Dermatology PANCE Questions
In a patient with dyshidrotic eczema on which area of the body would associated vesicles be found? A Axillae B Intertriginous areas C Palms D Upper back
C Vesicles associated with dyshidrotic eczema are most commonly found on the palms with the dorsum of the hands spared. The soles may also be affected in a similar fashion.
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.
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.
A patient is concerned about being exposed to condyloma acuminata. Which of the following tests is most appropriate to perform in order to better identify these lesions? A Acetowhitening B Tzanck smea C Potassium hydroxide test D Wood's light fluoroscopy
A Acetowhitening is used to facilitate the diagnosis of condyloma acuminata lesions. A 3 to 5% acetic acid solution is applied to these suspected genital warts for five to ten minutes. Condyloma lesions will whiten and appear as circumscribed macular or papular lesions with a granular surface.
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.
Which of the following is the most common type of skin cancer? A basal cell B melanoma C atypical nevi D squamous cell
A Basal cell cancer is the most common cause of skin cancer usually occurring on sun-exposed areas.
A female patient presents with a few common warts on her hands. She has tried over-the-counter preparations with little success and desires something that might work quicker, but has the least chance of scarring. Which of the following is the most appropriate intervention to accomplish this goal? A cryosurgery B dermabrasion C electrosurgery D topical acyclovir
A Cryosurgery with liquid nitrogen is effective treatment for common warts and has less of a chance of scarring than electrosurgery.
Which of the following skin rashes is pathognomonic of rheumatic fever? A erythema marginatum B erythema nodosum C diffuse petechiae D purulent bullae
A Erythema marginatum is one of the major Jones criteria for the diagnosis of acute rheumatic fever
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.
A 4-year-old presents with impetigo associated with the knee. No other areas are involved. The most appropriate treatment is A Topical mupirocin B Topical bacitracin C Topical neomycin D Topical polymyxin B E Oral cefalexin
A Impetigo is a contagious superficial skin infection most commonly seen in children, with a peak incidence between the ages of 2 and 6 years. The condition is the most common skin infection affecting children. Causative agents include group A beta-hemolytic streptococci (GABHS) and Staphylococcus aureus. Complications such as cellulitis, lymphangitis, and septicemia are rare and result from spread of the infection. The infection is transmitted via direct contact with the lesion. Antibiotic administration is the mainstay of therapy. If the area of affected skin is limited, mupirocin is an effective topical therapy and has been shown to be more effective than the other topical antibiotics (i.e., neomycin, bacitracin, polymyxin B, and gentamicin). There is insufficient evidence to determine whether oral antibiotics are better than topical agents in patients with more extensive disease, although there are obvious practical reasons to choose oral agents if large amounts of skin are involved. Antibiotic categories to consider include penicillins, cephalosporins, and macrolides. Oral antibiotics have significantly more side effects, especially GI effects, than topical agents.
Which of the following is the more appropriate choice for outpatient treatment of cellulitis in which CA-MRSA is not suspected? A Cephalexin B Linezolid C Doxycycline D Terbinafine
A In cases of cellulitis without draining wounds or abscess, streptococci continue to be the likely etiology, and beta-lactam antibiotics are appropriate therapy, as noted in the following: In mild cases of cellulitis treated on an outpatient basis, dicloxacillin, amoxicillin, and cephalexin are all reasonable choices; Clindamycin or a macrolide (clarithromycin or azithromycin) are reasonable alternatives in patients who are allergic to penicillin; Levofloxacin may also represent an alternative, but the prevalence of resistant strains has increased, and fluoroquinolones are best reserved for gram-negative organisms with sensitivity demonstrated by culture; and Some clinicians prefer an initial dose of parenteral antibiotic with a long half-life (eg, ceftriaxone followed by an oral agent).
