Prometric Dermatology Exam March 2020 PDF

2020 Dermatology Prometric Exam 2020 Mcq ‫بسم هللا الرحمن الرحيم‬ ‫علا ْمتَنَـا‬ ‫س ْب َحانَ َك ال ِع ْل َم لَنَا ِإ اال َما َ‬ ‫قَالُوا ُ‬ ‫ِإنـ ا َك أَنـْتَ ا ْلعَ ِليـ ُم ا ْل َح ِكيـ ُم‬ ‫صدق هللا العظيم‬ ‫سورة البقرة‪ :‬اآلية (‪.)32‬‬ List of contents Chapter Title Pages Total 1 Cos...

2020 Dermatology Prometric Exam 2020 Mcq ‫بسم هللا الرحمن الرحيم‬ ‫علا ْمتَنَـا‬ ‫س ْب َحانَ َك ال ِع ْل َم لَنَا ِإ اال َما َ‬ ‫قَالُوا ُ‬ ‫ِإنـ ا َك أَنـْتَ ا ْلعَ ِليـ ُم ا ْل َح ِكيـ ُم‬ ‫صدق هللا العظيم‬ ‫سورة البقرة‪ :‬اآلية (‪.)32‬‬ List of contents Chapter Title Pages Total 1 Cosmetology and Lasers 1-5 5 2 Vascular 6 - 13 8 3 Metabolic 14 - 21 8 4 Connective Tissues 22 - 30 9 5 Surgery 31 - 37 7 6 Bullous disease 38 - 42 5 7 Hair and Pigmentary 43 - 47 5 8 Genodermatosis 48 - 61 14 9 Nail 62 - 64 3 10 11 Drugs 65 - 76 12 Papulosquamous 77 - 87 11 12 Tumors 88 - 103 16 13 14 Ethics and Safety 104 - 108 5 Eczema and Hypersensitivity 109 - 118 10 15 Granuloma 119 - 121 3 16 Acne 122 1 17 Infection 123 - 141 19 18 Histopathology in exam 142 1 19 Stains and Markers 143 1 20 Board Vital 144- 145 2 List of figures Chapter Title Pages Total 1 Cosmetology and Lasers 146 - 147 2 2 Vascular 148 - 150 3 3 Metabolic 151 - 158 8 4 Connective Tissues 155 - 158 4 5 Surgery 159 - 161 3 6 Bullous disease 162 - 163 2 7 Hair 164 - 165 2 8 Genodermatosis 166 - 171 6 9 Nail 172 - 173 2 10 11 Drugs 174 - 181 8 Papulosquamous 182 - 186 5 12 13 Tumors 187 - 194 8 Eczema and Hypersensitivity 195 - 199 5 14 Granuloma 200 - 201 2 15 Acne 202 1 16 Infection 203 - 207 5 Cosmetology and Lasers Prometric MCQ March 2020 Cosmetology and Lasers Cosmetology and Lasers 1. Type of filler long lasting or permanent filler: a. HA b. Collagen c. Silicon d. Fat e. Carboxymethyl cellulose ✓ Note:if sculptra (poly lactic acid) it is most right ✓ Sometimes: carboxy methyl acetate. 2. Filler in nasolabial fold, which one is longest lasting filler: a. Hyaluronic b. Ca hydroxyapatite c. Collagen d. Microsperules 3. Patient was injected by filler and botox then balnching appeared in forehead a. Hyaluronidase inj b. Nitroglycerin patch c. Massage 4. Itching pallor and pain after injection of filler and botox first step is: a. Hot fomentations b. Nitroglycerin patch c. Hyalorinidase injection due to pain mentioned ✓ If pallor only filler and botox use nitroglycerin patch ✓ If pallor only use nitroglycerin patch ✓ If filler only use hot fomentation ✓ If both botox and filler and pain with pallor use hyalourinadase 5. Picture of case of melasma in skin type 2" a. Salyclic acid 10% b. AHA 5% c. TCA 25% d. Jessener solution+ acetic acid 1 Prometric MCQ March 2020 Cosmetology and Lasers 6. Old male 50 years deep forehead farrows and deep nasolabial fold increase with muscle activity how to get best improvement a. Peel b. Fractional laser c. Filler d. Botox 7. Picture of vein in arm laser removal 1320 nm chromophore a. Water b. HB c. Melanin 8. Blanching after filler injection what is next a. Hot fomentation and massage due to blanching b. Nitroglycerin patch c. Hyaluorinidase injection 9. Melasma laser a. Q switched ruby 694 b. Q switched Nd yag 10. Patient treatment with UVB 1500 stop one week return on a. 1000 b. 5000 c. 1500 or (same dose) d. 2000 11. Acne keloidal laser a. Nd yag for hair removal b. Co2 for resurfacing 12. Causes of tanning ‫حسب السؤال‬ a. Oxidation of melanin (early from UVA) b. Melanosomes c. Melanin increase d. Increase