Skin and SubQ Flashcards

Question 1

Q

Which of the following epidermal layers is the primary site of mitotic activity, providing regenerative cells for the epithelium?

A. Stratum Basale
B. Stratum Spinosum
C. Stratum Granulosum
D. Stratum Corneum

Answer

A

A. Stratum Basale

Question 2

Q

Which layer of the epidermis contains cells that develop basophilic keratohyalin granules and exocytose lipid-containing granules to form a protective barrier?

A. Stratum Basale
B. Stratum Spinosum
C. Stratum Granulosum
D. Stratum Lucidum

Answer

A

C. Stratum Granulosum

Question 3

Q

The spiny appearance of keratinocytes in which layer is attributed to desmosomal connections between cells?

A. Stratum Lucidum
B. Stratum Spinosum
C. Stratum Granulosum
D. Stratum Corneum

Answer

A

B. Stratum Spinosum

Question 4

Q

In which layer of the epidermis would you expect to find anucleate, flattened cells forming a protective barrier against water loss?

A. Stratum Granulosum
B. Stratum Basale
C. Stratum Spinosum
D. Stratum Corneum

Answer

A

D. Stratum Corneum

Question 5

Q

Which of the following statements is TRUE regarding the Stratum Lucidum?

A. It contains actively dividing keratinocytes.
B. It is only found in thick skin such as the palms and soles.
C. It forms the deepest layer of the epidermis.
D. It is the primary location of hemidesmosomes anchoring the cells to the basement membrane.

Answer

A

B. It is only found in thick skin such as the palms and soles.

Question 6

Q

Which epidermal layer primarily contains cuboidal to columnar epithelial cells involved in continuous replication and is attached to the basement membrane by hemidesmosomes?

A. Stratum Spinosum
B. Stratum Basale
C. Stratum Granulosum
D. Stratum Corneum

Answer

A

B. Stratum Basale

Question 7

Q

Which of the following epidermal layers is characterized by the presence of lipid-rich lamellar granules, providing a barrier against environmental insults?

A. Stratum Basale
B. Stratum Granulosum
C. Stratum Spinosum
D. Stratum Corneum

Answer

A

B. Stratum Granulosum

Question 8

Q

What is the primary function of the Stratum Corneum?

A. Cellular replication and keratinocyte differentiation
B. Lipid production and exocytosis
C. Protection against mechanical, chemical, and bacterial disruption, as well as water loss
D. Anchoring the epidermis to the basement membrane

Answer

A

C. Protection against mechanical, chemical, and bacterial disruption, as well as water loss

Question 9

Q

Which of the following layers is found only in the palms and soles, composed of flat, translucent keratinocytes?

A. Stratum Spinosum
B. Stratum Lucidum
C. Stratum Granulosum
D. Stratum Basale

Answer

A

B. Stratum Lucidum

Question 10

Q

The keratinocytes in which layer undergo programmed cell death as part of their lifecycle?

A. Stratum Basale
B. Stratum Spinosum
C. Stratum Granulosum
D. Stratum Corneum

Answer

A

C. Stratum Granulosum

Question 11

Q

Which of the following cells makes up 90% of the epidermis and is responsible for the formation of the skin barrier?

A. Langerhans Cells
B. Keratinocytes
C. Melanocytes
D. Merkel Cells

Answer

A

B. Keratinocytes

Question 12

Q

Which epidermal component is derived from the neural crest and plays a key role in skin pigmentation?

A. Keratinocytes
B. Langerhans Cells
C. Melanocytes
D. Merkel Cells

Answer

A

C. Melanocytes

Question 13

Q

Which of the following cells are slow-adapting mechanoreceptors, essential for light touch sensation, and are located in the digits and lips?

A. Langerhans Cells
B. Melanocytes
C. Merkel Cells
D. Keratinocytes

Answer

A

C. Merkel Cells

Question 14

Q

Which cell type is known for its role in adaptive immunity, contains Birbeck granules, and can be impaired by UVB radiation?

A. Melanocytes
B. Keratinocytes
C. Langerhans Cells
D. Merkel Cells

Answer

A

C. Langerhans Cells

Question 15

Q

Which of the following cells are responsible for melanin production and are found in the stratum basale?

A. Keratinocytes
B. Langerhans Cells
C. Melanocytes
D. Merkel Cells

Answer

A

C. Melanocytes

Question 16

Q

Rod or rocket-shaped Birbeck granules are found in which type of epidermal cell?

A. Keratinocytes
B. Melanocytes
C. Langerhans Cells
D. Merkel Cells

Answer

A

C. Langerhans Cells

Question 17

Q

Which cells in the epidermis are primarily involved in sensing light touch and contain neurosecretory granules with peptides?

A. Keratinocytes
B. Merkel Cells
C. Langerhans Cells
D. Melanocytes

Answer

A

B. Merkel Cells

Question 18

Q

Which cells, derived from monocytes, interdigitate between keratinocytes to form a dense network and sample antigens for T-cell presentation?

A. Merkel Cells
B. Melanocytes
C. Langerhans Cells
D. Keratinocytes

Answer

A

C. Langerhans Cells

Question 19

Q

Which epidermal cells are present in less than 1% of the epidermal population and are typically found in the basal layer with an effector memory T-cell phenotype?

A. Keratinocytes
B. Lymphocytes
C. Merkel Cells
D. Melanocytes

Answer

A

C. Langerhans Cells

Question 20

Q

Toker cells, implicated in Paget’s disease of the nipple, are typically found in which part of the epidermis?

A. Stratum Basale
B. Nipple epidermis
C. Stratum Corneum
D. Hair follicles

Answer

A

B. Nipple epidermis

Question 21

Q

Which of the following is the primary function of eccrine sweat glands?

A. Release sebum into the hair follicle
B. Temperature regulation via evaporative heat loss
C. Activated by adrenergic system at puberty
D. Excretion of hormones

Answer

A

B. Temperature regulation via evaporative heat loss

Question 22

Q

Which sweat glands undergo excretion involving “decapitation” of part of the cell and are activated by sex hormones?

A. Eccrine Sweat Glands
B. Apocrine Sweat Glands
C. Apoeccrine Sweat Glands
D. Sebaceous Glands

Answer

A

B. Apocrine Sweat Glands

Question 23

Q

Which of the following components is NOT part of the pilosebaceous unit?

A. Hair follicle
B. Sebaceous gland
C. Sweat gland
D. Erector pili muscle

Answer

A

C. Sweat gland

Question 24

Q

Sebaceous glands are most abundant in which areas of the body?

A. Palms and soles
B. Face and scalp
C. Axilla and groin
D. Forearms and legs

Answer

A

B. Face and scalp

Question 25

Q

Which of the following is TRUE about the structure and function of nails?

A. The nail root is located distally.
B. The nail plate shape is determined by the underlying phalanx.
C. Nails are primarily made of sebum.
D. The hyponychium is proximal to the nail matrix.

Answer

A

B. The nail plate shape is determined by the underlying phalanx.

Question 26

Q

What type of sweat glands are most effective in thermoregulation and are activated by the cholinergic system?

A. Eccrine Sweat Glands
B. Apocrine Sweat Glands
C. Apoeccrine Sweat Glands
D. Sebaceous Glands

Answer

A

A. Eccrine Sweat Glands

Question 27

Q

Which of the following glands is associated with producing an odor after bacterial action, despite initially being odorless?

A. Sebaceous Glands
B. Eccrine Sweat Glands
C. Apocrine Sweat Glands
D. Apoeccrine Sweat Glands

Answer

A

C. Apocrine Sweat Glands

Question 28

Q

Which sweat glands are primarily responsible for excreting solutes like electrolytes and are found on the palms, soles, and forehead?

A. Eccrine Sweat Glands
B. Apocrine Sweat Glands
C. Apoeccrine Sweat Glands
D. Sebaceous Glands

Answer

A

A. Eccrine Sweat Glands

Question 29

Q

Which component of the nail is continuous with the germinal nail matrix and adheres to the nail plate?

A. Hyponychium
B. Nail Plate
C. Nail Root
D. Erector Pili Muscle

Answer

A

C. Nail Root

Question 30

Q

Which type of sweat glands are similar to apocrine glands but open directly to the skin surface and are surrounded by myoepithelial cells?

A. Eccrine Sweat Glands
B. Apocrine Sweat Glands
C. Apoeccrine Sweat Glands
D. Sebaceous Glands

Answer

A

C. Apoeccrine Sweat Glands

Question 31

Q

Which of the following is a primary function of the dermis?

A. Produces melanin to protect against UV radiation
B. Provides protective and supportive tissue for the epidermis
C. Acts as a barrier against water loss
D. Facilitates keratinocyte replication

Answer

A

B. Provides protective and supportive tissue for the epidermis
Rationale: The dermis is a mesoderm-derived tissue that protects and supports the epidermis, anchoring it to the underlying subcutaneous tissue. It plays a crucial role in providing nutrients to the epidermis and contains components that allow for skin elasticity, strength, and sensation.

Question 32

Q

Which component makes up 98% of the dermis’ dry weight and provides structural support?

A. Elastic fibers
B. Collagen
C. Fibroblasts
D. Ground substance

Answer

A

B. Collagen
Rationale: Collagen is the primary fibrous protein in the dermis, making up 98% of its dry weight. It provides structural support and tensile strength. UV radiation can degrade and disorganize collagen fibers, leading to wrinkling and weakening of the skin.

Question 33

Q

Which of the following best describes the role of elastic fibers in the dermis?

A. Provide resistance to shear forces at the dermal-epidermal junction
B. Allow the skin to stretch and return to its original configuration
C. Form the main structural network of the papillary layer
D. Protect the dermis from UV radiation damage

Answer

A

B. Allow the skin to stretch and return to its original configuration
Rationale: Elastic fibers are responsible for the retractile properties of the skin, allowing it to stretch up to twice its original length and return to its original state. These fibers are produced by fibroblasts and vary in thickness and orientation depending on their location within the dermis.

