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DERMA MODULE Flashcards

1
Q

Tinea corporis can be transmitted through

a. Direct contact with infected person
b. From fomites
c. Autoinoculation of reservoir
d. All of the above

A

a. Direct contact with infected person
b. From fomites
c. Autoinoculation of reservoir

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2
Q

The causative agent of fungal infection presenting large, confluent, polycyclic or psoriasiform plaques, and immunosuppressed individuals?

a. Tinea corporis
b. Tinea imbricata
c. Tinea rubrum
d. All of the above

A

c. Tinea rubrum

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3
Q

Which of the following act as virulence factor used by any dermatophytes in the pathogenesis of a “ring-worm”?

a. Keratase
b. Keratinase
c. Keratolytic proteases
d. all of the above

A

c. Keratolytic proteases

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4
Q

Which of the following is true about the annular formation of a classic tinea corporis?

a. The dermatophyte usually forms ring formations in the epidermis of the skin
b. This results from inflammatory host response against the spreading dermatophyte
c. This is due to the secretion of lipases and other virulence factors from the dermatophytes
d. All of the above

A

b. This results from inflammatory host response against the spreading dermatophyte

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5
Q

Recurrent or chronic Tinea corporis is due to:

a. In host response, there is defective cell mediated immunity
b. Successful adherence of the spores to the surface of keratinized tissue
c. Invasion by the release of specific protease and ceramides
d. All of the above

A

a. In host response, there is defective cell mediated immunity

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6
Q

A 50 years old/F diabetic was complaining of itchiness “ringworm” in her buttocks. Upon examination, there were a few lesions found annular plaque with scales. As her physician, you identified that this is a fungal infection. What is the treatment?

a. Oral antifungal for 7 days
b. Topical antifungal will suffice, 2x a day for a month
c. Apply moisturizer to the lesion to get rid of the scales
d. Use sulfur soap

A

b. Topical antifungal will suffice, 2x a day for a month

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7
Q

The four basic features of skin lesion includes

a. Stages of primary and secondary lesions
b. Distribution of eruption
c. Arrangement of cells
d. Shape of cells

A

b. Distribution of eruption

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8
Q

A 20/F consulted in the OPD for redness, itching, sores in her genital area. Upon examination the physician found vesicles in the affected area. He was thinking of a possible herpes virus infection. What diagnostic test can help his diagnosis?

a. Tzanck smear
b. Skin biopsy
c. Patch test
d. Diascopy

A

a. Tzanck smear

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9
Q

A sample was collected from a patient. Using Wood’s Light, colonies of pale blue were observed. Which of the following specimens is seen in the collected sample?

a. C. minutissimum
b. Pseudomonas
c. M. Adouni
d. M. canis

A

b. Pseudomonas

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10
Q

21/M complains of acute onset itchiness on the right thigh, demarcated plaques with scaling and central clearing, what could this indicate?

a. Psoriasis
b. Tinea Corporis
c. Contact Dermatitis
d. Allergic Dermatitis

A

b. Tinea Corporis

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11
Q

This layer of the skin serves as heat insulator and shock absorber

a. Epidermis
b. Reticular layer
c. Papillary layer
d. Subcutaneous layer

A

d. Subcutaneous layer

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12
Q

Which of the following is NOT TRUE about sebaceous glands?
a. They secrete a combination of wax esters, squalane, cholesterol esters, and triglycerides
b. They are also located in areas with no hair follicles
c. Their secretions help prevent fungal infections
d. They are holocrine glands

A

b. They are also located in areas with no hair follicles

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13
Q

Which of the following is not true about the functions of the epidermis?

a. Ultraviolet light is blocked in the stratum corneum and the melanosomes
b. Langerhan cells internalize external antigens and present them to T lymphocytes to the lymph nodes
c. Eosinophils intercept and destroy microorganisms in the epidermis
d. Regulate temperature through cutaneous blood flow

A

d. Regulate temperature through cutaneous blood flow

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14
Q

Which of the following is not true about the pathogenesis of Seborrheic dermatitis?

a. Mutation encoding zinc finger protein may result in development of seborrheic like dermatitis
b. Zinc supplementation may affect imrpove seborhheric dermatitis
c. Increased calmodulin act causes dermal hyperproliferation in SD
d. Staphylococcus aureus and Candida albicans do not have links in the development of Seborrheic dermatitis

A

b. Zinc supplementation may affect imrpove seborhheric dermatitis

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15
Q

In the presence of Malassezia, which of the following cytokine levels is expected to decrease?

a. IL-2
b. IL-4
c. IL-8
d. IL-10

A

a. IL-2

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16
Q

Which of the following is a risk factor for SD

a. Atopic dermatitis
b. Parkinson’s disease
c. Pityriasis rosea
d. Chronic kidney disease

A

b. Parkinson’s disease

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17
Q

A 2nd year medical student asked his classmate to check his skin lesion at the back after SGD session. Previously, one of these lesions “popped” but was unable to further describe the fluid. Upon his classmates’ examination, there were elevated circumscribed cavities measuring up to 0.5cm in diameter with some consisting of yellowish fluid. This lesion are identified as?