melanocytes (delayed from UVB) 13. Lip vascular lesion laser a. Nd yag 1064 b. 585 2 Prometric MCQ March 2020 Cosmetology and Lasers 14. Which type of light used in PDT in treatment of acne: a. Visible b. Red c. Blue d. Violet ✓ Note: if with ALA red light if alone blue light 15. Which type of laser used in Haemangioma a. 755 b. 1064 c. 585 16. What is the pulse duration of laser used in treatment of Haemangioma? a. 0.5 b. 2 c. 8 d. 20 ✓ Note: 0.45-40 ms bolognoia 17. Venous lake histopathology what is commonest site? a. Lips 18. Picture of lips having venous lake which type of laser used in treatment a. 755 b. 1064 c. 585 d. 2940 ✓ note: electrosurgery or a hemoglobin-targeting laser is usually effective. 19. Picture Which type of laser used in nevus of Ota? a. 755 b. 532 q-switched ND yag c. 1064 q-switched ND yag d. 595 ✓ Device used for nevus of ota must be QS so the first choice is c then b. 20. Wavelength responsible for immediate darkening of the skin a. 320-340 b. 320-290 c. 290-200 3 Prometric MCQ March 2020 Cosmetology and Lasers 21. Picture of acne keloidalis nuchae type of laser used in treatment? a. 10600 b. 1064 c. 585 d. 755 22. Infant with hemangioma and has cardiac problems or seizures a. Increase fluence b. Increase pulse duration c. Decrease wavelength 23. Picture of child girl with birthmark above eye and have seizures laser ttt in mj/sec a. 2 b. 5 c. 10 d. 20 ✓ Note: if asked about fluence it is 5 mj 24. The best lesion respond to laser is: a. Nevus of ota b. Beckersmelanosis c. Blue nevus 25. Most common complication of infraorbital Botox injection a. Festooning b. Photophobia c. Nystagmus d. Blindness 26. Type of lipid in sebum when increase sebum increse a. Cholesterol b. Squalene c. Sebolic acid d. Wax esters 27. Case of solar urticaria with wavelength a. 320 b. 450 visible light c. 280 4 Prometric MCQ March 2020 Cosmetology and Lasers 28. UVA2 wavelength: a. 320-340 29. Wave length of immediate tanning: a. 290 b. 311 c. 340 d. 200 30. Enzyme involved in cell membrane: a. Transglutaminase lorici 31. Most common collagen in adult skin: a. 1 b. 3 c. 2 d. 5 32. What is the cytoskeleton in keratinocytes? a. Tonofilament b. Desmosome c. Odler bodies d. Hyaline granules 33. What makes up the majority of protein envelop of keratinocyte a. Loricrin b. Involucrin c. Fillaggrin d. Envoplakin 5 Vascular Prometric MCQ March 2020 Vascular Vascular 1. Infant 1 year 15 kg with hemangioma what is the treatment: a. 15 mg propranolol b. 30 mg propranolol c. 15mg prednisolone d. 30mg prednisolone 2. Side effect of drugs used in Hemangioma a. Bradycardia b. Hypotension c. Sleeplessness 3. Picture of hemangioma in infant what type of seizers a. Focal b. Contralateral c. Generalized. 4. Female patient has this lesion what association ‫ فوق عنيها اليمين‬pws ‫صورة بنت عندها‬ a. Dandy walker syndrome b. Vermis agenesis c. Cerebellar atrophy 5. Picture of very huge hemangioma what is association PHEACES a. (Dandy Walker syndrome) most common and cerebral hypoplasia or dysplasia 6. Hemangioma best topical treatment a. Timolol b. Propranolol ✓ If port wine sirolimus 7. Picture of cyanotic leg in warm and improve in cold findings a. Thrombocytosis b. SCL70 8. Case of vasculitis (dilated follicular opening description of granuloma faciale) treatment a. Dapsone b. Colchicine c. Steroid 6 Prometric MCQ March 2020 Vascular 9. Case of Klippel trenaunay Syndrome investigation needed a. X ray b. Doppler U/S or - MRA c. MRI d. Brain