Dermatology 1 – Flashcards
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A mother brings her 5-year-old son to your facility presenting with several blisters on his cheek and around his nose. On examination, you note several large flaccid, thin-roofed bullae on both cheeks, minimal involvement around the nose and several outcrops of bullae on his wrists. What treatment is most appropriate? A) Bacitracin ointment B) Dicloxacillin orally C) Penicillin orally D) Mupirocin ointment E) Amoxicillin orally
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B) Dicloxacillin orally- The clinical picture is suggestive of impetigo. Most S aureuscultured from impetigo is penicillin resistant, so a penicillinase-resistant penicillin such as dicloxacillinwould be effective. Bacitracin ointment is not indicated for the treatment of impetigo. Penicillin would not be effective. Mupirocin cream would be indicated if there was only a small area infected. Amoxicillin is not effective for penicillin resistant S. aureus.
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A 40-year-old man presents with a 3-day history of right-sided chest pain. It is gradually increasing in intensity, burning in character, and like a band across his mid chest and mid back on the right side. Today he noticed a light rash in this area and out of concern visited his doctor. He has no fever, but complains of fatigue and malaise. His past medical history includes GERD, for which he is on lansoprazole daily, asthma, for which he uses albuterol inhaler daily, and knee arthritis, for which he uses over-the-counter low dose naproxen as needed. Family history is noncontributory. On examination, he is afebrile with a BP of 128/80 mm Hg and a pulse of 70 BPM. Oral exam is unremarkable, lungs are clear, and abdomen benign. On the right side of his chest, there are small vesicles with surrounding erythema in the mid region. The skin is excruciatingly tender in a dermatomal fashion along the affected area. What is the most likely diagnosis? A) NSAID-induced GERD symptoms B) Herpes zoster infection C) Costochondritis D) Candida intertrigo E) Herpes simplex infection
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B) Herpes Zoster infection- the dermatomal distribution of burning pain associated with a vesicular rash indicates herpes zoster infection, which is a frequent condition seen in the office. All patients who have had chicken pox earlier are susceptible to get this from reactivation of the same virus hiding in the neural cells.
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A 25-year-old Asian woman presents to the hospital complaining of an itchy lesion on the back of her neck for the past 1 year. She is a medical student, and she says the itchiness increases when she is studying for exams. She also reports that her roommate says that she even scratches it when she is sleeping. On examination, you note a scaly, well-circumscribed lichenified plaque on her posterior nuchal region. What is the most likely diagnosis? A) Asteatotic eczema B) Stasis dermatitis C) Contact dermatitis D) Lichen simplex chronicus E) Lichen planus
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D) Lichen simplex chronicus- Lichen simplex chronicus consists of a well-circumscribed scaly plaque with lichenification and hyperpigmentation due to chronic scratching or rubbing which can also occur during sleep. It commonly involves the occiput, back of the neck, arms, dorsum of the feet, and ankles. Management includes the use of topical or intralesional injection of glucocorticoids, oral antihistamines as well as breaking the itch-scratch cycle.
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A 23-year-old woman came to the outpatient clinic complaining of sunburn. She said that she used a water resistant sunscreen as directed by her physician, but still she got burned. On further discussion, she was asked how she applied it, and she said she applied a considerable amount on all her exposed body parts 20 minutes before sun exposure, then bathed in the sea and sat on the shore for 4 hours. What is the most likely cause of her sunburn? A) She needs a higher SPF sunscreen B) She needs to increase the amount of applied sunscreen C) She needs to apply the sunscreen more evenly D) She needs to reapply the sunscreen at least every 2 hours E) The sea water washed off the sunscreen
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D) She needs to reapply the sunscreen at least every 2 hours
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A 28-year-old man presents with a 1-week history of having an itchy, scaly rash on his elbows. When he scratches it really hard, scales come off and the rash bleeds. Your examination reveals the elbows are affected bilaterally; the knees are also affected. The lesions appear as whitish scales on an erythematous base that is irregular and well demarcated. The antecubial fossae and popliteal fossae are unaffected. What is an appropriate treatment? A)Topical fluorinated glucocorticoids B) Mineral oil C) Topical pimecrolimus D) Topical metronidazole E) Aluminum chloride hexahydrate
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A) Topical fluorinated glucocorticoids- The clinical picture is suggestive of psoriasis. Since the lesions are limited to the extremities, treatment includes topical fluorinated glucocorticoids. The appropriate treatment is soaking the areas in water, removing the scales, applying glucocorticoids to wet skin, and covering the area with plastic wrap overnight.
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A 4-year-old boy presents with headache, anorexia, dull abdominal pain, and skin lesions. About 3 weeks ago, the mother noticed several small red bumps on his feet that had changed into blisters and crusts and spread to his legs and lower abdomen. The child says that "bumps" only itch and hurt a little bit. His past medical and family history are non-contributory. Nobody in the surroundings is sick, and nobody has similar problems. His immunizations are up to date. On examination, you find a pale boy with periorbital edema; he is in mild distress. He has multiple discrete yellowish-brown crusted lesions that are 0.5-1 cm in diameter and have an erythematous base. Some lesions are fragile vesicles, some are pustular with honey colored discharge, and some are crusted. Regional lymph nodes are swollen. The rest of the exam is within normal limits. What diagnostic step should be taken next? A) Urinalysis B) Biopsy of the skin C) Complete blood count D) Peripheral smear E) Rapid antigen detection test
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A) Urinalysis- Your patient has probably impetigo, which is the most common superficial bacterial skin infection in children; it is often caused by S.aureus, S.pyogenes, or both. In a child 2 - 6 years old, headache, anorexia, a dull back, abdominal pain, and edema 3 weeks after pyoderma is suggestive of acute glomerulonephritis. It is actually an acute nephritic syndrome in which inflammation of the glomerulus is secondary to an immunologic mechanism. It is caused by group A Beta hemolytic Streptococcus. Children also have hypertension, proteinuria, hematuria, and RBC casts in urine. Therefore, urinalysis is the most important diagnostic step.
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A 26-year-old man is brought to the emergency department by ambulance for second-degree burns to his right arm, anterior surface of his right leg, and his anterior trunk, sparing his genital area. Which of the following represents a reasonable estimation of the extent of his burns? A) 18% B) 36% C) 45% D) 44% E) 35%
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B) 36%- 9% for his right arm, 9% for the anterior surface of his right leg, 9% for his anterior upper torso, and 9% for his anterior lower torso, for a total of 36%
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An 11-year-old male is seen for a patch of itchy skin on his fore head. He had just returned from a vacation in Florida where he visited with friends who have several pets. His mother states that he has not been sick lately. The lesion appeared over night one week ago and has been growing slowly since then. The lesion is ½-dollar size, annular with sharp margins, and lightly scaly. KOH examination of scale shows hyphae. Refer to the image. What is the most likely diagnosis? A) Pityriasis rosea B) Scabies C) Seborrheic dermatitis D) Nummular eczema E) Tinea faciei
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E) Tinea faciei- Tinea faciei (corporis) is a fungal skin infection that can be caused by Microsporum, Trichophyton, or Epidermophyton. .Some of the organism makes affected skin fluoresce bright bluish-green under a Wood's lamp. On non-hair-bearing skin, tinea can have the typical annular ("ringworm") appearance or present as deep inflammatory nodules or granulomas. Fungus-infected pets can be the source of infection, especially in tinea faciei. Tinea faciei is treated with topical antifungals like imidazole, triazolo, haloprogin, tolnaftate, and ciclopirox olamine. If nails of hair-bearing areas are involved, systemic therapy with griseofulvin is necessary.
