Dermatologie

1. A young boy comes to you with multiple areas of hypopigmented plaques on the body. Examination, you saw grouped flesh-colored tiny papules on the trunk, along the Blaschko lines. Those lesions are asymptomatic. The kid is otherwise healthy. You made a diagnosis of lichen striatus. What should you tell the parents?

2. A 30 year old man comes to you with diffuse, thick, scaly burning plaques on the palm and the sole, especially on the pressure part. You saw some hyperkeratotic lesions on the elbows the patient did not notice. You made a diagnosis of psoriatic palmoplantar keratoderma. The patient is an active businessman, travelling a lot. What you should advise as a first line treatment?

3. A 20 year old woman just married 3 weeks ago, brought to your office by her husband for a few asymptomatic, brown hyperkeratotic plaques on both legs. Some violin papules were also present on the arms. Those lesions are started since 6 months ago. By the way, he just learned he was infected by Hepatitis C virus. What is your next step? Tell the patient what you are going to do:

4. A 25 year old man works 200km away from his family. He consulted for desquamative skin on the palms and soles for about 3 months. The skin lesions are mild itching. Close examination, the palm and sole are covered with hyperkeratotic, partly hyperpigmented plaques. Multiple slightly scaly plaques found on the trunk. He reported about painless papules which are later became ulcerated that last for one week on his genital area. There was no nail changed neither joints pain. What is your likely diagnosis?

5. A 6 year old boy presented with history of atopic dermatitis. She developed multiple keratotic follicular papules on the extensor surface of the arms and on the side of the thighs. His skin feels rough and look like goose-flesh. You diagnosed it as keratosis pilaris. What will be your advices?

6. A 20 year old girl consulted for multiple ovals, gray to blue brown macules and patches on the neck, trunk and extremities for about 8 weeks. Examination of the scalp, palms, soles, nail and mucous membrane we could not find any pathologic change. Now you diagnose as Erythema dyschromicum perstans. What will be your advices to patient?

7. An 18 year old footballer developed itchy, erythematous, annular, scaly plaques on the back, buttocks and the thighs. His General practitioner prescribed triamcinolone cream for 2 weeks, but it does help just for a couple of days, the skin lesion was keeping growing at the periphery. What is your most likely diagnosis?

8. A 12 year old boy consulted for annular, partly arciform, erythematous patches and plaques on the trunk and extremities for about 2 days. Those patches and plaques are not scaling. One week before the onset of the skin lesion the child developed fever and arthralgia. Laboratory examination revealed high ESR and CRP. ECG show a prolong PR-interval. What is your likely diagnose?

9. A 40 year old man consulted for erythematous and white plaques on the glans, especially around urethral meatus. The preputium became narrow. He reported about painful intercourse and dysuria. What is your likely diagnosis?

10. A 25 year old mal patient consulted for erythematous, slightly scaly itchy plaques on the scalp, eyebrows, around the nose and beard areas. The chest and pubic areas were also affected. You made a diagnosis of seborrheic dermatitis. What laboratory examination you would suggest him to do?

11. A 35 year old woman presented with erythematous lesions on the face. Those lesions are more pronounce (more red and itching) when she exposed to the sunlight. Clinical examination we saw telangiectasia on the cheeks and on the nose. Your diagnosis was rosacea. You plan to treat her with topical medications. Which one would be the best?

12. A 60 year old woman was diagnosed lung tuberculosis since about 3 months. She is now under TB-drugs and was than developed multiple erythematous follicular papules on the face and upper trunk. You diagnosed acneiform eruption. Which drug could be the most responsible?

13. A 35 year old man consulted for painful erosive plaques on the neck, armpits and on the groins. He reported about similar relapsed lesions since about one year. Those lesions are sometimes macerated malodorous vegetative and fissured. Culture was negative. Skin biopsy show acantholysis, but negative immunofluorescence. What is your likely diagnosis?

14. A 30 year old man presented with generalized redness and scaling skin for about 6 weeks. Skin on the back of hands and on the back of feet was scaling. The palms and soles were not thickening. The lesions were itching, especially on the genital area and on the hands and feet. There was no nail changed, no joint pain. He was treated for his asthma with steroid inhalation and Singular 10 mg BID. No other medication was reported. General practitioner have tried to prescribe him Betamethasone cream BID for a month, but was not better. He met a new girlfriend 3 months ago. What is your likely diagnosis?