MRI e. Search for association 10. Cryoglobulinemia defect or mutation in a. Cd40 ligand 11. POEM (board vital most commonly occurring with Castleman syndrome) a. Tufted angioma b. Glomeruloid hemangioma c. Kaposi hemangioma 12. Picture of histopathology GMS stain with ‫ أرضية خضرا وكور بني‬clinically a. Popular b. Ulcer c. Keloid like clinical (Lobomycosis) ttt is surgical d. Nodule 13. Case of Klippeltrenaunay syndrome treatment a. Surgical treatment for venous malformation b. Sclerotherapy / epiphysiodesis 14. Flushing investigations diarrhea, bronchospasm (carcinoid syndrome): a. Urinary 5HIAA 15. Female patient her hand hurt with warmth and decrease with cold a. SLE b. Thrombocytosis 16. Picture of erythema abigne (description reticulate pigmentation or picture) on back what is cause a. Heat pads (Hot blankets) 7 Prometric MCQ March 2020 Vascular 17. Photo of leg with rash bilateral which cryoglobulin decrease investigations (cyanotic leg pic) a. I With Waldenström's macroglobulinemia or multiple myeloma b. II Viral infections (HCV) (HIV) mixed cryoglobulinemia syndrome c. III Autoimmune disorders or HCV 18. Picture of hemangioma and his brother has same lesion what is the disease a. Dandy Walker 19. Picture of patient leg with rash management a. Dapsone b. Colchicine c. Steroid 20. Patient has neutrophilia (thrombosis) without vasculitis in leg lesion looks like vasculitis treatment (mostly sweet’s syndrome): a. Cortisone b. Aspirin 21. Marker in revoluting capillary hemangioma??? a. GLUT1 (glucose transfer) 22. Patient with varicose veins and injected it sever pain and swelling after injection what next : a. Doppler b. Compression ✓ Note: anesthesia used tumescent anesthesia etas 2019 23. Child with varicose veins and one limb bigger than the other what next a. CT b. MRI c. Doppler d. Duplex 24. Case of hemangioma in face association a. Arachnoid cyst b. Vermis agenesis c. Dandy walker ✓ Note: the most common is Dandy walker then cerebellar (vermis) hypoplasia or dysplasia 8 Prometric MCQ March 2020 Vascular 25. Case of varicose vein, pain in lower leg investigations a. Doppler b. X ray 26. Bleu nevus most common site a. Neck b. Face c. Limbs (hand and foot) 27. Description of granuloma faciale ask for line of treatment a. Steroid injection intralesional 28. Hemangioma in face (PHACES) what next investigation a. MRI brain b. Echo c. Ultrasound d. Angiography if said high risk e. CT ✓ Note: arterial studies due to anomalies in heart before propranolol treatment MRA due to head and on neck (posterior fossa malformation) and ophthalmology 29. Picture (huge hemangioma association) of baby with big hemangioma what is association a. Dandy Walker syndrome b. Vermis agenesis c. Corpus callosum tumor 30. Marker of involuting hemangioma all except: a. CD43 b. von Willebrand c. CD31 d. GLUT1 31. Bilateral vascular ulcer without vasculitis. Most common cause a. Factor V Leiden b. Protein C or S deficiency c. Antithrombin III deficiency 32. Erythema nodosum treated with unknown medication and has eczema, what is the drug a. Potassium iodide 9 Prometric MCQ March 2020 Vascular 33. Picture Gene mutation in vascular birthmark (girl beside her eye) a. PWS it is GNAQ gene on ch9q21 34. Infant with hemangioma and seizures pulse duration laser treatment: a. 0.5 b. 2 c. 1 d. 20 35. Picture of hemangioma what common side effect to drug: a. Bradycardia b. Sleep disturbance c. Bronchial problems 36. Sweet syndrome most poor prognostic sign a. Leukocytosis b. Thrombocytopenia c. High ferritin 37. Painful lesion on hand (sweet $) + clinical picture + abnormal lab CBC increase WBCs increase neutrophil fever 38.5, How long white blood cells take time for recovery? a. 9m b. 6m c. 12m 38. 