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PANCE/PANRE Book > Derm > Flashcards

Derm Flashcards

1
Q

A 15 yo female w a history of asthma and aspirin allergy presents to the pediatric clinic with a contender, intensely pruritic rash. The lesions first started as tiny blisters that are now erythematous and scaly. There are sharply defined, coin shaped lesions that are seen especially on the shins bilaterally. No satellite lesions. Likely diagnosis?

A

Nummular eczema

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2
Q 
A 43 year old male presents with a multicolored, irregular shaped lesion that has increased in size over the last 6 months. Which of the following is the most important prognostic factor?
A. color variation
B. irregularity of the border
C. diameter >6mm
D. Rapidity in growth of lesion
E. thickness of lesion
A

E, thickness of lesion

**thickness of lesion is the most important prognostic factor for malignant melanoma!

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3
Q

Most common cause of skin cancer related deaths in US?

A

Malignant melanoma

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4
Q

Most common type of skin cancer in US?

A

Basal cell carcinoma

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5
Q

A 63 yo Caucasian male comes in for a well visit. The PA notices a lesion on his nose that is a small, translucent papule with central ulceration, telangiectasis and rolled borders. Which of the following is the next most appropriate step?
A. punch biopsy
B. avoid hot and cold weather, hot drinks and alcohol
C. avoid sun and use sunscreen
D. apply acetic acid to look for whitening
E. topical corticosteroids

A

A, bunch biopsy.

Basal cell carcinoma is a malignant skin tumor. This is a classic presentation of a basal cell carcinoma (small, raised, translucent pearly papule with central ulceration and rolled borders)

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6
Q

Basal cell carcinoma most commonly occurs on the….

A

face, nose, and trunk

and most commonly found in fair-skinned individuals with prolonged sun exposure and patients w xeroderma

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7
Q

Which of the following is NOT part of the routine management of atopic dermatitis?
A. topical corticosteroids
B. immediately drying the skin after showering to reduce irritation and keeping the skin dry
C. use of unscented hypoallergenic lotions
D. topical antibiotics for secondary bacterial infections
E. antihistamines for the itching

A

B, immediately drying the skin after showering to reduce irritation and keeping the skin dry

Dry skin exacerbates atopic dermatitis (eczema). Patients are often encouraged to use moisturizers as soon as they shower to maintain skin hydration.

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8
Q 
Which of the following is classically associated with a NEGATIVE Nikolsky sign?
A. toxic epidermal necrolysis
B. scalded skin syndrome
C. pemphigus vulgaris
D. steven johnson syndrome
E. bullous pemphigoid
A

E, bullous pemphigoid

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9
Q

A chronic, widespread autoimmune blistering skin disease primarily seen in the elderly. Due to a type II hypersensitivity autoimmune reaction against the basement membrane, leading to sub epidermal blistering.

*because it is sub epidermal, it is usually associated with a negative Nikolsky sign

A

Bullous Pemphigoid

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10
Q

Sloughing off of the epidermis with slight pressure applied to the skin

A

Nikolsky sign

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11
Q

TEN, SJS, pemphigus vulgaris all have a…

A

Positive Nikolsky sign

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12
Q 
Which of the following is most commonly used in the diagnosis of suspected HPV?
A. postassium hydroxide
B. acetic acid
C. india ink
D. cold agglutinin test
E. ELISA
A

B, acetic acid

HPV can be diagnosed clinically, histologically or by the application of acetic acid, which causes whitening of the lesions

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13
Q

A 34 yo female w a history of sarcoidosis gets a tattoo with a black and red dye. 4 days later, she develops painful, erythematous plaques on the anterior shins bilaterally. What does she have?

