Derm AAD Quizzes
A 1-year-old girl has a 3-month history of a very pruritic eruption, shown in this photo. Lesions are also present on the face and antecubital fossa. Of the following, the MOST likely diagnosis is: a. Atopic dermatitis b. Allergic contact dermatitis c. Psoriasis d. Seborrheic dermatitis e. Tinea corporis
a. Atopic dermatitis
A 3 month-old baby has developed erythematous, oozing patches on the cheeks and chin and frequently rubs his face. Which of the following is the most likely diagnosis? a. Atopic dermatitis b. Candidal dermatitis c. Dyshidrotic dermatitis d. Impetigo e. Irritant Dermatitis
a. Atopic dermatitis
This patient has erythroderma, a diffuse inflammation of the skin. The patient is at risk of dehydration. What other acute and potentially deadly complication is this patient at risk for due to compromise of the skin barrier? a. Bacterial infection b. Dyschromia / Pigmentary alteration c. Overhydrated skin d. Squamous cell carcinoma
a. Bacterial infection
Which of the following is a class 1 (super potent) topical steroid: a. Clobetasol propionate 0.05% cream b. Hydrocortisone butyrate 0.1% cream c. Hydrocortisone 2.5% ointment d. Mometasone furoate 0.1% lotion e. Triamcinolone acetonide 0.1% ointment
a. Clobetasol propionate 0.05% cream
Your patient's brother was recently diagnosed with melanoma. She asks about risks for melanoma. Which of the following is true? a. Consistent use of SPF 30 sunscreen has been shown to decrease melanoma incidence b. Daily sunscreen with SPF 70 or higher is recommended for all skin types c. Getting a base tan from indoor tanning reduces your risk of melanoma d. Most melanomas occur in families with a genetic mutation in CDKN2A or BRCA2 e. Performing skin exams at home does not improve melanoma outcomes
a. Consistent use of SPF 30 sunscreen has been shown to decrease melanoma incidence
A male patient has been treating the lesions on his hand (see photo) with over-the-counter salicylic acid solution off and on for one year. He is embarrassed by the appearance of his hands and the lesions are spreading. Which of the following treatments is the MOST appropriate at this time? a. Cryotherapy with liquid nitrogen b. Intralesional triamcinolone acetonide c. Surgical excision d. Topical calcineurin inhibitor e. Topical retinoid
a. Cryotherapy with liquid nitrogen
The difference between a vesicle and a bulla is: a. Diameter of the lesion b. Extension into the dermis c. Location on the body d. Presence of pus vs. clear serous e. Thickness (height) of the lesion fluid
a. Diameter of the lesion
A 54-year-old man developed a diffuse red papular eruption three weeks after starting allopurinol for elevated uric acid. Skin lesions became confluent and were associated with anasarca, recurrent high fevers, arthralgias, myalgias, decreased urine output, and proteinuria. Laboratory studies revealed a leukocytosis with dramatic eosinophilia, and elevated liver enzymes. Based on the history and clinical findings, which of the following drug reactions do you suspect? a. Drug-Induced Hypersensitivity Syndrome b. Fixed Drug Eruption c. Stevens-Johnson Syndrome d. Toxic epidermal necrolysis e. Vasculitis
a. Drug-Induced Hypersensitivity Syndrome
This 64-year old woman presented to the emergency room with these lesions scattered over her whole body and involving her lips and oral mucosa. What is the most appropriate morphologic term for this finding? a. Erosion b. Macule c. Patch d. Petechiae e. Wheal
a. Erosion
Which of the following diagnoses BEST describes the patient in the photo? a. Erythematotelangietatic Rosacea b. Papulopustular Rosacea c. Phymatous Rosacea d. Ocular Rosacea
a. Erythematotelangietatic Rosacea
A 18 year-old man has a new painful raised erythematous nodule on his knee that is fluctuant on palpation. What is the most appropriate management for this patient? a. Incision and drainage b. Monitor c. Oral cephalosporin (cephalexin) d. Topical antibiotic (mupirocin)
a. Incision and drainage
Your patient has an actinic keratosis on the forehead. What treatment would you recommend? a. Liquid nitrogen cryotherapy b. Radiation therapy c. Topical acyclovir d. Topical mupirocin e. Ultraviolet light therapy
a. Liquid nitrogen cryotherapy
Your patient has an actinic keratosis on the forehead. What treatment would you recommend? a. Liquid nitrogen cryotherapy b. Radiation therapy c. Topical acyclovir d. Topical mupirocin e. Ultraviolet light therapy
a. Liquid nitrogen cryotherapy
A 16-year-old male presents to your office for his health maintenance visit. He has not used any treatment for his acne (see photo). The MOST appropriate initial treatment plan is: a. Start oral doxycycline, topical tretinoin and benzoyl peroxide wash and see him in follow-up in 3 months b. Start oral doxycycline, topical tretinoin and benzoyl peroxide wash and see him in follow-up in 6 months c. Start topical tretinoin and benzoyl peroxide wash and see him in follow-up in 3 months d. Start topical tretinoin and benzoyl peroxide wash and see him in follow-up in 6 months
a. Start oral doxycycline, topical tretinoin and benzoyl peroxide wash and see him in follow-up in 3 months
This patient has this eruption on his abdomen. He is a swimmer so extensively shaves his body hair and recently took antibiotics for a sinus infection. Which one of the features of this case is NOT a risk factor for methicillin-resistant Staph aureus (MRSA) infection? a. Swimmer b. Body shaving c. Recent antibiotic use d. Abdomen location
a. Swimmer
Which of the following is most likely a basal cell carcinoma? (No pics again...) a. b. c. d. e.
