Mt 3 Soruları

Question 1

Clostridium türü bakterilerin çoğunlukla da Clostridium perfringens’in etken olduğu bu hastalık, travma veya cerrahi girişimler sonucu iskelet kaslarında ortaya çıkan nekrozla karakterize, progresif ve toksemik bir hastalıktır
Bu hangi hastalığı anlatmaktadır¿

Answer 1

Gazlı gangren (myonecrosis)

Question 2

erythematous papules and plaques accompany itching and diminish within a day, which disease is this

Answer 2

Urticaria

rash of urticaria consists of circumscribed, raised, blanching erythematous papules and plaques, some of which have a central pallor, located on neck, arms and back. The mucous membranes, palms, and soles are spared

Question 3

Which of the following pharmaceutical system is not used to deliver agents to treat dermatological disorders?

Emulsions
Cream
Transdermal therapeutic system
Oinment

Answer 3

Tts. It is for vitamins and painkillers

Question 4

What is the most reliable test for the diagnosis of septic arthritis?

Blood culture
Procalcitonin
C reactive protein (CRP)
Synovial fluid aspirate
Erythrocyte sedimentation rate (ESR)

Answer 4

Synovial fluid aspirate

Question 5

Which of the following is a deformity that does not require treatment and possibly resolves spontaneously?

Developmental dysplasia of the hip
Flexible pes planus
Tarsal coalitions Congenital
convex pes valgus /vertical talus
Pes Equino varus

Answer 5

Flexible pes planus

Question 6

In which disease Pastia’s lines are seen?

Scarlet fever
Toxic epidermal necrolysis
Staphylococcus scalded skin syndrome
Recurrent perineal erythema
Streptococcal toxic shock syndrome

Answer 6

Scarlet fever

Question 7

Which of the following physical examination method for diagnosis of developmental dysplasia of the hip is diagnostic?

Ortholani / Barlow
Swelling of the hip
Length discrepancy of the lower extremity
Limitation of abduction of hip
Pain on hip movement

Answer 7

Ortholani / Barlow

Question 8

Which of the followings is not a component of compartment syndrome?

Paresthesia
Pulselessness
Plasmapheresis
Pain

Answer 8

Plasmapheresis.

Compartment syndrome is defined as elevation of pressure in a compartment. 5P’s of Compartment syndrome are pain-paresthesia- pulselessness-pallor and paralysis
It is a real emergency situation and should be treated with emergent fasciotomy, if diagnosed too late has devastating complications resulting with severe disabilities in the affected extremity.

Paresthesia: uyuşukluk karıncalanma hissi

Question 9

Patient has mild fever for the last 3 days. Afterwards, her parents noticed a rash which was prominent on her face and trunk initially, then spreading to arms and legs. A few children in day-care had a similiar rash recently. Physical examination showed widespread presence of macules, papules, vesicles, and pustules in close proximity over her body. She was restless and itching her skin all the time during the examination

What is the diagnosis¿

Varicella
Measless
Mumps
Rubella

Answer 9

Varicella

Question 10

INFO CARD
Plain film is the first imaging technique.
Osteid osteoms are typical mostly painful lesions.
Usg is the frist choice about new born congenital hip displasia.

Answer 10

Info

Question 11

Which of the following statements regarding hip dislocation is not correct ?

The classic position of an anteriorly dislocated hip is flexion, abduction and external rotation.

90% of all pure dislocations are anterior hip dislocations.

Treatment involves closed reduction under anesthesia in order to avoid femoral or acetabular fractures.

Hip joint dislocation is the third most common dislocation seen in humans.

Following reduction, if the joint is concentric and stable; full weightbearing as tolerated is permitted.

Answer 11

90lı şık. Posterior doğrusu.

Question 12

A 26-year-old man presents to the dermatologist complaining about the lesions that he has noticed recently on the skin adjacent to his penis. He is concerned about having acquired a sexually transmitted disease through one of several recent sexual encounters. The dermatologist defined the lesions as smooth dome- shaped/umblicated papules with a central depression. An excisonal biopsy is performed for one of the lesions. The histopathologic examination revealed verrucous epidermal hyperplasia and intracytoplasmic inclusions located to the corneal and granular layer of the epidermis.
Which of the following viruses can be the etiologic agent for this lesion?

Human papiloma virus
HIV
Hepatit B virus
Pox virus
Herpes simplex virus type 2

Answer 12

Pox.

The gross appearance and histologic appearance are characteristic of molluscum contagiosum, which is caused by poxvirus. The cells in the epidermis contain large intracytoplasmic inclusions, which are called molluscum bodies. The molluscum bodies are accumulations of viral particles.

Molluscum contagiosum, ciltte küçük pembe veya ten rengi kabarıklıklara neden olan virüs kaynaklı bir hastalıkdır. Zararlı değildir ve hastaların genellikle başka şikayetleri yoktur. Virüs şişliklerin içindedir ve hafif bulaşma riski bulundurmaktadır. Bu çıkıntılar genellikle uzun bir süre sonunda kaybolur.

Question 13

Is a complete cord hemitransection usually seen after penetrating traumas of the spinal cord. Characterized by ipsilateral motor, proprioception, vibration and contralateral pain-temperature deficit. Has excellent prognosis depending on the cause.”
Which spinal cord injury pattern is defined above?

Brown-Sequard syndrome
Conus medullaris syndrome
Posterior cord syndrome
Central cord syndrome

Answer 13

Brown-Sequard syndrome

Question 14

Info

The term melanocytic lesion refers to proliferations of neural crest-derived melanocytic cells in the skin ranging from benign freckles and nevi (moles) to malignant melanoma.

Answer 14

Info

Question 15

Which of the following disease-modifying anti-rheumatic drugs (DMARDs) is the first and only drug to be indicated to slow down structural joint damage in romatoid arthritis (RA)?

Methotrexate
Sulfasalazine
Leflunomide
Hydroxychloroquine

Answer 15

Leflunomide is an immunomodulatory drug that decreases pyrimidine synthesis by inhibiting the enzyme “dihydroorotate dehydrogenase” (DHODH), inhibiting both T cell proliferation and production of auto-antibodies by B cells.

Question 16

A 30-year-old man is evaluated for an intensely pruritic erythematous papular and vesicular dermatitis involving the forearms and buttocks bilaterally. He is treated with a high-potency topical steroid, which helps with the itching; however, the rash fails to resolve. After that a skin biopsy is performed from this patient, which shows granular deposits of IgA within the dermal papillae with direct immunofluorescence technique. Which of the following histopathological findings is related with this patient’s disease?

Suprabasal and intraepidermal clefting, extensive acantholysis of keratinocytes resembling dilapidated brick wall

Subepidermal blisters with papillary neutrophilic microabscesses

Suprabasal acantholytic blisters leaving a single layer of basal cells

Epidermal hyperplasia and severe spongiosis

Subepidermal non-acantholytic blisters and superficial perivascular inflammatory infiltrate of lymphocytes and eosinophils

Answer 16

Subepidermal blisters with papillary neutrophilic microabscesses

The distribution of the rash, the clinical description, and histopathological ad DIF findings (Subepidermal blisters with papillary neutrophilic microabscesses and granular deposits of IgA within the dermal papillae) all indicate dermatitis herpetiformis due to underlying celiac disease. The gluten-containing foods would be most likely to aggravate the patient’s condition. Dermatitis herpetiformis is associated with IgA autoantibodies to fibrils that bind the epidermal basement membrane to the dermis, and also produces subepidermal blisters. The association of dermatitis herpetiformis with celiac disease provides a clue to its pathogenesis. Genetically predisposed individuals develop lgA antibodies to dietary gluten (derived from the wheat protein gliadin).

Suprabasal acantholytic blisters leaving a single layer of basal cells resembling row of tombstones: Pemphigus vulgaris

Suprabasal and intraepidermal clefting, extensive acantholysis of keratinocytes resembling dilapidated brick wall: Hailey-hailey disease

Subepidermal non-acantholytic blisters and superficial perivascular mixed inflammatory infiltrate: Bullous pemphigoid

Epidermal hyperplasia and severe spongiosis can be the histopathological features of acute eczematous dermatitis (spongiotic dermatitis), not a bullous disease

Question 17

Which of the following is not associated with the prolonged course of urticaria?

Presence of IgG autoantibodies
Initial disease severity
Diurnal variation
Presence of angioedema
Combination of CSU (Chronic spontaneous urticaria) and physical urticarias

Answer 17

Diurnal variation

Question 18

Which of the following is not a feature of inflammatory arthritis?

Erythema
Symmetric pain even at rest
Joint swelling
Warmth
Typically about 10 minutes of morning stiffness

Answer 18

Typically about 10 minutes of morning stiffness

Genelde inflammatory artrit tipi olan RA dan görülebileceği üzere 10dktan uzun sürer. RA 30dkdan uzun sürer mesela

Question 19

Which bactery cause cellulitis¿

Answer 19

S pyogenes

Question 20

Which of the followings are the signs / symptoms of osteoarthritis?

Locking sensation of the knee
Crepitations
Pain
Morning stiffness lasting for more than an hour
Gait changes

Answer 20

Morning stiffness içeren şık dışında hepsi. Çünkü 30dkdan az sürer

Question 21

Which of the following sentences is not correct for cellulitis?

Group A Streptoccoccal and Staphylococcal species are the main causative agents.
Cellulitis is a common infection of the deep dermis and subcutaneous tissue.
Children are more likely than adults to have facial involvement.
Unilateral lower extremity involvement is typical.
Cellulitis has well defined borders.

Answer 21

Cellulitis DOES NOT have well defined borders. Others are correct.

Question 22

What is the most common agent that causes septic arthritis

Answer 22

S aureus

Question 23

A 53-year-old woman presents with a two-month history of difficulty climbing stairs and arising from the seated position. On physical examination, she has a purplish discoloration of the skin over the forehead, eyelids, and cheeks. She has tenderness on palpation of the quadriceps muscles.
What’s the most likely diagnosis?

Rheumatoid arthritis
Granulomatosis with polyangiitis
Systemic sclerosis
Dermatomyositis
Felty’s syndrome

Answer 23

Dermatomyositis

Dermatomiyozit nadir görülen bir inflamatuar hastalıktır. Bu rahatsızlığın gelişmesi ile birlikte ciltte döküntü, kas güçsüzlüğü ve inflamatuar miyopati olarak bilinen kas iltihaplanması şikayetleri ortaya çıkar. Dermatomiyozit her yaştan bireyi etkileyebilen bir durumdur.

Granulomatosis with polyangiitis (GPA) is a rare vasculitis affecting small vessels. Hallmark features include necrotizing granulomas and pauci-immune vasculitis that most commonly affects the upper respiratory tract, lungs, and kidneys.

Felty syndrome is a rare extra-articular manifestation of seropositive rheumatoid arthritis characterized by RA, neutropenia, and splenomegaly. While the etiology remains somewhat obscure, baseline data suggests an association with certain human leukocyte antigen (HLA) subtypes.

Question 24

loss of joint space, subchondral sclerosis (hardening of the bone just beneath the cartilage), and calcium deposition within the surrounding tissues typically indicates which disease¿

Answer 24

loss of joint space, subchondral sclerosis (hardening of the bone just beneath the cartilage), and calcium deposition within the surrounding tissues typically indicates osteoarthritis. Osteoarthritis is a degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone changes. Calcium deposition, also known as calcification or calcinosis, can occur in the soft tissues surrounding the joint as a result of the degenerative process.

Question 25

Which of the following is incorrect regarding fungal infections of skin and soft tissue? Typical ringworm lesions have an inflamed circular border containing papules and vesicles surrounding a clear area of relatively normal skin. Dermatophytes infect only deeper tissues not superficial keratinized tissues. The most commonly used medium for cultivating fungi is Sabouraud’s agar, which contains only glucose and peptones as nutrients. The simplest method is to mix a clinical specimen, such as skin scrapings, with a 10% solution of potassium hydroxide (KOH) on a microscope slide under a coverslip. Fungi can often be identified by directly observing their distinctive morphologic features on direct microscopic examination of infected pus, fluids, or tissues.

