LE 1 - MED 1 Flashcards
- The layers of the skin from the deepest to the most superficial is
a. Basal, spinous, granular, stratum corneum
b. Basal, granular, spinous, stratum corneum
c. Granular, basal, spinous, stratum corneum
d. Spinous, basal, granular, stratum corneum
a. Basal, spinous, granular, stratum corneum
Rationale:
The skin, specifically the epidermis, has several layers. When considering these layers from the deepest to the most superficial, they are:
Stratum Basale (Basal layer): This is the deepest layer of the epidermis, where new skin cells are produced. Keratinocytes begin their journey here, proliferating and then migrating upwards.
Stratum Spinosum (Spinous layer): This layer is just above the stratum basale. As keratinocytes move up from the basal layer, they start to become more flattened and spiky, which gives this layer its name.
Stratum Granulosum (Granular layer): As keratinocytes progress upwards, they enter the granular layer where they begin to die and produce more keratin, a protein that gives skin its toughness and waterproofing capabilities.
Stratum Corneum: This is the most superficial layer of the epidermis. It consists of several layers of dead, flattened keratinocytes that are continuously shed and replaced from the layers below. It serves as a protective barrier against environmental elements and pathogens.
- A 20 year old female sought consultation due to vesicles she discovered 2 days after a date with a handsome young man. She denied being intimate except for a good night kiss. The organism causing this vesicular lesion is:
a. Herpes simplex 1
b. Herpes simplex 2
c. Treponema pallidum
d. Chlamydia trachomatis
a. Herpes simplex 1
Brief Rationale:
Herpes simplex 1 (HSV-1): Causes oral herpes, which manifests as cold sores or fever blisters. It’s transmitted via direct contact, including kissing, making it the most probable cause in this scenario.
Herpes simplex 2 (HSV-2): Primarily causes genital herpes, which is usually spread through sexual contact. Less likely to be contracted through kissing.
Treponema pallidum: Causes syphilis, which presents as a painless chancre, not vesicles. Transmission is typically sexual.
Chlamydia trachomatis: Causes chlamydia, a genital infection. It doesn’t cause vesicular lesions and is transmitted sexually.
- Punctate depression of the nails are seen in this condition
a. Psoriasis
b. Iron deficiency
С. Cirrhosis
d. leprosy
a. Psoriasis
Brief Rationale:
Psoriasis: One of the nail changes seen in psoriasis is “pitting,” which appears as punctate depressions on the nail surface.
Iron deficiency: Can lead to koilonychia (spoon-shaped nails), but not punctate depressions.
Cirrhosis: While cirrhosis can cause nail changes, like Terry’s nails or clubbing, it does not typically result in punctate depressions.
Leprosy: While leprosy can cause various nail changes due to nerve damage and secondary infections, punctate depressions are more classically associated with psoriasis.
- Brown macules and patches associated with papules and nodules with button holing
a. Neurofibromatosis
b. Tuberous sclerosis
c. Systemic lupus erythematosus
d. Dermatomyositis
a. Neurofibromatosis
Brief Rationale:
Neurofibromatosis: This condition is characterized by brown macules called “café-au-lait” spots and neurofibromas, which are nodular skin lesions. The “button holing” sign refers to the ability to push a portion of the neurofibroma into its underlying subcutaneous attachment.
Tuberous sclerosis: This is a genetic disorder that can cause various skin manifestations including hypomelanotic macules, facial angiofibromas, and shagreen patches, but not the specific combination described in the question.
Systemic lupus erythematosus (SLE): SLE can produce a malar rash or discoid lesions, but it does not result in brown macules with nodules and the characteristic button holing.
Dermatomyositis: This inflammatory muscle disease can lead to skin changes such as Gottron’s papules and a heliotrope rash, but it doesn’t cause the features described in the question.
- Round scaling patches of hair loss, hair broken off close to the surface of the scalp
a. Alopecia areata
b. Tinea capitis
c. trichotillomania
d. Seborrheic dermatitis of the scalp
b. Tinea capitis
Brief Rationale:
Alopecia areata: This is an autoimmune condition that results in non-scarring hair loss. Affected areas typically appear as smooth, round patches without scaling.
Tinea capitis: This is a fungal infection of the scalp. It presents as round patches of hair loss with scaling, and the affected hairs often break off just above the surface of the scalp, giving a characteristic “black dot” appearance.
Trichotillomania: This is a condition where individuals pull out their own hair. It results in irregularly shaped patches of hair loss, and the remaining hairs can have varying lengths. Broken hairs may be evident, but there isn’t the characteristic scaling seen in tinea capitis.
Seborrheic dermatitis of the scalp: This condition can cause redness, scaling, and itching of the scalp, but it doesn’t typically result in patches of hair loss with hairs broken off near the scalp surface as described.
- Nail plates turns white with a ground glass appearance, a distal band of reddish brown and obliteration of the lunula
a. Terry’s nails
b. Leukonychia
c. Beau’s lines
d. Mees’ lines
a. Terry’s nails
Brief Rationale:
Terry’s nails: This condition is characterized by the nail plates turning white with a ground glass appearance. There’s often a distal band of reddish-brown and the lunula (the crescent-shaped white area near the nail base) is typically obliterated.
Leukonychia: Refers to white spots or streaks on the nails. It doesn’t have the characteristic ground glass appearance, distal band, or obliterated lunula seen in Terry’s nails.