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A 17-year-old female goes to an urgent care center with complaints of a painful, swollen, red left forearm. She states that her symptoms began about 2 days ago following a bug bite and presented as a small red area. She recalls a bug bite in the area but no other injuries to the arm. She denies fever, chill, nausea, or vomiting but states that she has had increased pain and swelling over the last day or so. She has no significant past medical history and had been well until this recent illness. Physical examination reveals a well developed, well nourished patient in mild distress. Her exam is significant for an erythematous, warm, shiny plaque area measuring approximately 5 cm in diameter with a well-defined border on her left forearm. Vital signs are as follows: blood pressure 110/72 mmHg, pulse 78 beats per minute, temperature 99.6F, respiratory rate 14 breaths/min. The most common cause of this condition in the United States is A) Staphylococcus aureus B) Pseudomonas aeruginosa C) Clostridium perfringens D) Streptococcus pyogenes E) Streptococcus pneumoniae
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D) Streptococcus pyogenes- The condition is erysipelas, and its most common cause in the U.S. is Streptococcus pyogenes, a group A beta hemolytic strep organism. Erysipelas may affect children or adults and was once known as St. Anthony's Fire due to its appearance.
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A patient presents with a rash that involves the hands and wrists. On examination of the rash, you note flat-topped, sharply defined purple papules measuring 1 to 10 mm in size. You apply mineral oil and examine the lesions with a hand lens and note white lines within the lesions. You also notice that he has nail dystrophy and a white lacy pattern on his buccal mucosa. What would be an appropriate treatment? A) Topical glucocorticoids with intralesional triamcinolone B) Topical ketoconazole plus coal tar C) Topical pimecrolimus with hydroxyzine D) PUVA photochemotherapy only E) Topical glucocorticoids only
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A) Topical glucocorticoids with intralesional triamcinolone- The clinical picture is suggestive of lichen planus. Treatment includes topical glucocorticoids for cutaneous lesions. Add triamcinolone for mucosal lesions.
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An 8-year-old male presents to your office, complaining of a pruritic rash. The rash began as a few small, red bumps on the arms a few weeks ago, but has now spread across his body, and the itching has gotten worse. The itching is worse at night, and he is having problems sleeping because of the pruritus. His mother and brother now have similar eruptions. Examination of his skin reveals diffuse excoriation, with scattered vesicles and erythematous papules. In a few areas, the lesions appear linear. What should you prescribe? A) Topical steroids for Rhus dermatitis B) Oral steroids for Rhus dermatitis C) Oral antibiotics for impetigo D) Topical antifungal for tinea infection E) Topical scabicide for scabies
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E) Topical scabicide for scabies
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A 21-year-old man presents with itchy skin changes. He works as a lifeguard. About a week ago, he noticed red, round patch on his belly that spread to his trunk and legs. He denies recent infections, allergies, and illnesses; he does not take any medications, and he admits that he occasionally smokes marijuana. The rest of his personal and family history is noncontributing. On examination, you find round and annular, scaly, pruritic, papulosquamous changes on his torso and legs. There are no changes on his mucosa, and the rest of physical examination is within normal limits. In order to make a diagnosis, what should be your next step? A) Potassium hydroxide preparation B) Skin biopsy C) Venereal Disease Research Laboratory test D) Intradermal prick test E) Tzanck smear of the lesion
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A) Potassium hydroxide preparation- The clinical picture of skin changes and the patient's occupational history suggest tinea corporis. You should confirm your diagnosis with potassium hydroxide preparation of skin scrapings that will demonstrate the presence of fungal hyphae.
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A 35-year-old female comes to your office for a rash that has been getting worse over the past few months. Since it is on her face, it is embarrassing and she wants treatment for it. You have known this patient for a few years and she has no major medical problems except for mild hypertension for which she is on atenolol. She is a non-smoker but she consumes two glasses of wine everyday with her evening meal. She has no history of allergies. She uses makeup on her face but only occasionally; she denies using any over the counter creams to treat the rash. On exam, rosacea is present on the cheeks, the nose and the forehead. The neck and upper back are spared. Which of the following constitutes the initial step in the management of rosacea? A) She should discontinue atenolol B) She should avoid alcohol consumption C) She should have an ANA test done D) She should undergo isotretinoin therapy E) She should undergo pulsed dye laser therapy
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B) She should avoid alcohol consumption- The initial therapeutic step is avoidance of exacerbating factors for rosacea; in this case alcohol consumption. Common exacerbating/ triggering factors include hot or cold temperatures, alcohol, beverages, spicy food, wind, exercise and emotional stress. The treatment for mild rosacea includes topical treatments with metronidazole gel, clindamycin lotion, or a sulfacetamide/sulfur lotion
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A 22-year-old man presents with painful blisters at the right angle of his mouth for the past day. He has had tingling and burning sensations at the site for 3-4 days. He has no significant past history. On examination, his temperature is 99.5°F, but other vitals are normal. Multiple small vesicles are seen at the right angle of the mouth. There are no such lesions elsewhere. What is the treatment of choice for this condition? A) Ribavirin B) Zidovudine C) Acyclovir D) Interferon E) Amantadine
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C) Acyclovir- From the history and examination, it appears that the client has a herpes simplex infection (herpes labialis), and the treatment of choice is acyclovir for this condition. It is usually caused by herpes simplex virus (HSV) 1. Other lesions caused by this virus include pharyngotonsillitis and genital herpes.
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A 20-year-old white college student comes in with a complaint of hypopigmented patches which appeared gradually during the summer. He reports no history of unprotected sex. Scaling on scratching is present, but no pruritus. On examination he has hypopigmented patches over the face and chest but no vesicles or pustules. What is the most likely condition? A) Leprosy B) Tinea versicolor C) Tinea cruris D) Vitiligo E) Tinea capitis
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B) Tinea versicolor- mild superficial infection of the skin. It is characterized by multiple, usually asymptomatic, scaly patches varying from white to brown in color. They are most frequently seen on chest, neck, and abdomen and occasionally on the face. The condition is usually seen in young adults. Diagnosis of this condition is made on the basis of clinical findings. On microscopic examination of scraping from the lesion under a woods lamp, yeast and short plump golden hyphae are seen. Treatment of T. versicolor involves topical therapy with selenium sulfide, imidazoles, and zinc pyrithione.
