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PSBIM: PGH REVIEW > DERMA > Flashcards

DERMA Flashcards

1
Q

A patient presented to the Derma OPD with a periorbital weeping, eczematous skin lesion as shown. He noted that this started after switching to a new shaving cream brand. What is the diagnosis?

a. Allergic Contact Dermatitis
b. Bullous impetigo
c. Pemphigus vulgaris
d. Angioedema

A

The correct answer is: Allergic Contact Dermatitis

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2
Q

A patient consulted because of a “rash” that appeared on this abdomen. He noted that this appeared and worsened whenever he wore a particular pair of jeans. What is the best initial treatment for this patient?

a. Oral prednisone
b. Topical clobetasol
c. Bland emollients
d. Oral antihistamine

A

The correct answer is: Topical clobetasol

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3
Q

What drug causes the characteristic yellow discoloration seen?

a. Quinacrine
b. Clofazimine
c. Daunorubicin
d. Cyclophosphamide

A

The correct answer is: Quinacrine

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4
Q
  1. What type of adverse drug reaction is a acute generalized exanthematous pustulosis?
    a. Type IVa
    b. Type IVb
    c. Type IVc
    d. Type IVd
A

The correct answer is: Type IVd

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5
Q

What differentiates Stevens-Johnson Syndrome from Toxic Epidermal Necrolysis?

a. Extent of surface area involved
b. Depth of skin involvement
c. Presence of mucosal involvement
d. Type of offending drug

A

The correct answer is: Extent of surface area involved

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6
Q

A patient presented with generalized desquamation with involvement of the oral mucosa after intake of an unrecalled drug. Which of the following is a risk factor for poorer prognosis for this disease?

a. Gastrointestinal involvement
b. Younger age
c. Specific causative drug
d. Ethnicity

A

The correct answer is: Gastrointestinal involvement

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7
Q

Patients with moderate to severe affectation of this disease would sometimes require systemic therapy. Which of the following antibiotics is an appropriate choice?

a. Co-amoxiclav
b. Nafcillin
c. Oxacillin
d. Doxycycline

A

The correct answer is: Doxycycline

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8
Q

A 20/F presented with pruritus on her back and trunk. On examination, hypopigmented patches were seen. KOH smear was done which revealed the following findings. What is the diagnosis?

a. Tinea versicolor
b. Candidiasis
c. Verruca vulgaris
d. Seborrheic dermatitis

A

The correct answer is: Tinea versicolor

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9
Q

What is the classification of this dermatologic manifestation of SLE?

a. Acute
b. Subacute
c. Chronic
d. Discoid

A

The correct answer is: Acute

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10
Q

A 35/F consulted your clinic due to dandruff. On physical examination, there are demarcated papules with silvery scales on the scalp, onycholysis and punctate pitting of the nails. Which is TRUE regarding the clinical manifestations of this condition?

a. Skin lesions evolve quickly
b. Lesions are typically observed in the axilla, groin, navel, and submammary region
c. Disease may remit spontaneously.
d. Presence of infection aggravates skin lesions

A

Diagnosis: Psoriasis (C53, p.333)
A. Skin lesions evolve quickly - indolent
B. Lesions are typically observed in the axilla, groin, navel, and submammary region – This is inverse psoriasis. Typical distribution is on the flexor surfaces usually.
C. Disease may remit spontaneously. - rarely
D. Presence of infection aggravates skin lesions

The correct answer is: Presence of infection aggravates skin lesions

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11
Q

Most common variety of psoriasis?

a. Plaque-type
b. Pustular
c. Guttate
d. Inverse

A

The correct answer is: Plaque-type

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12
Q

Which represents the end stage of a variety of eczematous disorders?

a. Nummular Eczema
b. Lichen Planus
c. Lichen Simplex Chronicus
d. Asteatotic Eczema

A

Treatment is centered on breaking the cycle of itching & scratching
(C53, p. 331)

The correct answer is: Lichen Simplex Chronicus

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13
Q

A 50/M consulted your clinic due to pruritic rash on his shins. On physical examination, there are circular scaly plaques on both pretibial areas. Which is an appropriate treatment for this case?

a. High-potency glucocorticoid
b. Cetirizine for pruritus
c. Emollient for dry areas
d. Use sulfur soap to clean the area

A

Diagnosis: Nummular eczema (C53, p. 332)
Treatment is the same as atopic dermatitis.
A. High-potency glucocorticoid – low to mid-potency
B. Cetirizine for pruritus – sedating antihistamine
C. Emollient for dry areas
D. Use sulfur soap to clean the area – mild soap

The correct answer is: Emollient for dry areas

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14
Q

A 50/M with diabetes consulted your clinic due to ulcers on the distal lower extremities. On physical examination you noted varicosities, hyperpigmentation and pitting edema. Which is TRUE regarding the treatment of this case?

a. Antibiotic therapy is given to clear all bacterial growth in the ulcer.
b. Glucocorticoids should be applied to the ulcer to accelerate wound healing.
c. Ulcers should be covered with an occlusive dressing.
d. Compression stockings with a gradient of 30-40 mmHg should be used.

A

Diagnosis: Stasis dermatitis (C53, p. 332)
A. Antibiotic therapy is given to clear all bacterial growth in the ulcer. – ulcers tend to be colonized but not are not necessarily infected
B. Glucocorticoids should be applied to the ulcer to accelerate wound healing. – will RETARD wound healing but may be applied in SURROUNDING area
C. Ulcers should be covered with an occlusive dressing. - semipermeable
D. Compression stockings with a gradient of 30-40 mmHg should be used.

The correct answer is: Compression stockings with a gradient of 30-40 mmHg should be used.

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15
Q

A 48/F consulted your clinic due to bipedal edema of 1 year duration. It is usually worse at the end of the day, after prolonged standing. On physical examination, you observed the presence of varicose veins, and brawny edema of the distal lower extremities with scaling and hyperpigmentation. Which is TRUE regarding the pathophysiology of this condition?

a. Typical initial site of involvement is the medial aspect of the ankle
b. Hyperpigmentation is due to the proliferation of subdermal fibrocytes
c. The brawny edema observed is due to hemosiderin deposition
d. Ulceration precedes the development of edema

A

Diagnosis: Stasis dermatitis (C53, p. 332)
A. Typical initial site of involvement is the medial aspect of the ankle
B. Hyperpigmentation is due to the proliferation of subdermal fibrocytes – hemosiderin deposition
C. The brawny edema observed is due to hemosiderin deposition – dermal fibrosis
D. Ulceration precedes the development of edema – stasis dermatitis precedes ulceration

The correct answer is: Typical initial site of involvement is the medial aspect of the ankle

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16
Q

Seborrheic dermatitis commonly overlaps with which skin condition?

a. Atopic Dermatitis
b. Nummular Eczema
c. Stasis Dermatitis
d. Psoriasis

A

D. Psoriasis – hence the term “Sebopsoriasis”

The correct answer is: Psoriasis

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17
Q

A 45/F consulted your clinic due to dandruff. On physical examination you noted erythematous patches on the nasolabial fold, scalp, and eyebrows. What is the first line agent?

a. Clobetasol
b. Ciclopirox
c. Urea lotion
d. Tacrolimus

A 
Diagnosis: Seborrheic dermatitis (C54, p. 333)
A. Clobetasol
B. Ciclopirox – an antifungal
C. Urea lotion
D. Tacrolimus

The correct answer is: Ciclopirox

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18
Q

A 50/M just returned from a winter vacation in Hokkaido, Japan and is consulting for burning and itchy sensation on both shins. On physical examination you observed dry, cracked skin in the pretibial area with some scaling. What is the diagnosis?

a. Asteatotic Eczema
b. Atopic Dermatitis
c. Lichen Simplex Chronicus
d. Nummular Eczema

A

A. Asteatotic Eczema – dry skin exacerbated by the dry, cold weather
B. Atopic Dermatitis
C. Lichen Simplex Chronicus
D. Nummular Eczema

The correct answer is: Asteatotic Eczema

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19
Q

A 48/F consulted your clinic due to cracked skin on her hands. She works as a laundrywoman and cleaner. On physical examination, you observed vesicles on the palms and lateral aspects of her fingers, some of which had erythematous bases and purulent discharge. Which of the following is an appropriate management for this case?

a. Advise patient to use latex gloves whenever her hands are exposed to water, detergents, and harsh chemicals.
b. Hot moist compress should be applied to the lesions.
c. Mid- to high-potency glucocorticoid ointment
d. Empiric coverage for dermatophyte infection.

A

Diagnosis: Dyshydrotic eczema (C53, p. 332)
A. Advise patient to use latex gloves whenever her hands are exposed to water, detergents, and harsh chemicals. - vinyl
B. Hot moist compress should be applied to the lesions. – cold moist
C. Mid- to high-potency glucocorticoid ointment
D. Empiric coverage for dermatophyte infection. - bacterial

The correct answer is: Mid- to high-potency glucocorticoid ointment

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20
Q

A 50/M consulted your clinic due to an erythematous plaque on his hypogastric area (from his belt buckle).

What is your diagnosis?
a. Psoriasis
b. Lichen simplex chronicus
c. Irritant Contact Dermatitis
D. Allergic Contact Dermatitis
A

D. Allergic Contact Dermatitis – from his belt buckle

The correct answer is: Allergic Contact Dermatitis

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21
Q

How many grams of a topical agent is required to cover the entire body surface of an average adult?

a. 20 g
b. 30 g
c. 40 g
d. 50 g

A

The correct answer is: 30 g

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22
Q

A patient is on pimecrolimus cream for atopic dermatitis. Which of the following is a side effect of this medication?

a. Lymphoma
b. Adrenal insufficiency
c. Skin atrophy
d. Rosacea

A

A. Lymphoma
B. Adrenal insufficiency – topical glucocorticoid
C. Skin atrophy – topical glucocorticoid
D. Rosacea – topical glucocorticoid

The correct answer is: Lymphoma

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23
Q

TRUE regarding non-pharmacologic management of Atopic Dermatitis

a. Frequent and prolonged bathing is recommended
b. Moisturizers are best applied immediately after bathing
c. Sulfur soap should be used when bathing
d. Anti-bacterial wash with dilute sodium hypochlorite are useful for prevention of secondary skin infections.

