Dermatology Blueprint

Dermatology Blueprint
Questions, Answers, and Explanations

Question 1 1. Which of the following organism are responsible for causing the disease pictured below in the photograph? A. Coxsackie Virus B. Parvovirus C. Herpes Zoster D. Ebstein Barr Virus

Answer 1 1. Choice B is the correct answer. This child has Fifth's Disease or Erythema Infectiosum. This caused by the Parvovirus. It is characterized by a slapped cheek appearance. It often has a prodrome of fever, coryza, malaise, headache and sore throat. Coxsackie is the virus that causes hand foot and mouth disease. Herpes zoster is the virus that causes chicken pox.

Question 2 2. Which of the following is the best treatment for the condition listed below in the photograph? A. Griseofulvin B. Nizoral Shampoo C. Nystatin D. Lamisil

Answer 2 2. Choice A is the correct answer. Tinea Capitis is treated most effectively orally. Topical preparations such as nizoral shampoo or nystatin are not effective. Lamisil is used for onychomycosis.

Question 3 3. Your patient is a 34 year old female that presents with first and second degree burns to her entire head and neck, entire right arm and her anterior torso. She weighs 110 kilograms. What should be the patient's IV fluid rate for the first 8 hours? A mL/hr B mL/hr C mL/hr D. No IV Fluids are necessary

Answer 3 3. Choice A is the correct answer. The patient has 36% TBSA burns. She weighs 110 kg. So this applied to the Parkland Formula you get 4 x 110 kg x 36 = 15, 840 mL for the first 24 hours. Divide this by 2 and this gives you 7920 mL for the first 8 hours. When you divide 7920/8 you get the correct answer of 990 mL/hr.

Question 4 4. Which of the following skin disorders has less than 10% of epidermal detachment? A. Toxic Epidermal Necrolysis B. Steven Johnson Syndrome C. Scalded Skin Syndrome D. Pityriasis Rosea

Answer 4 4. Choice B is the correct answer. Steven Johnson Syndrome has less than 10% of epidermal detachment. Toxic Epidermal Necrolysis has greater than 30% of epidermal detachment. Pityriasis Rosea does not involve epidermal detachment. Scalded Skin Syndrome is caused by certain strains of staphylococcus infections. Toxins are produced that cause damage to the skin.

Question 5 5. Which of the following skin disorders has an association with asthma and allergic rhinitis? A. Contact Dermatitis B. Psoriasis C. Erythema Multiforme D. Atopic Dermatitis

Answer 5 5. Choice D is the correct answer. Atopic Dermatitis does have an association with allergic rhinitis and asthma. It is a Type I Hypersensitivity reaction. Lesions are typically present over months to years. Treated with low potency steroid creams and wet dressings. UVA and UVB can be helpful. Contact dermatitis, Psoriasis, and Erythema Multiforme do not have an association with asthma and allergic rhinitis.

Question 6 6. Which of the following are not considered part of the accepted treatment of acneiform vulgaris? A. Cleocin T B. Isotretinoin C. Birth Control Pills D. Cyclosporine

Answer 6 6. Choice D is the correct answer. Acne Vulgaris results from as changed in the keratinization pattern in the hair follicle. The secretion is blocked. Lesions are a result of interaction between bacteria and hormones. Cleocin T helps kill this bacteria. Isotretinoin inhibits sebaceous gland function and keratinization. The estrogen in the birth control pills help interfere with interaction between the bacteria and the hormones. The immunosuppressive cyclosporin has no role in treatment of acne.

Question 7 7. Your patient is a 51 year old male that presents with a lesion in the picture listed below. He indicates he has not seen a doctor in over 30 years. Which of the following is the best test to order (other than biopsy) to help look for a potential etiology of this disease? A. VDRL B. Western Blot Test C. Hepatitis C Surface Antigen D. Culture patient for HSV

Answer 7 7. Choice B is the correct answer. This patient has HIV until proven otherwise. This picture is of a patient with Kaposi Sarcoma. VDRL is a test for syphilis and this has not been implicated in relation to Kaposi Sarcoma. Hepatitis C and HSV have not been implicated in this disorder either.

Question 8 8. Which of the following skin cancers has the worse prognosis? A. Lentigo Maligna Melanoma B. Superficial Spreading Melanoma C. Basal Cell Carcinoma D. Nodular Melanoma

Answer 8 8. Choice D is the correct answer. Nodular Melanoma has the worse prognosis because it grows deep. It makes up about 16% of melanomas. Lentigo Maligna Melanoma has the best prognosis of the melanomas because it grown radially and does not extend deep. The most common type of melanoma is superficial spreading melanoma and this makes up 70% of all melanomas. Basal Cell Carcinoma is the slowest growing skin cancer and in general has the best prognosis.

Question 9 9. Your patient is an 18 year old female recently started on bactrim for a UTI. She comes in with the rash depicted below and shortness of breath and diffuse wheezing. She is starting having trouble swallowing. You have ordered albuterol aerosol, solumedrol, and zantac IV. Her vitals are as follow: BP 75/43, Pulse-112, O2 Sat 91% on 100% NRB. Which of the following is the most important therapeutic intervention? A. Diphenhydramine IV B. Epinephrine C. Ipratropium Bromide Aerosol D. Zantac Drip

Answer 9 9. Choice B is the correct answer. This patient is hypotensive and exhibiting signs of her airway swelling. This is one of the major indications for epinephrine. The alpha antagonist epinephrine will help reduce the swelling and increase the patient's blood pressure. These cytokines that cause this are released from the mast cells. Diphenhydramine is indicated but will not help the patient immediately. There is no evidence to suggest that ipratropium or a Zantac drip will show benefited patient outcomes.

Question 10 10. Which organism has been implicated in the rash shown below in the photograph? A. Coxsackie Virus B. Poxvirus C. Parvovirus D. HSV

Answer 10 10. Choice B is the correct answer. Molluscum Contagiosum is caused by the poxvirus. Cocksackie Virus causes hand, foot and mouth disease. Fifth's disease is caused by Parvovirus. HSV is the virus the causes herpes simplex

Question 11 11. Which of the following is not an etiology of Erythema Multiforme? A. Connective Tissue Disease B. HSV C. Idiopathic D. Oral Contraceptives

Answer 11 11. Choice D is the correct answer. Most commonly erythema multiforme is idiopathic. The most common infection causing erythema multiforme is HSV. Connective tissue disease, pregnancy, malignancy, physical agents, and medications (PCN, Sulfonamides, Dilantin and Allopurinol) are all cause of Erythema Multiforme.

Question 12 12. Your patient is a 54 year old female that presents with the rash in the photograph below. All of the following are recognized treatments for this condition except: A. Acyclovir B. Prednisone C. Tetracycline D. Azathioprine

Answer 12 12. Choice A is the correct answer. This is Bullous Pemphigoid. It comes from an interaction of the autoantibody with bullous pemphigoid antigen on the surface of keratinocytes. The bullous lesions come from molecules released from mast cells. Prednisone and azathioprine have been shown to be helpful with this mechanism. Tetracycline has also been shown to be helpful but the mechanism is unknown. Acyclovir is not an accepted treatment regarding this.

Question 13 13. Your patient is a 45 year old female with the rash in the photograph below. She notes it is exacerbated by being in hot environments. All of the following are accepted treatments for this condition except: A. Metronidazole Gel B. Topical Erythromycin C. Minocycline D. Triamcinolone Cream

Answer 13 13. Choice D is the correct answer. This patient has Rosacea. Metronidazole Gel, Topical Erythromycin, and Minocycline are accepted treatments. Triamcinolone cream is best used for steroid response dermatoses.

Question 14 14. Which of the following organisms are responsible for the rash listed below: A. Pediculus Humanus B. Phthirus Pubis C. Sarcoptes Scabiei D. Borrelia burgdorferi

Answer 14 14. Choice C is the correct answer. Sarcoptes Scabiei is the organism that causes scabies. Pediculus Humanus is the parasite that causes Pediculus Capitis (Scalp Lice). Phthirus Pubis is the parasite that causes pubic lice. Borrelia burgdorferi is the bacteria that causes lyme disease.

Question 15 15. Which of the following is not true regarding Basal Cell Carcinoma? A. 80 percent involve the head and neck B. Basal Cell Nevus Syndrome or Gorlin's Syndrome patients may have hundreds of basal cell lesions throughout their body C. Erivedge is an oral chemotherapy agent approved for use D. Topical treatments can be used but for lesions that are above the neck

Answer 15 15. D is the correct answer. Topical treatments can be used on lesions that are below the neck and not above. These lesions tend to be less aggressive. Eighty percent of the lesions are on the head and neck the most sun exposed areas. BCNS or Gorlin syndrome is a genetic disorder where there is hundreds of basal cell lesions on the body.

Question 16 16. What is the best treatment for the condition depicted below in the photograph? A. Lamisil cream B. Lamisil orally C. Prednisone D. Lotrisone

Answer 16 16. Choice B is the correct answer. Onychomycosis responds best to systemic treatment with oral antifungal agents such as lamisil. Topical treatments such as lamisil cream or combination antifungal and steroid creams such as lotrisone are not effective. Prednisone dose not help in the treatment of Prednisone.

Question 17 17. Which condition listed below has Koplik Spots?
A. Rubella B. Measles C. Molluscum Contagiosum D. Roseola

Answer 17 17. Choice B is the correct answer. Measles is a condition that has Koplik spots. Rubella has erythematous macules that appear initially on the face and work their way inferiorly. It can have posterior auricular and posterior cervical lymphadenopathy. Molluscum has raised pigmented papules.

Question 18 18. Your patient is a 58 year old that presents with the rash listed below in the photograph. The rash is painful and started yesterday. Which of the following is the best therapeutic intervention? A. Acyclovir Orally B. Acyclovir Topical C. Prednisone D. Triamcinolone

Answer 18 18. Choice A is the correct answer. This is rash is painful and vesicular which is consistent with shingles. This is an infection that travels along the dermatome and requires systemic treatment. Acyclovir topically can be used but will not be as effective. Prednisone and triamcinolone will not be effective.

Question 19 19. Which organism is known to cause the rash listed below: A. Poxvirus B. Parvovirus C. Herpes Simplex Virus D. Human Papillomavirus

Answer 19 19. Choice D is the correct answer. Verruca Plana (Flat Warts) and Verruca Plantaris (Plantar Warts) are caused by the Human Papilloma Virus. They can be treated with salicylic acid, lactic acid topically, cryosurgery, or electrosurgery. Herpes Simplex does not cause warts. Parvovirus causes Fifth's Disease. Poxvirus causes Molluscum.

Question 20 20. Which of the following is not a difference between full thickness and partial thickness burns? A. Full thickness burns are wet and partial thickness burns are dry B. Deep full thickness burns (3rd degree or greater) will not have any sensory input C. Full thickness burns are dry and partial thickness burns are wet D. Full thickness burns have evidence of penetration to the deeper tissues

Answer 20 20. Choice A is the correct answer. Full thickness burns will have a dry appearance and partial thickness burns will not. Partial thickness burns will be wet and maintain their sensory innervation. Full thickness burns will have evidence of penetration to the burns to the deeper tissues such as muscle and bone exposed.

Question 21 21. Your patient is a 83 year old female that presents to the ER with the skin ulcer listed below. Please choose the most correct stage of the ulcer listed below: A. Stage I B. Stage II C. Stage III D. Stage IV

Answer 21 21. Choice B is the correct answer. Stage I ulcers just have non blanchable erythema with no skin breakdown. Stage II ulcers have some loss of the dermis with an open wound and have a red area in the center. There is no slough. Stage III is full thickness. There maybe subcutaneous tissue visible but there is no muscle, bone, or tendons visible. Stage IV ulcers are full thickness ulcers with bone, muscle, and tendons exposed.

Question 22 22. Which of the following is not true of vitiligo?
A. It is characterized by the development of white macules and the complete presence of melanocytes B. Management includes sunscreens and cosmetic cover up C. Repigmentation can be attempted with topical steroids, UVA and systemic UVA D. It can be associated with thyroid disease

Answer 22 22. Choice A is the correct answer. Vitiligo is actually characterized by the complete absence of melanocytes. This is what causes the white macules. Management is with topical steroids, UVA and systemic UVA. It is associated with thyroid disease and other medical conditions.

Question 23 23. Which of the following medical conditions have not been implicated in the skin condition listed below in the photograph? A. Hyperinsulinemia B. Obesity C. Malignancy D. Sunburn

Answer 23 23. Choice D is the correct answer. Acanthosis Nigricans, a diffuse thickening and hyperpigmented area of skin is caused by hyperinsulinemia, obesity, endocrine disorders, and malignancy. Usually on the axillae and bodily folds. It is caused by an overactive secretion of pituitary peptide or non specific growth effect of hyperinsulinemia

Question 24 24. What is the best management option for the skin disorder depicted in the photograph listed below? A. Acyclovir B. Bactrim C. Triamcinolone cream D. Acyclovir cream

Answer 24 24. Choice C is the correct answer. Dyshidrotic eczema in acute phase can have a vesicular appearance. It differs from herpes in that it is not on an erythematous base and typically herpetic ulcers are more pink. Acyclovir and acyclovir cream would be appropriate for herpetic infections. Bactrim would be appropriate for bacterial infections especially staph infections. Triamcinolone would be most appropriate in this case.