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A 10-year-old boy presents after his mother noticed a rash on his scalp that has been present for 1 week. Her son had been scratching his head often and she noticed areas where his hair appears to have fallen out. She treated it with over the counter preparations, but it has not improved. The boy is active and otherwise healthy. The rash appears as erythematous, circular, scaly patches. There are areas where the hairs have become brittle and broken off. A scraping of one of the patches was placed in potassium hydroxide solution and showed hyphae. What is the most likely diagnosis of this patient's condition? A) Vitiligo B) Tinea versicolor C) Psoriasis D) Tinea capitis E) Seborrheic dermatitis
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D) Tinea capitis- The lesions usually begin as round and often reddened papules on the scalp. Over the course of a few days, the papules become scaly and they coalesce to form a ring-like shape. The hair often breaks off in the affected area, making the infection more noticeable. There can be itching, swelling, and occasionally a purulent discharge.
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A 40-year-old man presents with a 3-day history of having a wound on his left hand. The wound is red, warm, painful, and swollen over the right thenar eminence; several small puncture marks are present. A culture of the wound reveals Pasteurella canis. What is this man's occupation? A) Bouncer in a nightclub B) Dog catcher for the city C) Farmer D) Fisherman E) Scuba diver/seashell salesman
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B) Dog catcher for the city-Pasteurella canis is the most common organism recovered from dog bites. A dog catcher might well have an infection with this organism after a dog bite. Pasteurella multocida is common in cat bites. A bouncer in a nightclub might come into contact with human teeth in the course of his work ("clenched-fist injury"). He would be more likely to have an infection with Eikenella corrodens or Streptococcus spp-common pathogens in human bites. A farmer might have a skin infection with any number of fungi living in soil such as Blastomyces dermatitidis. Fishermen are commonly wounded by spines or teeth of fish. Mycobacterium marinum can occasionally be cultured from these wounds. Painful cellulitis in a scuba diver who comes into contact with salt water, seashells, coral, clams, oysters, etc. might be caused by any number of Gram-negative organisms, including Vibrio vulnificus.
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A 2-year-old boy is brought to your office by his mother after she noticed that he often scratches his head. She also notes patchy loss of hair on the top of his head. She has been sending him to a daycare center for the past 2 months. On examination, you note patchy loss of hair in the right parietal area and another area of "black dot" alopecia about 4 cm lateral to it. The area of hair loss shows a grayish ring-shaped scaly lesion. A KOH preparation demonstrates branching hyphae and spores. The best treatment for this condition is: A) Topical fluconazole B) Oral prednisolone C) Topical ciclopirox D) Topical hydrocortisone E) Oral griseofulvin
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E) Oral griseofulvin- The correct diagnosis is tinea capitis, best treated with oral griseofulvin.
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A 67-year-old woman presents to a dermatologist with painful vesicles on an erythematous base. He diagnoses her with herpes zoster. In what type of configuration would her lesions be expected to be found? A) Serpiginous grouping B) Dermatomal grouping C) Linear grouping D) Retiform grouping E) Iris grouping (bull's eye)
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B) Dermatomal grouping-Herpes zoster lesions follow dermatomal patterns.
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A self-conscious 42-year-old woman schedules an appointment to see a dermatologist because she has skin plaques on her knees and elbows and pitting to her fingernails as well. At her appointment, the dermatologist notices that she has silvery flakes of epithelium on the skin lesions. What is the correct term for these flakes? A) Scale B) Blister C) Erosion D) Papule E) Scar
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A) Scale-Scales are flakes of epithelium. Scales can vary in thickness and consistency; that is, they can be dry or oily. Scales can occur in a specific area either of the body or all over the body. Psoriasis is an example of a condition in which scales can be seen.
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An 87-year-old female in a nursing home has dementia, malnutrition, and incontinence and is bed bound. The visiting physician notes a deep pressure injury on the sacrum with visible bone in the base of the wound. The wound is also draining large amounts of purulent material. Which of the following provides the best solution for daily wound cleansing? A) Hydrogen peroxide B) Iodine surgical scrub (diluted 1:10) C) Ivory soap (diluted 1:10) D) Normal saline E) Acetate solution
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D) Normal saline- for irrigation of pressure ulcer
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A 50-year-old Hispanic man presents with an oval skin growth on his forehead. He noticed the growth 2 weeks ago, and it has gradually grew in size and is now bleeding spontaneously. He has been a farmer for the past 30 years and often works in the fields. He gives a history of cocaine abuse in his 20s. He is a diabetic and hypertensive on treatment with Metformin and Atenolol, respectively. On exam, there is an erythematous papule about 3x3 cm in size, which bleeds on probing. His BMI is 30. Biopsy of the lesion reveals squamous cell carcinoma (SCC) of the skin. What is a risk factor for SCC in this man? A) Cocaine abuse B) His ethnicity C) His gender D) Obesity E) Atenolol
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C) His gender-Squamous cell carcinoma (SCC) of the skin is more common in men than women in the ratio 2:1 due to greater cumulative sun exposure during their lifetime.
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A 7-year-old boy presents with a rash on both legs. The rash started several days ago while he was summer camping. He tells you that some of his friends had similar changes on their skin, but they were not as extensive as he has now. His past medical history is significant for atopic dermatitis that was never put under complete control. On examination, you find several vesicles on his ankles, a few honey brown crusted lesions with an erythematous bases, and several other lesions in various stages of crusting and oozing. Some of them itch. The rest of the examination, including local lymph nodes status, is normal. What is the most likely diagnosis? A) Scabies B) Dyshidrosis C) Atopic dermatitis D) Varicella-zoster E) Impetigo
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E) Impetigo- Your patient most probably has impetigo, a superficial skin infection typically caused by Streptococcus pyogenes group A. It is associated with hot weather; it can be transmitted from person to person under the condition of poor hygiene, and it can be secondary to his pre-existing atopic dermatitis (superinfection).
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A 35-year-old woman presents with intensely pruritic, red papules over the anterior wrists. On close examination, the papules are shiny with flat surface and occasional central umbilication. A red plaque is seen along the scratch line at the anterior forearm. What is the best initial therapy for the patient? A) Oral corticosteroid or immunosuppressant B) Anti-retroviral agents C) UVA phototherapy D) Topical corticosteroid E) Gluten-free diet and dapsone
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D) Topical corticosteroid- Explanation Lichen planus is characterized with flat-topped, pruritic, red-to-violaceous papules or plaques, mostly on the wrists. Lesions are polygonal with occasional central umbilication.
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A 2-year-old female presents with her parents to the pediatric dermatologist after being diagnosed with atopic dermatitis (eczema) by her pediatrician about 6-8 months ago. What treatment plan would most likely be recommended for long term management of her disease? A) Frequent lubrication with emollient cream and twice daily hydrocortisone 1% B) Bathing twice daily followed by twice daily hydrocortisone 1% C) Bathing twice daily followed by twice daily Betamethasone dipropionate 0.05% D) Frequent lubrication with emollient cream and daily Betamethasone dipropionate 0.05% E) Frequent lubrication with emollient cream only
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A)- Emollients should be applied at least twice a day. 0.5-1% topical corticosteroids should also be applied twice daily.
