotretinoin. She denies depression or any GI complications. She is pleased with her progress but doesmention painful red bumps on her lower legs for 1 week. She attributes these to her cheer practice. Whatis the most likely cause of her lower extremity lesions.

1 Training regimen

2 Abusive boyfriend

3 Oral contraceptives

4 Allergy medication

5 Recent strep infectionQ/Q(M)-482789 Report a Problem

A 17 year old high school cheerleader returns to clinic for follow up of her acne and management of herisotretinoin. She denies depression or any GI complications. She is pleased with her progress but doesmention painful red bumps on her lower legs for 1 week. She attributes these to her cheer practice. Whatis the most likely cause of her lower extremity lesions.

3 Oral contraceptives

The patient is likely experiencing erythema nodosum (EN), a delayed hypersensitivity response to a widevariety of eliciting factors. They consist of an eruption of erythematous, tender nodules, typically overthe anterior tibial areas. Common causes include oral contraceptives, which is a probable choice giventhat the patient is likely taking them as part of her isotretinoin treatment. Strep infection is also a commoncause of EN but with no mention of symptoms is less likely in this case. Other causes include TB, fungalinfections, sarcoidosis, ulcerative colitis, and regional enteritis.


A 48 year-old man with a long history of alcohol abuse and dependence presents with angular cheilitis,atrophic glossitis, a scrotal dermatitis that spares the midline and extends to the thighs, photophobia, and

blepharitis. Which nutritional deficiency do you suspect?

1 Vitamin B12

2 Vitamin C

3 Pyridoxine

4 Vitamin B2

5 Iron



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A 48 year-old man with a long history of alcohol abuse and dependence presents with angular cheilitis,atrophic glossitis, a scrotal dermatitis that spares the midline and extends to the thighs, photophobia, and

blepharitis. Which nutritional deficiency do you suspect?

4 Vitamin B2

The patient presents with classic findings of the oral-ocular-genital syndrome seen in the setting ofvitamin B2 (riboflavin) deficiency. This deficiency occurs most often in alcoholics. It characteristically

presents with angular cheilitis, atrophic glossitis (magenta), a seborrheic-like dermatitis around the nose,genital dermatitis (scrotal dermatitis sparing the midline and extending to the thighs), photophobia, and

blepharitis.


Which of the following medications is NOT associated with exacerbating or causing this eruption?

1 Lithium

2 Prednisone

3 Phenytoin

4 Isoniazid

5 Propranolol


Which of the following medications is NOT associated with exacerbating or causing this eruption?

5 Propranolol

Acne and acneiform eruptions can be caused or exacerbated by cortiosteroids, oral contraceptives,androgens, ACTH, lithium, phenytoin, halogens, INH, and haloperidol.


Which of the following is true regarding this entity?

1 The subcutaneous variant is most common in children

2 75% of localized lesions are still present 2 years after diagnosis

3 Localized lesions often ulcerate and heal with scarring

4 The perforating variant classically involves the lower extremities

5 Diabetes is present in the majority of patients with the generalized variant


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Which of the following is true regarding this entity?

1 The subcutaneous variant is most common in children

Granuloma annulare is the entity pictured. Subtypes include localized GA, generalized GA, macular GA,

subcutaneous GA, and perforating GA. The subcutaneous variant is most common in children; there isoften a history of trauma to the area. Localized lesions never ulcerate and heal without scarring; 75% oflocalized lesions clear within 2 years. The perforating variant classically involves the dorsa of the hands.Diabetes is present in 20% of patients with the generalized variant.


A 35 year-old woman presents with predominantly lower facial inflammatory acne, hirsutism, andirregular menses. She has failed multiple conventional treatments. Laboratory work-up reveals a veryhigh level of DHEA-S. You are most concerned about:

1 Congenital adrenal hyperplasia

2 Adrenal tumor

3 Polycystic ovary syndrome

4 Toxicity from prolonged use of spironolactone

5 Progestin excess from oral contraceptives


A 35 year-old woman presents with predominantly lower facial inflammatory acne, hirsutism, andirregular menses. She has failed multiple conventional treatments. Laboratory work-up reveals a veryhigh level of DHEA-S. You are most concerned about:

2 Adrenal tumor

A patient whose acne fails to respond to conventional therapy, whose acne flares cyclically, withhirsutism, alopecia, or irregular menses warrants an endocrine work-up, including free and totaltestosterone, LH, FSH, and DHEA-S. Although rare, very high levels of DHEA-S may suggest anadrenal adrogen-secreting tumor.



