Derm Quiz Questions (through fungal) Flashcards

1
Q

What is the BEST morphological term for these primary lesions?

a. papules
b. pustules
c. bullae
d. vesicles
e. nodules

A

d. vesicles

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2
Q

The lesions pictured are most accurately described as:

a. Angulated purpuric patches w/ bullous epidermal necrosis
b. Hemorrhagic vesicles
c. Patchy erythema w/ edematous nodules
d. Palpable purpura
e. Patchy erythema with bullae

A

a. Angulated purpuric patches with bullous epidermal necrosis

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3
Q

This photo demonstrates a chronic tinea infection, the secondary feature most prominent in this image is:

a. Atrophy
b. Ulceration
c. Erosion
d. Crusting
e. Lichenification

A

e. Lichenification

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4
Q

64y/o F presents to the ER w/ these lesions scattered over her whole body and involving her lips and oral mucosa. What is the most appropriate morphologic terminology for the clinical findings pictured here?

a. Eroded plaque
b. Necrosed nodule
c. ulcerated plaque
d. Crusted tumor
e. Friable patch

A

C. Ulcerated plaque

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5
Q

A physician contacts you for consultation of the pt pictured here. They describe the findings as “many small dark red macules that don’t fade or blanch when pressure is applied”. What is the most appropriate morphological description of this finding?

a. Erythematous patch
b. Clustered purpuric macules
c. Crusted erosion w/ peripheral erythema
d. Petechiae coalescing into purpuric patcch
e. Hemorrhagic perifollicular plaque

A

d. Petechiae coalescing into purpuric patcch

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6
Q

Which of the following is an indication for a total body skin exam?

a. New pt. with acne on her forehead
b. New pt with a sister who has melanoma
c. New pt w/ a mole on his chin that he’s had since childhood w/o change
d. New pt w/ a paternal aunt w/ a h/o melanoma
e. New pt w/ a wart on her right index finger

A

b. New pt with a sister who has melanoma

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7
Q

60 y/o F presents w/ a pruritic lesion on her back that is becoming more raised (see photo). The most likely dx is:

a. Dermatofibroma
b. Flat wart
c. melanoma
d. Seborrheic keratosis
e. Solar Lentigo

A

d. Seborrheic keratosis

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8
Q

58y/o F presents to clinic w/ skin colored lesions on her neck. Based onthe image, which of the following is the most likely dx?

a. Acrochordons

B. Nodular basal cell carcinoma

C. dermatofibromas

D. seborrheic keratoses

e. common warts

A

a. Acrochordons

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9
Q

32y/o M presents w/ an asymptomatic papule on his thigh that he noted following an inflamed hair follicle (see photo). It dimples on either side when squeezed. What is the most likely dx?

A. benign melanocytic nevus

b. Dermatofibroma
c. epidermal inclusion cyst
d. Keloid
e. Seborrhic keratosis

A

b. Dermatofibroma

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10
Q

42y/o African American F presents w/ brown papules located around her eyes and on the malar cheeks. Several of her aunts were similarly affected at the same age. She would like them removed. Which of the following txs is omst likely to cause hypopigmentation?

a. Liquid nitrogen
b. Low voltage electrodessication
c. Keratolytic moisturizer
d. Snip excision

A

a. Liquid nitrogen

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11
Q

60 y/o F presents w/ scattered light brown macules on her dorsal hands and face, which have increased in number in recent years. They don’t bleed and are otherwise unchanged. She works as a dog walker just outside of LA. Based on image and hx, what is the most likely dx?

a. Actinic keratoses
b. Nodular basal cell carcinomas
c. Melanomas
d. Solar lentigines
e. Common warts

A

d. Solar lentigines

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12
Q

A Male patient has been treating the lesions on his hand (see photo) with OTC salicylic acid solution off and on for one year. He is embarrassed by the appearance of his hands and the lesions are spreading. What is the best tx?

a. Cryotherapy with liquid nitrogen
b. Intralesional triamcinolone acetonide
c. Surgical excision
d. Topical calcineurin inhibitor
e. Topical retinoid

A

a. Cryotherapy with liquid nitrogen

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13
Q

30 y/o M has this lesion on his finger x3 years. What is the most appropriate morphologic term to describe this lesion?

a. Cyst
b. Nodule
c. Papule
d. Plaque
e. Vesicle

A

c. Papule

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14
Q

This patient has the pink papules and plaques seen here. What serotype of HPV is the most likely cause?

a. HPV 1
b. HPV 2
c. HPV 5
d. HPV 6
e. HPV 7

A

D. HPV 6

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15
Q

8y/o F presents for well child visit. Sarah also has a plantar wart. You are discussing with her mother the available vaccination for disease prevention, including HPV vaccines. What should you tell the mom?

a. The HPV vaccine is FDA-approved for girls her daughters 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 cancers
e. The FDA approved HPV vaccines are also labeled as genital wart therapies

A

d. The FDA approved HPV vaccines have been shown to decrease rates of cervical cancers

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16
Q

30y/o M presents with this painful plaque on his foot. After examining his hands and feet you tell him that its a wart and it looks like it is the only one. He hasn’t tried to treat it before and wants to start. What should you recommend?

a. Imiquimod
b. Salicylic acid
c. Shave removal
d. Squaric acid
e. Tretinoin

A

B. Salicylic acid

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17
Q

18y/o F w/ presents with multiple warts on her hands for the past 4 years. She had them “frozen” by another provider and it hurt so much that she is refusing “anything” that hurts. Which of the tx options below would be appropriate for her?