Question 25 25. Which of the following are not one of the 5 P's of Lichen Planus? A. Pain B. Purple C. Pruritic D. Polygonal

Answer 25 25. Choice A is the correct answer. The five P's of Lichen Planus are: planar, polygonal, pruritic, purple, and papular

Question 26 26. Which of the following statements regarding Pityriasis Rosea is incorrect? A. Possibility of being caused by the Herpes 7 Virus B. May last for 6-12 weeks C. Exanthem phase precedes herald patch D. Tends to occur in a "Christmas Tree" pattern

Answer 26 26. Choice C is incorrect. The herald patch precedes the exanthem of pityriasis rosea and occurs in a Christmas Tree pattern. It can last for up to 6-12 weeks. The etiology is actually is unknown but it is possible caused by the Herpes 7 virus.

Question 27 27. What is the best management option of the lesion listed below in the photograph? A. Bactroban Ointment B. Bactrim C. Observation D. Excision

Answer 27 27. Choice D is the correct answer. Actinic Keratosis are managed best when they can be removed. 5 FU topically can be used. Bactrim or Bactroban ointment would be appropriate if this lesion was infected. Actinic Keratosis tend to occur in sun exposed areas

Question 28 28. What is the best management option for the skin condition depicted below? A. Permethrin B. Griseofulvin C. Nizoral Shampoo D. Prednisone

Answer 28 28. Choice A is the correct answer. Permethrin is the treatment of choice for scalp lice. Griseofulvin and Nizoral are appropriate to be used together for Tinea Capitis. Prednisone would not be helpful in either condition

Question 29 29. Which of the following is not true regarding spider bites? A. Black Widow Spiders and Brown Recluse Spiders tend to be the most harmful of all spiders B. The Black Widow Spider venom has a neurotoxin that produces reactions at the side with systemic reactions C. These bites are best treated with Amoxicillin D. Systemic reactions include fever, headache, arthralgias, nausea, and vomiting.

Answer 29 29. Choice C is the correct answer. These bites are best treated with bactrim or doxycycline. There is a high incidence of MRSA associated with these spider bites. The remainder of the answers are true.

Question 30 30. Which of the following is the best treatment option for the skin condition depicted below in the photograph? A. Zithromax IV B. Prednisone C. TED Hose D. Zosyn IV

Answer 30 30. Choice D is the correct answer. Zosyn is the treatment of choice for circumferential cellulitis such as this. Zithromax has poor skin penetration. Prednisone would be helpful if this was a contact dermatitis. TED hose will help with any edema but will not fix the cellulitis

Question 31 31. Your patient is a 45 year old female that presents with this painless freely movable lesion depicted in the photograph below. Which of the following is the best management option? A. Incision and Drainage B. Observation C. Biopsy D. Place of cephalexin for 10 days

Answer 31 31. Choice B is the correct answer. This presentation is typical for lipomas. They are typically round, painless, and freely movable. These typically are not removed unless they bother the patient. Biopsy would be necessary if the diagnosis. Lipomas typically occur on the neck, trunk, and extremities. Cephalexin would be appropriate if there was a question of a soft tissue infection but this lesion is painless so this is not likely.

Question 32 32. Which of the following is not true regarding Melasma?
A. It is an acquired dark brown or light brown hyperpigmentation that occurs in the exposed areas to sunlight B. The mainstay of treatment is UVA and UVB C. The mainstay of treatment is SPF sunblock D. It is associated with pregnancy, oral contraceptives, or can be idiopathic

Answer 32 32. Choice B is the correct answer. The hyperpigmentation is exacerbated by exposed areas of light. The patients with Melasma need to have high SPF sunblock over sun exposed areas. It is associated with pregnancy, oral contraceptives, or can be idiopathic.

Question 33 33. What is the best management option for the disease depicted the the photograph below? A. Keflex 500 mg QID B. Bactrim DS one PO BID C. Warm Compresses D. Incision and Drainage

Answer 33 33. Choice D is the correct answer. Incision and drainage is needed for definitive treatment of a pilonidal abscess, Keflex, bactrim, and warm compresses each would help but not definitively treat pilonidal abscess.

Question 34 34. How long does urticaria have to persist before it is considered chronic urticaria? A. Greater than 15 days B. Greater than 30 days C. Greater than 60 days D. Greater than 90 days

Answer 34 34. Choice B is the correct answer. Acute urticaria persists for less than 30 days. Chronic urticaria lasts greater than 30 days.

Question 35 35. Which of the following is the best management option for the condition depicted below in the photograph? A. Hydrocortisone Cream B. Prednisone tapered for 2 weeks C. Acyclovir D. Benadryl

Answer 35 35. Choice B is the correct answer. This case of contact dermatitis is too severe for topical treatment with hydrocortisone. In addition, it is low potency steroid. Benadryl would help help with the symptoms but not do much for the underlying disorder. Shingles is not in the differential because this lesion crosses the midline so acyclovir is not indicated.

Question 36 36. Which of the following is not a treatment for the skin condition depicted below? A. Combination of crude tar in zinc oxide B. Topical Steroids C. Intra-lesion injections with triamcinolone D. Lotrisone Cream

Answer 36 36. Choice D is the correct answer. Lichen Simplex Chronicus is a predilection of the skin that responds to trauma by epidermal hyperplasia. It has no fungal properties so lotrisone is not indicated. It can be treated with a combination of crude tar and zinc oxide, topical steroids, intra-lesion injections of triamcinolone, or occlusive dressings.

Question 37 37. What is the incidence of arthritis associated with psoriasis? A. 1-2% B. 5-8% C % D %

Answer 37 37. Choice B is the correct answer. Psoriatic arthritis has an incidence of about 5-8 percent.

Question 38 38. Which of the following is the best management option for the skin condition depicted below? A. Skin biopsy B. Topical Triamcinolone C. Intra-lesion injection of triamcinolone D. Removal with cautery or surgery

Answer 38 38. Choice D is the correct answer. Seborrheic keratosis are benign skin lesions that occur after the age of 30. Skin biopsy is not necessary. Topical or intra-lesion injection of triamcinolone would not be helpful. Removal is definitive treatment.

Question 39 39. Which of the following is the best management option for the skin disorder pictured in the photograph below? A. Bactroban Ointment B. Bactrim C. Prednisone D. Permethrin

Answer 39 39. Choice D is the correct answer. Lesion lesion occur between the web spaces consistent with scabies. Bactroban ointment and bactrim would be appropriate if an infection is suspected. Prednisone would be over treatment is this was suspected to be contact dermatitis. There is only a couple of lesions and this could be treated with topical steroids if it was contact dermatitis.

Question 40 40. Which of the following would be definitive treatment for the skin condition listed below? A. Skin Biopsy B. Warm soaks C. Incision and Drainage D. Topical Bactroban

Answer 40 40. Choice C is the correct answer. This is a paronychia which is an accumulation of purulent material around the nail apparatus. This needs incision and drainage for definitive treatment. Skin biopsy is not indicated. Warm soaks would help but not provide definitive treatment. Topical bactroban may help but will not provide definitive treatment. The patient after incision and drainage should be on cephalexin and bactrim or doxycycline pending cultures.

Question 41 41. Which of the following is not true regarding Condyloma Accuminatum? A. Can occur on oral or genital epithelium B. Early lesions can be visualized with 5% acetic acid C. It is caused by HSV D. Lesions more advanced have a cauliflower appearance

Answer 41 41. Choice C is the correct answer. Condyloma is caused by the the HPV not HSV. It does occur on oral or genital epithelium. Advance lesions resemble cauliflower appearance. Early lesions can be visualized with 5% acetic acid

Question 42 42. What is the organism that causes the rash depicted in the photograph below? A. Poxvirus B. Parvovirus C. HPV D. Coxsackie Virus

Answer 42 42. Choice C is the correct answer. Coxsackie virus is the causative organism in hand foot and mouth disease. Parvovirus cause Fifth's disease. HPV causes condyloma. Poxvirus cause molluscum contagiosum

Question 43 43. Which of the following is not true regarding Molluscum Contagiosum? A. It is contagious and can be transferred from skin to skin contact B. Patients with HIV can get lesions on their face C. Aldara cream can help the rash D. It is caused by a obligate parasite

Answer 43 43. Choice D is the correct answer. Molluscum is caused by the poxvirus. It is very contagious and spread by contact. It is a self limited epidermal infection that causes skin colored papules.

Question 44 44. Your patient is 14 year old that presents with the rash depicted below in the photograph. Which of the following is the best management option? A. Acyclovir B. Clindamycin C. Keflex and bactroban ointment D. Prednisone

Answer 44 44. Choice C is the correct answer. Impetigo is best treated with keflex and bactroban. This helps with strep and staph coverage both. It also will help with MRSA. Some clinicians add bactrim to this. Clindamycin is effective against strep and staph but there is some degree of resistance when treating MRSA. Prednisone and acyclovir are not indicated here.

Question 45 45. Which of the following is the best treatment for the condition depicted below in the photograph? A. Nystatin B. Diflucan C. Chlorhexidine mouthwash D. Prednisone

Answer 45 45. Choice A is the correct answer. Nystatin is the treatment of choice for thrush. Prednisone can exacerbate it or make it worse. It can also be caused by dentures, oral inhaled steroids, diabetes, or immunosuppression. It is common in infants.

Question 46 46. What is the best management option for the rash depicted below in the photograph? A. Diflucan B. Miconazole Topical C. Triamcinolone D. Prednisone

Answer 46 46. Choice B is the correct answer. Tinea corporis with an isolated lesion is best treated with Miconazole. If systemic treatment is needed, griseofulvin is indicated. This rash has a mycotic appearance and has a raised well demarcated border. This rash does not look like a steroid responsive dermatoses.

Question 47 47. What degree of burn is the depicted in the photograph below? A. First Degree Burn B. Second Degree Burn C. Third Degree Burn D. Fourth Degree Burn

Answer 47 47. Choice C is the correct answer. First degree burns included the outer layer of skin and is similar to sunburn without blisters. Second degree involves the entire epidermis and upper layers of the dermis. Third degree involves all layers of the skin and extends to subcutaneous tissue. There is no exposed muscle and bone. Fourth degree is down to the bone and muscle.

Question 48 48. Which of the following is not true regarding hidradenitis suppurativa? A. It is a disease of the apocrine gland of the axillae and the anogenital region B. Its cause is unknown C. There is keratinous plugging of the apocrine duct, dilation of the hair follicle, and severe inflammatory changes of the apocrine ducts, and the bacterial growth causes a dilated duct D. These patients rarely need surgery

Answer 48 48. Choice D is the correct answer. These patients frequently need incision and drainage and to excise recurrent fibrotic nodules and tracts. Ruptured duct gland causes extension and inflammation or infection which causes tissue destruction and then leads to ulceration, fibrosis, and sinus tract formation.

Question 49 49. Which of the following is the pathogenesis of epithelial inclusion cyst formation? A. It is formed by an infected hair B. It is formed from an infected sebaceous cyst C. Occurs secondary to traumatic implantation of the epidermis within the dermis and causes keratin within the cyst cavity D. It is from an infected apocrine gland

Answer 49 49. Choice C is the correct answer. Epithelial inclusion cysts occur secondary to implantation of the epidermis within the dermis and there is accumulation of the keratin in the cyst cavity.

Question 50 50. Which of the following is not part of the accepted treatment of the skin condition listed below? A. Prednisone B. Zantac C. Benadryl D. Protonix

Answer 50 50. Choice D is the correct answer. Steroids, H1 blockers, H2 Blockers, Albuterol (for bronchospasm) and epinephrine (for life threatening systemic symptoms) are part of the accepted treatment of urticaria.

Question 51 51. Which of the following is not seen in CREST Syndrome?
A. Sarcoidosis B. GERD C. Telangiectasia D. Raynaud's

Answer 51 51. A is the correct answer. Sarcoidosis is not a part of CREST Syndrome. CREST Syndrome is a group of disorders that include Calcinosis, Raynaud's Esophageal Motility Disorders, Sclerodactyly, and Telangiectasia. It is a form of scleroderma.

Question 52 52. Which of the following is not a cause of Erythema Multiforme? A. Herpes Simplex Virus B. Pregnancy C. Syphilis D. Penicillin

Answer 52 52. C is the correct answer. Syphilis is not a cause of Erythema Multiforme. Erythema Multiforme is a Type IV Hypersensitivity reaction that occurs in a variety of conditions and has many causes. The major causes of erythema multiforme include the following: herpes simplex virus, pregnancy, connective tissue disease, and occasionally malignancy. Some of the major drugs that can cause erythema multiforme include sulfa, penicillin, tegretol, phenytoin, valproic acid, cipro, erythromycin, minocycline and vancomycin. Erythema multiforme presents as target shaped lesions on the body.

