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PANCE Dermatology Test Exam 2|
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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. 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 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. 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. 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
Avoidance of cutaneous irritants, such as wool and other rough clothing, is the cornerstone of therapy for atopic dermatitis. 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 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. Pharmacologic treatment of a cat bite in the person with no allergies consists of which of the following? A Trimethoprim-sulfamethoxazole (Bactrim) B Cephalexin (Keflex) C Ceftriaxone (Rocephin) D Amoxicillin-clavulanate (Augmentin) D Amoxicillin-clavulanate (Augmentin) has activity against Pasteurella multocida which is the causative agent in the majority of cat bite infections. Which of the following 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. As a general rule, sutures in the face should be removed in A 2 days
B Prostaglandins C Prednisone D IgE D IgE triggers the release of histamine from mast cells that leads to urticaria. 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 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 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 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. In which of the following patients would one most likely find acanthosis nigricans? A A 55 year-old obese female with hyperinsulinemia
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. 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.
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. 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 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
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. 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. 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. 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. 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.
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. 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 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. 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. 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?
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. 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. 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 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 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