a. Vesicle
b. Bulla
c. Pustule
d. Cyst

A

b. Bulla

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18
Q

The patient presented with flat, pigmented spots on the skin which were originally thought as birthmarks. This cafe au lait spots are known as:

a. Patches
b. Papules
c. Plaques
d. Macule

A

d. Macule

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19
Q

Which of the following explains the pathogenesis of seborrheic dermatitis?

a. It is a classic cell mediated, delayed (type iv) hypersensitivity reaction
b Seborrheic dermatitis is linked with abnormalities immune response to Pityrosporum ovale resulting in depressed helper t cell immune response
c. There are complex alterations to epidermal growth and differentiation and multiple biologic, immunologic and vascular abnormalities
d. There is high levels of cathelicidin peptides that enable stratum corneum tryptic- enzyme mediated inflammation response in the epidermis

A

b Seborrheic dermatitis is linked with abnormalities immune response to Pityrosporum ovale resulting in depressed helper t cell immune response

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20
Q

True of the infantile form of seborrheic dermatitis

a. Mostly located at the front of the scalp
b. Extends to the extensors and intertriginous areas
c. Tends to be chronic and last up until puberty
d. Presents with adherent yellow-brown, greasy scales

A

d. Presents with adherent yellow-brown, greasy scales

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21
Q

Which of the following clinical patterns is common in infantile seborrheic dermatitis?

a. Leiner’s disease
b. Seborrheic blepharitis
c. Seborrheic otitis externa
d. Pityriasiform

A

a. Leiner’s disease

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22
Q

Treatment for Adult Seborrheic Dermatitis

a. High Potency Glucocorticoids for Face and Neck
b. Oral Antifungal for Scalp Seborrheic Dermatitis
c. Removal of scales with Keratolytic Agent
d. Short-Term Systemic Glucocorticoids for Severe Cases

A

d. Short-Term Systemic Glucocorticoids for Severe Cases

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23
Q

Which of the following statements about Psoriasis is FALSE?

a. mostly related with asians
b. occur at any age, mostly at age between 15 and 30
c. does not occur at age under 10 years old
d. none of the a

A

a. mostly related with asians

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24
Q

The uninvolved psoriatic skin of psoriatic patients

a. appears similar to the skin of non-psoriatic patients
b. manifest subclinical morphologic and biochemical changes, particularly involving lipid biosynthesis with “histopathological parakeratosis”
c. have noted pinhead-sized macular lesions there is marked edema, and mononuclear cell infiltrates are found in the upper dermis
d. reveal an approximately 50% increase ib epidermal thickening in the “normal-appearing” skin immediately adjacent to lesions

A

b. manifest subclinical morphologic and biochemical changes, particularly involving lipid biosynthesis with “histopathological parakeratosis”

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25
Q

These are characterized by uniform elongation of rete ridges, with thinning of the epidermis overlying the dermal papillae.

a. Initial lesion
b. Developing lesion
c. Mature lesion
d. T-cells

A

c. Mature lesion

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26
Q

This is associated with the early onset of psoriasis

a. Female gender and onset of puberty
b. T-cell specific immunosuppressant cyclosporin A (CsA)
c. German and East African descent
d. HLA-Cw6 Antigen I with positive family history

A

d. HLA-Cw6 Antigen I with positive family history

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27
Q

Acute variant of pustular psoriasis which causes systemic manifestations and can potentially have life- threatening complications such as sepsis and dehydration.

a. Von Zumbusch type
b. Impetigo herpetiformis
c. Pustulosis Palmaris et Plantaris
d. Annular Pustular Psoriasis

A

a. Von Zumbusch type

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28
Q

Which of the following characteristics distinguishes guttate psoriasis from the other clinical types of psoriasis?

a. It is characterized by eruption of small papules (2-3 cm in diameter) over the upper trunk and proximal extremities
b. It is typically manifests at an early age and as such is found frequently in infants and children
c. Antibiotic treatment has not been shown to be beneficial or to shorten the disease course
d. Staphylococcal throat infection frequently precedes or is concomitant with the onset or flare of guttate psoriasis

A

c. Antibiotic treatment has not been shown to be beneficial or to shorten the disease course

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29
Q

Which of the ff statement is true about the diagnosis of psoriasis

a. Histopathologic examination is usually necessary to make diagnosis
b. Serum Uric Acid is elevated in up to 50% of patients and is mainly correlated with the extent of lesions and the activity of the disease
c. In severe psoriasis vulgaris, generalized pustular psoriasis, and erythroderma, a positive nitrogen balance can be detected, manifested by an increase in serum albumin
d. Markers of systematic inflammation are commonly increased in chronic plaque psoriasis uncomplicated by arthritis

A

b. Serum Uric Acid is elevated in up to 50% of patients and is mainly correlated with the extent of lesions and the activity of the disease

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30
Q

Patient J.S was diagnosed with chronic plaques psoriasis with moderate severity. What percentage of his body surface is affected?

a. <5%
b. 5-10%
c. 10-30%
d. 30-40%

A

c. 10-30%

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31
Q

The treatment option for the above patient includes:

a. PUVA
b. Cyclosporine A
c. Hydroxyurea
d. Methotrexate

A

a. PUVA

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32
Q

TRUE of Topical steroid treatment of Psoriasis

a. Effective for long term
b. Pregnant: X Category
c. Long-term use may cause hypercortisolism
d. Contraindicated to those with active skin infection