Question 53 53. Your patient is a 34 year old female who presents with a pruritic rash below. The rash encompasses both arms and legs as well as the torso. There are other people in the house that have the same rash. Base upon the above data, what is the best therapeutic intervention? A. Prednisone B. Bactrim and Keflex C. Triamcinolone D. Permethrin Topical

Answer 53 53. The correct answer is D permethrin. These papular excoriated lesions in the web space in a linear fashion are characteristic of scabies. This patient has a rash involving almost their entire body. You notice the head and neck are not mentioned and often spared in scabies. Prednisone would be effective in contact dermatitis. These lesions are more characteristic of scabies. Bactrim and keflex would be helpful in folliculitis or bed bugs that were infected. Triamcinolone would be helpful for more localized treatment of contact dermatitis or steroid responsive dermatoses. The parasite that cause scabies is sarcoptes scabiei.

Question 54 54. Your patient is a 44 year old male who presents with the rash below. What is the best therapeutic intervention based upon your assessment? A. Triamcinolone B. Keflex C. Prednisone D. Acyclovir

Answer 54 54. The correct answer is D acyclovir. This patient has herpes zoster characterized by grouped lesions on an erythematous base in a dermatomal distribution. They occur most commonly on the trunk. They are somewhat ulcerated which is the natural progression of the disease. Triamcinolone would be appropriate for localized treatment of contact dermatitis or steroid responsive dermatoses. It would also work for psoriasis. Prednisone would be appropriate if the dermatitis was more systematically involved. Keflex would be appropriate if it was infectious or cellulitis not thought to be caused by MRSA.

Question 55 55. Your patient is a 45 year old female who presents with the rash on her face listed below. She is also complaining of diffuse arthritis as well as oral ulcers. She has also noted with any sort of sun exposure she has what she feels is a hyperactive response to her skin. Based on this information. What is your most likely diagnosis? A. Psoriasis B. Systemic Lupus Erythematosus C. Rosacea D. Nummular Eczema

Answer 55 55. The correct answer is B systemic lupus erythematosus. This clinical presentation is consistent with SLE. The fact that she has this malar (butterfly shaped) rash along with the other constellation of symptoms including arthritis, oral ulcers, as well as photosensitivity means she meets diagnostic criteria for SLE. In order for a patient to meet diagnostic criteria for SLE they have to meet 4 of 11 criteria which include: malar rash, discoid rash, photosensitivity, oral ulcers, serositis, or a positive ANA. SLE can also give you disorders of the following systems: renal, neurologic, hematologic, or immunologic systems. Rosacea can give you a similar rash on the face but there is typically not systemic symptoms. There is typically not nasolabial sparing with the rash either. You can also get arthritis with psoriasis but typically do not get oral ulcers and the rest of the systemic symptoms especially photosensitivity.

Question 56 56. Which of the following is not one of the 5 P's of Lichen Planus? A. Planar B. Purple C. Pruritic D. Polyarthritis

Answer 56 56. D is the correct answer. Polyarthritis is not one of the 5 P's of Lichen Planus. The 5 P's of Lichen Planus are planar, polygonal, pruritic, purple, and papular.

Question 57 57. Your patient is a 67 year old female hemodialysis who presents with a rash on her bilateral lower legs shown below. She also states she has noticed this getting progressively worse over the last year. Based upon the data above. Which of the following is the most likely diagnosis? A. Cellulitis B. Venous Stasis Dermatitis C. Psoriasis D. Systemic Lupus Erythematosus

Answer 57 57. The correct answer is B. Chronic Venous Stasis Dermatitis typically has that symmetrical brownish discoloration of the bilateral lower extremities from the poor venous return. They may also have some ulcers, dry skin, or loss of hair associated with it. While cellulitis can be bilateral, it is unusual and it is more of a deep red color. Psoriasis typically is seen over joints like the elbows and knees but can occur anywhere. It is usually more of a dry flaky appearance and can sometimes be white or gray. While patients with SLE can have renal dysfunction, this type of rash is not considered to be part of the diagnostic criteria.

Question 58 58. Your patient is a 45 year old female who presents with the rash below. She has also noted that the rash burns and itches at times. She also has noted pits in her fingernails develop over the last several months. She notes this rash on both of her elbows. Based upon the above data, what is the diagnosis? A. Discoid Lupus B. Contact Dermatitis C. Psoriasis D. Nummular Eczema

Answer 58 58. C is the correct answer. Psoriasis typically gives you the whitish, gray, or silver flaky plaques over areas of trauma and is often symmetrical. It typically burns or itches. Commonly we will see patients with the pits in their fingernails. Approximately 7% of the patients who have psoriasis can have arthritis associated with it. Nummular eczema and contact dermatitis typically do not have that thick of a plaque and that flaky appearance. Discoid Lupus typically affects the face, ears, and scalp but can involve any area of the body. The lesions are typically red, scaly, with a crusty appearance. The central area may look lighter in color.

Question 59 59. Your patient is a 25 year old male that presents with this diffuse rash on his trunk that he has no associated symptoms with. Based upon the picture as well as the above information, what is most likely diagnosis? A. Psoriasis B. Erythema Nodosum C. Erythema Multiforme D. Pityriasis Rosea

Answer 59 59. D is the correct answer. Pityriasis Rosea typically has a herald patch like seen in the photograph and gives a christmas tree like appearance. Patients typically will not have any associated symptoms and just notice a rash when they come in. Some of them may have some associated itching. Psoriasis does not have this appearance. It is typically scaly and is more of a thicker continuous plaque. It is seen more of areas of trauma. Erythema nodosum is usually painful nodules seen on the extensor surfaces of the body. Erythema multiforme is target shaped red lesions seen on the body.

Question 60 60. What organism is likely responsible for the rash seen on the child's face with a fever listed below? A. Coxsackie Virus B. Parvovirus B19 C. Staphylococcus D. Streptococcus

Answer 60 60. B is the correct answer. This is Fifth's Disease which is also known as Erythema Infectiosum. It is caused by the Parvovirus B19. It usually lasts for 7-10 days but can last for several weeks. Staph is responsible for some cellulitis and impetigo infection on the the face in children. Coxsackie virus causes hand foot and mouth disease. Can also cause meningitis, myocarditis, and pericarditis. Coxsackie virus also causes herpangina.

Question 61 61. Which of the following has been known to trigger outbreaks of the condition demonstrated below in the photograph below? A. Nutritional Deficiencies B. Direct trauma C. Menstrual Cycle D. Penicillin

Answer 61 61. The correct answer is D. Why the exact etiology of aphthous ulcers is not clear, there are several conditions that have been tied to triggering them. They include the following: stress, lack of sleep, mechanical trauma, deficiency of B Vitamins, iron deficiency, folic acid deficiency, certain foods like chocolate, and certain times of menstrual cycle.

Question 62 62. Which organism is the causative organism causing the painless lesions seen in the picture below? A. Treponema Pallidum B. Herpes Simplex Virus C. Coxsackie Virus D. Borrelia burgdorferi

Answer 62 62. The correct answer is A. The picture demonstrates secondary Syphilis. They are painless papules on the palms. Treponema Pallidum is the causative organism. Herpes Simplex Virus causes painful vesicles in the oral area or genitals. Coxsackie virus can cause hand foot and mouth but is painful. Borrelia Bergoderi is the causative organism for lyme disease.

Question 63 63. What is the recommended treatment for the condition depicted below in the picture? A. Griseofulvin B. Nystatin Shampoo C. Miconazole D. Mupirocin

Answer 63 63. A is the correct answer. Griseofulvin is the only effective treatment for tinea capitis. Topical treatments such as nystatin shampoo and miconazole are ineffective. Mupirocin is treatment for localized bacterial infections in particular staphylococcal.

Question 64 64. What is the recommended treatment for the condition depicted in the photograph below? A. Permethrin B. Mycelex C. Triamcinolone D. Mupirocin

Answer 64 64. B is the correct answer. Mycelex (Clotrimazole) is one most common agents used for tinea pedis. Permethrin is the treatment for scabies. Triamcinolone is a medium potency topical steroid used in treatment of contact dermatitis and steroid responsive dermatoses. Mupirocin is a topical antibacterial great against staphylococcal infections.

Question 65 65. Your patient is a 6 year old boy who present with rhinorrhea and cough. He has a low grade fever. He has this rash shown below. What is his diagnosis? A. Herpes Zoster B. Impetigo C. Tinea D. Eczema

Answer 65 65. B is the correct answer. This rash is characteristic of impetigo. It has this yellowish crusty material on the surface of a plaque. Causative organisms include staph aureus and strep pyogenes. Oral and topical antibiotic therapy should be targeted at that. Herpes zoster has more of a vesicular or ulcerated appearance and does not have a crusty surface. Tinea has more of a desquamation appearance to it and does not have the yellow crusty material. Eczema is typically a lighter more pink patchy lesion.

Question 66 66. Which of the following is not a skin manifestation of AIDS? A. Herpes Simplex B. Kaposi Sarcoma C. Molluscum Contagiosum D. Aphthous Ulcers

Answer 66 66. D is the correct answer. Aphthous ulcers have not been tied to AIDS. It is not unusual to see patients with fulminant AIDS to have herpes simplex lesions, Kaposi Sarcoma or Molluscum Contagiosum.

Question 67 67. What is the diagnosis of the skin lesion depicted below? A. Benign Nevus B. Malignant Melanoma C. Basal Cell Carcinoma D. Squamous Cell Carcinoma

Answer 67 67. B is the correct answer. The lesion is characteristic of a malignant melanoma. It has some of the key characteristics of a malignant melanoma. It has asymmetry where half over half of the lesion is not like the other. It has an irregular border. It has multiple colors within the lesion. Most importantly its diameter is bigger than a pencil eraser. A benign nevus usually has a normal variation in color and is smaller than a pencil eraser. A Basal Cell Carcinoma is a firm small raised or flat area that can be shiny or waxy. They have been known to bleed with minor injury. BCC may range from a few millimeters to several centimeters in diameter. Squamous cell carcinoma often usually look like scaly red patches, open sores or elevated growths with a central depression. These may be crusty or bleed.

Question 68 68. Your patient is a 64 year old male who presents with the rash in the picture below. Based upon the above information, what is the best management option? A. Start the patient on glucocorticoids B. Transfer the patient to a burn center C. Start the patient on 1 gram of Vancomycin IV D. Start the patient on Rocephin 1 gram IV E. Both A and B

Answer 68 68. The correct answer is both A and B. This is a severe case of pemphigus. This is an autoimmune disorder and steroids will also help with the progression. This patient is going to need wound management similar to a burn patient. Vancomycin and Rocephin would be helpful for secondary infections or if Steven Johnson Syndrome was suspected.

Question 69 69. Your patient is a 56 year old female who was started on Lisinopril 2 weeks ago. She presents to you looking like the photograph below. She is having trouble swallowing and talking also. What enzyme is this patient lacking? A. Bradykinin B. C1 Esterase C. Phosphodiesterase D. Prostaglandins

Answer 69 69. B is the correct answer. Angioedema is a common adverse reaction seen in patients who take ACE inhibitors. These patients often lack C1 esterase which we treat with fresh frozen plasma. Patients who take ACE inhibitors will have elevated bradykinin levels but that is often what causes the dry cough. Prostaglandins is helps lower blood pressure in patients who take ACE inhibitors. Phosphodiesterase has nothing to do with this mechanism.

Question 70 70. What is the diagnosis of the rash listed below in this 74 year old male? A. Vasculitis B. Systemic Lupus Erythematosus C. Drug Eruption D. Disseminated Varicella

Answer 70 70. The correct answer is C. Drug eruption usually gives that deep pink color and macules seen in patches. Vasculitis is about the same color but typically affects gravity dependent areas more and not the trunk. These lesions are not vesicular or ulcerated and do not look like varicella. This rash is not discoid or malar and is not consistent with SLE.

Question 71 71. Your patient is a 4 year old male that present with fever that has been persistent for 8 days. He has been complaining of a sore throat, and erythematous conjunctiva, and peeling in his hands and feet. He does have some lymphadenopathy. On physical exam you had noted reddened mucus membranes in the mouth with cracked lips. There is a photograph below of the patient. Based upon the above information, what is the most likely diagnosis? A. Kawasaki's Disease B. Fifth's Disease. C. Eczema D. Scarlatina

Answer 71 71. A is the correct answer. This clinical presentation is textbook for Kawasaki's Disease. The major symptom is a fever greater than 5 days in this age group. It usually does not respond to anti-pyretics. It gives the deep red color to the mucus membranes and can have an associated conjunctivitis. Fifth's disease would give you a rash on the cheeks like this but not have a fever for 8 days. You also would not have that deep color red on the lips. Eczema of course would not give you a fever or conjunctivitis. Scarletina would not have a fever lasting for 8 days, and give you pink eye or deep red color to the lips.

Question 72 72. Your patient is a 34 year old male who present to the ER with the rash below. Based upon the information above, what is the most likely diagnosis? A. Angioedema B. Urticaria C. Vasculitis D. Erythema Multiforme

Answer 72 72. B is the correct answer. Urticaria produces lesions like seen in the photo. You commonly see them in the trunk and axilla, but you can see them anywhere. A diagnosis of angioedema cannot be made because it affects the lips and mouth but urticaria can be associated with it. Erythema multiforme lesions are target shaped. Vasculitis is seen more on the dependent areas of the body like the extremities and is is usually a deeper color. It can be seen anywhere though.