A 26 year-old female comes to the office for evaluation of a painful lump on her right buttock for the past week. Initially, it was a firm, tender nodule that has increased in size and tenderness in the past two days. On physical examination of the right buttock, there is a 3-cm fluctuant tender red nodule. Which of the following is the most appropriate initial intervention? A Incision and drainage B Mupirocin ointment C Systemic antibiotics D Moist compresses
A Incision and drainage is the mainstay of therapy for abscesses
A 58 year-old female comes to the office because she noticed a white spot on her tongue. She has a 42 pack/year smoking history. On examination, she has an 8 mm white thickened, keratinized lesion on the ventral tongue. The lesion cannot be removed by rubbing the mucosal surface. Which of the following studies is most appropriate to confirm the suspected diagnosis? A Incisional biopsy B Tzanck smear C Gram stain D Potassium hydroxide wet prep
A Leukoplakia is characterized as a white plaque that cannot be removed by wiping the mucosal surface. Tobacco use is strongly associated with an increased incidence of leukoplakia and oral cancer. An incisional biopsy of the lesion is required for histologic evaluation of the tissue.
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.
A 16 year-old female comes to the office because her acne has become more severe and she would like to discuss treatment. She was originally prescribed topical clindamycin gel 1 year ago to treat open and closed comedones on her face. Despite regular use of the medication, she now has several comedones and papulopustules across her nose, cheeks, chin and forehead. Which of the following would be an appropriate additional treatment for moderate acne? A Intralesional steroids B Oral doxycycline C Benzoyl peroxide gel D Metronidazole cream
B For moderate acne, oral antibiotics are added to the topical medications treatment regimen.
Erythema infectiosum (fifth disease) is caused by A Parvovirus B Adenovirus C Rhinovirus D Paramyxovirus E Herpes virus
A Parvovirus B19 is the causative agent responsible for erythema infectiosum, or fifth disease. The incubation period is 6 to 14 days. Outbreaks frequently occur at day schools, elementary schools, or junior high schools, and they frequently occur in the spring. Symptoms include a distinctive facial rash that has a "slapped-cheek" appearance, fever, arthralgias, and fatigue. Within 2 days, the facial rash gives rise to a generalized lacelike macular rash that involves the trunk. It has become increasingly clear over the past several years that parvovirus B19 causes arthritis and arthralgias in adults and children. Although parvovirus infections in adults are most commonly asymptomatic, an estimated 50% to 60% of women with symptomatic disease manifest arthropathy. Men appear to be affected much less frequently. Blood cell counts during the illness show leukopenia, lymphopenia, and thrombocytopenia with decreased reticulocytes. Because parvovirus B19 infects erythroid progenitor cells in the bone marrow and causes temporary cessation of RBC production, patients who have underlying hematologic abnormalities (and thus depend on a high rate of erythropoiesis) are prone to cessation of RBC production if they become infected. This can result in a transient aplastic crisis, which may occur in persons with chronic hemolytic anemia and conditions of bone marrow stress. Thus, patients with sickle cell anemia, thalassemia, acute hemorrhage, and iron-deficiency anemia are at risk. The diagnosis of erythema infectiosum is made clinically, and laboratory studies are not needed under normal circumstances. Serologic tests are usually relied on for the diagnosis of parvovirus B19 infection in patients with transient aplastic crisis or arthropathy; a positive parvovirus B19- specific IgM antibody or a significant rise in parvovirus B19- specific IgG titer is indicative of an acute or recent infection. Exposure during pregnancy can lead to fetal hydrops, spontaneous abortion, and fetal death. Supportive care during an attack of fifth disease is usually adequate, and the illness is self-limited. The risk of respiratory transmission is decreased significantly when the rash starts to fade. Children with erythema infectiosum are not infectious and can attend school and day care.
Which of the following types of infection is most likely to benefit from hyperbaric oxygen therapy? A Clostridial infection B Group A beta hemolytic streptococcus C Serratia marcescens D Methicillin resistant Staphylococcus aureus
A Patients with clostridium myonecrosis (gas gangrene) will benefit from hyperbaric oxygen therapy, penicillin therapy, and radical surgical excision.
A patient presents with 3 weeks of worsening pruritic rash located on the upper extremities and interdigital spaces. He is a migrant farm worker with no history of skin disorders. Examination reveals excoriated, erythematous papules with numerous 3-4 mm long, narrow tracts spreading from the papules. What is the best treatment for this patient? A Permethrin (Nix) B Prednisone (Deltasone) C Montelukast (Singulair) D Pimecrolimus (Elidel)
A Permethrin is used to kill the scabies mite.