Answer 25

Dermatophytes infect only superficial keratinized tissues therefore 2nd option is the answer

Question 26

A 36-year-old man presented with the complaint of the presence of asymptomatic recurrent scales around the nose and on the eyebrows. Physical examination revealed greasy yellowish scales on mild erythematous ground in these areas. The patient was otherwise completly healthy. What is the most likely diagnosis in this patient? Discoid eczema Allergic contact dermatitis Psoriasis vulgaris Atopic dermatitis Seborrhoeic dermatitis

Answer 26

Seborrhoeic dermatitis Seborrhoeic dermatitis usually affects the seborrhoeic and hairy areas such as scalp, ears, eyebrows, face, pre-sternal area, armpits, umblicus and groin. It shows a chronic and recurrent course, and characterized by greasy yellowish scales Türkçesi egzama

Question 27

Which of the following features regarding discoid lupus erythematosus are correct? 1 Linear granular deposition of immunoglobulin A along the dermoepidermal and dermal follicular junctions 2 Characterized by a lichenoid infiltrate of lymphocytes along the dermoepidermal junction 3 A typical sign of red butterfly-shaped rash over the cheeks and nose sparing the nasolabial folds occur 4 Systemic manifestations of systemic lupus erythematosus are also common in this disease 5 Most common chronic form of cutaneous lupus

Answer 27

1 ve 4 yanlış. The features of DLE: -Systemic manifestations of systemic lupus erythematosus are mostly absent / rare in this disease -A typical sign of red butterfly-shaped rash over the cheeks and nose sparing the nasolabial folds occur -Histopathologically characterized by a lichenoid infiltrate of lymphocytes along the dermoepidermal junction and/or dermal- follicular epithelial interface -Linear granular deposition of immunoglobulin G and complement along the dermoepidermal and dermal follicular junctions

Question 28

Does osteophytes seen in OA or RA

Answer 28

OA Bone spurs, or osteophytes, are bony growths that form in your joints or in the spine. They cause damage to your bones, muscles, or tendons, often as a result of osteoarthritis. These smooth growths may not cause any symptoms or need treatment.

Question 29

Is pannus formation seen in OA or RA

Answer 29

RA Normalde hücre ve damar yapısından fakir olan sinoviyum, kanlanmanın fazla olduğu, proliferasyon gösteren, tümör dokusuna benzer destrüktif bir doku haline gelir. Bu dokuya PANNUS denir.

Question 30

Are bouchard and heberden nodes seen in Oa or RA

Answer 30

Oa Heberden distal bouchrad meta parmak eklemlerinde oluşan şişkinlikler

Question 31

Morning stiffnes that gets improved by activity s seen in OA OR RA

Answer 31

OA

Question 32

Inhibition of which of the following enzymes most likely mediated the therapeutic effect of leflunomide added to methotrexate therapy in a 40-y.o. woman suffering from rheumatoid arthritis? Dihydrofolate reductase Type II topoisomerase Cyclooxygenase-1 Dihydroorotate dehydrogenase

Answer 32

Dihydroorotate dehydrogenase Leflunomide is a disease-modifying antirheumatic drug (DMARD) immunosuppressant approved for the treatment of rheumatoid and psoriatic arthritis. Its mechanism of action involves the inhibition of dihydroorotate dehydrogenase, an enzyme involved in pyrimidine synthesis. As a consequence, there is a reduction in uridine triphosphate levels and pyrimidine synthesis in leucocytes and other rapidly dividing cells. Leflunomide is about as effective as methotrexate in rheumatoid arthritis and enhances methotrexate activity when given concomitantly. Therefore, it is often added to methotrexate therapy, as in this case.

Question 33

A specific chromosomal translocation, t(11;22) (q24;q12) or a variant is found in most of the said diseases family of tumors. Clinical manifestations may include constitutional symptoms such as fever, fatigue, and weight loss. Which tumor is this¿

Answer 33

Ewing sarcoma

Question 34

The patient has enlarging lesion on his upper back. The lesion is an erythematous, tender, round, perifollicular nodule with multiple pustules protruding from the surface. S aureus is most common causative agent of the disease. Which disease is this

Answer 34

Carboncule (çıban)

Question 35

A previously healthy 18 month old infant developed high fever abruptly. His parents saw that the body temperature was 40 other finding and he seemed well when the fever was controlled with paracetamol. However, three days later, a rapid defervescence (abrupt loss) of fever followed by the onset of a pink rash over the trunk was noticed. You examined the baby. He was a well developed and healthy boy, having no fever, and except for the mild, pink, morbilliform rash, other physical findings were unremarkable.The clinical follow up showed that the rash resolved in two days. What is your diagnosis? Chickenpox Roseola infantum Erythema infectiosum Rubella Measles

Answer 35

Roseola infantum: 6 aylıktan daha küçük çocuklar anneden geçen antikorlar nedeniyle altıncı hastalığa karşı bağışıktırlar. Roseola infantum olarak da isimlendirilen altıncı hastalıkta oluşan en ayırt edici belirti rahatsızlığın 3-7. günleri arasında yüksek ateş sonrası gelişen cilt döküntüsüdür.

Question 36

The wife of a 56-year-old man comments that the 'mole' on the back of her husband's neck has seemed to be much larger than she remembered it 2 months ago. On physical examination it is 1 x 1.2 cm and has irregular pigmentation and irregular borders. The biopsy of this lesion seen here microscopically. Histopathologically the lesion is composed of large pigmented polygonal cells with large nucleoli and the lesion has infiltrative border. Which of the following is the most likely diagnosis? Acanthosis nigricans Actinic keratosis Dermatofibroma Hypertrophic scar Malignant Melanoma Verruca vulgaris

Answer 36

Malignant melanoma. Changes in 'moles' are suspicious for melanoma. Note the large polygonal cells with large nucleoli and cytoplasmic pigmentation. The features of the lesion is compatible with malignant melanoma

Question 37

Verrucous epidermal hyperplasia with a cup-like architecture and large intracytoplasmic inclusions within epidermis

Answer 37

Molluscum contagiosum

Question 38

Collection of neutrophils beneath the stratum corneum and formation of subcorneal pustules accompanied with bacteria

Answer 38

Impetigo

Question 39

Epidermal hyperplasia, koilocytosis, keratohyalin granules and intracytoplasmic eosinophilic inclusions

Answer 39

Verrucae vulgaris

Question 40

Hydropic swelling of epidermis, intraepithelial vesicular lesions, formation of pink to purple intranuclear inclusions containing virions, İnclusion-bearing multinucleated syncytia

Answer 40

Herpes simplex infection

Question 41

Fungal microorganisms in hyphae and yeast forms (spaghetti and meatballs appearance) found within the cornified layer associated with neutrophilic infiltration

Answer 41

Tinea versicolor

Question 42

Which eruptive disease of childhood shows the following characteristic eruption pattern? Exanthema typically beginning at the hairline and spreading in a cranial to caudal direction; the lesions are red macules initially, then progress to papules, vesicles, and pustules and then crust within 48 hours. Different highly pruritic skin rashes (macules, papules, vesicles, pustules) present in the same anatomic area. Chickenpox Roseola infantum Measles Erythema infectiosum

Answer 42

Chickenpox

Question 43

Which of the following is a purine analog and acts through inhibition of xanthine oxidase which is especially reserved for chronic treatment of severe tophaceous gout or renal urate stones? Lesinurad Febuxostat Colchicine Allopurinol

Answer 43

Allopurinol. It is the only purine (note “purin” in its name) analog Feedback: within antigout drugs acting through inhibition of xanthine oxidase reserved for chronic treatment of severe tophaceous gout or renal urate stones.

Question 44

77-year-old woman with a sore, pruritic, blistering eruption for three days prior to arrival. Examination of the palms, soles, dorsal aspect of the feet, legs, buttocks, and inner thighs revealed well-demarcated, tense bullae (fig1). They ranged in size from 1cm to 3 cm. They were not clustered in a rosette pattern. There was oral mucosal involvement and also crusting over the left lower lip. On the histopathologic examination; surface epithelium cleanly detached from the underlying connective tissue at the point of the basement membrane zone is revealed (fig2). On direct immunofluorescence deposits of IgG along the basement membrane zone were detected in a linear pattern (fig3). Which of the following is the most probable diagnosis of this patient? Hailey hailey disease Bullous pemphigoid Pemphigus vulgaris Linear IgA bullous disease Dermatitis herpetiformis

Answer 44

Bullous pemphigoid: Chronic, immune mediated, subepithelial blistering disease that predominantly affects mucous membranes. Autoantibodies directed at components of the basement membrane zone (Autoantibodies are against to the components of the basement membrane, particularly the BP antigens BP180 and BP230). Lesions present as tense bullae which do not easily rupture because of the deep location. DIF reveals linear deposition of immunoglobulin and complement at DEJ

Question 45

Joint infection may be caused by the spread of microorganisms from the near epiphysis. This route can not be used for a specific period of time due to the existence of a natural barrier of the physis plate. Which of the following refers to that period of time? Between 18 months and 16 years 0-18 months 0-6 months >18 months to 24 months Adulthood In fetal period

Answer 45

Between 18 months and 16 years The existence of transpyhseal vessels may induce a joint Feedback: infection which may arise from epiphysis osteomyelitis. An open physis line is a natural barrier to resist such an infection. The existence of such a barrier usually blocks the involvement of joints from nearby epiphyseal/metaphyseal osteomyelitis.

Question 46

Which of the following is the mechanism of action of a drug administered to a 50- y.o. man who developed muscle rigidity, tachycardia, labile blood pressure, profuse diaphoresis, and high fever (>40°C) shortly after the initiation of general anesthesia with halothane and succinylcholine prior to his inguinal hernia surgery? (The anesthesia was discontinued at once, and the drug of interest was administered by rapid intravenous push.) Blockade of excitatory neurotransmitter release in the brain Blockade of Ca2+ channels in the sarcoplasmic reticulum Increased K + conductance in the skeletal muscle cell membrane Blockade of Ca 2+ channels in the skeletal muscle cell membrane Activation of GABA B receptors in the spinal cord

Answer 46

Blockade of Ca 2+ channels in the sarcoplasmic reticulum The clinical picture of the patient suggests the diagnosis of Feedback: malignant hyperthermia, a rare but potentially life-threatening disorder that can be triggered by a variety of stimuli, including the administration of certain anesthetics (mainly halothane) and neuromuscular blocking agents (mainly succinylcholine). The disorder is related to a hereditary impairment in the ability of the sarcoplasmic reticulum (SR) to sequester calcium (Ca 2+ ); therefore, a prolonged release of Ca 2+ occurs after the triggering event through SR Ca 2+ channels (ryanodine receptors, RyR). This causes massive muscle contraction, hyperthermia, and lactic acidosis. Dantrolene is a drug of choice in this disorder because it blocks RyRs in the skeletal muscle SR, thus preventing the massive release of Ca 2+ . Cardiac and smooth muscle are minimally affected by dantrolene because they have a different subtype of RyRs in their SR.

Question 47

Which of the following statements regarding a triad in a striated muscle are correct? It is formed by two terminal cisternae and one t-tubule. Propagates the action potential from the sarcolemma to the terminal cisternae. It forms at the level of A-I junction of a sarcomere. It is found in cardiac muscle. It contains fascia adherens, gap junctions and desmosomes

Answer 47

1 2 3 doğru

Question 48

Which of the following class of drugs is not indicated for eczema treatment? Calcineurin inhibitors Glucocorticoids Antibacterials Retinoids

Answer 48

Antibacterials Eczema is not caused by bacteria, however, glucocorticoids may be combined with antibacterial or antifungal agents if infection is present.

Question 49

A 35-year-old woman presents with pain, fever and swelling in her right leg. Examination reveals well-demarcated erythema and spreading streaks of lymphedema. Which of the following is the most likely diagnosis of this patient's condition? Necrotising cellulitis Myositis Erysipelas Necrotising fasciitis Impetigo

Answer 49

Erysipelas This patient has clinical features of erysipelas, a type of superficial cellulitis with dermal and superficial lymphatic involvement. Erysipelas is a bacterial infection that leads to pain, edema, and well-demarcated erythema.