A. Adhesive (duct) tape

B. Apple cider vinegar home therapy

C. Imiquimod cream 5 nights a week

D. Laser therapy

E. Referral to dermatologist

A

E. Referral to dermatologist

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18
Q

A 14 y/o girl (see photo) presents to your office w/ her mother. How would you describe her skin lesion?

a. Nodulocystic acne
b. Primarily comedonal acne
c. Primarily inflammatory acne
d. Rosacea
e. She does not have acne

A

b. Primarily comedonal acne

19
Q

A 15 y/o female presents to clinic w/ acne w/ 30-40 comedones on the forehead, cheeks, and chin w/ very few erythematous papules and no scarring. She reports that topical benzoyl peroxide is not working. What should you prescribe now?

a. Oral isotretinoin
b. Oral Minocycline
c. oral spironolactone
d. Topical abx
e. Topical retinoid

A

e. Topical retinoid

20
Q

A 16 y/o M presents to your office for his health maintenance visit. He has not used any tx for his acne (see photo). The MOST appropriate initial tx plan is:

a. Start oral Doxycycline, topical tretinoin and benzoyl peroxide wash and f/u in 3 months
b. Start oral doxy, topical tretinoi and benzoyl peroxide wash and f/u in 6 months
c. start topical tretinoin and benzoyl peroxide was and f/u in 3 months
d. Start topical tretinoin and benzoyl peroxide wash and f/u in 6 months

A

a. Start oral Doxycycline, topical tretinoin and benzoyl peroxide wash and f/u in 3 months

21
Q

Which of the following diagnoses BEST describes the patient in the photo?

a. Erythematotelangietactic Rosacea
b. Papulopustular Rosacea
c. Phymatous Rosacea
d. Ocular Rosacea

A

a. Erythematotelangietactic Rosacea

22
Q

A 52 y/o M presents w/ erythematous papules and pustules on his cheeks and nose for several years (see photo). He also is embarrassed by ther erythema on his nose and worries that his friends thinks hes 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 2-3x daily

A

c. Metronidazole cream twice daily

23
Q

Oral tetracyclines are not used in children <8y/o b/c:

a. Risk of bleaching hair
b. Risk of damage to tooth enamel and developing bones
c. RIsk of hyperkalemia
d. Risk of hyperpigmentation of the skin

A

b. Risk of damage to tooth enamel and developing bones

24
Q

When prescribing meds for acne vulgaris, an important step is to establish reasonable expectations w/ the pt. How long might the pt have to wait before seeing improvements in his/her acne?

a. 1-2 wks
b. 3-4 wks
c. 2-3 months
d. 4-6 months

A

c. 2-3 months

25
Q

Acne rosacea can be differentiated from acne vulgaris by which of the following features?

a. Absence of comedones
b. Distribution limited to the face
c. Inflammatory papules and pustules
d. Irriation from topical products

A

a. Absence of comedones–> ANSWER

b. Distribution limited to the face (individuals can be acne vulgaris limited to the face)
c. Inflammatory papules and pustules (Seen in both acne rosacea and acne vulgaris)
d. Irriation from topical products (True in both acne rosacea anbd acne vulgaris)

26
Q

Which of the following meds is indicated to tx acne in pregnant women?

a. Oral Doxycycline
b. Oral Isotretinoin
c. Oral Minocycline
d. Topical Clindamycin

A

d. Topical Clindamycin

27
Q

Which of the following patients would be most appropriate to refer to derm?

a. Pt has both comedonal acne and few inflammatory lesions on the face, chest and back
b. Pt has no improvement in moderate acne after 1 month of tx w/ topical retinoid
c. Pt is a post-adolescent female w/ new onset acne
d. Pt has extensive nodular lesions w/ cysts and diffuse scarring

A

d. Pt has extensive nodular lesions w/ cysts and diffuse scarring

28
Q

An 18y/o white female returns to your clinic for acne. She has comedones that have improved w/ topical retinoid therapy and benzoyl peroxide, but she still gets pustules and inflammatory papules. She plays field hocky. You decide to prescribe doxycycline. What side effect should you warn her about?

a. Decreased efficacy of birth control pills
b. Hyperpigmentation
c. Hypertriglyceridemia
d. Photosensitivity
e. Staining of teeth

A

d. Photosensitivity

29
Q

A 20y/o M presents to clinic with a rash on the scalp, extensor elbows, knees and umbilicus. You note sharply demarcated erythematous plaques w/ silvery scale in those locations; there is no central clearing. The soles of the feet are normal. What is the most likely dx?