6 years old boy with indurated nodule and neutrophil & WBC high and no vasculitis(sweet syndrome) ,what is next a. Blood culture b. Bone marrow biopsy 39. picture histopathology EN what type a. Granulomatus septal panniculitis b. Septal panniculitis c. Granulommatous lobular panniculitis d. Lobular panniculitis 40. Patient after doing angiography developed cyanotic leg mostly associated with a. Eosinophilia b. Neutrophilia c. Neutropenia d. Lymphocytosis 10 Prometric MCQ March 2020 Vascular 41. Female patient 55 years old on renal dialysis complains of ulcers at tendon achilis. What treatment suitable? a. Prednisolone b. Warfarin c. Hyperic oxygen d. Sodium thiosulphate 42. Picture of patient with lesion as plexiform neuroma on shoulder what is the association a. Scoliosis b. Renal hamartoma c. Renal cell carcinoma 43. Brown mamiliated lesion of scalp + café au lait on body association: **in ETAS clitoral hypertrophy a. Scoliosis (‫ صوره‬mccune Albright syndrome) 44. Picture of patient has lesion brownish or violaceous in lower limb as if it is eczemafrom vasculitis his brother has same lesion a. Prothrombin gene defect b. Thrombin gene defect c. Factor 5 gene defect 45. Male patient has this lesion after angiography , ‫ رجله جايب صورة‬what needed to confirm the diagnosis: a. Neutrophilia b. Eosinophilia c. Lymphocytosis 46. Male patient has plaque pigmented on his leg Kaposi and hhv8 +ve need treatment a. Sirlomus 47. Pyoderma gangernosum a. IVIG b. Cyclosporin c. Biologic ( infliximab, adalimumab, etanercept and ustekinumab )off label 48. Pt with Nodular lesion at tendon achillis ‫ واالختيارات كلها‬vasculitis a. Erythema elevatum duitinum ✓ Another q about investigation: may be 1. Infection (strep, hepatitis, HIV, syphilis) 2. Gammopathy. 11 Prometric MCQ March 2020 Vascular 49. Hemangioma treatment a. 585 b. 755 c. 10600 50. Histopathology of EN and what to know this patient is going to be allergic to what? a. Potassium iodide 51. Male patient ‫ بس جايبين صوباع رجله الكبير‬5 ‫ نفس الحاله رقم‬after angiography: a. Eosinophilia b. Neutrophilia c. Creatine kinase 52. Pancreatic panniculitis description of pathology (ghost cells) with: a. Lymphocytosis b. Neutrophilia c. Neutropenia d. Eosinophilia 53. Itchy follicular papules with eosinophilic folliculitis invtigations : a. HIV b. CD4 c. CD8 54. patient with blue coloration on leg a. Cryoglobulin type1 b. Cryoglobulin type2 c. Cryoglobulin type3 d. Cryoglobulin type4 55. Baby and mother having the same condition left second or third rib anomalies a. Gorlin syndrome 56. Lesion in leg without picture description of histopathology having neutrophilia no thrombosis a. Dapson b. Steroid 12 Prometric MCQ March 2020 Vascular 57. Patient with livedo racemose + purpura and increase urea and creatinine and pulmonary problems what is type of ANCA (with MPA) a. Cytoplasmic b. Nuclear c. Perinuclear ✓ Note: another question asks about gene in wagner it is HLA-DPB1 gene 58. Dilative cardiomyopathy with deep venous thrombosis and skin rash and high eosinophil (hyperesinophilic syndrome): 1. Mepolizumab 2. Imatinib 3. Pemblizumab 4. Atlizumab 59. Case of vasculitis ‫ معاها‬lung affection away from lumen of airway, what type of ANA: a. Cytoplasmic b. Thermonuclear c. Nuclear 60. What is the first indicator of rapid involuting hemangioma (RICH) a. CD 30 or 31 or 34??? b. Glucose transport ✓ Note: GLUT1 is becoming negative and CD133 is indicator 13 Metabolic Prometric MCQ March 2020 Metabolic Disorder Metabolic 1. Case of lipoid proteinosis, hoarseness of voice treatment a. Steroid b. Acitretin 2. 