MSKD Jeopardy

Dermatology Microbiology

100

A patient comes in with a painful ulcerated lesion on her lip. She has had similar lesions before, often around times of stress. What is the most likely causative agent of her lesion?

• A. HSV 1
• B. HSV 2
• C. EBV
• D. Rubeola

Answer A. cold sores are caused by HSV 1

200

• A 62-year-old woman is being evaluated for a painful red blistering rash on her left lower abdomen and wrapping around to her left lower back. The patient has recently started methotrexate and prednisone for her worsening SLE. The patients history reveals she has not had any immunizations in her lifetime. What is the most likely diagnosis?
• A. Bullous Pemphigoid
• B. Pemphigus Vulgaris
• C. Psoriasis
• D. Shingles

Ans. D this patient most likely has shingles, given the presentation of multiple vesicles on an erythematous base and considering the use of prednisone, an immunosuppressant. The cause of shingles is the varicella-zoster virus, also known as the human herpesvirus type 3

300

• A 14-year-old boy comes in with complaints about bumps on his face. He has not recently been sick. Physical exam reveals many hypopigmented, flat-topped papules. His face appears as shown. Which of the following pathogens is the cause of this patient’s most likely diagnosis?
• A. Coxsackievirus A
• B. Herpes simplex virus type 1
• C. Human papillomavirus
• D. Molluscum contagiosum virus

Answer: C these are flat warts, or verruca plana often found in children and young adults

400

• A 12-year-old wrestler is brought in by his parents due to a new rash on his arms. Physical exam reveals small, round, flesh-colored, umbilicated papules with no surrounding erythema. The patient says they are not painful and do not itch. Which best describes the most likely causative virus?
• A. Enveloped double stranded DNA
• B. Naked single stranded DNA
• C. Enveloped single stranded RNA
• D. Naked positive sense RNA

• Ans.  A. Molluscum contagiosum is a member of the poxvirus family. The poxvirus are all enveloped double stranded DNA

500

• A 60-year-old man comes to the physician because of a large, itchy, red plaque on his lower back that has been present for the past year and has not been relieved by topical antihistamines and antifungals. A biopsy reveals atypical cells at the dermal-epidermal junction with small collections in the epidermis. The abnormal cells most likely developed from what cells?
• A. T cells
• B. Macrophages
• C. Melanocytes
• D. B cells

Ans. A This patient is exhibiting signs of mycosis fungoides, including a large, chronic, pruritic plaque with lymphocytic invasion of the skin. Mycosis fungoides is a type of cutaneous T-cell lymphoma.

Dermatology Clinical

100

• A 42 year old man comes to the physician because of a 8-month history of a slowly enlarging lump on his back. On physical examination, there is a painless, soft, and mobile subcutaneous nodule measuring 3 × 3 cm on his back. The overlying skin appears normal. What is the most likely diagnosis?
• A. Dermatofibroma
• B. Abscess
• C. Lipoma
• D. Fibroma

Ans. C    lipoma, a benign soft tissue tumor, given her findings of a nontender, soft, mobile, skin-colored nodule.

200

• A 6 month old girl is brought into the physician for skin evaluation. She appears to have a complete lack of skin pigmentation with light colored irises. A diagnosis of albinism is made. Which best describes the process behind this disease?
•  A. Decreased number of melanocytes from autoimmune destruction
• B. Normal melanocyte number with decreased melanin production
• C. Increased breakdown and clearance of melanin
• D. Complete absence of melanocytes due to gene mutation

Answer B    Albinism has normal melanocyte number with decreased melanin production due to decreased tyrosinase activity or defective tyrosine transportation. Increased skin cancer risk.

300

• A 25 year old woman comes to the physician with complaints of skin changes. She has several large patches of hypopigmentation. A diagnosis of vitiligo is made. What best describes the embryological origin of the affected cells?
• A. Neural Crest
• B. Mesoderm
• C. Surface Ectoderm
• D. Endoderm

Answer A. Melanocytes originate from neural crest cells

400

• A man from Hawaii comes in about concerns about a lesion on his shoulder. The lesion is flesh colored, shiny, and has visible branching blood vessels. A biopsy shows hyperchromatic cells arranged in islands surrounded by mucinous stroma. What is the most likely diagnosis?
• A. Basal Cell Carcinoma
• B. Squamous Cell Carcinoma
• C. Melanoma
• D. Actinic Keratosis

Answer A 

• BCC manifests as pink or flesh-colored pearly papules on sun-exposed skin with arborizing telangiectasias.
• Typical histologic features of BCCs include islands of basaloid cells in a mucinous stroma with areas of peripheral palisading nuclei and hyperchromatic cells with little cytoplasm.