Question 34

Q

The papillary layer of the dermis is characterized by which of the following?

A. Coarse fiber network and ground substance
B. Dense, highly organized collagen bundles
C. Papillae that increase surface area and resistance to shear forces
D. Greater density of elastic fibers than the reticular layer

Answer

A

C. Papillae that increase surface area and resistance to shear forces
Rationale: The papillary layer of the dermis consists of papillae that interdigitate with the ridges of the deep portion of the epidermis. This increases the surface area between the dermis and epidermis, improving nutrient diffusion and increasing resistance to mechanical shear forces.

Question 35

Q

Which component of the dermis assists in redistributing forces placed on cutaneous tissues and facilitates the development of dermal structure?

A. Collagen fibers
B. Elastic fibers
C. Ground substance
D. Reticular layer

Answer

A

C. Ground substance
Rationale: The ground substance, which contains proteoglycans and glycosaminoglycans, surrounds the fibrous network of the dermis. It can hold up to 1000 times its weight in water, which helps in dermal structure development, cell migration, and redistributing mechanical forces on the skin.

Question 36

Q

Which layer of the dermis consists primarily of a coarse network of fibers and ground substance?

A. Papillary Layer
B. Reticular Layer
C. Subcutaneous Layer
D. Epidermal Layer

Answer

A

B. Reticular Layer
Rationale: The reticular layer of the dermis is made up of a coarse network of collagen and elastic fibers surrounded by ground substance. It provides tensile strength and elasticity to the skin and lies deeper than the papillary layer.

Question 37

Q

Which of the following nerve components is responsible for processes such as sweat secretion and piloerection?

A. Afferent nerve endings
B. Corpuscular receptors
C. Efferent nerve fibers
D. Sensory neurons

Answer

A

C. Efferent nerve fibers
Rationale: Efferent (motor) nerve fibers control activities such as arteriovenous (AV) shunting, piloerection (raising of hair), and sweat secretion. These fibers can be either myelinated or unmyelinated, depending on their specific function in the dermis.

Question 38

Q

Which of the following factors contributes to wrinkling and weakening of the dermis, particularly in sun-exposed areas?

A. Loss of fibroblasts in the reticular layer
B. Disorganization of elastic fibers
C. Degradation of collagen fibers by UV radiation
D. Accumulation of ground substance in the papillary layer

Answer

A

C. Degradation of collagen fibers by UV radiation
Rationale: UV radiation damages collagen fibers in the dermis, leading to their degradation and disorganization. This weakens the structural integrity of the dermis, causing wrinkles and other signs of skin aging, especially in sun-exposed areas.

Question 39

Q

Which component of the dermis is responsible for providing tensile strength and resistance to stretching?

A. Elastic fibers
B. Collagen fibers
C. Ground substance
D. Papillary layer

Answer

A

B. Collagen fibers
Rationale: Collagen fibers in the dermis provide tensile strength and resistance to stretching, making the skin durable and capable of withstanding mechanical stress. These fibers are primarily found in the reticular layer of the dermis.

Question 40

Q

What is the main role of the papillary layer in the dermis?

A. Provide a dense network of collagen fibers
B. Serve as the primary location for AV shunting and piloerection
C. Facilitate nutrient diffusion across the dermal-epidermal junction
D. Support the formation of elastic fibers for skin flexibility

Answer

A

C. Facilitate nutrient diffusion across the dermal-epidermal junction
Rationale: The papillary layer increases the surface area between the dermis and epidermis through its papillae. This enhanced surface area facilitates the diffusion of nutrients to the epidermis, which does not contain blood vessels, ensuring that the epidermal cells remain nourished.

Question 41

Q

Which of the following cells are primarily responsible for producing dermal fibers and the ground substance in the dermis?

A. Dermal Dendrocytes
B. Fibroblasts
C. Mast Cells
D. Myofibroblasts

Answer

A

B. Fibroblasts
Rationale: Fibroblasts are the fundamental cells of the dermis, responsible for producing all the fibers (such as collagen and elastin) and the ground substance that surrounds these fibers. They play a critical role in maintaining dermal structure and function.

Question 42

Q

Which cell type plays a key role in wound contraction by harboring myofilaments of smooth muscle actin and desmin?

A. Mast Cells
B. Dermal Dendrocytes
C. Myofibroblasts
D. Fibroblasts

Answer

A

C. Myofibroblasts
Rationale: Myofibroblasts are specialized fibroblasts that contain myofilaments of smooth muscle actin and desmin. These cells assist in wound healing by contracting and reducing the surface area of the wound, facilitating the closure of wounds.

Question 43

Q

Which of the following cells is responsible for antigen uptake and presentation, playing a significant role in wound healing and tissue remodeling?

A. Fibroblasts
B. Dermal Dendrocytes
C. Mast Cells
D. Myofibroblasts

Answer

A

B. Dermal Dendrocytes
Rationale: Dermal dendrocytes are mesenchymal dendritic cells found in the papillary dermis. They are involved in antigen uptake, processing, and presentation to the immune system. They also help orchestrate wound healing and tissue remodeling.

Question 44

Q

Which type of cells release histamine and cytokines upon encountering antigens, resulting in vasodilation and dermatitis?

A. Dermal Dendrocytes
B. Myofibroblasts
C. Fibroblasts
D. Mast Cells

Answer

A

D. Mast Cells
Rationale: Mast cells are immune system effector cells that release histamine and cytokines during immediate type I hypersensitivity reactions. When primed with IgE antibodies, they respond to specific antigens, causing vasodilation, inflammation, and allergic reactions, such as dermatitis.

Question 45

Q

Which cell type is most involved in immediate type I hypersensitivity reactions, such as those seen in allergic dermatitis?

A. Fibroblasts
B. Mast Cells
C. Dermal Dendrocytes
D. Myofibroblasts

Answer

A

B. Mast Cells
Rationale: Mast cells are key players in type I hypersensitivity reactions. Upon exposure to allergens, they release histamine and cytokines, causing vasodilation, swelling, and symptoms associated with allergic dermatitis.

Question 46

Q

Which cells are characterized by a spindle or stellate shape and contain a well-developed rough endoplasmic reticulum?

A. Dermal Dendrocytes
B. Mast Cells
C. Myofibroblasts
D. Fibroblasts

Answer

A

D. Fibroblasts
Rationale: Fibroblasts are spindle or stellate-shaped cells found in the dermis. They have a well-developed rough endoplasmic reticulum (RER), which allows them to produce and secrete large amounts of collagen and other dermal fibers necessary for skin structure.

Question 47

Q

Which cell type helps decrease the surface area of wounds by contraction during the healing process?

A. Dermal Dendrocytes
B. Mast Cells
C. Myofibroblasts
D. Fibroblasts

Answer

A

C. Myofibroblasts
Rationale: Myofibroblasts play a crucial role in wound healing by contracting the wound edges, thereby reducing the wound surface area. This function is facilitated by the presence of myofilaments of smooth muscle actin and desmin within these cells.

Question 48

Q

Which of the following plexuses provides a vascular loop to every papilla in the papillary dermis?

A. Deep Dermal Plexus
B. Subpapillary Plexus
C. AV Shunts
D. Perforating Arteries

Answer

A

B. Subpapillary Plexus
Rationale: The Superficial Subpapillary Plexus is located between the papillary and reticular dermis and provides a vascular loop to every dermal papilla, ensuring proper blood supply to the superficial dermis.

Question 49

Q

Which plexus is located at the junction of the reticular dermis and hypodermis?

A. Superficial Subpapillary Plexus
B. Deep Dermal Plexus
C. AV Shunts
D. Lymphatic Vessels

Answer

A

B. Deep Dermal Plexus
Rationale: The Deep Dermal Plexus is located at the junction between the reticular dermis and the hypodermis, receiving blood supply from perforating arteries originating from larger vessels below the cutaneous tissues.

Question 50

Q

Which of the following functions are served by AV shunts in the cutaneous vasculature?

A. Insulation and protection from mechanical forces
B. Transporting extravasated fluid back to the venous system
C. Diverting blood flow to conserve or release body heat
D. Storing energy and regulating sweat secretion

Answer

A

C. Diverting blood flow to conserve or release body heat
Rationale: AV shunts connect the superficial and deep dermal plexuses. They can divert blood flow to or away from the skin, regulating body temperature by either conserving or releasing heat. They can also divert blood flow to vital organs as needed.

Question 51

Q

Which vessels begin blindly within the vascular loop of the dermal papillae and help transport extravasated fluid back to the venous system?

A. AV Shunts
B. Lymphatic Vessels
C. Perforating Arteries
D. Deep Dermal Plexus

Answer

A

B. Lymphatic Vessels
Rationale: Lymphatic vessels begin blindly within the vascular loop of the dermal papillae. They are responsible for transporting extravasated fluid and proteins from the soft tissues back into the venous circulatory system, playing a crucial role in maintaining tissue fluid balance.

Question 52

Q

Which component of cutaneous innervation conveys information from the environment to the brain?

A. Myelinated fibers
B. Efferent nerve fibers
C. Afferent nerve endings
D. AV Shunts

Answer

A

C. Afferent nerve endings
Rationale: Afferent nerve endings are responsible for conveying sensory information from the environment (such as touch, temperature, and pain) to the brain. These include free nerve endings and specialized corpuscular receptors that detect stimuli.

Question 53

Q

Which of the following functions is controlled by the efferent nerve component in the skin?

A. Transmitting sensory signals to the brain
B. AV shunting, piloerection, and sweat secretion
C. Insulation and energy storage
D. Conduction of afferent signals

Answer

A

B. AV shunting, piloerection, and sweat secretion
Rationale: Efferent nerve fibers control motor functions in the skin, including AV shunting (diverting blood flow), piloerection (hair standing on end), and sweat secretion to regulate temperature and respond to environmental stimuli.

Question 54

Q

What is the primary function of the lipid-laden adipocytes in the hypodermis?