A

A. Frequent and prolonged bathing is recommended – no more often than daily
B. Moisturizers are best applied immediately after bathing
C. Sulfur soap should be used when bathing – mild soap should be used
D. The initial use of doxycycline or clindamycin is preferable for secondary infection of eczematous skin lesions. – Dicloxacillin or cephalexin is preferable.

The correct answer is: Moisturizers are best applied immediately after bathing

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24
Q

A 20/F consulted your clinic due to pruritic plaques on both popliteal fossae for the past 6 months. On physical examination, you observed xerotic skin and lichenified plaques on both popliteal fossae. Which of the following is an appropriate treatment to give?

a. High-potency topical glucocorticoid
b. Cetirizine
c. Tacrolimus ointment
d. Clindamycin

A

A. High-potency topical glucocorticoid – NOT recommended for intertriginous areas
B. Cetirizine – non-sedating antihistamines are of little use in controlling pruritus of AD
C. Tacrolimus ointment – non-glucocorticoid anti-inflammatory that may be used in intertriginous areas
D. Clindamycin – appropriate IF secondary infection is present

The correct answer is: Tacrolimus ointment

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25
Q

A 25/F consulted due to pruritus. She also has allergic rhinitis. Her siblings have bronchial asthma. Which is TRUE regarding the clinical presentation of her condition?

a. Allergic rhinitis coexists in 80% of patients with this condition.
b. Lesions are typically distributed on the extensor surfaces.
c. For majority of patients, the onset of disease occurs during adulthood.
d. Weeping inflammatory patches are characteristic lesions in adults.

A

A. Allergic rhinitis coexists in 80% of patients with this condition.
B. Lesions are typically distributed on the extensor surfaces. – flexural such as antecubital and popliteal fossae
C. For majority of patients, the onset of disease occurs during adulthood.
D. Weeping inflammatory patches are characteristic lesions in adults. – infantile pattern

The correct answer is: Allergic rhinitis coexists in 80% of patients with this condition.

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26
Q

What is the typical histologic pattern of eczema?

a. Presence of melanocytic segments
b. Inflammatory cell infiltration of the dermis
c. Dermal fibrosis
d. Spongiosis

A

Eczema typically presents histologically with spongiosis or intercellular edema of the epidermis.

The correct answer is: Spongiosis

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27
Q 
A 28/M consulted your clinic due to pruritus for the past 2 months. Physical examination revealed hyperpigmentation, lichenification and scaling of the antecubital fossae
What is your diagnosis?
a. Allergic Contact Dermatitis
b. Atopic Dermatitis
c. Irritant Contact Dermatitis
d. Psoriasis
A

Hyperpigmentation, lichenification and scaling of the antecubital fossae (p. 330). Photo from HPIM F53-1.

The correct answer is: Atopic Dermatitis

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28
Q

Which cancer is associated with paraneoplastic pemphigus?

a. Acute myelocytic leukemia
b. Small cell lung cancer
c. Non-Hodgkin’s lymphoma
d. Papillary thyroid cancer

A

The correct answer is: Non-Hodgkin’s lymphoma

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29
Q

Which represents the end stage of a variety of eczematous disorders?

a. Nummular Eczema
b. Lichen Planus
c. Lichen Simplex Chronicus
d. Asteatotic Eczema

A

The correct answer is: Lichen Simplex Chronicus

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30
Q

What is the most common variety of psoriasis?

a. Plaque type
b. Guttate
c. Pustular
d. Inverse

A

The correct answer is: Plaque type

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31
Q

A 70/M consulted due to a papule on his face. Physical examination showed a large dome-shaped with a central keratotic crater. What is the diagnosis?

a. Actinic keratosis
b. Basal cell cancer
c. Melanoma
d. Squamous cell cancer

A

D. Squamous cell cancer – the lesion being described is a keratoacanthoma

The correct answer is: Squamous cell cancer

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32
Q

A 65/M was diagnosed with superficial basal cell carcinoma. What is the treatment of choice for this patient?

a. Wide excision
b. Electrodessication and curettage
c. Sonidegib
d. Laser therapy

A

A. Wide excision – for invasive, ill-defined and aggressive tumors
B. Electrodessication and curettage – most commonly employed method
C. Sonidegib – metastatic or advanced BCC
D. Laser therapy

The correct answer is: Electrodessication and curettage

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33
Q

Best predictor of metastatic risk for malignant melanoma?

a. Breslow thickness
b. Anatomic site of primary
c. Radial size of the primary lesion
d. Age

A

A. Breslow thickness
B. Anatomic site of primary – also prognostic
C. Radial size of the primary lesion - thickness
D. Age – effect of age is not straightforward

The correct answer is: Breslow thickness

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34
Q

Most common histologic subtype of malignant melanoma?

a. Lentigo maligna
b. Superficial spreading
c. Nodular
d. Acral lentiginous

A

The correct answer is: Superficial spreading

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35
Q

A 50/M consulted due to an enlarging mole on his nose. He is worried that it might be cancerous as his father was diagnosed with melanoma at age 60. Which is TRUE regarding risk factors for skin cancer?

a. First-degree relatives have a threefold risk of developing melanoma than those without a family history.
b. Majority of melanomas are familial.
c. The actual risk of transformation of nevus into melanoma is high
d. The presence of multiple nevi is one of the strongest risk factors

A

A. First-degree relatives have a threefold risk of developing melanoma than those without a family history. – twofold
B. Majority of melanomas are familial. – only 5-10% are truly familial
C. The actual risk of transformation of nevus into melanoma is high - LOW
D. The presence of multiple nevi is one of the strongest risk factors

The correct answer is: The presence of multiple nevi is one of the strongest risk factors

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36
Q

A 28/M with HIV consulted due to painful vesicles on the lateral aspect of his thumb. Which is an appropriate treatment for this condition?

a. Acyclovir
b. Topical betamethasone
c. Clindamycin
d. Oral Prednisone

A

Diagnosis is herpetic whitlow (C197, p. 1442)

The correct answer is: Acyclovir

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37
Q

Which dermatologic condition may be the FIRST indication of immunodeficiency in patients with HIV infection?

a. Seborrheic dermatitis
b. Eosinophilic pustular folliculitis
c. Reactivation herpes zoster
d. Recurrent herpes simplex

A

A. Seborrheic dermatitis – increases in prevalence & severity as CD4+ counts decline
B. Eosinophilic pustular folliculitis
C. Reactivation herpes zoster – indicates modest decline
D. Recurrent herpes simplex – increase in frequency with declining CD4+ counts

The correct answer is: Reactivation herpes zoster

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38
Q

Most common dermatologic problem in patients with HIV infection?

a. Seborrheic dermatitis
b. Folliculitis
c. Ichthyosis
d. Reactivation herpes zoster

A

A. Seborrheic dermatitis – occurs up to 50% of patients with HIV
B. Folliculitis – 20%
C. Ichthyosis – not increased in frequency, but if present may be severe
D. Reactivation herpes zoster – 10-20%

The correct answer is: Seborrheic dermatitis

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39
Q

Which cancer is associated with paraneoplastic pemphigus?

a. Acute myelocytic leukemia
b. Small cell lung cancer
c. Non-Hodgkin’s lymphoma
d. Papillary thyroid cancer

A 
Other neoplasms associated with PP 
Chronic lymphocytic leukemia
Thymoma
Spindle cell tumors
Waldenström’s macroglobulinemia
Castleman’s disease
(C55, p. 357)

The correct answer is: Non-Hodgkin’s lymphoma

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40
Q

A 75/M was referred due to bullae formation on the trunk. On physical examination, there are tense vesicles & bullae on the trunk with erythematous urticarial bases. The lesions are non-pruritic and there are no oral lesions. What is the diagnosis?

a. Pemphigus vulgaris
b. Bullous pemphigoid
c. Pemphigus foliaceus
d. Epidermolysis bullosa acquisita

A

A. Pemphigus vulgaris – has mucosal involvement
B. Bullous pemphigoid
C. Pemphigus foliaceus – crusts & shallow erosions on scalp, central face, upper chest, and back
D. Epidermolysis bullosa acquisita – blisters, erosions, scars, and milia on sites exposed to trauma; widespread; tense blisters may be seen initially

The correct answer is: Bullous pemphigoid
Question 40

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41
Q

Which of the following is a skin biopsy finding in discoid lupus erythematosus?

a. Acantholysis in suprabasal epidermis
b. Sparse infiltrate of mononuclear cells in the dermis
c. Hydropic degeneration of basal keratinocytes
d. Epidermal atrophy

A

A. Acantholysis in suprabasal epidermis – pemphigus vulgaris
B. Sparse infiltrate of mononuclear cells in the dermis – acute cutaneous lupus
C. Hydropic degeneration of basal keratinocytes – acute cutaneous lupus
D. Epidermal atrophy – chronic/discoid lupus

The correct answer is: Epidermal atrophy

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42
Q

Which of the following cutaneous manifestations are seen in ACUTE cutaneous lupus?

a. Evanescent erythema of upper chest
b. Psoriasiform eruption on chest and back
c. Discoid rash
d. Papulosquamous eruption on extensor surfaces

A

Feedback
A. Evanescent erythema of upper chest
B. Psoriasiform eruption on chest and back - subacute
C. Discoid rash - chronic
D. Papulosquamous eruption on extensor surfaces - subacute

The correct answer is: Evanescent erythema of upper chest

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43
Q

Which skin finding is seen in dermatomyositis but is rare in lupus and scleroderma?

a. Raynaud’s phenomenon
b. Poikiloderma
c. Malar rash
d. Sclerodactyly

A

B. Poikiloderma - areas of hypopigmentation, hyperpigmentation, mild atrophy, and telangiectasia

The rest of the findings may be seen in SLE, Scleroderma or overlap syndromes.