b. (donut shaped red lesion on shoulder)
Which of the following patients needs to be seen in dermatology every year? a. A 42 year old woman with about 15 normal nevi; no personal or family history of skin cancer b. A 35 year old man with a history of melanoma in situ 3 years ago c. A 32 year old woman with a history of three dysplastic nevi that were excised d. A 27 year old man with 3 dysplastic nevi; no personal or family history of skin cancer e. A 48 year old woman with a grandfather who had melanoma in his 70s
b. A 35 year old man with a history of melanoma in situ 3 years ago
The mother of a 2 year old with atopic dermatitis asks how frequently she should bathe her. What is the best answer? a. Bathing is not recommend for children with atopic dermatitis b. Bathing once per week is optimal for children with atopic dermatitis c. Bathing once or even twice daily can be helpful in some cases, so long as gentle cleansers are used and moisturizers are applied immediately after bathing d. Bathing 3-4 times daily is ideal for all patients with atopic dermatitis e. Bathing in salt water is the only acceptable way for patients with atopic dermatitis
c. Bathing once or even twice daily can be helpful in some cases, so long as gentle cleansers are used and moisturizers are applied immediately after bathing
Your patient presents with a three day history of a new expanding red tender plaque on his right lower leg. The probable diagnosis is: a. Psoriasis b. Nummular eczema c. Cellulitis d. Stasis dermatitis e. Allergic contact dermatitis
c. Cellulitis
Which of the following is true regarding respecting patient modesty during skin exams? a. Adult diapers in wheelchair/ bed-bound patients should stay on to preserve modesty b. Chaperones should only be offered if the patient appears litigious c. Doctors should ask permission before moving the gown to examine the next body part d. Medical providers should not touch their patient's skin during full body exam e. Patients should just lift up their clothing to show you spots they are worried about
c. Doctors should ask permission before moving the gown to examine the next body part
Mr. Thompson is a 40-year-old male who presented to the emergency room with a diffuse pruritic rash that began on his trunk and spread peripherally. The rash started 10 days after he began taking ampicillin for "food poisoning." There are no mucosal lesions or systemic symptoms. Based on the history and photo, what is the most likely diagnosis? a. Disseminated zoster b. Drug-induced hypersensitivity syndrome c. Exanthematous drug eruption d. Fixed drug eruption e. Stevens Johnson Syndrome
c. Exanthematous drug eruption
A 41-year-old male experiences a painful, solitary bulla at the same location on his glans penis intermittently after episodes of constipation. He takes a laxative each time he experiences constipation. Which of the following drug reactions is the most likely diagnosis? a. Drug-induced hypersensitivity syndrome b. Exanthematous drug eruption c. Fixed drug eruption d. Stevens-Johnson Syndrome e. Vasculitis
c. Fixed drug eruption
A 30-year-old nurse is transferred to a new hospital and begins to develop red, painful, chapped hands (see photo). He has been working on a unit with multiple patients on contact precautions, and he has been washing his hands frequently with soap and water. On exam there are multiple fissures and scaling, but no vesicles are seen. What is the most likely diagnosis? a. Allergic contact dermatitis b. Dyshidrotic dermatitis c. Irritant contact dermatitis d. Nummular dermatitis e. Psoriasis
c. Irritant contact dermatitis
The cell of origin in a squamous cell carcinoma is the a. Basal cell b. Endothelial cell c. Keratinocyte d. Melanocyte e. Neuron
c. Keratinocyte
The name of the antigen presenting cell in the epidermis that is required for the induction of allergic contact dermatitis is: a. Fibroblasts b. Keratinocytes c. Langerhans cells d. Mast cells e. Melanocytes
c. Langerhans cells
Which of the following is the best way to find a melanoma in a 38 year-old half Irish/half Chinese male patient with moderate sun damage, lentigines, and nevi, but no personal or family history of melanoma? a. Educate the patient to do a skin exam at home every 2 years b. Immediate referral to dermatology without performing a skin exam c. Look for an "ugly duckling" among his typical nevi on a full body skin exam d. Perform an exam limited to sun-exposed skin e. Perform biopsy/removal of the largest or darkest 3 moles at every 6 month visit
c. Look for an "ugly duckling" among his typical nevi on a full body skin exam