500

• A woman is started on a course of Vancomycin for a methicillin-resistant S aureus infection. The attending physician makes sure to have a slow infusion of the drug along with additional medication. What is the physician trying to prevent?
• A. Rapid consumption of clotting factors and purpura
• B. Antibody sensitization to the dermal epidermal junction
• C. Dilation of blood vessels due to histamine release
• D. Swelling and necrosis at the IV site

• Answer. C Vancomycin can cause red man syndrome. This can be prevented by slow infusion of the drug and pretreatment with antihistamines.

MSK Physio/Biochem

100

During a marathon, a 28-year-old woman initially has pain and distress but suddenly feels exhilaration about halway through the race. The best explanation is most likely to be increased release of what?

A. Beta-endorphin

B. ACTH

C. Epinephrine

D. Glucagon

A. Beta-endorphin

200

A 57 year-old-woman experiences a hip fracture. She gets hip replacement surgery and during the first 6 weeks bone ingrowth anneals making a bone metal interface. Type 1 collagen secretion in the first stage of matrix formation is mediated by which of the following cell types?

A. Chondroblasts

B. Chondrocytes

C. Osteocytes

D. Osteoblasts

D. Osteoblasts

300

A 30-year-old woman is brought to the emergency department because of pain in her upper arm after falling off a horse. X-ray shows a closed simple fracture of the humerus. Serum studies 3 weeks later are most likely to show an increased concentration of what?

A. Alkaline phosphatase

B. Calcium

C. Creatine kinase

D. Phosphorus

A. Alkaline phosphatase

400

A child born without limbs, is found to have a mutation in a receptor for a fibroblast growth factor. The absence of limbs most likely resulted from a disruption of the processes, controlling which of the following?

A. Apoptosis.

B. Differentiation.

C. Epithelial, mesenchymal conversions.

D. Proliferation.

D. Proliferation

500

A 45 year old woman says that her feet feel hot. The skin of her feet is pink, dry, and hot. Which of the following fibers are most likely to be disrupted? 

A. Autonomic afferent

B. Postganglionic sympathetic

C. Preganglionic parasympathetic

D. Somatic cutaneous afferent 

B. Postganglionic Sympathetic

MSK Clinical

100

Acting bilaterally, the external oblique muscles produce which movement of the vertebral column?

A. Extension.

B. Flexion.

C. Lateral flexion.

D. Rotation. 

B. Flexion

200

A previously healthy, 2-year-old boy has a 1x2 cm mass at the midline of the neck immediately above the larynx. The mass is non-tender and moves when he swallows. The mass is most likely to be

A. A branchial cleft cyst. 

B. Lymphadenopathy. 

C. A submental abscess. 

D. A thyroglossal duct cyst. 

E. The thyroid gland. 

D. Thyroglossal duct cyst

300

And examiner strokes a wisp of cotton across the patient’s left cornea. There is no response. The examiner then strokes the cotton across the patient’s right eye; both eyes blink. The most likely explanation of these findings is damage to which of the following cranial nerves on the left?

A. Optic. 

B. Oculomotor. 

C. Trigeminal. 

D. Abducens. 

E. Facial. 

C. Trigeminal

400

A 61-year-old woman has a 10 year history of progressive pain in the hip, knees, and hands. She has symmetric swelling in formation of nodules in the distal enter phalangeal joints of her hands and pain on movement of both knees. There is no increased warmth or tenderness. The most likely cause of her joint pain is

A. Gout.

B. Lyme disease.

C. Osteoarthritis.

D. Sudo gout.

E. Rheumatoid arthritis

C. Osteoarthritis

500

A 17-year-old boy is brought to the clinic because of shooting pain in his right hand following a snowboarding accident in which he directly struck a tree with his arms raised. On physical examination, the right fingers are held in flexion at the proximal and distal interphalangeal joints. The patient also has decreased sensation over the medial aspect of his right palm, weakness of the hypothenar eminence, and inability to maintain finger abduction against resistance. What part of the brachial plexus is damaged?

A. Lateral Cord

B. Middle Trunk

C. Lower Trunk

D. Upper Trunk

C. Lower Trunk 

This patient most likely has an injury to the lower trunk of his right brachial plexus. A lower trunk injury (Klumpke palsy) may present with hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints (“claw hand”)