The correct answer is: Poikiloderma
Question 37

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44
Q

A 25/M consulted due to fever. On physical examination, there are palpable nonblanching purpura on the lower extremities. Which is the LEAST likely differential?

a. Staphylococcal scalded skin syndrome
b. Ecthyma gangrenosum
c. Henoch-Schonlein purpura
d. Meningococcemia

A

Diagnosis is meningococcemia. (C54, p. 353)
A. Staphylococcal scalded skin syndrome - only one that presents as bullae & not purpura
B. Ecthyma gangrenosum
C. Henoch-Schonlein purpura
D. Meningococcemia

The correct answer is: Staphylococcal scalded skin syndrome

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45
Q

A 40 year old obese male consulted due to hyperpigmentation in his neck and flexural areas. What test should be ordered?

a. Fasting blood sugar
b. Thyroid function test
c. 8 am serum cortisol
d. Fasting insulin

A

Diagnosis is vitiligo.
Most common associated disorder is autoimmune thyroid disorder

The correct answer is: Fasting blood sugar

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46
Q

A 38/F consulted due to hypopigmented patches on her face and hands. What is the disorder that is most frequently associated with this condition?

a. Addison’s disease
b. Type 1 Diabetes Mellitus
c. Hashimoto’s Thyroiditis
d. Pernicious anemia

A

Diagnosis is vitiligo.
Most common associated disorder is autoimmune thyroid disorder

The correct answer is: Hashimoto’s Thyroiditis

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47
Q

A 30/F consulted due to red rash on her face and hands. On physical examination, there are oval macules less than 1 cm, which on closer inspection turned out to be telangiectasias. This patient needs to be worked up for what disease?

a. Hereditary hemorrhagic telangienctasia
b. Dermatomyositis
c. Systemic Lupus Erythematosus
d. Scleroderma

A

These are mat telangiectasias seen in scleroderma
Most common locations = sites prone to ischemia such as face, hands, oral mucosa

The correct answer is: Scleroderma

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48
Q

Which drug can cause anagen effluvium?

a. Colchicine
b. Daunorubicin
c. Warfarin
d. Lithium

A

The rest cause diffuse hair loss, usually by inducing a telogen effluvium

The correct answer is: Daunorubicin

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49
Q

A 48/F consulted the clinic due to baldness. On physical examination, a male-pattern baldness was observed. Which work-up is indicated in her case?

a. Dehydroepiandrosterone sulfate (DHEAS)
b. KOH smear & Woods Lamp examination
c. TSH, FT4, FT3
d. Scalp biopsy

A

Male pattern baldness points to hyperandrogenism. She needs to be worked up for possible adrenal or ovarian sources of hyperandrogenism

The correct answer is: Dehydroepiandrosterone sulfate (DHEAS)

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50
Q

A 35/F was admitted due to fever and cough. She has a history of being treated for eczema of the knees and elbows. On physical examination, you observed generalized skin erythema with some areas studded with pustules. What is the diagnosis?

a. Exfoliative dermatitis
b. Pityriasis rubra pilaris
c. Pustular psoriasis
d. Sezary syndrome

A

History of eczema on knees and elbows points to psoriasis.
The presence of concomitant infection triggered the erythroderma.

The correct answer is: Pustular psoriasis

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51
Q

A 29/M consulted your clinic due to a palmoplantar papular eruption associated with myalgia. What physical examination finding should be sought out?

a. Scarring alopecia
b. Condyloma lata
c. Nail pitting
d. Wickham’s striae

A

Diagnosis: Secondary Syphilis
Eruption may resemble pityriasis rosea
Condyloma lata is an associated finding that will be helpful in clinching the diagnosis

The correct answer is: Condyloma lata

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52
Q

A 48/F consulted your clinic due to scaly plaques of 6 months duration. She was previously told she had eczema and was prescribed topical steroids but her lesions failed to improve. Skin biopsy of the lesion showed atypical lymphocytes in the epidermis and dermis. What is the diagnosis?

a. Bowen’s Disease
b. Lichen Planus
c. Mycosis Fungoides
d. Psoriasis

A

May be confused with eczema or psoriasis in its early stages
Fails to respond to therapy to those disease
May develop within lesions of large-plaque parapsoriasis
Skin Bx: Atypical T lymphocytes

The correct answer is: Mycosis Fungoides

53
Q

Most common malignancy associated with erythroderma?

a. Cutaneous T Cell Lymphoma
b. Non-Small Cell Lung Cancer
c. HTLV-1 Associated Adult T Cell Leukemia
d. Hodgkin’s Lymphoma

A

There have been isolated case reports of erythroderma secondary to some solid tumors—lung, liver, prostate, thyroid, and colon

The correct answer is: Cutaneous T Cell Lymphoma

54
Q

A 25/M consulted your clinic due to an itchy rash of 3 weeks duration. It started as a red papule on the trunk followed by the appearance of red circular pruritic lesions. There is no involvement of the palms or soles. What is the diagnosis?

a. Secondary Syphilis
b. Pityriasis Rosea
c. Psoriasis
d. Nummular Eczema

A

Red papule = herald patch
Predilection site = trunk
Red circular lesions follow the herald patch.
Secondary syphilis is a close DDx = distinguished by palm & sole involvement in syphilis

The correct answer is: Pityriasis Rosea

55
Q

A 40/M consulted your clinic due to pruritic papules and plaques on his wrist (multiple flat-topped, violaceous papules and plaques). On physical examination, you also observed nail dystrophy.

What is your diagnosis?

a. Lichen planus
b. Psoriasis
c. Pityriasis Rosea
d. Dermatophytosis

A

Both Psoriasis & Lichen Planus have nail dystrophy.
Note the multiple flat-topped, violaceous papules and plaques on the picture.

The correct answer is: Lichen planus

56
Q

A 35/F has psoriasis and arthritis and was advised to start systemic therapy. The patient has not been compliant with previous medications as she kept forgetting to take them. Which medication would be appropriate to give to her?

a. Methotrexate
b. Acitrecin
c. Cyclosporine
d. Apremilast

A

A. Methotrexate – the only one among the choices that is dosed once weekly making it better for compliance

The correct answer is: Methotrexate

57
Q

A 32/F has psoriasis, spondylitis & arthritis. Which biologic agent is efficacious for both conditions?

a. Certolizumab pegol
b. Golimumab
c. Ixekizumab
d. Secukinumab

A

A. Certolizumab pegol – Psoriatic arthritis (PsA)
B. Golimumab – Psoriatic arthritis (PsA)
C. Ixekizumab – Psoriasis (Ps)
D. Secukinumab – PsA & Ps

The correct answer is: Secukinumab
Question 23

58
Q

A 25/F has a solitary silvery plaque on her right elbow. There are no other skin lesions nor nail changes on physical examination. Which is an appropriate treatment to give?

a. Anthralin
b. Coal Tar
c. Calcipotriene
d. Salicylic Acid

A 
Diagnosis: Limited Psoriasis
A. Anthralin
B. Coal Tar
C. Calcipotriene – topical Vitamin D analogue which has replaced these other choices for limited psoriasis
D. Salicylic Acid

The correct answer is: Calcipotriene

59
Q

Which of the following treatments for psoriasis is correctly matched with the adverse effect?

a. Tazarotene – skin cancer
b. Oral glucocorticoid – pustular psoriasis
c. Apremilast – teratogenicity
d. Acitrecin – pancytopenia

A

A. Tazarotene – skin cancer (Psoralens are the ones which predisposes to skin cancer. Tazarotene is a topical retinoid)
B. Oral glucocorticoid – pustular psoriasis
C. Apremilast – teratogenicity (Hypersensitivity, GI symptoms)
D. Acitrecin – pancytopenia (Teratogenicity, as it is a retinoid)

The correct answer is: Oral glucocorticoid – pustular psoriasis

60
Q

A 28/M has erythematous scaly plaques on both knees and elbows. On physical examination, you observed sausage digits. What other disease will he need to be screened for?

a. Diabetes
b. Hepatitis A
c. Bronchial asthma
d. Colon cancer

A

Diagnosis is plaque-type psoriasis with psoriatic arthritis. Given increased risk of metabolic syndrome, he needs to be screened for diabetes. In case he would need immunosuppressive therapy, he will also need to be screened for TB, HIV, and Hepatitis B or C.

