Mt 3 Soruları Flashcards

Question 1

Q

Clostridium türü bakterilerin çoğunlukla da Clostridium perfringens’in etken olduğu bu hastalık, travma veya cerrahi girişimler sonucu iskelet kaslarında ortaya çıkan nekrozla karakterize, progresif ve toksemik bir hastalıktır
Bu hangi hastalığı anlatmaktadır¿

Answer

A

Gazlı gangren (myonecrosis)

Question 2

Q

erythematous papules and plaques accompany itching and diminish within a day, which disease is this

Answer

A

Urticaria

rash of urticaria consists of circumscribed, raised, blanching erythematous papules and plaques, some of which have a central pallor, located on neck, arms and back. The mucous membranes, palms, and soles are spared

Question 3

Q

Which of the following pharmaceutical system is not used to deliver agents to treat dermatological disorders?

Emulsions
Cream
Transdermal therapeutic system
Oinment

Answer

A

Tts. It is for vitamins and painkillers

Question 4

Q

What is the most reliable test for the diagnosis of septic arthritis?

Blood culture
Procalcitonin
C reactive protein (CRP)
Synovial fluid aspirate
Erythrocyte sedimentation rate (ESR)

Answer

A

Synovial fluid aspirate

Question 5

Q

Which of the following is a deformity that does not require treatment and possibly resolves spontaneously?

Developmental dysplasia of the hip
Flexible pes planus
Tarsal coalitions Congenital
convex pes valgus /vertical talus
Pes Equino varus

Answer

A

Flexible pes planus

Question 6

Q

In which disease Pastia’s lines are seen?

Scarlet fever
Toxic epidermal necrolysis
Staphylococcus scalded skin syndrome
Recurrent perineal erythema
Streptococcal toxic shock syndrome

Answer

A

Scarlet fever

Question 7

Q

Which of the following physical examination method for diagnosis of developmental dysplasia of the hip is diagnostic?

Ortholani / Barlow
Swelling of the hip
Length discrepancy of the lower extremity
Limitation of abduction of hip
Pain on hip movement

Answer

A

Ortholani / Barlow

Question 8

Q

Which of the followings is not a component of compartment syndrome?

Paresthesia
Pulselessness
Plasmapheresis
Pain

Answer

A

Plasmapheresis.

Compartment syndrome is defined as elevation of pressure in a compartment. 5P’s of Compartment syndrome are pain-paresthesia- pulselessness-pallor and paralysis
It is a real emergency situation and should be treated with emergent fasciotomy, if diagnosed too late has devastating complications resulting with severe disabilities in the affected extremity.

Paresthesia: uyuşukluk karıncalanma hissi

Question 9

Q

Patient has mild fever for the last 3 days. Afterwards, her parents noticed a rash which was prominent on her face and trunk initially, then spreading to arms and legs. A few children in day-care had a similiar rash recently. Physical examination showed widespread presence of macules, papules, vesicles, and pustules in close proximity over her body. She was restless and itching her skin all the time during the examination

What is the diagnosis¿

Varicella
Measless
Mumps
Rubella

Answer

A

Varicella

Question 10

Q

INFO CARD
Plain film is the first imaging technique.
Osteid osteoms are typical mostly painful lesions.
Usg is the frist choice about new born congenital hip displasia.

Question 11

Q

Which of the following statements regarding hip dislocation is not correct ?

The classic position of an anteriorly dislocated hip is flexion, abduction and external rotation.

90% of all pure dislocations are anterior hip dislocations.

Treatment involves closed reduction under anesthesia in order to avoid femoral or acetabular fractures.

Hip joint dislocation is the third most common dislocation seen in humans.

Following reduction, if the joint is concentric and stable; full weightbearing as tolerated is permitted.

Answer

A

90lı şık. Posterior doğrusu.

Question 12

Q

A 26-year-old man presents to the dermatologist complaining about the lesions that he has noticed recently on the skin adjacent to his penis. He is concerned about having acquired a sexually transmitted disease through one of several recent sexual encounters. The dermatologist defined the lesions as smooth dome- shaped/umblicated papules with a central depression. An excisonal biopsy is performed for one of the lesions. The histopathologic examination revealed verrucous epidermal hyperplasia and intracytoplasmic inclusions located to the corneal and granular layer of the epidermis.
Which of the following viruses can be the etiologic agent for this lesion?

Human papiloma virus
HIV
Hepatit B virus
Pox virus
Herpes simplex virus type 2

Answer

A

Pox.

The gross appearance and histologic appearance are characteristic of molluscum contagiosum, which is caused by poxvirus. The cells in the epidermis contain large intracytoplasmic inclusions, which are called molluscum bodies. The molluscum bodies are accumulations of viral particles.

Molluscum contagiosum, ciltte küçük pembe veya ten rengi kabarıklıklara neden olan virüs kaynaklı bir hastalıkdır. Zararlı değildir ve hastaların genellikle başka şikayetleri yoktur. Virüs şişliklerin içindedir ve hafif bulaşma riski bulundurmaktadır. Bu çıkıntılar genellikle uzun bir süre sonunda kaybolur.

Question 13

Q

Is a complete cord hemitransection usually seen after penetrating traumas of the spinal cord. Characterized by ipsilateral motor, proprioception, vibration and contralateral pain-temperature deficit. Has excellent prognosis depending on the cause.”
Which spinal cord injury pattern is defined above?

Brown-Sequard syndrome
Conus medullaris syndrome
Posterior cord syndrome
Central cord syndrome

Answer

A

Brown-Sequard syndrome

Question 14

Q

Info

The term melanocytic lesion refers to proliferations of neural crest-derived melanocytic cells in the skin ranging from benign freckles and nevi (moles) to malignant melanoma.

Question 15

Q

Which of the following disease-modifying anti-rheumatic drugs (DMARDs) is the first and only drug to be indicated to slow down structural joint damage in romatoid arthritis (RA)?

Methotrexate
Sulfasalazine
Leflunomide
Hydroxychloroquine

Answer

A

Leflunomide is an immunomodulatory drug that decreases pyrimidine synthesis by inhibiting the enzyme “dihydroorotate dehydrogenase” (DHODH), inhibiting both T cell proliferation and production of auto-antibodies by B cells.

Question 16

Q

A 30-year-old man is evaluated for an intensely pruritic erythematous papular and vesicular dermatitis involving the forearms and buttocks bilaterally. He is treated with a high-potency topical steroid, which helps with the itching; however, the rash fails to resolve. After that a skin biopsy is performed from this patient, which shows granular deposits of IgA within the dermal papillae with direct immunofluorescence technique. Which of the following histopathological findings is related with this patient’s disease?

Suprabasal and intraepidermal clefting, extensive acantholysis of keratinocytes resembling dilapidated brick wall

Subepidermal blisters with papillary neutrophilic microabscesses

Suprabasal acantholytic blisters leaving a single layer of basal cells

Epidermal hyperplasia and severe spongiosis

Subepidermal non-acantholytic blisters and superficial perivascular inflammatory infiltrate of lymphocytes and eosinophils

Answer

A

Subepidermal blisters with papillary neutrophilic microabscesses

The distribution of the rash, the clinical description, and histopathological ad DIF findings (Subepidermal blisters with papillary neutrophilic microabscesses and granular deposits of IgA within the dermal papillae) all indicate dermatitis herpetiformis due to underlying celiac disease. The gluten-containing foods would be most likely to aggravate the patient’s condition. Dermatitis herpetiformis is associated with IgA autoantibodies to fibrils that bind the epidermal basement membrane to the dermis, and also produces subepidermal blisters. The association of dermatitis herpetiformis with celiac disease provides a clue to its pathogenesis. Genetically predisposed individuals develop lgA antibodies to dietary gluten (derived from the wheat protein gliadin).