A. Insulation and protection from mechanical forces
B. Secretion of sebum
C. Antigen presentation to the immune system
D. Sensory reception

Answer

A

A. Insulation and protection from mechanical forces
Rationale: The hypodermis (subcutaneous tissue) contains lipid-laden adipocytes that provide insulation, energy storage, and protection from mechanical forces by cushioning the body and allowing the skin to glide over underlying tissues.

Question 55

Q

Which layer connects the dermis to the underlying muscle and fascia?

A. Papillary Dermis
B. Hypodermis
C. Reticular Dermis
D. Superficial Subpapillary Plexus

Answer

A

B. Hypodermis
Rationale: The hypodermis is a richly vascularized layer of loose connective tissue that separates and connects the dermis to the underlying muscles and fascia. It also plays a role in storing energy and providing insulation.

Question 56

Q

Which of the following is NOT a function of the hypodermis?

A. Energy storage
B. Providing insulation
C. Facilitating nutrient diffusion to the epidermis
D. Protecting from mechanical forces

Answer

A

C. Facilitating nutrient diffusion to the epidermis
Rationale: The hypodermis primarily functions in insulation, energy storage, and protection from mechanical forces. Nutrient diffusion to the epidermis occurs via the blood supply within the dermis, not the hypodermis.

Question 57

Q

Which of the following best describes the function of the lymphatic vessels in the dermis?

A. Insulation and protection from mechanical forces
B. Transporting fluid and proteins from tissues back to the venous system
C. Regulating blood flow and temperature
D. Producing collagen and elastin fibers

Answer

A

B. Transporting fluid and proteins from tissues back to the venous system
Rationale: Lymphatic vessels in the dermis transport extravasated fluid and proteins from tissues back to the venous system, helping maintain fluid balance and remove excess tissue fluid.

Question 58

Q

Which of the following areas is most commonly affected by hidradenitis suppurativa (HS)?

A. Face and scalp
B. Palms and soles
C. Axilla and inguinal folds
D. Elbows and knees

Answer

A

C. Axilla and inguinal folds
Rationale: Hidradenitis suppurativa (HS) typically affects areas rich in apocrine glands such as the axilla, perineum, inframammary, and inguinal folds. These regions are prone to inflammation and infection in HS.

Question 59

Q

What is the hallmark symptom of hidradenitis suppurativa?

A. Small, painless papules
B. Tender, deep nodules that coalesce and drain
C. Diffuse erythema without drainage
D. Vesicles with clear fluid

Answer

A

B. Tender, deep nodules that coalesce and drain
Rationale: HS presents with painful, tender, deep nodules that can expand, coalesce, and spontaneously drain. This often leads to the formation of sinus tracts and significant scarring.

Question 60

Q

Which gene mutation has been linked to hidradenitis suppurativa?

A. TP53 gene
B. BRCA1 gene
C. γ-Secretase gene
D. CFTR gene

Answer

A

C. γ-Secretase gene
Rationale: Mutations in the γ-secretase gene have been linked to hidradenitis suppurativa. This mutation contributes to the inflammation and pilosebaceous unit involvement seen in HS.

Question 61

Q

Which of the following treatments is appropriate for Stage I and II hidradenitis suppurativa?

A. Radical excision
B. Systemic antibiotics (e.g., clindamycin)
C. Biologic agents
D. Laser treatment

Answer

A

B. Systemic antibiotics (e.g., clindamycin)
Rationale: For Stage I and II HS, topical and systemic antibiotics such as clindamycin are commonly used to manage inflammation and infection. More advanced treatments like radical excision and biologics are reserved for severe Stage II and Stage III.

Question 62

Q

Which of the following describes a method used to decrease the recurrence of hidradenitis suppurativa after surgical resection?

A. Topical steroids
B. Split-thickness skin grafting
C. Corticosteroid injections
D. Antihistamine therapy

Answer

A

B. Split-thickness skin grafting
Rationale: After surgical resection, methods such as split-thickness skin grafting, local or regional flaps, and healing by secondary intention are used to reduce the recurrence rate of HS, which can be as high as 50%.

Question 63

Q

Which of the following is a known risk factor for developing hidradenitis suppurativa?

A. Male gender
B. Smoking and obesity
C. Physical activity
D. Low carbohydrate diet

Answer

A

B. Smoking and obesity
Rationale: Smoking and obesity are significant risk factors for HS, and the condition is more common in females than males. Flares can also occur premenstrually, and the disease typically starts in the 3rd decade of life.

Question 64

Q

What is characteristic of Stage II hidradenitis suppurativa?

A. Single abscess without sinus tracts
B. Recurrent abscesses with limited sinus tracts and cicatrization
C. Near-diffuse involvement of interconnected abscesses
D. Small papules with no drainage

Answer

A

B. Recurrent abscesses with limited sinus tracts and cicatrization
Rationale: In Stage II HS, there are recurrent abscesses that are widely separated and have limited sinus tracts and cicatrization (scarring). Stage I involves no sinus tracts, and Stage III involves diffuse interconnected abscesses.

Stages of Hidradenitis Suppurativa
1. Stage I:
* Single or multiple abscesses without sinus tracts and cicatrization
2. Stage II:
* Recurrent single or multiple abscesses widely separated with limited sinus tracts and an entire area
3. Stage III:
* Diffuse or near-diffuse involvement of multiple interconnected tracts and abscesses across

Answer 65

A

C. Stage III
Rationale: Stage III HS is the most severe stage and is characterized by diffuse or near-diffuse involvement of interconnected sinus tracts and abscesses across large areas, leading to extensive scarring.

Answer 66

A

A. Hyperkeratosis and granuloma formation
Rationale: Progression of HS involves the atrophy of sebaceous glands, inflammation of the pilosebaceous unit, hyperkeratosis, and the formation of granulomas, leading to the chronic nature of the disease.

Answer 67

A

C. 50%
Rationale: Despite complete surgical resection, hidradenitis suppurativa has a high recurrence rate of approximately 50%. This makes post-surgical management strategies, such as split-thickness skin grafting, important for reducing recurrence.

Answer 68

A

B. Sterile pustules that progress into painful ulcers with purple borders
Rationale: Pyoderma gangrenosum is characterized by sterile pustules that evolve into painful ulcerating lesions with purple borders, commonly on the legs.

Answer 69

A

C. Legs
Rationale: Pyoderma gangrenosum most commonly affects the legs, but it can also manifest in other locations, including mucosal tissues and solid organs.

Answer 70

A

D. Presence of psoriasis
Rationale: Pyoderma gangrenosum is associated with hematologic malignancies and inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease (IBD), but psoriasis is not a recognized risk factor.

Answer 71

A

C. Peristomal
Rationale: Peristomal pyoderma gangrenosum occurs around stomas, often affecting patients with conditions like Crohn’s disease or those who have undergone surgery that involves the creation of a stoma.

Answer 72

A

B. Systemic anti-inflammatory medications (e.g., steroids)
Rationale: The first-line treatment for pyoderma gangrenosum is systemic anti-inflammatory medications such as steroids, which help reduce the inflammation driving the ulcerative process.

Answer 73

A

B. Inflammatory bowel disease (IBD)
Rationale: Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is commonly associated with pyoderma gangrenosum. Other conditions such as rheumatoid arthritis and hematologic malignancies are also linked to the disorder.

Answer 74

A

A. Sepsis due to secondary bacterial infection
Rationale: Although pyoderma gangrenosum lesions are sterile, secondary bacterial infection can occur, leading to complications such as sepsis if not properly managed with wound care and appropriate antimicrobial treatments.

Answer 75

A

A. Calcineurin inhibitors
Rationale: Calcineurin inhibitors, such as tacrolimus or cyclosporine, are commonly used as part of immunosuppressive therapy for pyoderma gangrenosum, particularly in more severe or refractory cases.

Answer 76

A

C. It is reserved for wound closure after medical management
Rationale: Surgery in pyoderma gangrenosum is typically reserved for wound closure after inflammation has been controlled with medical therapy. It is used to help close large or non-healing ulcers through techniques such as primary closure or skin grafting.

Answer 77

A

A. Address the Crohn’s disease with appropriate therapy
Rationale: Addressing the underlying disorder, such as Crohn’s disease, is a critical aspect of managing pyoderma gangrenosum. Treating the root cause of the inflammation can help improve the skin lesions and prevent recurrence.

Answer 78

A

C. Extent of body surface area involvement
Rationale: The key difference between SJS and TEN is the extent of body surface area involvement. SJS involves less than 10% of the body surface area, while TEN involves more than 30%. Cases with intermediate involvement are classified as SJS-TEN overlap.

Answer 79

A

B. Nikolsky sign
Rationale: Nikolsky sign is a key clinical finding in epidermal necrolysis. It is positive when the skin detaches and sloughs off with slight pressure, indicating a weakened epidermal-dermal junction.

Answer 80

A

B. Medication use (e.g., anticonvulsants, sulfonamides)
Rationale: The majority of cases of epidermal necrolysis are caused by medications, particularly aromatic anticonvulsants, sulfonamides, allopurinol, and oxicam NSAIDs.

Answer 81

A

A. Mucous membrane involvement
Rationale: Mucous membrane involvement is seen in 90% of cases of SJS and TEN, affecting the oral, genital, ocular, and respiratory mucosa, often leading to severe pain and complications.

Answer 82

A

B. Penicillin
Rationale: Penicillin is not one of the drugs most commonly associated with epidermal necrolysis, whereas aromatic anticonvulsants, sulfonamides, allopurinol, and oxicam NSAIDs are commonly implicated.

Answer 83

A

B. Discontinue the offending agent
Rationale: The first step in managing SJS or TEN is to immediately discontinue the offending drug. Early withdrawal of the causative agent significantly improves outcomes.

Answer 84

A

B. Inhibits the Fas-L cytotoxic pathway
Rationale: IVIG has been studied as a treatment for TEN due to its ability to inhibit the Fas-L cytotoxic pathway, which plays a role in keratinocyte apoptosis and skin damage in this disorder.