A 52-year-old male presents with erythematous papules and pustules on his cheeks and nose for several years (see photo). He also is embarrassed by the erythema on his nose and worries that his friends think he's an alcoholic. The most appropriate next step is: a. Clobetasol cream twice daily b. Ketoconazole cream twice daily c. Metronidazole cream twice daily d. Moisturizers 2-3 times daily
c. Metronidazole cream twice daily
A 54-year-old man presents to dermatology clinic with a 1 cm pink plaque on his right cheek. Based on the image, what is the MOST likely diagnosis? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Sebaceous hyperplasia e. Squamous cell carcinoma
b. Basal cell carcinoma
A 28-year-old woman presents with a brown mole on her face, which she states has been there for "as long as she can remember." Based on the image, which of the following is the most likely diagnosis? a. Actinic keratosis b. Benign congenital nevus c. Lentigine d. Melanoma e. Seborrheic keratosis
b. Benign congenital nevus
Which one of these is not a primary function of the skin? a. Temperature regulation b. Calcium-phosphate homeostasis c. Interaction with the environment d. Social Interaction (Appearance) e. UV-protection
b. Calcium-phosphate homeostasis
Which of the following treatments would you recommend for this patient (see photo)? a. Apply hydrogen peroxide b. Compression wraps c. Oral antibiotics d. Oral antifungal e. Topical antibiotic ointment
b. Compression wraps
Which of the following topical steroids is most appropriate to use on the patient in this photo? a. Clobetasol b. Desonide c. Fluocinonide d. Triamcinolone
b. Desonide
A 30-year-old female is diagnosed with allergic contact dermatitis of the face, likely due to a nickel allergy from the frames of her glasses. What treatment would you recommend other than avoidance of nickel? a. Clobetasol ointment b. Desonide cream c. Fluconazole gel d. Ketoconazole cream e. Triamcinolone ointment
b. Desonide cream
What is the most likely etiology of this patient's cellulitis? a. Eikenella corrodens b. Group A strep c. Group B strep d. Pasteurella multocida
b. Group A strep
A 9-year old child presents with this dark brown "spot" on his lip. His mother says it appeared about 2 months ago. What is the most appropriate morphologic term for this lesion? a. Bulla b. Macule c. Patch d. Plaque e. Vesicle
b. Macule
What is the BEST morphological description for these primary lesions? (lesions measure less than 0.5cm) a. Erosions b. Macules c. Nodules d. Papules e. Plaques
b. Macules
A 22-year-old female was referred to the dermatology clinic for a presumed diagnosis of psoriasis. Her rash is limited to the area in the picture shown. Which of the following treatments would you recommend for this patient? a. Calcineurin inhibitors (e.g. pimecrolimus cream) b. Moderate potency topical steroid (e.g. fluocinonide ointment) c. Methotrexate d. Tumor necrosis factor inhibitor (e.g. adalimumab) e. Ultraviolet light therapy
b. Moderate potency topical steroid (e.g. fluocinonide ointment)
Which of the following is an indication for a total body skin exam? a. New patient with acne on her forehead b. New patient with a sister who has melanoma c. New patient with a mole on his chin that he's had since childhood without change d. New patient with a paternal aunt with a history of melanoma e. New patient with a wart on her right index finger
b. New patient with a sister who has melanoma
A 25-year-old female presents to you with a rash over her eyelids after using a new cosmetic brand. What is the BEST test to confirm the cause of the rash depicted in this photo? a. Indirect immunofluorescent antibody (IIF) test b. Patch testing c. Prick skin testing d. Punch biopsy e. Radioallergosorbent test (RAST)
b. Patch testing
A 3 year-old boy has ill-defined hypopigmented patches on the cheeks that seemed to appear over the summer. What is the best diagnosis? a. Pityriasis rosea b. Pityriasis alba c. Pityriasis versicolor d. Tinea faceii e. Keratosis pilaris
b. Pityriasis alba
A 14-year-old girl (see photo) presents to your office with her mother. How would you describe her skin lesions? a. Nodulocystic acne b. Primarily comedonal acne c. Primarily inflammatory acne d. Rosacea e. She does not have acne
b. Primarily comedonal acne
Oral tetracyclines are not used in children younger than 8 years of age because: a. Risk of bleaching of the hair b. Risk of damage to tooth enamel and developing bones c. Risk of hyperkalemia d. Risk of hyperpigmentation of the skin
b. Risk of damage to tooth enamel and developing bones
