Dermatology Final Review

What treatment for psoriasis requires females not to be pregnant and they should not become pregnant for at least 2 years? Several systemic treatments are available for severe or recalcitrant cases of psoriasis. Which of the following requires that women who use it not be pregnant and that they should be warned against becoming pregnant for at least 2 yr after treatment ends? A. Acitretin B. Methotrexate C. Immunomodulatory agents D. Cyclospoirine

A. Acitretin

Which of the following diagnostic tests can determine whether a lesion is vascular or hemorrhagic? A. Diascopy B. Punch biopsy C. Tzanck test D. Examination by Wood light

A. Diascopy

The primary morphology of a macule-type lesion is A. Flat and nonpalpable B. Elevated and palpable C. Lesion that can be either elevated or depressed D. Firm lesion that extends into subcutaneous tissue

A. Flat and nonpalpable

In addition to primary and secondary morphology, color can help identify skin lesions. Which of the following, if present, would suggest Pseudomonas aeruginosa infection? A. Green fingernails B. Violet skin C. Yellow skin D. Skin shades of blue, silver, and gray

A. Green fingernails

Where does candidiasis occur most commonly? A. folds of the skin B. soles of the feet C. nails D. in the nostrils

A. folds of the skin

Which of the following unjustifiably decreases the concern of doctors and patients about a basal cell carcinoma lesion? A. it alternately crusts and heals B. it begins as a shiny papule C. it enlarges slowly D. telangiectasis are present

A. it alternately crusts and heals

Patients with chronic mucocutaneous candidiasis develop red, pustular, thickened, crusted patches on the nose, forehead, and elsewhere. These patches may resemble which of the following conditions? A. psoriasis B. drug interactions C. eczema D. shingles

A. psoriasis

Acne may be inflammatory or noninflammatory and can manifest as several types of lesions. Noninflammatory acne is characterized by comedones. Comedones are characterized by which of the following? A. sebaceous plugs impacted within follicles B. bacterial colonization of follicles C. follicular plugging with keratinatiocytes D. free fatty acids on follicular epithelium

A. sebaceous plugs impacted within follicles

Male-pattern or female-pattern hair loss usually requires no testing. When it occurs in young men with no family history, the physician should question the patient about which of the following? A. use of anabolic steroids B. psychologic stressors C. trichotillomania D. restrictive dieting

A. use of anabolic steroids

Which of the following best describes plaques? A. Clear fluid-filled blisters > 10 mm in diameter B. Firm papules or lesions that extend into the dermis or subcutaneous tissue C. Palpable lesions > 10 mm in diameter that are elevated compared with the skin surface D. Elevated lesions caused by localized edema

C. Palpable lesions > 10 mm in diameter that are elevated compared with the skin surface

What are warning signs for melanoma?

American Cancer Society's ABCDE; Asymmetric, irregular Border, variegated or dark Color, Diameter >6 mm, Evolving mole

Which of the following skin disorders may be accompanied by small-joint arthritis manifesting as stiffness and pain? A. Scabies B. Psoriasis C. Atopic dermatitis D. Lichen planus

B. Psoriasis

Which of the following is the most common pathogen causing cellulitis? A. Escherichia coli B. pseudomonas aerugina C. proteus mirabilis D. streptococcus pyogenes or staphylococcus aureus

D. streptococcus pyogenes or staphylococcus aureus

Onycholysis is separation of the nail plate from the nail bed or complete nail plate loss. Which of the following causes onycholysis? A. Infection with Pseudomonas B. A drug reaction C. Onychotillomania D. Tobacco smoking

B. A drug reaction

Which of the following helps differentiate a drug rash from typical measles? A. The patient has enlarged, tender lymph nodes. B. Cephalocaudal progression is absent. C. A drug rash seldom occurs in children > 3 yr. D. A drug rash does not resemble measles.

B. Cephalocaudal progression is absent.

Which of the following diagnostic tests is often done to evaluate pigmented lesions? A. Shaving B. Deep excision C. Patch test D. Scraping

B. Deep excision

Some patterns of skin lesions are consistent with certain diseases. For example, which of the following patterns is consistent with psoriasis? A. May be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth B. Frequently affects the scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft C. Frequently arises on the wrists, forearms, genitals, and lower legs D. Involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts

B. Frequently affects the scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft

About 50% of nail dystrophies result from which of the following? A. Cancer B. Fungal infection C. Congenital abnormalities D. Psoriasis

B. Fungal infection

The majority of cases of erythema multiforme are caused by which of the following? A. Hepatitis C virus B. Herpes simplex virus infection C. Systemic lupus erythematosus (SLE) D. Vaccines

