Rosh Review Derm (PART 1) PDF

A 22-year-old man presents with patches of skin discoloration that he noticed about two weeks ago. He works as a lifeguard during the summer and noticed it after his first week of work. The affected skin is not painful or pruritic. Upon physical exam, you notice some hypopigmented, whitish, oval-sha...

A 22-year-old man presents with patches of skin discoloration that he noticed about two weeks ago. He works as a lifeguard during the summer and noticed it after his first week of work. The affected skin is not painful or pruritic. Upon physical exam, you notice some hypopigmented, whitish, oval-shaped macules on the patient’s abdomen. The patient is diagnosed with tinea versicolor. Which of the following is the best initial treatment for this condition? Avoid irritants such as harsh soaps or fragrances, for one month Oral fluconazole once every six months Oral fluconazole once per week for four weeks Topical ketoconazole to be applied daily for two weeks A 42-year-old woman presents with concerns about a persistent cutaneous lesion that is resistant to therapy. She reports a 2 cm light pinkish-orange and slightly scaly annular patch on her right lower abdomen that appeared 2 weeks ago. It is not pruritic. She has been treating it twice a day with a prescription topical antifungal, and the lesion has not improved or resolved. Yesterday, she developed more lesions in other areas that are similar in color but much smaller. She reports having influenza last month and did not receive antiviral therapy. Which cutaneous distribution of lesions differentiates the most likely disorder from other dermatoses? Acral distribution Extensor surface distribution Fir-tree pattern distribution Zosteriform distribution A 40-year-old woman with hepatitis C virus presents to the clinic with a purple, papular, pruritic, and polygonal rash on her ankles and volar wrists. Which of the following additional findings is characteristic of the most likely diagnosis? Erythema migrans Involvement of the palms and soles Vesicular lesions on an erythematous base Wickham striae A 25-year-old man presents to the clinic with erythematous, pruritic, and tender bumps on his buttocks. He says that the bumps sometimes have pustules at the end. He states that he sweats a lot and does not have good personal hygiene. He reports no recent exposure to a heated swimming pool or hot tub. Which of the following is the most likely diagnosis? Hidradenitis suppurativa Keratosis pilaris Pseudomonas aeruginosa folliculitis Staphylococcus aureus folliculitis A 27-year-old woman presents to her provider with a rash over her entire torso, and some on her arms and legs. Her vital signs are normal. She reports mild itchiness that improves with taking diphenhydramine, however, she is anxious about why she has the rash and how to make it go away. She has had no recent changes to her hygiene, cosmetic products, or laundry products. She is healthy overall but did complete a 10-day course of sulfamethoxazole-trimethoprim for a urinary tract infection two days ago. On exam, she has a morbilliform rash and there are no hives, pustules, or petechiae. Her mucous membranes are not involved, and her face, palms, and soles are spared. Based on her history and exam, a reaction to the antibiotic is suspected as the cause of the rash, and she is given reassurance the rash should self-resolve in the next one to two weeks. Which of the following mechanisms is likely responsible for her reaction and rash? Antigen exposure, causing release of vasoactive substances Antigen exposure, sensitizing T cells, which then mediate tissue injury Antigen or hapten binding to antibodies, leading to cell or tissue injury Formation or deposition of antigen-antibody complexes in vessels or tissue A 24-year-old man with a history of atopic dermatitis is recently diagnosed with nummular eczema. Which of the following best describes the appearance of his skin on physical exam? Presence of a few erythematous, scaly, well-demarcated, rough plaques that are thickened with exaggerated skin lines Presence of a few round, erythematous, scaly plaques with raised erythematous narrow borders and central clearing Presence of multiple round-to-oval erythematous plaques that appear on the face and scalp Presence of multiple “coin-shaped” erythematous plaques that are on the arms and legs A 65-year-old woman presents to her dermatologist with a small growth on her face for the past 6 months. She has a history of tanning and using tanning beds at least once per week. On physical exam, there is a 1 cm pink, pearly papule with a rolled border. A telangiectasia can be seen just below the surface of the lesion. Which of the following is the most likely diagnosis? Acrochordon Basal cell carcinoma Melanocytic nevi Seborrheic keratoses A 27-year-old man with a history of intravenous drug use presents to the clinic with redness and swelling along the lateral nail fold of his index finger. There is no associated abscess. Which of the following antibiotics is the best treatment for this patient if methicillin-resistant Staphylococcus aureus needs to be covered? Oral cephalexin Oral clindamycin Oral dicloxacillin Topical mupirocin