Question 73 23. Your patient is a 16 year old male that presents with the rash seen below. He is also complaining of abdominal pain and joint swelling. He also has a low grade fever of His urine reveals trace blood and protein. Based upon the above information, what is the most likely diagnosis? A. Scabies B. Henoch Schonlein Purpura C. Rocky Mountain Spotted Fever D. Meningococcemia

Answer 73 23. B is the correct answer. HSP is a vasculitis that typically comes after a respiratory infection. It is a vasculitis that can cause blood and protein in the urine. It can also cause renal problems so that needs to be monitored. Scabies is incorrect because the rash does not look like that and will not give you fever, abdominal pain, joint pain, or blood/protein in the urine. Meningococcemia can give you a petechial rash but will not cause abdominal pain or joint pain or swelling. Rocky Mountain Spotted Fever does not give you a purple rash like seen in the picture.

Question 74 74. What is the diagnosis of the rash listed below?
A. Pyogenic Granuloma B. Carbuncle C. Malignant Melanoma D. Squamous Cell Carcinoma

Answer 74 74. A is the correct answer. Pyogenic granulomas typically occur on the digits and can occur after a minor trauma. Treatment is usually surgical excision. They typically have a minor trauma before they appear but not always. Carbuncles do not have this type of appearance. They are skin covered and have some induration and do usually occur on the digits. Malignant melanoma has a black or purple appearance usually and is not raised. Squamous cell carcinoma is usually not that raised and does not have that dark red fleshy appearance.

Question 75 75. What is the best treatment for the rash depicted in the picture below? A. Prednisone B. Miconazole C. Triamcinolone D. Diphenhydramine

Answer 75 75. The correct answer is B. This rash is tinea versicolor. It is best treated with topical antifungals such as miconazole. Prednisone is effective in contact dermatitis, allergic rashes, and steroid responsive dermatoses. Triamcinolone is good for localized dermatitis. Diphenhydramine is great for itching for symptomatic relief and to help in allergic rashes.

Question 76 76.. Please identify the lesion below.
A. Basal Cell Carcinoma B. Seborrheic Keratosis C. Melanoma D. Pityriasis

Answer 76 76. B is the correct answer. Seborrheic keratosis is one of the most common types of non cancerous skin growths that usually occur in older patients. They usually appear as a brown, black, or pale growth on the face or torso. These lesions usually have a scaly, elevated appearance. Multiple lesions can occur at the same time. Basal cell usually are pearly or waxy. There color can be white, light pink, or skin colored. They tend to bleed easy. They may have a sunken area in the middle. Melanomas have an irregular border, are more flat, and exceed the diameter of a pencil eraser. They are usually dark brown or black. Pityriasis rosea is a rash the affects predominantly the trunk. Usually has a herald patch in the center and resemble a christmas tree appearance.

Question 77 77. Which of the following best describes the skin lesion depicted below? A. Pemphigus B. Cutaneous abscess C. Kerion D. Shingles

Answer 77 77. C is the correct answer. Kerion is a scalp lesion that develops with tinea capitis that is an inflamed secondarily infected lesion. It has a boggy granulated appearance. It is best treated with oral antifungals, and oral antibiotics may be needed. Pemphigus is a bullous lesion that usually affects the torso the most. This is not a cutaneous abscess. This is not shingles because there is no vesicular appearance and it does not follow a dermatomal distribution.

Question 78 78. Which of the following best describes the lesion listed below? A. Tinea Corporis B. Erythrasma C. Substantia Nigricans D. Vitiligo

Answer 78 78. B is the correct answer. It is often difficult to differentiate between tinea corporis and erythrasma They both are well demarcated. Erythrasma usually has a darker brown appearance and is thicker. This is important because it erythrasma is caused by corynebacterium and tinea is fungal. It usually responds to erythromycin. This is not Vitiligo.

Question 79 4. What is the diagnosis of the rash listed below?
A. Malar rash B. Rosacea C. Fifth's Disease D. Photosensitivity

Answer 79 79. A is the correct answer. This rash is a malar. It has the characteristic butterfly appearance with the nasolabial fold sparing. Rosacea and Fifth's disease just affects the cheeks and usually has a deeper red appearance. Photosensitivity does not affect the face in this way just in that area. This patient needs a further workup for SLE.

Question 80 80. Which of the following diagnoses best fit the picture listed below? A. MRSA B. Cellulitis C. Contact Dermatitis D. Shingles

Answer 80 80. D is the correct answer. This is shingles. This is characteristic grouped vesicles on a erythematous base in a dermatomal distribution. Contact dermatitis can have blister appearance but does not follow a dermatomal distribution. MRSA typically has a more erythematous appearance and does not follow a dermatomal distribution. It may have a central necrotic center. Cellulitis too does not follow a dermatomal distribution and has more of a reddened and warm appearance.

Question 81 81. Which of the following best describes the lesions in the picture below? A. Folliculitis B. Shingles C. Molluscum Contagiosum D. Scabies

Answer 81 81. C is the correct answer. Molluscum appears as flesh colored papules that turn red as your body fights the viral infection. The center is dimpled. These differ from folliculitis in that it is more pustular lesions. Shingles are vesicular lesions that are grouped on an erythematous base. Scabies tends to be much smaller and spares the head and neck. It is often found in the web spaces of fingers and toes.

Question 82 82. Please identify the lesions listed in the picture below. A. Aphthous Ulcers B. Molluscum C. Condyloma D. Oral Keratoses

Answer 82 82. C is the correct answer. Oral condyloma presents as pink or white papillary lesions that are exophytic and may be flat and spongy. They often present in immunosuppressed individuals. Aphthous ulcers present as flat white lesions that are blister like and painful. Molluscum usually is not seen in the mouth.

Question 83 83. Please identify the skin lesions listed below.
A. Lichen Planus B. Kaposi Sarcoma C. Psoriasis D. Eczema

Answer 83 83. B is the correct answer. Kaposi sarcoma often appears as red or purple patches on the skin, mouth, liver or in the GI tract. It is a slow growing cancer caused by a strain of the herpes virus. It is seen in patients with AIDS. Lichen planus presents with polygonal, purple, papules that are pruritic. Eczema presents as a scaly dry patches of skin. Psoriasis appears as white or gray plaques over areas of trauma usually.

Question 84 84. Please identify the skin lesion depicted below?
A. Herpetic Whitlow B. Felon C. Warts D. Actinic Keratosis

Answer 84 84. B is the correct answer. Felon is a infection of the fat pad of the finger. A herpetic whitlow is a deeper red color with vesicles rather than pustular lesions. Warts are more dimpled and do not have a an erythematous appearance. An actinic keratosis is a dry scaly patchy that occurs over a sun exposed area of your skin. They are usually considered to be precancerous.

Question 85 85. Please identify the skin lesion listed below:
A. Contact Dermatitis B. Shingles C. Psoriasis D. Molluscum

Answer 85 85. A is the correct answer this is contact dermatitis. It presents as a confluence of blisters and plaques in response to an allergic irritant. This is not a shingles because it does not follow a dermatomal distribution. Molluscum is pearly white or flesh colored papules that turn red as your body starts to fight the virus.

Question 86 86. Identify the rash depicted in the photo below:
A. Urticaria B. Tinea Corporis C. Granuloma Annulare D. Erythema Multiforme

Answer 86 86. D is the correct answer. Erythema multiforme presents as pink target shaped lesions. Urticaria presents as patches often seen on torso, back and auxilia, but can be anywhere. Tinea corporis are well demarcated and circular but are usually singular and have a raised border.

Question 87 87. Please identify the skin pathology depicted in the photo below: A. Scalded Skin Syndrome B. Disseminated Candidia C. Toxic Epidermal Necrolysis D. Photosensitivity

Answer 87 87. C is the correct answer. Toxic Epidermal Necrolysis typically has a prodrome of a week or two with fever, malaise, and sore throat, TEN then typically has mucus membrane involvement which are painful and may cause pain with eating or breathing.

Question 88 88. Please identify the rash below: A. Nummular eczema
B. Erythema Nodosum C. Tinea Corporis D. Pityriasis

Answer 88 88. A is the correct answer. Nummular eczema is "coined shaped." It has dry flaky patches of pruritic lesions. Erythema nodosum is more painful and is not flaky. Tinea is well demarcated and more circular. Pityriasis is usually on the trunk and has a herald patch and has a christmas tree appearance.

Question 89 89. Please identify the lesion below: A. Ganglion
B. Inclusion Cyst C. Lipoma D. Carcinoma of the finger

Answer 89 89. B is the correct answer. Inclusion cyst presents as tender raised areas that may be flesh colored or erythematous. Ganglions are usually painless, freely movable, usually in the wrists. Lipomas are usually wider and not raised that much. They are freely movable.

Question 90 90. Please identify the rash in the picture below:
A. Tinea Versicolor B. Discoid Lupus Erythematosus C. Nummular Eczema D. Erythema Multiforme

Answer 90 90. B is the correct answer. Discoid Lupus Erythematosus is a chronic scarring made worse with sun exposure. These patients may or may not have SLE. Treatment involves sunscreen, topical steroids, and/or antimalarial agents. Nummular eczema is not as raised or as scarred as that lesion. Tinea versicolor is a lighter color. Erythema multiforme is target shaped.

Question 91 91. Please identify the lesions seen in the picture listed below: A. Psoriatic Nails B. Subungual hematoma C. Splinter hemorrhages D. Fungal infection of Nails

Answer 91 91. C is the correct answer. Splinter hemorrhages can be seen in bacterial endocarditis. They look like little splinter under the nail. They may be caused by tiny clots that damage the capillaries under the nail. Psoriatic nails typically are exhibited by pits in the nail. Subungual hematoma is purple or black area under the nail caused by direct trauma.

Question 92 92. What is the best treatment of the condition listed below? A. Lotrimin B. Lamisil C. Bactrim D. Prednisone

Answer 92 92. B is the correct answer. Onychomycosis is best treated orally. Lotrimin is a topical antifungal preparation. Bactrim is an oral antibiotic. Prednisone has not shown to be effective in this condition.

Question 93 93. Which condition is responsible for the condition listed below? A. Fungal infection B. COPD C. Psoriasis D. SLE

Answer 93 93. C is the correct answer. Psoriasis causes pitting in the nails. It is estimated roughly 7% of patients with this condition exhibit psoriatic arthritis. Fungal infections do not cause pitting. Lupus does not cause pits in the nail.

Question 94 94. Please identify the skin lesion listed below:
A. Aphthous Ulcers B. Impetigo C. Herpes Labialis D. Oral Candidia

Answer 94 94. C is the correct answer. Herpes labialis presents as either a single vesicle or grouped vesicles that coalesce. Impetigo has a yellow or crusty brown appearance to it. Aphthous ulcers have a flat white appearance to it.

Question 95 95. Please identify the rash depicted below in the photograph: A. Folliculitis B. Contact Dermatitis C. Cellulitis D. Vasculitis

Answer 95 95. D is the correct answer. Vasculitis typically presents as a deep red, pink, or purple lesions on the extremities. They are usually scattered such as in the picture. Cellulitis tends to be together and solid. Folliculitis has a more pustular appearance. Contact dermatitis typically does not have a deep red appearance.

Question 96 96. Please identify the pathology listed below in the photography: A. Retropharyngeal Abscess B. Peritonsillar Abscess C. Uvular Angioedema D. Retropharyngeal burns

Answer 96 96. C is the correct answer. This is a unusual presentation of angioedema but it can present this way. Peritonsillar abscess usually present as a fullness just to either side of the midline around the junction of the hard and soft palate. Retropharyngeal abscess are difficult to see with visualization of the posterior oropharynx.

Question 97 97. Identify the lesion listed below in the picture:
A. Abscess B. Herpetic Whitlow C. Tinea D. Coxsackie Virus

Answer 97 97. B is the correct answer. These are vesicular lesions. This is not indurated or fluctuant as seen in an abscess. This does not look like hand foot and mouth disease.

Question 98 98. Please identify the pathology seen in the photograph below: A. Cellulitis B. Gout C. Septic Arthritis D. Tinea Pedis

Answer 98 98. B is the correct answer. This is gout with tophi. Cellulitis is a deeper red color and does not have the white lesions associated with it. Septic arthritis is typically accompanied with an effusion and does not have the white tophi.

Question 99 99. Please identify the lesion depicted below:
A. Erythema Nodosum B. Bug Bites C. Psoriasis D. Scabies

Answer 99 99. A is the correct answer erythema nodosum. Erythema nodosum present with painful raised lesions usually on the extensor surface of the extremities. Bug bite are not as large and do not just prefer the extensor surfaces.