The correct answer is: Diabetes

61
Q

A 48/M consulted due to the presence of an annular plaque on his arm. On physical examination, the plaque is hypopigmented with raised edges and is anesthetic. What is your diagnosis?

a. Psoriasis
b. Tinea corporis
c. Leprosy
d. Granuloma annulare

A

a well-defined, hypopigmented, anesthetic macule with anhidrosis and a raised granular margin

The correct answer is: Leprosy
Question 50

62
Q

True of furunculosis: (HPIM 20th, Chapter 53, p335)

a. Caused by Group A Streptococcus
b. Characterized by annular scaly plaques
c. Family members or close contacts may also be affected
d. Treatment include topical selenium sulfide lotion or azoles

A
  • Caused by S. aureus, and this disorder has gained prominence in the last decade because of CA-MRSA
  • Painful, erythematous nodule that can occur on any cutaneous surface
  • Family members or close contacts may also be affected
  • Furuncles can rupture and drain spontaneously or may need incision and drainage, which may be adequate therapy for small solitary furuncles without cellulitis or systemic symptoms
  • Whenever possible, lesional material should be sent for culture
  • Current recommendations for methicillin-sensitive infections are β-lactam antibiotics
  • Warm compresses and nasal mupirocin are helpful therapeutic additions
  • Severe infections may require IV antibiotics

The correct answer is: Family members or close contacts may also be affected

63
Q

A 7/M was referred for evaluation of rash. On PE, pustules with honey colored crusts were seen around his mouth. This condition is best prevented by: (HPIM 20th, Chapter 143, p1085)

a. Attention to adequate hygiene
b. Application of topical mupirocin
c. Prophylaxis with either a dicloxacillin or cephalexin
d. None of the above

A
  • Colonization of unbroken skin with GAS precedes clinical infection
  • Minor trauma, such as a scratch or an insect bite, may then serve to inoculate organisms into the skin
  • Impetigo is best prevented, therefore, by attention to adequate hygiene
  • Usual sites of involvement are the face (particularly around the nose and mouth) and the legs, although lesions may occur at other locations
  • Dicloxacillin or cephalexin can be given at a dose of 250 mg four times daily for 10 days
  • Topical mupirocin ointment is also effective

The correct answer is: Attention to adequate hygiene

64
Q

Characterized by honey-colored crusted papules, plaques or bullae caused by infection with Group A Streptococcus and S. aureus: (HPIM 20th, Chapter 53, p336)

a. Tinea versicolor
b. Candidiasis
c. Impetigo
d. Dermatophytosis

A

The correct answer is: Impetigo

65
Q

A 51-year old obese female consulted because of pruritic rash at inframammary region. PE showed edematous, erythematous and scaly lesion with satellite pustules. What will you prescribe? (HPIM 20th, Chapter 53, p336)

a. Topical clotrimazole
b. Lotion containing salicylic acid
c. Topical moisturizers
d. Pimecrolimus cream

A

• Affinity for sites chronically wet and macerated, including the skin around nails (onycholysis and paronychia), and in intertriginous areas
• Intertriginous lesions are characteristically edematous, erythematous, and scaly, with scattered “satellite pustules
• Treatment involves removal of any predisposing factors such as anti- biotic therapy or chronic wetness
• Topical nystatin or azoles (miconazole, clotrimazole, econazole, or ketoconazole)
• Mild glucocorticoid lotion or cream (2.5% hydrocortisone)
• Systemic therapy is usually reserved for immunosuppressed patients or individuals with chronic or recurrent disease who fail to respond to appropriate topical therapy
o Oral fluconazole

The correct answer is: Topical clotrimazole

66
Q

A 34/F was referred due to multiple warts on the face and neck. PE showed multiple sessile, dome-shaped lesions. The most useful and convenient method for treating warts in almost any location is: (HPIM 20th, Chapter 53, p337)

a. Salicylic acid plasters or solutions
b. Cryotherapy with liquid nitrogen
c. Podophyllin solution
d. Topical imiquimod

A
  • Caused by papillomaviruses
  • Filiform warts are most commonly seen on the face, neck, and skinfolds
  • Cryotherapy with liquid nitrogen: most useful and convenient method for treating warts in almost any location

The correct answer is: Cryotherapy with liquid nitrogen

67
Q

Most common location for acne: (HPIM 20th, Chapter 53, p337)

a. Face
b. Back
c. Chest
d. Extremities

A

The correct answer is: Face

68
Q

Which of the following statement is correct regarding use of isotretinoin in patients with acne vulgaris? (HPIM 20th, Chapter 53, p338)

a. Dose is based on patient’s weight
b. Isotretinoin is given twice daily for 5 months
c. Its use is highly regulated due to its potential for severe adverse events, primarily teratogenicity and anxiety
d. All female patients should have two negative pregnancy tests prior to initiation of therapy

A
  • Patients with severe nodulocystic acne unresponsive to the therapies discussed above may benefit from treatment with the synthetic retinoid isotretinoin
  • Its dose is based on the patient’s weight, and it is given once daily for 5 months
  • Its use is highly regulated due to its potential for severe adverse events, primarily teratogenicity and depression
  • All female patients have two negative pregnancy tests prior to initiation of therapy and a negative pregnancy test prior to each refill

The correct answer is: Dose is based on patient’s weight

69
Q

A 14/M consulted due to pimples seen on his forehead. PE showed mildly inflammed comedones. True regarding its treatment except: (HPIM 20th, Chapter 53, p338)

a. Retinoic acid, benzoyl peroxide or salicylic acid may alter pattern of epidermal desquamation, preventing the formation of comedones
b. Minimal to moderate pauci-inflammatory disease may respond adequately to local therapy alone
c. Severe nodulocystic acne unresponsive to topical agents may benefit from treatment with isotretinoin
d. Oral contraceptives are not approved for use in the treatment of acne vulgaris.

A
  • Minimal to moderate pauci-inflammatory disease may respond adequately to local therapy alone
  • Overly vigorous scrubbing may aggravate acne due to mechanical rupture of comedones
  • Retinoic acid, benzoyl peroxide, or salicylic acid may alter the pattern of epidermal desquamation, preventing the formation of comedones and aiding in the resolution of preexisting cysts
  • Topical antibacterial agents (such as azelaic acid, erythromycin, clindamycin, or dapsone) are also useful adjuncts to therapy
  • Patients with moderate to severe acne with a prominent inflam- matory component will benefit from the addition of systemic therapy, such as tetracycline in doses of 250–500 mg bid or doxycycline in doses of 100 mg bid
  • Several oral contraceptives are now approved by the FDA for use in the treatment of acne vulgaris
  • Patients with severe nodulocystic acne unresponsive to the thera- pies discussed above may benefit from treatment with the synthetic retinoid isotretinoin

The correct answer is: Oral contraceptives are not approved for use in the treatment of acne vulgaris.

70
Q

True of urticaria: (HPIM 20th, Chapter 56, p366)

a. Most frequent type of cutaneous reaction to drugs
b. Characterized by blanching erythematous macules and papules
c. May be caused by an IgE-dependent mechanism, circulating immune complexes, or nonimmunologic activation of effector pathways
d. Rechallenge may be done in an outpatient setting

A
  • Second most frequent type of cutaneous reaction to drugs
  • Characterized by pruritic, red wheals of varying size rarely lasting more than 24 hours
  • Observed in association with nearly all drugs, most frequently ACE inhibitors, aspirin, NSAIDs, penicillin, and blood products
  • Drug-induced urticaria may be caused by three mechanisms: an IgE-dependent mechanism, circulating immune complexes (serum sickness), and nonimmunologic activation of effector pathways
  • Future drug avoidance is recommended
  • Rechallenge, especially in individuals with severe reactions, should only occur in an intensive care setting

The correct answer is: May be caused by an IgE-dependent mechanism, circulating immune complexes, or nonimmunologic activation of effector pathways

71
Q

A 68/M with metastatic non-small cell lung cancer developed rash, pruritus and vitiliginous depigmentation after initiation of therapy. Which medication is responsible for this reaction? (HPIM 20th, Chapter 56, p365)

a. Sorafenib
b. Erlotinib
c. Ipilimumab
d. Capecitabine

A
  • Acral erythema: cytarabine, doxorubicin, methotrexate, hydroxyurea, fluorouracil, and capecitabine
  • Hair textural changes: erlotinib
  • Follicular eruptions and focal bullous eruptions at palmoplantar, flexural sites or areas of frictional pressure: sorafenib
  • Rash, pruritus, and vitiliginous depigmentation: ipilimumab

The correct answer is: Ipilimumab

72
Q

Drug associated with pemphigus: (HPIM 20th, Chapter 56, p364)

a. Furosemide
b. Vancomycin
c. Terbinafine
d. D-penicillamine

A
  • New onset SLE: IL-2, IFN-α, and anti-TNF-α
  • Granulomatous disease and sarcoidosis: IFN and TNF-inhibitors
  • Pemphigus: D-penicillamine and ACE inhibitors
  • Bullous pemphigoid: furosemide and PD-1 inhibitors
  • Linear IgA bullous dermatosis: vancomycin
  • Nephrogenic systemic fibrosis: gadolinium contrast
  • Neutrophilic dermatoses: GCSF, azacitidine, ATRA and the FLT3- inhibitor class of drugs

The correct answer is: D-penicillamine

73
Q

A 60/F, known hypertensive on amlodipine 10mg OD, was referred for evaluation of rash. On PE, patient was highly febrile, with innumerable pinpoint pustules with underlying erythema. Lesions are most pronounced in the antecubital area. Which statement is true regarding this condition? (HPIM 20th, Chapter 56, p369)

a. Erosions tend to be deep and prominently involve the mucosa
b. Skin biopsy shows full thickness epidermal necrosis
c. Principal differential diagnosis is erythema multiforme
d. Patch testing with the responsible drug often results in a localized pustular eruption

A
  • Patients typically present with diffuse erythema or erythroderma, as well as high spiking fevers, and leukocytosis
  • One to two days later, innumerable pinpoint pustules develop overlying the erythema
  • Pustules are most pronounced in body fold areas; however, they may become generalized and, when coalescent, can lead to superficial erosion
  • Erosions tend to be more superficial, and prominent mucosal involvement is lacking
  • Skin biopsy shows collections of neutrophils and sparse necrotic keratinocytes in the upper part of the epidermis
  • The principal differential diagnosis for AGEP is acute pustular psoriasis, which has an identical clinical and histologic appearance
  • β-Lactam antibiotics, calcium channel blockers, macrolide antibiotics, and other inciting agents (including radiocontrast and dialysates) have been reported
  • Patch testing with the responsible drug often results in a localized pustular eruption

The correct answer is: Patch testing with the responsible drug often results in a localized pustular eruption

74
Q

A 44-year-old female consulted due to fever and flu-like symptoms for 3 days followed by appearance of diffuse morbilliform rash involving the face. She was diagnosed to have hypertension and hyperuricemia 6 weeks ago and was prescribed amlodipine and allopurinol, which she took with good compliance. On PE, patient was hypotensive. You noted fever, icteric sclerae, cervical and inguinal lymphadenopathies and hepatomegaly. CBC showed mild eosinophilia and atypical lymphocytes. Which statement is correct? (HPIM 20th, Chapter 56, p368)

a. Mycophenolate mofetil should be started
b. Patient should be closely monitored for development of early-onset autoimmune thyroiditis
c. Patient should undergo cardiac evaluation
d. Most fatalities result from heart failure