https://remnote-user-data.s3.amazonaws.com/fS4kWEk9MnBlr7XYodEUAivdxGmTob4-qLC1FQx357rbO9Fm-vgOj90rpFf-Jk9lN6606_Vn1LL6lk_DI0KE-WQAobW9OHkzTeMqjj4v5DRGTCtkJJCAMstnlq0lw7E-.png A woman presents to the clinic reporting a thickened patch of skin on the anterior surface of her lower leg, as seen in the picture above. She states this lesion has been present for over 5 years and the skin has progressively become tougher and more noticeably discolored. She reports habitually scratching this area due to her underlying atopic dermatitis. Which of the following is the best diagnosis? Lichen planus Lichen sclerosus Lichen simplex chronicus Lichen striatus A 42-year-old, right-handed woman presents to your office with three days of pain and swelling of her right middle finger. On physical examination, she has swelling, erythema, and marked tenderness over the proximal nail fold. The nail itself appears normal. Which of the following is the most likely diagnosis? Felon Herpetic whitlow Onychomycosis Paronychia A 35-year-old man presents to the office with redness to his forehead and cheeks for the past few months. He has tried over-the-counter topical preparations, which have not helped. Upon physical examination, you note mild erythema to the cheeks, forehead, and nose with the presence of multiple telangiectasias, skin thickening, and dryness. He states that he experienced flushing to the face as a child that has progressively gotten worse. Which of the following is the most likely diagnosis? Acne vulgaris Rosacea Seborrheic dermatitis Systemic lupus erythematosus Which of the following patient populations experiences an increased incidence of lichen planus? Patients taking selective serotonin reuptake inhibitors Patients who abuse alcohol Patients with diabetes mellitus Patients with hepatitis C Which of the following treatment options is considered first line in the treatment of mild to moderate atopic dermatitis? Crisaborole Hydrocortisone Phototherapy Tacrolimus Which of the following factors is included in the ABCDE clinical prediction criteria to determine the risk of malignant melanoma? Asymmetry Bleeding Circumference > 15 mm Diameter > 4 mm A 32-year-old woman presents with concern for a new rash on both of her elbows. The lesions are not painful or itchy. She is otherwise well with no other new symptoms or recent illnesses. On exam, well-demarcated erythematous plaques with silvery scales are noted, which are concerning for psoriasis. Which of the following is likely the first step in the pathogenesis of this disease? Keratinocytes that produce an inflammatory response Production of cytokines Up-regulation and differentiation of T cells Up-regulation of dendritic cells A 30-year-old woman presents to her dermatologist. She states she has recently been sunbathing, but her tan is not even. She has noticed some whitish patches under her arms and across her chest. Her only medication is an oral contraceptive. She recalls having a similar reaction to the sun as a child where only her face was affected. Her mother had a similar reaction to sun exposure. Which of the following would be the initial test for this condition? Antinuclear antibody testing Potassium hydroxide preparation Punch biopsy Tzank smear A 28-year-old woman presents with concerns for skin changes to her hands, and now a new spot on her face. The spots are not itchy or painful. She recently gave birth to her first child and there were no complications with the pregnancy or delivery. She has had no recent illnesses. On exam she has several well-demarcated pale macules and patches between 1–4 cm in diameter on both of her hands and one near her lips, concerning for vitiligo. Which of the following mechanisms is most likely responsible for pathogenesis of this disease? Autoimmune Genetic Infectious Neoplastic A 60-year-old woman presents to the clinic with a new mole on her back. The patient reports the lesion has been growing. Physical exam reveals irregular borders and variegated color. Biopsy confirms the diagnosis of melanoma and shows that the lesion is 1.5 millimeters thick. Which of the following in the next best step? Cryotherapy Excision with narrow margins Excision with wide margins Radiation therapy Which of the following is an appropriate second-line therapy for acne vulgaris? Isotretinoin Oral doxycycline Oral trimethoprim-sulfamethoxazole Topical benzoyl peroxide A 35-year-old woman presents to the clinic with raised lesions on her elbows and knees that are erythematous, well-defined, and symmetric. The lesions have an overlying silvery scale. She states that she has a family history of similar lesions. Which of the following is the most likely diagnosis? Erythrodermic psoriasis Guttate psoriasis Plaque psoriasis Pustular psoriasis A 20-year-old woman presents to her primary care provider with a complaint of an itchy rash. She states that she had a headache and sore throat about one week ago. She noticed an itchy spot on her chest a few days ago, but today the rash is all over her back and between her breasts. On physical exam, the initial patch is pink, oval-shaped, and about 5 cm in diameter with a central clearing surrounded by a scaly collar. The newer lesions are smaller and are seen in the cleavage lines and proximal extremities. A potassium hydroxide