A

ERYTHEMA NODOSUM

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14
Q 
A 19 yo female presents to the ER with sudden onset of blanchable, edematous, pink papules that form irregular wheals. The pt states that on the way to the ER, so of the lesions disappeared and new lesions appeared. Which of the following signs are classically associated with this condition?
A. Auspitz Sign
B. Koebners phenomenon 
C. Dermatographism
D. Nikolsky's sign
E. Koplik's spots
A

C, dermatographism

classic description of Urticaria

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15
Q

A type I hypersensitivity reaction associated with IgE and increased mast cells in the skin.Classically presents with BLANCHABLE edematous pink papules that form irregular wheals. These wheals may disappear with the appearance of new lesions

A

Urticaria

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16
Q

A small papule or plaque with a velvety, warty “stuck on” appearance

A

Seborrheic keratosis

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17
Q

A red elevated nodule with adherent white scales and crusted blood at the margins

A

Squamous cell carcinoma

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18
Q

Dry, rough scaly, “sandpaper” like rash with hyperkeratotic plaques

A

Actinic keratosis

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19
Q

Asymmetric, multi color, 7-mm lesion w irregular borders and rapid change in apperance

A

Malignant melanoma

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20
Q 
Which of the following is the predisposing factor for the development of lichen simplex chronicus?
A. HPV
B. lichen planus
C. urticaria
D. erythema nodosum
E. atopic dermatitis
A

E, atopic dermatitis

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21
Q

A complication of atopic dermatitis (eczema) in which the pt develops skin thickening due to repetitive itching and scratching of the eczematous lesions

A

Lichen simplex chronicus

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22
Q

Which of the following is NOT a recommendation in the management of pediculosis?
A. bedding and clothing should be laundered in hot water with detergent
B. bedding and clothing should be placed in dryer on high for at least 20 mins
C. Permethrin lotion should be left on for 8 hours
D. Toys that cannot be washed should be placed in an air tight plastic bag for 14 days
E. Lindane should be applied after a bath or shower to maximize its absorption

A

E, Lindane should be applied after a bath or shower to maximize its absorption

**Lindane is neurotoxic and can cause headaches and seizures in high doses. It is NOT to be used after a bath or a shower bc it will lead to increased absorption through opened pores of the skin and subsequent higher incidence of toxicity

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23
Q

Overgrowth of Malassezia furfur

A

Pitryiasis (tinea) versicolor

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24
Q

Type I IgE hypersensitivity reaction of the dermis and subcutaneous tissue

A

Urticaria

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25
Q

Keratin hyperplasia in the stratum basale and spinosum due to T cell activation

A

Psoriasis

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26
Q

type II hypersensitivity reaction in the basement membrane..this leads to sub epidermal blistering (and therefor a negative Nikolsky sign)

A

Bullous pemphigoid

27
Q

(Not on LOs but for FYI..)

Autoimmune disruption of the desmosome layer

A

Pemphigus vulgaris

28
Q 
A 20 yo female with a history of hay fever and allergic rhinitis presents with tiny, erythematous, edematous, ill defined blisters primarily on the antecubital and popliteal fossae bilaterally. The rash later dries and scales and is intensely pruritic. Which of the following is the most appropriate management?
A. oral acyclovir
B. topical fluconazole
C. topical metronidazole
D. topical corticosteroids
E. oral griseofulvin
A

D, topical corticosteroids

Atopic dermatitis (eczema) initial management of choice is to reduce the immune and inflammatory response with topical corticosteroids

29
Q

What is the most common premalignant skin condition?

A

Actinic keratosis

30
Q 
A 23 yo male presents to the clinic with a single eschar. He states that he had local burning to the site for 4 hours before it became blanched. The blanching progressed to an erythematous margin with a red halo in the center and became a hemorrhagic bulla until the black eschar formed. He states it occurred after sleeping on a porch in New Orleans. What is likely the diagnosis?
A. Rocky mountain spotted fever
B. Lyme disease
C. Brown recluse spider bite
D. Ehrlichiosis
E. Coccidiomycosis
A