Question 100 100. Identify the skin lesions depicted below:
A. Tinea Corporis B. Erythema multiforme C. Pityriasis D. Urticaria

Answer 100 100. A is the correct answer. Ringworm typically has a raised border with well demarcated borders. Erythema multiforme is target shaped and circular but does not have a raised border. Urticaria is just raised and blanches. Pityriasis usually is on the trunk with a herald patch.

Question 101 101. A 69-year-old obese man with a long history of steroid dependent COPD, has a groin rash of several months duration. The rash involves the intertriginous area but spares the scrotum. It appears as a reddish brown plaque with sharply defined scaling borders. Which of the following is the MOST likely diagnosis? A. Intertrigo B. Erythrasma C. Tinea cruris D. Candidiasis E. Contact dermatitis

Answer 101 101. Choice C is the correct answer. Tinea corporis tends to occur in warm, moist areas such as the inguinal folds. His history of steroid use puts him at risk for this. Erythrasma would have a tendency to have more of an acute component to it. Tends to present also as reddish plaque.

Question 102 102. Which of the following skin lesions is MOST related to repeated or chronic sun exposure and is SCC confined to the epidermis? Keratoacanthoma Junctional nevus Actinic keratosis D. Dermatofibroma E. Seborrheic keratosis

Answer 102 102. Choice C is the correct answer. Actinic keratosis tend to occur in sun exposed areas. They are considered a precancerous condition.

Question 103 103. Which of the following BEST defines a keloid skin lesion? A. Scar that extends beyond its margins B. Choristoma of cutaneous origin C. Epithelial cyst of the eyelid D. Foreign body reaction E. Congenital hematoma

Answer 103 103. Choice A is the correct answer. A keloid is a scar that extends beyond its margins.

Question 104 104. A 5-year-old boy has an intensely pruritic eruption on his trunk, arms, hands and penis. The itch is worse at night. Examination reveals multiple excoriated papules located around the waist, in the axillary folds, and on the extensor surfaces of the wrists. There are papules noted on the fingers and palms. Which of the following is the MOST likely diagnosis? A. Eczema B. Scabies C. Prurigo nodularis D. Contact dermatitis E. Dermatitis herpetiformis

Answer 104 104. Choice B is the correct answer. Scabies typically has an itch that is worse at night. Scabies prefers the extensor surfaces and the web spaces of the hands and feet. Scabies also typically spares the head and neck.

Question 105 105. A 47-year-old man has a three week history of a non-pruritic ovoid shaped papules and plaques. They are distributed along the lines of skin cleavage. The face and distal extremities are spared. The eruption was preceded by a similar but larger lesion on the lateral aspect of the abdomen. Which of the following is the MOST appropriate treatment of this condition? A. PO Acyclovir B. Topical Bacitracin C. Direct sun exposure D. Topical antifungal ointment E. Application of Selsun blue shampoo

Answer 105 105. Choice C is the correct answer. Pityriasis Rosea presents as ovoid papules and plaques. Direct sun exposure has been known to help this condition. Pityriasis in general is a self limited condition and will resolve on its own over weeks.

Question 106 106. Which of the following conditions is MOST likely be triggered by any of the following factors: age, immunosuppressive drugs, lymphoma, fatigue or radiation therapy? A. Verruca plana B. Herpes Zoster C. Parvovirus B19 D. Eczema herpeticum E. Molluscum contagiosum

Answer 106 106. Choice B is the correct answer. Herpes Zoster can be exacerbated by age, immunosuppression, stress, fatigue, cancer, or radiation therapy.

Question 107 Which of the following dermatoses MOST commonly involves the scalp, eyebrows, nasolabial folds, and the ears? Eczema Rosacea C. Psoriasis D. Seborrhea E. Acne vulgaris

Answer 107 107. Choice D is the correct answer. Seborrhea prefers the scalp, eyebrows, nasolabial folds, and the ears.

Question 108 108. A 25-year-old woman has a history of diabetes presents with a “spot” near her ankle. Examination reveals a ring of flesh-colored papules approximately 2.5 cm in diameter. There is no pruritus, scaling or discharge. Which of the following is the MOST likely diagnosis? A. Tinea corporis B. Plain xanthoma C. Neurofibromatosis D. Granuloma annulare E. Pyoderma gangrenosum

Answer 108 108. Choice D is the correct answer. Granuloma annulare usually presents as flesh colored papules on the extremities that do not itch or scale.

Question 109 A 25-year-old man has “warts” around his umbilicus. Examination reveals flesh colored dome shaped lesions ranging in size from 1-3 mm. Some have central umbilication. Which of the following is the MOST likely diagnosis? A. Drug eruption B. Rhus dermatitis C. Verruca vulgaris D. Condyloma acuminata E. Molluscum contagiosum

Answer 109 109. Choice E is the correct answer. Molluscum contagiosum presents as papular lesions characterized by central umbilication.

Question 110 A 36-year-old woman has an itchy, painful vulvar rash. Physical examination reveals a clustered, vesicular rash over the right labia. Which of the following cell types is a Tzanck smear MOST likely to reveal in this condition? "School-of-fish" pattern Giant cells with 2-15 nuclei C. Small, spiral bacterium (spirochete) D. Gram negative intracellular diplococci E. Granular eosinophilic intranuclear inclusions

Answer 110 110. Choice B is the correct answer. Tzanck smears with herpes simplex reveals giant cells with multiple nuclei.

Question 111 111. A 65-year-old man has a “growth” on his index finger. Examination reveals a 1 cm smooth dome shaped scaling papule with a central keratin filled crater. Which of the following is the MOST likely diagnosis? Acrochordon B. Fibrokeratoma C. Dermatofibroma D. Cutaneous horn E. Keratoacanthoma

Answer 111 111. Choice E is the correct answer. Keratoacanthomas present as a smooth dome shaped papule with central keratin filled craters usually on digits.

Question 112 112. Which of the following BEST characterizes small, well-defined lesions (<0.5 cm) containing deposits of blood or blood products? A. Wheals B. Papules C. Macules D. Vesicles E. Petechiae

Answer 112 112. Choice E is the correct answer. Petechiae is defined as well defined less than 5 mm containing deposits of blood or blood products.

Question 113 113. A 16-year-old girl is brought in with a 3-day history of a rash over the lower legs and arms. Mother denies new detergents but admits the family had a “clean-up” day in the backyard 6 days previous. The rash is intensely pruritic. The rash is a well-defined erythematous area with vesicular eruptions in most areas. The left leg has an area of confluent vesicles that have become bullae. Which of the following is the MOST appropriate treatment of this condition? A. Oral acyclovir B. Warm, dry compresses C. Prophylaxis with Keflex D. Topical steroids to blisters only E. Prednisone, 40 mg/day for 6 days

Answer 113 113. Choice E is the correct answer. Contact dermatitis that is diffuse is best treated with systemic steroids such as prednisone.

Question 114 114. Which of the following medications is recommended orally for soft tissue cellulitis infection suspected MRSA in nature? A. Erythromycin B. Bactrim C. Vancomycin D. Keflex E. Gentamicin

Answer 114 114. Choice B is the correct answer. Bactrim is the oral antibiotic of choice for treating MRSA. Vancomycin is only useful when given parenterally for soft tissue skin infections.

Question 115 115. Which of the following lesions is BEST described as: a rounded mass of neoplastic cells with well-defined peripheral contours; appearing as pearly white or pink, dome-shaped papule? Lichen sclerosis Actinic keratosis Squamous cell carcinoma Cutaneous T-Cell lymphoma Nodular Basal cell carcinoma

Answer 115 115. Choice E is the correct answer. Nodular basal cell carcinoma is best described as rounded mass of neoplastic cells with well defined peripheral contours appearing as pearly white or pink domed shaped papule.

Question 116 116. A 33-year-old woman has multiple, irregular plaques with a red base and superimposed silvery white thick scales. A punch biopsy shows increased mitotic figures and increased capillary blood supply. Which of the following is the MOST likely diagnosis? A. Seborrheic dermatitis B. Pityriasis rosea C. Lichen planus D. Sporotrichosis E. Psoriasis

Answer 116 116. Choice E is the correct answer. Psoriasis presents with superimposed silvery white thick scales.

Question 117 117. Which of the following medications is the MOST common cause for Stevens-Johnson syndrome (Vesiculobullous disease of the skin, mouth, eyes and genitalia)? Erythromycin B. Naprosyn C. Dilantin D. Inderal E. Aspirin

Answer 117 117. Choice C is the correct answer. Dilantin is the the most common medications that cause Steven Johnson Syndrome.

Question 118 118. A 5-year-old boy is seen with a 1-day history of an itchy rash that began on the face and is spreading to the trunk. Examination reveals a low grade fever and numerous well-defined erythematous lesions. There are several with vesicles and one or two that are crusting. Which of the following is the average incubation period in an immunocompetent child with this condition? A. 2 days B. 7 days C. 14 days D. 24 days E. 30 days

Answer 118 118. Choice C is the correct answer. The average incubation period for varicella in an immunocompetent child is 14 days.

Question 119 119. A 56-year-old man has a solitary ulcer at the glans penis with a clean, nontender, non purulent base and smooth, regular, sharply defined borders. Which of the following organisms is the MOST likely cause of this condition? A. H. ducreyi B. T. pallidum C. C. trachomatis D. C. granulomatis E. Herpes zoster virus

Answer 119 119. Choice B is the correct answer. Syphilis is caused by T. Pallidum which causes painless ulcers in the genital region primarily.

Question 120 120. A 25-year-old woman has 4 weeks of malaise, 2 weeks of fever and joint pain and reports swelling of her vulva. Examination reveals a mass in the right inguinal region of discharging pus with marked swelling of the vulva. Which of the following is the BEST initial therapy? A. Acyclovir B. Levaquin C. Doxycycline D. Vancomycin E. Penicillin VK

Answer 120 120. Choice C is the correct answer. Lymphogranuloma Venereum is best treated with doxycycline. Chlamydia is frequently the causative agent.

Question 121 121. An 8-year-old girl has a scaly, itchy rash on the dorsal aspect of her toes each winter for the past three years. Her father has athlete’s foot, her mother has hay fever, and her maternal aunt has psoriasis. Which of the following is the MOST likely diagnosis? A. Psoriasis B. Candidiasis C. Atopic eczema D. Dermatophytosis E. Contact dermatitis from socks

Answer 121 121. Choice C is the correct answer. This patient likely has atopic dermatitis which is exacerbated with cool dry environments.

Question 122 122. A strawberry hemangioma on a 1-year-old girl's neck has grown to the size of a half dollar since its first appearance at about one month of age. Which of the following is the BEST treatment plan? A. Freezing B. Reassurance C. Surgical excision D. Radium implantation E. Sub Intensive roentgen therapy

Answer 122 122. Choice B is the correct answer. Hemangiomas usually grow fast early on and then go dormant or even shrink/or may go away completely.

Question 123 123. Which of the following disease processes is associated with Pemphigus vulgaris? A. Hepatitis B. Diabetes C. Hyperthyroidism D. Myasthenia gravis E. Systemic lupus erythematosus

Answer 123 123. Choice D is the correct answer. Myasthenia gravis is associated with pemphigus vulgaris.

Question 124 124. Which of the following agents is MOST commonly associated with scarlet fever? A. Streptococcal erythrogenic toxin B. Staphylococcal aureus C. Coxsackievirus D. B19 parvovirus E. Herpesvirus-6

Answer 124 124. Choice A is the correct answer. Streptococcal erythrogenic toxin is associated with scarlet fever.

Question 125 125. Which of the following organisms is MOST likely to produce a soft, dry and powdery nail surface? A. Fusarium B. Aspergillus C. Scopulariopsis D. Cephalosporium E. T. mentagrophytes

Answer 125 125. Choice E is the correct answer. T. Mentagrophytes are most likely to produce a soft dry powdery nail service.

Question 126 126. A mother is concerned about recurrent lice infestation in their home. How long can adult lice survive off their host (trapped in carpet or similar) before dying? A. 1 day B. 5 days C. 10 days D. 21 days E. 30 days

Answer 126 126. Choice C is the correct answer. Lice can survive off their host for 10 days before dying.

Question 127 127. Which of the following BEST describes five or more lesions that are uniformly pale brown macules that vary in size from 0.5 to 20 cm? A. Lentigo B. Freckles C. Melasma D. Cafe-au-lait E. Tuberous sclerosis

Answer 127 127. Choice D is the correct answer. Cafe-au lait spots are 5 or more lesions that are uniformly brown macules that vary in size for 0.5 cm to 20 cm.

Question 128 128. “Winter” itch has been especially bad for a 32-year-old hairdresser. Her hands are crisscrossed with shallow red fissures and there are areas of thicker tan-brown scale. Which of the following is the BEST initial therapy? 12% lactate lotion (Lac-Hydrin) Oral steroid dose pack Benoquin cream Decaspray Vitadye

Answer 128 128. Choice A is the correct answer. Xerosis and atopic dermatitis respond nicely to Lac Hydrin and help moisturize the skin.