15. A 20 year old car repairer consulted for recurrent multiple inflammatory follicular papules on the face and on the upper trunk sine about one year. He play regularly sport and did expose a lot to sunlight. He drinks about 1500ml beer in the week, but he is not smoker. He was treated with 5% Benzoyl Peroxide that seem to reduce the inflammation for a while. New lesions still coming every day. You diagnosis was acneiform eruption. What was the reason for his skin problem?

16. A 33 year old mal patient consulted for arthralgia on the wrists, knees and on the ankles. Patient reported that he has recurrent ulcers on the oral mucosa which are lasting for about one week each attack. Complete Blood Count was normal. No hair lost. No erosion on oral mucosa. Multiple atrophic scars on the perianal area. Multiple erythematous painful nodule on the limbs and sometime also on the body, but those lesion health without atrophic scars. What would be your diagnosis?

17. A 60 year old woman presented with follicular papules, some are confluence to orange-red scaly plaques on the body. The palms were covered with orange-red, waxy plaques. We remarked also diffuse erythema with desquamation and follicular hyperkeratosis on the knees. There was neither nail change nor joint pain. Transaminasis was normal. RPR was negative. What is your likely diagnosis?

18. A 45 year old alcoholic mal patient consulted for multiple violin erythematous papules for about 6 weeks. Patient is treating for his Hyperblood pressure with ACE one tablet daily. He also takes hydroxychloroquine 400mg daily and paracetamol 500mg three times daily since about 4 months. For hyperlipidemia his GP prescribed him Simvastatin. The man has tremble hands after stoping alcohol. He received Vitamin B1 twice daily. Skin biopsy confirmed a diagnosis of lichenoid dermatosis. Which of the following medications that most likely to trigger his dermatosis?

19. A 65 year old man consulted for multiple pruritic, crusted and eroded papules on the center of the back and mid of chest since 7 days after Christmas. There was no lesion in the fold areas. No history of skin disease neither in the childhood nor in the family. He has a long history of sun exposure without protection. Skin biopsy show acantholysis with dyskeratosis, associated with intraepidermal clefting. What is your likely diagnosis?

20. A 17 year old boy consulted for keratotic, red and brown papules partly confluence to plaques on the margin of scalp, neckand on the chest since about 5 years. Upon examination, we saw the same lesions on the groins. Longitudinal erythronychia was found. Examination of the oral mucosa we found whitish papules on the palate. Skin biopsy we saw acantholysis and apoptosis. What is your likely diagnosis?

21. You are the doctor of a female patient suffering from acne conglobata (nodulare cystic acne) and you want to treat her with systemic isotretinoin in order to avoid scar formation. What do you not advice?

22. A 15 year old girl presented with multiple blackhead and whitehead comedones. Examination there was neither inflammatory papule nor pustule. The back and chest was spears. You made a diagnosis of acne comedonica. What is your most appropriate first line treatment

23. You see a 19 year old patient with acne and you want to give her some advices. Which of the following statements is not much helpful her?

24. Facial gram-negative dermatitis (tick the correct answer):

25. A 32 year old woman presented with erythema and telangiectasia on the face since about 6 months. Those lesions are relapsed very often. What should you tell the patient to avoid the “Flare-ups" of her rosacea:

26. A 35 year old, 90kg, jobless women consulted for multiple painful, fluctuant pseudocysts and abscesses on the axillary area, under the breasts and on her buttocks since the age of 18. She was treated by many doctors for hidradenitis suppurativa, but still developed same lesions. You decide now to treat her by surgical operation. What should you advice to the patient to make wound healing faster?

27. A18 year old, 1.70m tall and weight 95 kg consulted for multiple painful nodule and abscesses with some hyperplasia scars on the axillary, buttocks and also on the groins. For fear of developing sever hidradenitis suppurativa, you should give some advices to him. What should you tell him?