A. Allergic contact dermatitis

B. Atopic dermatitis

C. Psoriasis

D. Secondary Syphilis

E. Seborrheic dermatitis

A

C. Psoriasis

30
Q

A 22 y/o F 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 treatment 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

A

B. Moderate potency topical steroid (e.g. fluocinonide ointment)

31
Q

34y/o F 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

A

D. Swelling of the PIP and DIP joints

32
Q

A 14y/o M presents to his pediatrician w/ a 3yr 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 BSA and the topical treatments are not working. He is embarrassed to participate in gym class b/c 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 3 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 diesease

A

C. Refer him to a dermatologist for consideration of systemic treatment

33
Q

A 68y/o italian male come to your clinic for evaluation of HTN and high cholesterol. He asks you in passing about some dryness and mild itching on both his feet for several years that has not improved with OTC hydrocortisone 1% creat and moisturizers. WHat is the next step in determining the dx?

A. Patch testing for allergic contact dermatitis

B. Potassium hydroxide test

C. Biopsy to r/o skin cancer

D. Bacterial swab culture

A

B. Potassium hydroxide test

34
Q

26y/o Lebanese M presents w/ 2 years of white spots on his neck, upper chest and back, that are more noticeable in the spring and summer months and get better in the winter. You perform a KOH exam in the office as shown. What tx would you recommend?

A. Desonide cream

B. Pimecrolimus cream

C. Oral prednisone

D. Selenium sulfide wash

E. Ultraviolet light therapy

A

D. Selenium sulfide wash

35
Q

Ms. Hernandez is a 30y/o Asian indian female who presents with several months of worsening pruritic dry scaly skin b/w the toes and over the lateral aspects of her right foot. More recently she developed blisters on the plantar aspect of the foot beneath the toes that opened and started peelingl. She doesnt report any skin changes on her left foot or anywhere else on her body. She did not have any change in her shoes or skin care regimen (lotions, soaps, etc). Which dx is MOST likely?

A. Contact dermatitis (eczema)

B. Dyshidrotic eczema

C. Friction blisters

D. Psoriasis

E. Tinea Pedis

A

E. Tinea Pedis

36
Q
A
37
Q

A KOH test is performed and you see the following through the microscope. What are the findings?

A. Budding yeast forms, no hyphae

B. Mites, eggs, and scybala

C. Multinucleated giant cells

D. Normal keratinocytes (skin cells) only

E. Septate hyphae

A

E. Septate hyphae

38
Q

This 54 y/o white man presents w/ several yrs of erythema and greasy scale on his central face, including the glabella, eyebrows, and nasolabial folds (see photo) the appropriate next step is:

A. Avoidance of spicy foods, alcohol or hot liquids

B. Clobetasol cream twice daily

C. Ketoconazole cream once to twice daily

D. Moisturizers 2-3x daily

E. Topical retinoid cream

A

C. Ketoconazole cream once to twice daily

39
Q

A 28 y/o White female developed an itchy rash on her wrist about 2 months ago. She used clotrimazole cream daily for 2 weeks w/o much help. She was prescribed topical triamcinolone which decreased the redness and itching, but now the rash is expanding after 3 wks of treatment. A KOH exam was floridly positive. What is the next appropriate treatment?

A. Naftifine cream or gel

B. Nystatin cream or ointment

C. Oral Ketoconazole

D. Oral terbinafine

E. Selenium sulfide shampoo

A

D. Oral terbinafine

40
Q

A 32 y/o healthy black male c/o 5 years of progressive thickening and discoloration of his first toenails and he is worried it is spreading to other toes. Which of the following do you recommend first?

A. Ciclopirox nail lacquer

B. Empirically begin oral fluconazole

C. Empirically begin oral ketoconazole

D. Empirically begin oral terbinafine

E. Perform fungal culture or KOH to confirm dx

A

E. Perform fungal culture or KOH to confirm dx

41
Q

For a patient w/ seborrheic dermatitis of the scalp, what advice would you give w/ regard to using anti-dandruff shampoos?

A. Allow them to sit on the scalp overnight then rinse out in the AM

B. Avoid using any topical steroids on the scalp if you are usin antidandruff shampoos

C. Leave them in for at least 3-5min before rinsing out

D. They should be applied to a dry scalp

E. You should avoid a conditioner after using them

A

C. Leave them in for at least 3-5min before rinsing out

42
Q
A
43
Q

A 48y/o white F c/o redness under both her breasts for the past 7 months. It is mildly itchy and didn’t get better after her husband suggested she use his athletes foot cream on it. What do you tell her?

A. Air dry the area after showers and consider repeating this once more during the day

B. Biopsy is usually recommended to rule out other conditions

C. It is important to keep the area hydrated with creams or lostions

D. If this were caused by yeast, OTC athlete’s foot creams like miconazole would not help

E. The majority of these cases are caused by Candida yeast

A

A. Air dry the area after showers and consider repeating this once more during the day

44
Q

What clinical finding in intertrigo suggests it may be caused by Candida yeast?

A. A yellowish transudate over symmetric erythematous patches

B. Annular scaling patches with central clearing

C. Lichenified erythematous plaques w/ hyperpigmentation

D. Satelite macules, papules or pustules

E. Ulceration in the center of the intertriginous folds

A

D. Satelite macules, papules or pustules