Question 129 129. Which of the following physiological mechanisms is MOST likely to cause the overwhelming sepsis associated with toxic epidermal necrolysis (TEN)? A. fluid loss B. full-thickness loss of epidermis C. necrosis of the subcutaneous tissue D. loss of the reticular layer of the dermis E. proliferation of the papillary layer of the dermis

Answer 129 129. Choice B is the correct answer. Full thickness loss of the epidermis can cause sepsis by taking away the natural defensive barrier of the human body, the skin.

Question 130 130. A 43-year-old obese woman has several blackheads in the left axilla. There is deep dermal inflammation with erythema and heat production and the area is quite tender. There is a single cordlike band of scar tissue present in the superior aspect of the axilla. Which of the following is the MOST likely diagnosis? Furuncles B. Folliculitis C. Cystic acne D. Metastatic breast cancer E. Hidradenitis suppurativa

Answer 130 130. Choice E is the correct answer. Hidradenitis suppurativa presents with deep dermal inflammation and heat production and tenderness to palpation of the axilla. There is usually a single cordlike band of scar tissue that is quite tender.

Question 131 131. Which of the following organisms is the MOST likely to be cultured from a large walled-off collection of pus that is painful, firm and warm to touch? Pseudomonas aeruginosa Staphylococcus aureus Peptostreptococcus Escherichia coli Lactobacillus

Answer 131 131. Choice B is the correct answer. Staphylococcus aureus is the most likely organism to cause an abscess or furuncle.

Question 132 132. A 31-year-old woman has several, round, protruding, smooth-surfaced masses with a small channel communicating with the surface in the posterior auricular fold. Which of the following is the MOST likely diagnosis? A. Lipoma B. Pilar cyst C. Syringoma D. Comedone E. Epidermal cyst

Answer 132 132. Choice E is the correct answer. Epidermal cysts present a smooth surface masses which have a small communicating channel with the surface of an articular fold.

Question 133 133. A 6-year-old boy has multiple erythematous-based lesions on the left lateral chest, axilla and inner left arm. The vesicular lesions have an inner-tube shaped rim. There is a thin, honey-colored crust in the center of several of the lesions. He has several similar lesions on the face. Which of the following is the MOST appropriate therapy for this condition? A. Acyclovir B. Griseofulvin C. Tetracycline D. Doxycycline E. Cephalexin

Answer 133 Choice E is the correct answer. This patient has impetigo and is best treated with cephalexin.

Question 134 A 35-year-old man with no previous history of hair loss is diagnosed with Telogen effluvium. Which of the following medications is MOST likely to cause this condition? A. Prilosec B. Pravachol C. Naprosyn D. Cimetidine E. Acetaminophen

Answer 134 134. Choice D is the correct answer. Telogen effluvium is hair loss that has a specific cause. It can be caused by a number of medications. Cimetidine is a common cause. Other causes include: retinoids, beta blockers, calcium channel blockers, and antidepressants.

Question 135 135. A port-wine stain involving the superior and middle branches of the trigeminal nerve is MOST commonly associated with which of the following neurocutaneous syndromes? A. Ataxia telangiectasia B. Rendu-Osler-Weber C. Fabry-Anderson D. Sturge-Weber E. Cobb

Answer 135 135. Choice D is the correct answer. Port wine staining of the superior and middle branches of the trigeminal nerve is referred to as Sturge Weber syndrome.

Question 136 136. Which of the following is the end point of freeze around the lesion for cryosurgery of a wart on the hand? A. No rim B. 1-2 mm rim C. 3-4 mm rim D. 5-6 mm rim E. 7-8 mm rim

Answer 136 136. Choice B is the correct answer. One to two millimeters is the correct end point of freeze around a wart for cryosurgery of the hand.

Question 137 137. A 45-year-old man has a well-defined, elevated, flat-topped plague over the right forehead area. There is adherent scaling present. Which of the following is the MOST likely diagnosis? Erythema nodosum B. Sjogren’s syndrome C. Erythema multiforme D. Discoid lupus erythematosus E. Systemic lupus erythematosus

Answer 137 137. Choice D is the correct answer. Discoid lupus tends to present as well defined flat plaque with adherent scaling. This patient’s lesion is on his face. Erythema nodosum occurs on the extensor surfaces of the extremities. Erythema multiforme is target shaped lesions that usually occur on the extremities.

Question 138 138. Which of the following BEST defines a 42-year-old man with erythema, edema, papules, pustules, and telangiectasia in the facial area which are chronic and recurrent? A. Miliaria B. Rosacea C. Folliculitis D. Carbuncles E. Acne vulgaris

Answer 138 138. Choice B is the correct answer. Rosacea presents with papules, pustules, and telangiectasia that presents on the facial area that is chronic and recurrent.

Question 139 139. Which of the following medications is MOST likely to exacerbate a pre-existing psoriasis? A. Lithium B. Cisplatin C. Captopril D. Probenecid E. Tetracycline

Answer 139 139. Choice A is the correct answer. Lithium would be the most likely out of these medications to exacerbate psoriasis.

Question 140 140. Which of the following foods is NOT usually associated as a cause of Urticaria? A. Oranges B. Shellfish C. Tomatoes D. Rye bread E. Strawberries

Answer 140 140. Choice A is the correct answer. Oranges are not known for causing urticaria or significant food allergy.

Question 141 141. Which of the following findings is MOST likely associated with systemic sclerosis (scleroderma)? A. Q-wave changes on ECG B. Widespread purpura C. Splenomegaly D. Raynaud's E. PO2 <65%

Answer 141 141. Choice D is the correct answer. Raynaud’s is associated with scleroderma and is associated with CREST syndrome.

Question 142 142. A 24-year-old woman with AIDs complains of severe sore throat and dysphagia for the last week. Examination reveals the tongue has deep erosions and thick plaques on the back of the throat. There are white plaques on the buccal mucosa as well. Which of the following lab tests would BEST confirm the cause of the oral lesions? A. PAS stain B. VDRL titer C. Tzanck smear D. Anaerobic culture E. KOH slide preparation

Answer 142 142. Choice E is the correct answer. KOH slide preparation wound confirm candida which would be the most likely explanation for these physical findings on an AIDS patient.

Question 143 143. Which of the following is the MOST influential risk factor in the development of malignant melanoma? Age Gender Sun exposure Tobacco abuse Chemical exposure

Answer 143 143. Choice C is the correct answer. Sun exposure and sunburn are the most influential factors in development of malignant melanoma.

Question 144 144. Which of the following biopsy techniques in MOST useful for elevated lesions when a full thickness of tissue is unimportant? A. Punch B. Shave C. Curettage D. Cryotherapy E. Electrodesiccation

Answer 144 144. Choice B is the correct answer. Shave biopsy is the best method to use when full thickness of tissue is not important.

Question 145 145. A 19-year-old woman has over to 3.0 cm pruritic, round pustules in occluded areas consistent with her bikini bathing suit. They have been there for 24 hours and her last time in the hot-tub was three days ago. Which of the following is the MOST likely diagnosis? Scabies Acne mechanica Heat induced dermatitis Pseudomonas folliculitis E. Molluscum contagiosum

Answer 145 145. Choice D is the correct answer. “Hot Tub” folliculitis is most likely caused by the organism pseudomonas.

Question 146 146. Which of the following laboratory tests are recommended prior to the use of Isotretinoin for treatment of acne? A. CPK Isoenzymes B. BUN and Creatinine C. Prothrombin studies D. Liver function studies E. Thyroid function studies

Answer 146 146. Choice D is the correct answer. Liver function tests are recommended prior to starting isotretinoin because of its potential hepatotoxicity.

Question 147 147. A 43-year-old woman is experiencing hive-like swelling of the lips, palms, and soles for the last 24 hours. In the last hour she has developed dyspnea and intense pruritus. Which of the following medications is MOST likely the trigger of this condition? Enalapril Phenytoin Omeprazol Propranolol E. Fluconazole

Answer 147 147. Choice A is the correct answer. ACE inhibitors are known for causing angioedema in patients with C1 esterase deficiency. It presents just like this patient did in this scenario.

Question 148 A 2-year-old boy has had a fever for 7 days, edema of the extremities, joint pain and erythema of the palms and soles. There is an erythematous exanthem rash and evidence of peeling skin over the feet and hands. Leukocytosis is 26,000. Which of the following is the MOST likely diagnosis? Parvovirus B-19 Rheumatic fever C. Roseola infantum D. Kawasaki syndrome E. Infectious mononucleosis

Answer 148 148. Choice D is the correct answer. Kawasaki syndrome is a vasculitis that presents with a fever over 5 days, edema in the extremities, joint pain, and erythema in the palms and soles. There may also be associated conjunctivitis and pharyngitis.

Question 149 149. A 52-year-old Asian woman has a macular, round, sharply demarcated, red plaque on the lateral left thigh. This is the third time it has shown up in the last two years in the exact same location. It is mildly pruritic and is slightly warmer than surrounding skin. Which of the following is the MOST likely diagnosis? A. Erythema multiforme B. Fixed drug eruption C. Coxsackievirus D. Lichen planus E. Vasculitis

Answer 149 149. Choice B is the correct answer. Fixed drug eruptions presents as a mildly pruritic, macular, sharply demarcated plaques, usually on the torso or extremities.

Question 150 150. Which of the following BEST defines a flat (macular), dark brown lesion that is uniform in color and usually round or oval; most lesions are hairless and vary in size from 0.1 to 0.6 cm? A. Pigmented macule B. Congenital nevi C. Junctional nevi D. Melanoma E. Halo nevi

Answer 150 150. Choice C is the correct answer. Junctional nevi present as uniform dark brown usually oval or round lesions that vary in size from 1-6 mm.

Question 151 151. An 8-year-old girl has numerous small non-pruritic discrete plaques with silvery central scales on her trunk for the past few days. She had "Strep" throat three weeks ago which was treated with Penicillin. Some pitting is noted on her fingernails. Which of the following is the MOST likely diagnosis? A. Herpes Zoster B. Tinea corporis C. Pityriasis rosea D. Guttate psoriasis E. Post-glomerulonephritis exanthema

Answer 151 151. Choice D is the correct answer. Guttate psoriasis usually develops quickly. One of the the known “triggers” is streptococcal infections.

Question 152 152. Which of the following is the cornerstone of successful therapy of malignant melanoma? A. Laser electrodesiccation B. Early surgical excision C. Isotope radiotherapy D. Chemotherapy E. Cryotherapy

Answer 152 152. Choice B is the correct answer. Early surgical excision is the cornerstone of successful therapy for malignant meloma.

Question 153 153. Which of the following scabicides has been associated with neurotoxicity when used in infants with extensive cutaneous disease? A. Kwell (Lindane) B. Eurax (Crotamiton) C. 10% sulfur ointment D. Diflucan (Fluconazole) E. Lotrimin (Clotrimazole)

Answer 153 153. Choice A is the correct answer. Kwell has been associated with neurotoxicity when used with infants with significant cutaneous involvement.

Question 154 154. An 18-year-old male has pustular, hemorrhagic lesions on the distal extremities over the knees and ankles. History reveals chills and fever that has subsided and no other systemic symptoms. Which of the following is the MOST likely diagnosis? A. Allergic Vasculitis B. Acute rheumatic fever C. Gonococcal septicemia D. Rocky Mountain Spotted fever E. Subacute bacterial endocarditis

Answer 154 154. Choice C is the correct answer. Gonococcal septicemia present with pustular, hemorrhagic lesions on the distal extremities over the knees and ankles usually in a young patient. The rest of these disorders would have some other systemic symptoms also.

Question 155 155. A 3-year-old female has a few papules along her upper thigh. They are dome shaped, flesh colored, and appear slightly umbilicated. Which of the following is the MOST likely diagnosis? A. Herpes simplex B. Verruca vulgaris C. Bowenoid papulosis D. Condyloma acuminata E. Molluscum contagiosum

Answer 155 155. Choice E is the correct answer. Molluscum contagiosum presents with flesh colored papules that are slightly umbilicated.

Question 156 156. Which of the following locations is the MOST common for typical scabies lesions? The anterior knees The scalp, neck and face The ears, buttocks and ankles The finger webs, wrists and waist The flexor surfaces of knees and elbows

Answer 156 156. Choice D is the correct answer. Scabies typically presents in finger web spaces, wrists, waists, and toe web spaces. Scabies also usually spares the head and neck.

Question 157 157. Which of the following is the MOST common skin cancer? Adenocarcinoma Basal cell carcinoma Malignant melanoma Malignant mixed tumor Squamous cell carcinoma

Answer 157 157. Choice B is the correct answer. Basal cell carcinoma is the most common type of skin cancer.

Question 158 158. A 27-year-old man has chronic thickening of the nails with loosening of the nail plate from the nail bed giving the nail a yellow discoloration. Which of the following is the MOST likely diagnosis? Psoriasis Paronychia Tinea pedis Lichen planus Candida onychomycosis

Answer 158 158. Choice E is the correct answer. Onychomycosis presents with yellow thickened nails that can have loosening of the nail plate.

Question 159 159. A 14-year-old girl has small erosions covered by moist, honey-colored crusts on her chin. She has no history of trauma. Which of the following is the MOST likely diagnosis? A. Eczema B. Impetigo C. Psoriasis D. Ritter’s disease E. Allergic contact dermatitis

Answer 159 Choice B is the correct answer. Impetigo presents with moist,honey colored crust usually on the face of children.