A
  • Mortality rates as high as 10% have been reported, with most fatalities resulting from liver failure
  • Systemic glucocorticoids (1.5–2 mg/kg/d prednisone equivalent) should be started and tapered slowly over 8–12 weeks, during which time clinical symptoms and labs (including complete blood count with differential, basic metabolic panel, and liver function tests) should be followed carefully
  • A steroid-sparing agent such as mycophenolate mofetil may be indicated in cases of rapid recurrence upon steroid taper
  • Given the severe long-term complications of myocarditis, patients should undergo cardiac evaluation in cases of severe DIHS or if heart involvement is suspected due to hypotension or arrhythmia
  • Patients should be closely monitored for resolution of organ dysfunction and for development of late-onset autoimmune thyroiditis and diabetes (up to 6 months)

The correct answer is: Patient should undergo cardiac evaluation

75
Q

A 50/F was referred for evaluation of purpuric papules and macules involving the lower extremities. Further work up showed elevated creatinine. Cutaneous small vessel vasculitis was considered. This finding on skin biopsy can be a clue to possible drug etiology: (HPIM 20th, Chapter 56, p369)

a. Presence of perivascular eosinophils
b. Nonspecific inflammatory changes
c. Collections of neutrophils and sparse necrotic keratinocytes in the upper part of the epidermis
d. Full thickness epidermal necrosis

A
  • Presents with purpuric papules and macules involving the lower extremities and other dependent areas
  • May involve other organs, including the kidneys, joints, gastrointestinal tract, and lungs, necessitating a thorough clinical evaluation for systemic involvement
  • Drugs are implicated as a cause of roughly 15% of all cases of small vessel vasculitis
  • May also be idiopathic or due to underlying infection, connective tissue disease, or (rarely) malignancy
  • Presence of perivascular eosinophils on skin biopsy can be a clue to possible drug etiology.

The correct answer is: Presence of perivascular eosinophils

76
Q

A 23/M PLHIV developed morbilliform eruption in response to prior sulfonamide exposure. What will be your recommendation? (HPIM 20th, Chapter 56, p371)

a. Skin prick testing
b. Patch testing
c. Intradermal testing
d. Desensitization

A

ROLE OF TESTING FOR CAUSALITY AND DRUG RECHALLENGE (HPIM 20th, Chapter 56, p371)
• Skin-prick testing
o Clinical value in limited settings
o In patients with a history suggesting immediate IgE-mediated reactions to penicillin, skin-prick testing with penicillins or cephalosporins has proven useful for identifying patients at risk of anaphylactic reactions to these agents
o Negative skin tests do not totally rule out IgE-mediated reactivity
 Risk of anaphylaxis in response to penicillin administration in patients with negative skin tests is about 1%
• Desensitization
o Considered in those with a history of reaction to a medication that must be used again
o Efficacy of such procedures has been demonstrated in cases of immediate reaction to penicillin and positive skin tests, anaphylactic reactions to platinum chemotherapy, and delayed reactions to sulfonamides in patients with AIDS
o Often successful in HIV-infected patients with morbilliform eruptions to sulfonamides but is not recommended in HIV-infected patients who developed erythroderma or a bullous reaction in response to prior sulfonamide exposure

The correct answer is: Desensitization

77
Q

Findings suggestive of severe cutaneous adverse drug reaction (HPIM 20th, Chapter 56, p370)

a. Eosinophil count < 1000/ul
b. Negative Nikolsky sign
c. Mucous membrane erosions
d. Low grade fever

A

The correct answer is: Mucous membrane erosions

78
Q

True of fixed drug eruptions: (HPIM 20th, Chapter 56, p367)

a. Hyperpigmentation often results after resolution of acute inflammation
b. With rechallenge, the process recurs a different location
c. Lesions often involve the scalp
d. Most patients have a single lesion

A

FIXED DRUG ERUPTIONS (HPIM 20th, Chapter 56, p367)

  • One or more sharply demarcated, dull red to brown lesions, sometimes with central dusky violaceous erythema and central bulla
  • Hyperpigmentation often results after resolution of the acute inflammation
  • With rechallenge, the process recurs in the same (fixed) location but may spread to new areas as well
  • Lesions often involve the lips, hands, legs, face, genitalia, and oral mucosa, and cause a burning sensation
  • Most patients have multiple lesions
  • Fixed drug eruptions have been associated with pseudoephedrine (frequently a nonpigmenting reaction), phenolphthalein (in laxatives), sulfonamides, tetracyclines, NSAIDs, barbiturate

The correct answer is: Hyperpigmentation often results after resolution of acute inflammation

79
Q

A 44-year-old female consulted due to fever and flu-like symptoms for 3 days followed by appearance of diffuse morbilliform rash involving the face. She was diagnosed to have hypertension and hyperuricemia 6 weeks ago and was prescribed amlodipine and allopurinol, which she took with good compliance. On PE, you noted fever, icteric sclerae, cervical and inguinal lymphadenopathies and hepatomegaly. CBC showed mild eosinophilia and atypical lymphocytes. What is true about this condition? (HPIM 20th, Chapter 56, p367)

a. Reactivation of herpesvirus 6 and Epstein-Barr virus (EBV) has been frequently reported in this syndrome
b. Mucosal erosions are frequent, usually at 2 or more sites
c. Skin biopsy showing full thickness epidermal necrosis in the absence of substantial dermal inflammation is consistent with the diagnosis
d. Patch testing the suspect drug would result in a localized pustular eruption

A

DRUG INDUCED HYPERSENSITIVITY SYNDROME (HPIM 20th, Chapter 56, p367)
• Presents with a prodrome of fever and flu-like symptoms for several days, followed by the appearance of a diffuse morbilliform eruption usually involving the face
• Facial swelling and hand/foot swelling are often present
• Lymphadenopathy, fever, and leukocytosis (often with eosinophilia or atypical lymphocytosis)
• Hepatitis, nephritis, pneumonitis, myositis, and gastroenteritis (in descending order)
• Cutaneous reaction usually begins 2–8 weeks after the drug is started and persists after drug cessation
• Reactivation of herpes viruses, in particular human herpesviruses 6 and 7, EBV, and cytomegalovirus (CMV), has been frequently reported in this syndrome

The correct answer is: Reactivation of herpesvirus 6 and Epstein-Barr virus (EBV) has been frequently reported in this syndrome

80
Q

Histamine-related anaphylactoid reaction characterized by flushing, diffuse maculopapular eruption and hypotension is associated with which drug? (HPIM 20th, Chapter 56, p367)

a. Tetracycline
b. Radiocontrast agents
c. Vancomycin
d. Lamotrigine

A

ANAPHYLACTOID REACTIONS (HPIM 20th, Chapter 56, p367)

• Vancomycin is associated with red man syndrome
o A histamine-related anaphylactoid reaction characterized by flushing, diffuse maculopapular eruption, and hypotension
o In rare cases, cardiac arrest may be associated with rapid IV infusion of the medication

The correct answer is: Vancomycin

81
Q

A 5/M was referred for evaluation of fever and rash. It was accompanied by cough, ear pain and sore throat, for which he was given amoxicillin. PE showed blanching erythematous macules and papules on the trunk and intertriginous area; no facial swelling or angioedema noted. What is your diagnosis?
(HPIM 20th, Chapter 56, p366)
a. Morbilliform eruptions
b. Viral exanthem
c. Graft-versus-host disease
d. Drug induced hypersensitivity syndrome

A

MACULOPAPULAR/MORBILLIFORM ERUPTIONS (HPIM 20th, Chapter 56, p366)

  • Often start on the trunk or intertriginous areas, and consist of blanching erythematous macules and papules that are symmetric and confluent
  • Most common of all drug-induced reactions
  • May be associated with moderate to severe pruritus and fever
  • Viral exanthem is another differential diagnostic consideration (especially in children) and graft-versus-host disease is also a consideration in the proper clinical setting
  • Absence of enanthems; absence of ear, nose, throat, and upper respiratory tract symptoms; and polymorphism of the skin lesions support a drug rather than a viral eruption
  • Common offenders include aminopenicillins, cephalosporins, antibacterial sulfonamides, allopurinol, and antiepileptic drugs

The correct answer is: Viral exanthem

82
Q

Causes drug-induced lipofuscinosis with characteristic red-brown coloration: (HPIM 20th, Chapter 56, p365)

a. Clofazimine
b. Minocycline
c. Quinacrine
d. Bismuth

A

PIGMENTATION CHANGES (HPIM 20th, Chapter 56, p365)
• Blue gray pigmentation: long term minocycline and amiodarone
• Gray-brown pigmentation: phenothiazine, gold, bismuth
• Red-brown coloration: clofazimine
• Yellow discoloration: quinacrine

The correct answer is: Clofazimine

83
Q

A 32/F with Protein C deficiency on 7th day of warfarin anticoagulation was referred due to a sharply demarcated, purpuric lesion with hemorrhagic bullae and eschar formation. How will you manage the patient? (HPIM 20th, Chapter 56, p365)

a. Fluid management, atraumatic wound care, prednisone 1-2mg/kg
b. Epinephrine and intravenous glucocorticoids
c. Vitamin K, heparin, surgical debridement and intensive wound care
d. Oral antihistamine and emollients

A

WARFARIN NECROSIS OF THE SKIN (HPIM 20th, Chapter 56, p365)
• Common sites: breasts, thighs, and buttocks
• Sharply demarcated, erythematous, or purpuric, and may progress to form large, hemorrhagic bullae with necrosis and eschar formation
• Rare reaction (0.01–0.1%)
• Usually occurs between the third and tenth days of therapy with warfarin
• Usually in women
• Treated with vitamin K, heparin, surgical debridement, and intensive wound care
• Treatment with protein C concentrates may also be helpful.
• Newer anticoagulants such as dabigatran etexilate may avoid warfarin necrosis in high-risk patients

