Derm

Question 1

A 50 year old obese woman presents to clinic with skin-colored lesions on her neck. Based on the image, which of the following is the most likely diagnosis?

A) Acrochordons

B) Nodular basal cell carcinoma

C) Dermatofibromas

D) Seborrheic Keratoses

E) Common warts

Answer 1

A) Acrochordons

Question 2

A 60 year old female presents with a pruritic lesion on her back that is becoming more raised. (See photo). The most likely diagnosis is a

A) dermatofibroma

B) Flat wart

C) Melanoma

D) Seborrheic keratosis

E) Solar Lentigo

Answer 2

D) Seborrheic keratosis

Question 3

A 32-year-old male presents with an asymptomatic papule on his thigh that he noted following an inflamed hair follicle. It dimples on either side when squeezed. What is the most likely diagnosis?

A) Benign melanocytic Nevis

B) Dermatofibroma

C) epidermal inclusion cyst

D) keloid

E) Seborrheic keratosis

Answer 3

B) Dermatofibroma

Question 4

A 42 year-old African American woman presents with brown papules located around her eyes and on the malar cheeks. Several of her aunts were similarly affected at the same age. She would like them removed. Which of the following treatments is most likely to cause hypopigmentation?

A) liquid nitrogen

B) Low voltage electrodessication

C) Keratolytic moisturizer

D) Snip excision

Answer 4

A) Liquid nitrogen

Question 5

A 60-year-old woman presents with scattered light-brown macule on her dorsal hands and face, which have increased in number in recent years. They do not bleed and are otherwise unchanged. She works as a dog walker just outside of Los Angeles. Based on the image and history, what is the most likely diagnosis?

A) Actinic keratoses

B) Nodular basal cell carcinomas

C) Melanomas

D) Solar lentigines

E) Common warts

Answer 5

D) Solar lentigines

Question 6

Which of the following is a major criterion for neurofibromatosis(NF) 1 and an important finding to look on a physical exam when screening suspected patients?

A) Axillary freckling

B) Connective tissue nevus

C) Dental enamel pits

D) Facial angiofibromas

E) Hypopigmented macules

Answer 6

A) axillary freckling

Question 7

Patients with neurofirbomatosis 1 need to be followed closely for which of the following conditions?

A) Alopecia

B) Bradycardia

C) development delays and learning disabilities

D) Hematuria

E) Low blood pressure

Answer 7

C) development delays and learning disabilities

Question 8

The patient featured in the photographs below has reddish papules on the nose, chin, and medial cheeks. You notice many small, scattered hypopigmented macules, what other physical exam findings would suggest that this patient has tuberous sclerosis?

A) dental enamel pits

B) gingival fibromas

C) Larger hypopigmented macules

D) Periungual fibromas

E) All the above

Answer 8

E) all of the above Features of tuberous sclerosis include dental enamel pits, gingival fibromas, large hypopigmented macules and patches (“ash-leaf spots”), and periungual fibromas

Question 9

You refer a newborn to Genetics because you discovered 5 hypopigmented patches (all 1-2cm) during her newborn nursery skin exam. Genetic testing confirms tuberous sclerosis (TS). Which of the following is part of the recommended clinical management for patients with TS?

A) Annual electrocardiogram (ECG)

B) Annual liver ultrasound

C) annual orthopedic evaluation

D) Baseline magnetic resonance imaging (MRI) of the brain and electroencephalogram (EEG)

E) Monthly urinalysis

Answer 9

D) Baseline magnetic resonance imaging (MRI) of the brain and electroencephalogram (EEG) Due to CNS involvement and seizure potential, guidelines recommend MRI of the brain at diagnosis and every 1-2 years thereafter (in asymptomatic patients under 25 years of age). Guidelines also recommend a baseline EEG.

Question 10

Patients with Sturgeon-Weber Syndrome can have which of the following findings associated with their capillary malformations?