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 Question 16 Explanation: Medications are most frequently implicated in toxic epidermal necrolysis. These usually include, analgesics (NSAIDs), antibiotics (Ampicillin) and anticonvulsants (Carbamazepine).
A 9 year-old boy comes to the office with his mother to discuss treatment for chronic dry skin, and pruritic inflammatory lesions of the flexor surfaces of the neck, hands and wrists. Past medical history is significant for allergic rhinitis in the spring and fall. On physical examination the skin lesions are excoriated, and lichenified with crusted patches. Which of the following prevention strategies can help minimize the symptoms in this patient? A Avoid rubbing or scratching B Limit sun exposure C Take hot baths D Consume hot liquids
A Rubbing or scratching plaques can exacerbate the pruritis and lichenification in 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 66 year-old woman with type 2 diabetes comes to the office because she has had a painful red patch that has been spreading on her right lower leg over the past 3 days. Her temperature is 100.4 degrees F. Physical examination of her right lower leg reveals a 3 cm tender, warm, erythematous, and edematous plaque. Which of the following pathogens is most likely causing this patient's symptoms? A Staphylococcus aureus B Haemophilus influenzae C Proteus mirabilis D Escherchia coli
A S. aureus and group A beta-hemolytic streptococci are the most common causes of cellulitis.
A patient presents with profound itching. Examination reveals short, reddish lesions on the wrists, elbows, and finger webs. Papules are also noted in these areas. There appears to be burrow marks emanating proximal to the finger webs. Which of the following is the most likely diagnosis? A Scabies B Body lice C Rocky Mountain Spotted Fever D Lyme Disease
A Scabies is an infestation of a mite that is usually spread by skin to skin contact. Patients present with intractable pruritus, often with minimal cutaneous findings. There may be an associated inflammatory papule or nodule along with a burrow that is sometimes seen early in the course of the infestation.
A 28 year-old male presents with burns sustained from hot grease splashed on his left hand earlier this afternoon. The burn extends from his palm to the volar aspect of his wrist and has an erythematous base, covered by an intact blister. There are a few small scattered blisters over the dorsum of the left hand. Which of the following is the initial intervention of choice? A Tetanus prophylaxis B Admission to a burn unit C Intravenous fluid administration D Debridement of blisters
A Tetanus prophylaxis should be initially considered in all burn patients.
A 37 year-old right-handed landscaper comes to the office for evaluation of recurrent itching and stinging of the skin on his right hand. Physical examination reveals confluent papules, vesicles, erosions and crusts on the dorsum of his right hand. Which of the following is the most appropriate initial diagnostic study in this patient? A Skin scraping and microscopy B Patch testing C RAST testing D Skin biopsy
B In patch testing, substances are applied to the skin in shallow cups and left in place for 24-48 hours.
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.
A 4-year-old boy is brought to your office by his mother. The child has evidence of a stomatitis and a vesicular rash that affects his hands and feet. The most likely cause is A Coxsackievirus B Adenovirus C Syphilis D Varicella E Measles
A The coxsackievirus is responsible for several infections that usually affect the pediatric population. There are two types of the virus: Coxsackievirus A A16 is responsible for hand, foot, and mouth disease, which is characterized by stomatitis and a vesicular rash that affects the hands and feet. It is usually mild, affects young children, and may occur in epidemics. A2, A4, A5, A6, A7, and A10 are responsible for herpangina, which is a more severe febrile illness that sometimes leads to febrile seizures. Other symptoms include a severe sore throat; vesiculoulcerative lesions that affect the tonsils, soft palate, and posterior pharynx; headaches; myalgias; and vomiting. Coxsackievirus B B1, B2, B3, B4, and B5 are responsible for pleurodynia with pain associated with the area of diaphragmatic attachment. Other symptoms include fever, headache, sore throat, malaise, and vomiting. Orchitis and pleurisy may also occur. Coxsackievirus B infection is rare in persons older than 60 years and is more common in children and young adults. The infection is transmitted by hand-to-mouth contact and may become widespread in certain populations. This virus has been called "the great pretender" because of the variety of clinical syndromes it can produce. Many infections that are caused by the virus are subclinical. More serious conditions caused by coxsackievirus B include myocarditis, orchitis, myalgia, and pleurodynia. Pleurodynia may be severe and can occur in epidemics referred to as Bornholm disease, named after the original description of an early epidemic on the Danish island of Bornholm. Patients with pleurodynia are usually children or young adults who present with severe pleuritic pain, tachypnea, and systemic upset. The condition is usually self-limiting, but there can be serious, though rare, long-term
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.