A

d. Contraindicated to those with active skin infection

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33
Q

Phototherapy is an important treatment for psoriasis. What is the first line option?

a. PUVA
b. Excimer laser
c. NB-UVB
d. Climatotherapy

A

c. NB-UVB

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34
Q

This is a superficial defect of the epidermis that is well-defined and may involve up to the level of the papillary bodies.

a. Fissure
b. Erosion
c. Ulcer
d. Excoriation

A

b. Erosion

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35
Q

A 2nd medical student suddenly developed an itchy rash in the skin that immediately spread across her body. The following statement best describe urticaria except

a. Flat type that disappears within 2-3 days
b. Irregular in shape with changing pseudopods
c. Edema in papillary bodies is the reason for its shape
d. Also known as hives

A

a. Flat type that disappears within 2-3 days

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36
Q

Which among the following is true about the prevalence of pityriasis versicolor?

a. it does not have racial predilection
b. occurs more in males than females
c. 50% in more humid and warm countries
d. occurs in adolescents and young adults

A

b. occurs more in males than females

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37
Q

Which Malassezia species is predominant in the pathogenesis of tinea versicolor?

a. M. furfur
b. M. globosa
c. M. dermatitis
d. M. restricta

A

b. M. globosa

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38
Q

Clinical finding of your tinea versicolor

a. mild pruritus
b. color and location
c. patches have wrinkled surface
d. the scale as dust-like or furfuraceous

A

d. the scale as dust-like or furfuraceous

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39
Q

Which of the following substances is directly responsible for interfering melanin production causing persistent hypopigmentation in tinea versicolor

a. Azelaic acid
b. Pteridin
c. Pityricin
d. Vaccenic acid

A

a. Azelaic acid

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40
Q

Which of the following is the confirmatory test for the diagnosis of tinea versicolor?

a. Culture
b. KOH preparation
c. Skin biopsy
d. Woods lamp

A

b. KOH preparation

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41
Q

Treatment for the patient with extensive Pityriasis versicolor

a. Fluconazole 200mg OD single dose
b. Ketoconazole 200mg OD for 3 days
c. Itraconazole 200mg OD for 7days
d. Terbinafine 200mg OD for 14 days

A

c. Itraconazole 200mg OD for 7days

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42
Q

Which of the following cells is defective in patients with vitiligo

a. keratinocytes
b. melanocyte
c. Langerhans cell
d. Merkel cell

A

b. melanocyte

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43
Q

Generalized Vitiligo is commonly associated with which of the following

a. peripheral nerve manifestation
b. infectious fungal infection
c. type 2 diabetes mellitus
d. autoimmune thyroid disease

A

d. autoimmune thyroid disease

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44
Q

Which is true regarding the epidemiology of vitiligo?

a. Females are more affected than male
b. It develops in all age
c. Occur more frequently in regions with high temperature
d. Segmental vitiligo is the most common subtype

A

b. It develops in all age

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45
Q

Which support the autoimmune basis of vitiligo:

a. defective antioxidant defense confers melanocytes to susceptible to both immunogenic toxicity induced by ROS
b. Vitiligo is a disease affecting the entire epidermis, abnormalities genetic morphological and functional of melanocyte and keratinocytes
c. Ultrastructural abnormalities of keratinocytes from perilesional vitiligo skin have been related to impaired mitochondrial activity, and are thought to affect the production of specific melanocyte growth factors
d. Vitiligo-like lesion appear in IL-2 immunotherapy of cutaneous melanoma

A

d. Vitiligo-like lesion appear in IL-2 immunotherapy of cutaneous melanoma

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46
Q

A 35 year old male student with vitiligo was arguing with the resident physician regarding autoimmunity as possible cause he denied any autoimmune disease. The resident was explaining that it was multifactorial disorder and biochemical hypothesis is also a consideration. Which of the following supports the biochemical hypothesis of the pathogenesis of vitiligo?

a. humoral immunity
b. reduce enzymatic antioxidant capacity of keratinocytes that leads to elevated level of nitrogen peroxide
c. autoimmune
d. autoantibodies

A

c. autoimmune

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47
Q

Which of the ff is the second-line drug treatment for vitiligo?

a. Corticosteroids
b. Calcineurin inhibitors
c. Calcipotriol
d. Topical PUVA

A

c. Calcipotriol (TOPICAL)

d. Topical PUVA (PHYSICAL)

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48
Q

Narrowband UVB is the preferred mode of treatment for patients with vitiligo. Which of the following is true?

a. The most commonly used protocol is 3x weekly until minimal erythema dose is reached
b. Approximately 6 months of therapy are required to achieve maximal repigmentation
c. 3 months of treatment before condition can be classified as unresponsive
d. The most responsive sites for this treatment modality are the hands and feet

A

c. 3 months of treatment before condition can be classified as unresponsive

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49
Q

PUVA is not recommended for children below 12 years old. Which of the following is the long term delayed risk of this therapy

a. Cataracts
b. Brain tumors
c. Psoriasis
d. Hematologic disorders

A

a. Cataracts

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50
Q

Which of the following is used in depigmentation of patients with widespread vitiligo?

a. 20% monobenzyl ether of hydroquinone
b. Pseudocatalase
c. UVA
d. Systemic steroid