A) Bone erosion

B) Cysts

C) Engorged veins

D) Pulsation

E) Soft tissue overgrowth

Answer 10

E) Soft tissue overgrowth Presumably because of the underlying GNAQ mutation, capillary malformations can have associated soft tissue hypertrophy.

Question 11

Capillary malformations (port-wine stains) like the one seen here can be associated with leptomeningealangiomatosis and seizures in the setting of Sturgeon-Weber Syndrome (SWS). Which of the following is recommended? (On the face)

A) Referral to endocrinology to test for growth hormone deficiency

B) Referral to ophthalmology to screen for glaucoma

C) Referral to orthopedics to evaluate for leg-length discrepancy

D) Referral to otolaryngology to screen for airway involvement

E) all of the above

Answer 11

B) refer to ophthalmology to screen for glaucoma Port wine stains involving the skin around the eye (especially the eyelid) can be associated with glaucoma. They can arise at any time and can be congenital, so urgent ophthalmology referral is appropriate.

Question 12

The 7 year old girl has had 2 months of hair loss with scaling in a few small patches. This one of the front of her scalp is most noticeable. What is the first step in making the correct diagnosis?

A) bacterial culture

B) blood test for thyroid stimulating hormone

C) Fungal culture

D) No testing needed for Seborrheic dermatitis

E) Punch biopsy

Answer 12

C) Fungal culture

Question 13

A 10 year old boy has patches of hair loss with hairs of different lengths. His parents cut the hair short to try to prevent him from pulling on it. There is no scaling. What is the most likely diagnosis?

A) Alopecia areata B) early male pattern hair loss C) telogen effluvium D) tinea capitals E) Trichotillosis

Answer 13

E) Trichotillosis

Question 14

A 30 year old woman has two patches of hair loss that shed suddenly, but there are a few hairs growing within them. There is no scale, and the skin feels very smooth. What do you tell her about the prognosis?

A) aggressive treatment with oral medication is needed in most cases

B) Most patients with this condition progress to total baldness of the scalp

C) The hairs are likely to regrow on their own within 6-12 months

D) this condition is a sign of internal malignancy

E) This condition may lead to permanent scarring

Answer 14

C) the hairs are likely to regrow on their own within 6-12 months

Question 15

A 35 year old woman with normal menstrual periods complains of sudden hair loss throughout the scalp, over the past few weeks. She is not getting much sleep with her 6 month old breastfeeding throughout the night. She notices more hairs in the drain in the shower and on her hair brush. What is the most likely cause of this hair loss?

A) Adrenal tumor

B) Hyperthryoidism

C) medication - induced hair loss

D) pregnancy and delivery

E) Trichotillosis

Answer 15

D) Pregnancy and delivery

Question 16

This 58 year old woman complains of gradual hair loss starting on the top of her scalp. She’s worried about going bald and wants to ask your recommendation for treatment? What would you recommend first?

A) full endocrine workup with hormone levels

B) oral fin astride

C) oral spironolactone

D) Stop all medications

E) Topical minoxidil

Answer 16

E) Topical minoxidil

Question 17

A 45 year old woman complains of gradual loss of hair in the front of her scalp. There is similar change on the sides. What would you recommend to prevent further hair loss.

A) Biopsy to rule out other causes

B) wash the hair daily

C) Wear braids or extensions or weaves

D) wearing the hair in a natural, non pulling styles

E) Chemical relaxers twice a month

Answer 17

D) wear the hair in natural, non pulling styles

Question 18

A 36 year old woman presents with a year of progressive hair loss. She notices scaling around the hair follicles, a tender sensation, a shiny scalp without hair follicles in patches. What is the best course of action?

a) oral finasteride

B) reassureance that this will likely resolved n 6-12 months without intervention

C) recommended topical minoxidil

D) referral to a dermatologist

E) surgical hair transplant

Answer 18

D) Referral to a dermatologist

Question 19

A 43 year old woman presents to you for evaluation of white spots on her tongue that have been present for at least a month. They are not painful or itchy and do not bleed. She denies fever or pain with swallowing. Her PMHx is significant for HIV infection diagnosed 4 years ago. She has not been able to afford her HIV medications since losing insurance 6 months ago. Her most recent CD4 count a month ago was 152. Physical exam reveals white corrugated plaques on the lateral margins of the tongue that cannot be scarped off with a tongue blade. Which of the following is most likely to cause these lesions?