The correct answer is: Vitamin K, heparin, surgical debridement and intensive wound care

84
Q

Key immune mediators in SJS/TEN: (HPIM 20th, Chapter 56, p363)

a. IgE
b. Eosinophils
c. IL-4, IL-5 and IL-13
d. Granulysin

A

The correct answer is: Granulysin

85
Q

A 36-year-old epilepsy patient was referred for evaluation of rash. The patient initially presented with fever, conjunctivitis and sore throat with subsequent development of generalized painful rashes which was noted a few days after starting him on phenytoin for status epilepticus. Dusky macules involving more than half of the patient’s body were seen. Which of the following tests may aid in rapid diagnosis? (HPIM 20th, Chapter 56, p368)

a. Frozen section skin biopsy
b. Serum immunoglobulins
c. Patch testing
d. Antihistone antibody test

A

STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS (HPIM 20th, Chapter 56, p368)
• Characterized by blisters and mucosal/epidermal detachment
o Full-thickness epidermal necrosis
o Absence of substantial dermal inflammation.
• SJS: <10% epidermal detachment
• SJS/TEN overlap: 10–30% epidermal detachment
• TEN >30% detachment
• Signs and symptoms: fever >39°C (102.2°F); sore throat; conjunctivitis; and acute onset of painful dusky, atypical, target-like lesions
• Poor prognosis: intestinal and upper respiratory tract involvement, older age and greater extent of epidermal detachment.
• Mortality: SJS – at least 10%; TEN - 30%
• Drugs that most commonly cause SJS/TEN: sulfonamides, allopurinol, antiepileptics (e.g., lamotrigine, phenytoin, carbamazepine), oxicam NSAIDs, β-lactam and other antibiotics, and nevirapine
• Frozen section skin biopsy may aid in rapid diagnosis

The correct answer is: Frozen section skin biopsy

86
Q

Which of the following side effect is correctly matched to the drug used to treat leprosy?

a. Clofazimine – red-black skin discoloration
b. Dapsone – QT prolongation
c. Rifampin – exfoliative dermatitis
d. Minocycline – hepatotoxicity

A

A. Clofazimine – red-black skin discoloration
B. Dapsone – QT prolongation (hemolysis)
C. Rifampin – exfoliative dermatitis (hepatotoxicity)
D. Minocycline – hepatotoxicity
(C174, p. 1264)

The correct answer is: Clofazimine – red-black skin discoloration

87
Q

Which of the agents used to treat leprosy is bactericidal?

a. Dapsone
b. Clofazimine
c. Streptomycin
d. Rifampin

A

The correct answer is: Rifampin

88
Q

A 52/F with leprosy presented with ulnar nerve enlargement. Which of the following is TRUE regarding complications of leprous neuropathy?

a. Pain and heat receptors are spared while position and vibration sense are affected.
b. Involvement of the ulnar nerve results in impairment in thumb opposition and grasp.
c. Plantar ulceration at the metatarsal heads is the most common complication of leprous neuropathy.
d. Tendon transfers may be done to restore function once treatment is initiated

A

A. Pain and heat receptors are spared affected while position and vibration sense are affected spared.
B. Involvement of the ulnar nerve results in impairment in thumb opposition and grasp. – median
C. Plantar ulceration at the metatarsal heads is the most common complication of leprous neuropathy.
D. Tendon transfers may be done to restore function once treatment is initiated – 6 months after initiation of tx and once episodes of acute neuritis have resolved

The correct answer is: Plantar ulceration at the metatarsal heads is the most common complication of leprous neuropathy.

89
Q

A 48/F started treatment for leprosy 6 months ago. She is currently consulting due to the appearance of painful papules on her arms associated with fever. What type of reactional state is the patient experiencing?

a. Type 1 lepra downgrading
b. Type 1 lepra reversal
c. Type 2 lepra
d. Lucio’s phenomenon

A

A. Type 1 lepra downgrading – inflammation of lesions PRIOR to tx
B. Type 1 lepra reversal – inflammation of lesions AFTER initiation of tx
C. Type 2 lepra – diagnosis is erythema nodosum leprosum
D. Lucio’s phenomenon – recurrent crops of ulcerative lesions

The correct answer is: Type 2 lepra

90
Q

A 50/F consulted due to skin nodules. On physical examination, there is loss of eyebrows, dry skin, symmetric nodular lesions, palpable ulnar nerve, and claw hand deformity. What is the classification of her leprosy?

a. Tuberculoid
b. Borderline Tuberculoid
c. Borderline Lepromatous
d. Lepromatous

A

The correct answer is: Lepromatous

91
Q

An 80/F was referred for evaluation of rash. Your impression was erysipelas. How will you describe the characteristic lesion? (HPIM 20th, Chapter 143, p1085)

a. Honey-colored crusts and erythematous weeping erosions; occasionally, bullous lesions may be seen
b. Bright red appearance of the involved skin, which forms a plateau sharply demarcated from surrounding normal skin
c. Finely punctate erythema; petechiae can occur and have a linear configuration within the exanthem in body folds
d. Punched-out ulcerative lesions with necrotic sloughing or pseu- domembrane formation

A
  • Characterized by a bright red appearance of the involved skin, which forms a plateau sharply demarcated from surrounding normal skin
  • Lesion is warm to the touch, may be tender, and appears shiny and swollen
  • Skin often has a peau d’orange texture, which is thought to reflect involvement of superficial lymphatics
  • Superficial blebs or bullae may form, usually 2–3 days after onset
  • Lesion develops over a few hours and is associated with fever and chills.
  • Tends to occur on the malar area of the face (often with extension over the bridge of the nose to the contralateral malar region) or on the lower extremities

The correct answer is: Bright red appearance of the involved skin, which forms a plateau sharply demarcated from surrounding normal skin

92
Q

A 20/M consulted due to pruritic lesion involving his toes. On PE, erythema, edema, scaling with vesiculations were seen along the web space between the fourth and fifth toes. How will you confirm your diagnosis? (HPIM 20th, Chapter 53, p336)

a. Direct microscopic examination with KOH
b. Skin biopsy
c. Patch testing
d. Skin prick testing

A
  • Infection of the foot (tinea pedis) is the most common der- matophyte infection and is often chronic
  • Characterized by variable erythema, edema, scaling, pruritus, and occasionally vesiculation
  • Infection may be widespread or localized but generally involves the web space between the fourth and fifth toes
  • Diagnosis of tinea can be made from skin scrapings, nail scrapings, or hair by culture or direct microscopic examination with KOH. Nail clippings may be sent for histologic examination with periodic acid–Schiff (PAS) stain

The correct answer is: Direct microscopic examination with KOH

93
Q

Oral oral antifungal agents are often used in which type of dermatophyte infection? (HPIM 20th, Chapter 53, p336)

a. Tinea cruris
b. Tinea pedis
c. Tinea capitis
d. Tinea corporis

A
  • For dermatophyte infections involving the hair and nails and for other infections unresponsive to topical therapy, oral antifungal agents are often used
  • Topical therapy is generally effective for uncomplicated tinea corporis, tinea cruris, and limited tinea pedis

The correct answer is: Tinea capitis

94
Q

A 38/F consulted due to appearance of rashes on her chest and shoulders. PE showed oval scaly macules and papules which appeared hypopigmented. KOH smear from scaling lesions showed “spaghetti and meatballs” appearance. What will you recommend? (HPIM 20th, Chapter 53, p336)

a. Treat with oral antifungal agents
b. Apply lotion containing sulfur
c. Apply topical miconazole
d. Treat with mild glucocorticoid lotion

A
  • Caused by a nondermatophytic, dimorphic fungus, Malassezia furfur, a normal inhabitant of the skin
  • Oval scaly macules, papules, and patches concentrated on the chest, shoulders, and back but only rarely on the face or distal extremities
  • On dark skin the lesions often appear as hypopigmented areas, whereas on light skin they are slightly erythematous or hyperpigmented
  • A KOH preparation from scaling lesions will demonstrate a confluence of short hyphae and round spores (“spaghetti and meatballs”)
  • Lotions or shampoos containing sulfur, salicylic acid, or selenium sulfide are the treatments of choice and will clear the infection if used daily for 1–2 weeks and then weekly thereafter
  • These preparations are irritating if left on the skin for >10 min; thus, they should be washed off completely
  • Treatment with some oral antifungal agents is also effective, but they do not provide lasting results and are not FDA approved for this indication.