Suprabasal acantholytic blisters leaving a single layer of basal cells resembling row of tombstones: Pemphigus vulgaris

Suprabasal and intraepidermal clefting, extensive acantholysis of keratinocytes resembling dilapidated brick wall: Hailey-hailey disease

Subepidermal non-acantholytic blisters and superficial perivascular mixed inflammatory infiltrate: Bullous pemphigoid

Epidermal hyperplasia and severe spongiosis can be the histopathological features of acute eczematous dermatitis (spongiotic dermatitis), not a bullous disease

Question 17

Q

Which of the following is not associated with the prolonged course of urticaria?

Presence of IgG autoantibodies
Initial disease severity
Diurnal variation
Presence of angioedema
Combination of CSU (Chronic spontaneous urticaria) and physical urticarias

Answer

A

Diurnal variation

Question 18

Q

Which of the following is not a feature of inflammatory arthritis?

Erythema
Symmetric pain even at rest
Joint swelling
Warmth
Typically about 10 minutes of morning stiffness

Answer

A

Typically about 10 minutes of morning stiffness

Genelde inflammatory artrit tipi olan RA dan görülebileceği üzere 10dktan uzun sürer. RA 30dkdan uzun sürer mesela

Question 19

Q

Which bactery cause cellulitis¿

Answer

A

S pyogenes

Question 20

Q

Which of the followings are the signs / symptoms of osteoarthritis?

Locking sensation of the knee
Crepitations
Pain
Morning stiffness lasting for more than an hour
Gait changes

Answer

A

Morning stiffness içeren şık dışında hepsi. Çünkü 30dkdan az sürer

Question 21

Q

Which of the following sentences is not correct for cellulitis?

Group A Streptoccoccal and Staphylococcal species are the main causative agents.
Cellulitis is a common infection of the deep dermis and subcutaneous tissue.
Children are more likely than adults to have facial involvement.
Unilateral lower extremity involvement is typical.
Cellulitis has well defined borders.

Answer

A

Cellulitis DOES NOT have well defined borders. Others are correct.

Question 22

Q

What is the most common agent that causes septic arthritis

Question 23

Q

A 53-year-old woman presents with a two-month history of difficulty climbing stairs and arising from the seated position. On physical examination, she has a purplish discoloration of the skin over the forehead, eyelids, and cheeks. She has tenderness on palpation of the quadriceps muscles.
What’s the most likely diagnosis?

Rheumatoid arthritis
Granulomatosis with polyangiitis
Systemic sclerosis
Dermatomyositis
Felty’s syndrome

Answer

A

Dermatomyositis

Dermatomiyozit nadir görülen bir inflamatuar hastalıktır. Bu rahatsızlığın gelişmesi ile birlikte ciltte döküntü, kas güçsüzlüğü ve inflamatuar miyopati olarak bilinen kas iltihaplanması şikayetleri ortaya çıkar. Dermatomiyozit her yaştan bireyi etkileyebilen bir durumdur.

Granulomatosis with polyangiitis (GPA) is a rare vasculitis affecting small vessels. Hallmark features include necrotizing granulomas and pauci-immune vasculitis that most commonly affects the upper respiratory tract, lungs, and kidneys.

Felty syndrome is a rare extra-articular manifestation of seropositive rheumatoid arthritis characterized by RA, neutropenia, and splenomegaly. While the etiology remains somewhat obscure, baseline data suggests an association with certain human leukocyte antigen (HLA) subtypes.

Question 24

Q

loss of joint space, subchondral sclerosis (hardening of the bone just beneath the cartilage), and calcium deposition within the surrounding tissues typically indicates which disease¿

Answer

A

loss of joint space, subchondral sclerosis (hardening of the bone just beneath the cartilage), and calcium deposition within the surrounding tissues typically indicates osteoarthritis. Osteoarthritis is a degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone changes. Calcium deposition, also known as calcification or calcinosis, can occur in the soft tissues surrounding the joint as a result of the degenerative process.

Question 25

Q

Which of the following is incorrect regarding fungal infections of skin and soft tissue?

Typical ringworm lesions have an inflamed circular border containing
papules and vesicles surrounding a clear area of relatively normal
skin.

Dermatophytes infect only deeper tissues not superficial keratinized tissues.

The most commonly used medium for cultivating fungi is Sabouraud’s
agar, which contains only glucose and peptones as nutrients.

The simplest method is to mix a clinical specimen, such as skin
scrapings, with a 10% solution of potassium hydroxide (KOH) on a
microscope slide under a coverslip.

Fungi can often be identified by directly observing their distinctive
morphologic features on direct microscopic examination of infected
pus, fluids, or tissues.

Answer

A

Dermatophytes infect only superficial keratinized tissues therefore 2nd option is the answer

Question 26

Q

A 36-year-old man presented with the complaint of the presence of asymptomatic recurrent scales around the nose and on the eyebrows. Physical examination revealed greasy yellowish scales on mild erythematous ground in these areas. The patient was otherwise completly healthy.
What is the most likely diagnosis in this patient?

Discoid eczema
Allergic contact dermatitis
Psoriasis vulgaris
Atopic dermatitis
Seborrhoeic dermatitis

Answer

A

Seborrhoeic dermatitis

Seborrhoeic dermatitis usually affects the seborrhoeic and hairy areas such as scalp, ears, eyebrows, face, pre-sternal area, armpits, umblicus and groin. It shows a chronic and recurrent course, and characterized by greasy yellowish scales

Türkçesi egzama

Question 27

Q

Which of the following features regarding discoid lupus erythematosus are correct?

1 Linear granular deposition of immunoglobulin A along the
dermoepidermal and dermal follicular junctions

2 Characterized by a lichenoid infiltrate of lymphocytes along the dermoepidermal junction

3 A typical sign of red butterfly-shaped rash over the cheeks and nose sparing the nasolabial folds occur

4 Systemic manifestations of systemic lupus erythematosus are also
common in this disease

5 Most common chronic form of cutaneous lupus

Answer

A

1 ve 4 yanlış.

The features of DLE: -Systemic manifestations of systemic lupus erythematosus are mostly absent / rare in this disease -A typical sign of red butterfly-shaped rash over the cheeks and nose sparing the nasolabial folds occur
-Histopathologically characterized by a lichenoid infiltrate of lymphocytes along the dermoepidermal junction and/or dermal- follicular epithelial interface -Linear granular deposition of immunoglobulin G and complement along the dermoepidermal and dermal follicular junctions

Question 28

Q

Does osteophytes seen in OA or RA

Answer

A

OA

Bone spurs, or osteophytes, are bony growths that form in your joints or in the spine. They cause damage to your bones, muscles, or tendons, often as a result of osteoarthritis. These smooth growths may not cause any symptoms or need treatment.

Question 29

Q

Is pannus formation seen in OA or RA

Answer

A

RA

Normalde hücre ve damar yapısından fakir olan sinoviyum, kanlanmanın fazla olduğu, proliferasyon gösteren, tümör dokusuna benzer destrüktif bir doku haline gelir. Bu dokuya PANNUS denir.

Question 30

Q

Are bouchard and heberden nodes seen in Oa or RA

Answer

A

Oa

Heberden distal bouchrad meta parmak eklemlerinde oluşan şişkinlikler

Question 31

Q

Morning stiffnes that gets improved by activity s seen in OA OR RA

Question 32

Q

Inhibition of which of the following enzymes most likely mediated the therapeutic effect of leflunomide added to methotrexate therapy in a 40-y.o. woman suffering from rheumatoid arthritis?

Dihydrofolate reductase
Type II topoisomerase
Cyclooxygenase-1
Dihydroorotate dehydrogenase

Answer

A

Dihydroorotate dehydrogenase

Leflunomide is a disease-modifying antirheumatic drug (DMARD)
immunosuppressant approved for the treatment of rheumatoid and psoriatic arthritis. Its mechanism of action involves the inhibition of dihydroorotate dehydrogenase, an enzyme involved in pyrimidine synthesis. As a consequence, there is a reduction in uridine triphosphate levels and pyrimidine synthesis in leucocytes and other rapidly dividing cells. Leflunomide is about as effective as methotrexate in rheumatoid arthritis and enhances methotrexate activity when given concomitantly. Therefore, it is often added to methotrexate therapy, as in this case.