Which of the following is the only disease that forms an ulcer at the site of inoculation? A Tularemia B Scabies C Lyme disease D Rocky Mountain Spotted Fever
A Tularemia is an acute infection that is transmitted by handling the flesh of infected animals, by the bites of insect vectors and by inoculation of conjunctiva.
Zostavax (varicella-zoster vaccine) is contraindicated in which of the following groups of patients? A Chemotherapy patients B Adults over 60 years of age C Patients allergic to eggs D Patients who have recovered from shingles
A Zostavax is a live attenuated vaccine and is contraindicated in patients with immunodeficiency states, malignancy affecting the bone marrow, pregnant women, and patients taking immunosuppressive medications.
Which of the following malignancies is associated with the skin condition shown here (acanthosis nigricans)? A Ovarian carcinoma B Gastric carcinoma C Malignant melanoma D Multiple myeloma E Hodgkin's lymphoma
B Acanthosis nigricans is associated with hyperpigmented areas that typically affect flexural folds (axilla). The two basic types of acanthosis nigricans are benign and malignant. The benign form is associated with obesity, diabetes, Stein- Leventhal syndrome, Cushing's disease, Addison's disease, pituitary disorders, and hyperandrogenic syndromes. Drugs, including glucocorticoids, nicotinic acid, diethylstilbestrol, and growth hormone therapy, have also caused acanthosis nigricans. Many cases are idiopathic. Malignant acanthosis nigricans is associated with an intestinal cancer such as gastric carcinoma.Acanthosis nigricans is associated with hyperpigmented areas that typically affect flexural folds (axilla). The two basic types of acanthosis nigricans are benign and malignant. The benign form is associated with obesity, diabetes, Stein- Leventhal syndrome, Cushing's disease, Addison's disease, pituitary disorders, and hyperandrogenic syndromes. Drugs, including glucocorticoids, nicotinic acid, diethylstilbestrol, and growth hormone therapy, have also caused acanthosis nigricans. Many cases are idiopathic. Malignant acanthosis nigricans is associated with an intestinal cancer such as gastric carcinoma.
The bite from which of the following is associated with fever, lacrimation, rhinorrhea, bradycardia, hypertension, and tachyarrhythmias? A Brown recluse spider B Black widow spider C Black flies D Bedbugs
B Black widow spider bites can inject venom that contains a neurotoxin which can produce reactions at the site of the bite along with varying degrees of systemic symptoms.
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.
Which of the following statements about measles immunizations is true? A Allergies to eggs or neomycin are not contraindications to the measles vaccine B Those who received killed virus immunization between 1963 and 1967 should receive a live attenuated booster vaccination C Infants receiving vaccination before 15 months of age do not need booster vaccinations D The present immunization is a genetically derived recombinant vaccine E Those born before 1956 should receive a measles booster vaccination
B Measles immunization is accomplished with a live attenuated virus given at 12 to 15 months of age in the MMR vaccine and then as a booster with the preschool physical at 4 to 6 years of age. Those vaccinated with the killed virus (available in the United States from 1963 to 1967) should be given the live attenuated vaccine, because ineffectiveness is associated with the killed virus given during that period. Those born before 1956 are, in most cases, immune as a result of natural infection and therefore require no additional vaccination. Also, infants vaccinated before 12 months of age should receive two additional boosters. Prior anaphylactic reactions to eggs or neomycin are relative contraindications to the administration of the measles vaccine. A pediatric allergist or immunologist should be consulted before administration.