A) HPV

B) Epstein-Barr virus

C) Candida albicans

D) squamous cell carcinoma

E) Amelanotic melanoma

Answer 19

B) Epstein Barr

Question 20

A 28 year old woman presents to the clinic with a 6 month history of bumps near the anal area that are sometimes itchy and will occasionally bleed. On further history, you gather that she is transgender with an assigned male natal sex and currently identifies as female. She smokes daily though denies alcohol or illicit drug use. She has multiple sexual partners and engages in unprotected anal sex. She tells you that she has been treated for both syphillis and gonorrhea in the past. On examination, you note extensive soft, verrucous, vegetative, and exophytic plaques extending from the anal verge. There are no genital lesions. Which of the following is the next best step in management?

A) start HPV vaccination series

B) treat with cryotherapy

C) obtain serum HIV and RPR

d) perform a skin biopsy

E) refer to colorectal surgery

Answer 20

C) obtain serum HIV and RPR Given the extensive condylomata, social and behavioral risk factors, and history for multiple sexually transmitted infections. Critical to rule out HIV and syphillis.

Question 21

Your patient’s HIV testing returns positive, and her CD4 count is 75. She is started on HAART. A confirmatory skin biopsy shows condylaoma as well as high grade squamous intraepithelial lesion with high risk, oncogenic HPV detected on in-situ hybridization. You start ablative treatment on these lesions along with topical imiquimod. However, she continues to be concerned about a nonspecific anorectal pain, tenesmus, and worsening rectal bleeding. Which of the following is the next best step in management?

A) obtain a fecal occult blood test

B) referral for anal cytology and or high resolution anoscopy

C) stop treatment for condylomata and monitor for symptoms resolution

D) start abx for possible colitis

E) Direct to her primary care provider for tx for possible hemorrhoids 8

Answer 21

B) referral for anal typology and or high resolution anoscopy

Question 22

A 29 year old man with hx of alcohol abuse presents with asymptomatic purplish lesions on his palms, soles, and legs. He noticed this a few weeks ago and recalls have a sore spot on his penis several months ago that resolved on its own. He otherwise feels well. He is sexually active with both men and women and does not consistently use condoms. Which of the following is the next best step in management?

A) perform a Koch prep to rule out superficial fungal infection

B) take a thorough drug/medication history and obtain a hep C antibody

C) Prescribe topical steroids for symptomatic relief

D) Obtain serum RPR and HIV

E) reassure; this is a viral rash and will resolve on its own

Answer 22

D) obtain serum RPR and HIV

Question 23

A 34 year old woman presents with a diffuse, itchy rash of 3 weeks duration. The rash started near her chest and shoulders and has spread to the back, abdomen, arms, and legs. It is mildly pruritic. Her history is notable for recent diagnosis of HIV and was started on tenofovir/emtricitabine and eltigravir approx 5 weeks ago. Her initial viral load was 100 copies and CD4 was 490. On exam, there are coalescing erythematous plaques with trace overlying scale on the trunk, shoulders, and thighs with numerous discrete erythematous macules on the distal extremities. There is no mucosal involvement. She is afebrile and otherwise feels well. Which of the following is the next best step?