Question 160 160. Which of the following medications has been shown to decrease post-herpetic neuralgia, if given in the first 48 hours of the disease? A. Keflex B. Accutane C. Acyclovir D. Tetracycline E. Topical sulfa cream

Answer 160 160. Choice C is the correct answer. Acyclovir has been shown to decrease post herpetic neuralgia as well as the rash if instituted within 48 hours of the onset of symptoms.

Question 161 161 . A 25-year-old woman, who was treated with trimethoprim-sulfamethoxazole for an urinary tract infection one week ago. She now has symmetrically distributed plaques on extensor surfaces of the upper extremities, including the palms. The lesions are erythematous with deep violaceous center that are surrounded by concentric pale and red rings. Some of the lesions have a vesicle in the center. Which of the following is the MOST likely diagnosis? A. Urticaria B. Erythema migrans C. Erythema nodosum D. Erythema multiforme E. Epidermal necrolysis

Answer 161 161. Choice D is the correct answer. Erythema multiforme has numerous causes including infections and reactions to medications. Sulfa medications are the second most common medication causing EM second to penicillin. They present as target like lesions usually on the extremities.

Question 162 162. Which of the following BEST represents the laboratory finding of an oral Candidiasis (thrush)? Acid fast bacilli Gram positive rods Non-visualized virus Gram negative bacillus Budding yeast-like fungus

Answer 162 162. Choice E is the correct answer. Candidiasis is represented in laboratory findings as budding yeast like fungus.

Question 163 163. Which of the following represents a bacterial infection of the skin? Keratosis pilaris Verruca vulgaris Lupus erythematosus Ecthyma gangrenosum Molluscum contagiosum

Answer 163 163. Choice D is the correct answer. Ecthyma gangrenosum is a bacterial infection of the skin usually caused by pseudomonas in immunosuppressed patients.

Question 164 164. Which of the following BEST represents the definition of a lesion larger than 1 cm in diameter and filled with clear serous fluid? A. Wart B. Bulla C. Papule D. Vesicle E. Pustule

Answer 164 164. Choice B is the correct answer. The term that best describes a lesion greater than 1 cm that is filled with clear serous fluid is a bulla.

Question 165 A mother of a 3-month-old infant is concerned about a red nodular, protuberant growth on the child’s forearm. It appears to be enlarging slightly, though it seems to cause the child no discomfort. It has well defined borders and is non-tender. Which of the following is the MOST likely diagnosis? Keloid Melanoma Telangiectasia Nevus flammeus Strawberry hemangioma

Answer 165 165. Choice E is the correct answer. Strawberry hemangioma is the most likely diagnosis in this age group with this type of skin lesion.

Question 166 166. A 18-year-old patient has a red, warm, raised, sharply bordered plaque which has been enlarging peripherally. The patient’s temperature is 102ºF and there is lymphatic “streaking”. Which of the following is the MOST appropriate therapy? Topical antibiotics Systemic antibiotics Boric acid compresses Excision and drainage with biopsy Cleansing with cool, moist oatmeal soaks

Answer 166 166. Choice B is the correct answer. This patient needs parenteral antibiotics with the fever and lymphangitic streaking appreciated on physical exam with the cellulitis.

Question 167 167. Which of the following medications is the MOST common cause of drug-related lupus in the United States? A. Naprosyn B. Prednisone C. Nitrofurantoin D. Procainamide E. Hydroxychloroquine

Answer 167 168. Choice D is the correct answer. Procainamide is the most common cause of drug related lupus in the United States.

Question 168 A 17-year-old man is complaining of “skin problems”. Examination reveals numerous (>25) inflamed papules and pustules over his face and back. No active cysts are noted. Which of the following is the BEST initial oral therapy? A. Accutane B. Prednisone C. Tetracycline D. Azithromycin E. Oral contraceptives

Answer 168 168. Choice D is the correct answer. Tetracycline is the best initial treatment for a 17 year old with acne eruption. Accutane should be used for refractory cases. Oral contraceptive would not be appropriate for a male patient.

Question 169 19. Which of the following skin lesions are sharply circumscribed, appear to be stuck on the skin surface, and have a variable tan-brown-black coloration? A. Acrochordon B. Dermatofibroma C. Nevus sebaceous D. Keratoacanthoma E. Seborrheic keratoses

Answer 169 169. Choice E is the correct answer. Seborrheic Keratoses are skin lesions that are sharply circumscribed and appear to be stuck on skin surface with a variable tab brown coloration.

Question 170 170. In patients diagnosed with melanoma which of the following is considered the SINGLE MOST important indicator of prognosis? A. Gender B. Tumor thickness C. Age of the patient D. Sun exposure history E. Anatomic location of the lesion

Answer 170 170. Choice B is the correct answer. Tumor thickness/penetration is the single most important indicator for prognosis.

Question 171 171. Which of the following is the MOST common causative organism of bullous impetigo? Pseudomonas sp. Staphylococcal sp. Corynebacterium sp. Human papilloma virus Trichophyton tonsurans

Answer 171 171. Choice B is the correct answer. Staphylococcal species is the most common organism causing bullous impetigo.

Question 172 172. Which of the following is the BEST initial therapy for pseudofolliculitis barbae? Modify shaving technique Application of benzoyl peroxide Intralesional steroid injections Systemic antibiotics Systemic retinoids

Answer 172 172. Choice A is the correct answer. the best initial therapy for pseudofolliculitis barbae is modification of shaving technique.

Question 173 173. A 3-year-old boy has sudden onset of a rash. Mother reports the child has been having a fever up to 103ºF and decreased appetite for the last three days. The fever subsided last evening but she became concerned when the rash developed this morning. Examination reveals a non-toxic child with multiple small scattered pink macules on the trunk . Which of the following is the MOST likely diagnosis? Rubella B. Roseola C. Scarlet fever D. Fifth’s disease E. Pityriasis rosea

Answer 173 173. Choice B is the correct answer. Roseola presents with a high fever that subsides and pink macular rash on the trunk appears after the fever goes away.

Question 174 174. A 7-year-old girl has a three day history of low grade fever and fatigue. Mom noticed a rash on the child’s chest that is mildly pruritic. Examination reveals scattered papulovesicular lesions in different stages of development. Which of the following is the MOST likely diagnosis? A. Varicella B. Herpes Zoster C. Herpes simplex D. Molluscum Contagiosum E. Rocky Mountain Spotted fever

Answer 174 174. Choice A is the correct answer. Varicella present with papular and vesicular lesions in various stages of development usually dispersed primarily on the torso.

Question 175 A middle-aged woman has dry skin on the soles of her feet for many years and whose toenails are undermined with a crumbly material. During the past few summers she has had circumscribed, itchy, and scaly patches of dermatitis about her ankles. OTC steroids have made it worse. Which of the following is the MOST likely diagnosis? A. Psoriasis B. Lichen planus C. Pityriasis rosea D. Dyshidrotic eczema E. Trichophyton infection

Answer 175 175. Choice E is the correct answer. Trichophyton infections present on toenails over years and have scaly dry skin on the soles of their feet. Their toenails are undermined by crumbly material.

Question 176 176. Which of the following statements regarding herpes simplex virus (HSV-1 and HSV-II) is TRUE? A. Transmission of HSV-I frequently occurs by droplet nuclei B. HSV-I tends to occur “above the belt” vs HSV II in the genital area C. If started early (first 24 hours), Acyclovir is an effective cure for HSV-II D. Infection in one are confers protection from infections in other areas E. After the primary infection, the virus lies dormant in the squamous epithelial cells

Answer 176 176. Choice B is the correct answer. HSV I tends to occur above the belt and HSV type II occurs in the genital area.

Question 177 177. A 32-year-old man presents with a problem with tanning. Specifically, he has patches on his chest that fail to tan with exposure to sun and remain quite pale. These same areas are occasionally pruritic. Which one of the following fungal infection is MOST likely to be the cause of this condition? A. Sporothrix schenckii B. Candida albicans C. Trichophyton spp. D. Tinea rubrum E. P. orbiculare

Answer 177 177. Choice E is the correct answer. P. Orbiculare presents with patches that fail to tan and remain pale and itch. This is due to a fungal infection.

Question 178 28. A 26-year-old woman has an occasionally itchy rash on the trunk. The rash is papulosquamous with tan or fawn-colored plaques covered by fine scales. The lesions seem to have their axis along the skin cleavage lines. Patient relates the one distinct lesion which has an erythematous appearance with central clearing, was the first lesion. Which of the following is the MOST likely diagnosis? A. Psoriasis B. Lichen planus C. Tinea corporis D. Pityriasis rosea E. Secondary syphilis

Answer 178 178. Choice D is the correct answer. Pityriasis Rosea is a papular tan or fawn colored plaque with fine scales that present in a Christmas tree pattern.

Question 179 179. A 5-year-old girl is seen for a school physical. Examination of the skin reveals numerous brown spots, each greater than 3 cm in size. They are present on the trunk and extremities. One spot is 5 cm in size and many smaller (< 1 cm) are noted, especially in the axilla. Which of the following is the MOST likely diagnosis? Hemochromatosis Neurofibromatosis Gardner's syndrome Peutz-Jeghers syndrome Xeroderma pigmentosum

Answer 179 179. Choice B is the correct answer. Neurofibromatosis presents with numerous spots greater than 3 cm in size and smaller lesions can be noted also.

Question 180 30. A 26-year-old man from Cape Cod is seen with a 3-week history of an expanding slightly burning ring of redness that first surrounded a red papule on the abdomen. He complains of headaches, anorexia and malaise. Examination reveals 100.8ºF fever and a raised, red rash with central clearing but no scaling. Which of the following vectors is the MOST likely associated with this condition? A. Flea B. Tick C. Spider D. Housefly E. Kissing bug

Answer 180 180. Choice B is the correct answer. This patient was likely bitten by a tick. Tick bites typically have a slightly ring like rash and will have a low grade fever with malaise. These can be carriers for Lyme disease.

Question 181 A 36-year-old man has a pruritic follicular rash that he reports comes and goes. He has noticed it seems to show up 2-3 days after he visits his girlfriend and they use the Hot Tub. Which of the following organisms is MOST likely responsible for this condition. A. Escherichia coli B. Erysipelothrix insidiosa C. Staphylococcus aureus D. Pseudomonas aeruginosa E. Streptococcus pneumoniae

Answer 181 181. Choice D is the correct answer. Pseudomonas is the organism responsible for hot tub folliculitis.

Question 182 182. Which of the following is the MOST appropriate initial treatment for rapidly progressive urticaria that has hypotension and trouble swallowing? A. Epinephrine 1:1000 B. Cyproheptadine C. Terfenadine D. Astemizole E. Ranitidine

Answer 182 182. Choice A is the correct answer. Epinephrine is indicated for rapidly progressing urticaria with hypotension and throat swelling.

Question 183 183. Which of the following locations is MOST commonly associated with the first signs of Pemphigus vulgaris in the elderly? A. Inguinal creases B. Lower genitalia C. Soft palate D. Fingertips E. Pinna

Answer 183 183. Choice C is the correct answer. A common first location of pemphigus vulgaris in elderly is the soft palate.

Question 184 184. A 28-year-old woman presents with hair loss. She reports no new shampoos or treatments as she has been too busy with her 4 month old daughter to have her hair done. Examination reveals a diffuse non-scarring alopecia. Which of the following is the MOST likely diagnosis? Tinea capitis Alopecia areata Trichotillomania Telogen effluvium E. Cicatricial baldness

Answer 184 184. Choice D is the correct answer. Telogen effluvium is the most likely diagnosis. Her medications needs to be reviewed. It also could be from the stress of her new daughter.

Question 185 185. Which of the following drug classes is MOST likely associated with a skin reaction of erythema nodosum? A. Penicillin B. Phenothiazines C. Oral contraceptives D. Oral hypoglycemics E. Antiparasitic agents

Answer 185 185. Choice C is the correct answer. Oral contraceptives would be the most likely agent causing erythema nodosum in this list of medications.

Question 186 186. Which of the following statements concerning benign moles is TRUE? A. Junctional nevi are quite common at birth B. The nevi begins as a compound type in childhood C. Nevi that are confined to the dermis are usually flat D. The presence of a “halo” indicates early cancerous changes E. Compound nevi are uniformly round or oval and hair may be present

Answer 186 186. Choice E is the correct answer. Compound nevi are uniformly round or oral and may have hair. They are benign nevi.

Question 187 187. Which of the following skin conditions is BEST characterized by dusky red, well localized lesions with scaling, follicular plugging, atrophy and telangiectasia? A. Psoriasis B. Fixed drug eruption C. Exfoliative dermatitis D. Seborrheic dermatitis E. Discoid lupus erythematosus

Answer 187 187. Choice E is the correct answer. Discoid lupus presents with localized lesions with scaling, follicular plugging, atrophy, and telangiectasia.