Question 50

Which of the following features are considered as a risk factor in the development of Developmental dysplasia of the hip (DDH)? Aged mother Positive family history Vertex presentation at birth Male sex Intrauterine packaging problems

Answer 50

2 ve 5

Question 51

Which of the below listed joints are considered as a ball and socket type joint? The subtalar joint The knee joint The hip joint The metacarpophalangeal joints The shoulder joint

Answer 51

Hip and shoulder

Question 52

A 3 year boy was brought to the family health care center because of fever and rash. From the history you learned that he had fever, cough, a running nose and red eyes for the last couple of days, and yesterday morning the mother noticed a red rash on his face and neck , which is now spreading to his chest and back. Mother told that two other children at the same day care had similiar rash. His physical examination was remarkable for fever, cough, coryza, conjuntivitis, and a discrete morbiliform rash in the form of coalescing erythematous macules and papules . What is your most likely diagnosis ? Rubella Erythema Infectiosum Scarlet fever Measles

Answer 52

Measles These signs and symptoms strongly suggest measless. Feedback: Particularly cough+coryza+conjuctivitis ( 3Cs) and morbiliform rash.

Question 53

A 65-year-old woman presented with a 1 cm × 1 cm erythematous keratotic plaque on the palmar aspect of the left hand seen at the first picture. Physical examination was otherwise unremarkable. The lateral edge of the lesion was biopsied for further evaluation. Histopathological examination showed hyperkeratosis, parakeratosis, and full thickness atypia of the epidermis. No invasion beyond the basement membrane was noted. According to the microscopic findings which of the following is the most likely diagnosis of this lesion? Psoriasis Seborrheic keratosis Verruca vulgaris Bowen's disease Squamous cell carcinoma

Answer 53

Bowen’s disease. Bowen's disease, or squamous cell carcinoma (SCC) in situ, is an intraepithelial neoplasm with a risk of progression to SCC. It is most often located in sun-exposed areas. Head and neck are most commonly involved followed by the lower and the upper extremities. While the dorsal aspects of the hands are commonly affected, occurrence on the palms is rare. Histopathologic exam showing full-thickness atypia of the epidermis with loss of normal maturation of the keratinocytes will differentiate palmar Bowen's disease from the other entities.

Question 54

Which of the following disease-modifying antirheumatic drugs (DMARDs) is a mouse/human chimeric monoclonal antibody against TNF alpha? Abatacept Infliximab Adalimumab Etanercept

Answer 54

Infliximab Infliximab is a cytotoxic drug that inhibits the activity of the T-cells and B-cells. It is a mouse/human chimeric (denoted by “xi”) monoclonal antibody (mab) that binds to and inhibits the activity of tumor necrosis factor (TNF-alpha). TNF-alpha is a mediator of inflammation and immune activation. The main indication for infliximab is in the treatment of Crohn's disease, which is an inflammatory condition of the intestinal tract.

Question 55

A 4 year-old child is referred to pediatric clinic with limping. He had an upper respiratory tract infection prior to his complaints. He did not have high fever and any rash. On physical exam he looks well, there is painful hip on flexion. There is no hepatosplenomegaly. Complete blood count including acute phase reactants and antistreptolysin antibodies are normal. What is the provisional diagnosis? Brucella arthritis Perthes disease Toxic synovitis Septic arthritis Acute rheumatic fever

Answer 55

Toxic synovitis

Question 56

Which of the following statements are correct for hip dislocations? (Choose as many as required) The main treatment of hip dislocations is urgent open (surgical) reduction and fixation of the hip joint with bone screws. It is the most common joint dislocation seen in humans. Posterior dislocation is the most commonly seen type among all hip dislocations In posterior hip dislocation, the leg on the affected side lies in flexed, internally rotated and adducted position. The ethiology is traumatic in the majority of cases.

Answer 56

3 4 ve 5 doğru. The most common joint dislocation seen in humans is shoulder dislocation, followed by elbow and hip dislocation. The ethiology is traumatic in the majority of cases. Posterior dislocation is the most commonly seen type among all hip dislocations, which the leg on the affected side lies in flexed, internally rotated and adducted position. The main treatment of hip dislocations is urgent closed reducton. Surgical reduction is preferred on late admittances and failed close reductions.

Question 57

Which of the following tumor reveals a histology similar to lipoma which is composed of a mixture of normal-appearing adipocytes intermixed with atypical adipocytes? Dedifferentiated liposarcoma Well-differentiated liposarcoma Rhabdomyosarcoma Myxoid liposarcoma Pleomorphic liposarcoma

Answer 57

Well-differentiated liposarcoma Histology of well-differentiated liposarcoma is similar to lipoma Feedback: showing a mixture of normal-appearing adipocytes intermixed with atypical adipocytes. Pleomorphic liposarcoma histology differs with pleomorphic cells, myxoid liposarcoma differs with myxoid background. Dedifferentiated liposarcoma is hard to diagnose by just adipocytes and rhabdomyosarcoma is a skeletal muscle tumor.

Question 58

Which of the listed factors are considered as risk factors for developmental dysplasia of hip? Firstborn Male sex Breech presentation at birth Oligohydramnios Old mothers

Answer 58

1 3 4 Firstborn (primiparity) babies, female sex, breech presentation at Feedback: birth, young mothers, positive family history, intrauterine packaging problems, oligohydramnios, newborns with greater weight and height, newborns with deformities of the feet or spine are considered as risk factors for DDH.

Question 59

Which one of the below listed reflexes is indicative of the termination of the spinal shock? Spurling’s reflex Achilles reflex Bulbocavernosus reflex Ankle clonus Babinsky reflex

Answer 59

Bulbocavernosus reflex Bulbocavernous reflex is the first reflex to return once the spinal Feedback: shock is over; it’s presence heralds the end of the stage of spinal shock and onset of recovery.

Question 60

Which one of the below listed tests is used for examining lumbar spinal mobility? Hoffmann test Laseque test Schober's test Patrick's test

Answer 60

Schober’s test

Question 61

Which one of the listed factors is not considered as a treatment goal in the treatment of Legg Perthes Calve disease? Increasing the blood flow to the necrotic femoral epiphysis Limitation of loading in order to prevent collapse of the head Resolution of symptoms Restoration of range of motion Keeping the femoral head contained within the acetabulum

Answer 61

Increasing the blood flow to the necrotic femoral epiphysis Conservative or surgical treatment options for LPC disease all aim to decrease pain, increase the ROM of the hip joint, keep the femoral head within the acetabulum, and prevent further collapse of the femoral head. Increasing the blood flow to the affected femoral head is not possible with the current treatment options.

Question 62

Which one of the statements listed below is not correct considering femoral shaft fractures? Stress ractures may be seen in prolonged use of biphosphonates. Rigid intramedullary nailing is the most preferred way of fixing femoral shaft fractures in the adult population. Low impact injuries in the elderly may cause a femoral shat fracture due to osteoporosis. Hip spica casting is the standard treatment of femoral fractures in the elderly. In contaminated, open femoral shaft fractures, external fixation may temporarily be used in order to avoid complications.

Answer 62

Hip spica casting is the standard treatment of femoral fractures in the elderly. Hip spica casting is the preferred treatment modality for femoral shaft fracture in children up to 5 years of age. Rigid fixation (intramedullary nailing or plating ) is the proper treatment in adults.

Question 63

A 50-year-old woman recently diagnosed with gouty arthritis started a treatment with a drug that inhibits leukocyte migration and phagocytosis secondary to inhibit ion of tubulin polymerization. Which of the following drugs did the patient most likely take? Colchicine Indomethacin Prednisone Allopurinol

Answer 63

Colchicine can be used to stop an acute gout attack or, most often, for the prevent ion of further at tacks, as in this case. The drug binds to the intracellular protein, tubulin, thereby preventing its polymerization into microtubules and thus blocking mitosis in metaphase. Cells with the highest rate of division are affected early. Granulocyte migration into the inflamed area and phagocytosis of urate crystals by macrophages are inhibited, thus relieving the pain and inflammation of gouty arthritis. These actions are specific, and the drug is devoid of general analgesic or anti-inflammatory effects.

Question 64

Which of the following endogenous molecule is targeted by infliximab which was added to the ongoing treatment of a 50-year-old woman with refractory rheumatoid arthritis (RA)? Interleukin-1 (IL-1) Vascular endothelial growth factor (VEGF) Interleukin-10 (IL-10) Tumor necrosis factor-α (TNFα)

Answer 64

Tumor necrosis factor-α (TNFα) Infiximab is a chimeric monoclonal antibody (mab) that binds with Feedback: high affinity to soluble and possibly membrane-bound tumor necrosis factor-α (TNF-α). TNF-α is a proinflammatory cytokine that appears to be especially important in the inflammatory processes associated with autoimmune disorders, such as RA, ankylosing spondylitis, Crohn disease, and psoriasis. TNF-α-blocking agents such as infliximab are used in RA, especially for refractory type.

Question 65

A 10-year-old male presents with rashes. His condition started 5 days ago with fever, sore throat, and painful swallowing and then after 3 days, it was noticed that flushed cheeks and papular rashes on his trunk which are non-confluent lesions then it spread to the extremities. The rashes felt like sandpaper. The vital signs show a temperature of 39 C , cardiac rate 110/min, and a respiratory rate of 22 breaths/min. The physical exam shows blanching papular rashes on his trunk and extremities, tonsillopharyngeal congestion with exudate, and cervical lymphadenopathy. Which one is not associated with this clinic? Palmolpantar desquamation occurs in 7-10 days Penicillines are used for the treatment Glomerulonephritis can be seen as a complication It is a toxin related disease There is no enanthem seen in the course of the disease

Answer 65

There is no enanthem seen in the course of the disease Scarlet fever is associated with bacterial pharyngitis caused by Group A beta-hemolytic streptococci (GAS). Typically, scarlet fever is associated with acute pharyngitis. As a result, fever, sore throat, pain with swallowing, and cervical adenopathy is present. If there is no pharyngitis, the source of infection can be a wound or burn which is infected with GAS. In addition to a classic sandpaper rash, physical findings can include a strawberry tongue (enanthem of the disease) and pastia lines. Pastia lines are pink or red lines formed of confluent petechiae, which are found in folds of the skin such as the antecubital fossa. The rash usually persists for about one week and may be followed by desquamation.

Question 66

A 16-year-old female presents for a one-year history of recurrent episodes of a pruritic skin rash. The skin lesions last for fewer than 24 hours and there is no residual scarring. She denies history of fever. She is otherwise healthy. On examination, there are pink to red papules and plaques with a central pallor of different sizes on her axilla, back and legs. Which of the following is the first line of treatment for this patient's condition? Oral antihistamine Topical antihistamine Oral steroid Subcutaneous adrenaline Topical steroid

Answer 66

Oral antihistamine The patient in this clinical scenario presents with chronic urticaria. The principles of management are to avoid exacerbating factors and to control symptoms as long as the urticaria persists. Pharmacological agents are directed at preventing mast cell degranulation and the effects of mast cell mediators released. H1- antihistamines (e.g., cetirizine, loratadine, fexofenadine), taken regularly, are the first-line pharmacological treatment. The dose can be up-titrated to 4 times the standard dose if symptoms remain at 2 to 4-week intervals.

Question 67

A 17-year-old girl was well until about 3 weeks ago, when she began complaining of being “tired all the time.”On examination, her temperature is 38°C . Her cervical CT showed a lesion on the cervical vertebrae.. Hemoglobin: 10.2; WBC: 9600 with increased neutrophils. She has needle injuries on her forearms. Gram-negative rods grew in the blood culture. S.aureus S. typhi S.pyogenes E.faecalis P.aeruginosa

Answer 67

P.aeruginosa Pseudomonas aeruginosa hematogenous osteomyelitis is often seen in intravenous drug abusers, and this organism has a predilection for the cervical vertebrae.