Question 33

Q

A specific chromosomal translocation, t(11;22) (q24;q12) or a variant is found in most of the said diseases family of tumors.

Clinical manifestations may include constitutional symptoms such as fever, fatigue, and weight loss.

Which tumor is this¿

Answer

A

Ewing sarcoma

Question 34

Q

The patient has enlarging lesion on his upper back. The lesion is an erythematous, tender, round, perifollicular nodule with multiple pustules protruding from the surface. S aureus is most common causative agent of the disease.

Which disease is this

Answer

A

Carboncule (çıban)

Question 35

Q

A previously healthy 18 month old infant developed high fever abruptly. His parents saw that the body temperature was 40 other finding and he seemed well when the fever was controlled with paracetamol. However, three days later, a rapid defervescence (abrupt loss) of fever followed by the onset of a pink rash over the trunk was noticed. You examined the baby. He was a well developed and healthy boy, having no fever, and except for the mild, pink, morbilliform rash, other physical findings were unremarkable.The clinical follow up showed that the rash resolved in two days.
What is your diagnosis?

Chickenpox
Roseola infantum
Erythema infectiosum
Rubella
Measles

Answer

A

Roseola infantum: 6 aylıktan daha küçük çocuklar anneden geçen antikorlar nedeniyle altıncı hastalığa karşı bağışıktırlar. Roseola infantum olarak da isimlendirilen altıncı hastalıkta oluşan en ayırt edici belirti rahatsızlığın 3-7. günleri arasında yüksek ateş sonrası gelişen cilt döküntüsüdür.

Question 36

Q

The wife of a 56-year-old man comments that the ‘mole’ on the back of her husband’s neck has seemed to be much larger than she remembered it 2 months ago. On physical examination it is 1 x 1.2 cm and has irregular pigmentation and irregular borders. The biopsy of this lesion seen here microscopically. Histopathologically the lesion is composed of large pigmented polygonal cells with large nucleoli and the lesion has infiltrative border.
Which of the following is the most likely diagnosis?

Acanthosis nigricans
Actinic keratosis
Dermatofibroma
Hypertrophic scar
Malignant Melanoma
Verruca vulgaris

Answer

A

Malignant melanoma.

Changes in ‘moles’ are suspicious for melanoma. Note the large polygonal cells with large nucleoli and cytoplasmic pigmentation. The features of the lesion is compatible with malignant melanoma

Question 37

Q

Verrucous epidermal hyperplasia with a cup-like architecture and large intracytoplasmic inclusions within epidermis

Answer

A

Molluscum contagiosum

Question 38

Q

Collection of neutrophils beneath the stratum corneum and formation of subcorneal pustules accompanied with bacteria

Question 39

Q

Epidermal hyperplasia, koilocytosis, keratohyalin granules and intracytoplasmic eosinophilic inclusions

Answer

A

Verrucae vulgaris

Question 40

Q

Hydropic swelling of epidermis, intraepithelial vesicular lesions, formation of pink to purple intranuclear inclusions containing virions, İnclusion-bearing multinucleated syncytia

Answer

A

Herpes simplex infection

Question 41

Q

Fungal microorganisms in hyphae and yeast forms (spaghetti and meatballs appearance) found within the cornified layer associated with neutrophilic infiltration

Answer

A

Tinea versicolor

Question 42

Q

Which eruptive disease of childhood shows the following characteristic eruption pattern?
Exanthema typically beginning at the hairline and spreading in a cranial to caudal direction; the lesions are red macules initially, then progress to papules, vesicles, and pustules and then crust within 48 hours. Different highly pruritic skin rashes (macules, papules, vesicles, pustules) present in the same anatomic area.

Chickenpox
Roseola infantum
Measles
Erythema infectiosum

Answer

A

Chickenpox

Question 43

Q

Which of the following is a purine analog and acts through inhibition of xanthine oxidase which is especially reserved for chronic treatment of severe tophaceous gout or renal urate stones?

Lesinurad
Febuxostat
Colchicine
Allopurinol

Answer

A

Allopurinol.

It is the only purine (note “purin” in its name) analog Feedback:
within antigout drugs acting through inhibition of xanthine oxidase reserved for chronic treatment of severe tophaceous gout or renal urate stones.

Question 44

Q

77-year-old woman with a sore, pruritic, blistering eruption for three days prior to arrival. Examination of the palms, soles, dorsal aspect of the feet, legs, buttocks, and inner thighs revealed well-demarcated, tense bullae (fig1). They ranged in size from 1cm to 3 cm. They were not clustered in a rosette pattern. There was oral mucosal involvement and also crusting over the left lower lip. On the histopathologic examination; surface epithelium cleanly detached from the underlying connective tissue at the point of the basement membrane zone is revealed (fig2). On direct immunofluorescence deposits of IgG along the basement membrane zone were detected in a linear pattern (fig3).
Which of the following is the most probable diagnosis of this patient?

Hailey hailey disease
Bullous pemphigoid
Pemphigus vulgaris
Linear IgA bullous disease
Dermatitis herpetiformis

Answer

A

Bullous pemphigoid: Chronic, immune mediated, subepithelial blistering disease that predominantly affects mucous membranes. Autoantibodies directed at components of the basement membrane zone (Autoantibodies are against to the components of the basement membrane, particularly the BP antigens BP180 and BP230). Lesions present as tense bullae which do not easily rupture because of the deep location. DIF reveals linear deposition of immunoglobulin and complement at DEJ

Question 45

Q

Joint infection may be caused by the spread of microorganisms from the near epiphysis. This route can not be used for a specific period of time due to the existence of a natural barrier of the physis plate.
Which of the following refers to that period of time?

Between 18 months and 16 years
0-18 months
0-6 months
>18 months to 24 months
Adulthood
In fetal period

Answer

A

Between 18 months and 16 years

The existence of transpyhseal vessels may induce a joint Feedback:
infection which may arise from epiphysis osteomyelitis. An open physis line is a natural barrier to resist such an infection. The existence of such a barrier usually blocks the involvement of joints from nearby epiphyseal/metaphyseal osteomyelitis.

Question 46

Q

Which of the following is the mechanism of action of a drug administered to a 50- y.o. man who developed muscle rigidity, tachycardia, labile blood pressure, profuse diaphoresis, and high fever (>40°C) shortly after the initiation of general anesthesia with halothane and succinylcholine prior to his inguinal hernia surgery? (The anesthesia was discontinued at once, and the drug of interest was administered by rapid intravenous push.)

Blockade of excitatory neurotransmitter release in the brain
Blockade of Ca2+ channels in the sarcoplasmic reticulum
Increased K + conductance in the skeletal muscle cell membrane
Blockade of Ca 2+ channels in the skeletal muscle cell membrane
Activation of GABA B receptors in the spinal cord

Answer

A

Blockade of Ca 2+ channels in the sarcoplasmic reticulum

The clinical picture of the patient suggests the diagnosis of Feedback:
malignant hyperthermia, a rare but potentially life-threatening disorder that can be triggered by a variety of stimuli, including the administration of certain anesthetics (mainly halothane) and neuromuscular blocking agents (mainly succinylcholine). The disorder is related to a hereditary impairment in the ability of the sarcoplasmic reticulum (SR) to sequester calcium (Ca 2+
);
therefore, a prolonged release of Ca 2+
occurs after the triggering
event through SR Ca 2+
channels (ryanodine receptors, RyR). This
causes massive muscle contraction, hyperthermia, and lactic acidosis. Dantrolene is a drug of choice in this disorder because it blocks RyRs in the skeletal muscle SR, thus preventing the massive release of Ca 2+
. Cardiac and smooth muscle are
minimally affected by dantrolene because they have a different subtype of RyRs in their SR.

Question 47

Q

Which of the following statements regarding a triad in a striated muscle are correct?