The correct answer is: Apply lotion containing sulfur

95
Q

Etiologic agent of Tinea versicolor (HPIM 20th, Chapter 53, p336)

a. Trichophyton
b. Microsporum spp.
c. Epidermophyton
d. Malassezia furfur

A

The correct answer is: Malassezia furfur

96
Q

A 74/M, with no known comorbids, consulted because of painful facial rash. He also complained of loss of taste. On PE, you saw vesicles along the right external auditory canal associated with right facial palsy. Which statement describes this syndrome? (HPIM 20th, Chapter 188, p1355)

a. It affects the geniculate ganglion of the sensory branch of the facial nerve
b. It affects the branches of the trigeminal nerve
c. Etiologic agent is Cytomegalovirus
d. Etiologic agent is Epstein-Barr virus

A

RAMSAY HUNT SYNDROME (HPIM 20th, Chapter 188, p1355)
• Etiologic agent: Varicella Zoster Virus
• Pain and vesicles appear in the external auditory canal
• Patients lose their sense of taste in the anterior two-thirds of the tongue while developing ipsilateral facial palsy
• Geniculate ganglion of the sensory branch of the facial nerve is involved

The correct answer is: It affects the geniculate ganglion of the sensory branch of the facial nerve

97
Q

A 68/M, with history of CABG, was admitted due to fever and left leg swelling. On PE, patient is normotensive but tachycardic and lethargic. His left leg appeared dusky/mottled and edematous. Marked tenderness was also noted. (HPIM 20th, Chapter 143, p1083)

a. Fluid management, atraumatic wound care, prednisone 1-2mg/kg
b. Epinephrine and intravenous glucocorticoids
c. Vitamin K, heparin, surgical debridement and intensive wound care
d. Fluid management, surgical debridement, penicillin G (2–4 mU IV q4h) plus clindamycin (600–900 mg IV q8h)

A

NECROTIZING FASCIITIS/MYOSITIS (HPIM 20th, Chapter 143, p1083)

  • Involves the superficial and/or deep fascia investing the muscles of an extremity or the trunk
  • GAS is implicated in ~60% of cases of necrotizing fasciitis
  • Onset of symptoms is usually quite acute and is marked by severe pain at the site of involvement, malaise, fever, chills, and a toxic appearance
  • Physical findings, particularly early on, may not be striking, with only minimal erythema of the overlying skin.
  • Pain and tenderness are usually severe
  • As the infection progresses (often over several hours), the severity and extent of symptoms worsen, and skin changes become more evident, with the appearance of dusky or mottled erythema and edema
  • The marked tenderness of the involved area may evolve into anesthesia as the spreading inflammatory process produces infarction of cutaneous nerves

The correct answer is: Fluid management, surgical debridement, penicillin G (2–4 mU IV q4h) plus clindamycin (600–900 mg IV q8h)

98
Q

A 21/M PLHIV consulted due to painless ulcer in the anus and the mouth. PE showed an ulcer with cartilaginous consistency on palpation of the edge and base. No other skin lesions were seen. He denied history of drug allergy. How should the patient be managed? (HPIM 20th, Chapter 177, p1281, 1285)

a. Lumbar tap and if CSF normal, give Penicillin G benzathine (single dose of 2.4 mU IM)
b. Lumbar tap and if CSF abnormal, give Penicillin G benzathine (single dose of 2.4 mU IM)
c. Lumbar tap and if CSF normal, give doxycycline (100 mg PO bid) for 2 weeks
d. Lumbar tap and if CSF abnormal, give Aqueous crystalline penicillin G (18–24 mU/d IV, given as 3–4 mU q4h or continuous infusion) for 10–14 days

A

PRIMARY SYPHILIS (HPIM 20th, Chapter 177, p1281, 1285)
• Typical primary chancre usually begins as a single painless papule that rapidly becomes eroded and usually becomes indurated, with a characteristic cartilaginous consistency on palpation of the edge and base of the ulcer.
• In MSM it may also be found in the anal canal or rectum or in the mouth
• Penicillin G benzathine cures >95% of cases of early syphilis, although clinical relapse can follow treatment, particularly in patients with concurrent HIV infection.
• Because the risk of neurologic relapse may be higher in HIV-infected patients, CSF examination is recommended for HIV-seropositive individuals with syphilis of any stage, particularly those with a serum RPR titer of ≥1:32 or a CD4+ T cell count of ≤350/μL. Therapy appropriate for neurosyphilis should be given if there is any evidence of CNS infection.

The correct answer is: Lumbar tap and if CSF normal, give Penicillin G benzathine (single dose of 2.4 mU IM)

99
Q

This condition is characterized by annular scaly plaques, may involve hair loss, and hyphal elements are seen on KOH preparation. (HPIM 20th, Chapter 53, p336)

a. Impetigo
b. Dermatophytosis
c. Candidiasis
d. Tinea versicolor

A

The correct answer is: Dermatophytosis

100
Q

A 30/F underwent upper GI endoscopy for dyspepsia. Urease test was positive and H pylori eradication regimen (Amoxicillin 2g/day + Clarithromycin 1g/day + PPI) was given for 2 weeks. She subsequently consulted due to appearance whitish lesion on the tongue. How will you manage the patient? (HPIM 20th, Chapter 53, p337)

a. Oral fluconazole
b. Oral nystatin
c. Oral terbinafine
d. Oral itraconazole

A

CANDIDIASIS (HPIM 20th, Chapter 53, p337)
• Causative organism is usually Candida albicans
• These organisms are normal saprophytic inhabitants of the gastrointestinal tract but may overgrow due to broad-spectrum antibiotic therapy, diabetes mellitus, or immunosuppression and cause disease
• Lesions may occur on the tongue or buccal mucosa (thrush) and appear as white plaques.
• Fissured, macerated lesions at the corners of the mouth (perlèche) are often seen in individuals with poorly fitting dentures and may also be associated with candidal infection
• Oral fluconazole is most commonly prescribed for cutaneous candidiasis
• Oral nystatin is effective only for candidiasis of the gastrointestinal tract

The correct answer is: Oral nystatin

101
Q

Example of drug responsible for hypertrichosis: (HPIM 20th, Chapter 56, p365)

a. Testosterone
b. Corticotropin
c. Oral contraceptives
d. Minoxidil

A

DRUG-INDUCED HAIR GROWTH (HPIM 20th, Chapter 56, p365)
• Hirsutism
o An excessive growth of terminal hair with masculine hair growth pattern in a female
o Most often on the face and trunk
o Due to androgenic stimulation of hormone-sensitive hair follicles (anabolic steroids, oral contraceptives, testosterone, corticotropin)
• Hypertrichosis
o Distinct pattern of hair growth, not in a masculine pattern
o Typically located on the forehead and temporal regions of the face
o Glucocorticoids, vasodilators (diazoxide, minoxidil), diuretics (acetazolamide), anticonvulsants (phenytoin), immunosuppressive agents (cyclosporine A), psoralens, and zidovudine

The correct answer is: Minoxidil

102
Q 
According to Fitzpatrick Classification of skin type and sunburn sensitivity, which type would sometimes burn, always tan? 
(HPIM 20th, Chapter 57, p373)
a. Type II
b. Type III
c. Type IV
d. Type V
A

The correct answer is: Type IV

103
Q

hich skin type is at decreased risk for the development of acute sunburn and cutaneous malignancy? (HPIM 20th, Chapter 57, p377)

a. Type I
b. Type II
c. Type III
d. Type IV

A
  • Natural photoprotection is provided by structural proteins in the epidermis, particularly keratins and melanin
  • The amount of melanin and its distribution in cells are genetically regulated, and individuals of darker complexion (skin types IV–VI) are at decreased risk for the development of acute sunburn and cutaneous malignancy

The correct answer is: Type IV

104
Q

Pathogenesis of photoaging: (HPIM 20th, Chapter 57, p374)

a. UVR is important in the pathogenesis of photoaging in human skin
b. The epidermis and its connective tissue matrix are major targets for sun-associated chronic damage
c. Solar elastosis is characterized by a massive increase in thickened irregular masses of abnormal-appearing collagen fibers.
d. Collagen fibers are also abnormally clumped in the subcutaneous layer of sun-damaged skin

A
  • UVR is important in the pathogenesis of photoaging in human skin, and ROS are likely involved
  • The dermis and its connective tissue matrix are major targets for sun-associated chronic damage
  • Solar elastosis, a massive increase in thickened irregular masses of abnormal-appearing elastic fibers
  • Collagen fibers are also abnormally clumped in the deeper dermis of sun-damaged skin

The correct answer is: UVR is important in the pathogenesis of photoaging in human skin

105
Q

Major absorber of UV-B: (HPIM 20th, Chapter 57, p372)

a. Stratum corneum
b. Stratum granulosum
c. Stratum spinosum
d. Stratum basale

A

• Two major compartments
o Epidermis: stratified squamous epithelium
o Dermis: rich in matrix proteins such as collagens and elastin
• Both compartments are susceptible to damage from sun exposure
• Stratum corneum, is a major absorber of UV-B
• <10% of incident UV-B wavelengths penetrate through the epidermis to the dermis
• Approximately 3% of radiation below 300 nm, 20% of radiation below 360 nm, and 33% of short visible radiation reach the basal cell layer in untanned human skin
• UV-A readily penetrates to the dermis and is capable of altering structural and matrix proteins that contribute to photoaging of chronically sun- exposed skin, particularly in individuals of light complexion

The correct answer is: Stratum corneum

106
Q

True of scabies: (HPIM 20th, Chapter 452, p3324)

a. The etiologic agent is Pediculus humanus
b. Gravid female mites (~0.3 mm in length) burrow within the stratum basale, depositing several eggs per day
c. Newly fertilized female mites are transferred from person to person mainly by direct skin-to-skin contact
d. Scabies mites continue to live even in the absence of a suitable host.

A
  • Etiologic agent: Sarcoptes scabiei var. hominis
  • Gravid female mites (~0.3 mm in length) burrow superficially within the stratum corneum, depositing several eggs per day
  • Newly fertilized female mites are transferred from person to person mainly by direct skin-to-skin contact
  • Transfer is facilitated by crowding, poor hygiene, and sex with multiple partners
  • Generally, scabies mites die within a day or so in the absence of a suitable host
  • Transmission via sharing of contaminated bedding or clothing occurs less frequently than is often thought

The correct answer is: Newly fertilized female mites are transferred from person to person mainly by direct skin-to-skin contact

107
Q

A 23/F consulted due to nocturnal pruritus. On PE, small papules and vesicles were seen along the volar wrists and digital web spaces. The following statements are correct except: (HPIM 20th, Chapter 452, p3325)

a. Permethrin cream (5%) is less toxic than 1% lindane preparations
b. Scabicides are applied thinly but thoroughly from the jawline down after bathing and removed 8-14 hours later with soap and water
c. Within 1 day of effective treatment, scabies infestations become noncommunicable.
d. Only symptomatic close contacts of confirmed cases should be treated.