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An 18-year-old man presents with a rash. He states that the rash began a few weeks ago and has worsened over the past 2 weeks. He denies fever, chills, nausea, vomiting, or weight loss. He also denies recent travel or illness. He has no significant past medical history and is otherwise very healthy. Physical exam reveals a well-developed well-nourished man in no acute distress. He has areas of hyperpigmentation on his back and chest. A scraping taken from the back area showed orange fluorescence under UV light. What is the most likely cause of this patient's symptoms? A) Vitiligo B) Tinea versicolor C) Psoriasis D) Tinea unguium E) Seborrheic dermatitis
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B) Tinea versicolor- Tinea versicolor is a common fungal infection. It is common in adults and adolescents. The most commonly affected areas include the chest, back, and shoulders. Occasionally, it can be found on the face. It causes the affected skin to change color and become either lighter or darker. It was believed to be caused by a yeast called Malassezia furfur, but recent evidence points to Malassezia globosa as the cause. Diagnosis can be confirmed by using an ultraviolet light (Wood's light). The affected areas usually fluoresce and appear to be orange in color. If they do not fluoresce, the skin will appear darker than normal skin. A scraping of the skin will show the presence of hyphae in a characteristic "spaghetti and meatballs" appearance when exposed to potassium hydroxide.
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A 20-year-old African American woman presents to the hospital complaining of itchy rashes on her hands. She reports that they have been persistent for the past 2 years. On examination you note deep seated vesicles with scaling on her palms bilaterally. What is the most likely diagnosis? A) Atopic dermatitis B) Seborrhoic dermatitis C) Hand eczema D) Nummular dermatitis E) Pompholyx
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E) Pompholyx- This patient most probably has Pompholyx. It is characterized by scaling and deep-seated vesicles on the palms, fingers, and soles, which are pruritic. There may also be erythema and scaling.
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You see a 35-year-old African-American male for a painless tumor on his left hand. He also complains about malaise, fever, headache, and nausea. He works at a textile mill, which processes imported goat hair. He reports having cut himself about a week earlier at work. The lesion is a red-brown papule with peripheral edema, vesiculation, and induration. It shows an ulcer and formation of Black eschar in the center. What is the most likely diagnosis? A) Cutaneus anthrax B) Molluscum contagiosum C) Furuncle D) Melanoma E) Impetigo
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A) Cutaneus anthrax- caused by bacillus anthracis. The gram-positive, encapsulated, facultatively anaerobic rod is transmitted to humans by contact with infected animals and their products. It is also known as woolsorter's disease. The incubation period varies from 12 hours to 5 days.
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A 55-year-old man presents with lesions on the top of his head. He says that he noticed them about 6 months ago and did not think much about them until he noticed more of them appearing. On physical examination of the scalp, you note slight balding and multiple lesions scattered on the scalp that appear to be < 1 cm in size. The lesions are yellow-brown, dry, and scaly. Upon palpatation, the lesions have a rough, coarse texture, and they are tender. What is your initial diagnosis? A) Actinic keratosis B) Squamous cell carcinoma C) Solar lentigo D) Dermatofibroma E) Seborrheic keratosis
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A) Actinic keratosis- The clinical picture is suggestive of actinic keratosis. Actinic keratosis are single or multiple, discrete, dry, rough, adherent scaly lesions that occur on the habitually sun-exposed skin of adults. They have a rough type texture to them, like sandpaper, and they are usually described as "better felt than seen".
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A 27-year-old female comes to your clinic complaining of painful, itchy blisters on her private parts. She is G0/Ab0/P0, has a regular monthly cycle (29/5), menarche at 13, and has had a steady partner for 2 years. She does not use any method of birth control, including condoms. She states that both her partner and she are monogamous and he does not have any symptoms. Two days earlier, she had been feeling sick. She was taking OTC aspirin, but still has an elevated temperature of 37.5°C. Upon examination you palpate enlarged lymph nodes in the inguinal area and see multiple vesicles on her labia and perineum, some ruptured and some crusted over. There is no vaginal discharge and the rest of the pelvic exam is inconspicuous. What is the proper treatment for this condition? A) Penicillin B) Acyclovir C) Fluconazole D) Cefotetan E) Metronidazole F) Doxycycline
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B) Acyclovir- The symptoms described above are typical for genital herpes, caused by the herpes simplex virus. There is no cure for herpes infections but oral acyclovir, an antiviral drug, can reduce the number of recurrences.
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A 15-year-old male presents with a complaint of red, itchy, small blisters on his feet and ankles. This began early in the summer while attending band camp. He denies taking medication. On clinical exam, there are red papules with some dry scales. The area affected is limited to the foot and ankle area. What is the most likely diagnosis? A) Contact dermatitis B) Atopic dermatitis C) Nummular eczema D) Lichen simplex E) Erythema multiforme
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A) Contact dermatitis- common inflammation due to external agents that can appear anywhere on the body. The lesions can be papules, blisters, and pustules and appear red, scaly, and dry. Treatment includes a detailed history to remove the causative agent, antihistamines, cold compresses, and or topical/systemic steroids.
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An 8-year-old girl is referred to you by her pediatrician for hair loss for 3 months. She has been in good health since birth except for usual minor childhood illnesses such as colds and ear infections. The mother states that 3 months ago she noted small bald areas developing on the child's scalp when she brushed the child's hair. The child denies any pain or itching of the scalp, and she denies pulling at her hair. There have been no other symptoms. She has not taken any medications and has no known allergies. On exam, you find three round silver dollar sized areas of complete alopecia. The scalp is normal. The most likely diagnosis is A) Toxic alopecia B) Alopecia areata C) Tinea capitis D) Traction alopecia E) Trichotillomania
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B) Alopecia areata- Alopecia areata is characterized by hair loss in round or oval patches on the scalp. The skin within the plaques of hair loss is normal. Alopecia areata occurs in 1% of the population; 60% of patients are less than 20 years old. It is associated with atopy and autoimmune diseases. The course of alopecia areata is unpredictable, but may resolve spontaneously in 6 to 12 months. Occasionally, high potency topical steroid preparations are prescribed.
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A 50-year-old woman has had a facial rash and a 10-year history of reddening of her face that comes and goes. On physical exam, you note erythema, telangiectasia, red papules, and tiny pustules bilateral on both cheeks. What is the most likely diagnosis? A) Perioral dermatitis B) Rosacea C) Seborrheic dermatitis D) Atopic dermatitis E) Lichen simplex
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B) Rosacea- Rosacea is a chronic inflammatory condition of the facial pilosebaceous units. Peak incident occurs between the ages of 40 and 50 years
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A 59-year-old, fair skinned caucasian woman presents with a lesion on her eyelid that has been growing slowly for the past 6 months. She reports that she has been an avid gardener most of her life. On examination, you find a nontender nodule with a pearly border on her right lower eyelid. What is the most likely diagnosis? A) Basal cell carcinoma B) Squamous cell carcinoma C) Malignant melanoma D) Kaposi's sarcoma E) Paget's disease
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A) Basal cell carcinoma- Basal cell carcinomas (BCC) arises from epidermal basal layer cells. Patients can present with a shiny, pearly nodule (Noduloulcerative BCC), some of which have more melanin (Pigmented BCC), or may present with erythematous, scaling plaques (Superficial BCC), or with a solitary, flat, yellowish plaque (Morpheaform BCC). BCC are slow growing, locally invasive tumors that rarely metastasize. Patients with squamous cell carcinomas (SCC) may present with a red papule or crusted plaque on the lips, ears, or hands.