Answer 85

A

A. Maintain euvolemia and prevent fluid loss
Rationale: Maintaining euvolemia and managing fluid losses are critical in the supportive care of patients with epidermal necrolysis. The loss of the skin barrier leads to significant insensible water loss and hemodynamic instability.

Answer 86

A

B. Secondary infections
Rationale: Secondary infections are a significant complication of TEN due to the extensive skin damage and loss of the protective skin barrier, increasing the risk of sepsis and systemic infection.

Answer 87

A

B. Systemic corticosteroids
Rationale: The use of systemic corticosteroids in SJS and TEN remains controversial due to mixed results in clinical studies, with some reports suggesting benefit and others indicating potential harm, including increased risk of infection.

Answer 88

A

C. Erythema
Rationale: Erythema is a common acute skin change that manifests within weeks of radiation exposure. Other acute changes include edema and alopecia.

Answer 89

A

C. Ulceration
Rationale: Chronic skin changes after radiation exposure include ulceration, fibrosis, telangiectasia, and poor wound healing. These changes can present weeks to years after exposure.

Answer 90

A

B. Basal keratinocytes
Rationale: Basal keratinocytes, along with hair follicle stem cells and melanocytes, are the most radiosensitive components of the skin, making them highly susceptible to radiation-induced damage.

Answer 91

A

C. Skin moisturizers and local wound care
Rationale: Minor radiation injuries are generally managed with skin moisturizers and local wound care to support healing and minimize skin damage.

Answer 92

A

A. UVA
Rationale: UVA radiation (320-400 nm) penetrates the deepest into the skin, with 20%-30% of its energy reaching the deep dermis. It accounts for 95% of UV radiation reaching the Earth’s surface.

Answer 93

A

D. Stratum corneum
Rationale: UVB radiation (290-320 nm) is mostly absorbed in the stratum corneum, where 70% of its energy is retained. It can penetrate as deep as the papillary dermis, but primarily affects the epidermis.

Answer 94

A

A. Hyperpigmentation and melasma
Rationale: Long-term effects of UV radiation include irregular pigmentation, melasma, actinic lentigines, and photoaging (wrinkling and skin damage).

Answer 95

A

C. UVC
Rationale: UVC radiation (100-290 nm) is filtered by the ozone layer and does not reach the Earth’s surface, unlike UVA and UVB, which have biological effects on human skin.

Answer 96

A

C. Erythema and edema
Rationale: Erythema and edema are short-term effects of radiation that can present within hours to days after exposure, especially in cases of acute radiation injury.

Answer 97

A

C. Surgical excision and reconstruction
Rationale: In cases of severe radiation injury, the appropriate management often includes surgical excision and reconstruction to remove damaged tissue and promote healing.

Answer 98

A

C. Within 6 hours
Rationale: While there is no systematic evidence to guide the optimal timing of closure within 24 hours, many surgeons prefer primary closure of simple lacerations within 6 hours of injury to reduce the risk of infection and promote healing.

Answer 99

A

B. Contaminated or infected wounds
Rationale: Contaminated or infected wounds are typically not closed immediately. They are managed with secondary intention or delayed primary closure to prevent trapping infection inside the wound.

Answer 100

A

B. Healing with a moist, antimicrobial wound environment
Rationale: Partial-thickness injuries (with preservation of pilosebaceous units) can heal on their own if managed with a moist, antimicrobial wound environment, which promotes natural healing and reduces the risk of infection.

Answer 101

A

D. Dog bite to the hand
Rationale: Hand bites, particularly dog bites, are at high risk for deep infections because of the hand’s relatively avascular structures, which allow infections to spread rapidly, potentially leading to long-term morbidity.

Answer 102

A

C. Capnocytophaga canimorsus
Rationale: Capnocytophaga canimorsus is a bacterial species commonly involved in early infections of dog bites. Polymicrobial infections are also common in early stages, with a shift to dominant pathogens in later stages.

Answer 103

A

B. Amoxicillin or Clavulanate for 3 to 7 days
Rationale: Amoxicillin or Clavulanate is the recommended antibiotic prophylaxis for human bite wounds to reduce the risk of infection, given the high bacterial load in human bites.

Answer 104

A

A. Pasteurella species
Rationale: Pasteurella species are commonly found in cat bite wounds, contributing to the high risk of infection associated with these injuries. Other bacteria like Francisella tularensis (tularemia) may also be present.

Answer 105

A

B. Secondary intention healing
Rationale: For grossly contaminated bite wounds in non-aesthetic areas, the wound is typically left to heal by secondary intention to avoid infection and complications from immediate closure.

Answer 106

A

C. Split- or full-thickness skin grafting
Rationale: Full-thickness wounds typically require split- or full-thickness skin grafting depending on the size of the defect and the need for future cosmesis and durability.

Answer 107

A

A. Monomicrobial infections with one dominant pathogen
Rationale: Late-stage infections of dog bite wounds are typically monomicrobial, with one dominant pathogen taking over after the initial polymicrobial infection has resolved.

Answer 108

A

B. Alkaline burn
Rationale: Alkaline burns are more severe than acidic burns because they cause liquefactive necrosis, leading to deeper tissue penetration. Acids, on the other hand, cause coagulative necrosis, which forms an eschar and limits further damage.

Answer 109

A

C. Liquefactive necrosis
Rationale: Alkaline burns cause liquefactive necrosis, which allows the chemical tC. Liquefactive necrosis
Rationale: Alkaline burns cause liquefactive necrosis, which allows the chemical to penetrate deeper into tissues, causing more extensive damage compared to acidic burns, which cause coagulative necrosis.o penetrate deeper into tissues, causing more extensive damage compared to acidic burns, which cause coagulative necrosis.

Answer 110

A

B. Bleach
Rationale: Bleach is an example of an alkaline substance that can cause burns. Other examples include stain removers (NaOH) and cement (Ca(OH)₂).

Answer 111

A

D. 2 hours
Rationale: For alkaline burns, the recommended duration for irrigation with distilled water or saline is 2 hours to ensure thorough dilution of the chemical agent and to prevent further tissue damage.

DILUTION
ACID = 30 MINUTES
ALKALINE = 2 HOURS

Answer 112

A

B. Application of neutralizing agents
Rationale: Neutralizing agents are discouraged in the treatment of chemical burns because they can cause exothermic reactions, which may increase tissue damage.

Answer 113

A

C. Hydrofluoric acid
Rationale: Hydrofluoric acid burns are specifically treated with calcium gluconate to prevent systemic toxicity and help neutralize the fluoride ion.

Chemical Agents with Specific Treatments:
Calcium Gluconate: For hydrofluoric acid burns
Polyethylene Glycol: For phenol burns

Answer 114

A

B. Irrigation and antimicrobial dressings
Rationale: Partial-thickness chemical burns are managed with irrigation and antimicrobial dressings to prevent infection and support healing.

Answer 115

A

D. Extravasation injury
Rationale: Extravasation injury occurs during the administration of cytotoxic drugs and can lead to significant morbidity in patients with fragile veins or poor tissue perfusion, such as neonates or critically ill individuals.

Answer 116

A

B. Limb elevation
Rationale: Conservative management of extravasation injury includes limb elevation to minimize swelling and promote drainage of the extravasated drug.

Answer 117

A

C. Surgical debridement
Rationale: After wound demarcation in full-thickness skin necrosis from extravasation injury, the next step is surgical debridement to remove necrotic tissue and prevent infection.

Answer 118

A

B. Duration and degree of temperature exposure
Rationale: The extent of thermal injury depends on the degree of temperature the tissue is exposed to and the duration of exposure. Longer exposure to higher temperatures causes more extensive damage.

Answer 119

A

C. Zone of Coagulation
Rationale: The Zone of Coagulation is the inner zone of thermal injury, characterized by necrotic, non-viable tissue due to the direct effects of heat on the tissue.

Answer 120

A

C. Zone of Stasis
Rationale: The Zone of Stasis is the middle zone where tissue viability is questionable. With proper burn care, this zone may contain salvageable tissue, and interventions can help reduce further damage.

Answer 121

A

B. Zone of Hyperemia
Rationale: The Zone of Hyperemia is the outer zone of a burn injury. It shows signs of inflammation and is likely to remain viable with minimal intervention.

Answer 122

A

C. Salvaging viable tissue to reduce the extent of the burn
Rationale: The primary goal in the Zone of Stasis is to salvage viable tissue and prevent further damage, thereby reducing the extent of injury and improving outcomes.

Answer 123

A

C. Zone of Coagulation
Rationale: The Zone of Coagulation contains the most necrotic, non-viable tissue and will likely require surgical debridement to remove dead tissue and prevent infection.

Answer 124

A

C. Zone of Hyperemia
Rationale: The Zone of Hyperemia exhibits the most pronounced inflammatory response, as this area is characterized by tissue inflammation that is still viable and capable of healing.

Answer 125

A

B. Conversion to necrosis and expansion of the injury
Rationale: If burn care is inadequate in the Zone of Stasis, it can lead to conversion of the tissue to necrosis, resulting in an expansion of the injury and potentially more severe damage.

Answer 126

A

D. No specific intervention is typically needed
Rationale: The Zone of Hyperemia generally remains viable with minimal intervention. The primary goal is to manage inflammation and prevent infection, but the tissue is likely to heal without specific invasive measures.

Answer 127

A

C. Zone of Coagulation → Zone of Stasis → Zone of Hyperemia
Rationale: The Zone of Coagulation is at the center of the burn, surrounded by the Zone of Stasis, and the outermost zone is the Zone of Hyperemia.

Answer 128

A

B. Individuals who are chronically bed- or wheelchair-bound
Rationale: Chronically bed- or wheelchair-bound individuals are at high risk for developing pressure ulcers due to prolonged pressure over bony prominences and reduced mobility.

Answer 129

A

C. Ischial tuberosity
Rationale: The ischial tuberosity is a common site for pressure ulcers in patients who are seated for extended periods because this area experiences high tissue pressure while sitting.