A 42-year-old Native American woman presents to your office complaining of dark spots on her face. Her medical history is unremarkable except for two previous uncomplicated pregnancies. She is now taking oral contraceptives. The most likely diagnosis is A Solar lentigo B Melasma C Sunburn D Lupus erythematosus E Scleroderma
B Melasma, also referred to as chloasma, is described as the "mask of pregnancy." The condition typically affects women with dark complexions and appears as hyperpigmentation of the skin, usually associated with the face. It is caused by long-term sun exposure, pregnancy, and oral contraceptives. In many cases, the condition is idiopathic. Diagnosis is made clinically. Treatment involves the use of bleaching creams, hydroquinone, and chemical peels for more resistant cases. In some instances, the condition disappears after pregnancy or the discontinuation of oral contraceptives.
What is the most common examination finding in a patient diagnosed with mumps? A Occipital lymph node swelling B Parotid gland tenderness C Splenic enlargement D Testicular tenderness
B Parotid gland tenderness and swelling are the hallmark findings of mumps.
A 13 year-old child presents with a lesion on his right forearm that is occasionally pruritic. On examination, a 2 cm ring of erythema with a scaly border and central clearing is noted. A suspected diagnosis is confirmed by the presence of A a positive patch test. B hyphae on a KOH prep. C gram-positive cocci on Gram stain. D multinucleated cells on Tzanck smear
B Ring-shaped lesions with scaly borders and central clearing are most likely caused by fungal infection. Microscopic examination of scrapings reveals hyphae on KOH prep.
A 43 year-old woman presents with episodes of facial flushing with increased skin temperature followed by the development of tiny papules and pustules primarily on her cheeks and chin. These symptoms worsen when she eats spicy foods. On examination, telangiectasia are noted along the nasal folds and tiny pustules on both cheeks. Which of the following is the most likely diagnosis? A Atopic dermatitis B Rosacea C Lupus D Acnevulgaris
B Rosacea is chronic, episodic flushing of the face followed by the development of tiny papules and pustules. Eating spicy foods or drinking hot liquids or alcohol can cause exacerbation of the symptoms.
As a general rule, sutures in the face should be removed in A 2 days B 5 days C 7 days D 10 days
B Sutures of the face should be removed in 3-5 days in order to allow for adequate healing and to limit the amount of scarring.
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.
A 72 year-old farmer comes to the office for evaluation of a pearly ulcerated papule on his right nostril. The papule has been bleeding off and on for the past couple weeks. Which of the following findings would be most concerning on the physical examination of this patient? A Cherry angioma B T elangiectasia C Spider angioma D Pyogenic granuloma
B Telangiectatic vessels are often visible skin findings with basal cell carcinoma.
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 patient is first seen with burns to the entire right arm, the anterior right leg, and genitals. The estimated burn surface area would be calculated as: A 15% B 19% C 23% D 27% E 37%
B The total burn surface area would be calculated as 19%: 9% for the entire right arm; 9% for the anterior right leg (half of 18%); and 1% for the genitalia. The Rules of Nines (first degree not included in calculation) is used to determine the extent of injury: head and neck, 9%; arm (each), 9%; trunk (anterior), 18%; trunk (posterior), 18%; leg (each), 18%; and genitalia, 1%.
A 60 year-old male presents with a slowly developing facial lesion first noticed 4-5 months ago. He describes it as non-painful and non-pruritic but notes it to be extremely scaly. He denies a history of similar lesions or dermatologic disease. Examination reveals a one centimeter, firm nodule at the right temple with heavy keratinization. There is no fluctuance or skin discoloration. Which of the following is the most likely diagnosis? A Actinic keratosis B Squamous cell cancer C Granuloma annulare D Merkel cell carcinoma
B This is a very typical scenario for a squamous cell cancer occurring in a sun exposed area, with slow development and heavy keratinization.