C, Brown recluse spider bite

31
Q 
A 43 yo male diagnosed with subarachnoid hemorrhage is admitted into the ICU for observation. He is given blood pressure control, phenytoin, for seizure prophylaxis and a repeat head CT scan 24 hours later to monitor the bleed. 72 hours later, he develops an acute onset of fever and rash. On exam, the rash is composed of dull, dusty red, purpuric macules surrounded by a pale edematous rim and peripheral halo. There are mucosal erosions and crusts on the lips and the buccal mucosa with a negative Nikolsky sign. What is likely the dx?
A. Mobiliform drug rash
B. Erythema multiforme minor
C. Steven Johnson syndrome
D. Erythema multiforme major
E. Toxic epidermal necrolysis
A

D, Erythema multiforme major

Description is classic Erythema multiforme (EM)
EM minor= no mucosal involvement
EM major= mucosal involvement (which is present in this case)

32
Q

Most common type of cutaneous drug reaction. It is characterized by a generalized distribution of “bright red” macules and papules that coalesce to form plaques.

A

Multiform drug reaction

33
Q

Cutaneous drug reaction that usually begins with sore throat, myalgias and fevers. It progresses to widespread ulcerative lesions and blisters o the mucous membrane. They also develop erythematous, pruritic macules on the skin associated with epidermal detachment and detachment of the skin (positive Nikolsky sign).

A

Steven Johnson Syndrome

if it affects 30% or more, then Toxic Epidermal Necrolysis, TEN

34
Q 
An 8 yo male presents to the office w a rash on his face.His mother states the rash started out as fluid-filled blisters which ruptured, leaving a "honey colored" crust ..what is likely the diagnosis?
A. bullous impetigo
B. Molloscum contagiosum
C. non bullous impetigo
D. ecthyma
E. poison ivy
A

C, non bullous impetigo

***Non bullous impetigo is characterized by vesicles or pustules that develop honey colored crusts **

(FYI bullous impetigo is a rare form associated with vesicles that form large bulae, rupture, leaving thin “varnish like” crusts)

35
Q

Non bullous impetigo is commonly caused by what pathogens?

A

Staph Aureus and group A streps (like Strep pyogenes)

36
Q

Which type of dermatitis is an autoimmune disorder strongly associated with celiac disease (due to IgA complex deposition in the dermal papillae)

*it is characterized by papulovesicular rash most commonly seen on the extensor surfaces, includes forearms and scalp

A

Dermatitis herpetiformis

37
Q

A chronic disease of the apocrine follicles, characterized by clusters of abscesses and/or epidermoid cysts, especially affecting the groin and axilla

A

Hidradenitis suppurativa

38
Q 
A 45 yo male accidentally trips with a hot oil vat and sustained burns to his legs, abdomen, chest, and groin. Aprox. what percent of his body is burned?
A. 27
B. 37
C. 28
D. 54
E. 55
A

E, 55

18% for R leg
18% for L leg
18% for chest/abdomen
1% for groin

18+18+18+1= 55

39
Q 
A 45 yo female presents to the clinic w a very pruritic rash. On exam, there are multiple purple, polygonal, flat papules with fine scales and irregular borders primarily on the shins and scalp. Her nails are atrophic. Exam of her mouth shows there is a papular rash with white striations seen on the buccal mucosa. Which of the following infectious etiologies is most commonly associated w this dermatologic disorder?
A. hepatitis C virus
B. ebstein barr virus
C. group A hemolytic strep
D. paramyxovirus
E. togavirus
A

A, hepatitis C virus

Lichen planus is an idiopathic, cell mediated dermatologic rash classically associated with the 5 Ps
**there is thought to be increased incidence in patients with chronic Hep C infections

40
Q 
A 15 yo female is treated for suspected MRSA cellulitis with cephalexin and trimethoprim-sulfamethoxazole. After 5 days, she developed a runny nose, body aches and fever. The next day, she developed a painful rash that started on the face and chest and involved the palms and soles. The rash later progressed to vesicles and bullae formation, covering 37% of the body. No target lesions present. There are also painful hemorrhagic erosions in the mouth including the buccal mucosa with a grayish-white membrane. There is sloughing of the skin with gentle application of pressure. What is likely the diagnosis?
A. Toxic epidermal necrolysis
B. Erythema multiforme major
C. Mobiliform drug rash
D. Steven Johnson Syndrome
E. Erythema multiforme minor
A