Answer 130

A

C. 30 mmHg
Rationale: The average perfusion pressure of microcirculation is around 30 mmHg. When tissue pressure exceeds this value, local tissue ischemia can occur, leading to tissue damage.

Answer 131

A

B. 150 mmHg
Rationale: When a patient is lying supine, the pressure over the sacrum can reach 150 mmHg, which is significantly higher than the microcirculation pressure (30 mmHg), leading to tissue ischemia.

Answer 132

A

C. Stage 3
Rationale: Stage 3 pressure ulcers involve full-thickness injury that extends down to, but does not involve, the fascia, and there is no undermining of the surrounding tissues.

Answer 133

A

B. Wide debridement and tension-free closure
Rationale: The primary goals of surgical intervention in pressure ulcers are wide debridement of devitalized tissue and tension-free closure using well-vascularized tissue to close dead space and promote healing.

Answer 134

A

A. Repositioning the patient every 2 hours
Rationale: Repositioning the patient every 2 hours is essential to prevent prolonged pressure over bony prominences and reduce the risk of developing pressure ulcers.

Answer 135

A

B. Muscle and skin
Rationale: Muscle and skin tissues, which have higher metabolic demands, are more susceptible to damage from hypoperfusion caused by prolonged pressure and ischemia.

Answer 136

A

B. Applying a silicone dressing and offloading pressure
Rationale: Stage 1 pressure ulcers, characterized by non-blanching erythema, should be managed by offloading pressure and applying prophylactic silicone dressings to prevent progression of the injury.

Answer 137

A

C. Scapula
Rationale: While bony prominences like the ischial tuberosity, greater trochanter, sacrum, and heel are common sites for pressure ulcers, the scapula is not as commonly affected compared to other areas.

Answer 138

A

B. Stimulate autogenous dermal regeneration while protecting underlying structures
Rationale: The primary goal of bioengineered skin substitutes is to stimulate autogenous dermal regeneration by providing a regenerative matrix, which also protects the underlying soft tissue and structures.

Answer 139

A

C. Autografts
Rationale: Autografts are skin grafts taken from the patient’s own body and placed over a soft tissue defect, providing an effective option for skin regeneration without the risk of immune rejection.

Answer 140

A

C. Allografts
Rationale: Allografts are skin substitutes obtained from human organ donors, used to cover soft tissue defects, though they carry a risk of immune rejection.

Answer 141

A

B. Members of other animal species
Rationale: Xenografts are skin substitutes harvested from members of other animal species, such as pigs, and used to temporarily cover wounds or soft tissue defects.

Answer 142

A

B. They are constructed de novo and may be combined with biological materials
Rationale: Synthetic and semisynthetic biomaterials are constructed de novo and may be combined with biological materials to create skin substitutes that aid in wound healing and tissue regeneration.

Answer 143

A

B. Allografts
Rationale: Allografts, which are derived from human donors, carry the highest risk of immune rejection since they come from another person.

Answer 144

A

C. 1 to 2 weeks
Rationale: Tissue incorporation of bioengineered skin substitutes generally occurs within 1 to 2 weeks, depending on the type of graft and the condition of the wound bed.

Answer 145

A

B. Allografts
Rationale: Allografts may be chosen when the patient’s own tissue (autografts) is unavailable or unsuitable for grafting, such as in cases of extensive tissue loss or when immediate coverage is needed.

Answer 146

A

B. Xenograft
Rationale: Xenografts are often used as temporary wound coverings to provide protection and facilitate healing until a more permanent solution, such as an autograft, can be performed.

Answer 147

A

A. Collagen
Rationale: Collagen and other biological materials may be combined with synthetic biomaterials to enhance the regenerative properties of bioengineered skin substitutes, helping to support tissue healing and repair.

Answer 148

A

C. Staphylococcus aureus
Rationale: Staphylococcus aureus is the most common causative agent of skin and soft tissue infections, including abscess formation.

Answer 149

A

B. Neutropenia
Rationale: Individuals with neutropenia, as well as those with diabetes or cirrhosis, are at higher risk of developing

Answer 150

A

A. Cellulitis
Rationale: Cellulitis is a common skin infection often caused by Staphylococcus aureus or Streptococcus species, leading to inflammation of the skin and subcutaneous tissue.

Answer 151

A

C. Bacterial abscess
Rationale: Staphylococcus aureus commonly causes bacterial abscesses, which present as collections of pus in the skin and subcutaneous tissue.

Answer 152

A

B. Necrotizing fasciitis
Rationale: Patients with diabetes are at increased risk for necrotizing fasciitis and other serious infections caused by gram-negative organisms, due to their compromised immune system and impaired wound healing.

Answer 153

A

C. Broken skin or trauma
Rationale: Broken skin or trauma increases the risk of Staphylococcus aureus infections, as the bacteria can enter through breaches in the skin barrier, leading to localized or systemic infections.

Answer 154

A

B. Cellulitis
Rationale: Cellulitis is characterized by rapidly spreading erythema and edema, often associated with systemic symptoms such as fever. It is most commonly caused by Staphylococcus aureus and Streptococcus species.

Answer 155

A

B. Patients with cirrhosis
Rationale: Patients with cirrhosis are at higher risk of developing skin infections from gram-negative bacteria due to liver dysfunction and associated immune impairment.

Answer 156

A

B. Incision and drainage
Rationale: The primary treatment for a bacterial abscess caused by Staphylococcus aureus is incision and drainage to remove the collection of pus. Antibiotics may be used in some cases, but drainage is the mainstay of treatment.

Answer 157

A

B. Disrupted skin barrier
Rationale: Immunocompromised individuals with a disrupted skin barrier are at increased risk of developing skin infections, as pathogens like Staphylococcus aureus can enter through breaches in the skin, leading to infection.

Answer 158

A

B. Honey-colored crusting on the face
Rationale: Impetigo is a superficial skin infection, most commonly seen in children, characterized by honey-colored crusting, especially on the face.

Answer 159

A

A. Folliculitis
Rationale: Folliculitis is characterized by inflammation of the hair follicle and is often associated with minor infections of the skin’s appendages.

Answer 160

A

D. Cellulitis
Rationale: Cellulitis is a deeper skin infection that affects the deeper dermis and subcutaneous tissue, often causing redness, swelling, and warmth over the affected area.

Answer 161

A

B. Carbuncle
Rationale: A carbuncle is an abscess that involves multiple draining sinus tracts, representing a more severe infection compared to a single abscess or furuncle.

Answer 162

A

B. Topical antimicrobials like 2% mupirocin
Rationale: Minor uncomplicated infections such as impetigo are commonly treated with topical antimicrobials, such as 2% mupirocin, which is effective against MRSA.

Answer 163

A

A. β-lactam antibiotics (e.g., penicillin, first-generation cephalosporins)
Rationale: Streptococcus coverage is typically achieved with β-lactam antibiotics, such as penicillin or first-generation cephalosporins, in cases of uncomplicated skin infections.

Answer 164

A

C. Folliculitis
Rationale: Folliculitis often resolves with adequate hygiene and warm soaks, and typically does not require antibiotic therapy unless the infection worsens.

Answer 165

A

B. Trimethoprim-sulfamethoxazole
Rationale: Trimethoprim-sulfamethoxazole is an effective antibiotic for treating MRSA infections, such as purulent cellulitis, which requires MRSA coverage.

Answer 166

A

D. Trimethoprim-sulfamethoxazole and a β-lactam antibiotic
Rationale: Dual coverage for Streptococcus and MRSA can be achieved by combining trimethoprim-sulfamethoxazole (for MRSA) with a β-lactam antibiotic (for Streptococcus).

Answer 167

A

B. Erysipelas
Rationale: Erysipelas is a cutaneous infection localized to the upper layers of the dermis, characterized by well-demarcated redness and swelling, commonly caused by Streptococcus species.

Answer 168

A

B. Crepitus
Rationale: Crepitus, which feels like the sensation of rubbing your hair between your fingers, is a hallmark sign of gas-forming organisms in necrotizing soft tissue infections, including necrotizing fasciitis

Answer 169

A

B. β-hemolytic Streptococcus
Rationale: Type 2 NSTIs are typically caused by a monomicrobial source, most commonly β-hemolytic Streptococcus or Staphylococcus aureus, including MRSA.

Answer 170

A

C. Purpura
Rationale: Purpura is often associated with sepsis in streptococcal infections and indicates a more severe systemic inflammatory response.

Answer 171

A

C. Type 3 NSTI
Rationale: Type 3 NSTIs are rare but fulminant, caused by Vibrio vulnificus infections following exposure to saltwater, often after trauma to the skin.

Answer 172

A

B. Clostridium perfringens
Rationale: Type 1 NSTIs are caused by polymicrobial infections, often including anaerobic bacteria like Clostridium perfringens, along with gram-positive cocci and gram-negative rods.

Answer 173

A

C. Vancomycin
Rationale: Vancomycin is the first-line antibiotic choice for MRSA coverage in complicated skin infections, especially in cases of necrotizing soft tissue infections.

Answer 174

A

B. Immediate surgical debridement
Rationale: Immediate surgical debridement is critical in managing necrotizing soft tissue infections to remove necrotic tissue and control the source of infection.

Answer 175

A

B. IV antibiotics covering gram-positive, gram-negative, and anaerobic bacteria
Rationale: In managing NSTIs, broad-spectrum IV antibiotics that cover gram-positive, gram-negative, and anaerobic bacteria are essential for controlling infection.

Answer 176

A

B. It suggests an abscess with a collection of purulent material
Rationale: Fluctuance on physical examination indicates the presence of an abscess, characterized by a collection of purulent material.

Answer 177

A

D. All of the above
Rationale: Findings such as lymphangitis, purpura, and bullae suggest a more serious infection and are associated with systemic inflammatory responses, necessitating prompt treatment.

Answer 178

A

C. Actinomyces israelii
Rationale: Actinomyces israelii is the most common species responsible for actinomycosis in humans. It is a gram-positive rod found in the oropharynx, gastrointestinal tract, and female genital tract.