A

a. 20% monobenzyl ether of hydroquinone

51
Q

A delayed type hypersensitivity reaction with immunologic response by IFN- , IL-2 cytokines. It gives rise to granulomatous lesions.

a. Tuberculoid Leprosy
b. Lepromatous Leprosy
c. Borderline Leprosy
d. Indeterminate Leprosy

A

a. Tuberculoid Leprosy

52
Q

T-cell immunity highly impaired; granulomas are poorly formed.

a. Tuberculoid Leprosy
b. Lepromatous Leprosy
c. Borderline Leprosy
d. Indeterminate Leprosy

A

b. Lepromatous Leprosy

53
Q

The patient has overabundance of Th2 response, causing production of non-protective antibody response

a. Tuberculoid Leprosy
b. Lepromatous Leprosy
c. Borderline Leprosy
d. Indeterminate Leprosy

A

b. Lepromatous Leprosy

54
Q

If early recognition of IL 4, 5, 6, 10, this polar leprosy is more likely

a. Tuberculoid Leprosy
b. Lepromatous Leprosy
c. Borderline Leprosy
d. Indeterminate Leprosy

A

b. Lepromatous Leprosy

55
Q

The most infectious form of leprosy and predominant in most cases in mexico

a. Tuberculoid leprosy
b. Lepromatous leprosy
c. Borderline leprosy
d. Indeterminate leprosy

A

b. Lepromatous leprosy

56
Q

A 30 year old male had gradually progressive plaque on the buttock for the last 3 years. The plaque is 13 cm in diameter, annular in shape with crusting and induration and scarring in the center

a. Tuberculoid leprosy
b. Lepromatous leprosy
c. Borderline leprosy
d. Indeterminate leprosy

A

c. Borderline leprosy

57
Q

The following statements are true of leprosy except:

a. Skin to skin contact is an important route of transmission
b. Invasion of peripheral nerves is through binding of Schwann cell
c. Physicians and nurses caring for the leprosy patients and the co-workers of these patients are not at risk for leprosy
d. Failure to cultivate organism in a cell-free media is because it is an obligatory intracellular organism and has few respiratory enzymes

A

a. Skin to skin contact is an important route of transmission

58
Q

Which of the following is a common ophthalmologic finding in patients with lepromatosy

a. Iritis
b. Pterygium
c. Conjunctival hemorrhage
d. Myopia

A

a. Iritis

59
Q

Which is the common nerve affected in lepromatous patients

a. Radial
b. Ulnar
c. Facial
d. Median

A

b. Ulnar

60
Q

Which of the ff is true regarding pathogenesis, prevention, and control of leprosy?

a. Vaccination at birth with BCG has not proved variably the prevention of leprosy
b. Chemoprophylaxis with dapsone may reduce all cases of leprosy
c. Leprosy transmission requires close prolonged household contact, hospitalized patients don’t need to be isolated
d. The only leprosy patients who will cure themselves without therapy are those with TT

A

d. The only leprosy patients who will cure themselves without therapy are those with TT

61
Q

Which among the following is TRUE regarding the complications of leprosy?

a. Plantar ulcerations, particularly at the calcaneus, is probably the most common complication of leprous neuropathy.
b. Footdrop as a result of peroneal nerve palsy should be treated with a simple nonmetallic brace in the shoe or surgical correction attained by tendon transfers
c. BT patients have a higher chances of becoming impotent and infertile
d. Patients with various forms, but particularly those with the BT form, may develop abscesses of nerves (commonly the radial nerve), and cellulitis with the adjacent skin

A

b. Footdrop as a result of peroneal nerve palsy should be treated with a simple nonmetallic brace in the shoe or surgical correction attained by tendon transfers

62
Q

25/M, visited a derma clinic because of worsening of his skin lesion for 1 month. He has observed large erythematous, dry, plaques. He experienced numbness and anhidrosis. He is diagnosed with leprosy. What is the treatment?

a. Dapsone 100mg/ day for 5 years
b. Dapsone 100mg/day plus rifampin 600mg/month for 6 months
c. Rifampin 100mg plus dapsone 600mg/ day for 5 days
d. Dapsone 100mg/day plus chlorpromazine 50mg/day for 3 years

A

a. Dapsone 100mg/ day for 5 years

b. Dapsone 100mg/day plus rifampin 600mg/month for 6 months (WHO)

63
Q

Most common causative agent of ACD is

a. Azoanalines
b. Thimesoral
c. Dialkyl thioureas agent
d. GMT

A

b. Thimesoral

64
Q

During the sensitization phase, subsequent exposure to the allergen occurs via, EXCEPT?:

a. Intradermal
b. Transepidermal
c. Subcutaneous
d. Inhalation

A

a. Intradermal

65
Q

Which of the following events characterized the first phase of ACD?

a. Recruitment of hapten specific T- cell by the keratinocyte and antigen presenting cell
b. Macrophage recruits T cells to increase immune response
c. IFN-γ and TNF stimulate macrophages to stimulate more cytokines
d. Antigen presenting cells express hapten-protein complex in the form of HLA-DR

A

d. Antigen presenting cells express hapten-protein complex in the form of HLA-DR

66
Q

Which of the following cutaneous manifestations is present in chronic allergic contact dermatitis?