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A 35-year-old woman notices a change in the appearance of a mole on her neck. Physical examination reveals that the lesion is an irregular, nodular, superficial mass with a variegated appearance. Biopsy demonstrates a primary malignant tumor. What factor is most predictive of the patient's long term prognosis? A) Circumference of lesion B) Darkness of lesion C) Degree of color variation D) Depth of lesion E) Sharpness of border between lesion and adjacent skin
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D) Depth of lesion- The lesion is a malignant melanoma. Melanomas can develop either de novo or in an existing mole. Sunlight exposure is a significant risk factor and fair-skinned persons are at increased risk of developing melanoma. The most significant factor for long term prognosis is the depth of the lesion, since the superficial dermis lies about 1 mm under the skin surface, and penetration to this depth is associated with a much higher incidence of metastasis than is seen with a more superficial location.
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A 24-year-old patient presents to your clinic with a new rash. She said she has never had this before and is concerned. You ask about symptoms and the only thing she states is that it mildly itches. On physical examination, you note scattered multiple lesions and sharply marginated plaques with central clearing that produce annular configurations that appears only on the arms, neck, and trunk. Which of the following may denote the etiologic cause of this disorder? A) The patient is on a new medication B) This patient had a chemical exposure C) The patient works with animals D) The patient has a history of allergies E) The patient is having a bacterial skin infection
answer
C) The patient works with animals- The clinical picture is suggestive of Tinea corporis. Individuals whose occupation is working with animals can contract this condition.
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A 16-year-old boy attended the outpatient clinic complaining of joint pain and sudden fever. Upon examination, the patient had numerous inflammatory nodules on the trunk with ulcers with overhanging borders. Hips and knees were affected. The patient was feverish. What is your diagnosis? A) Bacterial infection of skin B) Rosacea C) Folliculitis D) Acne fulminans E) Acne vulgaris
answer
D) Acne fulminans- Acne fulminans is characterized by sudden onset of severe and often ulcerating acne with fever and polyarthritis with failure to respond to antibacterial therapy. It is common in young males.
question
During an annual physical exam, your patient states that although she does not currently have an outbreak, she has had 7 outbreaks of genital herpes this year. She asks you how she can prevent future outbreaks. As per CDC recommendations, what action will you take? A) Place her on suppressive therapy B) Teach her how to douche C) Encourage her to avoid sexual contact during outbreaks D) Have the patient use a sitz bath to relieve pain of the vesicles E) Apply Abreva (Docosonol) topical ointment to the vesicles
answer
A) Place her on suppressive therapy- If patient is having a recurrent herpes outbreak (>6 outbreaks a year), placing a patient on suppressive therapy decreases recurrence by 70-80%.
question
A 21-year-old female presents to the office with a complaint of "painful bumps on my shins". The patient stated they appeared when she "got the flu last week". She has been using acetaminophen for the discomfort and to manage her flu symptoms. No other medications have been taken. On clinical exam of the anterior aspect of the patient's legs, the nodules appear symmetrical, red, shiny, and are 3cm in diameter. Palpation elicits pain. What is the most likely diagnosis? A) Urticaria B) Erythema multiforme C) Erythema Ab Igne D) Erythema nodosa E) Nummular eczema
answer
D) Erythema nodosa- Erythema nodosa is an acute inflammatory condition characterized by painful nodules on the anterior aspect of the legs. It is often symptomatic of a bacterial, viral, or fungal disease or drug eruption. This occurs most often in women and between the ages of 20-30 years. Clinical features include acute fever, malaise, and joint pain. Lesions are nodular, painful, red, and shiny. The symptoms last 2 weeks and heal without scarring.
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The nurse taking care of a 76-year-old woman at a nursing home notices an ulcer on the left lateral malleolus. The woman is mostly confined to bed due to severe disabling bilateral hip osteoarthritis. She has been a diabetic for the past 10 years, is on insulin, and has been recently diagnosed with depression. Examination reveals a 2x3 cm ulcer over the left lateral malleolus. There is full-thickness loss of tissue with exposure of subcutaneous fat. There is a large amount of slough in the ulcer, but there is no undermining. Sensations are intact in all dermatomes of the lower extremities. Dorsalis pedis, popliteal, and femoral arteries are bilaterally palpable. Examination of the back and lower limbs reveals another similar ulcer on the left greater trochanter of the femur. What is the most likely diagnosis? A) Venous ulcer B) Neuropathic ulcer C) Decubitus ulcer D) Ischemic ulcer E) Actinomycotic ulcer
answer
C) Decubitus ulcer- A decubitus ulcer, or pressure sore/ulcer, is a localized injury resulting from continuous pressure on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface. These ulcers most commonly occur on the hip and buttocks, but may also be seen on the heels and lateral malleoli. More than 70% ulcers occur over the age of 65 years. Several risk factors exist, including prolonged immobility, diabetes, poor nutrition, chronic renal, cardiac, or lung disease, and immunosuppression.
question
A 24-year-old patient presents to your clinic with a new rash. She said she has never had this before and is concerned. You ask about symptoms and the only thing she states is that it mildly itches. On physical examination, you note scattered multiple lesions and sharply marginated plaques with central clearing that produce annular configurations that appears only on the arms, neck, and trunk. After confirming that your patient has been working with animals, you suspect a tinea corporis infection. What would be the appropriate treatment? A) Place wet cloth on lesions for 10 minutes, remove loose tissue and then apply topical steroids B) Coal tar solution BID for 2 weeks C) Wet dressings with clothes soaked in Burow's solution changed every 2 to 3 hours D) Topical clotrimazole applied BID for 4 weeks, one more week after lesions have cleared and at least 3 cm beyond margin E) PUVA photochemotherapy
answer
D) - appropriate treatment
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A 36-year-old patient comes to your clinic complaining of a foot rash. He states he has had it for a few weeks, and it usually begins to itch after he takes off his socks. You examine his foot and note maceration, peeling, and fissuring of the toe webs. Which of the following choices is an available treatment for this patient? A) No treatment necessary B) Selenium sulfide BID C) Wash with soap and water TID D) Burow's wet dressing E) Coal tar
answer
D) Burow's wet dressing- appropriate treatment
question
A 3-year-old female presents with lesions on the flexural aspect of her arms. She is taking no medications. Her mother states symptoms appeared within this week when they were traveling to the mountains for a winter trip. On clinical exam, erythematous, papular lesions are present with weeping and scaling. What is the most likely diagnosis? A) Contact dermatitis B) Atopic dermatitis C) Nummular eczema D) Lichen simplex E) Erythema multiforme
answer
A) Contact dermatitis- Contact dermatitis is a common inflammation due to external agents that can appear anywhere on the body. The lesions can be papules, blisters, and pustules and appear red, scaly, and dry. Treatment includes a detailed history to remove the causative agent, antihistamines, cold compresses, and or topical/systemic steroids.