28. A 30 year old patient was treated by his doctor at the province by triamcinolone injection for multiple scaly plaques on the elbows, knees and also on the scalp. 4 months later he developed more plaques on the body and limbs. Palms and soles are coved with pustules. The flexures areas are speared. There is no dysuria. Conjunctiva and sclera look normal. What is you likely diagnosis:

29. What is the typical morphological appearance of lichen planus of the skin (tick correct answer):

30. How would you treat extensive erosive lichen planus in the mouth (tick correct answer):

31. How does not lichen planus appear in the mouth (tick correct answer):

32. The characteristic signs of lichen sclerosus on the vulva are the following. Which is the best answer?

33. What would be the best medication to treat a 30 year old woman with lichen sclerosus on the vulva?

34. A young man consulted for his relapsing Seborrheic dermatitis. Which of the following topical medication you should not advise him to use?

35. The following complications are seen in lichen sclerosus of the anogenital area. Which one is unlikely to happen?

36. Which is a medication that can worsen psoriasis?

39- Which body part is not often affected by psoriasis?

40. Which is a common trigger for guttate psoriasis in children?

41. What is the most common joint to be involved in psoriatic arthritis?

42. What is the first line treatment for limited plaque psoriasis with body surface area < 5%?

42. Which is a feature of psoriatic arthritis?

43. What HLA is associated with reactive arthritis (Reiter’s disease)?

44. What is a cutaneous finding in reactive arthritis (Reiter’s disease)?

45- What infection is associated with reactive arthritis?

46. Which is not a body part affected by type 3 pityriasis rubra pilaris?

47. What is the most common variant of adult PRP?

48. Which infection can be associated with oral lichen planus?

50. What is the most specific finding of nail lichen planus?

51. Which of the following histologic feature is not seen in lichen planus?

52. What type of lichen planus is most common on the glans penis?

53. What is a long standing complication of vulvar ulcerative lichen planus?

54. Which of the following is a cause of lichenoid drug eruption?

55. What is the most common group to be affected by lichen striatus?

56. What is an organ system involved in acute GVHD?

57. What is the target antigen in Staph scalded skin syndrome?

58. What is one reason that erythroderma can be life threatening?

59. Which of the following is NOT a cause of erythroderma?

61. Which diagnosis is the most pruritic erythroderma?

66. What is the causative organism for seborrheic dermatitis?

67. Which of the following is a first line treatment for seborrheic dermatitis?

68. What is the distribution for Grover’s disease?

69. What is the nail finding for Darier disease?

71. What is the most effective systemic medication for Darier’s disease?

72. Which of the following are exacerbating factor(s) for Darier disease?

73. What is the inheritance pattern for generalized (not Blaschkoid) Darier’s disease?

74. What is the mutation in Hailey-Hailey?

75. What is the classic histologic feature for diagnosis of porokeratosis?

76. What is a complication that could not be seen in Hailey-Hailey?

77. What is the most common skin type for ashy dermatosis?

78. What is the characteristic scale of deep erythema annulare centrifugum?

79. Which of the following is NOT part of the Jones major criteria for rheumatic fever?

80. Which is the classic morphology for erythema migrans?

81. Which cancers have NOT been associated with erythema gyratum repans?

82. Which is the fastest migrating gyrate erythema?

83. Oral tetracycline is not used in pregnant women with acne because of what potential complication in the infant:

84. You have an 18 year old male with severe nodulocystic acne with scarring which has been resistant to many topical medications. All of the following could be considered as a next step in treatment except:

85. You see a 17 y.o female for severe nodulocystic acne of 2 years. She has been on topical therapy (antibiotics and benzoyl peroxide) and oral antibiotics. She is interested in a “stronger therapy”. You discuss use of Isotretinoin use with her. You explain possible complications and side effects to her. You include the following point in your discussion:

86. An obese 18 y.o. Male is referred to you. He has a rash on his neck .He thought it was from his skin “being dirty”, but was unable to scrub it off. On exam you note hyperpigmented velvety changes of his posterior and lateral neck. On history you also find out he has Diabetes Mellitus. His most likely diagnosis is:

87. A 10 y.o. Female present with new onset acne. She has no prior therapy. She has scattered comedones and papules on her face only. Which of the following would you not consider in her therapy?