A 26 year-old presents with two days of a generalized, non-pruritic rash with concurrent low grade fever and sore throat. He is otherwise in good health with no history of dermatologic problems other than acne and a non-painful ulceration at the base of his penis seven months ago that resolved spontaneously. Examination reveals a macular- papular rash spread diffusely over the body including the palms and soles of the feet. Shallow ulcers are noted on the buccal mucosa while the pharynx is moderately erythematous. Which of the following is the most appropriate initial diagnostic study? A Tzanck smear of lesion B Serum FTA-Absorption test C Streptococcus pyogenes culture D Epstein-Barr IgM titer
B With secondary syphilis, 100% of persons test positive with serum FTA-Absorption test.
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 ensure the diagnosis.
Which of the following is considered the antibiotic of choice in the treatment of human bite wounds? A Ampicillin B Penicillin C Augmentin D Ciprofloxacin
C Augmentin is considered to be the antibiotic of choice for human bites that may be contaminated with Eikenella corrodens, strep viridans, and staph aureus.
Which of the following is an indication for workup in patients with suspected cellulitis? A Regional lymphadenopathy B Infection site on the torso C Tachypnea D Infection site >10 mm
C Generally, no workup is required in uncomplicated cases of cellulitis that meet the following criteria: Limited area of involvement; Minimal pain; No systemic signs of illness (eg, fever, chills, dehydration, altered mental status, tachypnea, tachycardia, hypotension); and No risk factors for serious illness (eg, extremes of age, general debility, immunocompromised status). Because the bacterial etiology of cellulitis in typical cases is expected to represent streptococcal and, less commonly, staphylococcal infection, additional procedures are also usually unnecessary. However, in more severe disease or unique clinical scenarios, additional procedures may be indicated. For serious infections, perform a blood culture, Gram stain, and culture of needle aspiration or punch biopsy specimens to pinpoint the etiology. Blood cultures are only positive in 5-15% of patients with cellulitis. Aspiration of the leading edge of cellulitis margins rarely yields positive results but may be performed if clinicians are facing difficult situations. The IDSA recommends bloodwork for patients with soft-tissue infection who have signs and symptoms of systemic toxicity; such tests include blood cultures, complete blood cell (CBC) with differential, and levels of creatinine, bicarbonate, creatine phosphokinase, and C-reactive protein (CRP).
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 26 year-old female presents with several pruritic lesions on her dorsal forearms. The lesions are erythematous with vesicles, with a few beginning to weep. She works in a photography laboratory, but denies any other possible exposures. Which of the following is the most useful diagnostic test? A VDRL serology B KOH prep C Patch testing D Gram's stain
C Patch testing with a suspected agent is usually positive in cases of allergic contact dermatitis.
A 23 year-old African American female presents with concern regarding "lightening" of the skin in her knees, face, clavicles, and wrists. These areas appear to be increasing in size. She was recently diagnosed with pernicious anemia. In order to confirm her diagnosis, which of the following tests is indicated? A Wood's light B KOH prep C Skin biopsy D Gram stain
C Skin biopsy in a patient with vitiligo will show complete absence of melanocytes and will confirm the diagnosis.
A 36 year-old female comes to the office because a mole on her left calf has changed. On physical examination of the left posterior lower leg, there is a 12 mm, asymmetrical, variegated blue-black macule with raised pink plaque in the upper half of the lesion. Which of the following is the most appropriate clinical management of this lesion? A Cryosurgery B Topical retinoids C Excisional surgery D Topical chemotherapy
C Surgical excision of suspected melanoma is necessary for histologic diagnosis and treatment of the lesion.
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.
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 mother brings in her 3 month-old infant and states that she has noticed a rash on her infant's scalp. Physical examination reveals the presence of erythematous and scaling crusty lesions involving the vertex of the scalp. Which of the following is the most appropriate initial intervention? A selenium sulfide shampoo B permethrin 1% cream rinse C warm olive oil compresses D scrubbing of scalp with hexachlorophene
C This infant most likely has scalp seborrheic dermatitis ("cradle cap"). Initial treatment consists of warm olive oil compresses to remove any crusts followed by use of baby shampoo or mild hydrocortisone cream.