question
A 32-year-old man with a past medical history of allergic rhinitis and asthma that is well-controlled complains of recurrent pruritis associated with an erythematous rash in the flexural areas of his elbows and knees. The lesions seem to become worse when he scratches the lesions and when he is under stress. He denies any recent insect bites, travel, fever, chills, new clothing, or detergent use. Physical examination reveals rough-appearing erythematous plaques in the bilateral antecubital and popliteal fossae, with areas of excoriations within the lesions. What intervention is most appropriate at this time? A) Triamcinolone 0.1% applied to the lesions once or twice daily B) Cephalexin 500 mg by mouth every 12 hours C) Acyclovir 200 mg by mouth 5 times per day D) Tacrolimus ointment 0.03% applied to the lesions twice daily E)Prednisone 40 mg by mouth daily tapered over 2-4 weeks
answer
A) Triamcinolone 0.1% applied to the lesions once or twice daily- The dermatologic lesions described in this patient, along with his coexisting past medical history, are most indicative of an eczematous eruption. Corticosteroids should be applied sparingly to the dermatitis once or twice daily and rubbed in well. In general, one should begin with triamcinolone 0.1% or a stronger corticosteroid and then taper to hydrocortisone or another slightly stronger mild corticosteroid. Systemic corticosteroids are indicated only for severe acute exacerbations.
question
A 32-year-old man presents with symptoms of a skin rash. He has had the rash on his left arm for about a month and has tried only over-the-counter hydrocortisone cream without change. He denies previous skin lesions and states that this one is asymptomatic. The physician assistant (PA) who sees the patient immediately tells him that he has tinea corporis. How should the lesions be described in his office visit note? A) Sharply defined annular papules with central clearing B) Well-marginated, erythematous half-moon-shaped plaques C) Polycyclic hypopigmented macules with fine scaling D) Umbilicated white papules formed in groups E) Erosions covered by honey-colored crusts
answer
A) Sharply defined annular papules with central clearing
question
A 13-year-old boy presents for a school physical. He has been healthy since birth except for mild, recurrent upper respiratory infections. He has gained 25 lbs since his last check-up 1 year ago. On physical exam, the only abnormal finding is hyperpigmented, velvety plaques on the back of his neck and in both axillae. What is this finding is most often associated with in children? A) Addison disease B) Diabetes mellitus C) Acromegaly D) Stein-Leventhal syndrome E) Obesity
answer
E) Obesity- The skin findings described are typical for acanthosis nigricans. It is found in approximately 7% of children and is almost always associated with obesity. Often the term pseudoacanthosis nigricans is used to describe the lesions in obese children.
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A 61-year-old woman presents with a 3-week history of breakouts on her face. She presented with a similar issue 6 months earlier, but she did not receive treatment for it. Physical examination reveals erythema and dilated vessels on the cheeks. What would be an appropriate treatment? A) Oral Erythromycin B) Topical Isotretinoin C) Topical Metronidazole cream D) Oral sulfamethoxazole and trimethoprim E) Topical steroids
answer
C) Topical Metronidazole cream- This patient is presenting with rosacea. In its mildest form, erythema and dilated vessels are seen on the cheeks. The initial management of rosacea is topical metronidazole gel or cream twice daily.
question
An 83-year-old female is bedridden in a nursing home. She develops a lesion, which goes below the surface of the tissue. It is like a crater within her skin. There is a loss of the epidermis and dermis. Inflammation accompanies the lesion. What is the skin lesion called? A) Crust B) Tumor C) Macule D) Pustule E) Ulcer
answer
E) Ulcer
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A 75-year-old woman presents with dryness and itchiness of her legs for the past 2 weeks. She reports that it has been recurrent for the past 2 winters. On examination, you note pretibial erythematous fine cracks. What is the most likely diagnosis of her skin condition? A) Asteatotic eczema B) Stasis dermatitis C) Contact dermatitis D) Lichen simplex chronicus E) Lichen planus
answer
A) Asteatotic eczema- characterized by fine cracks, which may be erythematous, usually on the pretibial surfaces of elderly people during winter. They may also be pruritic. Management includes application of topical emollients and avoidance of irritants.
question
A surgeon performs an exploratory laparotomy, producing a large incision in the patient's abdomen. Poor blood supply to what area is most likely to cause problems during the healing process? A) Adipose tissue B) Aponeuroses C) Loose connective tissue D) Muscle E) Skin
answer
A) Adipose tissue- Surgeons worry about their obese patients more than their underweight patients because a thick layer of relatively poorly vascularized subcutaneous fatty tissue is both mechanically unstable (it holds stitches poorly) and heals very slowly. These patients have a frequent rate of dehiscence (tearing open of the incisional site) with subsequent difficult-to-control infection (access by antibiotics, leukocytes, and serum antibodies are all hampered by the poor blood supply).
question
A 20-year-old Caucasian female student is seen in an outpatient clinic for a 2-day history of complaints of painful urination, fever, and myalgia. The patient denies sneezing, cough, diarrhea, nausea, and vomiting. She is sexually active and admits to having had 3 partners within the last month. She is not aware of any symptoms in these men. The patient takes oral contraceptives, and her partners have not been using condoms. The physical examination is unremarkable except the genitalia area. There is localized inguinal lymphadenopathy and clusters of fluid-filled blisters on her introitus. There is no vaginal or urethral discharge, and the cervix does not show any lesions. Temperature: 38.8° C, RR: 115/75, HR: 85/min. What is the appropriate treatment? A) Foscarnet 40mg/kg i.v once daily B) Valacyclovir 1g every 12 hours for 7-10 days C) Valacyclovir 500mg every 12 hours for 5 days D) Topical cidofovir gel 1% applied twice daily for 10 days E) Famciclovir 125mg every 12 hours for 5 days
answer
B) Valacyclovir 1g every 12 hours for 7-10 days- The patient most likely suffers from a primary episode of genital herpes. Valacyclovir (Valtrex) and famciclovir (Famvir), as well as acyclovir (Zovirax), have been approved for treatment of acute episodes and suppressive therapy of genital herpes infections. All 3 drugs lessen subclinical viral shedding and reduce the frequency and severity of reoccurring eruptions. However, there is a difference in the amount of drug needed for sufficient treatment
question
A 23-year-old female with non-insulin dependent diabetes presents with a chief complaint that the "sore on the bottom of my foot doesn't heal and gets my socks wet". The patient states the "sore" presented gradually and has slowly worsened. The patient's past medical history (PMH) is negative. Physical exam of the right foot shows a 1cm, partial thickness ulcer present on the plantar aspect of the 5th MTPJ. The borders are well defined with white hyperkeratosis and clear serous drainage. There is no pain upon palpation. Which is the most likely type of ulcer? A) Hypertensive B) Neurotrophic C) Venous insufficiency D) Vasospastic E) Hematologic
answer
B) Neuropathic- Neurotrophic ulcers occur on the weight-bearing area of the foot. The depth varies from superficial to deep. The size varies and pain is absent because of the loss of sensation to the lower extremity.