It is formed by two terminal cisternae and one t-tubule.
Propagates the action potential from the sarcolemma to the terminal cisternae.
It forms at the level of A-I junction of a sarcomere.
It is found in cardiac muscle.
It contains fascia adherens, gap junctions and desmosomes

Answer

A

1 2 3 doğru

Question 48

Q

Which of the following class of drugs is not indicated for eczema treatment?

Calcineurin inhibitors
Glucocorticoids
Antibacterials
Retinoids

Answer

A

Antibacterials

Eczema is not caused by bacteria, however, glucocorticoids may be combined with antibacterial or antifungal agents if infection is present.

Question 49

Q

A 35-year-old woman presents with pain, fever and swelling in her right leg. Examination reveals well-demarcated erythema and spreading streaks of lymphedema.
Which of the following is the most likely diagnosis of this patient’s condition?

Necrotising cellulitis
Myositis
Erysipelas
Necrotising fasciitis
Impetigo

Answer

A

Erysipelas

This patient has clinical features of erysipelas, a type of superficial cellulitis with dermal and superficial lymphatic involvement.
Erysipelas is a bacterial infection that leads to pain, edema, and well-demarcated erythema.

Question 50

Q

Which of the following features are considered as a risk factor in the development of Developmental dysplasia of the hip (DDH)?

Aged mother
Positive family history
Vertex presentation at birth
Male sex
Intrauterine packaging problems

Question 51

Q

Which of the below listed joints are considered as a ball and socket type joint?

The subtalar joint
The knee joint
The hip joint
The metacarpophalangeal joints
The shoulder joint

Answer

A

Hip and shoulder

Question 52

Q

A 3 year boy was brought to the family health care center because of fever and rash. From the history you learned that he had fever, cough, a running nose and red eyes for the last couple of days, and yesterday morning the mother noticed a red rash on his face and neck , which is now spreading to his chest and back. Mother told that two other children at the same day care had similiar rash.
His physical examination was remarkable for fever, cough, coryza, conjuntivitis, and a discrete morbiliform rash in the form of coalescing erythematous macules and papules . What is your most likely diagnosis ?

Rubella
Erythema Infectiosum
Scarlet fever
Measles

Answer

A

Measles

These signs and symptoms strongly suggest measless. Feedback:
Particularly cough+coryza+conjuctivitis ( 3Cs) and morbiliform rash.

Question 53

Q

A 65-year-old woman presented with a 1 cm × 1 cm erythematous keratotic plaque on the palmar aspect of the left hand seen at the first picture. Physical examination was otherwise unremarkable. The lateral edge of the lesion was biopsied for further evaluation. Histopathological examination showed hyperkeratosis, parakeratosis, and full thickness atypia of the epidermis. No invasion beyond the basement membrane was noted.
According to the microscopic findings which of the following is the most likely diagnosis of this lesion?

Psoriasis
Seborrheic keratosis
Verruca vulgaris
Bowen’s disease
Squamous cell carcinoma

Answer

A

Bowen’s disease.

Bowen’s disease, or squamous cell carcinoma (SCC) in situ, is an intraepithelial neoplasm with a risk of progression to SCC. It is most often located in sun-exposed areas. Head and neck are most commonly involved followed by the lower and the upper extremities. While the dorsal aspects of the hands are commonly affected, occurrence on the palms is rare. Histopathologic exam showing full-thickness atypia of the epidermis with loss of normal maturation of the keratinocytes will differentiate palmar Bowen’s disease from the other entities.

Question 54

Q

Which of the following disease-modifying antirheumatic drugs (DMARDs) is a mouse/human chimeric monoclonal antibody against TNF alpha?

Abatacept
Infliximab
Adalimumab
Etanercept

Answer

A

Infliximab

Infliximab is a cytotoxic drug that inhibits the activity of the T-cells and B-cells. It is a mouse/human chimeric (denoted by “xi”) monoclonal antibody (mab) that binds to and inhibits the activity of tumor necrosis factor (TNF-alpha). TNF-alpha is a mediator of inflammation and immune activation. The main indication for infliximab is in the treatment of Crohn’s disease, which is an inflammatory condition of the intestinal tract.

Question 55

Q

A 4 year-old child is referred to pediatric clinic with limping. He had an upper respiratory tract infection prior to his complaints. He did not have high fever and any rash. On physical exam he looks well, there is painful hip on flexion. There is no hepatosplenomegaly. Complete blood count including acute phase reactants and antistreptolysin antibodies are normal. What is the provisional diagnosis?

Brucella arthritis
Perthes disease
Toxic synovitis
Septic arthritis
Acute rheumatic fever

Answer

A

Toxic synovitis

Question 56

Q

Which of the following statements are correct for hip dislocations? (Choose as many as required)

The main treatment of hip dislocations is urgent open (surgical) reduction and fixation of the hip joint with bone screws.

It is the most common joint dislocation seen in humans.

Posterior dislocation is the most commonly seen type among all hip dislocations

In posterior hip dislocation, the leg on the affected side lies in flexed, internally rotated and adducted position.

The ethiology is traumatic in the majority of cases.

Answer

A

3 4 ve 5 doğru.

The most common joint dislocation seen in humans is shoulder dislocation, followed by elbow and hip dislocation. The ethiology is traumatic in the majority of cases. Posterior dislocation is the most commonly seen type among all hip dislocations, which the leg on the affected side lies in flexed, internally rotated and adducted position. The main treatment of hip dislocations is urgent closed reducton. Surgical reduction is preferred on late admittances and failed close reductions.

Question 57

Q

Which of the following tumor reveals a histology similar to lipoma which is composed of a mixture of normal-appearing adipocytes intermixed with atypical adipocytes?

Dedifferentiated liposarcoma
Well-differentiated liposarcoma
Rhabdomyosarcoma
Myxoid liposarcoma
Pleomorphic liposarcoma

Answer

A

Well-differentiated liposarcoma

Histology of well-differentiated liposarcoma is similar to lipoma Feedback:
showing a mixture of normal-appearing adipocytes intermixed with atypical adipocytes. Pleomorphic liposarcoma histology differs with pleomorphic cells, myxoid liposarcoma differs with myxoid background. Dedifferentiated liposarcoma is hard to diagnose by just adipocytes and rhabdomyosarcoma is a skeletal muscle tumor.

Question 58

Q

Which of the listed factors are considered as risk factors for developmental dysplasia of hip?

Firstborn
Male sex
Breech presentation at birth
Oligohydramnios
Old mothers

Answer

A

1 3 4

Firstborn (primiparity) babies, female sex, breech presentation at Feedback:
birth, young mothers, positive family history, intrauterine packaging problems, oligohydramnios, newborns with greater weight and height, newborns with deformities of the feet or spine are considered as risk factors for DDH.

Question 59

Q

Which one of the below listed reflexes is indicative of the termination of the spinal shock?

Spurling’s reflex
Achilles reflex
Bulbocavernosus reflex
Ankle clonus
Babinsky reflex

Answer

A

Bulbocavernosus reflex

Bulbocavernous reflex is the first reflex to return once the spinal Feedback:
shock is over; it’s presence heralds the end of the stage of spinal shock and onset of recovery.

Question 60

Q

Which one of the below listed tests is used for examining lumbar spinal mobility?

Hoffmann test
Laseque test
Schober’s test
Patrick’s test

Answer

A

Schober’s test

Question 61

Q

Which one of the listed factors is not considered as a treatment goal in the treatment of Legg Perthes Calve disease?

Increasing the blood flow to the necrotic femoral epiphysis
Limitation of loading in order to prevent collapse of the head
Resolution of symptoms
Restoration of range of motion
Keeping the femoral head contained within the acetabulum

Answer

A

Increasing the blood flow to the necrotic femoral epiphysis

Conservative or surgical treatment options for LPC disease all aim to decrease pain, increase the ROM of the hip joint, keep the femoral head within the acetabulum, and prevent further collapse of the femoral head. Increasing the blood flow to the affected femoral head is not possible with the current treatment options.