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The dermatosis pictured is most commonly associated with:

1 Insulin resistance

2 Cushing's syndrome

3 Acromegaly4 Polycystic ovarian syndrome

5 Gastric carcinoma


The dermatosis pictured is most commonly associated with:

1 Insulin resistanceInsulin resistance is the most common cause of acanthosis nigricans. Insulin-like growth factors,

produced by the liver in response to high levels of circulating insulin, bind epidermal growth factorreceptors to produce thickening of the epidermis and hyperkeratosis. Cushing's syndrome, acromegalyand polycystic ovarian syndrome are associated with acanthosis nigricans, although less common thaninsulin resistance. Paraneoplastic acanthosis nigricans is associated with gastrointestinal carcinoma,classically gastric carcinoma.


Eyebrow growth:1 Is androgen-dependent in men but not in women

2 Is regulated by dehydroepiandrosterone but not androstenedione

3 Is not androgen-dependent

4 Requires conversion of testosterone to dihydrotestosterone in the hair follicle

5 Is regulated only by testosterone and dihydrotestosterone


Eyebrow growth:


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patients with atopic dermatitis.


Pernio or Chilblains is an inflammatory skin condition which is triggered by cold, wet, non-freezingenvironmental conditions. Acral skin has violaceous discoloration accompanied by burning or itching.While avoidance and prevention is best, the most effective pharmacologic treatment is:

1 Nifedipine

2 Nicotinamide

3 Phenoxybenzamine

4 Psoralen+UVA

5 Aspirin


Pernio or Chilblains is an inflammatory skin condition which is triggered by cold, wet, non-freezingenvironmental conditions. Acral skin has violaceous discoloration accompanied by burning or itching.While avoidance and prevention is best, the most effective pharmacologic treatment is:

1 Nifedipine

Nifedipine is effective in about 70% of patients with pernio in prevention of the development of new skinlesions. The other options listed, other than aspirin, are anecdotally suggested to be helpful.


A patient develops pulmonary fibrosis, Raynaud's phenomenon and skin changes similar to systemicsclerosis. These changes resolve following discontinuation of which of the following medications?

1 Bleomycin

2 Penicillamine

3 Hydralazine

4 Minocycline

5 Isoniazide


A patient develops pulmonary fibrosis, Raynaud's phenomenon and skin changes similar to systemicsclerosis. These changes resolve following discontinuation of which of the following medications?

1 Bleomycin

The changes described above are similar to findings of scleroderma. Patients receiving bleomycin candevelop a reversible syndrome similar to scleroderma. The other four listed options are related to drug-induced lupus erythematosus and are not linked to scleroderma-like syndromes.



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What is the most likely diagnosis?

1 Voight line

2 Linea nigra

3 Fuchter line

4 Phytophotodermatitis

5 Incontinentia pigmenti


What is the most likely diagnosis?

2 Linea nigra

Linea nigra is a hyperpigmented, linear patch that often becomes apparent during pregnancy. It is thought

to be secondary to hormonal fluctuations and usually spontaneously resolves after pregnancy. Voight andFuchter lines delineate a vestigial hyperpigmentation of the dorsal aspect of organisms.


Which of the following viruses is associated the most with lichen planus?

1 Hepatitis C virus

2 Hepatitis B virus

3 Human immunodeficiency virus

4 Hepatitis A virus

5 Epstein-barr virus


Which of the following viruses is associated the most with lichen planus?

1 Hepatitis C virus

Lichen planus classically involves the wrists, ankles, and oral mucosa. It is characterized by violaceous

polygonal, purple, pruritic papules. It has a strong association with hepatitis C virus. Many otherassociations exist, including other viruses and medications, but hepatitis C is the best choice.


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Which of the following is NOT true regarding primary cutaneous amyloidosis?

1 AA is not the protein component

2 Amyloid is present around blood vessels3 AL is not the protein component

4 Notalgia paresthetica may be associated with the macular form

5Amyloid found in benign and malignant neoplasms does not represent primary cutaneousamyloidosis



1 AA is not the protein component

2 Amyloid is present around blood vessels

3 AL is not the protein component

4 Notalgia paresthetica may be associated with the macular form

5Amyloid found in benign and malignant neoplasms does not represent primary cutaneousamyloidosis



2 Amyloid is present around blood vessels

Keratin is the protein component in primary cutaneous amyloidosis. No amyloid is found around bloodvessels. Macular amyloidosis (which may have associated notalgia paresthetica) and lichen amyloidosisare forms of primary cutaneous amyloidosis. Secondary cutaneous amyloidosis presents with keratin-derived amyloid and is seen following PUVA therapy and in benign and malignant neoplasms.