Beau’s lines: These are horizontal (transverse) depressions in the nail plate. They do not cause the nails to turn white or have a ground glass appearance.
Mees’ lines: These are white horizontal bands across the nails. They differ from Terry’s nails in appearance and do not have the ground glass appearance or the distinct reddish-brown band.
- White lines or bands that appear on fingernails or toenails which can be a symptom of underlying health conditions such as arsenic poisoning or kidney failure.
a. Terry’s nails
b. Leukonychia
c. Beau’s lines
d. Mees’ lines
d. Mees’ lines
Brief Rationale:
Terry’s nails: The nail plates turn white with a ground glass appearance, often with a distal band of reddish-brown. They can be a sign of liver disease, congestive heart failure, or other conditions but are not described as white lines or bands due to arsenic poisoning or kidney failure.
Leukonychia: White spots or streaks on the nails.
Beau’s lines: Horizontal (transverse) depressions in the nail plate.
Mees’ lines: White horizontal bands across the nails. They can be a symptom of several conditions, including arsenic poisoning and kidney failure.
- A superficial infection of the proximal and lateral nail folds adjacent to the nail plate.
a. Paronychia
b. Nail psoriasis
c. Lichen planus of the nail
d. onychomycosis
a. Paronychia
Brief Rationale:
Paronychia: This is an infection (which can be bacterial or fungal) of the skin surrounding the nail, specifically the proximal and lateral nail folds. Symptoms may include redness, swelling, and pain around the nail.
Nail psoriasis: While this can affect the nail and the surrounding area, its primary signs include nail pitting, discoloration, and sometimes onycholysis (separation of the nail from the nail bed). It isn’t an infection of the nail folds.
Lichen planus of the nail: This can lead to nail thinning, ridging, and sometimes complete loss of the nail. It doesn’t present as an infection of the nail folds.
Onychomycosis: This is a fungal infection of the nail itself, leading to discoloration, thickening, and sometimes crumbling of the nail. It does not primarily affect the nail folds.
- Risk factors to pressure ulcers does not include:
a. Fecal or urinary incontinence
b. Low serum albumin and hypotension
c. atherosclerosis
d. race
d. race
Brief Rationale:
Fecal or urinary incontinence: Presence of moisture, especially from urine or feces, can damage the skin and increase the risk of pressure ulcer development.
Low serum albumin and hypotension: Low serum albumin levels can indicate poor nutrition, which can compromise skin health and wound healing. Hypotension can reduce blood flow to skin and tissues, increasing the risk of ulcers.
Atherosclerosis: This can reduce blood flow to peripheral tissues, compromising skin health and increasing the risk of pressure ulcers.
Race: While there might be some studies suggesting that certain races may have different risks for pressure ulcers, race in and of itself is not a direct risk factor for pressure ulcer development in the way that the other listed factors are.
- The skin forms a blister or sore partial thickness skin loss or ulceration involving the epidermis, dermis or both.
a. Stage 1 pressure ulcer
b. Stage 2 pressure ulcer
c. Stage 3 pressure ulcer
d. Stage 4 pressure ulcer
b. Stage 2 pressure ulcer
Brief Rationale:
Stage 1 pressure ulcer: The skin is not broken. It appears red on lighter skin and may not blanch when touched. On darker skin, the ulcer might have a blue or purple tint. It may be warm, swollen, and painful.
Stage 2 pressure ulcer: There is partial-thickness loss of skin, which may appear as a blister or a sore. This stage involves the epidermis and possibly the dermis.
Stage 3 pressure ulcer: The ulcer is a full-thickness skin loss, which may expose some subcutaneous tissue (but bone, tendon, and muscle are not exposed). It looks like a crater and might have a foul odor.
Stage 4 pressure ulcer: This is the most severe stage where there’s full-thickness skin and tissue loss. This ulcer might expose muscle, bone, or tendons.
- The nails grown this length during normal conditions
a. 0.1 mm daily
b. 0.25 mm daily
c. 0.5 mm daily
d. 1.0 mm daily
a. 0.1 mm daily
Brief Rationale:
Nails, particularly fingernails, grow at an average rate of about 0.1 mm per day. This translates to about 3 mm per month. Factors such as age, nutrition, genetics, and overall health can influence nail growth. Toenails tend to grow more slowly than fingernails.
- Clubbing of the nails is defined as
a. 180 degrees between the proximal nail fold and nail plate
b. Less than 180 degrees between the proximal nail fold and nail plate
c. More than 180 degrees between the proximal nail fold and nail plate
d. The absence of the “window” when two nails are facing each other
c. More than 180 degrees between the proximal nail fold and nail plate
Brief Rationale:
Nail clubbing is a physical sign characterized by bulbous enlargement of the ends of one or more fingers or toes and is associated with certain medical conditions. Clubbing is defined by an increased angle (more than 180 degrees) between the proximal nail fold and the nail plate. In the early stages of clubbing, the base of the nail becomes soft, and the skin next to the nail bed becomes shiny. As clubbing advances, the nails curve more, and the angle increases.