Question 68

A 19-year-old woman presents to the emergency department due to a sudden- onset rash. She reports that she presented one week ago, where she was diagnosed with streptococcal pharyngitis and prescribed amoxicillin. Currently, she complains of a sore throat and fatigue. The patient has no past medical history and takes no regular medications. On examination, she has an erythematous oropharynx without exudates, posterior cervical lymphadenopathy, splenomegaly, and a diffuse maculopapular rash without any mucosal involvement. What is the most likely diagnosis? Toxic epidermal necrolysis Morbilliform drug eruption Fixed drug eruption Toxic shock syndrome Stevens-Johnson syndrome

Answer 68

Morbilliform drug eruption This patient with a sore throat, fatigue, posterior cervical lymphadenopathy, and splenomegaly most likely has infectious mononucleosis. Patients who have mononucleosis and take a penicillin antibiotic, such as amoxicillin, can develop a morbilliform drug eruption. This patient is most likely having an adverse drug reaction (ADR). The most common drugs causing cutaneous ADRs are penicillin derivatives, allopurinol, sulfonamides, and nonsteroidal anti- inflammatories (NSAIDs). Mucous membrane involvement is rare. It would indicate a severe cutaneous ADR such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or a drug hypersensitivity reaction.

Question 69

A 56-year-old woman presented with a 2 months history of pruritic papules on the wrists. Dermatological examination showed numerous violaceous, polygonal, shiny papules with reticular white lines on their surfaces. In addition, bilateral buccal mucosa showed reticular white lines in a lace-like pattern. What is your most likely diagnosis in this patient? Discoid eczema Allergic contact dermatitis Lichen planus Pityriasis rosea Guttate psoriasis

Answer 69

Lichen planus Lichen planus (LP) is a pruritic, papular eruption characterized by its violaceous color, shiny appearence, polygonal shape, and fine scale. It is most commonly found on the flexor surfaces of the upper extremities. It can occur at any age but two thirds of patients are aged 30-60 years. White lines, called Wickham Stria, are often found on the papules. Pruritus is common and severe in LP. Oral lesions are classified as reticular, plaque-like, atrophic, papular, erosive, and bullous. A lace-like pattern on the buccal mucosa and the tongue is referred to as the reticular form of LP.

Question 70

A 68-year-old male patient presents to the dermatologist with a skin lesion on the dorsum of his left hand. The lesion is a red papulo-nodule with scale and ulceration. A biopsy is undertaken, and a diagnosis of cutaneous squamous cell carcinoma is made. What would most likely be found on histological examination of the biopsy? Proliferation of basaloid cells forming nests Atypical melanocytes Central invagination with a keratotic core Keratin pearls Keratin filled multiple cysts

Answer 70

Keratin pearls. Keratin pearls' are characteristically found in cutaneous squamous cell carcinomas. Atypical melanocytes are found in melanomas, not squamous cell carcinoma. Central invagination with a keratotic core is more consistent with a diagnosis of a keratoacanthoma. Proliferation of basaloid cells forming nests describes the histopathological finding in a basal cell carcinoma. Keratin-filed cysts are the classic histological finding in seborrheic keratosis, which is a benign proliferation of immature keratinocytes and is classically described as a well demarcated lesion with a 'stuck-on' appearance.

Question 71

Where does the sacroiliac joint pain radiate to? Anteror crurs Ventral part of thgh Lateral part of crurs Sole of foot Gluteal regon and posteror th

Answer 71

Gluteal region and posterior thigh

Question 72

Where does the sacroiliac joint pain radiate to? Anteror crurs Ventral part of thgh Lateral part of crurs Sole of foot Gluteal regon and posteror th

Answer 72

Gluteal region and posterior thigh

Question 73

Trendelenburg gait is caused by the failure of which muscle? M. sartorius M. gluteus maximus M. extensor hallucus longus M. gluteus medius M. tibalis anterior

Answer 73

Gluteus medius

Question 74

A 70-year-old male patient notices that a lesion that has been on the dorsum of his right hand for 2-3 years, has recently changed shape and has bleeding areas. The lesion is macroscopically skin-colored, hyperkeratotic and contains milimetric bleeding spots. In the biopsy taken from the lesion, both precursor areas and invasive focus suspected of squamous cell carcinoma were detected. Which of the following lesion is most likely the precursor lesion described above? Fibroepithelial polyp Actinic keratosis Seborrheic keratosis Epithelial cyst

Answer 74

Actinic keratosis Actinic keratosis is an epidermal dysplasia developing in skin sites commonly exposed to sunlight such as the face, ears, dorsum of the hands.They can be s kin colored, red or tan lesions usually smaller than 1 cm in diameter. It is considered as preneoplastic lesion of the skin. When the lesions are left untreated, may transform to squamous cell carcinoma.

Question 75

Related with necrotising fasciitis infections, which one is the most important factor associated with higher mortality rates? Delay to first debridment Greater degree of organ dysfunction Renal failure Greater extend of disease Disease due to Group A Streptococci

Answer 75

Delay to first debridment

Question 76

Which of the following defined histological levels would be appropriate to use when measuring the "Breslow thickness" in a patient with malignant melanoma? Stratum basale- Most superficial part of the tumor Stratum basale- Deepest part of the tumor Stratum granulosum- Most superficial part of the tumor Stratum corneum- Most superficial part of the tumor Stratum granulosum- Deepest part of the tumor Stratum corneum- Deepest part of the tumor

Answer 76

Stratum granulosum- Deepest part of the tumor Breslow thickness is expressed in millimeters and measures depth from the granular layer of the epidermis to the deepest part of the tumor •Breslow thickness is strongly correlated with melanoma survival and is a component of the clinical staging system for melanoma

Question 77

Which of the following findings are true for atopic dermatitis (AD)? I-AD usually starts on the cheeks and extensor extremities in infancy II- Diaper area is usually affected in infants with AD III- Typical involvement areas are the extensor areas in childhood AD IV- Presence of personal or family history of atopy is one of the major criteria for the diagnosis of AD

Answer 77

1 4 Typical involvement areas are the flexural areas, such as antecubital Feedback: fossae and popliteal fossae, in chilhood. In contrast to seborrhoeic dermatitis, diaper area is usually spared in infants with AD.

Question 78

Which of the following is incorrect regarding bacterial and viral Infections in skin and soft tissue? The very severe form of deep tissue infection called necrotizing fasciitis is often caused by Pseudomonas aeruginosa. Diabetes mellitus results in progressive peripheral neuropathy and small vessel occlusion. These conditions lead to inadvertent trauma, poor wound healing, and tissue necrosis Most of the superficial localized infections (impetigo, folliculitis, furuncles) are caused by S. aureus or beta-hemolytic streptococci Cellulitis is an inflammatory process involving the skin and supporting tissues, with some extension into the subcutaneous tissues Skin and soft tissue infections are common in every age group. They can infect the young and physically active as well as the elderly and sedentary.

Answer 78

The very severe form of deep tissue infection called necrotizing fasciitis is often caused by Streptococcus pyogenes.

Question 79

A 4-year-old girl was taken to the pediatrician by her mother due to bulging of left eye and vision problems. After physical examination and radiological evaluation, a local mass affecting left eye was detected. In the biopsy performed from the mass, malignant cells consisting of small round cells and tad-pole-like cells were observed. Which of the following is the most likely diagnosis based on current histopathological findings? Rhabdomyosarcoma Kaposi sarcoma Liposarcoma Schwannoma Lymphangioma

Answer 79

Rhabdomyosarcoma Malignant cells consisting of small round cells and tad-pole-like cells are features of rhabdomyosarcomas as well as spindle cells and pleomorphic cells. Liposarcomas would reveal atypical adipocytes, Kaposi sarcoma would vascular structures. Schwannoma and lymphangioma are benign tumors.

Question 80

A 45-year-old female presents to the rheumatology clinic with complaints of joint pain and stiffness, primarily in the small joints of the hands and feet. She reports that the symptoms have been progressively worsening over the past several months and are particularly prominent in the mornings. Upon further questioning, she mentions fatigue. Physical examination reveals symmetric swelling and tenderness in the proximal interphalangeal joints and metacarpophalangeal joints, along with limited range of motion. No significant findings on other systems. Additionally, she has mild ulnar deviation of the fingers and swan-neck deformity of the digits. Before the laboratory investigations; which of the following is the most likely diagnosis of this patient? Osteoarthritis Rheumatoid arthritis Psoriatic arthritis Gout Systemic lupus erythematosus

Answer 80

Rheumatoid arthritis Info: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by symmetrical polyarthritis, typically involving the small joints of the hands and feet. Patients often experience morning stiffness, joint swelling, and fatigue. Laboratory tests may show elevated acute-phase reactants (ESR, CRP) and positive rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Question 81

Match these with Osteoarthritis and Rheumatoid arthritis. Formation of osteophytes [a] Subchondral sclerosis [b] Bouchard nodes [c] Heberden nodes [d] Decreased joint space [e] Hypertrophy of joint capsule [f] Formation of pannus [g] Symmetrical involvement [h]

Answer 81

Formation of osteophytes --> Osteoarthritis Subchondral sclerosis--> Osteoarthritis Bouchard nodes--> Osteoarthritis Heberden nodes--> Osteoarthritis Decreased joint space--> Osteoarthritis Hyperthrophy of joint capsule--> Osteoarthritis Formation of pannus--> Rheumatoid Arthritis Symmetrical involvement--> Rheumatoid Arthritis

Question 82

Match the following definitions regarding the bone fracture types with the appropriate nomenclature of the fractures. Name of the fracture when the overlying skin is not intact [a] Name of the fracture when the bone is broken due to unknown prostate carcinoma [b] Name of the fracture when the ends of the bone at the fracture site are aligned [c] Name of the fracture when the bone is fragmented [d] Name of the fracture after repetitive loads of the same bone [e] Compound fracture Pathologic fracture Greenstick fracture Stress fracture Simple fracture Comminuted fracture Displaced fracture Non-displaced fracture

Answer 82

Name of the fracture when the overlying skin is not intact Compound fracture Name of the fracture when the bone is broken due to unknown prostate carcinoma Pathologic fracture Name of the fracture when the ends of the bone at the fracture site are aligned Non-displaced fracture Name of the fracture when the bone is fragmented Comminuted fracture Name of the fracture after repetitive loads of the same bone Stress fracture

Question 83

Bony callus formation [A] Fibrocartilaginous matrix formation [B] The bone composed of irregularly arranged collagen fibers [C] The bone composed of parallel arranged collagen fibers [D] The last step of inflammatory phase of fracture healing [E] The second phase of fracture healing [F] Inflammation Reparative phase Granulation tissue formation Hematoma formation Lamellar bone Woven bone Soft callus Hard callus Remodeling phase Inflammatory phase

Answer 83

Bony callus formation Hard callus Fibrocartilaginous matrix formation Soft callus The bone composed of irregularly arranged collagen fibers Woven bone The bone composed of parallel arranged collagen fibers Lamellar bone The last step of inflammatory phase of fracture healing Granulation tissue formation The second phase of fracture healing Reparative phase

Question 84

What are the most common symptoms of musculoskeletal system disorders that are associated with chronic diseases and also can diminish the quality of our lives? (Choose as many as required) Joint noises Rash Intentional weight loss Muscle Soreness Fatigue Papules Pain Stiffness Disability

Answer 84

Muscle Soreness Fatigue Pain Stiffness Disability Info: pain is the main symptom of MSD muscle soreness, disability fatigue stiffness are the others. painful noises is meaningful

Question 85

Which of the below listed tests aim to search pathologic reflexes? (Choose as many as required) Laseque Test Hoffmann Test Ankle Clonus Babinsky Test Femoral Stretch Test

Answer 85

Hoffmann Test, Babinsky Test and Ankle Clonus Hoffmann Test, Babinsky Test and Ankle Clonus are pathologic reflexes, wheras Laseque Test and Femoral Stretch Test are provocative tests for nerve root compression

Question 86

Which of the following features are considered as a risk factor in the development of Developmental Dysplasia of the Hip (DDH)? (Choose as many as required) Positive family history Aged mother Male sex Vertex presentation at birth Intrauterine packaging problems

Answer 86

Positive family history and intrauterine packaging problems. Info: Firstborn (primiparity), Young mothers, Oligohydramnios, Intrauterine packaging problems, Positive family history, Breech presentation at birth, Female sex, White skin color, Newborns with greater weight and height and Newborns with deformities of the feet or spine are considered factors for the development of DDH in humans. Male sex, Vertex presentation at birth and Aged mothers as listed here considered as risk factors for DDH.