A) Immediately stop all meds and recommend staring a new antiretroviral regimen as this may be developing Stevens-Johnson syndrome

B) Reassure that this is the acute ex anthem of primary HIV infection

C) Start prednisone and slowly taper over 3 weeks

D) start abx for likely bacterial infection

E) Reassure that this is a benign drug reaction and prescribe a short course of triamcinolone for symptomatic relief

Answer 23

E) reassure that this is a benign drug reaction and prescribe a short course of triamcinolone for symptomatic relief

Question 24

A 3 day old male presents a 24 hour history of small white to yellow papules and pustules surrounded by erythematous (blotchy) skin. Areas involved include the face, trunk, and extremities. A swab taken from one of the pustules shows only numerous eosinophils. The patient is afebrile and otherwise healthy. What is the most like diagnosis?

A) congenital candidiasis

B) Erythema toxicum neonatorum

C) herpes simplex

D) viral exanthem

E) staphylococcal impetigo

Answer 24

B) Erythema toxicum neonatorum This case is a typical presentation of erythema toxicum neonatorum. It is a common condition of healthy and usually full-term infants. There are erythematous macules and papules that rapidly progress to flaccid pustules on an erythematous base. Pustules are loaded with eosinophils.

Question 25

An 18 day old female is brought to your office by her mother with a 5 day history of several red “pimples” on both cheeks. After examining the baby you tell mom that her baby has neonatal acne. Mom is breastfeeding and she is concerned that her diet which includes dairy and gluten could be affecting her baby. What can you tell her?

A) Babies with neonatal acne will develop severe acne during puberty

B) Neonatal acne is caused by breast milk of mothers who have a rich diet of dairy and gluten. Therefore she needs to change her diet

C) Neonatal acne is the result of an inflammatory reaction to Pityrosporum (malaise is) species. This is a self-limited condition and usually doesn’t require any treatment

D) Neonatal acne needs to be treated with an oral antibiotic for several weeks to avoid carrying

E) Neonatal acne is more common in breastfed infants and so she should stop breastfeeding and use formula

Answer 25

C)

Question 26

You received a call from the gynecology ward regarding a female newborn that presents with a widespread rash involving the face, trunk and extremities. Her lesions consist of pustules and hyperpigmented macules with discrete scaling, consistent with transient neonatal pusutlar Melanesia. You performed a swab. What do you expect to find in the smear?

A) budding yeast with pseudohyphae

B) langerhans cells

C) multinucleated giant cells or intranuclear inclusion bodies

D) numerous eosinophils and negative gram stain

E) numerous neutrophils and a negative gram stain

Answer 26

E) Numerous neutrophils and a negative gram stain These findings are typical of transient neonatal pustular melanosis

Question 27

A 5 day old male is admitted to the NICU for fever and blisters. Some of the vesicles you see in his body are pictured in the photograph. You suspect that the baby has neonatal herpes. Which of the following tests is not useful for confirming your suspicion.

A) detection of HSV antigens using rapid direct immune fluorescence assays or enzyme immunoassay

B) HSV PCR assay from surface sites or blood or cerebrospinal fluid

C) Isolation of HSV in culture from surface or bloods

D) testing the baby’s mom for herpes

E) Tzank-stained smears of lesions

Answer 27

D) Testing the baby’s mom for herpes

Question 28

You are consulted regarding a 10-day old baby boy that presents at birth with multiple reddish brown papules and nodules of different sizes, some with crusting located on the scalp, face, trunk and diaper area. Some areas look petechial. He is afebrile and has no other findings. What is the most likely diagnosis?

A) Acropustulosis of infancy

B) incontinetia pigmenti

C) langerhans cell histiocytosis

D) Neonatal lupus

E) Transient neonatal pustular melanosis

Answer 28

C) langerhans cell histiocytosis

Question 29

A 4-month old girl is brought in by her father due to cradle cap since birth. You notice several erythematous plaques and greasy scales on the scalp and retro-articular areas with several excoriation secondary to scratching. Mom has been using organic baby shampoo with no improvement. Which would be your management for this baby?