A 38-year-old African American presents with the lesion shown here. The lesion shows a "milk-white" fluorescence with a Wood's light examination. The most likely diagnosis is. A Tinea versicolor B Tinea corpora C Amelanotic melanoma D Vitiligo E Leprosy
C Vitiligo is a disorder associated with depigmentation of the skin that is thought to be related to an autoimmune-mediated loss of melanocytes. Fifty percent of those who are affected have a family history of vitiligo. The lesions appear as hypopigmented chalk-white lesions and are more obvious on people who have dark complexions. The condition is bilateral and symmetric in appearance and typically forms around orifices (i.e., mouth, eyes, nose, and anus). Vitiligo is often cyclical. Some may experience partial repigmentation. Diagnosis is made clinically. A Wood's light examination reveals a "milk-white" fluorescence over the lesion. Treatment is limited, but includes potent topical steroids, psoralen plus ultraviolet A photochemotherapy, minigrafting, and cosmetics to hide areas.
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 30 year-old patient is seen for a non-painful mass on the upper back which has grown slowly over the past year. He denies previous trauma, drainage from the area or history of dermatologic diseases. Examination reveals a four centimeter firm, but highly mobile subcutaneous mass with no overlying skin discoloration or punctum with drainage. Which of the following is the most likely diagnosis? A Epidermoid cyst B Hemangioma C Keratoacanthoma D Lipoma
D A lipoma is a benign fatty tumor usually developing slowly in the subcutaneous layer and generally remaining small though can become very large.
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.
A 55 year-old female presents with a lesion on her face that is painful, bright red, with distinct raised borders. She also is complaining of fever and chills. There is no evidence of any marks which would show a portal of entry. Which of the following is the most likely diagnosis? A Impetigo B Erythrasma C Cellulitis D Erysipelas
D Erysipelas is a distinct type of superficial cellulitis with redness, a distinct and raised border, and sharp demarkation from uninvolved skin. It is typically associated with systemic symptoms such as fever and chills. It is caused by group A strep most commonly.
A young child is brought to the clinic because the mother noticed a rash while bathing the child. There is a very red slightly raised eruption on the child's face across both cheeks. The child has been in good health and does not appear ill today. The most likely diagnosis is A scarlet fever. B rubella. C roseola. D erythema infectiosum
D Erythema infectiosum is generally asymptomatic, presenting with red papules on the face that coalesce to give a "slapped cheek" appearance.
A 3 year-old child playing in an abandoned shed is bitten by a black widow spider. The mother rushes the child to the emergency department within 20 minutes of the incident. Which of the following if the best initial intervention? A Intramuscular steroids B Administration of antivenin C Immediate immersion in a cold bath D Hospital admission for symptomatic care
D Hospital admission for symptomatic care should be considered in children, pregnant women, and patients with preexisting cardiovascular disease.
Which of the following mediators is responsible for initiating the urticaric response? A Cyclic AMP B Prostaglandins C Prednisone D IgE
D IgE triggers the release of histamine from mast cells that leads to urticaria.
The drug of choice to treat a serious methicillin-resistant S. aureus (MRSA) skin infection is A Penicillin B Dicloxacillin C Cefuroxime D Vancomycin E Metronidazole
D MRSA has become the predominant cause of suppurative skin infection in many parts of the United States. Community-associated MRSA (CA-MRSA) usually causes furunculosis, cellulitis, and abscesses, but necrotizing fasciitis and sepsis can occur. CA-MRSA strains are usually susceptible to trimethoprim/ sulfamethoxazole, clindamycin, and tetracyclines. Patients with serious skin and soft tissue infections suspected to be caused by MRSA should be treated empirically with vancomycin, linezolid, or daptomycin. The most common reservoir is the nasal mucosa and oropharynx. Isolates are usually resistant to all the cillin-type antibiotics and the cephalosporins. Duration of therapy is based on the patient's response but is usually 2 to 4 weeks. Colonization occurs in approximately 50% of treated patients. Asymptomatic colonization with MRSA does not require systemic treatment.
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 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 patients is at highest risk for the development of the skin disorder known as erythrasma? A Lactating women B Postmenopausal women C Seniors living in cold northern climate D People living in tropical climate
D People living in warm, tropical climate, people wearing occlusive clothing or shoes, obese patients, and those with hyperhidrosis are at increased risk for erythrasma. The diagnosis of this condition is made by demonstration of a coral red fluorescence.