A 30-year old man presents to your clinic for this painful plaque on his foot. After examining his hands and feet you tell him that it's a wart and it looks like it is the only one. He hasn't tried to treat it before and wants to start treatment because it's painful. What is the most appropriate first-line therapy for this patient? a. Imiquimod b. Salicylic acid c. Shave removal d. Squaric acid e. Tretinoin
b. Salicylic acid
A 30-year old man has this lesion on his finger. It has been present for 3 years. What is the most appropriate morphologic term to describe this lesion? a. Cyst b. Nodule c. Papule d. Plaque e. Vesicle
c. Papule
A 20-year-old male presents to clinic with a rash on the scalp, extensor elbows, knees and umbilicus. You note sharply demarcated erythematous plaques with silvery scale in those locations; there is no central clearing. The soles of the feet are normal. What is the most likely diagnosis? a. Allergic contact dermatitis b. Atopic dermatitis c. Psoriasis d. Secondary syphilis e. Seborrheic dermatitis
c. Psoriasis
A 14-year-old male presents to his pediatrician with a 3-year history of well-controlled psoriasis primarily located on the elbows, knees and scalp. His current skin regimen includes high potency topical steroids and vitamin D analogues. Recently, the psoriasis has spread to involve more than 15% of his body surface area and the topical treatments are not working. He is embarrassed to participate in gym class because of the appearance of his skin. What is the next best step in his care? a. Increase the frequency of application of the topical medications to three times daily b. Start him on oral prednisone c. Refer him to a dermatologist for consideration of systemic treatment d. Add an antibiotic for superinfection e. Tell him there is nothing more that can be done for his disease
c. Refer him to a dermatologist for consideration of systemic treatment
A 6 year-old girl with severe atopic dermatitis is using a class 2 topical steroid on the face and arms for 2-3 weeks out of every month and still having frequent flares. She has required 2 courses of oral corticorsteroids in the past 6 months for severe flares, and has had 4 courses of oral antibiotics in the past year. What is the next best step? a. Order allergy testing b. Increase the strength of the patient's antihistamine c. Refer the patient to a dermatologist for further evaluation and management d. Initiate dilute bleach baths e. Stress improved moisturization
c. Refer the patient to a dermatologist for further evaluation and management
A 63-year-old patient presents with a lesion on his toe that has doubled in size in the past year. It is non-tender and does not bleed, but his wife says it's getting bigger and darker on one side. The macule is 7mm in diameter (see photos). Which of the following is the best next step? a. Liquid nitrogen cryotherapy b. Reassurance and observation c. Refer to dermatology for biopsy d. Refer to orthopedics for toe amputation e. Topical imiquimod cream
c. Refer to dermatology for biopsy
A 36-year-old fair-skinned man presents to your office for a total body skin exam. He has always had moles, which have begun to concern him because of all the recent news about melanoma and skin cancer. On exam, you note that the patient has about 20 moles on his back, all of which share a variegated coloration, irregular and poorly-defined borders, asymmetry, and size greater than 6 mm. Based on this description, which aspect of these lesions makes them LESS LIKELY to be melanoma? a. Asymmetry b. Irregular, poorly-defined borders c. Signature pattern of the lesions d. Size greater than 6 mm e. Variegated coloration
c. Signature pattern of the lesions
Which of the following is true regarding the order in which you perform a skin exam? a. Start with the head and then move to the face, neck, chest, abdomen, arms, etc. b. Try to use a different order each time you examine the skin c. You may use any order you want, but it's better to do it in the same order each time d. You must have the patient start sitting up, then have them stand e. You must lay the patient down, then have them flip over
c. You may use any order you want, but it's better to do it in the same order each time
Staph aureusThis 30-year old patient has a painful rash on his thigh. He works in construction and thinks this is where a piece of metal injured him a couple days ago. Over the past 24 hours the area is being more purple, spreading, and very painful. What is the most likely diagnosis? a. Cellulitis b. Impetigo c. necrotizing fasciitis d. stasis dermatitis
c. necrotizing fasciitis
Which of the following images is most consistent with impetigo? (Sorry, I don't have the upgraded version) a. b. c. d.