question
A 23-year-old woman comes to the office for a gynecologic examination. This is her first visit and she has no complaints. She tells you that she has not had a Pap smear in several years. Her menarche was at 12 years and she has had regular cycles since then. She has had several sexual partners in the past, but has been with her current partner in a monogamous relationship for one year. She reports that she had a chlamydial infection that was treated several years ago, but she denies a history of other sexually transmitted diseases. She has never been pregnant. On physical examination her cervix appears friable with a slight area of ulceration. There are several perineal and vaginal lesions, which appear as small cauliflower-like projections. The results of the Pap smear, which return in 1 week, show a low-grade squamous intraepithelial lesion (mild dysplasia, CIN I). The factor in this patient's case most closely correlated with the abnormal finding on the Pap test is A) Condyloma acuminata B) Condyloma lata C) Early age at menarche D) History of chlamydia E) Nulliparity
answer
A) Condyloma acuminata- Condyloma acuminata are soft, fleshy warts that are caused by the HPV
question
A 57-year-old man presents for a routine checkup; he is concerned about a lesion on his head. He appears healthy and has a rustic, tanned complexion. The patient has been a 1-pack a day smoker for more than 30 years, and he consumes alcohol on a daily basis. You notice that he has a rather crusted, rough, yellow-brown solitary lesion on the middle forehead at the hairline. You question him about his use of sunblock. He replies that he does not use any type of SPF protection. Additionally, he informs you that he has had major sunburns throughout life, and he spends the weekends on his sailboat when possible. What would be an appropriate treatment for this patient? A) Coal tar B) No treatment indicated C) Cryosurgery D) Topical steroids E) Mupirocin ointment
answer
C) Cryosurgery- This patient presents with actinic keratosis. The appropriate treatment for actinic keratosis is cryosurgery. Application of liquid nitrogen is a rapid and effective method of eradication.
question
A 40-year-old woman presents with itchy lesions on her left ankle for the past 6 months. On examination, you note that her left leg is erythematous with scaly patches and an ulcer over the medial malleolus. You also note that she also has bilateral varicose veins. What is the most likely diagnosis? A) Asteatotic eczema B) Stasis dermatitis C) Contact dermatitis D) Lichen simplex chronicus E) Lichen planus
answer
B) Statis dermatitis- haracterized by erythematous, pruritic scales with oozing patches usually over the medial aspect of the ankles. Hyperpigmentation and stasis ulcers may also be present. It develops on the lower limbs due to chronic venous incompetence. Management includes using topical glucocorticoids and emollients as well as avoiding irritants. Patients should also be encouraged to wear compression stockings and elevate the affected limb as much as possible.
question
A 32-year-old woman is brought to the emergency room with sudden onset of fever, headache, sore throat, profuse watery diarrhea, vomiting, and lethargy, which started in the morning. On physical examination, she is slightly confused, her temperature is 39° C (103° F), her blood pressure is 100/50mmHg and she has diffuse sunburn like a erythematous rash. When the emergency doctor is trying to find out if she is pregnant, she mentions that her period started 2 days ago. Which of the following is the most likely diagnosis? A) Scarlet fever B) Rocky Mountain spotted fever C) Meningococcemia D) Toxic shock syndrome E) Food poisoning
answer
D) Toxic shock syndrome- This is a typical case presentation of TSS. The patient is a young woman, menstruating and the disease has a sudden abrupt onset with a rapid deterioration. TSS is caused by Toxic shock syndrome toxin-1 (TSST-1) produced by Staphylococcus aureus. TSST-1 is a pyrogenic exotoxin, which causes fever, multiple organ dysfunction, rash, hypotension, syncope, and shock. TSS can be seen in menstruating women that use tampons, individuals with wound infections, or patients with nasal packing to stop bleeding from the nose.
question
A 44-year-old man with a 10-year history of psoriasis presents for a follow-up appointment. He is currently being managed with calcipotriene (Dovonex) cream and ultraviolet light therapy. In addition to the integumentary system, what other body system needs to be evaluated during your history and physical examination of this patient? A) Musculoskeletal B) Gastrointestinal C) Neurologic D) Genitourinary E) Pulmonary
answer
A) Musculoskeletal- About 5 - 10% of patients with psoriasis develop an associated psoriatic arthritis. These cases are most often found in patients with fingernail involvement. Psoriatic arthritis can present in 1 of 3 ways: (1) disease limited to the spine (psoriatic spondylitis); (2) asymmetric inflammatory arthritis involving the distal and proximal interphalangeal joints, and occasionally the knees, hips, ankles, and wrists; or (3) a seronegative rheumatoid arthritis-like disease. A large percentage of the patients with the 3rd form go on to develop a severe destructive arthritis
question
A 15-year-old male presents to the office with his mother with a complaint of constant itching and burning on his arms and thighs for 2 weeks. His mother admits to giving him acetaminophen without relief. The patient is taking no other medications. On clinical exam, there are multiple 2-cm wheals with a few small papules on his thighs and forearms. They are red and slightly raised. What is the diagnosis? A) Urticaria B) Erythema multiforme C) Erythema Ab Igne D) Erythema nodosa E) Nummular eczema
answer
A) Urticaria- Urticaria is chronic or acute and is characterized by wheals and papules. Itching and prickling sensations are constant. Both sexes are affected equally and it's often seen in childhood or teen years. The presenting areas are the arms, legs, thighs, and waist. The most common cause is an allergy to medications, foods, or physical agents. The symptoms usually disappear within 6 months (acute) or can last longer (chronic).
question
A 30-year-old woman and her 10-year-old son present with a vesicular outbreak on the skin (arms, legs, and face). There is no history of insect bites/infestation, exposure to chemicals, or use of medications. Vital signs are normal for both patients. The vesicles are described as itchy and red. The appearance of the condition seemed to coincide with a heat wave that's been impacting the area for the past 4 days. Vesicle material was obtained for Gram stain and culture. The Gram stain was positive for the presence of Gram-positive cocci in clusters and moderate white blood cells (refer to the image). Antibiotics were prescribed along with instructions to take care of the infected skin areas. The culture was significant for 4+ Gram-positive aerobic cocci that were beta-hemolytic on blood agar media, catalase-positive, and coagulase-positive. What is the diagnosis? A) Impetigo B) Folliculitis C) Carbuncle D) Furuncle E) Ecthyma
answer
A) Impetigo- a vesicular superficial infection of the skin that later becomes crusted. The predominant etiological agents that cause impetigo are Streptococcus pyogenes and Staphylococcus aureus. Impetigo infections are most common during the summer when it is hot and humid.