A, Toxic epidermal necrolysis

  • TEN is a cutaneous reaction that is most commonly seen after drug eruptions (i.e. sulfa drugs, anticonvulsant meds) and certain infections (i.e. mycoplasma, HIV, herpex simplex) and malignancies
  • **the fact that it covers 37% of body rules in TEN and rules out SJS
41
Q

(not on LOs but FYI…)

A solitary, glistening, friable red nodule or papule often seen after trauma

A

Pyogenic granuloma

42
Q 
What is the first line of treatment in melasma?
A. topical hydroquinone
B. topical corticosteroids
C. topical diphenhydramine
D. topical ketoconazole
E. oral hydoxychloroquine
A

A, topical hydroquinone

43
Q

Hypermelanosis especially seen in sun exposed areas. Classically associated with hyper pigmented areas which are unchanged under a black light (Wood’s lamp)

*most commonly seen with increased estrogen exposure (i.e. pregnancy and OCP use)

A

Melasma

44
Q 
A 34 yo female has well demarcated, round macules with fine scaling and areas of hypo pigmentation that does not tan when exposed to sunlight. A wood's lamp test shows yellow-green fluorescence. A KOH prep is performed, showing hyphae with a "spaghetti and meatball" appearance. Which of the following is most likely the diagnosis?
A. pityriasis rosea
B. pityriasis versicolor
C. non bullous impetigo
D. melasma
E. lichen planus
A

B, pityriasis versicolor

45
Q

Classically associated with a Herald patch (a solitary salmon colored macule) on the trunk that precedes the development of a generalized exanthema with multiple, smaller, bilateral symmetric round and oval salmon-colored macules with a white circular (collarette) scale along the cleavage lines in a christmas tree pattern along the trunk, sparing the face

A

Pityriasis rosea

46
Q

Oral involvement of Wickham striae (lesions with lacy white to gray striae), think of……

A

Lichen Planus

47
Q

Punctate bleeding spots when the plaques of psoriasis are unroofed

A

Auspitz sign

48
Q

Which of the following bests describes guttate psoriasis?
A. raised, dark red plaques with silvery-white scales
B. small, erythematous discrete papules with fine scales
C. generalized erythematous rash involving most of the skin especially at body folds with the absence of plaques
D. uniformly swollen “sausage” digits and joint stiffness
E. deep yellow non infected pustules that evolve into red macule on the palms and soles

A

B, small erythematous discrete papules with fine scales

(A describes plaque psoriasis
C describes inverse psoriasis
D describes psoriatic arthritis
E describes pustular psoriasis)

49
Q

A 19 yo female presents to the derm clinic with a generalized pruritic rash. Exam reveals bilateral, symmetric, round, oval salmon-colored macule with white circular scaling along the cleavage line in a Christmas tree pattern along the trunk. There is also a larger, solitary macule on the upper trunk which the patient states appeared before the other lesions. The rash spared the face. What is likely the diagnosis?

A

Pityriasis rosea

50
Q 
A 22 yo female presents to the derm clinic complaining of comedogenic acne with very small amounts of pustules. There are no nodular or cystic lesions seen. Which of the following is the best initial tx?
A. benzoyl peroxide
B. minocycline orally
C. spironolactone
D. isotretinoin
E. cephalexin
A

A, benzoyl peroxide

For mild acne (comedones with small amounts of pustules and papules), initially management includes benzoyl peroxide, topical retinoid, topical antibiotics, and in some cases, OCP for women

51
Q

Minocycline orally, spironolactone, cephalexin are indicated for which severity of acne?

A

Moderate (defined as comedones with larger amounts of papules and pustules)

52
Q

Isotretinoin is indicated for which severity of acne?