- Which of the following statements is NOT true?
a. Sebaceous glands open to the hair follicles
b. Eccrine sweat glands open directly to the skin surface
c. Apocrine glands open into hair follicles
d. Apocrine glands regulate temperature
d. Apocrine glands regulate temperature
Brief Rationale:
a. Sebaceous glands open to the hair follicles: This statement is true. Sebaceous glands produce sebum, an oily substance that helps to moisturize and protect the skin. They open into hair follicles.
b. Eccrine sweat glands open directly to the skin surface: True. Eccrine glands are the primary sweat glands of the human body and are found in most parts of the skin. They secrete sweat directly onto the skin surface to help regulate body temperature.
c. Apocrine glands open into hair follicles: True. Apocrine sweat glands are found mainly in the axillary and anogenital regions and open into hair follicles, not directly onto the skin’s surface.
d. Apocrine glands regulate temperature: False. Eccrine glands primarily function in thermoregulation. Apocrine sweat glands produce a thicker sweat that is associated with body odor. They are activated by emotional stress, sexual excitement, and other factors but are not primarily involved in temperature regulation.
- The lesion of larva migrans infection is best described as:
a. Serpiginous
b. Lichen-like
c. Burrows
d. Dermatomal
a. Serpiginous
Brief Rationale:
Larva migrans, also known as “creeping eruption,” is a skin infection caused by the larvae of certain species of nematodes (roundworms), most commonly by the hookworm species that infect animals.
The larvae in the skin produce:
a. Serpiginous: True. The term “serpiginous” refers to a wavy or snake-like pattern, which describes the appearance of the track left behind as the larva migrates through the skin.
b. Lichen-like: False. This term usually describes skin lesions that look like lichen from trees or rocks. It’s not a descriptor used for larva migrans.
c. Burrows: False. While burrows are a tunnel-like pattern in the skin, they are commonly associated with scabies, where the mite digs into the skin.
d. Dermatomal: False. A dermatomal pattern typically refers to a skin distribution that follows a sensory nerve, as seen in conditions like shingles (herpes zoster). Larva migrans doesn’t follow this pattern.
- A flat pigmented circumscribed area less than 1 cm in diameter is:
a. macule
b. papule
c. patch
d. wheal
a. macule
macule vs patch
Brief Rationale:
macule: A flat, circumscribed area that is a change in the color of the skin that is less than 1 cm in diameter. It’s not raised or depressed compared to the surrounding skin.
papule: A solid, raised lesion that is less than 1 cm in diameter. It can be brown, purple, pink, or red in color.
patch: Similar to a macule, but it is larger than 1 cm in diameter.
wheal: A raised, itchy area of skin that’s often a sign of an allergic reaction. It can be a part of urticaria (hives).
- An elevated circumscribed fluid filled lesion less than 0.5cm is:
a. wheal
b. papule
c. vesicle
d. cyst
c. vesicle
Blister: Vesicle vs Bulla
Brief Rationale:
wheal: A raised, itchy area of skin, often transient, that can be part of urticaria (hives). It’s more of a reaction than a fluid-filled lesion.
papule: A solid, raised lesion that is less than 1 cm in diameter. It’s not filled with fluid.
vesicle: An elevated, circumscribed, fluid-filled lesion that is less than 0.5 cm in diameter. Examples include blisters from burns or herpes simplex lesions.
cyst: A nodule consisting of an encapsulated liquid or semiliquid material, typically larger than a vesicle.
- Palpable circumscribed lesion larger and deeper than 1cm in diameter and extends into the dermal area is:
a. nodule
b. papule
c. vesicle
d. pustule
a. nodule
Papule vs Nodule
Brief Rationale:
nodule: A palpable, circumscribed lesion that is larger and deeper than a papule, typically greater than 1 cm in diameter, and extends into the dermal (and sometimes subdermal) areas.
papule: A solid, raised lesion that is less than 1 cm in diameter.
vesicle: An elevated, circumscribed, fluid-filled lesion less than 0.5 cm in diameter.
pustule: A circumscribed elevation of the skin containing purulent exudate (pus). It is similar in size to a vesicle but contains pus.
- An example of a disease with vesicles (fluid-filled, <0.5 cm) is:
a. Acne vulgaris
b. Rubella
c. Roseola
d. Chicken pox
d. Chicken pox
Vesicle: Chicken pox, Shingles, Poison ivy
Brief Rationale:
Acne vulgaris: Typically presents with pimples, blackheads, and whiteheads. While it might have pustules (filled with pus), it doesn’t typically produce vesicles.
Rubella (German measles): Presents with a fine, pink rash and other symptoms. It does not typically produce vesicles.
Roseola: Causes a high fever followed by a pink-red raised or flat rash, but not vesicles.
Chicken pox (Varicella): Characterized by an itchy rash that turns into fluid-filled blisters (vesicles) and then crusts over. It’s a classic example of a vesicular rash.
- A minute slightly raised tunnel in the epidermis found in a web of fingers can be created by?
a. Larva migrans
b. Yeast infection
c. Scabies
d. Larva migrans
c. Scabies
Brief Rationale:
Larva migrans: Refers to the “creeping eruption” caused by hookworm larvae. It typically presents as serpiginous tracks on the skin but doesn’t create tunnels in the epidermis like scabies.
Yeast infection: Yeast infections, particularly those caused by Candida species, can lead to skin rashes and other manifestations but do not cause minute tunnels in the skin.
Scabies: Caused by the mite Sarcoptes scabiei, scabies leads to the formation of minute slightly raised tunnels (burrows) in the epidermis. These burrows are a classic sign of scabies and can be especially visible in the web spaces between the fingers.
- Common benign brown raised papules that feel slightly greasy and velvety or warty and have a stuck appearance
a. Seborrheic keratosis
b. Verruca plana
c. Verruca vulgaris
d. Actinic keratosis
a. Seborrheic keratosis
Brief Rationale:
Seborrheic keratosis: These are common benign skin growths that appear as brown, black, or light tan patches on the skin. They can be slightly elevated and have a greasy or warty surface. Their appearance often looks like they are “stuck on” the skin, making them easy to distinguish.