question
A 73-year-old male presents with a complaint that his toenails are thick, hard to cut, discolored, and dystrophic. A KOH culture confirmed a fungal infection. What is the most likely diagnosis? A) Onychocryptosis B) Onychauxis C) Onychogryphosis D) Onycholysis E) Onychomycosis
answer
E) Onychomycosis- The term used for ingrown nail is onychocryptosis. Onychauxis is used to define a thickened, overgrown nail. A hooked or incurvated nail is defined by onychogryphosis. Onycholysis is the loosening or separation of all or part of the nail from the nail bed. Onychomycosis is a disease of the nail caused by a fungal infection.
question
A 9-year-old boy has 11 irregularly shaped, 2 X 3 cm, hyperpigmented lesions on the skin of his trunk. He has freckles in his axilla. He recently developed several cutaneous and subcutaneous masses and some visual disturbances. The MOST likely diagnosis is: A) Tuberous sclerosis B) McCune-Albright syndrome C) Encephalotrigeminal angiomatosis (Sturge-Weber syndrome) D) Spider angiomas E) Neurofibromatosis
answer
E) Neurofibromatosis- The irregularly shaped, 2 X 3 cm, hyperpigmented lesions on his skin are café au lait spots. He has freckles in his axilla. The cutaneous and subcutaneous masses are neurofibromas. They frequently do not develop until late in childhood or adolescence. This patient has also developed a glioma on the optic nerve, resulting in visual disturbances.
question
A 7-month old child presents to the emergency room exhibiting toxic epidermal necrolysis and large, flaccid bullae that are forming and rupturing under the epidermis, causing desquamation in the diaper area. This spectrum of disease describes a condition usually caused by: A) Toxin producing Staphylococcus aureus. B) Invasive Escherichia coli. C) Prophage infected Corynebacterium diphtheriae. D) Flesh-eating Streptococcus pyogenes. E) Dermal infection with Clostridium perfringens.
answer
A) Toxin producing Staphylococcus aureus- Scalded skin syndrome consists of three separate entities: toxic epidermal necrolysis, scarlatiniform erythema, and bullous impetigo, which appear to be a spectrum of disease. All three conditions are attributed to the action of the exfoliatin toxin of S. aureus
question
An 18-month-old infant presents with a 1-day history of fever that is currently 101° F rectally. You symptomatically treat the patient and ask the mother to return if the condition worsens. 2 days later, the mother returns because the infant has developed small red spots that became bumps and are now blisters. The mother also noted that the infant was scratching the lesions. The majority of these lesions are on the thorax. Each vesicle resides on its own erythematous base. What is the most likely diagnosis? A) Shingles B) Ramsey-Hunt syndrome C) Erythema infectiosum D) Primary Herpes simplex E) Varicella
answer
E) Varicella- The clinical picture is suggestive of a varicella infection. Signs and symptoms include fever and malaise, which are mild in children. The rash usually begins on the face and trunk and then spreads to the extremities. The lesions are pruritic. The lesions appear as maculopapular and then will become vesicles, then pustular, and then will crust over. All forms of the lesions can be seen at the same time. A classic description of primary varicella lesions are "dewdrop on a rose pedal," indicating that each vesicle resides on an erythematous base.
question
A 59-year-old Caucasian woman presents to the hospital complaining of a 1-month history of a lesion on her face. She reports a tendency to sunburn since her youth, as she grew up in Australia. She is not taking any medications and exercises regularly. On examination, you note that there is a brown, irregularly shaped macule 3 cm in diameter on her right cheek. It has darker brown spots scattered irregularly within it. What is the most likely diagnosis? A) Basal cell carcinoma B) Squamous cell carcinoma C) Malignant melanoma D) Kaposi's sarcoma E) Paget's disease
answer
C) Malignant melanoma- Malignant melanomas arise from melanocytes. The main types are: Superficial spreading melanomas, which present as irregular tan plaques with blue-black spots or nodules on any site. Nodular melanomas develop anywhere on the body as dark papules or plaques that grow rapidly. Lentigo maligna melanomas develop on sun-exposed areas such as the face as brown macules with darker spots scattered on its surface. Acral lentiginous melanomas are the most common form in blacks and develop on the palms, sole, subungual skin, and mucous membranes.
question
Which of the following is the typical configuration of lesions found in erythema multiforme? A) Serpiginous grouping B) Dermatomal grouping C) Linear grouping D) Retiform grouping E) Iris grouping
answer
E) Iris grouping- Lymphangitis and poison ivy are typically in linear groups, though poison ivy can also be irregular. Erythema ab igne, livedo reticularis, and x-ray dermatitis have a retiform, or network-like, grouping. Herpes zoster lesions follow dermatomal patterns. Erythema multiforme typically appears in an iris grouping (bull's eye), though it can also be annular (circular). The nodular lesions of late syphilis form a serpiginous grouping.
question
Which of the following is the typical presentation of nonbullous impetigo? A) vesicular honey-colored crusted superficial lesions B) edematous, red, indurated spreading lesion C) inflammatory hot lesion with diffuse erythema D) vesicopustular lesion that follows a dermatome
answer
A) vesicular honey-colored crusted superficial lesions
question
A 34-year-old female presents with an outbreak of grouped vesicular lesions on erythematous bases along a vermillion border. What patient education information would be important in minimizing the risk of recurrent outbreaks? A) prophylatic topical antibiotics B) avoid use of lipstick C) increase diary intake D) routine use of sunblock
answer
D) Regular use of sunblock can aid in reducing outbreaks of herpes simplex since sun exposure can trigger outbreaks.
question
Ten days after a visit to a strawberry farm, a patient presents with a 9-cm rash in her left axilla. The rash has been slowly expanding since its initial appearance and is characterized by a bright red outer border with partial central clearing. In addition, she complains of headache, fever, chills, malaise, and fatigue. What is the most likely diagnosis? A) measles B) Rocky Mountain spotted fever C) Lyme disease D) dermatophytosis
answer
C) Lyme disease
question
A generally healthy prepubescent 10-year-old female presents with concerns of recent nonpruritic hair loss on her scalp. She denies trauma, recent illness, fever or endocrine disorders. What is the most likely physical feature of her hair loss? A) patchy areas of hair loss with fine scale and no inflammation B) several 1- to 4-cm patches of hair loss with smooth skin and short stubs of new hair C) 20% to 50% of hair loss with large numbers of hairs with white bulbs after gently tugging D) triangular frontal-temporal recession of hair
answer
B) describes alopecia areata
question
A 23-year-old male prostitute presents seeking treatment for recurrence of a nonpainfull perianal rash. He gives a history of a similiar rash that was treated with multiple "freezign" treatments and a prescription for a gel that he used a couple of times. What is expected on physical exam? A) discrete papules, 2-5mm in diamete, slightly umbilicated, flesh colored, and dome shaped B) discrete, small (<4 mm), skin-colored to dark brown pedunculated lesions C) small groups of vesicles that erode, crust and heal in 10 to 14 days D) numerous pale pink, discrete lesion with narrow to wide projections on a broad base with a smooth or velvety, moist surface
answer
D) is the correct answer. The history of freezing and gels supports the diagnosis of condyloma acuminata.