Question 87

Which of the following is not correct for the Codman Triangle (periosteal reaction)? Commonly seen in benign bone tumors A radiographic feature of bone tumors Suggestive of an aggressive or rapidly growing bone tumor such as osteosarcoma Occurs when rapidly growing bone tumors Appears as a triangular area on the cortex

Answer 87

Commonly seen in benign bone tumors, this is incorrect. Info: Codman triangle is a radiologic sign seen most commonly on musculoskeletal plain films. It is the name given to a periosteal reaction that occurs when bone lesions grow so aggressively that they lift the periosteum off the bone and do not allow the periosteum to lay down new bone.

Question 88

Which of the following is the definition of allodynia? An increased sensitivity to a stimulus Exaggerated pain response from a stimulus that normally elicits pain Pain elicited from a nonpainful stimulus An unpleasant sensation that is either evoked or spontaneous in nature Diminished sensitivity to a normally painful stimulus

Answer 88

Pain elicited from a nonpainful stimulus

Question 89

Which of the following refers to the most common benign bone tumor consisted of a cartilage-cap that is attached to the underlying skeleton by a bony stalk? Osteochondroma Chondrosarcoma Osteoblastoma Osteoid osteoma Osteosarcoma

Answer 89

Osteochondroma Osteoid osteoma and osteoblastoma shows similar features histological not contain a cartilage cap. Osteosarcoma and chondrosarcoma are ma tumors. Osteochondroma is a cartilage forming bone tumor that is also n exostosis. It is the most common benign bone tumor consisted of a beni cap that is attached to the underlying skeleton by a bony stalk. Most com in the metaphysis of long bones (femur > humerus > tibia) and there is m predominance

Question 90

Which of the following symptoms/signs is consistent with inflammatory arthritis? Pain in the joint that occurs only with flexion Swelling only on the anterior side of the joint Joint pain that is worse in the evening Morning stiffness lasting more than an hour Joint pain that increases with activity

Answer 90

Morning stiffness lasting more than an hour Inflammatory joint pain involves the joints diffusely and is present at rest and with normal use. Nocturnal pain may interfere with sleep. This joint pain is associated with prolonged stiffness for greater than 30 to 60 minutes, which is worse in the morning or after inactivity (gelling). Fatigue is common, may be severe, and typically occurs by early afternoon after stiffness has improved.

Question 91

Which of the following trauma mechanisms would highly cause shoulder dislocation in an adult? DOMS (delayed onset muscle Soreness) FOOSH (fall on the outstreched hand) Strain injury Sprain injury Force transmission from steering wheel in a traffic accident

Answer 91

Force transmission from steering wheel in a traffic accident Info: force transmission vector may produce shoulder dislocation in a traffic accident. dashboard also may cause a hip dislocation or fractures

Question 92

Which of the listed joints are considered as a fibrous joint? (Choose as many as required) Symphisis pubis Proximal radio-ulnar joint Intervertebral discs Cranial sutures Distal tibio fibular joint

Answer 92

Cranial sutures Distal tibio fibular joint Info: Distal tibio fibular joint and cranial sutures are classified as fibrous joints. Intervertebral discs and symphisis pubis are cartilaginous joints, and proximal radio-ulnar joint is a synovial joint.

Question 93

Which one can not be seen in the Musculoskeletal trauma patient? Hyperthermia Consciousness Hypotension Hypoxia Bleedings Hypovolemia

Answer 93

Hyperthermia Response Feedback: Hyperthermia, frequently seen in patients following traumatic brain injury (TBI), may be due to posttraumatic cerebral inflammation, direct hypothalamic damage, or secondary infection resulting in fever.

Question 94

Which of the following statements include correct information about bone and soft tissue sarcomas seen in children and adolescents? (Choose as many as required) A specific chromosomal translocation, t(11;22) (q24;q12) or a variant is found in most of the Ewing sarcoma family of tumors. Rhabdomyosarcoma (RMS) , the most common soft tissue sarcoma in children, and may occur at virtually any anatomic site but are most commonly at head and neck and genitourinary tract Osteosarcoma is often located at the epiphysis or metaphysis of long bones that are associated with maximum growth velocity with distal femur, proximal tibia, proximal humerus being the most common sites of origin. Ewing sarcoma may originate from either long tubular bones or flat bones extremities and the central axis (pelvis, spine, and chest) , femur and pel most common sites. Osteosarcoma occurs equally at any age starting form infancy to elde originates from either long tubuler or flat bones

Answer 94

All are true except the last one. Additional info: Osteosarcoma is often located at the epiphysis or metaphysis of long are associated with maximum growth velocity (distal femur, proximal t humerus), but any bone may be involved. *Osteosarcoma most commonly affects adolescents; the peak inciden during the period of maximum growth velocity, but may occur at any a *The highest risk period for development of osteosarcoma is during th growth spurt, suggesting an association between rapid bone growth a transformation.

Question 95

A child is referred to emergency department with signs and symptoms of septic arthritis. What is the most likely source of bacteria? Penetrating damage by accident Hematogeneous route Diagnostic puncture of the joint Dissemination from osteomyelitis Spread from an adjacent soft tissue infection

Answer 95

Hematogeneous route

Question 96

Which are following two types of receptors can be activated to reduce spasticity? Alpha-1 adrenoceptors and the GABA receptors The serotonin receptors and the GABA receptors The alpha-2 adrenoceptors and the GABA receptors The histamine receptors and the cholinergic receptors

Answer 96

The alpha-2 adrenoceptors and the GABA receptors Info: The two types of receptors that can be manipulated to reduce spasticity are the GABA receptors (by baclofen, diazepam) and the alpha-2 adrenergic receptors (by tizanidine).

Question 97

Which of the following disease-modifying antirheumatic drugs (DMARDs) is a mouse/human chimeric monoclonal antibody against TNF alpha? Infliximab Etanercept Abatacept Adalimumab

Answer 97

Infliximab

Question 98

Which of the following drugs might have altered serum and urine urate levels from 18 mg/dL and 800 mg/24 h to 7.2 mg/dL and 530 mg/24 h, respectively, in a 50-yearold woman in three weeks of therapy? Naproxen Furosemide Acetylsalicylic acid Indomethacin Probenecid Allopurinol

Answer 98

Allopurinol Feedback: Because the patient’s urate levels are decreased after therapy both in serum and in urine, the drug must have decreased the formation of uric acid. Allopurinol inhibits the conversion of hypoxanthine to xanthine and xanthine to uric acid, thus decreasing uric acid formation.

Question 99

Which of the following imaging findings is important in the diagnosis of calcium pyrophosphate dihydrate arthritis? Tophi Chondrocalcinosis Marginal erosion Epin calcanei Periarticular osteopenia

Answer 99

Chondrocalcinosis Info: CPPD almost always occurs in joint tissues, most often in fibrocartilage and hyaline cartilage and commonly leads to chondrocalcinosis.

Question 100

A 5-year-old girl was admitted to the allergy clinic because of a rash. Parents first noticed a red macular rash over her cheeks, and thought it was an allergic reaction to the antibiotic prescribed 7 days ago, when a doctor saw her because of fever, cough and malaise. However, 3 days after this red fascial rash, they noticed a lace-like redpink rash over her body. They noticed that the rash was recurring and vanishing intermittently, for example when taking a warm bath, it was recurring, and when she was playing outdoors, it was vanishing. Physical examination was only remarkable for “ slapped cheek” appearance as well as a red reticulate macular /urticarial exanthema (lace-like) all over the body. She was otherwise healthy. What is the most likely diagnosis ? Erythema infectiosum Chickenpox Measles Rubella

Answer 100

Erythema infectiosum Info: Upper respiratory infection findings followed by "Slapped cheek” appearance and then apperance red reticulate macular /urticarial exanthema (

Question 101

A 50-year-old female presents to the dermatologist for her yealy control. She reports a chronic skin condition characterized by red, scaly plaques on her elbows, knees, and scalp. Upon examination, you note the presence of well-demarcated plaques covered with silvery-white scales. When the scales are removed, petechial hemorrhages develop at the sites. Which of the following is the most likely diagnosis of this patient? Pemphigus vulgaris Psoriasis Lichen planus Bullous pemphigoid Discoid Lupus Erythematosus

Answer 101

Psoriasis Info: Psoriasis is a chronic inflammatory skin condition characterized by wel erythematous plaques covered with silvery-white scales. Pemphigus vulgaris is a rare autoimmune disorder characterized by th intraepithelial blisters and erosions on the skin and mucous membrane presents with fragile blisters that rupture easily, leaving behind erosion Bullous pemphigoid is another autoimmune blistering disorder characte tense subepidermal blisters, often with erythematous or urticarial plaqu pemphigus vulgaris, bullous pemphigoid lesions tend to be more locali fragile. Lichen planus is an inflammatory skin condition characterized by prurit flat-topped papules and plaques with a violaceous hue. Wickham striae lines or dots on the surface of the lesions, are a characteristic feature. Discoid lupus erythematosus is a chronic autoimmune disorder characterised by erythematous, scaly plaques with adherent scale and follicular pluggin typically occur on sun-exposed areas such as the face, scalp, and ears lead to scarring and dyspigmentation.

Question 102

A 55-year-old male presents with a rapidly growing, dome-shaped lesion on his right forearm. He reports that the lesion appeared as a small, firm bump about a month ago and has since grown rapidly in size. On examination, you note a well-defined, erythematous papule with a central crateriform ulceration and a keratotic plug. There is no surrounding erythema or induration. A biopsy of the lesion reveals a central cupshaped invagination filled with keratin and a central keratin plug. Which of the following skin neoplastic diseases is most likely represented by the clinical and histopathological findings described above? Malignant Melanoma Keratoacanthoma Squamous Cell Carcinoma Actinic Keratosis Basal Cell Carcinoma

Answer 102

Keratoacanthoma Info: Keratoacanthomas are dome-shaped nodules with a central keratin plug, often appearing rapidly and spontaneously regressing. Basal cell carcinomas typically present as pearly or translucent nodules with telangiectatic vessels and rolled borders. Squamous cell carcinomas often appear as hyperkeratotic, erythematous plaques or nodules with central ulceration. Melanomas typically present as asymmetric, pigmented lesions wit borders and color variation. Actinic keratoses are typically erythematous, scaly patches or plaq found in sun-exposed areas.

Question 103

A 57-year-old female presents to the hospital with a worsening, diffuse, bullous eruption. The eruption started four weeks prior and was distributed mainly on her lower extremities. The patient went to her primary care physician, who prescribed antibiotics and told the patient that she had cellulitis. The patient took the antibiotics, but the rash continued to worsen. After completing the antibiotic course without improvement, the patient presented with diffuse and erythematous tense bullae ranging from 1.5 to 2 centimeters in diameter. The lesions can be appreciated on the patient’s face, neck, back, chest, abdomen, and extremities. The lesions were both pruritic and painful. On examination, the patient was afebrile and without leukocytosis, yet C-reactive protein was elevated. A punch biopsy performed showed a subepidermal blister with eosinophils and neutrophils. The underlying dermis demonstrated severe edema and infiltrate of eosinophils and lymphocytes. Direct immunofluorescence (DIF) of the skin revealed the linear deposition of immunoglobulin G (IgG) and complement C3 along the dermo-epidermal junction. Based on the clinical presentation, histopathologic features, and DIF findings, which of the following is the most likely diagnosis? Dermatitis herpetiformis Hailey hailey diasease Bullous pemphigoid Pemphigus vulgaris Linear IgA bullous dermatosis

Answer 103

Bullous pemphigoid Bullous pemphigoid is the most common of the blistering disorders, characterized by tense bullae or blistering lesions filled with clear fluid. Histologically, it presents with a subepidermal blister with eosinophils and neutrophils. Direct immunofluorescence typically reveals linear deposition of IgG and complement C3 along the dermoepidermal junction.