60 years old patient with multiple waxy papules on the trunk and lower limb with ecchymosis and bruises and macroglossia (mostly systemic amyloidosis) what is next? a. Bone marrow biopsy ‫اخر حاجة‬ b. Blood PTN fixation or detection 3 c. Fat aspiration d. Abdominal fat aspiration 1 e. Blood or urine electrophoresis 2 3. Treatment of previous condition: a. Chemo b. Steroid + Melphalan c. Anti siRNA. 4. Legius syndrome caused by SPRED1 gene and NF1like but no tumors, freckles, lipoma, macrocephaly, ADHD ✓ McCune–Albright by GNAS mutation, Fibrous dysplasia, Café au lait macules, including characteristic jagged "coast of Maine" borders and tendency not to cross the midline, Precocious puberty, Testicular abnormalities, Hyperthyroidism, Growth Hormone Excess, Cushing's Syndrome/ clitoral hypertrophy/scoliosis 5. Case of sever itchy macular hyperpigmentation on the back (macular amyloidosis) investigations: a. Calcitonin level or thyroid scan b. Congo red 6. 10 y old child normal with scars on knuckles ask: Urine porphyrin negative blood porphyrine positive a. Erythropoietic porphyria b. Congenital erythropoietic porphyria c. Heridetarycorporphyria d. Coproporphyria e. Varigat porphyria 14 Prometric MCQ March 2020 Metabolic Disorder 7. Hemochromatosis case (diabetes/joints /bronze) & generalized, hyperpigmentation & hepatomegaly what association? a. Copper accumulation b. C282y gene 8. Case of Wilsons disease a. ATP7B gene ✓ In patients with clinical features suggestive of Wilson disease (e.g. abnormal liver tests combined with neurologic symptoms), we start by obtaining liver biochemical tests, a complete blood count, serum ceruloplasmin and copper levels, an ocular slit-lamp examination, and a 24-hour urinary copper excretion. 9. Female patient with macular amyloidosis what is next a. Neurologist b. Endocrinologist 10. Picture of Juvenile xanthogranuloma next step a. Ophthalmologist. b. Neurologist. 11. Patient 30 years with itching interscapular brownish patch with rippling (amyloidosis) which organ associated a. Kidney b. Adrenal c. Thyroid d. Pituitary 12. Macular amyloidosis association: a. MEN type 2 A 15 Prometric MCQ March 2020 Metabolic Disorder 13. Male patient with erythematous rash and bone pain prober site for bone x ray a. Arm b. Leg c. Spine if skull or cranium not present Langerhans cell histiocytosis. st d. Skull or cranium 1 14. Genetic defect in litterer Siwe a. Mutation in BRAF gene 15. Child with erythema and bone pain and Histological finding epithelioid granuloma and few lymphocytes what gene defect (Blau syndrome) a. Carb 15 b. TNFR1 c. ACE 16. Fabry's disease defect (picture): a. GLA galactosidase A. 17. Pt with bilateral nodules on tendon Achilles {tubers xanthoma} What investigation? a. Cholesterol 18. 40 years female with generalized purpuric eruption all over body and sole ulcer (with path pic) a. MM b. Ulcerative LP 19. Same question treatment a. Mohs b. MTX c. Cyclosporin ✓ Another q what to monitor during treatment answer is creatinine 20. Mastocytosis aggravated drug a. Dextromethorphan 21. Mastocytosis mutation in which axon a. (codon 816) axen 17/C(KIT) 22. Hardness of the upper back of the patients a. IgG kappa b. IgG lambda 16 Prometric MCQ March 2020 Metabolic Disorder 23. Pt with skin colored papules and elastic skin on neck and angoid streaks on retina what to do? a. Introduce Aspirin b. Introduce Simvastatin c. Stop smoking d. Biologic. 