The best diagnosis for this congenital melanopenic lesion without extracutaneous associations is

1 Hypomelanosis of Ito

2 Segmental vitiligo

3 Ash leaf spots

4 Nevus anemicus

5 Nevus achromicus



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The best diagnosis for this congenital melanopenic lesion without extracutaneous associations is

5 Nevus achromicus

Nevus achromicus is another name for nevus depigmentosus. It usually presents at birth or appear duringearly infancy as normal pigmentation increases. Most individuals will have a solitary lesion of nevusdepigmentosus, but multiple lesions and segmental forms of nevus depigmentosus have been described.

Nevus depigmentosus tends to persist lifelong, but remains unchanged after onset. The hypopigmentedwhite spots of tuberous sclerosis are most difficult to distinguish from nevus depigmentosus, but lack ofother cutaneous or systemic manifestaions exclude tubrous sclerosis. Lesions of vitiligo tend to bedepigmented (melanocytopenic not melanopenic as in the question), and show a bright white colorationwith Wood's lamp examination. Nevus anemicus is a distinct vascular birthmark characterized by

blanching of cutaneous blood vessels, hence presenting as a "white" patch of skin that becomesunnoticeable when the surrounding skin is blanched with a glass slide ("diascopy").


Scalp biopsy of a 44-year-old female with suspected discoid lupus erythematosis would likely revealinflammation around which portion of the hair follicle:

1 Dermal papilla

2 Hair bulb

3 Matrix

4 Isthmus

5 Infundibulum


Scalp biopsy of a 44-year-old female with suspected discoid lupus erythematosis would likely revealinflammation around which portion of the hair follicle:

4 Isthmus

On biopsy, alopecia areata exhibits a peribulbar lymphocyticswarm of bees.Discoid lupus typicallyexhibits inflammation surrounding the isthmus, along with a perivascular dermatitis and vacuolarinterface changes. Lichen planopilaris exhibits inflammation most densely concentrated about theinfundibulum.



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A 22 year-old woman notes irregular menses and acne that has been refractory to several over-the-counter and prescription regimens. Appropriate initial work-up includes

1 Serum prolactin levels

2 24-hour urine cortisol

3 Serum free and total testosterone, LH, FSH, androstenedione

4 Serum free and total testosterone, LH, FSH, DHEA-S

5 Serum free and total testosterone, LH, FSH, 17-OH, hydroxylase


A 22 year-old woman notes irregular menses and acne that has been refractory to several over-the-counter and prescription regimens. Appropriate initial work-up includes

4 Serum free and total testosterone, LH, FSH, DHEA-S

The history and clinical appearance of this patient suggest a possible hormonal basis to her acne. Thework-up in answer d assesses for adrenal hormonal production and screens for PCOS. Androstenedione isof ovarian origin.


This radiograph shows a characteristic finding of severe psoriatic arthritis: bone proliferation at the baseof the distal phalanx with resorption of the tufts. What is the most common form of psoriatic arthritis?

1 Arthritis mutilans

2 Axial

3 Symmetric polyarthritis

4 Asymmetric oligoarthritis

5 Symmetric oligoarthritis


This radiograph shows a characteristic finding of severe psoriatic arthritis: bone proliferation at the baseof the distal phalanx with resorption of the tufts. What is the most common form of psoriatic arthritis?

4 Asymmetric oligoarthritis


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Approximately 70 % of psoriatic arthritis is asymmetric oligoarthritis. The slide depicts arthritis mutilans,which occurs in about 5% of patients with psoriatic arthritis.


Which HLA type is more commonly associated with this clinical finding?

1 HLA-B7

2 HLA-B15

3 HLA-B27

4 HLA-B51

5 HLA-DR4


Which HLA type is more commonly associated with this clinical finding?

3 HLA-B27The condition shown is balnitis circinata which is part of the constellation of findings in Reiter'ssyndrome in addition to arthritis, urethritis, and conjunctivitis. There is a higher incidence of thiscondition people with HLA-B27.


This patient was started on isotretinoin but failed to discontinue the tetracycline. He is at risk for whatcomplication?

1 Acne fulminans

2 Pseudotumor cerebri

3 Diarrhea

4 Depression

5 Myositis



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This patient was started on isotretinoin but failed to discontinue the tetracycline. He is at risk for whatcomplication?

2 Pseudotumor cerebri

Both isotretinoin and tetracycline are known to cause pseudotumor cerebri. In combination, the risk issignificantly elevated. Symptoms of pseudotumor cerebri include headaches, pulsatile tinnitus, diplopia,and blurred vision.