Question 104

A tissue scraping sample of a 5 year old girl with an unexplained atypical vesicular rash revealed multinucleated giant cells in a Tzanck test. Which of the following statement is definitely correct? It is a herpes simplex 2 virus infection It is a herpes simplex 1 virus infection It is a varicella zoster virus infection It can be a herpes simplex or varicella zoster virus infection It is a herpes zoster infection

Answer 104

It can be a herpes simplex or varicella zoster virus infection Info: Vesicular rash sample Tzank test revealing multinucleated giant cells can be caused by HSV 1, HSV 2 or VZV. The definitely true answer is : It can be a herpes simplex (HSV1 and 2) or varicella zoster virus infection A definitely true answer is HSV 1, HSV 2 or VZV. The others lack the other responsible viruses.

Question 105

Candidal infection of the mouth: [A] Dermatophyte infection of nail plate: [B] Candidal infection of the glans of the penis: [C] Candidal infection of skin fold: [D] Superficial infection of inguinal area: [E] Superficial fungal infection of body surfaces: [F] Superficial fungal infection of the foot [G] Superficial fungal infection of the beard area [H] Balanitis Onychomycosis Thrush Tinea cruris Tinea pedis Intertrigo Tinea barbae Tinea inguinalis

Answer 105

Candidal infection of the mouth: Thrush Dermatophyte infection of nail plate: Onychomycosis Candidal infection of the glans of the penis: Balanitis Candidal infection of skin fold: Intertrigo Superficial infection of inguinal area: Tinea inguinalis Superficial fungal infection of body surfaces: Tinea cruris Superficial fungal infection of the foot Tinea pedis Superficial fungal infection of the beard area Tinea barbae

Question 106

Circumscribed flat lesion larger than 10 mm in diameter [A] Elevated flat-topped lesion smaller than 10 mm [B] Elevated roughly spherical lesion greater than 10 mm [C] Discrete, pus filled raised lesion [D] Fluid filled raised lesion less than 10 mm [E] Intercellular edema of the epidermis [F] Intracellular edema of the epidermis [G] Complete loss of epidermis and a part of dermis [H] Loss of cohesion between keratinocytes [I] Diffuse epidermal hyperplasia [J] Thickening of the stratum corneum [K] Bulla Vesicle Acantholysis Acanthosis Nodule Macule Erosion Plaque Patch Spongiosis Hydropic swelling Papule Hyperkeratosis Ulceration Pustule

Answer 106

Circumscribed flat lesion larger than 10 mm in diameter Patch Elevated flat-topped lesion smaller than 10 mm Papule Elevated roughly spherical lesion greater than 10 mm Nodule Discrete, pus filled raised lesion Pustule Fluid filled raised lesion less than 10 mm Vesicle Intercellular edema of the epidermis Spongiosis Intracellular edema of the epidermis Hydropic swelling Complete loss of epidermis and a part of dermis Ulceration Loss of cohesion between keratinocytes Acantholysis Diffuse epidermal hyperplasia Acanthosis Thickening of the stratum corneum Hyperkeratosis

Question 107

Which of the following choices are correct in terms of the characteristics of the rash (eruption) seen in viral diseases in children? (Choose as many as required) The most important characteristics of rubella rash is being in a central distribution, umbilication, and presence of different highly pruritic skin rashes in the same anatomic area Roseola infantum is caused by HHV 6 and 7 , and the first clinical symptom is abrupt onset of high fever (40°C), which lasts for 3 days with nonspecific complaints followed by an abrupt loss of fever and the onset of a mild, pink, morbilliform rash The typical measles rash begins to erupt behind the ears and in the hairline area, then spreads over the rest of the skin over a period of a few days, and typically resolves in the same order as its appearance, and will often desquamate Rubella eruption appears on the face first, spreading in a cephalocaudal trend over 1 - 3 days, and tends to fade in 2 - 3 days in the same manner as it appeared without desquamation

Answer 107

All except the first one are true. The first one would be correct if it was varicella instead of rubella.

Question 108

Which of the following clinical findings about a melanocytic lesion that has been followed for 3 months raise suspicion for malignant melanoma or dysplastic nevus ? (Choose as many as required) Both halves of the lesion are similar and match each other Itchy for last 3 weeks Mixed color in the same lesion Same size since the first day The edges of the lesion is irregular 5 mm in diameter

Answer 108

Itchy for last 3 weeks Mixed color in the same lesion The edges of the lesion is irregular Info: Clinical evaluation of melanocytic lesions (When to suspect of a malignancy?): Asymmetry: Half of the lesion does not match the other half Border irregularity: The edges are ragged, notched, or blurred Color variegation: Pigmentation is not uniform and may display shades of tan, brown, or black; white, reddish, or blue discoloration is of particular concern Diameter: A diameter greater than 6 mm is characteristic, although some melanomas may be smaller in size; any growth in a nevus warrants an evaluation Evolving: Changes in the lesion over time are characteristic; this factor is critical for nodular or amelanotic (nonpigmented) melanoma, which may not exhibit the ABCD criteria above

Question 109

Which of the following features regarding Dermatitis herpetiformis are correct? (Choose as many as required) Ig A deposition on direct immunofluorescence occurs in a continuou linear pattern at the dermoepidermal junction The skin lesions are extremely itchy Histopathologically the detachement is at the dermoepidermal junction A chronic vesiculobullous skin disorder characterized by autoantibodies against desmoglein It is one of the extraintestinal manifestation of ulcerative colitis

Answer 109

The skin lesions are extremely itchy Histopathologically the detachement is at the dermoepidermal junction Info: A chronic vesiculobullous skin disorder characterized by autoantib tTG2 Ig A deposition on direct immunofluorescence occurs in a granula the dermoepidermal junction Histopathologically the detachement is at the dermoepidermal jun The skin lesions are extremely itchy It is the specific cutaneous manifestation of celiac disease

Question 110

Which of the test below is not helpfull in dermatophytoses diagnosis? Microscopic examination of roots of hair Wood lamb examination of the affected skin lesions Culture of skin and nail scraping samples Serology Skin scraping sample examination with15- 20% KOH preparation

Answer 110

Serology ınfo: In dermatophyte infections serology is not helpful in microbiological diagnosis Microscopic examination of roots of hair, skin scraping sample examination with15-20% KOH preparation, culture of skin and nail scraping samples and Wood lamb examination of the affected skin can be used in the diagnosis of dermatophyte infections.

Question 111

A 70-year-old male presents to the dermatology clinic with a new skin lesion on his che examination, you observe a dark brown, slightly raised lesion with smooth borders (Fig excisional biopsy is performed, and microscopic examination reveals hyperkeratosis, k horn cysts, and invagination cysts within the lesion. Based on the clinical and histopathological findings, which of the following is the most likely diagnosis of this lesion? Seborrheic keratosis Fibroepithelial polyp Squamous cell carcinoma Basal cell carcinoma Malignant melanoma

Answer 111

Seborrheic keratosis Info: Seborrheic keratosis is a common benign epidermal tumor characterize circumscribed, tan to brown, waxy plaques or papules with a stuck-on a Histologically, seborrheic keratosis shows hyperkeratosis, papillomatosi cysts within the epidermis, along with basaloid cells and melanin pigme

Question 112

A 62-year-old man presents with painful oral lesions and skin blisters that started a week ago. Physical examination reveals multiple flaccid (soft) bullae on the oral mucosa, chest, a well as erosions and crusting over the lips (fig 1). Biopsy of a skin lesion shows intraep formation with acantholysis (fig 2), and direct immunofluorescence reveals IgG deposit epidermis (fig 3). Which of the following is the most likely diagnosis of this patient? Linear IgA bullous disease Bullous pemphigoid Pemphigus vulgaris Dermatitis herpetiformis Hailey-Hailey disease

Answer 112

Pemphigus vulgaris

Question 113

A 25-year-old woman presents to the emergency department with complaints of sudden-onset, intensely itchy raised lesions on her arms, legs, and trunk. She reports that these lesions appeared approximately 30 minutes after she ate a meal containing shrimp, to which she has no idea about her allergy before. She denies any difficulty breathing or swallowing. On examination, you observe multiple erythematous, edematous, raised wheals distributed symmetrically on her body (Figure). Some of the lesions have coalesced to form larger areas of swelling. A skin biopsy is performed, which reveals superficial perivascular inflammation with dermal edema and a sparse infiltrate of eosinophils in the dermis. Based on the patient's history, clinical presentation, and histopathologic features, which of the following is the most likely diagnosis? Acute eczematous dermatitis Seborrheic dermatitis Psoriasis Bullous pemphigoid Urticaria

Answer 113

Urticaria Info: Urticaria, also known as hives, is a skin condition characterized by the sudden onset of raised, erythematous, edematous wheals that are intensely pruritic. It is often triggered by allergens, medications, infections, or physical stimuli. Acute eczematous dermatitis, also known as acute contact dermatitis, is a type of eczema characterized by erythema, edema, vesicles, and weeping or crusting lesions. It typically develops rapidly after exposure to an irritant or allergen. Histop

Question 114

A 45-year-old woman presents to her dermatologist with complaints of an itchy rash on her wrists and ankles that has been present for the past few weeks. Upon further questioning, she reports a history of a similar oral mucosal white lesions a few months ago. She denies any recent changes in medications or skincare products. On examination, you observe flat-topped, polygonal, shiny papules with a violaceous color distributed symmetrically on the flexor surfaces of her wrists and ankles. Some lesions have a fine, lacy network of white lines overlying them. Based on the patient's history and clinical presentation, which of the following is the most likely diagnosis? Stevens Johnson Syndrome Psoriasis Lichen planus Erythema multiforme Toxic epidermal necrolysis

Answer 114

Lichen planus Info: Lichen planus is an inflammatory skin condition characterized by pruritic, polygonal, flat-topped papules and plaques with a violaceous color. Wickham striae, fine white lines or dots on the surface of the lesions, are a characteristic feature.

Question 115

A 24-year-old man comes to the office because of a 2-day history of a red, itchy rash on his buttocks and legs. Physical examination shows the findings in the photograph. The infectious agent causing these findings most likely began to proliferate in which of the following locations? Eccrine gland Dermis Apocrine gland Sebaceous gland Hair follicle

Answer 115

Hair follicle

Question 116

A 29-year-old woman presents with an itchy and painful lesion of sudden onset on her elbow, which has occurred in exactly the same location multiple times (Figure). She denies recent trauma to the area and has had no direct contact with chemicals or other agents, such as plants or corrosive substances. She reports no systemic symptoms. Further questioning revealed that the lesion occurred recurrently and was associated with menstruation, when she would take oral naproxen for menstrual cramps. What is the most likely diagnosis? Bullous impetigo Fixed drug eruption Herpes simplex virus infection Erythema multiforme Bullous insect bite reaction Question 47 Which of the below histopathological findings is not specific for psoriasis? Selected Answer: Hypergranulosis Answers: Hypergranulosis Microabscesses Parakeratosis Lymphocytic infiltration in the dermis Acanthosis Response Feedback: One of the main features of psoriasis histopathology is “Hypogranulosis” which describes the thinning of the granular layer. Hypogranulosis is typically seen in diseases of increased cell turnover such as psoriasis. Question 48 Which of the following agents used in the treatment of severe cases of psoriasis may be combined with disease-modifying antirheumatic drugs (DMARDs)? Selected Answer: Glucocorticoids Answers: Vitamin D analogues Glucocorticoids Calcineurin inhibitors Retinoids Response Feedback: Analogs of vitamin D3 increase differentiation and inhibit proliferation of keratinocytes and therefore used both as monotherapy and in combination with topical corticosteroids, phototherapy (psoralen– ultraviolet A [PUVA] or ultraviolet B [UVB]), acitretin (second generation retinoid), methotrexate and cyclosporine. Question 49 Which of the following statement regarding urticaria is correct? Selected Answer: Urticaria can co-exist with angioedema which is a deeper swelling within the skin or mucous membranes Answers: The first step tretment is first-generation H1 antihistamines Dermographism is the most common form of acute urticaria. It is als called dermatographia and dermographic urticaria

Answer 116

Fixed drug eruption

Question 117

Which of the below histopathological findings is not specific for psoriasis? Hypergranulosis Microabscesses Parakeratosis Lymphocytic infiltration in the dermis Acanthosis

Answer 117

Hypergranulosis Info: One of the main features of psoriasis histopathology is “Hypogranulosis” which describes the thinning of the granular layer. Hypogranulosis is typically seen in diseases of increased cell turnover such as psoriasis.

