A
A patient presents with a rash, characterized by red macules and edematous papules with a clearing center. This best describes which of the following?
A. erythema marginatum
B. erythema multiforme
C. varicella
D. impetigo
B. Target lesions, also termed iris lesions, are characteristic of erythema multiforme. The rash may be recurrent but typically resolves over 3-6 weeks.
Which of the following is characterized by epidermal hyperplasia and an increase in the epidermal turnover?
A. Atopic dermatitis
B. Tinea corporis
C. Ecthyma
D. Psoriasis
D. Psoriasis is characterized by an increased epidermal cell turnover, increased numbers of epidermal stem cells, and an abnormal differentiation of keratin . This leads to the classic scale associated with psoriasis.
In which of the following patients would one most likely find acanthosis nigricans?
A. A 55 year-old obese female with hyperinsulinemia
B. A 55 year-old male with an enlarged spleen and pancytopenia
C. A 24 year-old female with increased Lyme titers
D. A 60 year-old male with increased triglycerides
A. Acanthosis nigricans is associated with patients who have hyperinsulinemia.
As a general rule, sutures in the face should be removed in
A. 3 days.
B. 5 days.
C. 7 days.
D. 10 days.
B. Sutures of the face should be removed in 5 days in order to allow for adequate healing and to limit the amount of scarring.
Which of the following is considered a risk factor for the development of malignant melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
D. brown-haired individuals
B. Inability to tan and propensity to burn are risk factors for developing malignant melanoma.
According to the Advisory Committee on Immunization Practices, which of the following is the recommended age range for the first or initial MMR (measles, mumps and rubella) vaccination?
A. 2-4 months
B. 12-15 months
C. 4-6 years
D. 11-12 year
B. The recommended age range for the initial vaccination against MMR is 12-15 months.
A 35 year-old female who recently returned from a backpacking trip complains of fatigue, malaise, fever, chills, and arthralgias. Physical examination reveals a 6 cm annular lesion with a red border and a clear center on her mid-back. Which of the following laboratory tests would support your diagnosis?
A. KOH prep of skin scrapings B. Blood cultures
C. RAST testing
D. Serologic antibody testing
D. Most people with Lyme Disease will have a positive serologic test after the first few weeks of infection and this would support the diagnosis.
Which of the following mediators is responsible for initiating the urticaria response?
A. Cyclic AMP
B. Prostaglandins
C. Prednisone
D. IgE
D. IgE triggers the release of histamine from mast cells that leads to urticaria.
In a patient suspected of having seborrheic dermatitis, the most common site of involvement would be the
A. upper extremities.
B. thighs.
C. scalp.
D. feet.
C. The most common site of involvement of seborrheic dermatitis is the scalp. Other common sites include the eyebrows, eyelids, nasolabial fold, and ears.
A patient presents with loss of pigmentation on the back of hands, face, and body folds due to the absence of epidermal melanocytes. There has been improvement with PUVA treatment. Which of the following is the most likely diagnosis?
A. Pityriasis alba
B. Tinea versicolor
C. Vitiligo
D. Melasma
C. Vitiligo is the acquired loss of pigmentation due to the absence of epidermal melanocytes presenting on the back of hands, face, or body folds.
A person with atopic dermatitis should be advised to
A. avoid cutaneous irritants.
B. take hot water baths or showers.
C. use a high potency glucocorticoid on skin after bathing.
D. begin a prophylactic antibiotic.
A. Avoidance of cutaneous irritants, such as wool and other rough clothing, is the cornerstone of therapy for atopic dermatitis.
A mother brings in her 2 year-old child stating that the child has had a 3-day history of a nonproductive cough, thick copious rhinorrhea, conjunctivitis, and a fever to 103 degrees. Physical examination reveals a well-hydrated child, with numerous 1-2 mm white papules on both buccal mucosa, normal heart and breath sounds. This presentation is most consistent with early
A. rubeola.
B. rubella.
C. varicella.
D. streptococcal pharyngitis
A. Rubeola (measles) is characterized by cough, coryza, and conjunctivitis, along with a fever as a prodrome. Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash and are pathognomonic for rubeola.
A mother brings a 3 month-old infant to the office because she is concerned about a red, vascular, nodular growth on the child's back. It appears to be enlarging slightly and the vessels are slightly dilated. It seems to cause the child no discomfort. The most likely diagnosis is
A. a hemangioma.
B. a pigmented nevus.
C. a salmon patch (stork bite).
D. a malignant melanoma.
A. A hemangioma is a bright red to deep purple vascular nodule or plaque that often develops at birth, may enlarge, and may regress and disappear with aging.
Pharmacologic treatment of a cat bite in the person with no allergies consists of which of the following?
A. Trimethoprim-sulfamethoxazole (Bactrim)
B. Cephalexin (Keflex)
C. Ceftriaxone (Rocephin)
D. Amoxicillin-clavulanate (Augmentin)
D. Amoxicillin-clavulanate (Augmentin) has activity against Pasteurella multocida which is the causative agent in the majority of cat bite infections.
Which of the following interventions is the treatment of choice for actinic keratosis?