Question 62

Q

Which one of the statements listed below is not correct considering femoral shaft fractures?

Stress ractures may be seen in prolonged use of biphosphonates.
Rigid intramedullary nailing is the most preferred way of fixing femoral shaft fractures in the adult population.
Low impact injuries in the elderly may cause a femoral shat fracture due to osteoporosis.
Hip spica casting is the standard treatment of femoral fractures in the elderly.
In contaminated, open femoral shaft fractures, external fixation may temporarily be used in order to avoid complications.

Answer

A

Hip spica casting is the standard treatment of femoral fractures in the elderly.

Hip spica casting is the preferred treatment modality for femoral shaft fracture in children up to 5 years of age. Rigid fixation (intramedullary nailing or plating ) is the proper treatment in adults.

Question 63

Q

A 50-year-old woman recently diagnosed with gouty arthritis started a treatment with a drug that inhibits leukocyte migration and phagocytosis secondary to inhibit ion of tubulin polymerization.
Which of the following drugs did the patient most likely take?

Colchicine
Indomethacin
Prednisone
Allopurinol

Answer

A

Colchicine can be used to stop an acute gout attack or, most often, for the prevent ion of further at tacks, as in this case. The drug binds to the intracellular protein, tubulin, thereby preventing its polymerization into microtubules and thus blocking mitosis in metaphase. Cells with the highest rate of division are affected early. Granulocyte migration into the inflamed area and phagocytosis of urate crystals by macrophages are inhibited, thus relieving the pain and inflammation of gouty arthritis. These actions are specific, and the drug is devoid of general analgesic or anti-inflammatory effects.

Question 64

Q

Which of the following endogenous molecule is targeted by infliximab which was added to the ongoing treatment of a 50-year-old woman with refractory rheumatoid arthritis (RA)?

Interleukin-1 (IL-1)
Vascular endothelial growth factor (VEGF)
Interleukin-10 (IL-10)
Tumor necrosis factor-α (TNFα)

Answer

A

Tumor necrosis factor-α (TNFα)

Infiximab is a chimeric monoclonal antibody (mab) that binds with Feedback:
high affinity to soluble and possibly membrane-bound tumor necrosis factor-α (TNF-α). TNF-α is a proinflammatory cytokine that appears to be especially important in the inflammatory processes associated with autoimmune disorders, such as RA, ankylosing spondylitis, Crohn disease, and psoriasis. TNF-α-blocking agents such as infliximab are used in RA, especially for refractory type.

Answer 59

A

There is no enanthem seen in the course of the disease

Scarlet fever is associated with bacterial pharyngitis caused by Group A beta-hemolytic streptococci (GAS). Typically, scarlet fever is associated with acute pharyngitis. As a result, fever, sore throat, pain with swallowing, and cervical adenopathy is present. If there is no pharyngitis, the source of infection can be a wound or burn which is infected with GAS. In addition to a classic sandpaper rash, physical findings can include a strawberry tongue (enanthem of the disease) and pastia lines. Pastia lines are pink or red lines formed of confluent petechiae, which are found in folds of the skin such as the antecubital fossa. The rash usually persists for about one week and may be followed by desquamation.

Answer 60

A

Oral antihistamine

The patient in this clinical scenario presents with chronic urticaria.
The principles of management are to avoid exacerbating factors and to control symptoms as long as the urticaria persists. Pharmacological agents are directed at preventing mast cell degranulation and the effects of mast cell mediators released. H1- antihistamines (e.g., cetirizine, loratadine, fexofenadine), taken regularly, are the first-line pharmacological treatment. The dose can be up-titrated to 4 times the standard dose if symptoms remain at 2 to 4-week intervals.

Answer 61

A

P.aeruginosa

Pseudomonas aeruginosa hematogenous osteomyelitis is often seen in intravenous drug abusers, and this organism has a predilection for the cervical vertebrae.

Answer 62

A

Morbilliform drug eruption

This patient with a sore throat, fatigue, posterior cervical lymphadenopathy, and splenomegaly most likely has infectious mononucleosis. Patients who have mononucleosis and take a penicillin antibiotic, such as amoxicillin, can develop a morbilliform drug eruption. This patient is most likely having an adverse drug reaction (ADR). The most common drugs causing cutaneous ADRs are penicillin derivatives, allopurinol, sulfonamides, and nonsteroidal anti- inflammatories (NSAIDs). Mucous membrane involvement is rare. It would indicate a severe cutaneous ADR such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or a drug hypersensitivity reaction.

Answer 63

A

Lichen planus

Lichen planus (LP) is a pruritic, papular eruption characterized by its violaceous color, shiny appearence, polygonal shape, and fine scale. It is most commonly found on the flexor surfaces of the upper extremities. It can occur at any age but two thirds of patients are aged 30-60 years. White lines, called Wickham Stria, are often found on the papules. Pruritus is common and severe in LP. Oral lesions are classified as reticular, plaque-like, atrophic, papular, erosive, and bullous. A lace-like pattern on the buccal mucosa and the tongue is referred to as the reticular form of LP.

Answer 64

A

Keratin pearls.

Keratin pearls’ are characteristically found in cutaneous squamous cell carcinomas.
Atypical melanocytes are found in melanomas, not squamous cell carcinoma.
Central invagination with a keratotic core is more consistent with a diagnosis of a keratoacanthoma.
Proliferation of basaloid cells forming nests describes the histopathological finding in a basal cell carcinoma.
Keratin-filed cysts are the classic histological finding in seborrheic keratosis, which is a benign proliferation of immature keratinocytes and is classically described as a well demarcated lesion with a ‘stuck-on’ appearance.

Answer 65

A

Gluteal region and posterior thigh

Answer 66

A

Gluteal region and posterior thigh

Answer 67

A

Gluteus medius

Answer 68

A

Actinic keratosis

Actinic keratosis is an epidermal dysplasia developing in skin sites commonly exposed to sunlight such as the face, ears, dorsum of the hands.They can be s kin colored, red or tan lesions usually smaller than 1 cm in diameter. It is considered as preneoplastic lesion of the skin. When the lesions are left untreated, may transform to squamous cell carcinoma.

Answer 69

A

Delay to first debridment

Answer 70

A

Stratum granulosum- Deepest part of the tumor

Breslow thickness is expressed in millimeters and measures depth from the granular layer of the epidermis to the deepest part of the tumor •Breslow thickness is strongly correlated with melanoma survival and is a component of the clinical staging system for melanoma

Answer 71

A

1 4

Typical involvement areas are the flexural areas, such as antecubital Feedback:
fossae and popliteal fossae, in chilhood. In contrast to seborrhoeic dermatitis, diaper area is usually spared in infants with AD.

Answer 72

A

The very severe form of deep tissue infection called necrotizing fasciitis is often caused by Streptococcus pyogenes.

Answer 73

A

Rhabdomyosarcoma

Malignant cells consisting of small round cells and tad-pole-like cells are features of
rhabdomyosarcomas as well as spindle cells and pleomorphic cells. Liposarcomas would
reveal atypical adipocytes, Kaposi sarcoma would vascular structures. Schwannoma and
lymphangioma are benign tumors.