Answer 179

A

B. Cervicofacial form
Rationale: The cervicofacial form is the most common presentation of actinomycosis, accounting for about 55% of cases. It typically manifests as a chronic infection in the submandibular or paramandibular area.

Answer 180

A

C. Chronic soft tissue swelling with sinus discharge
Rationale: Cervicofacial actinomycosis typically presents as chronic soft tissue swelling with sinus discharge, which may contain sulfur granules.

Answer 181

A

B. Presence of sulfur granules
Rationale: Sulfur granules, seen on histological examination, are a hallmark diagnostic finding of actinomycosis. These are yellowish clumps of organisms within the sinus tracts.

Answer 182

A

C. High doses of penicillin
Rationale: High doses of penicillin are the first-line treatment for actinomycosis, typically starting with intravenous administration followed by oral therapy for an extended period.

Answer 183

A

B. Extensive necrotic tissue
Rationale: Surgical treatment is indicated in cases of extensive necrotic tissue, poor response to antibiotics, or when tissue biopsy is needed to rule out malignancy.

Answer 184

A

C. Submandibular or paramandibular region
Rationale: Cervicofacial actinomycosis commonly presents in the submandibular or paramandibular area, causing soft tissue swelling and sinus tract formation.

Answer 185

A

C. Indicated for tissue biopsy, extensive necrosis, or poor antibiotic response
Rationale: Surgical intervention is indicated for extensive necrotic tissue, poor response to antibiotics, or when a tissue biopsy is required to rule out other conditions, such as malignancy.

Answer 186

A

B. Gram-positive rod
Rationale: Actinomyces israelii is a gram-positive rod that is responsible for causing actinomycosis.

Answer 187

A

D. Several months
Rationale: Antibiotic therapy for actinomycosis is typically prolonged, often lasting several months, with initial intravenous treatment followed by long-term oral therapy to ensure complete resolution of the infection.

Answer 188

A

B. Proliferation of endothelial cells surrounding blood-filled cavities
Rationale: Hemangiomas are benign vascular tumors that arise from the proliferation of endothelial cells surrounding blood-filled cavities.

Answer 189

A

C. Shortly after birth
Rationale: Hemangiomas typically present shortly after birth and undergo rapid growth during the first year of life.

Answer 190

A

B. Rapid growth during the first year, followed by gradual involution
Rationale: Hemangiomas usually exhibit rapid growth during the first year of life and then gradually involute over childhood in more than 90% of cases.

Answer 191

A

B. GLUT-1 glucose transporter protein
Rationale: Hemangiomas express the GLUT-1 glucose transporter protein, which can be used as a marker to differentiate hemangiomas from other vascular lesions.

Answer 192

A

C. Propranolol
Rationale: Propranolol is the first-line therapy for treating hemangiomas, leading to cessation of growth and regression of the lesion.

Answer 193

A

C. Obstruction of airway or vision, or high-output heart failure
Rationale: Surgical resection is indicated in cases where the hemangioma causes obstruction of the airway, vision, or gastrointestinal tract, or when it leads to high-output heart failure.

Answer 194

A

B. Systemic corticosteroids and interferon alpha
Rationale: Systemic corticosteroids and interferon alpha are used to impede tumor progression in hemangiomas when other treatments are ineffective or contraindicated.

Answer 195

A

B. Laser therapy
Rationale: Laser therapy is an option to impede tumor progression in hemangiomas, especially when medical treatments like propranolol or corticosteroids are not effective

Answer 196

A

B. High-output heart failure
Rationale: Hemangiomas that consume a large percentage of cardiac output can lead to high-output heart failure due to the increased blood flow demand by the tumor.

Answer 197

A

C. Consumptive coagulopathy or airway obstruction
Rationale: Surgical intervention is indicated for hemangiomas causing consumptive coagulopathy, airway obstruction, or other life-threatening complications.

Answer 198

A

C. Melanocytic hyperplasia or neoplasia
Rationale: Nevi are areas of melanocytic hyperplasia or neoplasia, leading to localized increases in melanocyte activity or growth.

Answer 199

A

C. Junctional nevi
Rationale: Junctional nevi are located entirely within the epidermis, where melanocytes proliferate in the junction between the epidermis and dermis.

Answer 200

A

B. Compound nevus
Rationale: A compound nevus is partially located in both the epidermis and dermis, representing a transition in melanocyte proliferation.

Answer 201

A

B. They result from abnormal development of melanocytes
Rationale: Congenital nevi result from abnormal development of melanocytes during embryogenesis and can affect surrounding skin structures.

Answer 202

A

B. Small size and symmetry
Rationale: Nevi are typically small and symmetric, making them benign lesions in most cases, unlike malignant melanomas, which often show asymmetry.

Answer 203

A

C. 5%
Rationale: Giant congenital nevi have about a 5% risk of developing into malignant melanoma, making regular monitoring crucial.

Answer 204

A

A. UV radiation exposure
Rationale: Exposure to UV radiation is associated with an increased density of nevi, as UV light can stimulate melanocyte activity.

Answer 205

A

C. Dermal nevi
Rationale: Dermal nevi are located completely within the dermis, distinguishing them from junctional or compound nevi.

Answer 206

A

C. Surgical excision
Rationale: Surgical excision is the first-line treatment for nevi, particularly when there is a risk of malignant transformation or when the lesion is symptomatic.

Answer 207

A

C. Large congenital nevi
Rationale: Serial excision and tissue expansion are often used in the treatment of large congenital nevi to minimize the risk of scarring and reduce the risk of malignant transformation.

Answer 208

A

B. Sebaceous cyst
Rationale: Sebaceous cysts are the most common type of cutaneous cyst and are characterized by overgrowth of epidermis leading to keratin accumulation.

Answer 209

A

B. A single keratin-clogged punctum at the skin surface
Rationale: Epidermoid cysts present as a dermal or subcutaneous cyst with a single keratin-clogged punctum at the skin surface, commonly occurring on the upper chest and back.

Answer 210

A

C. Scalp
Rationale: Trichilemmal cysts are most commonly found on the scalp and are more frequent in women. They lack a granular layer histologically.

Answer 211

A

D. Dermoid cyst
Rationale: Dermoid cysts are congenital and result from the persistence of epithelium within embryonic fusion lines. They commonly occur between the forehead and nose tip or on the eyebrows.

Answer 212

A

B. Presence of a granular layer in the cyst lining
Rationale: Epidermoid cysts consist of mature epidermis with a granular layer, unlike trichilemmal cysts which lack a granular layer.

Answer 213

A

C. Surgical excision
Rationale: Surgical excision is the primary treatment method for cystic lesions to remove the cyst lining and prevent recurrence.

Answer 214

A

C. Dermoid cyst
Rationale: Dermoid cysts often occur in congenital locations such as between the forehead and the tip of the nose, and may present near the eyebrows or intracranially.

Answer 215

A

B. Adolescents and young adults
Rationale: Epidermoid cysts are commonly seen in adults, particularly in adolescents and young adults.

Answer 216

A

C. They lack a granular layer
Rationale: Trichilemmal cysts are characterized by the absence of a granular layer and are commonly found on the scalp.

Answer 217

A

B. Dermoid cyst
Rationale: Dermoid cysts may communicate with the skin surface through a small fistula, particularly when located near embryonic fusion lines.

Answer 218

A

B. UV radiation exposure
Rationale: The greatest risk factor for actinic keratosis is UV radiation exposure, particularly in fair-skinned individuals who are frequently exposed to the sun.

Answer 219

A

B. 10%
Rationale: Approximately 10% of actinic keratosis lesions will transform into invasive squamous cell carcinoma within two years.

Answer 220

A

C. Actinic keratosis
Rationale: Actinic keratosis is considered a precursor lesion to squamous cell carcinoma, especially in sun-damaged skin, with around 60-65% of squamous cell carcinoma cases originating from actinic keratosis.

Answer 221

A

A. A well-demarcated, “stuck-on” papule or plaque
Rationale: Seborrheic keratosis typically appears as a well-demarcated, “stuck-on” papule or plaque, often seen in elderly individuals.

Answer 222

A

C. No malignant potential
Rationale: Seborrheic keratosis has no malignant potential and is considered a benign condition that does not transform into cancer.

Answer 223

A

D. All of the above
Rationale: Treatment options for actinic keratosis include fluorouracil, cryotherapy, and excision to prevent progression to squamous cell carcinoma.

Answer 224

A

B. Seborrheic keratosis
Rationale: Seborrheic keratosis is typically treated for cosmetic purposes and does not have malignant potential, making removal unnecessary from a medical standpoint.

Answer 225

A

D. All of the above
Rationale: Patients with actinic keratosis may experience bleeding, pruritus, or pain, especially if the lesion becomes irritated or progresses toward malignancy.

Answer 226

A

B. History of tanning bed use
Rationale: A history of tanning bed use and excessive UV exposure is associated with a higher density of actinic keratoses, especially in fair-skinned individuals.

Answer 227

A

B. Cryotherapy or excision for cosmetic reasons
Rationale: Seborrheic keratosis is commonly treated with cryotherapy or excision for cosmetic reasons, though treatment is not medically necessary due to its benign nature.

Answer 228

A

A. Benign, pedunculated growths of epidermal keratinocytes surrounding a collagenous core
Rationale: Acrochordons (skin tags) are benign, pedunculated growths made up of epidermal keratinocytes surrounding a collagenous core.

Answer 229

A

B. Pucker or dimple in the center when pinched
Rationale: Dermatofibromas often appear as pink to brown papules that pucker or dimple in the center when pinched, which is a characteristic clinical sign.

Answer 230

A

A. Lipoma
Rationale: Lipomas are the most common subcutaneous neoplasms and are benign with no malignant potential.

Answer 231

A

B. Liposarcomas are deep-seated, rapidly growing, and invasive
Rationale: Liposarcomas are malignant fatty tumors that are deep-seated, rapidly growing, painful, and often invasive, distinguishing them from benign lipomas

Answer 232

A

C. Surgical resection
Rationale: Surgical resection is recommended for lipomas that are causing local pain, a mass effect, or are located in cosmetically sensitive areas.