Verruca plana: Also known as flat warts, they are smooth, skin-colored or slightly pigmented, flat-topped papules. They do not have the greasy or “stuck on” appearance.
Verruca vulgaris: Common warts caused by human papillomavirus (HPV). They are rough, skin-colored bumps that often appear on the hands and fingers.
Actinic keratosis: These are rough, scaly patches on the skin that develop from years of exposure to the sun. They are precancerous lesions and do not have the “stuck on” appearance of seborrheic keratoses.
- Most common of all skin cancers with nil possibility of metastasis.
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant melanoma
d. Keratoacanthoma
a. Basal cell carcinoma
Brief Rationale:
Basal cell carcinoma (BCC): It is the most common type of skin cancer and has a very low metastatic potential. In fact, metastasis is exceedingly rare with BCC. It grows slowly and primarily causes local damage.
Squamous cell carcinoma (SCC): The second most common type of skin cancer. While it has a greater potential to metastasize compared to BCC, its metastatic risk is still relatively low but not nil.
Malignant melanoma: A more aggressive form of skin cancer with a significant risk of metastasis, especially if not detected early.
Keratoacanthoma: Often considered a variant of squamous cell carcinoma, keratoacanthoma grows rapidly but usually regresses spontaneously. Its potential for metastasis is debated, but it’s generally considered low.
- Fiery red up to 2 cm with a central body seen in liver disease.
a. Spider angioma
b. Purpura
c. Spider vein
d. Cherry angioma
a. Spider angioma
Brief Rationale:
Spider angioma: Also known as spider telangiectasia, it appears as a red spot (central body) from which small blood vessels (capillaries) radiate. It looks somewhat like a spider, hence the name. They can be associated with liver disease, especially cirrhosis, as well as other conditions like pregnancy.
Purpura: Refers to red or purple discolorations on the skin that don’t blanch when pressure is applied. They can be due to various causes, including bleeding disorders.
Spider vein: Also known as telangiectasias, these are small, dilated blood vessels near the surface of the skin or mucous membranes. They can appear anywhere on the body but often on the legs and face. They differ from spider angiomas in appearance and associations.
Cherry angioma: A common skin growth due to an overgrowth of blood vessels. They are bright red and can be found almost anywhere on the body. They are not specifically associated with liver disease.
- An acne scar that has a greater width than depth:
a. Box scar
b. Ice pick scar
c. Pock mark
d. Atrophic scar
a. Box scar
- The most number of hair is in this stage
a. anagen
b. catagen
c. telogen
d. Telogen effluvium
a. anagen
Brief Rationale:
Anagen: This is the active growth phase of hair follicles. The majority of hairs (about 85-90% in a healthy scalp) are in this stage at any given time, and it can last several years.
Catagen: A short transitional phase that lasts approximately 2-3 weeks. During this phase, the hair stops growing and detaches itself from the blood supply, and is then named a club hair.
Telogen: The resting phase, during which old hair falls out to make room for new anagen hairs. About 10-15% of all hairs are in this phase at any given time.
Telogen effluvium: This isn’t a phase of hair growth, but rather a condition. It’s a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase. It can be caused by various factors including physical stress, emotional stress, hormonal changes, dietary deficiency, and medications.
- The actively growing stage of the hair is
a. telogen
b. catagen
c. Telogen effluvium
d. anagen
d. anagen
Brief Rationale:
Anagen: This is the active growth phase of hair follicles where the cells in the root of the hair are dividing rapidly. The hair grows longer during this phase, which can last several years.
The other options provided:
Telogen: This is the resting phase of the hair follicle.
Catagen: This is a transitional phase where the hair stops growing and detaches from the blood supply.
Telogen effluvium: This is not a growth phase but rather a condition where there is temporary hair shedding.
- Melanin is produced in the
a. Spinous layer
b. Stratum corneum
c. Granular layer
d. Basal layer
d. Basal layer
d. Basal layer
Brief Rationale:
Melanin, the pigment responsible for the color of skin, hair, and eyes, is produced by melanocytes. Melanocytes are located in the basal layer (or stratum basale) of the epidermis.
- Diagnostic test to identify the presence of fungal infection
a. Skin lesion is excised or saucerized with a scalpel with lidocaine with or without epinephrine
b. Scale is removed using a no.15 scalpel blade, collected on a slide and treated with KOH solution
c. An early vesicle, not a pustule or crusted lesion, is unroofed and the base of the lesion is scraped gently with a blade
d. Non-invasive method of examining the skin surface using a high quality magnifying lens and specialized light source
c. An early vesicle, not a pustule or crusted lesion, is unroofed and the base of the lesion is scraped gently with a blade
Brief Rationale:
This option describes the procedure to obtain a sample for Tzanck smear, which is commonly used to diagnose viral infections like herpes simplex and varicella-zoster. It does not specifically identify fungal infections. The scraping from the base of a lesion, when examined under the microscope, can show characteristic multinucleated giant cells in cases of herpes infections.