Answer 74

A

Rheumatoid arthritis

Info: Rheumatoid arthritis (RA) is a chronic autoimmune disease
characterized by symmetrical polyarthritis, typically involving the small
joints of the hands and feet. Patients often experience morning
stiffness, joint swelling, and fatigue. Laboratory tests may show
elevated acute-phase reactants (ESR, CRP) and positive rheumatoid
factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Answer 75

A

Formation of osteophytes –> Osteoarthritis
Subchondral sclerosis–> Osteoarthritis
Bouchard nodes–> Osteoarthritis
Heberden nodes–> Osteoarthritis
Decreased joint space–> Osteoarthritis
Hyperthrophy of joint capsule–> Osteoarthritis
Formation of pannus–> Rheumatoid Arthritis
Symmetrical involvement–> Rheumatoid Arthritis

Answer 76

A

Name of the fracture when the overlying skin is not intact
Compound fracture

Name of the fracture when the bone is broken due to unknown
prostate carcinoma Pathologic fracture

Name of the fracture when the ends of the bone at the fracture site
are aligned Non-displaced fracture

Name of the fracture when the bone is fragmented
Comminuted fracture

Name of the fracture after repetitive loads of the same bone
Stress fracture

Answer 77

A

Bony callus formation Hard callus
Fibrocartilaginous matrix formation Soft callus
The bone composed of irregularly arranged collagen fibers
Woven bone
The bone composed of parallel arranged collagen fibers
Lamellar bone
The last step of inflammatory phase of fracture healing
Granulation tissue formation
The second phase of fracture healing Reparative phase

Answer 78

A

Muscle Soreness
Fatigue
Pain
Stiffness
Disability

Info: pain is the main symptom of MSD muscle soreness, disability
fatigue stiffness are the others. painful noises is meaningful

Answer 79

A

Hoffmann Test, Babinsky Test and Ankle Clonus

Hoffmann Test, Babinsky Test and Ankle Clonus are pathologic
reflexes, wheras Laseque Test and Femoral Stretch Test are
provocative tests for nerve root compression

Answer 80

A

Positive family history and intrauterine packaging problems.

Info: Firstborn (primiparity), Young mothers, Oligohydramnios, Intrauterine
packaging problems, Positive family history, Breech presentation at birth, Female sex, White skin color, Newborns with greater weight and height and Newborns with deformities of the feet or spine are considered factors for the development of DDH in humans. Male sex, Vertex presentation at birth and Aged mothers as listed here considered as risk factors for DDH.

Answer 81

A

Commonly seen in benign bone tumors, this is incorrect.

Info: Codman triangle is a radiologic sign seen most commonly on
musculoskeletal plain films. It is the name given to a periosteal
reaction that occurs when bone lesions grow so aggressively that
they lift the periosteum off the bone and do not allow the periosteum
to lay down new bone.

Answer 82

A

Pain elicited from a nonpainful stimulus

Answer 83

A

Osteochondroma

Osteoid osteoma and osteoblastoma shows similar features histological
not contain a cartilage cap. Osteosarcoma and chondrosarcoma are ma
tumors. Osteochondroma is a cartilage forming bone tumor that is also n
exostosis. It is the most common benign bone tumor consisted of a beni
cap that is attached to the underlying skeleton by a bony stalk. Most com
in the metaphysis of long bones (femur > humerus > tibia) and there is m
predominance

Answer 84

A

Morning stiffness lasting more than an hour

Inflammatory joint pain involves the joints diffusely and is present at
rest and with normal use. Nocturnal pain may interfere with sleep.
This joint pain is associated with prolonged stiffness for greater than
30 to 60 minutes, which is worse in the morning or after inactivity
(gelling). Fatigue is common, may be severe, and typically occurs by
early afternoon after stiffness has improved.

Answer 85

A

Force transmission from steering wheel in a traffic accident

Info: force transmission vector may produce shoulder dislocation in a
traffic accident. dashboard also may cause a hip dislocation or
fractures

Answer 86

A

Cranial sutures
Distal tibio fibular joint

Info: Distal tibio fibular joint and cranial sutures are classified as fibrous
joints. Intervertebral discs and symphisis pubis are cartilaginous
joints, and proximal radio-ulnar joint is a synovial joint.

Answer 87

A

Hyperthermia

Response
Feedback: Hyperthermia, frequently seen in patients following traumatic brain
injury (TBI), may be due to posttraumatic cerebral inflammation,
direct hypothalamic damage, or secondary infection resulting in
fever.

Answer 88

A

All are true except the last one.

Additional info: Osteosarcoma is often located at the epiphysis or metaphysis of long
are associated with maximum growth velocity (distal femur, proximal t
humerus), but any bone may be involved.
*Osteosarcoma most commonly affects adolescents; the peak inciden
during the period of maximum growth velocity, but may occur at any a
*The highest risk period for development of osteosarcoma is during th
growth spurt, suggesting an association between rapid bone growth a
transformation.

Answer 89

A

Hematogeneous route

Answer 90

A

The alpha-2 adrenoceptors and the GABA receptors

Info: The two types of receptors that can be manipulated to reduce
spasticity are the GABA receptors (by baclofen, diazepam) and the
alpha-2 adrenergic receptors (by tizanidine).

Answer 91

A

Infliximab

Answer 92

A

Allopurinol

Feedback:
Because the patient’s urate levels are decreased after therapy both
in serum and in urine, the drug must have decreased the formation of
uric acid. Allopurinol inhibits the conversion of hypoxanthine to
xanthine and xanthine to uric acid, thus decreasing uric acid
formation.

Answer 93

A

Chondrocalcinosis

Info: CPPD almost always occurs in joint tissues, most often in
fibrocartilage and hyaline cartilage and commonly leads to
chondrocalcinosis.

Answer 94

A

Erythema infectiosum

Info:
Upper respiratory infection findings followed by “Slapped cheek”
appearance and then apperance red reticulate macular /urticarial
exanthema (

Answer 95

A

Psoriasis

Info: Psoriasis is a chronic inflammatory skin condition characterized by wel
erythematous plaques covered with silvery-white scales.
Pemphigus vulgaris is a rare autoimmune disorder characterized by th
intraepithelial blisters and erosions on the skin and mucous membrane
presents with fragile blisters that rupture easily, leaving behind erosion
Bullous pemphigoid is another autoimmune blistering disorder characte
tense subepidermal blisters, often with erythematous or urticarial plaqu
pemphigus vulgaris, bullous pemphigoid lesions tend to be more locali
fragile.
Lichen planus is an inflammatory skin condition characterized by prurit
flat-topped papules and plaques with a violaceous hue. Wickham striae
lines or dots on the surface of the lesions, are a characteristic feature.
Discoid lupus erythematosus is a chronic autoimmune disorder characterised by
erythematous, scaly plaques with adherent scale and follicular pluggin
typically occur on sun-exposed areas such as the face, scalp, and ears
lead to scarring and dyspigmentation.

Answer 96

A

Keratoacanthoma

Info: Keratoacanthomas are dome-shaped nodules with a central
keratin plug, often appearing rapidly and spontaneously
regressing.
Basal cell carcinomas typically present as pearly or translucent
nodules with telangiectatic vessels and rolled borders.
Squamous cell carcinomas often appear as hyperkeratotic,
erythematous plaques or nodules with central ulceration.
Melanomas typically present as asymmetric, pigmented lesions wit
borders and color variation.
Actinic keratoses are typically erythematous, scaly patches or plaq
found in sun-exposed areas.

Answer 97

A

Bullous pemphigoid

Bullous pemphigoid is the most common of the blistering disorders,
characterized by tense bullae or blistering lesions filled with clear
fluid. Histologically, it presents with a subepidermal blister with
eosinophils and neutrophils. Direct immunofluorescence typically
reveals linear deposition of IgG and complement C3 along the dermoepidermal junction.

Answer 98

A

It can be a herpes simplex or varicella zoster virus infection

Info: Vesicular rash sample Tzank test revealing multinucleated giant
cells can be caused by HSV 1, HSV 2 or VZV. The definitely true
answer is : It can be a herpes simplex (HSV1 and 2) or varicella
zoster virus infection
A definitely true answer is HSV 1, HSV 2 or VZV. The others lack
the other responsible viruses.