Answer 233

A

C. Cross-sectional imaging (CT or MRI)
Rationale: Cross-sectional imaging (such as CT or MRI) is recommended prior to surgical resection of a suspected liposarcoma to assess the tumor’s depth, extent, and invasiveness.

Answer 234

A

B. Lipoma
Rationale: Lipomas are typically painless, slow-growing, and mobile masses that are well-circumscribed and located under the skin.

Answer 235

A

A. Acrochordon (skin tag)
Rationale: Acrochordons (skin tags) are benign and are often removed for cosmetic reasons, though they may also be removed if they become irritated or necrotic.

Answer 236

A

C. Acrochordon
Rationale: Acrochordons (skin tags) can become irritated or necrotic, which often prompts their removal, although removal is primarily for cosmetic purposes.

Answer 237

A

C. Risk of transformation to melanoma
Rationale: Dermatofibromas are benign lesions with no risk of malignant transformation, such as into melanoma.

Answer 238

A

B. Neurofibroma
Rationale: Neurofibroma is associated with Type 1 Neurofibromatosis (NF1), which can present with café-au-lait spots and Lisch nodules.

Answer 239

A

B. Fleshy, non-tender, pedunculated mass
Rationale: Neurofibromas often appear as fleshy, non-tender, sessile, or pedunculated masses and are typically asymptomatic.

Answer 240

A

B. Neuroma
Rationale: Neuromas are commonly found at sites of previous trauma or within surgical scar lines and often present as painful papules or nodules.

Answer 241

A

B. They arise from Schwann cells and do not contain axons
Rationale: Schwannomas are benign tumors that arise from Schwann cells of the peripheral nerve sheath and do not contain axons, although they may displace the affected nerve.

Answer 242

A

C. Pain
Rationale: Neuromas are typically painful lesions that occur at sites of previous trauma or surgery, often causing discomfort.

Answer 243

A

C. Schwannoma
Rationale: Schwannomas can arise sporadically or in association with Type 2 Neurofibromatosis (NF2), which is characterized by bilateral vestibular schwannomas.

Answer 244

A

C. Surgical excision and biopsy
Rationale: Surgical excision and biopsy are indicated for neurofibromas that are pruritic or suspicious for malignant transformation.

Answer 245

A

A. Café-au-lait spots and Lisch nodules
Rationale: Café-au-lait spots and Lisch nodules are hallmark features of Type 1 Neurofibromatosis (NF1), which is associated with neurofibromas.

Answer 246

A

B. Schwann cells and nerve axons
Rationale: Neuromas are caused by disordered growth of Schwann cells and nerve axons, often following trauma or surgery.

Answer 247

A

B. Displacement of the affected nerve and pain
Rationale: Schwannomas can cause displacement of the affected nerve and lead to pain along the nerve distribution, though they are typically benign.

Answer 248

A

C. UVB radiation exposure
Rationale: UVB radiation exposure from the sun is the primary risk factor for developing basal cell carcinoma (BCC), with UVB rays being more damaging than UVA.

Answer 249

A

C. p53
Rationale: The p53 tumor suppressor gene is defective in approximately 50% of BCC cases, leading to abnormal cell proliferation and tumor formation.

Answer 250

A

C. 20-50 years
Rationale: The latency period for BCC, from exposure to UV radiation to the development of the tumor, is typically between 20-50 years.

Answer 251

A

D. Nodular BCC
Rationale: Nodular BCC is the most common subtype and presents as raised, pearly pink papules with telangiectasias and a depressed center with raised borders.

Answer 252

A

B. Superficial BCC
Rationale: Superficial BCC is confined to the epidermis and presents as a flat, pink, scaling, or crusting lesion.

Answer 253

A

C. Infiltrative BCC
Rationale: Infiltrative BCC is the most aggressive subtype, often appearing as an opaque yellow-white color that blends with surrounding skin, without raised edges.

Answer 254

A

A. Upper lip for BCC and lower lip for SCC
Rationale: BCC typically affects the upper lip, while squamous cell carcinoma (SCC) is more common on the lower lip due to different patterns of UV exposure.

Answer 255

A

B. 4 mm
Rationale: A 4 mm margin is recommended for small, primary BCC in cosmetically sensitive areas to ensure complete excision while preserving surrounding healthy tissue.

Answer 256

A

B. Mohs microsurgical excision
Rationale: Mohs microsurgical excision involves sequential horizontal excision of tissue layers until no cancerous cells remain, minimizing tissue loss while ensuring complete tumor removal.

Answer 257

A

C. Every 6-12 months
Rationale: After treatment for basal cell carcinoma, patients should have regular full skin examinations every 6-12 months to monitor for recurrence or new skin cancers.

Answer 258

A

D. Morpheaform BCC

Rationale: Morpheaform BCC presents as an indurated lesion that often resembles an enlarging scar with indistinct clinical margins. It has a high rate of positive margins after excision, making it one of the more challenging subtypes to treat.

Answer 259

A

C. UV radiation exposure
Rationale: UV radiation exposure is the primary risk factor for developing SCC, with prolonged sun exposure contributing to its development.

Answer 260

A

C. HPV-16 and HPV-18
Rationale: HPV-16 and HPV-18 are known to increase the risk of developing squamous cell carcinoma, particularly in mucosal sites like the genitals.

Answer 261

A

B. Tumor arising at a site of prior radiation
Rationale: SCC that arises at a site of prior radiation is more likely to recur and have a worse prognosis.

Answer 262

A

B. Scaly or ulcerated papules or plaques that may bleed
Rationale: SCC often presents as a scaly or ulcerated papule or plaque that may bleed with minimal trauma.

Answer 263

A

B. Depth of invasion > 4 mm
Rationale: Depth of invasion > 4 mm is associated with a worse prognosis in patients with SCC due to the higher risk of metastasis and recurrence.

Answer 264

A

B. Marjolin’s Ulcer
Rationale: Marjolin’s Ulcer is a subtype of SCC that arises in areas of chronic wounds or burn scars and has a higher metastatic potential.

Answer 265

A

C. 6 mm
Rationale: For high-risk SCC lesions, a 6 mm surgical margin is recommended to ensure complete excision and reduce the risk of recurrence.

Answer 266

A

B. Erythroplasia of Queyrat
Rationale: Erythroplasia of Queyrat is a subtype of SCC that commonly affects the glans penis, presenting as a red, velvety lesion.

Answer 267

A

B. Mohs microsurgical excision
Rationale: Mohs microsurgical excision is indicated for SCC with positive margins, recurrent tumors, or those in cosmetically sensitive areas to ensure complete removal while preserving healthy tissue.

Answer 268

A

C. Keratoacanthoma
Rationale: Keratoacanthoma is a rapidly growing subtype of SCC that occurs more frequently in organ transplant and immunocompromised patients, characterized by a central keratin plug.

Answer 269

A

C. UV radiation exposure
Rationale: UV radiation exposure is the primary risk factor for developing melanoma, especially due to excessive sun exposure without protection.

Answer 270

A

A. Asymmetric, irregular borders, varying colors
Rationale: Melanoma often presents as asymmetric lesions with irregular borders and color variations (ABCDE rule: Asymmetry, Border, Color, Diameter, Evolution).

Answer 271

A

C. Breslow tumor thickness
Rationale: Breslow tumor thickness is the most important prognostic indicator for melanoma staging, replacing the older Clark’s level.

Answer 272

A

B. Excisional biopsy with 1-3 mm margins
Rationale: An excisional biopsy with 1-3 mm margins is recommended for diagnosing suspicious melanoma lesions to assess the entire lesion and adjacent normal tissue.

Answer 273

A

C. Superficial spreading melanoma
Rationale: Superficial spreading melanoma is the most common subtype, accounting for 50-70% of melanomas and often arising from a precursor melanocytic nevus.

Answer 274

A

D. Acral lentiginous melanoma
Rationale: Acral lentiginous melanoma is most common in dark-skinned individuals and occurs on palmar, plantar, and subungual surfaces, unlike other types related to sun exposure.

Answer 275

A

C. 2 cm
Rationale: For melanoma tumors >2 mm in thickness, a 2 cm surgical margin is recommended to ensure complete excision and minimize the risk of recurrence.

Answer 276

A

B. Sentinel lymph node biopsy (SLNB)
Rationale: Sentinel lymph node biopsy (SLNB) is the standard staging procedure for detecting subclinical nodal metastasis in patients with clinically node-negative melanoma.

Answer 277

A

B. Nodular melanoma
Rationale: Nodular melanoma is an aggressive subtype with an early vertical growth pattern, often diagnosed at a later stage due to its rapid progression.

Answer 278

A

B. PET-CT scan
Rationale: For patients with stage III melanoma or greater, PET-CT scans are commonly used for staging to assess distant metastasis, especially in high-risk cases.

Answer 279

A

A. Neuroendocrine tumor
Rationale: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin, which is rarer but has a worse prognosis compared to melanoma.

Answer 280

A

B. Rapidly growing flesh-colored to red or purple papule or plaque
Rationale: Merkel cell carcinoma typically presents as a rapidly growing, flesh-colored to red or purple papule or plaque.

Answer 281

A

B. Cytokeratin-20
Rationale: Cytokeratin-20 is a diagnostic marker for Merkel cell carcinoma and is often used to confirm the diagnosis.

Answer 282

A

B. Wide local excision with sentinel lymph node biopsy (SLNB)
Rationale: Patients with Merkel cell carcinoma and no clinical nodal disease should undergo wide local excision with sentinel lymph node biopsy (SLNB) to assess for occult metastasis.

Answer 283

A

B. 1-3 cm
Rationale: A margin of 1-3 cm is recommended for the excision of Merkel cell carcinoma, extending down to the fascia to ensure complete removal.