Question 188 188. Which of the following conditions is BEST characterized by vesicles of 1-2 mm on the palms, soles, and sides of the fingers, usually associated with mild pruritus? A. Angioedema B. Lyme disease C. Contact dermatitis D. Fixed drug eruption E. Dyshidrosis

Answer 188 188. Choice E is the correct answer. Dyshidrosis presents with vesicular lesions on palms, soles, and the sides of fingers associated with itching.

Question 189 All of the following statements are TRUE concerning the course and prognosis of toxic epidermal necrolysis (TEN) EXCEPT? A. The overall mortality rate is high (25-100%) B. TEN is found only in patients with a neoplasm C. Death is usually caused by overwhelming sepsis D. The lesions may vesiculate before becoming confluent E. Includes skin tenderness, malaise and fever with morbilliform rash

Answer 189 189. Choice B is the correct answer. The statement TEN is found in patients with a neoplasm is incorrect.

Question 190 All of the following statements are TRUE concerning Kaposi’s sarcoma EXCEPT A. The lesions are often quite uncomfortable B. Related tumors may occur in other organs C. Begin as violaceous macules that develop into nodules or plaques D. It is commonly associated with acquired immunodeficiency syndrome E. Classic Kaposi occurs most commonly in elderly male Jews or Greeks

Answer 190 190. Choice A is the correct answer. Lesions from Kaposi’s sarcoma are usually painless.

Question 191 191. All of the following are TRUE statements concerning Fixed Drug Eruptions EXCEPT A. Lesions heal with a scar B. Regional lymphadenopathy is absent C. Aspirin and Bactrim are two common causes D. Recur at same site each time drug is ingested E. Glans of the penis is a common site of occurrence

Answer 191 191. Choice A is the correct answer. Fixed drug eruption rashes do not leave scars.

Question 192 All of the following are TRUE regarding acne vulgaris EXCEPT May initially present after adolescence Plugging of the sebaceous duct occurs C. Primarily caused by poor hygiene practices D. A closed comedone is the earliest primary lesion E. May improve with administration of retinoid compounds

Answer 192 192. Choice C is the correct answer. Acne is not primarily caused by poor hygiene practices.

Question 193 193. All of the following are TRUE statements regarding atopic dermatitis EXCEPT A. Prevalence declines with age B. May be associated with asthma C. Worsens in humid environment D. Commonly has onset under the age of 2 E. May be associated with hand dermatitis in adulthood

Answer 193 193. Choice C is the correct answer. Atopic dermatitis does not worsen in a humid environment. It is usually worse in the dry winter months.

Question 194 194. All of the following are appropriate treatments for Psoriasis in a patient with LIMITED disease EXCEPT A. Methotrexate B. Topical steroids C. Intralesional steroid D. Coal tar preparations E. Anthralin preparations

Answer 194 194. Choice A is the correct answer. Methotrexate is not indicated for localized or limited psoriasis treatment.

Question 195 195. All of the following are associated with petechial eruptions EXCEPT A. Lyme disease B. Rocky Mountain Spotted fever C. Subacute bacterial endocarditis D. Disseminated intravascular coagulation E. Gonococcal and meningococcal septicemia

Answer 195 195. Choice A is the correct answer. Lyme disease is not associated with a petechial rash. It has a bullseye or target shaped rash.

Question 196 196. All of the following are common causes of contact dermatitis EXCEPT Nickel Lanolin Neomycin Petrolatum Chromium salts

Answer 196 196. Choice D is the correct answer. Petrolatum is not typically associated with contact dermatitis.

Question 197 197. Which condition below is best described by the following description? Tight, shiny, indurated skin; face mask-like. A. Pemphigus B. Lichen planus C. Scleroderma D. Acute SLE E. Granuloma annulare

Answer 197 197. Choice C is the correct answer. Scleroderma presents with tight, shiny, indurated skin, face mask like.

Question 198 198. Which condition below is best described by the following description? Chronic irregular red plaques, may be butterfly type on face A. Pemphigus B. Lichen planus C. Scleroderma D. Acute SLE E. Granuloma annulare

Answer 198 198. Choice D is the correct answer. Acute SLE may have chronic, irregular red plaques that may be butterfly (malar) rash on the face.

Question 199 199. Which condition below is best described by the following description? Papules to nodules forming raised peripheral rings and central clearing. A. Pemphigus B. Lichen planus C. Scleroderma D. Acute SLE E. Granuloma annulare

Answer 199 199. Choice E is the correct answer. Granuloma annulare has papules to nodules forming to raised peripheral rings and central clearing.

Question 200 200. Which condition below is best described by the following description? Flat-topped, polygonal, shiny to scaly violaceous papules. A. Pemphigus B. Lichen planus C. Scleroderma D. Acute SLE E. Granuloma annulare

Answer 200 200. Choice B is the correct answer. Lichen planus is flat topped, papules, purple, and polygonal.

Question 201 201. The classic facial malar rash of systemic lupus erythematosus can be distinguished from the "heliotrope" facial rash of dermatomyositis because the malar rash: A. is usually due to coexisting infection from non-resistant Staphylococcus aureus bacteria B. usually spares the nasolabial folds and periorbital areas C. is never raised D. occurs only when the ANA titer value is greater than 1:1280 E. precedes the onset of other symptoms from SLE in all cases

Answer 201 201. Choice B is the correct answer. The malar rash with SLE spares the nasolabial folds.

Question 202 202. Scalds are the most common burns in which of the following groups? A. Adolescents B. Elderly in nursing homes C. Children under the age of eight D. Adults years of age E. All of the above

Answer 202 202. Choice C is the correct answer. Scalds are the most common burns with children under the age of eight.

Question 203 203. A -24-year-old man is seen in the emergency department for a 4 cm scalp laceration that has clotted closed. Which of the following is the MOST appropriate care for the laceration? A. Leave the laceration alone since it has clotted, recheck 1 week B. Débride foreign material, irrigate well and close primarily C. Débride foreign material, irrigate and allow to granulate D. Apply pressure dressing and recheck in 2 weeks E. Inspect for foreign material, then apply adhesive strips

Answer 203 203. Choice B is the correct answer. Debride the foreign material, irrigate well and close primarily.

Question 204 204. Which of the following is the BEST technique for skin incisions for minor surgery? A. Longitudinal incisions along flexor creases B. Transverse incisions on extremities C. Elliptical incision (long to short axis) should be a 2:1 ratio D. Best made along areas of minimal tension (Langer’s lines) E. Should be closed with 0 silk.

Answer 204 204. Choice D is the correct answer. The best technique for skin incisions is made with areas of minimal tension (Langer’s Lines).

Question 205 205. Which of the following burn patients BEST qualifies for hospitalization per the Guidelines for Burn Unit care? A. Superficial (“first degree”) burns over the thighs B. Other than superficial burns of the face, feet, hands, perineum C. Full thickness burns over 1% of total body surface area D. Partial thickness burns over 10% of total body surface area E. Superficial burns of arms and legs with fractured wrist

Answer 205 205. Choice B is the correct answer. Burns other than superficial burns on face, feet, hands, and perineum qualifies for hospitalization per the guidelines for the Burn Care unit.

Question 206 206. Which of the following has been found to be an effective treatment for keloid scars? A. Oral steroid bursts B. Liquid nitrogen therapy C. Topical steroid ointment D. Intralesional triamcinolone E. Application of trichloroacetic acid

Answer 206 206. Choice D is the correct answer. The best effective treatment for keloid scars is intralesional triamcinolone.

Question 207 207. A 26-year-old female weighing 70 kg sustains second- and third-degree circumferential burns involving the entire right arm and left leg. Using the Rule-of-Nines to calculate the percentage of body surface area (TBSA) burned and the Parkland formula as a guide to fluid resuscitation, how much fluid should be given to this patient over the initial 24 hour period post burn injury? A. 7,560 mL B. 8,290 mL C. 9,640 mL D. 3,780 mL E. 5,320 mL

Question 207 207. Choice A is the correct answer. There is 27% TBSA burn x 70 kg x 4= Half should be given over the first eight hours and the other half should be given over the last 16 hours.

Question 208 208. Which of the following patients needs referral to a specialized burn treatment center? A. 20-year-old female with partial-thickness burns involving 7% total BSA B. 42-year-old male with partial-thickness burns of the dorsal forearm and wrist C. 10-year-old male with superficial solar burns of the legs, arms, and neck D. 34-year-old female with partial thickness burns from a lightning injury E. All of the above will require only outpatient treatment.

Answer 208 208. Choice D is the correct answer. A 34 year old female with partial thickness burns from lightning injury needs a burn center.

Question 209 209. In regards to wound management in the ED, what is the term used to describe when you clean and debride a wound then observe it for a period of 4 to 5 days after which it may be closed if no infection supervenes? A. Primary closure B. Tertiary closure C. Secondary closure D. Closure by neglect E. Secondary intention

Answer 209 209. Choice B is the correct answer. Tertiary closure is used to describe closing a wound when you clean and debride it and observe it for a period of 4-5 days.

Question 210 210. A 45 year-old white male presents with a chief complaint of a bleeding, scabbing sore on his nose that heals and recurs. You recognize it as the MOST common invasive malignant cutaneous neoplasm. Choose the BEST answer from the list below. Squamous Cell Carcinoma Malignant Melanoma Basal Cell Carcinoma Lentigo Maligna Superficial Spreading Melanoma

Answer 210 210. Choice C is the correct answer. This patient likely has a basal cell carcinoma.

Question 211 211. A 23 year-old white female presents with a chief complaint of a really painful bump on her right hip. It has been growing in size and the pain has really increased in the past 24 hours. Her vitals are: temperature, 99.8, BP 134/90, pulse 106, Respirations, 18. On physical exam you note a 3 cm red, warm nodule on her right hip right below her belt line. Your diagnosis is a carbuncle. From the choices below, select the BEST treatment for the primary management of this condition. Oral Antibiotics Benign neglect Intramuscular Antibiotics Incision, drainage and packing Warm compress and topical antibiotic

Answer 211 211. Choice D is the correct answer. This needs incision, drainage and packing.

Question 212 A 3 year-old child has dry, scaly plaques on the cheeks, spreading to the face, neck, wrists, antecubital and popliteal fossae over the past year and a half. For the past six months, the child has been scratching the areas intermittently. Which of the following is the MOST likely diagnosis? Impetigo Psoriasis Hemangioma Herpes Zoster Atopic dermatitis

Answer 212 212. Choice E is the correct answer. This child likely has atopic dermatitis.

Question 213 213. A 2 year-old is in for treatment of a URI when she is noted to have several coffee-brown birthmarks on the trunk and in the axilla. The largest measures 9 mm and the smallest 5 mm. Which of the following diseases is MOST likely to present with these skin lesions? A. Ehlers-Danlos syndrome B. Sturge-Weber disease C. Tuberous sclerosis D. Neurofibromatosis E. Down’s syndrome

Answer 213 213. Choice D is the correct answer. This child has neurofibromatosis.

Question 214 214. Upon performing a discharge physical for a neonate at 48 hours of age, you discover blotchy erythematous macules (2-3 cm in diameter) with a central pustule, most prominent on the chest but also apparent on the back, face and extremities. The MOST LIKELY diagnosis is: Milia Sebaceous gland hyperplasia Erythema toxicum neonatorum Miliaria Mottling

Answer 214 214. Choice C is the correct answer. This patient has erythema toxicum neonatorum.

Question 215 215. An 18 month-old child presents with a three day history of fever of 103 F. Last night the fever resolved, but now the child has an erythematous maculopapular rash on the chest and back. Which of the following is the MOST LIKELY diagnosis? Rubella Measles Scarlet fever Fifth’s disease Roseola

Answer 215 215. Choice E is the correct answer. This patient has Roseola characterized a resolving high fever for several days and then developing a erythematous maculopapular rash on chest and back.

Question 216 216. Which of the following present with Koplik’s spots?
Mumps Variola Measles Varicella Herpes simplex

Answer 216 216. Choice C is the correct answer. Measles presents with Koplik spots.

Question 217 217. When treating acne, all of the following are considered keratolytic agents, which normalize follicular keratinization, EXCEPT: Tretinoin (Retin-A) Azelaic acid (Azelex) Adapalene (Differin gel) Clindamycin 1% topical solution (Cleocin-T) Benzoyl peroxide

Answer 217 217. Choice D is the correct answer. Cleocin T is not a keratolytic agent.

Question 218 218. The BEST treatment for a 6-month old infant with scabies is: Lindane 1% lotion applied from chin to toes for 4 hours Permethrin 5% cream applied from chin to toes for 4 hours Ivermectin 200 mcg/kg po x 1 dose Malathion 0.5% lotion applied from chin to toes for 8-12 hours Mebendazole 100 mg po x 1 dose

Answer 218 218. Choice B is the correct answer. Permethrin 5% cream applied to chin to toes for 4 hours is the best treatment for infants with scabies.

Question 219 219. What is the MOST reliable way of making the early diagnosis of cellulitis? Blood cultures, CBC Aspirate specimens Biopsy specimens Erythema, edema, warmth, pain Wound cultures

Answer 219 219. Choice D is the correct answer. Cellulitis is diagnosed by palpating erythema, edema, warmth and pain.

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