preparation is negative. Which of the following is the most likely diagnosis? Guttate psoriasis Pityriasis rosea Secondary syphilis Tinea versicolor A 52-year-old woman presents to her dermatologist with a complaint of persistent facial redness and flushing that affects her cheeks, nose, chin, and forehead. She states that if she has spicy foods or is in the sun, her skin becomes very dry and stings. On physical exam, there is facial erythema in the central region of her face. No pustules or phymatous changes are present. Which of the following pharmacologic agents would be most effective in managing her facial erythema? Topical brimonidine Topical metronidazole Topical permethrin Topical retinoids A 45-year old woman with a history of atopy presents to the dermatologist due to an intensely pruritic rash on her hands. It has been coming and going every few weeks for the last six months. The pruritis seems to happen all of a sudden and lasts for a week or two, and allergy medicine, lotions, and hydrocortisone that control her eczema seem to have little to no effect on relieving the pruritis or rash. Previously, by the time she made an appointment to be seen, the rash had resolved. She shares pictures on her phone of an erythematous vesicular rash on her palms from the most recent eruption. On physical exam, both of her palms are dry with peeling patches marked with shallow fissures and she does not have any other active lesions. Which of the following is the most likely diagnosis? Atopic hand dermatitis Dermatophytid reaction Dyshidrotic eczema Herpetic infection A 35-year-old man who is positive for human immunodeficiency virus with a CD4 count of 99/mm³ presents to his primary care provider for follow-up. He has recently started antiretroviral therapy and has noticed a painless skin rash that has gotten significantly worse. On physical exam, which of the following presentations of rash would be most likely identified? Blanching erythematous “brick-red” maculopapular rash on the head and neck Coarse, sandpaper-like, erythematous, blanching rash that is diffuse Purple-brown, nonpruritic, nonpainful papules on the face and lower extremities Vesicular lesions distributed along a dermatome An 18-year-old man presents to the office with a new-onset rash for two weeks. He has a family history of hyperthyroidism and diabetes mellitus. He is a senior on his high school wrestling team and reports a high-stress lifestyle. He reports no recent sick contacts but does report receiving a course of amoxicillin for a sore throat last week. Vital signs include a T of 36.7°C, HR of 84 bpm, BP of 114/76 mm Hg, and RR of 16/minute. On physical examination, 1–1.5 cm silvery, annular plaques on an erythematous base located around the umbilicus and unevenly dispersed on his torso are noted. Which aspect of his historical information is most concerning for psoriasis? A family history of hyperthyroidism A high-stress lifestyle A recent streptococcal pharyngitis infection Involvement on the wrestling team What skin condition known as “the itch that rashes” involves lichenified plaques in a flexural distribution, especially of the antecubital and popliteal fossae, volar aspect of the wrists, ankles, and neck? Atopic dermatitis Psoriasis vulgaris Scabies Seborrheic dermatitis A healthy 30-year-old man with a history of vitiligo presents to his dermatologist with a complaint of burning areas on his scalp and beard and of losing hair in those areas over the past three weeks. He states that his father started losing his hair at about the same age. On physical exam, there are discrete oval-shaped areas of complete hair loss that are edged by short broken hairs. Hair pull test is positive. His fingernails show some pitting. Which of the following is the most likely diagnosis? Alopecia areata Anagen effluvium Tinea capitis Trichotillomania A 65-year-old woman with a history of inadequately controlled diabetes mellitus and recurrent cellulitis presents to the clinic with concerns for yellow, brittle toenails. Her recent laboratory studies indicate normal liver function. Moderate onychomycosis is diagnosed at this time. Which of the following antifungals would be most indicated for this patient? Ciclopirox Efinaconazole Tavaborole Terbinafine A 27-year-old pregnant patient presents to the dermatologist with worsening acne vulgaris. You decide to start her on medical therapy as her lesions are cystic and demonstrate a propensity to scar. Which of the following medications is absolutely contraindicated in this patient? Oral erythromycin Topical azelaic acid Topical salicylic acid Topical tazarotene Which of the following is the most important prognostic factor for patients with malignant melanoma? Breslow level Diameter Multiple lesions Rapid lesion evolution Which of the following is the most common type of skin cancer in the United States? Basal cell carcinoma Kaposi sarcoma Malignant melanoma Squamous cell carcinoma What finding differentiates rosacea from lupus erythematosus? Absence of Demodex folliculorum Exacerbation with heat Improvement with sun exposure Presence of a malar rash A 20-year-old man presents to the clinic with an erythematous greasy-appearing rash on his central face. Which of the following is the best