c. (honey crust lesions on the chin)
When prescribing medications for acne vulgaris, an important step is to establish reasonable expectations with the patient. How long might the patient have to wait before seeing improvements in his/her acne? a. 1-2 weeks b. 3-4 weeks c. 2-3 months d. 4-6 months
c. 2-3 months
An 8-year old child is brought in by his father. The boy has had several warts on the back of his hand for the past 3 months. The father wants to have the warts "burned off". The boy is more hesitant and thinks one of the warts on the back of his hand is "going away on its own". You decide to educate the boy and his father about the chance of spontaneous remission of warts. You tell the father that "without any treatment about ___ out of 4 kids have their warts go away after two years." a. 1 b. 2 c. 3 d. 4
c. 3
Your patient is a 50-year-old man with a new diagnosis of scabies, confirmed by a skin scraping which revealed the presence of mites and mite eggs. You prescribe 5% permethrin cream to be applied overnight to the entire body and instruct the patient to apply the permethrin twice (2 doses, separated by one week). How much cream should you dispense to the patient? You are prescribing the medication for only your patient and not for any family members or affected contacts. a. 15 grams b. 30 grams c. 60 grams d. 120 grams
c. 60 grams
Which of the following is most likely a basal cell carcinoma? a. A bright red round 3mm homogenous papule on the abdomen b. A fleshy skin-colored pedunculated papule in the armpit c. A pink translucent papule on the nasal tip that won't heal d. A stuck-on verrucous tan flat-topped plaque on the back e. A yellowish papule on the forehead with a central dell
c. A pink translucent papule on the nasal tip that won't heal
This patient has the pink papules and plaques seen here. What serotype of human papilloma virus (HPV) is the most likely cause? a. HPV 1 b. HPV 2 c. HPV 5 d. HPV 6 e. HPV 7
d. HPV 6
A 12 year-old boy with a long history of atopic dermatitis presents with a patch on the arm that is not improving despite two weeks of treatment with his usual class 3 topical corticosteroid. The area is open, oozing and has honey-colored crusting. Which of the following is the most likely diagnosis? a. Atopic dermatitis b. Candidal dermatitis c. Dyshidrotic dermatitis d. Impetigingized atopic dermatitis e. Irritant Dermatitis
d. Impetigingized atopic dermatitis
A 14 year-old girl with a history of atopic dermatitis on the hands and wrists notes that she is using hydrocortisone 2.5% ointment twice daily every day and is only getting minimal relief. On exam, there is thick lichenification of the hands and wrists with many excoriations. What is the best next step? a. Advise to stop all topical corticosteroids at this time b. Treat with an oral antibiotic for several weeks to exclude infection c. Advise daily dilute bleach baths to prevent infection d. Increase the potency of the topical steroid to fluocinonide given the location and thick lichenification e. Decrease the potency of the topical steroid to hydrocortisone 1% cream to minimize the chance of steroid-related side effects
d. Increase the potency of the topical steroid to fluocinonide given the location and thick lichenification
This 78 year-old man complains of a tender nodule that grew rapidly over the past 4 weeks near his left elbow. Based on the photo below and that history, the most likely diagnosis is: a. Actinic keratosis b. Basal cell carcinoma c. Intradermal nevus d. Keratoacanthoma e. Seborrheic keratosis
d. Keratoacanthoma
Which of the following patients would be most appropriate to refer to a dermatologist? a. Patient has both comedonal acne and few inflammatory lesions on the face, chest, and back b. Patient has no improvement in moderate acne after 1 month of treatment with topical retinoid c. Patient is a post-adolescent female with new onset acne d. Patient has extensive nodular lesions with cysts and diffuse scarring
d. Patient has extensive nodular lesions with cysts and diffuse scarring
What is the best way to improve your skills with performing the skin exam? a. Limit the skin exam to only the part(s) of the body the patient chooses to show you b. Listen to the heart or lungs through the patient's shirt or gown instead of removing it c. Only perform full body skin exams on patients who ask for one d. Perform full skin exams on as many patients as possible during training
d. Perform full skin exams on as many patients as possible during training