Bullous lupus erythematosus is most commonly associated with antibodies to:

1 Type IV collagen

2 Laminin 5

3 Desmoglein I

4 Plectin

5 Type VII collagenQ/Q(M)-482145 Report a Problem

Bullous lupus erythematosus is most commonly associated with antibodies to:

5 Type VII collagen

Type VII collagen is found in the sublamina densa and patients with bullous lupus erythematosus havebeen found to have antibodies to this protein. Bullous LE and EBA share antibasement membrane zoneantibodies of identical specificity (type VII collagen) as well as clinical and histologic overlap. Adifferentiating feature between bullous LE and EBA is that bullous LE has a dramatic response todapsone.


What is the most common infection that can cause guttate psoriasis?

1 Streptococcus pyogenes

2 Coccidiomycosis

3 Herpes4 Mycoplasma pneumonia


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2 POEMS syndrome

3 Necrobiotic xanthogranuloma

4 EED

5 Scleromyxedema


Which of the following disorders is most strongly associated with a monoclonal gammopathy of the IgG-lambda type?

5 Scleromyxedema

All of the above conditions are assocaited with some type of monoclonal gammopathy. Scleromyxedemais associated with an IgG-lambda monoclonal gammopathy. Scleredema and NXG are most oftenassociated with IgG-kappa, and both POEMS syndrome and EED are usually associated with IgAmonoclonal gammopathies.


A pregnant woman presents with mild inflammatory acne which is very bothersome to her. Which of thefollowing is the most appropriate treatment option based on FDA classifications of medication in

pregnancy?

1 Topical erythromycin/benzoyl peroxide gel

2 Topical tretinoin

3 Tazarotene 0.1% cream

4 Azelaic acid 20% cream

5 Bactrim


A pregnant woman presents with mild inflammatory acne which is very bothersome to her. Which of thefollowing is the most appropriate treatment option based on FDA classifications of medication in

pregnancy?

4 Azelaic acid 20% creamAzeleic acid is category B in pregnancy. The others are category C (benzoyl peroxide, topical tretinoin,and bactrim) or category X (tazarotene). The categories for safety of drugs in pregnancies are as follows:Category A: controlled studies in humans show no risk to fetus. Category B: controlled human studiesshow no risk to fetus but may show risk to animals, or no risk in animal studies but no human studiesconducted. Category C: risk to human fetus cannot be ruled out, studies are lacking; animal studiesequivocal. Category D: controlled suties show risk to human fetus, benefits may sometimes outweighrisk. Cateogory X: contraindicated in pregnancy.


An 8 year old healthy boy complaining of changes on his nails for the past 10 months. What is the mostlikely diagnosis?


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1 Psoriasis

2 Alopecia

3 Pachynonychia congenita

4 Chronic mucocutaneous candidiasis

5 Atopic dermatitisQ/Q(M)-482880 Report a Problem

An 8 year old healthy boy complaining of changes on his nails for the past 10 months. What is the mostlikely diagnosis?

1 Psoriasis

Nail involvement in psoriasis is common. It affects about 25-50% of pediatric patients with psoriasis,

more commonly during the second decade of life.Q/Q(M)-482880 Report a Problem

Spindle cell lipoma is commonly found on the:

1 Head

2 Lower extremities

3 Buttocks

4 Breast

5 Posterior shoulder


Spindle cell lipoma is commonly found on the:

5 Posterior shoulder

Spindle cell lipoma is a solitary benign tumor seen in adult male patients, and is most often located on theposterior shoulder and neck regions.The tumor histologically consists of mature collagen, adpose tissue,spindle cells, and mast cells. Treatment is with local excision.


Which of the following forms of angioedema is mediated by kinin release?

1 Hereditary angioedema

2 Acute allergic angioedema

3 Angioedema associated with urticarial vasculitis

4 NSAID angioedema

5 Infectious angioedema


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Which of the following forms of angioedema is mediated by kinin release?

1 Hereditary angioedema

Types of angioedema mediated through kinin release include hereditary angioedema, acquired C1inhibitor deficiency, and ACE inhibitor associated angioedema. These conditions are not associated withconcurrent urticaria.


What is the most common site of extracutaneous involvement in this non-infectious disease?

1 Lungs

2 Eyes

3 Bone Marrow

4 Liver

5 Nasal mucosa


What is the most common site of extracutaneous involvement in this non-infectious disease?

1 Lungs

Sarcoidosis is a non-infectious granulomatous disorder of unclear etiology. It has a predilection for thelungs (90%), lymph nodes (75-90%), eyes (25%), nasal mucosa (20%), bone marrow (25-40%), and liver(15-40%).


A positive ANA with a speckled staining pattern correlates with staining of what cellular component?