Question 118

Which of the following agents used in the treatment of severe cases of psoriasis may be combined with disease-modifying antirheumatic drugs (DMARDs)? Vitamin D analogues Glucocorticoids Calcineurin inhibitors Retinoids

Answer 118

Vitamin D analogues Info: Analogs of vitamin D3 increase differentiation and inhibit proliferation of keratinocytes and therefore used both as monotherapy and in combination with topical corticosteroids, phototherapy (psoralen– ultraviolet A [PUVA] or ultraviolet B [UVB]), acitretin (second generation retinoid), methotrexate and cyclosporine

Question 119

Which of the following statement regarding urticaria is correct? Urticaria can co-exist with angioedema which is a deeper swelling within the skin or mucous membranes The first step treatment is first-generation H1 antihistamines Dermographism is the most common form of acute urticaria. It is als called dermatographia and dermographic urticaria Acute urticaria is urticaria, with or without angioedema, that is pres 4 weeks

Answer 119

Urticaria can co-exist with angioedema which is a deeper swelling within the skin or mucous membranes

Question 120

In order to assess L3 root integrity, which function of the lower extremity muscles should be observed? Standing on his/her tip toes Standing on his/her heels Lifting his/her big toes o the ground Squatting of the patient and rising from squatting Flexing his/her hips

Answer 120

Squatting of the patient and rising from squatting Feedback: In order to assess L3 root integrity knee extensors should be tested. This could be done by asking the patient to squat and rise from squatting

Question 121

In which of the groups below can Pseudomonas aeruginosa be a usually detected etiologic agent for septic arthritis? Neonates Patients with Lyme disease Sexually active adults Intravenous drug user People with prosthetic joints

Answer 121

Intravenous drug user Info: Septic arthritis is generally caused by S. aureus and P. aureginosa in IV drug users. Other septic arthritis agents: Neonates --> S. agalacticae Kids and adults --> S. aureus , S. pyogenes, S. pneumoniae Prosthetic joints (hip/knee) --> S. aureus, S. epidermidis Sexually active adults --> N gonorrhea Lyme disease --> Is caused by B. burdorferi, but it is an immune mediated condition and no mowill be in the affected joint

Question 122

Septic arthritis symptoms may not include which of the following? Fatigue Weight loss Chills Relaxed position in the joint to increase joint space Fever

Answer 122

Weight loss

Question 123

Which of the below listed contraction types denes elongation of the muscle due to the resistance being greater than the force the muscle generates ? Isotonic Isometric Eccentric Co-concentric Concentric

Answer 123

Eccentric Eccentric contraction occurs where the lenght of the muscle increases during contraction.

Question 124

Which of the following is a feature of neuropathic pain? It can be related to the presence of chronic arthritis. It can present with increased temperature, swelling and stiness. It is a type of pain which is associated with the lesions of the pyramidal tractus. It can be associated with muscle weakness in the relevant area. It is not associated with lesions of the somatosensory system.

Answer 124

It can be associated with muscle weakness in the relevant area. Info: Neuropathic pain is a kind of pain arising from the lesions of the nervous system, and can also present with weakness if a motor lesion is also involved.

Question 125

Which of the following is a spindle cell tumor morphologically? Granular cell tumor Embryonal rhabdomyosarcoma Myxoma Alveolar soft part sarcoma Leiomyoma

Answer 125

Leiomyoma Leiomyoma, solitary brous tumor, dermatobroma, brosarcoma, leiomyosarcoma are among spindle shaped tumors morphologically. Glomus tumor, embryonal and alveolar rhabdomyosarcomas, Ewing sarcoma, neuroblastomas are among round cell tumors, granular cell sarcoma, alveolar soft part sarcoma are among epithelioid cell tumors and myxomas are among myxoid tumors.

Question 126

Which of the following statements are correct about rhabdomyosarcoma? (Choose as many as required) 1) Represents an aggressive neoplasm 2) It has 4 histologic subtypes: alveolar, epithelial, palisading, spindle cell 3) It is a malignant mesenchymal tumor with skeletal muscle differentiation 4) Common locations include head and neck, genitourinary system, extremities and retroperitoneum 5) Symptoms depend on the location and the size of the tumor

Answer 126

All except 2 are true. There are 4 subtypes of tumor histologically: alveolar, embryonal, pleomorphic, spindle cell NOT epithelial or palisading.

Question 127

Which of the following symptoms/signs is consistent with noninammatory arthritis? Pain not responding to NSAIDs Systemic ndings Joint pain that increases with activity Morning stiness lasting more than an hour Constitutional symptoms

Answer 127

Joint pain that increases with activity Info: Patients with non-inammatory joint pain have pain with activity that is relieved by rest. Although they may have stiness or gelling after inactivity, it typically lasts less than 15 minutes, and systemic fatigue is not common.

Question 128

Which of the listed X ray ndings determine the abnormal position of femoral head relative to the acetabulum in Developmental dysplasia of the hip (DDH)? (Choose as many as required) Larger ossic nucleus of the proximal femoral physis (compared to the normal side) in the acetabulum Proximal femoral physis located at the inner lower quadrant Proximal femoral physis resting above the Hilgenreiner line High acetabular index (< 25°) at the aected side Broken Shenton line at the aected side

Answer 128

3rd 4th and 5th statements are to be chosen. Info: X ray ndins that should be sought for determination of the abnormal position of femoral head relative to the acetabulum in DDH include: 1) Smaller ossic nucleus of the proximal femoral physis relative to the contralateral side 2) Proximal femoral physis resting above the Hilgenreiner line 3 Proximal femoral physis not located at the inner lower quadrant d) High acetabular index (< 25°) at the aected side e) Broken Shenton line at the aected side

Question 129

A 50-year-old woman recently diagnosed with gouty arthritis started a treatment with a drug that inhibits leukocyte migration and phagocytosis secondary to inhibition of tubulin polymerization. Which of the following drugs did the patient most likely take? Allopurinol Colchicine Indomethacin Prednisone

Answer 129

Colchicine Colchicine can be used to stop an acute gout attack or, most often, for the prevent ion of further at tacks, as in this case. The drug binds to the intracellular protein, tubulin, thereby preventing its polymerization into microtubules and thus blocking mitosis in metaphase. Cells with the highest rate of division are aected early. Granulocyte migration into the inamed area and phagocytosis of urate crystals by macrophages are inhibited, thus relieving the pain and inammation of gouty arthritis. These actions are specic, and the drug is devoid of general analgesic or anti-inammatory eects.

Question 130

All of the following diseases except one of them are “mechanical disorders” Which one is the exception? Osgood Schlatters disease Slipped capital femoral epiphysis Perthes disease Pes planus Transient synovitis of hip

Answer 130

Transient synovitis of hip

Question 131

Which of the following disease-modifying antirheumatic drug (DMARD) would be most appropriate for a 50-year-old patient recently diagnosed with mild rheumatoid arthritis? He was a heavy smoker and had a history of chronic bronchitis with frequent acute exacerbations usually treated with antibiotics. His joint pain continued despite ibuprofen therapy Rituximab Hydroxychloroquine Etanercept Lefunomide

Answer 131

Hydroxychloroquine The therapy of mild RA usually includes nonsteroidal antiinammatory drugs (NSAIDs) that can control symptoms of pain and swelling, but DMARD treatment is almost always added within 3 months of the RA diagnosis. Hydroxychloroquine seems to be the least toxic among DMARDs and is usually the initial choice. Immunosuppressants are relatively contraindicated in this patient because of his frequent respiratory tract infections.

Question 132

Which of the following is not a screening test for all types of inflammatory arthritis? Total Protein C-Reactive Protein (CRP) Erythrocyte Sedimentation Rate (ESR) Anti-Cyclic Citrullinated Peptide (Anti-CCP) Rheumatoid Factor (RF)

Answer 132

Total Protein Info: 1.Screening blood tests for all types of inammatory arthritis: –Erythrocyte Sedimentation Rate (ESR): An elevated ESR "supports" the presence of an inammatory arthritis. –C-Reactive Protein (CRP): This test is an alternative to obtaining the ESR. –Rheumatoid Factor (RF): A rheumatoid factor test should be obtained when rheumatoid arthritis (RA) is at least moderately possible in the patient. –Anti-Cyclic Citrullinated Peptide (Anti-CCP): Measuring antibodies to CCP is a new test for RA; it has higher specicity but lower sensitivity than RF. –Anti-Nuclear Antibody (ANA): ANA test is commonly obtained in patients with arthralgias or arthritis as a screening test for SLE or another connectivetissue disorder. More than 95% of patients with SLE have ANA; thus, a negative ANA result is a strong indicator that SLE is not present. However, a positive ANA result lacks specicity and may occur in persons with other connective-tissue diseases (Positive ANA incidence is 99% in SLE, 85% in Sjögren’s, 88% in Scleroderma, 55% in Rheumatoid Arthritis, and 40% in Juvenile Rheumatoid Arthritis)

Question 133

Which of the following is one of the common features of spondyloarthritis? Raynaud's phenomenon Tophi Enthesitis Glomerulonephritis Subcutaneous nodules

Answer 133

Enthesitis Info: The most typical features of SpA are inammatory back pain, sacroiliitis, spondylitis, asymmetric oligoarthritis and enthesitis. This group of diseases is seronegative (autoantibodies seen in CTDs are absent). Extramusculoskeletal ndings are anterior uveitis, psoriasis and IBD. SpA is strongly associated with HLA-B27

Question 134

Which of the following is the mechanism of dantrolene administered to a 50-y.o. man who developed muscle rigidity, tachycardia, labile blood pressure, profuse diaphoresis, and high fever (>40°C) shortly after the initiation of general anesthesia with halothane and succinylcholine prior to his inguinal hernia surgery? (The anesthesia was discontinued at once, and the drug of interest was administered by rapid intravenous push.) Blockade of Ca2+ channels in the sarcoplasmic reticulum Blockade of Ca2+ channels in the skeletal muscle cell membrane Increased K+ conductance in the skeletal muscle cell membrane Blockade of excitatory neurotransmitter release in the brain Activation of GABAB receptors in the spinal cord

Answer 134

Blockade of Ca2+ channels in the sarcoplasmic reticulum Info: The clinical picture of the patient suggests the diagnosis of malignant hyperthermia, a rare but potentially life-threatening disorder that can be triggered by a variety of stimuli, including the administration of certain anesthetics (mainly halothane) and neuromuscular blocking agents (mainly succinylcholine). The disorder is related to a hereditary impairment in the ability of the sarcoplasmic reticulum (SR) to sequester calcium (Ca2+); therefore, a prolonged release of Ca2+ occurs after the triggering event through SR Ca2+ channels (ryanodine receptors, RyR). This causes massive muscle contraction, hyperthermia, and lactic acidosis. Dantrolene is a drug of choice in this disorder because it blocks RyRs in the skeletal muscle SR, thus preventing the massive release of Ca2+. Cardiac and smooth muscle are minimally aected by dantrolene because they have a dierent subtype of RyRs in their SR.

Question 135

A 19-year-old male presents to the dermatologist with complaints of intense itching, particularly at the interdigital folds of his hands. He reports that the itching worsens at night. On physical examination, elevated hyperemic rashes with evidence of scratching are noted. Some of the lesions appear as thin, serpiginous lines. A biopsy of one of the lesions is performed. Microscopic examination reveals a wedge-shaped inammatory inltrate within the dermis, composed of a mixed inammatory cell population. What is the most likely diagnosis for this patient? Pemphigus vulgaris Scabies Tinea versicolor Candidiasis Molluscum contagiosum

Answer 135

Scabies Info: The clinical and histopathological ndings are consistent with scabies. Scabies is caused by the mite Sarcoptes scabiei, which burrows into the skin to lay eggs, creating characteristic track-like lesions and causing intense pruritus, especially at night.