Answer 99

A

Candidal infection of the mouth: Thrush
Dermatophyte infection of nail plate: Onychomycosis
Candidal infection of the glans of the penis: Balanitis
Candidal infection of skin fold: Intertrigo
Superficial infection of inguinal area: Tinea inguinalis
Superficial fungal infection of body surfaces: Tinea cruris
Superficial fungal infection of the foot Tinea pedis
Superficial fungal infection of the beard area Tinea barbae

Answer 100

A

Circumscribed flat lesion larger than 10 mm in diameter Patch
Elevated flat-topped lesion smaller than 10 mm Papule
Elevated roughly spherical lesion greater than 10 mm Nodule
Discrete, pus filled raised lesion Pustule
Fluid filled raised lesion less than 10 mm Vesicle
Intercellular edema of the epidermis Spongiosis
Intracellular edema of the epidermis Hydropic swelling
Complete loss of epidermis and a part of dermis Ulceration
Loss of cohesion between keratinocytes Acantholysis
Diffuse epidermal hyperplasia Acanthosis
Thickening of the stratum corneum Hyperkeratosis

Answer 101

A

All except the first one are true.

The first one would be correct if it was varicella instead of rubella.

Answer 102

A

Itchy for last 3 weeks
Mixed color in the same lesion
The edges of the lesion is irregular

Info: Clinical evaluation of melanocytic lesions (When to suspect of a
malignancy?):
Asymmetry: Half of the lesion does not match the other half
Border irregularity: The edges are ragged, notched, or blurred
Color variegation: Pigmentation is not uniform and may display
shades of tan, brown, or black; white, reddish, or blue discoloration
is of particular concern
Diameter: A diameter greater than 6 mm is characteristic, although
some melanomas may be smaller in size; any growth in a nevus
warrants an evaluation
Evolving: Changes in the lesion over time are characteristic; this
factor is critical for nodular or amelanotic (nonpigmented)
melanoma, which may not exhibit the ABCD criteria above

Answer 103

A

The skin lesions are extremely itchy
Histopathologically the detachement is at the dermoepidermal
junction

Info: A chronic vesiculobullous skin disorder characterized by autoantib
tTG2
Ig A deposition on direct immunofluorescence occurs in a granula
the dermoepidermal junction
Histopathologically the detachement is at the dermoepidermal jun
The skin lesions are extremely itchy
It is the specific cutaneous manifestation of celiac disease

Answer 104

A

Serology

ınfo: In dermatophyte infections serology is not helpful in microbiological
diagnosis
Microscopic examination of roots of hair, skin scraping sample
examination with15-20% KOH preparation, culture of skin and nail
scraping samples and Wood lamb examination of the affected skin
can be used in the diagnosis of dermatophyte infections.

Answer 105

A

Seborrheic keratosis

Info: Seborrheic keratosis is a common benign epidermal tumor characterize
circumscribed, tan to brown, waxy plaques or papules with a stuck-on a
Histologically, seborrheic keratosis shows hyperkeratosis, papillomatosi
cysts within the epidermis, along with basaloid cells and melanin pigme

Answer 106

A

Pemphigus vulgaris

Answer 107

A

Urticaria

Info: Urticaria, also known as hives, is a skin condition characterized by
the sudden onset of raised, erythematous, edematous wheals that
are intensely pruritic. It is often triggered by allergens, medications,
infections, or physical stimuli.
Acute eczematous dermatitis, also known as acute contact
dermatitis, is a type of eczema characterized by erythema, edema,
vesicles, and weeping or crusting lesions. It typically develops rapidly
after exposure to an irritant or allergen. Histop

Answer 108

A

Lichen planus

Info: Lichen planus is an inflammatory skin condition characterized by
pruritic, polygonal, flat-topped papules and plaques with a violaceous
color. Wickham striae, fine white lines or dots on the surface of the
lesions, are a characteristic feature.

Answer 109

A

Hair follicle

Answer 110

A

Fixed drug eruption

Answer 111

A

Hypergranulosis

Info: One of the main features of psoriasis histopathology is
“Hypogranulosis” which describes the thinning of the granular layer.
Hypogranulosis is typically seen in diseases of increased cell
turnover such as psoriasis.

Answer 112

A

Vitamin D analogues

Info: Analogs of vitamin D3 increase differentiation and inhibit proliferation
of keratinocytes and therefore used both as monotherapy and in
combination with topical corticosteroids, phototherapy (psoralen–
ultraviolet A [PUVA] or ultraviolet B [UVB]), acitretin (second
generation retinoid), methotrexate and cyclosporine

Answer 113

A

Urticaria can co-exist with angioedema which is a deeper swelling
within the skin or mucous membranes

Answer 114

A

Squatting of the patient and rising from squatting

Feedback:
In order to assess L3 root integrity knee extensors should be tested. This could
be done by asking the patient to squat and rise from squatting

Answer 115

A

Intravenous drug user

Info: Septic arthritis is generally caused by S. aureus and P. aureginosa in IV drug users. Other septic arthritis agents:

Neonates –> S. agalacticae
Kids and adults –> S. aureus ,
S. pyogenes, S. pneumoniae
Prosthetic joints (hip/knee) –> S. aureus, S. epidermidis
Sexually active adults –> N gonorrhea
Lyme disease –> Is caused by B. burdorferi, but it is an immune mediated condition and no mowill be in the
affected joint

Answer 116

A

Weight loss

Answer 117

A

Eccentric

Eccentric contraction occurs where the lenght of the muscle increases
during contraction.

Answer 118

A

It can be associated with muscle weakness in the relevant area.

Info: Neuropathic pain is a kind of pain arising from the lesions of the nervous
system, and can also present with weakness if a motor lesion is also involved.

Answer 119

A

Leiomyoma

Leiomyoma, solitary brous tumor, dermatobroma, brosarcoma,
leiomyosarcoma are among spindle shaped tumors morphologically. Glomus
tumor, embryonal and alveolar rhabdomyosarcomas, Ewing sarcoma,
neuroblastomas are among round cell tumors, granular cell sarcoma, alveolar soft
part sarcoma are among epithelioid cell tumors and myxomas are among myxoid
tumors.

Answer 120

A

All except 2 are true.

There are 4 subtypes of tumor
histologically: alveolar, embryonal, pleomorphic, spindle cell

NOT epithelial or palisading.

Answer 121

A

Joint pain that increases with activity

Info: Patients with non-inammatory joint pain have pain with activity that is relieved
by rest. Although they may have stiness or gelling after inactivity, it typically
lasts less than 15 minutes, and systemic fatigue is not common.

Answer 122

A

3rd 4th and 5th statements are to be chosen.

Info: X ray ndins that should be sought for determination of the abnormal position
of femoral head relative to the acetabulum in DDH include:
1) Smaller ossic nucleus of the proximal femoral physis relative to the
contralateral side
2) Proximal femoral physis resting above the Hilgenreiner line
3 Proximal femoral physis not located at the inner lower quadrant
d) High acetabular index (< 25°) at the aected side
e) Broken Shenton line at the aected side

Answer 123

A

Colchicine

Colchicine can be used to stop an acute gout attack or, most often, for the prevent
ion of further at tacks, as in this case. The drug binds to the intracellular protein,
tubulin, thereby preventing its polymerization into microtubules and thus blocking
mitosis in metaphase. Cells with the highest rate of division are aected early.
Granulocyte migration into the inamed area and phagocytosis of urate crystals by
macrophages are inhibited, thus relieving the pain and inammation of gouty
arthritis. These actions are specic, and the drug is devoid of general analgesic or
anti-inammatory eects.

Answer 124

A

Transient synovitis of hip

Answer 125

A

Hydroxychloroquine

The therapy of mild RA usually includes nonsteroidal antiinammatory drugs
(NSAIDs) that can control symptoms of pain and swelling, but DMARD treatment is
almost always added within 3 months of the RA diagnosis. Hydroxychloroquine
seems to be the least toxic among DMARDs and is usually the initial choice.
Immunosuppressants are relatively contraindicated in this patient because of his
frequent respiratory tract infections.