A) 10% salicylic acid ointment twice daily

B) low potency topical steroids and petrolatum or mineral oil

C) oral antibiotic to treat impetigo

D) Oral anti fungal

E) doensn’t require any treatment.

Answer 29

B) low potency topical steroids and petrolatum or mineral oil Petrolatum and mineral oil can help soften scales and allow for penetration of the low potency steroid that is used to treat the inflammatory component of Seborrheic dermatitis

Question 30

Heheheh

Answer 30

there we go

Question 31

A 49 year old woman was admitted to the hospital for fever and dyspnea and was treated for pneumonia complicated by uncontrolled diabetes. On day seven of her hospital stay, she developed bright red itchy spots on both of her legs but was afebrile and nearly ready fo discharge. What is the most likely diagnosis?

A) bacterial endocarditis

B) cellulitis caused by group a strep C) hospital acquired staphylococcus aureus cellulitis

D) Leukocytoclastic vasculitis from antibiotics

E) Septic emboli from an intravenous catheter

Answer 31

D) leukocytoclastic vasculitis from antibiotics

Question 32

A 43-year old diabetic male comes to the emergency department for six hours of an equisitely painful rapidly growing red and purple plaque on his left thigh that started with a small inflamed hair follicle or boil near a site of his insulin injections a day or two ago. The center has a small erosion and is darker than the surrounding tissue. The patient waited and hour in a gurney before being seen by the physician, and the nurse says the red and purple areas have grown about a centimeter in that time. The area is very tender to the touch. What is the next appropriate step?

A) High-dose prednisone intravenous

B) Head to toe computed tomography scan

C) lumbar puncture for cerebro spinal fluid examination

D) transfer to hyperbaric oxygen to treat loxoscelism

E) Urgent referral to surgical team

Answer 32

E) urgent referral to surgical team

Question 33

A 50 year old man complains of severe itching and redness on both legs for several weeks with some weeping. He has been afebrile and uses moisturizes or other over-the counter remedies twice daily. He can’t recall any history of leg swelling. What is the most likely diagnosis

A) Allergic contact dermatitis

B) asteatotic dermatitis

C) Cellulitis

D) Stasis dermatitis

E) Tinea corporals

Answer 33

A) allergic contact dermatitis

Question 34

A 42 year old woman complains of redness and pain on her left thigh for the past 2 days. It has started to have an odd shape moving up the leg and has a blister in the center. She has been afebrile. What is the most likely diagnosis?

A) allergic contact dermatitis

B) Herpes simplex virus

C) cellulitis

D) spider bite

E) stasis dermatitis

Answer 34

C) cellulitis

Question 35

A 52 year old woman complains of several days of itching, redness and tightness on both of her lower legs. Her legs swell during the day but are better after sleeping. She is afebrile.

A) allergic contact dermatitis

B) asteototic dermatitsi

C) Cellullitis

D) necrotizing fasciitis

E) stasis dermatitis

Answer 35

E) stasis dermatitis

Question 36

A 43 y/o diabetic male comes to the ED for six hours of an exquisitely painful rapidly growing red and purple plaque on his left thigh that started with a small inflamed hair follicle or boil near a site of his insulin injections a day or two ago. The center has a small erosion and is darker than the surrounding tissue. The patient waited an hour in a gurney before being seen by the physician, and the nurse says the red and purple areas have grown about a centimeter in that time. The area is very tender to the touch. What is the next appropriate step?

A. High-dose prednisolone IV

B. Head-to-toe CT scan

C. Lumbar puncture for CSF examination

D. Transfer for hyperbaric oxygen to treat loxoscelism

E. Urgent referral to surgical team

Answer 36

E. Urgent referral to surgical team

Question 37

You are consulted by general surgery about a new rash on this 16-year-old girl with these lesions scattered over her legs. Over the phone your colleague described the rash as “dark purple patch with overlying vesicle that does not fade when pressed on.” What is the most appropriate morphologic term for this finding?