treatment for the suspected diagnosis? Ketoconazole shampoo Topical clobetasol propionate ointment Topical hydrocortisone Topical triamcinolone ointment A 67-year-old man presents to the clinic with a new lesion present for two months. There is a 0.8 cm erythematous, tender papule with central hyperkeratosis present on the right lateral forehead. Which of the following physical exam findings differentiates squamous cell carcinoma from actinic keratosis? An infiltrated papule Erythema New onset Tenderness Which of the following genera of bacteria is most commonly associated with the development of acne vulgaris? Cutibacterium Demodex Staphylococcus Streptococcus https://remnote-user-data.s3.amazonaws.com/fx8wJbPLfonX4yr7mv7z06ziMV8LezKbwUhcD5rKkQcVsBAs5ZBx9p9Sbg7VLmL9XnpzbWrvt5ESkPzBJEVcMyJ5Zi1X4nkesCujGqwOo_UxeszbHnWH2vnEuDhCFGHh.png Which of the following is the best diagnosis of the condition pictured above? Atopic dermatitis Psoriasis Seborrheic dermatitis Tinea capitis A 72-year-old woman presents for a routine visit and medication refill. During her visit, she mentions that her right big toe has been bothering her. It is painful for her to wear shoes and cut her nails. On exam, a thickened, yellowed toenail is noted, affecting the distal two-thirds of the nail bed of her right great toe. The surrounding skin otherwise appears normal. A potassium hydroxide preparation is taken immediately, and hyphae are noted. A fungal culture is sent, and oral terbinafine is prescribed. Which of the following is the mechanism of action for this treatment? Binds to membrane sterols and increases membrane permeability Impairs fungal mitoses by disrupting mitotic spindle formation in fungi Inhibits 14-alpha-demethylase, preventing conversion of lanosterol into ergosterol, which is needed to build fungal cell walls Inhibits the enzyme squalene epoxidase, preventing synthesis of ergosterol, which is needed to build fungal cell walls A 21-year-old man presents to his dermatologist with the complaint of worsening acne. He was started on oral isotretinoin one week ago to treat his chronic acne as other medications were ineffective. On physical exam, there are multiple large nodules and friable plaques. The lesions have a hemorrhagic crust and there are a few areas of ulceration and erosion. Which of the following would be the mainstay treatment for this severe form of acne vulgaris? Increase isotretinoin dosage Oral antibiotics Oral glucocorticoids Topical retinoids A man presents to the clinic with rapid onset of painful and red swelling of the lateral nail fold of one of his fingers. There is no associated abscess or involvement of the pad of the finger. What is the best antibiotic treatment if coverage for methicillin-resistant Staphylococcus aureus is needed? Amoxicillin Cephalexin Dicloxacillin Doxycycline Which of the following is a risk factor for developing lichen simplex chronicus? Depression Female sex Genetic predisposition Hepatitis C infection https://remnote-user-data.s3.amazonaws.com/2aTv4uCBpahs4kLE-v_Ra2Mf7SzlQSSX3qLICxR-w7WcIwCQ9hvHP6wf1dHwWKx2TEw_qv_POcbxtF-2D6abLC-vuVsSD90bpy2N-HSENjj65-IzNbdJ3e8Rz0PFuInd.pngA patient presents to the urgent care with a new-onset, swollen, pruritic rash shown above. The rash began as a few vesicles that appeared after gardening yesterday. Which of the following is the most likely diagnosis? Cellulitis Contact dermatitis Eczema Psoriasis A 19-year-old woman is found to have polycystic ovarian syndrome resulting in increased levels of serum androgens. Which of the following dermatologic conditions is most likely to occur in this patient? Acne vulgaris Hyperhidrosis Rosacea Tinea infection Which of the following is the causative organism for tinea versicolor? Aspergillus Candida Corynebacterium Malassezia A 68-year-old man presents to the clinic with a lesion on his face that has slowly been growing over the past few years. He has no trauma, pain, or pruritis. On exam, a 6 mm well-demarcated erythematous nodule with a scaly appearance and an area of ulceration is noted on the left cheek. No pus, telangiectasias, or enlarged lymph nodes are noted in the area. Of the following skin disorders, which is the most likely diagnosis? Malignant melanoma Merkel cell carcinoma Nummular eczema Squamous cell carcinoma Which of the following is a risk factor for melasma? Advanced age Lighter skin tones Male sex Pregnancy A 35-year-old woman presents with a variably pigmented macule with irregular borders on her right anterior thigh. The lesion is 8 mm in diameter, and she says it has been growing for the past month. The patient has fair skin. What is the most likely diagnosis? Acral lentiginous melanoma Lentigo maligna melanoma Nodular melanoma Superficial spreading melanoma A 28-year-old man presents to the clinic desiring treatment for his psoriasis. On exam, several erythematous plaques with silver scales are noted on the anterior and posterior aspects of his trunk. The total body surface affected is approximately 3%. The patient has no joint pain, fever, or fatigue. Which of the following is the best choice for first-line treatment of this patient’s psoriasis? Oral adalimumab Oral methotrexate Topical betamethasone dipropionate cream 0.05% Topical tacrolimus ointment 0.1%