a. Scaling, fissuring, lichenification
b. Erythema, edema, vesicle formation
c. Erythema, scaly juicy papules and weeping
d. Erythema, vesicle formation, papules

A

a. Scaling, fissuring, lichenification

67
Q

Which of the following is the most potent sensitizer known and is commonly used as an ingredient of hair dyes that causes ACD of the scalp?

a. Glyceryl thioglycolate
b. Glyceryl monothioglycolate
c. Tosylamide formaldehyde resin
d. Benzophenone 3

A

b. Glyceryl monothioglycolate

68
Q

Which of the following is TRUE on the pattern of ACD?

a. FACE- most common in men
b. SCALP- affects the lateral surface of the face
c. LIPS- 2/3 of patients with cheilitis
d. NECK- Benzophenone-3 found in fragrances

A

b. SCALP- affects the lateral surface of the face

69
Q

Which of the following is TRUE regarding allergic contact dermatitis?

a. ACD accounts for 80% of the new incident cases in the subgroup of contact dermatitides
b. ACD is an adverse cutaneous non-inflammatory reaction caused by contact with specific exogenous allergen to which a person has developed allergic sensitization
c. In ACD, eczematous dermatitis always manifests as a severe, persistent, chronic disease
d. Recognition of the presenting signs and symptoms, and appropriate patch testing are crucial in the evaluation of a patient with suspected ACD

A

d. Recognition of the presenting signs and symptoms, and appropriate patch testing are crucial in the evaluation of a patient with suspected ACD

70
Q

Which of the following is TRUE in cutaneous findings in ACD?

a. Subacute lesions present with edema, erythema and vesicle formation
b. Stronger allergens often result in vesicle formation, whereas, weaker allergens often lead to papular lesion morphology with surrounding erythema and edema
c. Acute lesions appear as vesicular rash with oozing and scaly juicy papules
d. Most common symptom in ACD is typically erythematous lesions occurring in allergy

A

b. Stronger allergens often result in vesicle formation, whereas, weaker allergens often lead to papular lesion morphology with surrounding erythema and edema

71
Q

Anna, 21F, bought a silver necklace. A week after, she noticed erythematous small lesions with clear fluids. She went to the OPD for consultation, what is the best course of treatment?

a. Immediate initiation of topical corticosteroids
b. Identification and removal of enticing agent
c. Antihistamines for symptoms relief
d. Patch testing for identification of Myroxylon pereirae

A

b. Identification and removal of enticing agent

72
Q

Pertinent history of ACD except

a. History taking should begin with a discussion of the present illness focusing on the site of onset
b. A past history of skin disease, atopy, and general health should be routinely investigated
c. Detailed history of the usage of personal care products such as soap, shampoo, conditioner, deodorant, lotions, creams, medications, hair styling products, etc.
d. Antibiotic use, dose, frequency, duration

A

d. Antibiotic use, dose, frequency, duration

73
Q

Common misconceptions about ACD that can alter physicians ability to recognize contact dermatitis.

I. ACD is not always bilateral even when the antigen exposure is bilateral (i.e. shoe or glove allergy)
II. Even when exposure to an allergen is uniform (e.g., contact allergy to an ingredient of a cream that is applied on all of the face), eczematous manifestations are very often patchy
III. ACD can and does affect the palms and soles

A

I. ACD is not always bilateral even when the antigen exposure is bilateral (i.e. shoe or glove allergy)
II. Even when exposure to an allergen is uniform (e.g., contact allergy to an ingredient of a cream that is applied on all of the face), eczematous manifestations are very often patchy
III. ACD can and does affect the palms and soles

74
Q

This is the single most important clue to in the diagnosis of ACD

a. The dermatitis distribution typically involves the area of greatest eczematous dermatitis congruence to where the areas of greatest contact of the offending allergen/s is
b. The lesions of ACD will vary morphologically depending on the stage of the disease
c. Geometric or linear patterns or involvement of focal skin areas, may also be suggestive of exogenous etiology
d. Occupations requiring frequent handwashing, glove use, frequent chemical exposure should be prime suspect, among others

A

a. The dermatitis distribution typically involves the area of greatest eczematous dermatitis congruence to where the areas of greatest contact of the offending allergen/s is

75
Q

After applying a DIY perming kit at home, a 36yo housewife noted vesicles on her hand with redness and swelling. She applied Vaseline to soothe the pruritus. The following day, the vesicles then ruptured, with oozing, followed by the appearance of papules and plaques. She is on what stage of ACD?

a. Acute
b. Subacute
c. Chronic
d. Asymptomatic

A

a. Acute

76
Q

During sensitization phase, subsequent exposure to antigen occurs via these routes, except

a. Intradermal
b. Transepidermal
c. Subcutaneous
d. Inhalation

A

a. Intradermal

77
Q

Which among the following is true regarding patch test in contact dermatitis?

a. Patch test is applied in affected skin patients back for 48 hours
b. Patch test is carried out twice, the day of patch test removal 48 hours and 72 hours after epicutaneous exposure
c. Reading of metals and corticosteroids is sometimes delayed to 7 days
d. A positive test reaction is indicative of clinical disease as patch test measures whether an individual is sensitized or not