An 18-year-old white female returns to your clinic for acne. She has comedones that have improved with topical retinoid therapy and benzoyl peroxide, but she still gets pustules and inflammatory papules. She plays field hockey. You decide to prescribe doxycycline 100 mg twice daily. Which of the following side effects do you need to warn her about? a. Decreased efficacy of birth control pills b. Hyperpigmentation c. Hypertriglyceridemia d. Photosensitivity e. Staining of the teeth
d. Photosensitivity
You are consulted by general surgery about a new rash on this XX-year old boy/girl with these lesions scattered over his/her legs. Over the phone your colleague described the rash as "many small dark red macules that don't go away when I press on them." What is the most appropriate morphologic term for this finding? a. Ecchymosis b. Erosion c. Macule d. Purpura e. Telangiectasia
d. Purpura
4. A 13-year old boy is brought to the clinic by his father to get treatment for this condition on his face. What is the most appropriate morphologic term for these lesions? a. Erosion b. Nodule c. Plaque d. Pustule e. Vesicle
d. Pustule
You diagnose a 25-year-old college student with contact dermatitis on the dorsum of the hands. She continues to have chronic scaly, erythematous, pruritic plaques despite use of Clobetasol ointment twice daily for 1 month. The most appropriate next step is: a. Order a RAST test b. Punch biopsy of a plaque c. Recommend increased hand washing d. Refer to a dermatologist e. Switch to Triamcinolone cream twice daily
d. Refer to a dermatologist
You are taking care of a patient in the internal medicine clinic. She's 61, and five years ago she had a biopsy-proven basal cell carcinoma on her nose that was treated with imiquimod. In the past 6 months, she's noticed a new pink papule in the same spot that won't heal. What is the next appropriate action? a. Cryotherapy b. Excision with 5mm margins c. Repeat application of imiquimod 5 nights a week for 6 weeks d. Referral for Mohs micrographic surgery e. Referral for radiation therapy
d. Referral for Mohs micrographic surgery
Your patient is a 35-year-old woman with a history of squamous cell carcinoma who would like more information about sun protection. What patient education would you provide? a. Avoid tanning beds b. Seek shade, especially during 10AM-4PM, when the sun's rays are the strongest c. Use extra caution around water, snow, and sand d. Use a broad-spectrum sunscreen with an SPF of 30 or more e. All the answer choices are correct
e. All the answer choices are correct
Ten players on a basketball team have been diagnosed with impetigo. The team doctor should: a. Prescribe a topical antibiotic b. Prescribe an oral antibiotic c. Have them use an antibacterial soap d. Both a & c e. Both b & c
e. Both b & c
This patient has erysipelas. What statement(s) is(are) true? a. Area is painless b. Is a surgical emergency c. Should have a stat MRI d. Usually caused by Staph e. None of the above
e. None of the above
What is the best way to examine the skin of a 5-year old? a. Ask the parent to leave the room so they child doesn't feel self-conscious b. Avoid asking any direct questions to the child c. Have the parent sit across the room from the child d. Eliminate all play things from the room so there are no distractions e. Perform the exam with the child sitting on their parent's lap
e. Perform the exam with the child sitting on their parent's lap
A 12-year-old girl presentswith erythematous, excoriated papules with overlying crust in the antecubital fossa (see photo). She showers daily and is using a petrolatum-based emollient twice a day. What is the most appropriate next step in management? a. Decrease frequency of showers b. Increase frequency of emollient application c. Prescribe mupirocin ointment, topical, bid d. Prescribe hydrocortisone 1% cream, topical, bid e. Prescribe triamcinolone ointment 0.1%, topical, bid
e. Prescribe triamcinolone ointment 0.1%, topical, bid
This is an 18-year old young woman with multiple warts on her hands for the past 4 years. She had them "frozen" by another provider and it hurt so much she is refusing "anything" that hurts. Which of the treatment options below is the most appropriate choice for the care of this patient? a. Adhesive (duct) tape b. Apple cider vinegar home therapy c. Imiquimod cream 5 nights a week d. Laser therapy e. Referral to dermatologist
e. Referral to dermatologist
A 32-year-old woman presents to the emergency room with a rash covering 25% of her body surface area (see photo), which began 2 weeks after starting TMP/SMX for a urinary tract infection. In addition to her skin findings, she has oral and conjunctival erosions. Based on the history and photo, what is the most likely diagnosis? a. Disseminated herpes zoster b. Drug-induced hypersensitivity syndrome c. Fixed drug eruption d. Sepsis e. SJS/TEN