1 Ribonucleoproteins

2 Nucleolar RNA

3 Native DNA

4 Kinetochore

5 HistonesQ/Q(M)-480464 Report a Problem


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A positive ANA with a speckled staining pattern correlates with staining of what cellular component?

1 Ribonucleoproteins

A speckled ANA pattern correlates with staining of ribonucleoproteins and is seen in Mixed ConnectiveTissue Disease (MCTD), Systemic Lupus Erythematosus (SLE), systemic sclerosis and Sjogren's

syndrome. A nucleolar staining pattern correlates with staining of nucleolar RNA. Centromere stainingcorrelates with staining of kinetochore. A peripheral staining pattern correlates with staining of nativeDNA and a homogeneous staining pattern correlates with staining of native DNA and histones.


A common site for chloracne is the:

1 Occipital scalp

2 Forehead

3 Scrotum

4 Forearms

5 Shoulders


A common site for chloracne is the:

3 Scrotum

Common sites for chloracne include the malar cheek, the post-auricular scalp and in men, the scrotum.Q/Q(M)-474330 Report a Problem

An 8 year old boy with seasonal allergies presents with red brown macules on the trunk present forseveral months. Parent mentions that when these lesions are scratched they form an irritated, red wheal.Which of the following sign is likely described?

1 Asboe-Hansen sign

2 Homans sign

3 Dariers sign

4 Auspitz sign

5 Hutchinson sign


An 8 year old boy with seasonal allergies presents with red brown macules on the trunk present for

several months. Parent mentions that when these lesions are scratched they form an irritated, red wheal.Which of the following sign is likely described?


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3 Dariers sign

Dariers sign is seen in patients with urticarial pigmentosa, a common form of mastocytosis. Erythemaand wheals are commonly elicited with stroking or rubbing secondary to mast cell degranulation.Symptoms can range from very mild (flushing, hives, no treatment needed) to life-threatening (vascularcollapse). Asboe Hansen, commonly seen in pemphigus vulgaris, refers to extension of a bulla toadjacent unblistered skin when pressure is put on top of a bulla.


The diagnosis is:

1 Onychomycosis

2 Trauma-induced nail changes

3 Chronic paronychia

4 Pseudomonal infection

5 Psoriasis arthritis


The diagnosis is:

5 Psoriasis arthritis

This slide shows lateral onycholysis and subtle swelling of the distal interphalangeal joint (DIP), bothcharacteristic findings of psoriasis and psoriatic arthritis.


You suspect that a patient has acquired angioedema. Levels of which of the following would you expectto be low?

1 C1q, C3

2 C1q, bradykinin

3 C4, C1q4 bradykinin, C3


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5 C4, C3


You suspect that a patient has acquired angioedema. Levels of which of the following would you expectto be low?

3 C4, C1q

Initial screening test in angioedema for both inherited and acquired should include C4, which is low. C3is normal in angioedema. C1q is low in acquired angioedema but normal in the hereditary type.Bradykinin is elevated in both inherited and acquired angioedema.


A 40 year-old man presents with a complaint of nail changes for several years. He was treated by anoutside physician with terbinafine without improvement. On further questioning, he reports morning

shoulder stiffness and back pain that lasts 1-2 hours and improves with activity. Which of the followingis true regarding his condition?

1 50% of patients present with joint disease prior to skin involvement

2 Bony erosions are not commonly seen on radiographs

3 Cyclosporine is effective in treating the arthritis in this condition

4 A positive rheumatoid factor may be seen

5 Joint disease correlates with severity of skin involvement


A 40 year-old man presents with a complaint of nail changes for several years. He was treated by anoutside physician with terbinafine without improvement. On further questioning, he reports morningshoulder stiffness and back pain that lasts 1-2 hours and improves with activity. Which of the followingis true regarding his condition?

4 A positive rheumatoid factor may be seen

This patient has psoriatic nail changes and a history suggestive of psoriatic arthritis. Psoriatic arthritis isan inflammatory arthropathy associated with psoriasis. In 80% of patients the rheumatoid factor isnegative; however a positive rheumatoid factor may sometimes be seen. 80% of patients present with


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skin disease first. Large eccentric erosions are classically present on radiographs. Cyclosporine is noteffective in treating psoriatic arthritis. Mild skin disease may be associated with moderate-to-severe jointdisease, and vice versa.


Which form of sarcoidosis is associated with camptodactyly?

1 Lofgren's syndrome


3 Darier-Roussy

4 Mikulicz syndrome

5 Blau syndrome


Which form of sarcoidosis is associated with camptodactyly?

5 Blau syndrome

Camptodactyly is a flexion contracture of the 3rd through the

general dermatology mcqs

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