Answer 126

A

Total Protein

Info: 1.Screening blood tests for all types of inammatory arthritis:
–Erythrocyte Sedimentation Rate (ESR): An elevated ESR “supports”
the presence of an inammatory arthritis.
–C-Reactive Protein (CRP): This test is an alternative to obtaining the
ESR.
–Rheumatoid Factor (RF): A rheumatoid factor test should be
obtained when rheumatoid
arthritis (RA) is at least moderately possible in the patient.
–Anti-Cyclic Citrullinated Peptide (Anti-CCP): Measuring antibodies
to CCP is a new test for RA; it has higher specicity but lower
sensitivity than RF.
–Anti-Nuclear Antibody (ANA): ANA test is commonly obtained in
patients with arthralgias or
arthritis as a screening test for SLE or another connectivetissue disorder.
More than 95% of patients with SLE have ANA; thus, a negative ANA
result is a strong indicator that SLE is not present.
However, a positive ANA result lacks specicity and may occur in
persons with other connective-tissue diseases (Positive ANA
incidence is 99% in SLE, 85% in Sjögren’s, 88% in Scleroderma, 55%
in Rheumatoid Arthritis, and 40% in Juvenile Rheumatoid Arthritis)

Answer 127

A

Enthesitis

Info: The most typical features of SpA are inammatory back pain, sacroiliitis,
spondylitis, asymmetric oligoarthritis and enthesitis. This group of diseases is
seronegative (autoantibodies seen in CTDs are absent). Extramusculoskeletal
ndings are anterior uveitis, psoriasis and IBD. SpA is strongly associated with
HLA-B27

Answer 128

A

Blockade of Ca2+ channels in the sarcoplasmic reticulum

Info: The clinical picture of the patient suggests the diagnosis of malignant
hyperthermia, a rare but potentially life-threatening disorder that can be triggered
by a variety of stimuli, including the administration of certain anesthetics (mainly
halothane) and neuromuscular blocking agents (mainly succinylcholine). The
disorder is related to a hereditary impairment in the ability of the sarcoplasmic
reticulum (SR) to sequester calcium (Ca2+); therefore, a prolonged release of Ca2+
occurs after the triggering event through SR Ca2+ channels (ryanodine receptors,
RyR). This causes massive muscle contraction, hyperthermia, and lactic acidosis.
Dantrolene is a drug of choice in this disorder because it blocks RyRs in the skeletal
muscle SR, thus preventing the massive release of Ca2+. Cardiac and smooth
muscle are minimally aected by dantrolene because they have a dierent subtype
of RyRs in their SR.

Answer 129

A

Scabies

Info: The clinical and histopathological ndings are consistent with scabies. Scabies is
caused by the mite Sarcoptes scabiei, which burrows into the skin to lay eggs,
creating characteristic track-like lesions and causing intense pruritus, especially at
night.

Answer 130

A

Verrucae vulgaris

Info: The clinical and histopathological ndings are consistent with verrucae vulgaris,
also known as common warts. These lesions are caused by human papillomavirus
(HPV) infection and are characterized by epidermal hyperplasia, koilocytosis (a
change in epidermal cells due to viral infection), keratohyalin granules, and
intracytoplasmic eosinophilic inclusions.

Answer 131

A

The first three statements should be chosen.

Info: Acute eczematous dermatitis, also known as eczema, is an inammatory skin
condition commonly triggered by external factors such as allergens or irritants.
The histopathological hallmark is spongiosis (intercellular edema in the epidermis)
with vesicle formation and a mixed inammatory inltrate in the dermis.
Symptoms typically include intense itching and erythematous plaques.
Dermatographism, also known as dermographism urticaria, is an urticarial
eruption upon pressure or trauma to the skin.Additionally, direct
immunouorescence ndings in eczema are not characterized by linear IgG
deposition along the basement membrane, which is seen in conditions like bullous
pemphigoid.

Answer 132

A

The first three statements are correct

Answer 133

A

Basal Cell Carcinoma

Info: The clinical presentation of a pearly, translucent nodule with telangiectatic
vessels and rolled borders, along with histopathological ndings of nests of
basaloid cells with peripheral palisading and retraction artifacts, is characteristic
of Basal Cell Carcinoma (BCC).
Squamous Cell Carcinoma: Typically presents as hyperkeratotic, erythematous
plaques or nodules with central ulceration.

Malignant Melanoma: Usually appears as asymmetric, pigmented lesions with
irregular borders and color variation.
Keratoacanthoma: Presents as dome-shaped nodules with a central keratin plug
and rapid growth.
Actinic Keratosis: Appears as erythematous, scaly patches or plaques, often
found in sun-exposed areas

Answer 134

A

After a human bite

Answer 135

A

It will be Gram positive stained

Answer 136

A

All except the first one are correct.

Info: *Arthropathy only occurs in approximately 10% of children
*In older children, adolescents arthritis is more common (60% of adults) ,
while skin rash is less prominent and distinctive

Answer 137

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Cough , coryza and conjunctivitis are common prodromal symptoms.

Answer 138

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All except the second statement is correct.

Info: Erythema multiforme (EM) is an acute inammatory dermatosis often triggered by
infections (such as herpes simplex virus) or medications. It is a type IV
hypersensitivity reaction mediated by cytotoxic T cells that attack basal epithelial
cells. The characteristic lesion is a targetoid (target) lesion, which appears as a
central zone of necrosis surrounded by concentric rings of erythema.
Histopathological examination shows vesicle formation and cytotoxic T cells
targeting basal epithelial cells. Unlike chronic dermatoses like psoriasis, EM does
not involve chronic plaque formation and thickened skin. Oral mucosa can also be
involved in this disease.

Answer 139

A

Upper and lower endoscopy

Info: The patient exhibits signs of acanthosis nigricans, which, in the absence of
diabetes or obesity, can be a paraneoplastic syndrome associated with
gastrointestinal malignancies, particularly gastric adenocarcinoma. Therefore, an
upper and lower endoscopy is warranted to investigate potential underlying
malignancies.
Bone marrow biopsy: Not the most appropriate next step as the primary concern
is to rule out gastrointestinal malignancies associated with acanthosis nigricans.
MRI of the brain: Not indicated based on the presented symptoms and ndings.
Abdominal ultrasound: While useful, it does not provide the comprehensive
evaluation needed to detect gastrointestinal malignancies.
Skin patch testing: This is not relevant for the diagnosis of acanthosis nigricans or
its associated conditions.

Answer 140

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Pityriasis rosea

Info: Pityriasis rosea is an acute mild inflammatory exanthem characterized
by the development of erythematous scaly macules on the trunk. It is
more common in children and young adults. It begins with a solitary
salmon-colored macule that heralds the eruption (herald patch), and
over a few days it becomes a patch with a collarette of fine scale. Within
the next 1-2 weeks, a generalized exanthem usually appears. Bilateral
and symmetric macules with a collarette scale oriented with their long
axes along cleavage lines resembling a pine tree are typical for pityriasis
rosea.

Answer 141

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Urticaria

Answer 142

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Impetigo

Impetigo is a pyoderma that is usually caused by staphylococci or
streptococci.
The initial lesions are vesicles, which subsequently form characteristic
yellow, “honey-colored” crusts.
Impetigo is a common infection of the supercial layers of the epidermis
that is highly contagious.
Once a lesion is present, self-inoculation to other sites is very common.

Answer 143

A

All except the last one are correct.

Info: AD usually starts on the face (cheeks) cheeks or on the extensor extremities
which are the places that are easy to scratch and rub as they are crawling in
infancy. And, typical involvement areas are the exural areas, such as antecubital
fossae and popliteal fossae, in childhood.

Answer 144

A

Transdermal therapeutic system

Info: Transdermal Therapeutic Systems (TTS) or transdermal patches are special
systemic drug delivery systems that are applied directly to the skin. They are not
used to treat dermatological problems. The active substance is absorbed by the
skin and distributed through the body via the bloodstream.

Answer 145

A

Erysipelas

Response
Feedback: This patient has clinical features of erysipelas, a type of supercial cellulitis
with dermal and supercial lymphatic involvement.
Erysipelas is a bacterial infection that leads to pain, edema, and welldemarcated erythema.

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