88. You have a 13 y.o. Male patient who is started on topical benzoyl peroxide for facial acne. You may tell him the following facts except:

89. A differential diagnosis for acne could include the following except:

90. A 25 y.o female patient presents to you for the 1st time with nodulo-cystic acne. Each of the following would be important things to find out in her history except:

91. A 40 y.o female patient with chronic acne complains of the recent development of blue discoloration of her mucous membranes, sclera and scars. The drug most likely to cause this is:

92. You have a 16 y.o. Female patient with moderate acne. You make a decision to treat her with oral Doxycycline. Instructions given her could include all of the following except:

93. Rosacea patients commonly present with all the following except:

94. 40 y.o. Male presents with onychomycosis of the toenails. Medication options include all of the oral medications following except:

95. 20 y.o. Female was treated for lichen planus on her lower legs. The active disease has resolved, but she has severe post-inflammatory hyperpigmentation. She asks how long it will take to resolve. The best estimate would be:

96. Best treatment options for Vitiligo would not include:

97. 25 y.o male presents with a 3cm keloid on his right shoulder. Your treatment option for him would probably include:

98. Minocycline could be an effective treatment modality in all of the following except:

99. You have started a 45 y.o. Male with severe psoriasis on Methotrexate. You have also instructed him to take this essential treatment:

100. Griseofulvin is effective to treat all of the following except:

101. A 9 year old patient presents to your clinic with moderate atopic dermatitis requiring topical corticosteroid use. You counsel the parent about potential side effects of the medication. Which of the following is a common side effect of prolonged topical corticosteroid use?

102. A 28 year old female presents with erythematous papules on her central face. You have diagnosed her with rosacea. Of the following the most appropriate initial treatment would be:

103. A mother brings her 10 y.o. Daughter to you for advice on sun protection. You tell her the following about sunscreens (Choose the best answer) :

104. A 65 y.o. Obese woman has suffered from chronic leg swelling for several years. Her legs intermittently get red & swollen. Recently when this happens she applies a combination of Lanolin & Neosporin ointment. One week ago, she did this and her legs got very inflamed and developed blisters, oozing and severe pruritus. The most likely diagnosis is:

105. A 68 y.o. Male whom you have following for venous stasis disease for 10 years, develops a superficial leg ulcer over the last 2 months. Important facts learned in history taking would be all of the following except:

106. A 6 y.o. Girl presents with firm follicular papules on the lateral aspect of her arms and legs for 6 months. She has a history of atopic dermatitis and asthma. You have diagnosed her with keratosis pilaris. You would instruct the following points to her mother except:

107. A 31 y.o. Male works as a dog trainer for several years. Recently he developed a scaly plaque with a raised border and central clearing on his right forearm. It was mildly pruritic. His primary care physician started him on Triamcinolone cr. 0.05% BID. Since then the lesion has expanded and become more pruritic. The most likely diagnosis is:

108. You have a 30 y.o. Female patient had abdominal surgery 3 months ago. A month later she developed psoriasis plaques along the surgical excision scar. This reaction is best described as a:

109. Common side effects of overuse of topical corticosteroids include all of the following except:

110. A 38 y.o. Male presents to you with a complaint of dryness of his right hand. It has not improved despite using several hand creams. Examination of which of the following body areas would be most important in making his diagnosis:

111. Features frequently seen in patients with atopic dermatitis include the following except:

113. A 67 y.o. Male presents with a new onset of large (1cm) tense bullae on his legs with no pruritus. There was no other cutaneous or mucous membrane involvement. His health was otherwise unremarkable. Of the following diagnoses which is most likely his diagnosis:

114. Acyclovir is important in treating all of the following except:

115. Kerion is a clinical finding which can be seen in which chronic fungal infection?

117. The most common skin cancer is:

118. Most skin cancer deaths result from:

119. Squamous cell carcinoma can be a consequence of which of the following types of warts:

120. Staphylococcus Aureus can play a prominent role in all of the following except:

121. You have a 40y.o. Obese female pregnant for the 1st time. She complains of an urticarial eruption on her torso, but the umbilicus is clear. You diagnose her with Pruritic Urticarial Papules and Plaques of Pregnancy. (PUPP). Instructions you would give her include all of the following except:

122. All of the following dermatoses are frequently seen with pregnancy except:

123. A 32 y.o male presents with a rash, which developed over the last 2 months. It appears to worsen with sun exposure. On exam he has polycyclic, anular scaly plaques (“Medallion plaques”) on his upper shoulders and upper back. His most likely diagnosis is:

124. A 26 y.o female presents with a malar rash over the last 4-6 months. It flares after sun exposure. She also complains of redness of the chest and forearms after sun exposure. Review of system also reveals worsening pain and swelling of wrists and knees. You diagnose her with Systemic Lupus Erythematosus. Which of the following laboratory tests would you not order? :

125. A 28 y.o. Female presents with atrophic plaques with violaceous borders on her scalp, right ear and forehead. Clinically you diagnose her with Discoid Lupus. Which of the following would not be in your treatment plan? :

126. The following skin changes are commonly seen in Systemic Lupus Erythematosus except:

127. A 24 y.o. Pregnant female presents with a 4mm erythematous friable papule on her finger. She remembers scratching the finger a week before it appeared. She comes in because she has difficulty controlling the bleeding. The most likely diagnosis of this lesion is:

128. The following statements about cellulitis are true except:

129. An 18 y.o. Female asks you about what she should look for in choosing a sunscreen. You tell her to look for on the label for all of the following important factors except:

130. You have an 80 y.o. Male with a Basal Cell Carcinoma on his right cheek. Treatment options could include all of the following except:

131. You have a 45 y.o. Male with a cellulitis of his left lower leg. Of the following, which would not be an appropriate treatment:

133. The following statements about flat warts are true except:

135. An 18 y.o. Female presents with a new onset rash. On exam she had several small erythematous anular scaly plaques on her torso and extremities. Mildly pruritic. On history you found out she was diagnosed with a strep throat a couple weeks prior to the outbreak of the rash. Of the following which would make the most likely diagnosis:

136. The gold standard to measure the severity of psoriasis is the:

137. You have a 60 y.o. Female who presents with a new painful rash on her left chest and back x 2-3 days. On exam there are grouped vesicles in a dermatomal distribution on the left chest and back. The most likely diagnosis is:

138. Which of the following statements about Eczema Herpeticum is false:

139. A 56 y.o. Male with a long standing history of rosacea presents to your clinic. His major complaint is the bulbous changes of his nose. The appearance of the nose is usually referred to as:

140. You have a 30 y.o. Patient with recurrent erythema and papules in the malar region of the face. There was no evidence of scarring or atrophy. Your differential diagnosis may include all of the following except:

1. Reliable signs of malignancy are (which answer is correct?):

2. Typical signs for a benign skin tumour (which answer is incorrect?):

3. Which answer is incorrect?

4. Which answer is incorrect?

5. Risk factors to develop skin cancer are (which answer is correct?):

6. Characteristics for SCC are (which answer is incorrect?):

7. Characteristics for BCC are (which answer is incorrect?):

8. SCC differs from BCC by (which answer is correct?):

9. Differential diagnosis for a darkly pigmented nodule (which answer is incorrect?):

10. Differential diagnosis for multiple nodules on the scalp (which answer is incorrect?):

11. Differential diagnosis for a solitary nodule on the scalp (which answer is Incorrect?):

12. Differential diagnosis for a solitary hyperkeratotic plaque on the skin (which answer is incorrect?):

13. Differential diagnosis for an ulcerated non-pigmented nodule (which answer is inc orrect?):

14. Differential diagnosis for multiple hyperkeratotic,verrucous plaques on the trunk (which answer is incorrect?):

15. Which statement is correct?

16. Differential diagnosis for circumscribed homogeneous erythema (which answer is Inorrect?):

17. Differential diagnosis for depigmented macules (which answer is incorrect?):

18. Benign skin tumor that often shows ulceration (which answer is incorrect?):

19. Differential diagnosis for hyperkeratotic papules or plaques (which answer is incorrect?):

20. Differential diagnosis for annular plaques (which answer is incorrect?):

21. Differential diagnosis for a longstanding verrucous tumour on one sole (which answer is correct?):

22. Differential diagnosis for an ulcerated tumour on the penis (which answer is incorrect?)

23. Differential diagnosis for angiofibroma at the sulcus coronarius (which answer is correct?):

24. Differential diagnosis for an ulcerated tumour in the oral cavity (which answer is correct?):

25. Which answer is incorrect?

26. The following tumors are characteristic with rapid growth during the first 3 months after the onset of the lesion. Which one is not belong to the group?