A) erosion

b) macule
c) purpura
d) telangiectasia
e) violaceous erythema

Answer 37

c) purpura

Question 38

You see the patient, a 16-year-old with these lesions scattered over her legs and confirm she has petechiae and ecchymoses on her bilateral legs. They stop at her waist. She has mild abdominal pain, fatigue, myalgias, and arthralgias. Her vital signs are T99.0 HR94 RR12 Bp106/82. WBC are 14.5, platelets are 165,000, and PT/INR is normal. What is the most likely cause of her purpura?

a) External injury
b) hypocoagulable state
c) leukocytoclastic vasculitis
d) sepsis
e) scurvy

Answer 38

C) leukocytoclastic vasculitis

Question 39

A 28-year-old woman presents with scattered red macules on her legs, ankles, and feet that are neither painful or itchy. What is the next best step in diagnosis?

a) biopsy a lesion
b) culture the lesions
c) check to see if lesions blanch with pressure (diascopy)
d) perform a KOH test
e) preform a scratch test

Answer 39

c) dioscopy

Question 40

A 7-year-old boy presents to the urgent care clinic abdominal pain, joint aches, and a rash on his legs and feet. He does not have a history of frequent nosebleeds, easy bruising, or other episodes of abnormal bleeding. Based on the image and the patient’s history, what is the most likely diagnosis?

a) acute urticaria
b) disseminated intravascular coagulation
c) erythema nodosum
d) Henoch-Schonlein purpura
e) nutritional deficiency

Answer 40

d) Henoch-Schonlein purpura

Question 41

This is a 38-year-old man with a history of Crohn’s disease, recently treated with azathioprine and prednisone. He was well until 3 days ago when he reported worsening abdominal pain. No recent sick contacts or travel. He presented to the ED with somnolence, fever, abdominal pain and a new rash. Vital signs are T102.1 HR117, RR14, BP86/54. What is the most likely cause of his purpuric rash?

a) reaction to a medication
b) rocky mountain spotted fever
c) Related to sepsis
d) thrombocytopenia
e) clotting factor deficiency

Answer 41

c) related to sepsis

Question 42

This 69-year old woman has noticed an increase in these marks on her forearms in the past month or two. She feels otherwise well and her review of systems is negative except for pain in her knees, which has chronic and due to osteoarthritis. She takes hydrochlorothiazide for hypertension, naproxen twice daily for osteoarthritis, a multivitamin, ginseng, garlic, and fish oil. What is the next step in management of this patient?

a) biopsy
b) obtain CBC and coagulation panel
c) reassurance
d) start oral vitamin K
e) check iron stores

Answer 42

c) reassurance

Question 43

A 50 y/o man complains of severe itching and redness on both legs for several weeks and some weeping. He has been afebrile and uses moisturizers or other OTC remedies twice daily. He can’t recall any history of swelling. What is the most likely diagnosis.

A. Allergic contact dermatitis

B. Asteatotic dermatitis

C. Cellulitis

D. Stasis dermatitis

E. Tinea corporis

Answer 43

A. Allergic contact dermatitis

Question 44

A 42 y/o woman complains of redness and pain on her left thigh for the past 2 days. It has started to have an odd shape moving up the leg and has a blister in the center. She has been afebrile. What is the most likely diagnosis?

A. Allergic contact dermatitis

B. HSV

C. Cellulitis

D. Spider bite

E. Stasis dermatitis

Answer 44

C. Cellulitis

Question 45

A 52 y/o woman complains of several days of itching, redness and tightness on both her lower legs. Her legs swell during the day but are better after sleeping. She has been afebrile. What is the most likely diagnosis?

A. Allergic contact dermatitis

\B. Asteatotic dermatitis

C. Cellulitis

D. Necrotizing fasciitis

E. Stasis dermatitis

Answer 45

E. Stasis dermatitis