Question 136

A 28-year-old woman presents to the dermatology clinic with multiple skin lesions on her hands. She describes the lesions as raised, rough, and sometimes painful, especially when pressure is applied. The lesions have been present for several months and have slowly increased in size and number. On physical examination, you observe several well-circumscribed, rm, hyperkeratotic papules with a rough surface. A biopsy of one of the lesions is performed. Histopathological examination reveals epidermal hyperplasia, koilocytosis, keratohyalin granules, and intracytoplasmic eosinophilic inclusions. Based on the clinical presentation and histopathological ndings, what is the most likely diagnosis? Verrucae vulgaris Impetigo Molluscum contagiosum Herpes infection Tinea versicolor

Answer 136

Verrucae vulgaris Info: The clinical and histopathological ndings are consistent with verrucae vulgaris, also known as common warts. These lesions are caused by human papillomavirus (HPV) infection and are characterized by epidermal hyperplasia, koilocytosis (a change in epidermal cells due to viral infection), keratohyalin granules, and intracytoplasmic eosinophilic inclusions.

Question 137

A 35-year-old woman presents to the clinic with complaints of severe itching and red, blistering rashes on her hands and forearms. She reports that the symptoms started a few days after she began using a new brand of dishwashing detergent. Physical examination reveals erythematous, edematous plaques with oozing and crusting. A skin biopsy is performed, and histopathological examination shows spongiosis with vesicle formation and a mixed inammatory inltrate in the dermis. Which of the following statements regarding "acute eczematous dermatitis" are correct? (Choose as many as required) Symptoms typically include intense itching and erythematous plaques The condition is commonly triggered by external factors such as allergens or irritants. Histopathological ndings include spongiosis and dermal inammatory inltrate. Direct immunouorescence shows linear IgG deposition along the basement membrane. It is characterized by dermographism

Answer 137

The first three statements should be chosen. Info: Acute eczematous dermatitis, also known as eczema, is an inammatory skin condition commonly triggered by external factors such as allergens or irritants. The histopathological hallmark is spongiosis (intercellular edema in the epidermis) with vesicle formation and a mixed inammatory inltrate in the dermis. Symptoms typically include intense itching and erythematous plaques. Dermatographism, also known as dermographism urticaria, is an urticarial eruption upon pressure or trauma to the skin.Additionally, direct immunouorescence ndings in eczema are not characterized by linear IgG deposition along the basement membrane, which is seen in conditions like bullous pemphigoid.

Question 138

A 45-year-old woman presents to the dermatology clinic with painful blisters on her skin and in her mouth. She rst noticed the blisters in her mouth two months ago, which then spread to her chest and back. On examination, you observe multiple accid bullae and erosions on her chest, back, and oral mucosa. A biopsy of a skin lesion is performed, and histopathological examination reveals intraepithelial blister formation with acantholysis. Direct immunouorescence shows IgG and C3 deposits in a sh-net pattern along the plasma membranes of keratinocytes. Which of the following features regarding the patient's condition are correct? (Choose as many as required) It can also involve mucosa as well as skin. The blisters are mostly thin walled and painful. It is the most common type of pemphigus. IgG and C3 deposition occurs in a continuous linear pattern at the dermoepidermal junction. It is caused by autoantibodies that bind to proteins that are required for adherence of basal keratinocytes to the basement membrane.

Answer 138

The first three statements are correct

Question 139

A 60-year-old woman presents with a slowly growing lesion on her left cheek. She rst noticed the lesion several months ago, and it has gradually increased in size. On physical examination, you observe a 1.5 cm pearly, translucent nodule with visible telangiectatic vessels and a slightly rolled border. There is no ulceration or signicant surrounding erythema. The patient denies any pain or itching associated with the lesion. A biopsy is performed, and histopathological examination shows nests of basaloid cells with peripheral palisading and retraction artifacts within the dermis. Which of the following skin neoplastic diseases is most likely represented by the clinical and histopathological ndings described above? Keratoacanthoma Squamous Cell Carcinoma Malignant Melanoma Basal Cell Carcinoma Actinic Keratosis

Answer 139

Basal Cell Carcinoma Info: The clinical presentation of a pearly, translucent nodule with telangiectatic vessels and rolled borders, along with histopathological ndings of nests of basaloid cells with peripheral palisading and retraction artifacts, is characteristic of Basal Cell Carcinoma (BCC). Squamous Cell Carcinoma: Typically presents as hyperkeratotic, erythematous plaques or nodules with central ulceration. Malignant Melanoma: Usually appears as asymmetric, pigmented lesions with irregular borders and color variation. Keratoacanthoma: Presents as dome-shaped nodules with a central keratin plug and rapid growth. Actinic Keratosis: Appears as erythematous, scaly patches or plaques, often found in sun-exposed areas

Question 140

In which of the conditions below will Eikenella corrodens be responsible of the ≈ 30 % of the infections? In decubitus ulcers After a human bite After a cat bite After a dog bite Diabetic foot infection

Answer 140

After a human bite

Question 141

What will be the result if yeasts are stained with a Gram stain? It will be Gram negative stained It can not be stained with Gram, lactophenol cotton blue staining is needed visualization It will be Gram positive stained It will be Gram labile stained It can not be stained with Gram, acidfast stain is needed visualization

Answer 141

It will be Gram positive stained

Question 142

Which of the following statements dene the clinical characteristics of Erythema infectiosum (fifth disease) correctly? (Choose as many as required) It causes arthritis in young children commonly when compared to older children and adults. It is a common childhood disease caused by Human Parvovirus B19 which is transmitted via aerosolized respiratory secretions, contaminated blood, or the placenta. “Glove and sock syndrome” consisting of a purpuric eruption with painful edema and numerous small conuent petechiae at hands and feet is another manifestation of erythema infectiosum . Typical rash is in the form of reticulate macular or urticarial exanthema (lace-like) and it can wax and wane with environmental changes, emotional factors, etc for weeks to months.

Answer 142

All except the first one are correct. Info: *Arthropathy only occurs in approximately 10% of children *In older children, adolescents arthritis is more common (60% of adults) , while skin rash is less prominent and distinctive

Question 143

Which of the following statements does NOT define clinical characteristics of measles infection ? Cough , coryza and conjunctivitis are common prodromal symptoms. The rash of measles is in the form of coalescing erythematous macules and papules. Koplik spots may be seen during the prodromal phase. The typical rash begins to erupt behind the ears and in the hairline area, then spreads over the rest of the skin over a period of a few days. The eruption typically resolves following a caudal to cranial order, without desquamation.

Answer 143

Cough , coryza and conjunctivitis are common prodromal symptoms.

Question 144

A 25-year-old man presents to the emergency department with a sudden onset of red, targetshaped lesions on his palms and legs. He reports that the lesions appeared a few days after he started taking a new medication for his upper respiratory infection. On examination, there are multiple round erythematous macules, papules, vesicles, and bullae, some of which have a characteristic central clearing with surrounding rings (g1). A biopsy from one of the skin lesions shows vesicle formation and cytotoxic T cells attacking basal epithelial cells. According to your most likely diagnosis , which of the following statements are correct? (Choose as many as required) The characteristic lesion is a targetoid (target) lesion. Oral mucosa can not be involved in this disease It is a type IV hypersensitivity reaction. It is typically triggered by infections or medications. Histopathology reveals cytotoxic T cells attacking basal epithelial cells

Answer 144

All except the second statement is correct. Info: Erythema multiforme (EM) is an acute inammatory dermatosis often triggered by infections (such as herpes simplex virus) or medications. It is a type IV hypersensitivity reaction mediated by cytotoxic T cells that attack basal epithelial cells. The characteristic lesion is a targetoid (target) lesion, which appears as a central zone of necrosis surrounded by concentric rings of erythema. Histopathological examination shows vesicle formation and cytotoxic T cells targeting basal epithelial cells. Unlike chronic dermatoses like psoriasis, EM does not involve chronic plaque formation and thickened skin. Oral mucosa can also be involved in this disease.

Question 145

What is the most appropriate next step in the evaluation of an acanthosis nigricans patient? Upper and lower endoscopy Abdominal ultrasound Bone marrow biopsy Skin patch testing MRI of the brain

Answer 145

Upper and lower endoscopy Info: The patient exhibits signs of acanthosis nigricans, which, in the absence of diabetes or obesity, can be a paraneoplastic syndrome associated with gastrointestinal malignancies, particularly gastric adenocarcinoma. Therefore, an upper and lower endoscopy is warranted to investigate potential underlying malignancies. Bone marrow biopsy: Not the most appropriate next step as the primary concern is to rule out gastrointestinal malignancies associated with acanthosis nigricans. MRI of the brain: Not indicated based on the presented symptoms and ndings. Abdominal ultrasound: While useful, it does not provide the comprehensive evaluation needed to detect gastrointestinal malignancies. Skin patch testing: This is not relevant for the diagnosis of acanthosis nigricans or its associated conditions.

Question 146

A 21 year-old woman presented with a 3 weeks history of erythematous scaly macules on the body. The patient was otherwise in good health. She described the eruption as starting as a single macule and spreading over the next 2 weeks. On physical examination, in addition to a large round-oval macule with a collarette of ne scale, there were many small macules oriented with their long axes along cleavage lines resembling a pine tree. What is your most likely diagnosis in this patient? Pityriasis rosea Lichen planus Guttate psoriasis Nummular dermatitis Atopic dermatitis

Answer 146

Pityriasis rosea Info: Pityriasis rosea is an acute mild inflammatory exanthem characterized by the development of erythematous scaly macules on the trunk. It is more common in children and young adults. It begins with a solitary salmon-colored macule that heralds the eruption (herald patch), and over a few days it becomes a patch with a collarette of fine scale. Within the next 1-2 weeks, a generalized exanthem usually appears. Bilateral and symmetric macules with a collarette scale oriented with their long axes along cleavage lines resembling a pine tree are typical for pityriasis rosea.

Question 147

A 28-year-old male presents to the our out-patient clinic because he has an intensely itchy rash of 10 weeks duration. The lesions are present on and o but do not last more than 24 hours before new lesions develop. He has otherwise been healthy. The rash consists of circumscribed, raised, blanching erythematous papules and plaques, some of which have a central pallor, located on neck, arms and back. The mucous membranes, palms, and soles are spared. The rest of the examination is normal. What is the most likely diagnosis in this patient? Urticaria Contact dermatitis Psoriasis Drug eruption Seborrheic dermatitis

Answer 147

Urticaria

Question 148

After tending her children, a woman develops red facial macules. These lesions subsequently become vesicles that rupture and form honey-colored crusted erosions. What is the most likely diagnosis? Varicella Contact dermatitis Tinea faciei Impetigo Acne rosacea

Answer 148

Impetigo Impetigo is a pyoderma that is usually caused by staphylococci or streptococci. The initial lesions are vesicles, which subsequently form characteristic yellow, "honey-colored" crusts. Impetigo is a common infection of the supercial layers of the epidermis that is highly contagious. Once a lesion is present, self-inoculation to other sites is very common.

Question 149

Which of the following ndings are correct for atopic dermatitis (AD)? (Choose as many as required) Presence of personal or family history of atopy is one of the minor criteria for the diagnosis of AD Diaper area is usually spared in infants with AD Typical involvement areas are the exor areas in childhood AD AD usually starts on the cheeks and exor extremities in infancy

Answer 149

All except the last one are correct. Info: AD usually starts on the face (cheeks) cheeks or on the extensor extremities which are the places that are easy to scratch and rub as they are crawling in infancy. And, typical involvement areas are the exural areas, such as antecubital fossae and popliteal fossae, in childhood.

Question 150

Which of the following pharmaceutical system is not used to deliver agents to treat dermatological disorders? Emulsions Transdermal therapeutic system Ointment Cream

Answer 150

Transdermal therapeutic system Info: Transdermal Therapeutic Systems (TTS) or transdermal patches are special systemic drug delivery systems that are applied directly to the skin. They are not used to treat dermatological problems. The active substance is absorbed by the skin and distributed through the body via the bloodstream.

Question 151

A 35-year-old woman presents with pain, fever and swelling in her right leg. Examination reveals well-demarcated erythema and spreading streaks of lymphedema. Which of the following is the most likely diagnosis of this patient's condition? Erysipelas Necrotising fasciitis Myositis Impetigo Necrotising cellulitis

Answer 151

Erysipelas Response Feedback: This patient has clinical features of erysipelas, a type of supercial cellulitis with dermal and supercial lymphatic involvement. Erysipelas is a bacterial infection that leads to pain, edema, and welldemarcated erythema.