A. Mohs surgery
B. Cryotherapy
C. Acid peels
D. Radiation therapy
B. Cryotherapy is the treatment of choice for isolated superficial actinic keratosis.
A 26 year-old male complains of intense itching, especially at night and after hot showers, for the past 4 days. On physical examination he has a few red papules and areas of excoriation on his volar wrists, between his fingers, and around his waist. Proper diagnosis should include which of the following tests?
A. KOH prep
B. Gram stain
C. Skin scraping microscopy
D. Tzanck prep
C. The history and exam is consistent with a scabies infection. Scrapings from the burrows should be examined for the presence of mites, eggs, and feces.
Erythema nodosum is characterized by
A. subcutaneous red tender nodules.
B. brown pigmentation on the lower extremities.
C. tender lymph nodes in the groin.
D. scaling red macules.
A. Erythema nodosum produces erythematous red tender nodules, especially on the shins.
An elderly woman presents to your clinic complaining of unilateral facial pain and painful lesions. She also complains of blurred vision in the ipsilateral eye. On examination she has several vesicles on an erythematous base, some of the lesions with crusts. They are distributed in a dermatomal pattern and involve the skin overlying the maxillary region and the tip of her nose. Which of the following is the next most appropriate intervention in the care of this patient?
A. KOH prep
B. Culture for bacteria
C. Referral to an ophthalmologist
D. Application of corticosteroids
C. Immediate referral to an ophthalmologist is needed when herpes keratitis is suspected, as in this case. A fluorescein stain of the eye might reveal the typical dendritic corneal lesion.
A 65 year-old male presents with multiple lesions on his back. He denies any pruritis. Physical examination reveals the presence of multiple scattered brown plaques with a raised, warty surface that appear to be stuck onto the skin and feel greasy. Which of the following is the most likely diagnosis?
A. lentigines
B. actinic keratosis
C. keratoacanthomas
D. seborrheic keratosis
D. Seborrheic keratosis is a common benign plaque in the elderly that characteristically has a velvety or warty surface associated with a stuck on appearance and greasy feel.
A positive Wood's light examination (fluorescence) demonstrates
A. viral infection with herpes zoster.
B. bacterial infection with Treponema pallidum.
C. parasitic infestation with Pediculus humanus.
D. mycotic infection with Microsporum canis.
D. Microsporum causes tinea capitis and fluoresces blue-green under Wood's light.
A 28 year-old female with diabetes mellitus type 2 sustains a partial thickness burn to her left upper arm and her chest when hot grease spilled on her at home. The burn to her arm is circumferential and the estimated total body surface burned is 18%. She has no allergies. The most appropriate treatment of this patient would include
A. outpatient application of silver sulfadiazine.
B. debridement of all intact blisters.
C. IV cefazolin (Ancef, Kefzol).
D. transfer to a burn center.
D. Reasons for transfer to a burn center include a partial thickness burn covering greater than 10% of total body surface area. In addition, burns in patients with pre-existing medical conditions, such as diabetes, that could complicate their management, prolong recovery, or affect their outcome, is also a reason for transfer to a burn center.
A 45 year-old female presents to the emergency department with generalized, hot, erythema of the skin. Physical exam reveals an oral temperature of 102 degrees Fahrenheit, purulent conjunctivitis, and mucosal erosions. Her skin is painful and separates from the dermis with touch. Which of the following is the most likely cause for this condition?
A. Ampicillin
B. Prednisolone
C. Aspirin
D. Hydrochlorothiazide (HCTZ)
A. Medications are most frequently implicated in toxic epidermal necrolysis. These usually include, analgesics (NSAIDs), antibiotics (Ampicillin) and anticonvulsants (Carbamazepine).
A 34 year-old female presents with complaints of a skin rash associated with a low-grade fever, malaise and anorexia. She denies any pruritis. Physical examination reveals the presence of a diffuse maculopapular rash involving the palms and soles associated with generalized lymphadenopathy. Which of the following will confirm the suspected diagnosis?
A. VDRL
B. patch testing
C. acetowhitening
D. Gram stain and culture
A. This patient most likely has secondary syphilis. Serological tests, like the VDRL, are usually positive during this stage with high titers.
A 56 year-old, right hand dominant, carpenter presents to your clinic complaining of a prolonged bruise under his left thumbnail. He states that he first noticed it one year ago. Physical examination reveals a nontender left thumb with a 6 mm macular lesion located under the distal nail bed. It is mixed dark brown and black in color, with irregular borders. The most likely diagnosis is
A. lentigo.
B. trauma.
C. melanoma.
D. nevus.
C. Acral lentiginous melanoma may occur on the palm, sole, nail bed, or mucus membrane. This lesion is suspicious for a melanoma due to its irregular borders, being variegated in color, and its size. A biopsy is required and will insure the diagnosis.
What scabicide has been associated with neurotoxicity in infants and young children?
A. lindane (Kwell)
B. crotamiton (Eurax)
C. 10% sulfur ointment
D. permethrin (Elimite)
A. Lindane (Kwell) is concentrated in the CNS and toxicity from systemic absorption in infants has been reported.