A

c. Reading of metals and corticosteroids is sometimes delayed to 7 days

78
Q

All of the following are associated with the formation of vesicles in the lateral aspect of the fingers EXCEPT

a. Cheiropompholyx
b. Dyshidrotic hand eczema
c. Hyperkeratotic hand dermatitis
d. Id reaction

A

c. Hyperkeratotic hand dermatitis

79
Q

All of the following are etiologic factors associated with pompholyx, except:

a. Chronic exposure to skin irritants
b. Ingestion of metals like nickel, cobalt, and chromate in sensitized patients
c. History of exposure to UV A rays
d. History of tinea pedis infection

A

a. Chronic exposure to skin irritants

80
Q

A 66-year-old male, who is a retired nurse, presents with a chronic pruritic plaque on his left central palm. He has been applying fluocinonide cream but it does not seem to have an effect on his condition. The patient is most likely has

a. Allergic contact dermatitis
b. Tinea manuum
c. Hyperkeratotic hand dermatitis
d. Chronic vesiculobullous dermatitis

A

c. Hyperkeratotic hand dermatitis

81
Q

A 38yo female experienced intense itching on the lateral aspects of her fingers on both hands. A couple of days later, she noticed the appearance of vesicles and blisters on the affected area. Not long after, the large blisters started to rupture. She decided to visit a doctor as she has already been experiencing fever. Which of the following will the doctor expect to not see during examination?

a. Tenderness upon palpation of the axillary lymph nodes
b. Lichenification of the affected area
c. Tapioca appearance of intact lesions
d. Dried up appearance of ruptured lesions

A

b. Lichenification of the affected area

82
Q

This type of VPE usually presents with small vesicles on the lateral aspects of the finger, palms and soles as it becomes more chronic. The lesions may appear fissured and hyperkeratotic.

a. Cheiropompholyx
b. Chronic vesiculobullous dermatitis
c. Hyperkeratotic hand dermatitis
d. Id reaction

A

b. Chronic vesiculobullous dermatitis

83
Q

Considered as the first line treatment for vesicular palmoplantar eczema

a. Tacrolimus
b. Azathioprine
c. Prednisone
d. Retinoid

A

c. Prednisone

84
Q

A histologic feature of vesicular palmoplantar eczema

a. Presence of mixed infiltrates in the dermis
b. Neutrophilic infiltrates in the epidermis
c. Hyperproliferation and hyperkeratosis in more acute cases
d. Presence of intraepidermal spongiotic vesicles that involve acrosyringia

A

a. Presence of mixed infiltrates in the dermis

85
Q

Which of the following prevention of vesicular palmoplantar eczema is true?

a. Latex gloves rather than vinyl is recommended as patients have an underlying allergy or may develop one
b. Patch testing can be considered to identify allergens
c. Frequent use of emollients is not recommended as it may disrupt the normal skin-barrier function
d. Maintaining a high-cobalt diet has been suggested to decrease dyshidrotic flare

A

b. Patch testing can be considered to identify allergens

86
Q

Which of the following therapeutic approaches to management of VPE is TRUE?

a. Topical steroids, typically of low potency, usually the first-line agents
b. For chronic pompholyx and chronic vesicular dermatitis, oral prednisone may be required and is effective if initiated early
c. Mycophenolate mofetil is a novel retinoid with anti-inflammatory properties and is one of the newer therapies under study for VPE
d. Due to less side effects, systemic glucocorticoids is appropriate for long-term management

A

b. For chronic pompholyx and chronic vesicular dermatitis, oral prednisone may be required and is effective if initiated early

87
Q

A 21 year old male, call center agent came in for consult due to sudden onset of pruritic vesicular lesions on both palms and soles of feet. No fever, swelling, and lymphadenopathy was noted. He claims that he was under stress due to his workload. No allergies and similar lesions were noted in the past. On physical examination, there was a note of 0.5 to 1 cm fluid-filled lesions, symmetrical noted on bilateral palms and soles. Which of the following therapeutic options to initiate treatment?

a. Corticosteroids
b. Drying agents
c. Calcipotriene
d. Azathioprine

A

a. Corticosteroids

88
Q

What is the typical finding of KOH for dermatophyte?

a. Morphology of macro and microconidia
b. Change in color from yellow to bright red
c. Typical long narrow septate and branching hyphae are seen
d. PAS appears pink

A

c. Typical long narrow septate and branching hyphae are seen

89
Q

In using KOH exam, which specific part of the skin lesion yields the highest rate of positive findings?

a. Roof of the vesicle
b. Scale of the plaques
c. Floor of the vesicles
d. All of the above

A

a. Roof of the vesicle

90
Q

Which culture is used for diagnosing dermatophytic infections?

a. Grocott’s methenamine silver stain
b. KOH examination
c. Sabouraud medium
d. AOTA

A

c. Sabouraud medium

91
Q

32 F with pruritic lesions was diagnosed to have tinea pedis. After 2 weeks, there was presence of vesicles and papules with urticarial rash. Which of the following is criteria for the ID reaction?

a. Presence of fungal elements on the other side of the body
b. Absence of fungal elements from ID eruption
c. Clearing of ID reaction after resolution of fungal infection
d. All of the above

A

b. Absence of fungal elements from ID eruption

92
Q

How can you differentiate a dermatophytid and dermatophytosis fungal infection?