B. Herpes simplex virus infection

A 40-year-old woman comes to the office because of swelling and tenderness in her right leg below the knee. When examined, the skin is hot, red, and edematous, and its surface resembles the skin of an orange (peau d'orange). The factor in her history that differentiates a diagnosis of cellulitis rather than deep venous thrombosis (DVT) is A. unilateral presentation B. Peau d'orange C. lack of bruising over the affected area D. lack of bullae over the affected area

B. Peau d'orange

Some nail deformities and dystrophies can be clues to systemic problems. Which of the following disorders is likely in patients with yellow nail syndrome? A. Cirrhosis B. Pleural effusion C. Severe iron deficiency D. Renal failure

B. Pleural effusion

Which of the following treatments is most appropriate if herpes simplex virus infection is the suspected cause of erythema multiforme and recurrences are frequent (> 5 times/yr)? A. Cyclosporine B. Prophylactic antiviral drugs C. Topical anesthetics D. Topical corticosteroids

B. Prophylactic antiviral drugs

Which of the following describes the secondary morphology (lesion configuration) of annular lesions? A. Rings with central duskiness B. Rings with central clearing C. Lacy or networked pattern D. Grouped papules or vesicles

B. Rings with central clearing

Measles is highly contagious. Communicability begins several days before and continues until several days after the rash appears. Transmission is typically by large respiratory droplets that are discharged by cough and briefly remain airborne for a short distance. Which of the following is another means of disease transmission? A. Animal vectors B. Small aerosolized droplets C. Transmission by fomites on surfaces D. Contact with a vaccinated person living with an infected child

B. Small aerosolized droplets

Appropriate treatment of acne is based on the nature and severity of the lesions. Which of the following is appropriately treated by intralesional triamcinolone? A. severe acne B. cystic acne C. moderate acne D. comedones

B. cystic acne

Which of the following liquid vehicles are often more effective for controlled release of topical agents? A. foams B. gels C. lotions D. solutions

B. gels

Which of the following is often used to treat recurrent or incompletely treated cancers, large cancers, cancers at recurrence-prone sites, and morphea-like cancers with vague borders? A. curettage and electrodessication B. mohs surgery C. photodynamic therapy D. topical chemotherapy

B. mohs surgery

Treatment of androgenetic alopecia with finasteride in men may alter the levels of which of the following? A. cortisol B. prostate-specific antigen (PSA) C. thyroxine D. cholesterol

B. prostate-specific antigen (PSA)

For acne caused by endocrine abnormalities (eg, polycystic ovary syndrome, virilizing adrenal tumors in females), which of the following treatments is indicated? A. tetracycline B. spironolactone C. isotretinoin D. benzoyl peroxide

B. spironolactone

Scalp plaques are notoriously difficult to treat. Resistant skin or scalp patches may respond to local superficial intralesional injection of triamcinolone acetonide suspension diluted with saline. This treatment may cause which of the following? A. Basal cell carcinoma B. Exacerbation C. Local atrophy D. Systemic absorption

C. Local atrophy

If clinical characteristics are inconclusive, the diagnosis of Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN) can be confirmed by which of the following? A. Serum BUN concentration > 28 mg/dL B. Serum glucose concentration > 250 mg/dL C. Necrotic epithelium D. Evidence of infection

C. Necrotic epithelium

An infant whose mother has immunity to measles receives antibodies transplacentally; these antibodies are protective for a period of time. At what age should infants be vaccinated? A. Birth to 2 mo B. 4 mo C. 12 to 15 mo D. 18 to 24 mo

C. 12 to 15 mo

Which of the following drugs must be used cautiously when treating urticaria in elderly patients? A. Cetirizine B. Desloratadine C. Diphenhydramine D. Fexofenadine

C. Diphenhydramine

After an insect sting, local chemical cellulitis is often confused with secondary bacterial cellulitis. When should secondary bacterial cellulitis be considered? A. Swelling and erythema peak at 48 h. B. Pain from the sting diminishes. C. Erythema and swelling begin a day or two after the sting rather than immediately. D. A burning sensation is present

C. Erythema and swelling begin a day or two after the sting rather than immediately.

In Tzanck testing, multinucleated giant cells indicate which of the following? A. Candidiasis B. Erythrasma C. Herpes infection D. Tinea

C. Herpes infection

Risk factors for severe systemic complications and mortality include burns of > 40% of total body surface area (TBSA), patient age > 60 yr or < 2 yr, and presence of simultaneous major trauma or smoke inhalation. Which of the following is one of the most common systemic complications caused by burns? A. Hypoalbuminemia B. Rhabdomyolysis C. Infection D. Ileus