A

Severe, recalcitrant nodular or cystic acne that is no responsive to more conventional treatment

53
Q

Which kind of cyst is an abscess of the gluteal cleft?

A

Pilonidal cyst

54
Q

A cyst containing soft, cheese-like material

A

Epidermal or sebaceous cyst

55
Q

An abscess of the apocrine sweat glands

A

Hidradenitis suppurativa

56
Q

Which of the following best describes the pathophysiology of psoriasis?
A. Malassezia furfur overgrowth
B. Type I IgE hypersensitivity reaction of the dermis and subcutaneous tissues
C. Keratin hyperplasia in the stratum basale and spinosum due to T cell activation
D. Type II hypersensitivity reaction in the basement membrane
E. Autoimmune disruption of the desmosome layer

A

C, keratin hyperplasia in the stratum basale and spinosum due to T cell activation

(A is tinea versicolor
B is urticaria
D is bullous pemphigoid
E is pemphigus vulgaris)

57
Q

A 40 yo male presents to the dermatology clinic for conjunctivitis and a papulopustular rash on the face. He states the rash is getting worse. The rash is also associated with flushing and stinging if he consumes alcohol, hot chocolate, buffalo wings and if he takes hot baths, especially in the winter. On exam, there are telangiectasis seen on the nose. In addition to lifestyle chances, what if the first line management of choice?

A

Metronidazole topically

58
Q 
Which of the following is recommended in the management of severe, nodular, cystic acne that is not responsive to conventional medication therapy?
A. benzoyl peroxide
B. topical retinoid
C. spironolactone
D. isotretinoin
E. cephalexin
A

D, isotretinoin

59
Q

A 42 yo female presents with dark red, raised rash covered with thick silvery white scales on the nape of her neck and in her scalp. Exam of the hands shows pitting in the nails and yellow-brown discoloration under the nail bed. What is likely the diagnosis?

A

Psoriasis

60
Q 
A 10 yo boy presents to the pediatric clinic with small red itchy bumps on his hands bilaterally after a camping trip. Exam shows many fluid filled blisters in a straight line. In addition to diphenhydramine, which of the following is recommended for the management in severe cases?
A. topical mupirocin
B. topical ketoconazole
C. topical metronidazole
D. topical corticosteroids
E. oral griseofulvin
A

D, topical corticosteroid

*This boy has poison ivy. The rash of poison ivy begins as an erythematous, pruritic rash with the development of papules, plaques, vesicles and or bull arranged commonly in a linear or streak like configuration where a portion of the plant has made contact with the skin

61
Q 
A 40 yo male presents to the ER with a generalized, pruritic rash consistent with urticaria. On exam there are clear lung fields and no evidence of uvula or pharyngeal edema. Which of the following is the management of choice?
A. topical corticosteroids
B. diphenhydramine oral
C. fluconazole oral
D. clonidine oral
E. observation
A

B, diphenhydramine oral

aka Benadryl

62
Q 
A 67 yo male presents with a rash on the face. A biopsy is done, showing epidermal and dermal cells with large pleomorphic, hyperchromatic nuclei consistent with squamous cell carcinoma in situ. What is the diagnosis?
A. Caplan syndrome
B. Bowen's disease
C. Sezary's disease
D. Peutz Jegher's syndrome
E. Sturge-Weber syndrome
A

B, Bowen’s disease

63
Q 
A 43 yo male w a history of HIV infection presents to the clinic with multiple dome shaped, flesh colored pearly white papules with central umbilication. Squeezing the papules produces a curd-like material from the center. There is no surrounding erythema or telangiectasia. Which of the following is the most likely diagnosis?
A. sebaceous cysts
B. molloscum contagiosum 
C. basal cell carcinoma
D. acne vulgaris
E. Kaposi sarcoma
A

B, Molloscum contagiosum

(molloscum contagiosum is a benign viral infection most commonly seen in children, sexually active adults and patients with HIV)

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