1. Block 8 Pathology Exam 3
Bonus

2. Question 1
A 40-year-old woman consults a physician about a “mole” on her neck. The lesion is 2 cm in diameter, has irregular contours, and has a variegated dark red to brown to black color. Wide excision of the lesion demonstrates a malignant melanoma. The microscopic appearance of the lesion is shown in the figure. Which of the following stains has been used to show the presence of melanin pigment within tumor cells?
A) PAS
B) H&E
C) Fontana-Masson silver stain
D) Prussian blue
E) Masson trichrome

3. Question 2
A 5-year-old girl is brought to the physician by her parents for a routine health check-up. On physical examination the physician notices a large pigmented skin lesion that has developed increased hair growth. The gross appearance of the lesion is seen in the figure. Her parents state that the lesion has been present since birth and has not changed in appearance. Which of the following is the most likely diagnosis of the lesion?
A) Acanthosis nigricans
B) Congenital nevocellular nevus
C) Dermal nevus
D) Junctional nevus
E) Spitz nevus
Also called "garment" or "bathing trunk" nevi

4. Question 3
Which one of the pathologic conditions listed below and shown on the picture poses the greatest risk for the development of a malignant melanoma?
A) Blue nevus
B) Dysplastic nevus syndrome
C) Hermansky-Pudlak syndrome
D) Leser-Trelat syndrome
E) Staphylococcal scalded skin syndrome

5. Question 4
A 72-year-old man with no underlying medical conditions has several sharply demarcated brown macules and plaques, slightly raised, that look as if they are stuck on the surface of the skin. These lesions have been present for many years. They are not painful and they do not bleed. The gross appearance of the lesion is seen in the figure. Which of the following terms best describes these lesions?
A) Basal cell carcinoma
B) Junctional nevus
C) Keratoacanthoma
D) Seborrheic keratosis
E) Verruca vulgaris

6. Question 5
A 62-year-old man presents to the dermatology clinic because of a nodule on his left cheek. The lesion has been there for about 9 months, but lately it has become “crusty” and ulcerated. Physical examination shows a 1,5 cm shallow ulcer surrounded with a wide elevated border and covered with a crust that conceals a red granular base. The microscopic appearance of the lesion is seen in the figure. The most probable diagnosis is:
A) Squamous cell carcinoma
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Psoriasis
E) Mycosis fungoides

7. Question 6
A 30 year-old man presents 14 days after having a cold sore (herpes simplex infection). A symmetric eruption of mildly itching red macules, and papules that have a central dusky area (giving them a “target” appearance) develops on his extremities. The gross appearance of the rash is shown. Which of the following is the most likely diagnosis?
A) Pemphigus vulgaris
B) Psoriasis
C) Erythema multiforme
D) Urticaria
E) Staphylococcal scalded skin syndrome

8. Question 7
The type of microscope used to examine the image shown in the photograph is a(n):
A) Polarizing
B) Fluorescence
C) Electron
D) Phase contrast
E) Dark field

9. Question 8
A 23-year-old girl presented with multiple, tender, erythematous, 1- to 3-cm diameter, nodular swellings over the lower legs (shown) along with malaise and low-grade fever of 4 days’ duration. There was a history of sore throat 1 week prior to the skin lesions. Laboratory studies revealed an elevated ESR, a raised antistreptolysin O titer and a growth of Streptococcus pyogenes on throat swab culture. The most likely diagnosis is:
A) Psoriasis
B) Basal cell carcinoma
C) Malignant melanoma
D) Erythema nodosum
E) Nevocellular nevus

10. Question 9
A 57-year-old man presents with a slowly enlarging nodule on his right cheek. On physical examination there is a 0.7 mm waxy and translucent (pearly) nodule that shows a few teleangiectatic vessels on its surface. The lesion is excised and the microscopic appearance is shown. The most likely diagnosis is:
A) Malignant melanoma
B) Squamous cell carcinoma
C) Nevocellular nevus
D) Basal cell carcinoma
E) Verruca vulgaris

11. Question 10
A 36-year-old woman presents with a 3.0 cm diameter, pigmented lesion on the posterior aspect of her left calf (shown). The lesion is has enlarged during the past month and has bleed once. Based on the ABCD criteria this lesion is most likely a:
A) Seborrheic keratosis
B) Malignant melanoma
C) Basal cell carcinoma
D) Junctional nevus
E) Verruca vulgaris