e. SJS/TEN
A patient asks about a 5mm pink nodule on the left neck that has been present for a year and sometimes bleeds. What is the next appropriate step in therapy? a. Application of silver nitrate in clinic b. Home application of apple cider vinegar c. Immediate referral for Mohs micrographic surgery d. Recommend sunscreen use and follow-up in a year e. Shave biopsy or referral to a dermatologist
e. Shave biopsy or referral to a dermatologist
A colleague brings you into a room to see a patient (figure1). The patient, a 20-year-old man has had this lesion on his thigh since he was born. Your colleague is tries to describe it to you. What component of a complete description is missing from her description: "This young man has a well-demarcated, oval, brown evenly-pigmented patch on his left thigh." a. Color b. Location c. Primary morphology d. Shape e. Size
e. Size
Based on this image of a firm non-healing nodule on the scalp of a balding man, what is the most likely diagnosis? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Seborrheic keratosis e. Squamous cell carcinoma
e. Squamous cell carcinoma
Based on the morphologic features of the photo, what is the MOST likely diagnosis? a. Asteatotic dermatitis b. Bilateral cellulitis c. Necrotizing fasciitis d. Vasculitis e. Stasis dermatitis
e. Stasis dermatitis
A 15-year-old female presents to clinic with acne with 30-40 comedones on the forehead, cheeks, and chin, with very few erythematous papules, and no scarring. She reports that topical benzoyl peroxide is not working for her despite using it according to instructions for 6 months. She has no involvement of chest or back and has normal menstrual periods. Which of the following is the BEST addition to her acne treatment at this time? a. Oral Isotretinoin b. Oral Minocycline c. Oral Spironolactone d. Topical antibiotic e. Topical retinoid
e. Topical retinoid
Which of the following factors is of most prognostic value in determining survival rates in patients with primary cutaneous malignant melanomas? a. Age of patient b. Duration from onset to diagnosis c. Fitzpatrick skin type of patient d. Tumor diameter e. Tumor thickness
e. Tumor thickness
4. Which of the following is most concerning for melanoma and should be biopsied? (Yep, still no pics) a. b. c. d. e.
d. (irregular shape, different colors, rough borders)
A 52 year-old male thin smoker who frequently gets leg cramps when walking. Recently he started to get a sore over his anterior shin. Your evaluation and treatment would most likely include: a. ABI >0.9, recommend leg elevation b. ABI <0.7, recommend leg compression c. ABI >0.8, recommend light exercise d. ABI <0.6, recommend smoking cessation e. ABI >1.0, recommend wound-vac
d. ABI <0.6, recommend smoking cessation
Mr. Lewis is a 67-year-old man who presents to your primary care clinic with a lesion on his right foot (see photo). Which of the following abnormal findings would you expect on the physical exam? a. Hypertension b. Lower extremity edema c. Decreased dorsalis pedis pulses d. Decreased sensation to microfilament testing
d. Decreased sensation to microfilament testing
Oral antibiotic(s) that is (are) used to treat more extensive impetigo include a. Dicloxacillin b. Cephalexin c. Clindamycin d. Amoxicillin/clavulanate e. All of the above
e. All of the above
Acne rosacea can be differentiated from acne vulgaris by which of the following features? a. Absence of comedones b. Distribution limited to the face (Individuals can have acne vulgaris limited to the face) c. Inflammatory papules and pustules (Seen in both acne rosacea and acne vulgaris) d. Irritation from topical products (True in both acne rosacea and acne vulgaris)
a. Absence of comedones
The erythematous scaly papules on the dorsum of both hands of this 70-year-old gardener are most likely (see photo): a. Actinic keratosis b. Cherry angiomas c. Melanocytic nevi d. Seborrheic keratosis e. Solar lentigines
a. Actinic keratosis
A 63 year-old obese woman who has suffered from chronic leg swelling for several years. Her legs get intermittently red and swollen. When this happens she applies a combination of lanolin and Neosporin. One week ago, she did this and her legs got very inflamed and developed blisters, oozing and severe pruritus. The most likely diagnosis is: a. Allergic contact dermatitis b. Bullous Impetigo c. Cellulitis d. Erysipelas e. Irritant contact dermatitis