- The most common malignancy associated with erythroderma is
a. Breast cancer
b. Prostatic cancer
c. Cutaneous T-cell lymphoma
d. Papillary thyroid carcinoma
c. Cutaneous T-cell lymphoma
- Drugs most commonly associated with erythroderma except
a. allopurinol
b. febuxostat
c. Penicillin and sulfonamides
d. Carbamazepine and phenytoin
b. febuxostat
30.DIHS (drug - induced hypersensitivity syndrome) may be accompanied by the following EXCEPT:
a. Myocarditis and facial swelling
b. Interstitial nephritis and hepatitis
c. Thyroiditis fever and peripheral eosinophilia
d. None of the above
d. None of the above
Brief Rationale:
Drug-induced hypersensitivity syndrome (DIHS), also known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, is a severe adverse drug reaction. It can be characterized by various systemic symptoms, including:
*Myocarditis and facial swelling
*Interstitial nephritis and hepatitis
*Thyroiditis, fever, and peripheral eosinophilia
All of these are potential manifestations of DIHS/DRESS, so none of the above options are exceptions to the presentations of the syndrome.
- This secondary skin lesion is characterized by excessive accumulation of the stratum corneum. It is called:
a. Crust
b. lichenification
c. Scale
d. Erosion
c. Scale
- The skin lesion that results in loss of epidermis without an associated loss of the dermis is called:
a. Ulceration
b. Scales
c. Erosion
d. Lichenification
c. Erosion
- A 23 year-old female sought consultation due to intense pruritic lesions particularly at night beneath her breasts, webs of fingers, axilla and groin. On close examination, they were excoriations with papules and burrows. Her 5 year-old toddler also had the same skin lesions. The patient has:
a. Psoriasis
b. Eczema
c. Scabies
d. Impetigo
c. Scabies
Brief Rationale:
The description provided – intense itching (especially at night), presence of excoriations with papules and burrows, commonly affected areas (webs of fingers, axilla, groin, beneath the breasts), and the fact that the 5 year-old toddler also has the same skin manifestations – all strongly suggest a diagnosis of scabies. Scabies is caused by the Sarcoptes scabiei mite. The burrows mentioned are the characteristic tracks left by the female mite as she tunnels just beneath the surface of the skin. This condition is contagious, which further explains why both the mother and the toddler are affected.
- A 64 year-old retiree complained of severe pain at his right side of the thorax. On physical exam, he had multiple vesicular lesions limited to the dermatomal distribution of T10. He had fever, cough and coryza 7 days prior to consultation. The patient has:
a. Herpes simplex II infection
b. Impetigo
c. Herpes zoster
d. Varicella
c. Herpes zoster
Brief Rationale:
Herpes zoster, commonly known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV), which also causes chickenpox (varicella). After a person has had chickenpox, the virus remains dormant in nerve cells and can later reactivate as herpes zoster.
The key features mentioned in the scenario – severe pain, vesicular lesions in a dermatomal distribution (often a stripe of blisters wrapping around one side of the body), and a history suggestive of a viral illness (fever, cough, coryza) – strongly indicate herpes zoster. The vesicles typically occur along the path of a nerve, hence the dermatomal pattern.
- This secondary skin lesion is defined as a distinctive thickening of the skin that is characterized by accentuated skinfold markings. It is called:
a. Lichenification
b. Scale
c. Erosion
d. Crusting
a. Lichenification
- The following statements are true regarding Pustules EXCEPT:
a. It is a vesicle filled with leukocytes
b. It is a secondary skin lesion
c. The presence of pustules does not necessarily signify the existence of an infection
d. None of all the above since all statements are true
b. It is a secondary skin lesion
- Diagnostic skin test designed to assess whether a skin lesion will blanch with pressure
a. Dermoscopy
b. Diascopy
c. Wood’s light
d. Tzanck smear
b. Diascopy
- Diagnostic test used in the diagnosis of varicella-zoster virus is:
a. Dermoscopy
b. Diascopy
c. Wood’s light
d. Tzanck smear
d. Tzanck smear
- Tinea versicolor is identified using KOH by the presence of:
a. hyphae
b. pseudohyphae
c. Budding yeasts
d. “Spaghetti and meatballs” yeasts
d. “Spaghetti and meatballs” yeasts
- The following statements are true of stasis dermatitis EXCEPT:
a. Chronic stasis dermatitis is often associated with dermal fibrosis or brawny edema
b. Stasis dermatitis develops on the lower extremities secondary to arterial insufficiency and chronic edema
c. Early findings consist of mild edema and scaling associated with pruritus
d. The typical initial site of involvement is the medial aspect of the ankle, often over a distended vein
b. Stasis dermatitis develops on the lower extremities secondary to arterial insufficiency and chronic edema
- A 23 year old male sought consult due to skin discoloration. On examination, patient had chalk-white macules on his axillae, flexor wrist, extensor surface of the extremities and around the mouth. This patient has:
a. Melasma
b. Psoriasis
c. Rosacea
d. Vitiligo
d. Vitiligo
Brief Rationale:
Vitiligo is a skin condition characterized by patches of the skin losing their pigment. The affected regions are typically chalk-white in color. It can occur anywhere on the body, but common sites include the axillae, around the mouth, hands, and other areas as described. The exact cause of vitiligo is unknown, but it’s believed to be an autoimmune condition where the body’s immune system attacks and destroys the melanocytes in the skin.