a. Presence of vesiculo-papular & urticarial rashes
b. Positive KOH examination in id reaction
c. Culture negative in id reaction
d. All of the above

A

c. Culture negative in id reaction

93
Q

AJ, 40/M, a triathlete was complaining of pruritus lesion on his feet and right hand. As his friend, he decided to take a look and considered a fungal infection. What treatment would you recommend for this patient?

a. Oral intake of fluconazole once a day for 4 weeks
b. Terbinafine cream 2x daily for 1 week
c. Apply hydrocortisone cream 2x daily for 1 week and observe
d. Oral intake of cetirizine for pruritus

A

b. Terbinafine cream 2x daily for 1 week

94
Q

Which of the following statements is true in diagnosing tinea manuum?

a. In skin biopsy, histopath stain using PAS will turn pink if fungal elements are noted in stratum corneum
b. In using medium containing phenol red, there is change in color of the medium from bright red to yellow in the presence of dermatophyte
c. Dermatophytid reactions occur most of the time in patients with tinea pedis and tinea manuum
d. AOTA

A

a. In skin biopsy, histopath stain using PAS will turn pink if fungal elements are noted in stratum corneum

95
Q

Which of the following is the most common cause of tinea manuum?

a. T. rubrum
b. T. interdigitale
c. E. floccosum
d. T. mentagrophytes

A

a. T. rubrum

96
Q

In the pathogenesis of dermatophytes, which of the following is a feature of adherence?

a. Secretion of specific proteases, lipases, and ceramides
b. Inflammatory response associated with hypersensitivity
c. Penetration of dermatophytes through the skin
d. Hyphae thrive in keratinized tissues

A

d. Hyphae thrive in keratinized tissues

97
Q

Which one of the following features describe the moccasin type of tinea pedis?

a. Tense vesicle >3mm in diameter
b. Frequently associated with fever
c. Patchy or diffused scaling on the soles
d. Presence of bacterial coinfection

A

c. Patchy or diffused scaling on the soles

98
Q

A 35 year old male is working in a fitness and sports facility, consulted in their company clinic due to itchiness of the feet. On examination, the physician noted scaling, erythema and macerations on the 3rd interdigital spaces. Tinea pedis was considered in this case. The photo below shows the appearance of the affected area. Which of the following forms of the tinea pedis is most likely in this patient?

a. Interdigital
b. Chronic hyperkeratotic
c. Vesiculobullous
d. Acute ulcerative

A

a. Interdigital

99
Q

In the previous case mentioned above, what is the most common etiologic of this disease?

a. Staphylococcus aureus
b. Epidermophyton floccosum
c. Trichophyton rubrum
d. Malazzesia furfur

A
100
Q

Which of the following statements is correct of acne?

a. Occurrence of acne in girls always follow menarche
b. Papules and pustules are the predominant lesions among young patients
c. Mild degree of acne are usually seen at birth and neonatal periods
d. Nodulocystic lesions are common to black males than white males

A

c. Mild degree of acne are usually seen at birth and neonatal periods

101
Q

Which leads to the formation of microcomedone?

a. Follicular epidermal hyperproliferation
b. Excess Sebum Production
c. Inflammation
d. Activity of P. acnes

A

a. Follicular epidermal hyperproliferation

102
Q

Which of the following is a non-inflammatory lesion?

a. Papule
b. Pustule
c. Blackhead
d. Nodule

A

c. Blackhead

103
Q

Which of the following is true of the estrogen in the mechanism of sebum production?

a. It promotes the effects of androgens within the sebaceous gland
b. It promotes production of androgens by gonadal tissue via negative feedback loop on pituitary gonadotropin release
c. It regulates genes that suppress sebaceous gland growth or lipid production
d. Dose of estrogen required to decrease sebum production is lesser than the dose required to inhibit ovulation.

A

c. It regulates genes that suppress sebaceous gland growth or lipid production

104
Q

A 16 y/o presents to a dermatology clinic with acne with uncontrolled OTC facial cleansers and lotions. He has skin lesions on his chest, back and face that some of which are cystic and painful. He has been lifting weights for 6 months and wants to increase muscle mass. After his workouts, he drinks milk with whey protein. Which of the following is elevated in the patient’s blood?

a. Lipases
b. Hyaluronidases
c. Insulin-like growth factor - 1
d. Lysosomal enzymes

A

c. Insulin-like growth factor - 1

105
Q

This endocrine disorder with severe acne is associated with hyperandrogenism, insulin resistance and acanthosis nigricans?

a. Androgen secreting neoplasm
b. Congenital Androgen Hyperplasia
c. HAIR-An
d. Polycystic Ovarian Syndrome

A

c. HAIR-An

106
Q

Which of the following factors is a predictor of severe or long lasting nodulocystic acne?

a. Acne flare just before menses
b. High serum DHEAS level
c. Early onset acne at 6 years old
d. Postpubertal comedonal acne

A

b. High serum DHEAS level

107
Q

Bacterial resistance should be suspected in patients unresponsive to appropriate antibiotic therapy after ___ weeks

a. 6
b. 8
c. 10
d. 12

A

a. 6

108
Q

This has comedolytic properties but is somewhat weaker than retinoids. It can also cause exfoliation of stratum corneum through decreased cohesion of keratinocytes.