C. Infection

A 22-yr-old man who is visiting from out of town comes into an urgent care center complaining of malaise, fever, headache, cough, and red, itchy eyes that started about a week ago. Questioning reveals his primary care doctor had started him on sulfasalazine for his ulcerative colitis about a week earlier. He has been visiting the area for a few days and thought his symptoms were related to a "bug" he might have caught on the airplane, but then, suddenly, a rash appeared "all over." Physical examination detected that the patient has keratoconjunctivitis. There are macules in a target configuration on his face, neck, upper trunk, palms, and soles of his feet. The presumptive diagnosis is toxic epidermal necrolysis (TEN). Which of the following is the most likely cause of his symptoms? A. A viral infection B. Use of illegal drugs C. Prescription drug adverse effect D. Food-borne toxins

C. Prescription drug adverse effect

Electrical burns (see also Electrical Injuries) result from heat generation and electroporation of cell membranes associated with massive current of electrons. Which of the following describes A. Only the epidermis is affected. B. Fever and an elevated WBC count suggest that sepsis is developing. C. The burns often cause extensive deep tissue damage to tissues despite minimal apparent cutaneous injury. D. Skin and deeper tissue necrosis may progress over several hours.

C. The burns often cause extensive deep tissue damage to tissues despite minimal apparent cutaneous injury.

Which of the following disorders is very common among elderly patients and especially likely if itching is primarily on the lower extremities? A. Dermatitis herpetiformis B. Lichen planus C. Xerotic eczema D. Urticaria

C. Xerotic eczema

Chronic mucocutaneous candidiasis is characterized by red, pustular, crusted, and thickened plaques, especially on the nose and forehead. It is invariably associated with which of the following related conditions? A. addison disease B. hypoparathyroidism C. chronic oral candidiasis D. chronic paronychia

C. chronic oral candidiasis

In immunocompromised patients who are not responding to empiric therapy or in whom blood cultures do not isolate an organism, which of the following may be necessary? A. culture the skin B. culture the wound C. culture the tissue D. culture the urine

C. culture the tissue

In addition to puberty, which of the following is a trigger of acne? A. masturbation B. inadequate face washing C. occlusive cosmetics D. chocolate in the diet

C. occlusive cosmetics

In evaluating a patient whose symptoms suggest cellulitis, diagnosis is confirmed by A. wound culture B. blood culture C. physician examination D. history

C. physician examination

Systemic absorption and local adverse effects are more likely when topical corticosteroids are applied to which area? A. the trunk B. the hands C. the face D. the legs

C. the face

For patients who are allergic to penicillin and who have mild cellulitis caused by mammalian bites, which of the following antibiotic combinations is recommended? A. Streptomycin plus clavulanate B. vancomycin plus clavulanate C. cefazolin plus sulfamethoxazole D. trimethoprim plus sulfamethoxazole

D. trimethoprim plus sulfamethoxazole

Which of the following preventive measures is most likely to reduce risk of basal cell carcinoma? A. staying indoors in the early morning B. using sunscreen with a sun protection factor (SPF) of at least 15 C. using cunscreen when at a tanning salon D. wearing protective clothing when outdoors

D. wearing protective clothing when outdoors

Which of the following tests should be done if wheals persist for > 48 h or if the diagnosis is uncertain? A. Cryoglobulin titer B. Hepatitis serologies C. Ova and parasites D. Skin Biopsy

D. Skin Biopsy

Patients with widely disseminated purpuric macules and blisters and prominent involvement of the trunk and face are more likely to have which of the following disorders rather than erythema multiforme? A. Bullous pemphigoid B. Dermatitis herpetiformis C. Essential urticaria D. Stevens-Johnson syndrome (SJS)

D. Stevens-Johnson syndrome (SJS)

Acute urticaria most often results from which of the following conditions? A. Autoimmune disorders B. Bacterial infections C. Idiopathic causes D. Type I hypersensitivity reactions

D. Type I hypersensitivity reactions

The differential diagnosis of acne includes rosacea. Which of the following characterizes rosacea A. Acneiform eruption that begins suddenly B. Lesions in a perioral distribution C. Pustules in the same stage of development D. Usually no comedones

D. Usually no comedones

Which of the following is a common sign of local or systemic immunosuppression? A. vulvovaginal candidiasis B. candidal nail infections C. tine pedis D. oropharyngeal candidiasis

D. oropharyngeal candidiasis

In addition to clinical appearance, diagnosis of candidiasis is usually based on which of the following? A. symptoms, primarily itching B. skin culture C. cultures from affected nails D. potassium hydroxide wet mount

D. potassium hydroxide wet mount

Melanoma can develop from what?

an irregular mole

Melanoma can most likely be cured if what?

if it's in the epidermis only & hasn't gone to the deeper layers