- A 26 year old medical student sought consulation due to recurrent pruritus more pronounced at night followed by deep vesicular lesions on his palms, soles and sides of fingers and toes. As the vesicle enlarge, it ruptures and result to open wounds that usually resolves. This patient most likely has:
a. dyshidrotic eczema
b. seborrheic dermatitis
c. acne vulgaris
d. contact dermatitis
a. dyshidrotic eczema
Brief Rationale:
Dyshidrotic eczema, also known as pompholyx, is a type of eczema that presents with small, itchy blisters on the edges of fingers, toes, palms, and soles. These blisters can become large and eventually rupture, leading to painful, open sores that can get infected if not treated properly. The exact cause is unknown, but stress and allergic reactions are believed to play a role. The symptoms described in the scenario, such as recurrent pruritus (especially at night), vesicular lesions on the palms, soles, and sides of fingers and toes that rupture, align with the presentation of dyshidrotic eczema.
- Which of the FDA-approved systemic therapy for psoriasis causes hepatotoxicity?
a. Methotrexate and acitretin
b. cyclosporine and apremilast
c. methotrexate and cyclosporine
d. acitretin and apremilast
c. methotrexate and cyclosporine
- Which of the FDA-approved systemic therapy for psoriasis is teratogenic?
a. methotrexate and acitretin
b. cyclosporine and apremilast
c. methotrexate and cyclosporine
d. acitretin and apremilast
a. methotrexate and acitretin
- The following drugs drugs may have alopecia as a side effect EXCEPT
a. Heparin and beta blockers
b. Amphetamines
c. Propylthiouracil and carbimazole
d. Cephalosporins
d. Cephalosporins
- Nailfold telangiectasia is pathognomonic of which of the following?
a. Systemic Lupus Erythematosus
b. Systemic Sclerosis
c. Dermatomyositis
d. AOTA
e. NOTA
d. AOTA (All Of The Above)
Brief Rationale:
Nailfold telangiectasias are dilated small blood vessels that can be seen near the base of the fingernails. They can be associated with several connective tissue diseases:
Systemic Lupus Erythematosus (SLE): While nailfold telangiectasias are not the most common feature of SLE, they can be observed in some patients.
Systemic Sclerosis (Scleroderma): Nailfold telangiectasias are a common and characteristic feature of systemic sclerosis.
Dermatomyositis: Nailfold telangiectasias can be seen in dermatomyositis, along with other characteristic cutaneous findings.
- The most common pustular dermatosis is/are:
a. Folliculitis
b. Acneiform Eruptions
c. AOTA
d. NOTA
c. AOTA
- Tinea capitis is caused by
a. Trichophyton tonsurans
b. Candida albicans
c. Malassezia furfur
d. Agaricus bisporus
a. Trichophyton tonsurans
- How long should a patient rest before checking the blood pressure if he drank mountain dew soda upon arrival at your clinic?
a. 5-10 minutes
b. 15 minutes then repeat again after 15 minutes
c. 30 minutes
d. Immediately upon arrival
a. 5-10 minutes
- During BP monitoring, the decrease in the pressure from the cuff should be as slow as:
a. 2 mm Hg until Korotkoff sound is heard
b. 5 mm Hg until Korotkoff sound is heard
c. 10 mm Hg until Korotkoff sound is heard
d. irrelevant .
a. 2 mm Hg until Korotkoff sound is heard
- Which part of the comprehensive adult history uncover problems that the paitent has overlooked, particularly in areas unrelated to the present illness?
A. Review of Signs
B. Review of Symptoms
C. Review of systems
D.Review of medications
C. Review of systems
- Which of the following information is a symptom?
A. Tenderness in the right upper quadrant area of the abdomen
B. Abdominal pain in the right upper quadrant area
C. Both are symptoms
D. None of the above
B. Abdominal pain in the right upper quadrant area
- A 50 year old female went to the nurse to have her blood pressure take. the nurse referse the patient because she noted a silent interval while taking her BP. What do you call this phenomenon?
A. Isolated gap
B. Silent pause
C. muffling point
D. Auscultatory gap
D. Auscultatory gap
- Which of the following methods of taking the temperature is most reliable in cases with rapid respiratory rates?
A. Tympanic tempearature
B. Oral temperatures
C. Axillary temperature
D. Rectal temperature
A. Tympanic tempearature
- Which is not included in the 7 attributes of symptoms?
A. factors that aggrevate the symptom
B. setting which it occurs
C. associated manifestions
D. Previous hospitalization
D. Previous hospitalization
- Knowing that you are a medical student, Prof X, a 45 year old male neighbor came to you for advice. He is apparently well. You note that his blood pressure is 140/90. He has no history of hypertension. He claims his blood pressure from previous check ups are normal. What should you advice him regarding his blood pressure?
A. Start the patient with oral antihypertensive medications
B. Advise BP monitoring and get the average
C. Call for help and advice admission
D. Refer to a cardiologist for evaluation
B. Advise BP monitoring and get the average
- Using cuf that is too wide may lead to which of the ff errors in measuring BP?
A. Low on small arm, high on large arm
B. Low in both small and large
C. High in both small and large arm
D. High on small arm, low on large arm
A. Low on small arm, high on large arm
- Which part of the comprehensive adult history gives you as suggestions as to what kind of person you are talking to and what likely problems you are to encounter?
A. Personal and Social History
B. History of Present Illness
C. Identifying Data
D. Reliability
A. Personal and Social History
- Professsor X is a 25 year old male and is worried about his weight. He wants to know if he is at risk for hypertension. He claims to be Asian. You compute for his BMI. The result is 29.
What will you tell him regarding his BMI and risk for developing hypertension?