27. Actinic keratosis (which answer is incorrect?):

28. Seborrheic keratoses (which answer is correct?):

29. Dermatosis papulosa nigra (which answer is incorrect?):

30. Epidermal nevus (which answer is incorrect?):

32. Cysts (which answer is incorrect?):

33. Indications for the excision of cysts may be (which answer is correct?):

34. Differential diagnosis to BCC (which answer is correct?):

35. Syingoma is characterized by (which answer is incorrect?):

36. Which answer is incorrect?

37. Which answer concerning melanoma is incorrect?

38. Which answer concerning traumatic neuroma (amputation neuroma) is correct?

39. Differential diagnoses for auricular appendages are (which answer is incorrect?):

40. Which skin tumour is painful (which answer is incorrect?):

41. Which are clinical signs for transformation of lipoma into malignancy (which answer is incorrect?):

42. HIV-associated skin tumours are (which answer is incorrect?)

43. Which statement is incorrect?

44. Pruritus is present in the following conditions, which disease is not typically accompanied by pruritus?

45. The following symptoms are complications of an infantile hemangioma. Which one is not?

46. The following symptoms are typical for nevus flammeus. Which one is not?

A benign epithelial cell neoplasm derived from non-glandular surfaces is referred to as:

48. Which one of the following is not considered to be a distinctive pattern of non-neoplastic growth?

49. Which one of the following is considered to be the hallmark of malignancy

50. The process of neoplastic cells moving through the circulatory system and becoming lodged in a vessel causing obstruction is referred to as:

51. Which of the following variables best predicts prognosis for patient with a recent diagnosis of cutaneous melanoma and no clinical evidence of metastatic disease?

52. Dermoscopic features suggestive of malignant melanoma include:

53. Which syndrome is characterized by multiple keratoacanthomas beginning in childhood?

54. The risk of metastasis from SCC increase with the following factors. Which one is correct?

55. Which of the following features of thin melanomas (1mm thick) has been associated with an increased risk of metastasis?

56. The following vascular lesions are benign. Which one you know the best is malignant?

60 year- old farmer man consult for hyperpigmented, shiny nodule on the forehead for about 5 years. The lesion grows gradually. Dermoscopy shows telangiectatic border. What is your likely diagnosis?

A benign epithelial cell neoplasm derived from non-glandular surfaces is referred to as:

Which one of the following is not considered to be a distinctive pattern of non-neoplastic growth?

60. Each of the following is an anaplastic change except:

61. Which of the following is least likely to be used as a means of distinguishing a benign from a malignant neoplasm?

63. Which one of the following features is more characteristic of a benign than a malignant neoplasm

64. There are at least three (3) groups of DNA viruses known to have strong oncogenic potential in animal systems. Which one of the following is true for DNA viruses with the capability of causing neoplastic transformation

65. Which one of the following is considered to be the hallmark of malignancy

66. The process of neoplastic cells moving through the circulatory system and becoming lodged in a vessel causing obstruction is referred to as:

67. The following cysts are formed by lining of stratified squamous epithelium. Which one is NOT belong to the group?

68. The follow cysts are formed without an epithelial lining. Which one is not in the group?

72. The following vascular diseases are vascular tumors. Which one is NOT?

73. Actinic keratosis is a precursor of the following skin cancer. Which one is the correct answer?

74. The followings statements are about mycosis fungoides. Which one is not true?

75. Which of the following statement is not true about skin tag?

76. Which naevi commonly predispose to malignant melanoma

77. Stage I cutaneous T cell lymphoma treatment is following, Which one is the most appropriate?