An 18 year-old young woman comes to the office with a mildly itchy rash on her chest and back for the past two weeks. She noticed an initial area on her back two weeks ago, and now it has spread across her back and chest. On physical examination, she has several salmon-colored plaques with fine scale that follow the cleavage lines of the trunk. Which of the following is the most likely diagnosis? A Tinea versicolor B Seborrheic dermatitis C Psoriasis D Pityriasis rosea
D Pityriasis rosea is an acute eruption of fine scaling fawn-colored papules and plaques that are distributed along the cleavage lines of the trunk, often referred to as a Christmas tree pattern. A single plaque, called a herald patch, precedes the secondary eruption by 1-2 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.
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.
Which of the following lesions is most characteristic of psoriasis? A hypopigmented macules on hands and forearms B pruritic pustules on finger webs and wrist creases C crusting vesicles around the mouth and face D scaling plaques on knees and elbows
D Psoriasis most commonly presents with scaling plaques and papules on the scalp, elbows, forearms, lumbosacral regions, knees, hands, and feet.
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 23 year-old male comes to the office with an intensely itchy rash, especially at night for the past week. His roommates have similar symptoms but have not been evaluated. On physical examination, the wrists, web spaces of the hands, and axillae have thin linear markings, tiny vesicles, and excoriations. Which of the following is the most likely diagnosis? A Pediculosis B Folliculitis C Impetigo D Scabies
D Scabies is an infestation of the mite Sarcoptes scabiei. It is usually spread by skin-to-skin contact. Scabies is characterized by intense pruritic burrows, vesicles and excoriations of the finger webs, wrist creases and axillae.
An 8 year-old child is brought in by his mother with a two day history of spreading, non-pruritic red rash. The rash was preceded by moderate fever, sore throat and rhinorrhea. Examination reveals a moderately ill appearing child with a fine, macular-papular rash on an erythematous base spread diffusely over the trunk with some accentuation in the skin folds. The face is flush with perioral pallor. There is palpable anterior cervical lymphadenopathy. Which of the following is the most appropriate diagnostic study to establish the diagnosis? A Shave biopsy B Epstein-Barr virus Ig G C Complete blood count D Throat culture
D Scarlatina rash is due to infection with group A strep. A throat culture would be the most appropriate diagnostic study to establish the diagnosis in this patient.
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 patient sustained a 6 cm laceration on his anterior tibia that was primarily closed in the emergency department. What is the most appropriate time frame for removal of these sutures? A 1-2 days B 3-5 days C 6-8 days D 7-14 days
D Suture removal is based upon the area of the body that was sutured. Facial sutures are placed for 3-5 days, scalp sutures for 5-7 days, trunk sutures are placed for 6-8 days, and sutures on the extremity are placed for 7-14 days. Sutures on the extremities can stay for longer periods of time if the area is under maximal tension.
Which of the following is not a suitable treatment for the rash pictured here? A Curettage B Cryotherapy C Trichloroacetic acid D Imiquimod (Aldara) E 5-fluorouracil
E This is molluscum contagiosum (MC). MC is a benign superficial eruption resulting from viral infections of the skin. MC eruptions are usually self-limited and without sequelae, although they can be more extensive especially in immunocompromised persons. In patients with HIV, MC infection frequently is not self-limited and can be much more extensive and even disfiguring. MC may serve as a cutaneous marker of severe immunodeficiency and sometimes is the first indication of HIV infection. Lesions usually spontaneously disappear but treatment by local destruction or immunologic modulation can shorten the disease course. Spontaneous disappearance of MC lesions with no residual scarring is common. This may occur after a period of inflammation and minor tenderness. Autoinoculation is associated with scratching of the lesions and transmission to others can occur. Lesion destruction may be mechanical (curettage, laser, or cryotherapy with liquid nitrogen or nitrous oxide cryogun), chemical (trichloroacetic acid, tretinoin), or immunologic (imiquimod). Advantages to imiquimod therapy include minimal side effects and convenience of application.