A. He is obese and is not at risk for developing hypertension
B. He is obese and has increased risks for developing hypertension
C. He is overweight and is not at risk for developing hypertension
D. He is overweight and has increased risk for developing hypertension
B. He is obese and has increased risks for developing hypertension
- Which of the following can present with deep breathing that may be rapid, normal or slow in rate is usally brought about by metabolic acidosis?
A. Biot’s breathing
B. Hyperventilation
C. Cheyne-Stokes Breathing
D. Kussmaul Breathing
D. Kussmaul Breathing
- Which of the following statements is/are true in selecting the correct blood pressure cuff?
A. The width of the inflatable bladder of the cuff should be about 40% of upper arm circumference
B. The length of the inflatablle bladder should be about 80% of upper arm circumfererence
C. Both statements are correct
D. Neither statements are correct
C. Both statements are correct
12 Professor X is a 25-year-old male and is worried about his weight. He wants to now if he is at risk for hypertension. He claims to be Asian. You compute for his BMI. The result is 29. After answering professor X’s questions, he suddenly claims he is Caucasian, what will you tell him regarding his BMI and risk for developing hypetension.
A. He is obese and has increased risks for developing hypertension
B. He is obese and is not at risk for develping hypertension
C. He is overwweight and has increased risk for developing hypertension
D. He is overweight and is not at risk for developing hypertension
C. He is overwweight and has increased risk for developing hypertension
- A 45-year-old male claiming to be Professor X was brought to the emergency room due to chest pain. He was wheelchair-borne, and was clutching his chest upon entry. Initial vital signs were noted to be within normal. Which of the following shows he is in distress?
A. He was wheelchair- borne
B. He was clutching his chest upon entry
C. He was claiming to be Professor X
D. Vital Signs are within normal
B. He was clutching his chest upon entry
- Professor X wanted to have an ECG, After taking his vital signs, you noted his heart rate to be 68 with regular rhythm. Which of the following can be a possible ECG tracing?
A. Supraventricular Tachycardia
B. Complete Heart Block
C. Sinus Bradycardia
D. Second Degree AV block
C. Sinus Bradycardia
Brief Rationale:
Supraventricular Tachycardia (A) typically presents with a heart rate that is much faster, often > 150 beats per minute.
Complete Heart Block (B) is characterized by the atria and ventricles beating independently of each other due to a block in the atrioventricular (AV) node. The ventricular rate is typically slower, but the heart rate doesn’t have to be 68.
Sinus Bradycardia (C) is defined as a sinus rhythm with a resting heart rate of under 60 beats per minute in adults. Professor X’s heart rate of 68 is close to this range, and it is the most likely option given the choices.
Second Degree AV block (D) has two main types (Mobitz I and Mobitz II). Both types involve dropped beats, but the heart rate can be variable.
Given that Professor X has a heart rate of 68, which is a regular rhythm and near the bradycardic range, the most appropriate choice from the options given is Sinus Bradycardia.
- Which of the following pulse points is the most commonly used to assess amplitude and contour of the pulse wave?
a. carotid
b. femoral
c. temporal
d. radial
a. carotid
- Which of the following describes the term symptoms?
a. What the patient tells you
b. What you detect during the examination
c. Height
d. encompass all physical findings
a. What the patient tells you
- Which of the following statements is true of a comprehensive assessment of a patient?
a. addresses focused concerns of symptoms
b. creates platform for health promotion
c. assesses symptoms restricted to a specific body system
d. appropriate for established patients especially during routine or urgent care visits
b. creates platform for health promotion
18 Knowing that you are a medical student. Professor X, a 45 yr. old male neighbour came to you for advice. He is apparently well. You note that his blood pressure is 140/90. He has no history of hypertension. He claims his blood pressure from previous check-ups were normal. After several days of monitoring his average blood pressure is 120/90 which type of hypertension can you classify Professor X?
A. White coat hypertension
B.Essential hypertension
C. Masked hypertension
D. Secondary hypertension
A. White coat hypertension
19 which of the following pulse point is the most commonly used to assess the heart rate
A. Radial
B. Femoral
C. Carotid
D. Temporal
A. Radial
20 Professor X is a 25 year old male transgender says he has completed the process of change, what is his gender in your identifying data?
A. Male
B. In a relationship
C. Its complicated
D. Female
D. Female
- which part of the comprehensive adult history reflects the quality of the information provided by the patient?
a. reliability
b. Chief complaint
c. Review of systems
d. History of present illness
a. reliability
- Which of the following information is a sign?
A. Tenderness in the right upper quadrant area of the abdomen
B. Abdominal pain in the right upper quadrant area
C. Both are signs
D. Both are symptoms
A. Tenderness in the right upper quadrant area of the abdomen
- An unrecognized auscultatory gap may lead to which of the following errors in measuring blood pressure?
a. overestimation of systolic pressure or underestimation of diastolic pressure
b. overestimation of both systolic and diastolic blood pressure
c. underestimation of systolic pressure or overestimation of diastolic pressure
b. underestimation of both systolic and diastolic blood pressure
c. underestimation of systolic pressure or overestimation of diastolic pressure
Brief Rationale:
An auscultatory gap is a period where the Korotkoff sounds disappear during auscultation when measuring blood pressure. This can often be encountered in hypertensive patients. If not recognized, the clinician may mistakenly identify the return of the faint sounds as the systolic blood pressure (resulting in an underestimation of the systolic pressure) and the disappearance of sounds (which is normally the diastolic pressure) would be taken too high, hence overestimating the diastolic pressure.