a. Benzoyl Peroxide
b. Doxycycline
c. Salicylic acid
d. Tretinoin

A

c. Salicylic acid

109
Q

Hormonal therapy of acne oral contraceptive, one of its mechanism is

a. It decrease amount of gonadal androgen production by stimulating LH production
b. Increase amount of free testosterone by increasing sex hormone binding globulin
c. Inhibit the activity of 5-a reductase to stimulate conversion of testosterone to DHT
d. Blocks the androgen receptors on keratinocytes and sebocytes

A

a. It decrease amount of gonadal androgen production by stimulating LH production

110
Q

Which of the following is TRUE of tetracycline in the treatment of acne vulgaris?

a. reduces sebum production
b. contraindicated with children younger than 9 years old
c. hepatotoxicity is one of the common adverse effects
d. tetracycline is taken orally with food

A

b. contraindicated with children younger than 9 years old

111
Q

Gigi, a 19 year old female, sought consultation due to florid acne, irregular menses, hirsutism, and deepening of voice. Laboratory work up shows the following:
CBC: within normal limits
Serum DHEAS: 3000 ng/mL
Serum total testo: 400ng/mL
Serum free testo: 250 ng/mL?
What is the next BEST step in the laboratory workup of this patient:

a. Order a CT scan of abdomen to confirm adrenal tumor
b. Order serum 17 alpha hydroxy to confirm congenital adrenal hyperplasia
c. Order serum LH and FSH and compute LH:FSH ratio to confirm PCOS
d. Order transvaginal ultrasound to confirm ovarian neoplasm

A

d. Order transvaginal ultrasound to confirm ovarian neoplasm

112
Q

The following characterizes NRS subtype classification of Rosacea except

a. Subtypes may overlap the same individual
b. Rosacea progresses from one subtype to another
c. Prominent clinical variation occurs in rosacea subtypes
d. Subtype coincides with the classification devised by plewig and kligman

A

b. Rosacea progresses from one subtype to another

113
Q

Assessment of the severity of rosacea must include:

a. Rosacea grading system
b. Individual responsiveness to treatment
c. Consideration of its psychological, social, and occupational impacts
d. All of the above

A

d. All of the above

114
Q

Sparse, perivascular lymphohistiocytic infiltrate

a. Phymatous rosacea
b. Papulopustular rosacea
c. Erythematotelangiectatic rosacea

A

c. Erythematotelangiectatic rosacea

115
Q

Inflammatory infiltrate around blood vessels, hair follicles and sebaceous glands

a. Phymatous rosacea
b. Papulopustular rosacea
c. Erythematotelangiectatic rosacea

A

b. Papulopustular rosacea

116
Q

Presence of folliculorum mites within the follicular infundibulum and sebaceous ducts

a. Phymatous rosacea
b. Papulopustular rosacea
c. Erythematotelangiectatic rosacea

A

a. Phymatous rosacea

117
Q

A patient with Stage IV Breast Cancer in chronic pain has developed facial erythema and flushing. Consult was done with her oncologist and the oncologist suspects it to be medication induced. Which of the following medications is most likely the cause of the flushing?

a. Morphine
b. Tamoxifen
c. Cyclosporine
d. Hydrocortisone

A

b. Tamoxifen

118
Q

Which of the following is LEAST associated with chronic photodamage

a. Telangiectasia and erythema are prominent features
b. Actinic damage affects the periphery of the face and neck, the upper chest, and the posterior auricular skin
c. Hypopigmentation and hyperpigmentation
d. Mental and submental chin involvement

A

d. Mental and submental chin involvement

119
Q

Which of the following drugs (topical agent for rosacea) are safe to take during pregnancy:

a. Metronidazole, Sodium sulfacetamide
b. Sodium sulfacetamide, Sulfur
c. Azelaic acid, Sulfur
d. Metronidazole, Azaleic acid

A

d. Metronidazole, Azaleic acid

120
Q

this drug has a well established relationship in causing perioral dermatitis

a. Isotretinoin
b. Topical corticosteroid
c. Oral contraceptive pills
d. Salicylic acid

A

b. Topical corticosteroid

121
Q

What is the characteristic of the primary lesion of Perioral Dermatitis?

a.Facial erythema, flushing, scaling
b. Grouped erythematous papules, vesicles and pustules appearing in the perioral, perinasal and periocular regions
c. Eyelid margin erythema, scaling, crusting
d. Yellow-brown or red papules or nodules located on the cheeks and periorificial facial skin

A

b. Grouped erythematous papules, vesicles and pustules appearing in the perioral, perinasal and periocular regions

122
Q

The distinguishing clinical feature of this condition is characterized by synovial cyst, uveitis, granulomatous arthritis, papular rash

a. Blau syndrome
b. Perioral dermatitis
c. Sarcoidosis
d. Rosacea

A

a. Blau syndrome

123
Q

First Line therapy for Perioral Dermatitis

a. Topical Metronidazole
b. Erythromycin
c. Clindamycin
d. Azelaic Acid

A

a. Topical Metronidazole

124
Q

Medication for those sensitive to Tetracycline

a. Oral Erythromycin
b. Clindamycin
c. Doxycycline
d. Azelaic Acid

A

a. Oral Erythromycin

MODULE (9 decks)

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