a. Allergic contact dermatitis
A 78-year-old nonatopic woman with a history of hypertension and coronary artery disease underwent a dipyridamole stress echocardiography. During this procedure, her blood pressure was monitored for 45 minutes. Two days later, an intensely pruritic, sharply demarcated, erythematous vesicular eruption developed on her right arm. Which is the most likely diagnosis? a. Allergic contact dermatitis due to black rubber blood pressure cuff b. Atypical seborrheic dermatitis triggered by sweating c. Fixed drug eruption from the dipyridamole d. Hospital-acquired cellulitis caused by Staphylococcus aureus e. Irritant contact dermatitis from soaps
a. Allergic contact dermatitis due to black rubber blood pressure cuff
What is the most appropriate initial treatment for the above patient? a. An urgent surgery consult b. Start IV fluids and antibiotic coverage c. Schedule an MRI d. Obtain a skin biopsy
a. An urgent surgery consult
A 65-year-old man with a history of hypertension and hyperlipidemia presents with an ulcerated lesion on his right lateral leg for several weeks (see photo). He occasionally has cramping in his calf when walking. His dorsalis pedis and posterior tibial pulses are not palpable. The ulceration cannot be undermined, and his ankle-brachial index is 0.6 (normal is > 0.8). What is the most likely diagnosis? a. Arterial ulcer b. Diabetic ulcer c. Pressure ulcer d. Squamous cell carcinoma e. Venous ulcer
a. Arterial ulcer
MRSA risk factors include a. Prolonged hospitalization b. Hemodialysis c. Cosmetic body shaving d. Skin trauma e. All of the above
e. All of the above
An 86 year-old man with no prior history of skin cancer presents with a 5mm round light and darker brown macule on his left anterior deltoid that has a hypopigmented / white center and asymmetry of pigmentation. He's not sure how long it has been present. Which of the following do you recommend? a. Cryotherapy for 30 seconds b. Excision with 1 cm margins c. Observation and clinical follow-up in 6 months d. Shave biopsy of the entire depth and breadth of the lesion e. Topical imiquimod 5 nights a week for 6 weeks
d. Shave biopsy of the entire depth and breadth of the lesion
An 8 year-old patient presents to clinic with moderate atopic dermatitis requiring topical corticosteroids (see photo). You counsel the parent about potential side effects of this medication. Which of the following is a common side effect of prolonged topical corticosteroid use? a. Cushing's syndrome b. Glaucoma c. Photosensitivity d. Skin atrophy e. Skin infections
d. Skin atrophy
A 34-year-old female presents to the dermatology clinic with well-controlled plaque psoriasis. Which of the following conditions do you think you might find when you perform a total body exam? a. Eyelid dermatitis b. Multiple vesicles and pustules c. Subcutaneous nodules d. Swelling of the PIP and DIP joints
d. Swelling of the PIP and DIP joints
A mother brings in her 8-year old daughter Sarah for a well-child visit. Sarah also has a plantar wart. You are discussing with her mother the available vaccinations for disease prevention, including HPV vaccines. Which of the following statements is accurate? a. The HPV vaccine is FDA-approved for girls her daughter's age b. There are no FDA-approved HPV vaccines for males c. The FDA-approved HPV vaccines include serotypes for plantar warts d. The FDA-approved HPV vaccines have been shown to decrease rates of cervical cancer e. The FDA-approved HPV vaccines are also labelled as genital wart therapies
d. The FDA-approved HPV vaccines have been shown to decrease rates of cervical cancer
You are evaluating a patient with a pruritic eruption on the back (see photo). The patient recently had a surgical repair of a compound fracture of the femur and the primary team is worried she has herpes zoster. Which of the following statements is most accurate? a. This is an acneiform eruption, which will resolve without treatment b. This is an infection and she should be started on oral acyclovir c. This is an infestation and hospital infection control should be notified d. This is a delayed hypersensitivity reaction and her skin should be cleaned
d. This is a delayed hypersensitivity reaction and her skin should be cleaned
Which of the following medications is indicated to treat acne in a pregnant woman? a. Oral doxycycline b. Oral isotretinoin c. Oral minocycline d. Topical clindamycin
d. Topical clindamycin
This patient has an ulceration of her foot. What levels of the skin have been disrupted? a. Dermis b. Epidermis c. Subcutis d. a and b e. a, b and c
d. a and b