- professor X has been smoking approximately 15 sticks of cigarettes everyday for the past 20 yrs. how many pack-years of smoking does he have?
A. 15 pack-years
B. 20 pack-years
C. 10 pack-years
D. 25 pack-years
A. 15 pack-years
- A 65-year-old came to the emergnecy department due to changes in sensorium. After shaking her gently you note that she can open her eyes and looks at you. She slowly responds to verbal stimuli and appears confused, what is the level of consciousness of the patient?
A. Comatose
B. Stuporous
C. Lethargic
D. Obtunded
D. Obtunded
- Melanin is produced in the
A. Granular layer
B. Basal layer
C. Spinous layer
D. Stratum corneum
B. Basal layer
- Most common of all skin cancers with nil possibilities of metastasis.
A. basal cell carcinoma
B. kertatocanthoma
C. squamos cell carcinoma
D. malignant melanoma
A. basal cell carcinoma
- Deep red or reddish purple fading away overtime, with no pulsality. 1-3 mm in size
A. Purpura
B. Angioma
C. Ecchymosis
D. Spider veins
A. Purpura
- Which of the ff. is NOT true?
A. Apocrine glands regulate temp.
B. Sebaceous glands open to the hair follicles
C. Eccrine sweat glands open directly to the skin surface
D. Apocrine glands open inti hair follicles
A. Apocrine glands regulate temp.
- Palpable, circumscribed lesion larger and deeper than 1cm in diameter and extends in the dermal area
A. Pustule
B. Vesicle
C. Papule
D. Nodule
D. Nodule
- Round scaling patches of hair loss, hair broken off close to the surface of the scalp
A. Alopecia areata
B. Seborrheic dermatitis of the scalp
C. Tinea capitis
D. Trichotillomania
C. Tinea capitis
- Nail plate turns white with a ground glass appearance, a distal band of reddish brown and obliteration of the lunula
A. Leukonychia
B. Beau’s lines
C. Mee’s lines
D. Terry’s nails
D. Terry’s nails
- The most number of hair in this stage
A. Catagen
B. Telogen
C. Telogen Effluvium
D. Anagen
D. Anagen
- A minute slightly raised tunnel in the epidermis found in finger webs can be created by
A. Scabies
B. Larva migrants
C. Contact dermatitis
D. Yeast infection
A. Scabies
- The skin forms a blister or sore, partial thickness skin loss or ulceration involving the epidermis, dermis or both.
A. Stage 4 pressure ulcer
B. Stage 2 pressure ulcer
C. Stage 1 pressure ulcer
D. Stage 3 pressure ulcer
B. Stage 2 pressure ulcer
36.The actively growing stage of the hair is the
A. Telogen
B. Catagen
C. Anagen
D. Telogen effluvium
C. Anagen
- Punctate depression in the nails are seen in thsi condition.
A. Cirrhosis
B. Iron Deficiency
C. Leprosy
D. Psoriasis
D. Psoriasis
- Risk factors to pressure ulcers does not include
A. Race
B. Fecal or Urinary incontinence
C. Hypotension
D. Low albumin
E. Atherosclerosis
A. Race
- Fiery red, up to 2cm with a central body seen in liver disease
A. Spider angioma
B. Purpura
C. Cherry angioma
D. Spider vein
A. Spider angioma
40 The layers of the skin goes from deepest to most superficial as
A. Basal, spinous, granular, stratum corneum
B. Spinous, basal, granular, stratum corneum
c. granular, basal, spinous, stratum corneum
d. basal, granular, spinous, stratum corneum
A. Basal, spinous, granular, stratum corneum
- The nails grow this length during normal conditions
A. 1.0 mm
B. 0.1 mm
C. 0.5
D. 0.25
B. 0.1 mm
- A flat, pigmented, circumscribed area less than 1 cm in diameter
A. Patch
B. Papule
C. Macule
D. Wheal
C. Macule
- An elevated, circumscribed fluid-filled lesion less than 0.5 cm
A. Wheal
B. Nodule
D. Papule
D. Vesicle
D. Vesicle
- Common benign brown raised papules that feel slightly greasy and velvety or warty and have a stuck on appearance
A. Verruca Vulgaris
B. Seborrheic keratosis
C. Actinic keratosis
D. Verrica plana
B. Seborrheic keratosis
- An example of a vesicle
A. acne
B. Furuncle
C. Scabies
D. Chicken pox
D. Chicken pox
- An Acne scar that is greater width than depth
A. Pock mark
B. Atrophic scar
C. Box scar
D. Ice pick scar
C. Box scar
- A superficial infection of the proximal and lateral nail folds adjacent to the nail plate.
A. Nail psoriasis
B. Paronychia
C. Onychomycosis
D. Lichen planus of the nail
B. Paronychia
48 Clubbing of the nails is defined as
A. If there is no “window” when two nails are facing each other
B. More than 180 degrees between the proximal nail fold and nail plate
C. Less than 180 degrees between the proximal nai fold and nail plate
D. 180 degrees between the proximal nail fold and nail plate
B. More than 180 degrees between the proximal nail fold and nail plate
- Brown macules and patches associated with papules and nodules with button holing.
A. Systemic Lupus Erythematosus
B. Neurofibromatosis
C. Tuberous sclerosis
D. Dermatomyositis
B. Neurofibromatosis
50 The lesion of larva migrans is best described as
A. Geographic
B. Serpiginous
C. Burrow
D. Lichen-like
B. Serpiginous