Answer 284

A

C. UV exposure and age >65 years
Rationale: UV exposure and age >65 years are significant risk factors for Merkel cell carcinoma, along with immunosuppression and Merkel cell polyomavirus.

Answer 285

A

C. Completion lymphadenectomy and/or radiation therapy
Rationale: For patients with positive sentinel lymph nodes, completion lymphadenectomy and/or radiation therapy is recommended to address the risk of further spread.

Answer 286

A

B. Classic Kaposi’s sarcoma

Rationale: Classic Kaposi’s sarcoma typically occurs in older men without immunosuppression, often presenting as multiple nodules on the lower extremities. This form is less aggressive compared to AIDS-associated Kaposi’s sarcoma.

Answer 287

A

C. Human Herpesvirus 8 (HHV-8)
Rationale: Kaposi’s Sarcoma (KS) is caused by Human Herpesvirus 8 (HHV-8), leading to the proliferation and inflammation of endothelial-derived spindle cells.

Answer 288

A

C. Multifocal, rubbery blue-red nodules
Rationale: Kaposi’s Sarcoma commonly appears as multifocal, rubbery blue-red nodules on the skin, though it can occur anywhere in the body.

Answer 289

A

D. AIDS-Associated KS
Rationale: AIDS-Associated KS occurs in patients with HIV infection and is one of the AIDS-defining illnesses.

Answer 290

A

A. Lower extremities
Rationale: Kaposi’s Sarcoma often affects the lower extremities, but the lesions can be found anywhere in the body, including mucosal surfaces.

Answer 291

A

B. Photodynamic therapy
Rationale: For patients with AIDS-Associated KS who do not respond to antiviral therapy, photodynamic therapy, radiation therapy, cryotherapy, or intralesional injections can be considered.

Answer 292

A

C. HIV-Negative MSM Associated KS
Rationale: HIV-Negative MSM Associated KS is observed in HIV-negative men who have sex with men (MSM) and represents a unique form of the disease.

Answer 293

A

C. Fifth decade of life or later
Rationale: Kaposi’s Sarcoma is typically diagnosed in individuals after the fifth decade of life, although its incidence can vary based on the form of the disease.

Answer 294

A

C. Basal Cell KS
Rationale: Basal Cell KS is not a recognized form of Kaposi’s Sarcoma. The recognized forms include Classic KS, AIDS-Associated KS, Immunosuppression Associated KS, and others.

Answer 295

A

B. Human Herpesvirus 8 (HHV-8)
Rationale: HHV-8 is strongly associated with Kaposi’s Sarcoma, particularly in immunocompromised individuals such as those with HIV/AIDS or organ transplants.

Answer 296

A

A. Intralesional injections
Rationale: For limited mucocutaneous disease in Kaposi’s Sarcoma, treatments like intralesional injections, cryotherapy, or topical therapy may be used.

Answer 297

A

B. Antiviral therapy (HAART)

Rationale: Antiviral therapy (HAART) is the first-line treatment for AIDS-associated Kaposi’s sarcoma. It helps control HIV and reduces the progression of Kaposi’s sarcoma.

Answer 298

A

B. Fibroblasts
Rationale: Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade sarcoma that originates from fibroblasts.

Answer 299

A

B. Tumor depth
Rationale: The depth of the tumor is the most important prognostic factor for DFSP, as it influences the likelihood of local recurrence and treatment success.

Answer 300

A

B. Slow-growing, violaceous plaque
Rationale: DFSP typically presents as a slow-growing, asymptomatic, violaceous plaque, commonly found on the trunk, head, neck, or extremities

Answer 301

A

C. CD34
Rationale: DFSP is positive for CD34 and negative for factor XIIIa, which helps differentiate it from other skin lesions.

Answer 302

A

C. 3 cm
Rationale: A 3 cm surgical margin is recommended for wide local excision of DFSP, extending down to the deep underlying fascia to reduce the risk of recurrence.

Answer 303

A

B. Mohs microsurgery
Rationale: Mohs microsurgery is often used for DFSP in cosmetically sensitive areas to minimize tissue removal while ensuring complete tumor excision.

Answer 304

A

A. Imatinib
Rationale: Imatinib, a tyrosine kinase inhibitor, is used as adjuvant therapy for DFSP in cases of incomplete resection or unresectable tumors.

Answer 305

A

C. Nodal dissection
Rationale: Nodal dissection is not required in the treatment of DFSP as it has a low distant metastatic potential, although local recurrence is common.

Answer 306

A

B. Pleomorphic Sarcoma
Rationale: Malignant Fibrous Histiocytoma (MFH) is also referred to as Undifferentiated Pleomorphic Sarcoma and is a type of cutaneous spindle-cell soft tissue sarcoma.

Answer 307

A

B. Extremities, head, and neck
Rationale: MFH commonly occurs in the extremities, head, and neck, particularly in elderly patients.

Answer 308

A

B. Solitary, soft to firm, skin-colored subcutaneous nodules
Rationale: MFH presents as solitary, soft to firm, skin-colored subcutaneous nodules, typically affecting elderly patients.

Answer 309

A

C. Complete surgical resection
Rationale: Complete surgical resection is the treatment of choice for MFH to achieve local control and prevent recurrence.

Answer 310

A

C. Radiation therapy
Rationale: Radiation therapy is often used as an adjuvant therapy in MFH to improve local control after surgical resection.

Answer 311

A

C. Distant metastasis
Rationale: Distant metastasis is a contraindication to surgical resection in patients with MFH, as surgery is unlikely to provide benefit in the presence of widespread disease.

Answer 312

A

B. Spindle-cell soft tissue sarcoma
Rationale: MFH is classified as a spindle-cell soft tissue sarcoma, characterized by the proliferation of spindle-shaped tumor cells.

Answer 313

A

C. Mohs microsurgery
Rationale: Mohs microsurgery is not typically involved in the management of MFH; instead, complete surgical resection with adjuvant radiation therapy is commonly used.

Answer 314

A

A. Lymphedema-associated angiosarcoma (Stewart-Treves syndrome)

Rationale: Lymphedema-associated angiosarcoma (Stewart-Treves syndrome) occurs in individuals with chronic lymphedema following lymph node dissection. It typically presents as a violaceous plaque in the affected limb, often following breast cancer surgery.

Answer 315

A

B. Wide surgical excision

Rationale: Wide surgical excision with clear margins is the primary treatment option for angiosarcoma, although it has a high recurrence rate. Other treatments such as radiation and chemotherapy may be used in a multidisciplinary approach, especially in metastatic disease.

Answer 316

A

C. Vascular endothelial cancer
Rationale: Angiosarcoma is an aggressive cancer arising from vascular endothelial cells.

Answer 317

A

C. Lymphedema-associated angiosarcoma (Stewart-Treves syndrome)
Rationale: Lymphedema-associated angiosarcoma, also known as Stewart-Treves syndrome, occurs on the ipsilateral extremity following axillary lymphadenectomy.

Answer 318

A

C. Head and neck variant
Rationale: The head and neck variant of angiosarcoma typically affects patients >40 years old, presenting as an ill-defined red patch on the face or scalp, often with satellite lesions.

Answer 319

A

D. Surgical excision with wide margins
Rationale: Surgical excision with wide margins is the treatment of choice for localized angiosarcoma, though it has a high recurrence rate.

Answer 320

A

B. Chemotherapy and radiation therapy
Rationale: For patients with widely metastatic angiosarcoma, chemotherapy and radiation are used for palliation, although they do not significantly prolong overall survival.

Answer 321

A

B. Radiation-induced angiosarcoma
Rationale: Radiation-induced angiosarcoma typically involves the lower extremities and has a poor prognosis due to its aggressive behavior.

Answer 322

A

A. Epithelioid angiosarcoma
Rationale: Epithelioid angiosarcoma typically affects the lower extremities and, like radiation-induced angiosarcoma, has a poor prognosis.

Answer 323

A

B. Amputation
Rationale: Amputation is sometimes considered for angiosarcoma affecting the extremities, especially in cases of extensive or recurrent disease.

Answer 324

A

C. Extramammary Paget’s disease

Rationale: Extramammary Paget’s disease typically presents as an erythematous or non-pigmented plaque with an eczema-like appearance, commonly found in the genital, axillary, or perianal regions.

Answer 325

A

C. Surgical resection

Rationale: The treatment of choice for extramammary Paget’s disease is surgical resection, with the goal of achieving negative microscopic margins to prevent recurrence.

Answer 326

A

B. Adenocarcinoma
Rationale: EMPD is a rare adenocarcinoma arising from apocrine glands.

Answer 327

A

B. Axillary, perianal, and genital regions
Rationale: EMPD commonly affects the axillary, perianal, and genital regions of both men and women.

Answer 328

A

B. Erythematous or non-pigmented plaques resembling eczema
Rationale: EMPD typically presents as erythematous or non-pigmented plaques with an eczema-like appearance

Answer 329

A

C. Surgical resection with negative microscopic margins
Rationale: The primary treatment for EMPD is surgical resection aimed at achieving negative microscopic margins.

Answer 330

A

B. Radiation therapy
Rationale: Radiation therapy is often used as adjuvant therapy for additional locoregional control in patients with EMPD.

Answer 331

A

B. Eczema-like plaques and a high incidence of concomitant malignancies
Rationale: EMPD presents with eczema-like plaques and has a high incidence of concomitant malignancies, particularly gastrointestinal and genitourinary cancers.

Answer 332

A

B. Reducing recurrence through negative microscopic margins
Rationale: The primary goal of surgical treatment for EMPD is to ensure negative microscopic margins to reduce the risk of recurrence.

Answer 333

A

C. Previous gastrointestinal or genitourinary malignancies
Rationale: Previous gastrointestinal or genitourinary malignancies are significant risk factors for developing EMPD, given the association with concomitant malignancies.

Answer 334

A

C. Chemotherapy
Rationale: Chemotherapy is not typically a primary treatment for EMPD, whereas surgical resection and radiation therapy are commonly used to manage the disease.

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