A
  • Pruritus typically intensifies at night and after hot showers.
  • Scabetic lesions are most common on the volar wrists and along the digital web spaces
  • In males, the penis and scrotum become involved
  • Small papules and vesicles, often accompanied by eczematous plaques, pustules, or nodules, appear symmetrically at those sites and within intertriginous areas, around the navel and belt line, in the axillae, and on the buttocks and upper thighs
  • Permethrin cream (5%) is less toxic than 1% lindane preparations and is effective against lindane-tolerant infestations
  • Scabicides are applied thinly but thoroughly from the jawline down after bathing—with careful application to interdigital spaces and the umbilicus and under the fingernails—and are removed 8–14 h later with soap and water
  • Within 1 day of effective treatment, scabies infestations become non-communicable, but the pruritic hypersensitivity dermatitis induced by the dead mites and their remnant products frequently persists for weeks
  • To prevent reinfestations, bedding and clothing should be washed and dried on high heat or heat-pressed
  • Close contacts of confirmed cases, even if asymptomatic, should be treated simultaneously.

The correct answer is: Only symptomatic close contacts of confirmed cases should be treated.

108
Q

True of head lice: (HPIM 20th, Chapter 452, p3326)

a. Transmitted mainly by fomites such as shared headgear, bed linens and grooming implements
b. Chronic infestations tend to be asymptomatic
c. Head lice are known to serve as a natural vector for any pathogens
d. Mechanical removal of head lice and their eggs with a fine-toothed louse or nit comb successfully eliminate infestations

A
  • Head lice are transmitted mainly by direct head-to-head contact rather than by fomites such as shared headgear, bed linens, and grooming implements
  • Chronic infestations by head lice tend to be asymptomatic
  • Head lice are not known to serve as a natural vector for any pathogens
  • Mechanical removal of head lice and their eggs with a fine-toothed louse or nit comb often fails to eliminate infestations

The correct answer is: Chronic infestations tend to be asymptomatic

109
Q

True of body lice: (HPIM 20th, Chapter 452, p3326)

a. Body lice remain on clothing except when feeding and generally continue to live even if separated from their host
b. Intensely pruritic, bluish macules ~3 mm in diameter (maculae ceruleae) develop at the site of bites
c. Body lice are acquired by direct contact or by sharing of infested clothing and bedding
d. These lice are vectors for the agent of Rocky Mountain Spotted Fever

A
  • Body lice remain on clothing except when feeding and generally succumb in ≤2 days if separated from their host
  • Chronic infestations result in a postinflammatory hyperpigmentation and thickening of the skin known as vagabond’s disease
  • Body lice are acquired by direct contact or by sharing of infested clothing and bedding
  • These lice are vectors for the agents of louse-borne (epidemic) typhus, louse-borne relapsing fever, and trench fever

The correct answer is: Body lice are acquired by direct contact or by sharing of infested clothing and bedding

110
Q

True regarding treatment of louse infestation: (HPIM 20th, Chapter 452, p3326)

a. Mechanical removal of head lice and their eggs with a fine-toothed louse or nit comb often fails to eliminate infestations
b. Treatment of newly identified active infestations traditionally relies on a 10-min topical application of ~1% permethrin or pyrethrins, daily for a total of 10 days
c. Chronic infestations may be treated for ≤12 h with 0.5% permethrin
d. Lindane is applied for just 4 min and is most effective

A
  • Generally, treatment is justified only if live lice are discovered
  • The presence of nits alone is evidence of a former—not necessarily current—infestation
  • Mechanical removal of head lice and their eggs with a fine-toothed louse or nit comb often fails to eliminate infestations
  • Treatment of newly identified active infestations traditionally relies on a 10-min topical application of ~1% permethrin or pyrethrins, with a second application ~10 days later
  • Lice persisting after this treatment may be resistant to pyrethroids
  • Chronic infestations may be treated for ≤12 h with 0.5% malathion
  • Lindane is applied for just 4 min but seems less effective and may pose a greater risk of adverse reactions, particularly when misused.

The correct answer is: Mechanical removal of head lice and their eggs with a fine-toothed louse or nit comb often fails to eliminate infestations

111
Q

A 5/M was brought to the school clinic during recess for swelling and erythema of the right arm. Detached caterpillar hairs were noted in his clothing. Management should include the following except: (HPIM 20th, Chapter 452, p3331)

a. Treatment of caterpillar stings consists of repeated application of adhesive or cellophane tape to remove the hairs
b. Local ice packs
c. Oral glucocorticoids
d. Oral antihistamines

A
  • Treatment of caterpillar stings consists of repeated application of adhesive or cellophane tape to remove the hairs, which can then be identified microscopically
  • Local ice packs, topical glucocorticoids, and oral anti- histamines relieve symptoms

The correct answer is: Oral glucocorticoids

112
Q

Erythema infectiosum presents in adult patients as arthritis, fever and rash. Which of the following is the etiologic agent for this condition? (HPIM 20 Chapter 16 p106)

a. Epstein-Barr virus
b. Human Herpes Virus 6
c. Human Parvovirus B19
d. Paramyxovirus

A

The correct answer is: Human Parvovirus B19

113
Q

Transient, blanchable erythematous macules and papules, 2-4 mm, usually on trunk are seen in which of the following conditions? (HPIM 20th, Chapter 16, p107)

a. Erythema multiforme
b. Erythema nodosum
c. Herpes simplex
d. Typhoid fever

A

The correct answer is: Typhoid fever

114
Q

Which of the following conditions is characterized by evanescent 2- to 5-mm erythematous papules appearing on the trunk and proximal extremities at the height of high-grade fever episodes, polyarthritis, splenomegaly and markedly elevated erythrocyte sedimentation rate (>100 mm/h)? (HPIM 20th, Chapter 16, p108)

a. Hand-foot-and-mouth disease
b. Infectious mononucleosis
c. Sodoku
d. Still’s disease

A

The correct answer is: Still’s disease

115
Q

Gastrointestinal involvement in a Drug-induced Hypersensitivity Syndrome (DIHS) is almost exclusively seen in patients who use the following drug: (HPIM 20th, Chapter 56, p367)

a. Minocycline
b. Allopurinol
c. Abacavir
d. Lamotrigine

A
  • Allopurinol classically induces DIHS with renal involvement
  • Cardiac and lung involvements are more common with minocycline
  • Gastrointestinal involvement is almost exclusively seen with abacavir
  • Some medications typically lack eosinophilia - abacavir, dapsone, lamotrigine

The correct answer is: Abacavir

116
Q

Contact dermatitis is considered a Type IVa adverse drug reaction. What is the key pathway involved in this reaction? (HPIM 20th, Chapter 56, p363)

a. IgE
b. IgG-mediated toxicity
c. Immune complex
d. T lymphocyte-mediated macrophage inflammation

A

The correct answer is: T lymphocyte-mediated macrophage inflammation

117
Q

What proportion of cases of HIV will manifest seborrheic dermatitis?

a. 10%
b. 20%
c. 33.3%
d. 50%

A

The correct answer is: 50%

118
Q

Recurrent Herpes simplex infection among cases of HIV indicate which of the following?

a. New HIV infection during active treatment
b. Declining CD4 counts
c. Expected among HIV cases on anti-retroviral treatment
d. Drug resistance to current treatment

A

The correct answer is: Declining CD4 counts

119
Q

Claw-hand deformity is most common in which classification of leprosy?

a. Tuberculoid
b. Bordeline tuberculoid
c. Lepromatous
d. Borderline lepromatous

A

The correct answer is: Lepromatous

120
Q

Which of the following portend a poor prognosis for patients with SJS/TENS?

a. Allopurinol as inciting agent
b. Facial involvement
c. Older age
d. Exposure to antipyretic after lesions have set in

A

The correct answer is: Older age

121
Q

Which of the following indicate severe cutaneous drug reaction?

a. Basophilia
b. Fever
c. Lymphocytopenia
d. Petechial rash

A

The correct answer is: Fever

122
Q

Purpura and petechial rash in the lower extremities is consistent with drug hypersensitivity in which of the listed biopsy findings?

a. Presence of perivascular eosinophils
b. Nonspecific inflammatory changes
c. Collections of neutrophils and sparse necrotic keratinocytes in the upper part of the epidermis
d. Full thickness epidermal necrosis

A

The correct answer is: Presence of perivascular eosinophils

123
Q

TNF inhibitors have been associated with which of the following conditions?

a. Amyloidosis
b. Bullous pemphigoid
c. Extensive seborrhea
d. Granulomatous diseases and sarcoidosis

A

The correct answer is: Granulomatous diseases and sarcoidosis

124
Q

The most useful and convenient method for treating warts in almost any location is:

a. Salicylic acid plasters or solutions
b. Cryotherapy with liquid nitrogen
c. Podophyllin solution
d. Topical imiquimod

A

The correct answer is: Cryotherapy with liquid nitrogen

125
Q

Characterized by honey-colored crusted papules, plaques or bullae caused by infection with Group A Streptococcus and S. aureus:

a. Tinea versicolor
b. Candidiasis
c. Impetigo
d. Dermatophytosis

A

The correct answer is: Impetigo

126
Q

What is the characteristic description of lesions of candida infection?

a. Inflammatory annular scaly placques
b. Hypo or hyperpingmented patches in the truck
c. Inflammatory papules with satellite pustules
d. Patches of alopecia in involved skin

A

The correct answer is: Inflammatory papules with satellite pustules

127
Q

Which listed organism causes furunculosis?

a. Staphlococcus aureus
b. Candida sp
c. Malassezia furfur
d. Saarcoptes scabiei

A

The correct answer is: Staphlococcus aureus

128
Q

Which of the following is indication for oral antifungal treatment?

a. Uncomplicated tinea corporis
b. Tinea cruris
c. Limited tinea pedis
d. Hair and nail infection

A

The correct answer is: Hair and nail infection

PSBIM: PGH REVIEW (12 decks)

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