24. Most common in PXE a. Peripheral arterial disease b. Cardiomyopathy c. Pulmonary problems d. Intermittent claudication. 1 2 if intermittent claudication not present 25. child with porphyria treatment a. Phlebotomy b. Hydroxychloroquine c. IVIG 26. Picture of hands (bullae, blister, hypertrichosis, milia) (porphyria) what is associated organism a. HCV 27. patient with cutaneous amyloidosis what association a. Thyroid tumor b. Renal c. Adrenal d. Lung. 17 Prometric MCQ March 2020 Metabolic Disorder 28. Picture of 2 cubital fossa in adult, non-itchy, ‫ انا شخصتها‬xanthoma ttt a. Phototherapy b. Imiquimod c. Antibiotic d. Steroid 29. Skin colored popular lesion in back of female, stain colloidal iron, (scleromyxdema) what next step? 1. Immunofixation 2. Bone marrow biopsy to exclude multiple myeloma. 30. Perforating Disease (histopathology: collagen within a keratin plug or extruding through the epidermis), consistent clinical features (keratotic papules or umbilicated papulonodules), with renal failure, what investigation u will order? a. Creatinine b. Leukocyte c. Liver enzyme. 31. Patient has nodules on olecranon ligament what is the investigation: a. Cholesterol 32. Picture of patient with vesicular eruption on hand arm face by histopathology no inflammatory infiltrate treatment a. Phlebotomy if PCT b. Steroid c. IVIG 33. Case of Hypothesia &hypohydrosis investigations: a. G6PD b. Chest x ray c. MRI d. CBC 34. Infant 2 months has scaly erythematous skin since birth with vomiting and diarrhea and no weight gain as child grow below 5th percentile. what investigation next to do? a. ALT leaner ds b. Urea c. Creatinine d. Skin biopsy. 18 Prometric MCQ March 2020 Metabolic Disorder 35. Mucinosis muco-polysaccharide. 36. Scleromyxdema mutation in keratin a. Lambda b. Kappa 37. Case of macular amyloidosis investigations: a. Neurological b. Calcitonin c. Thyroid ‫ال يوجد‬ 38. Case of Langerhans cell histiocytosis investigation needed x-ray on: a. Arm b. Spine if skull or cranium not present which is more accurate c. Leg d. Cranium or skull 39. Pathological description of angiokeratoma and what enzyme defect a. Galactosidase A ✓ An angiokeratoma would show hyperkeratosis and rete ridges encircling dilated vessels in the papillary dermis. 40. Picture of urticaria pigmentosa the most affected a. Git (most affected) b. Lung c. CNS (Least affected genitourinary then neuroendocrine > CNS 19 Prometric MCQ March 2020 Metabolic Disorder 41. Case of (hypertrichosis & vesicles) PCT investigation needed: a. Ferritin b. CBC c. MRI 42. Wilson disease ‫جه مرتين‬ a. Diagnosis b. Associated ‫والمره التانيه‬ 43. Case of child 3 months with vomiting & brown lesions and did x-ray showed osteolytic lesions (LCH) what is the treatment: a. Methotrexate b. Cyclosporin c. Vincristine or vinblasten ✓ N.B for symptomatic patients with skin-only LCH oral MTX , 6-mercaptopurine, hydroxyurea , topical corticosteroids, topical nitrogen mustard, oral methotrexate, and oral thalidomide ✓ Unifocal or multifocal involvement of one organ or system, single agent prednisone, or combination of vinblastine and prednisone, curettage of bone lesions 44. Case of scleromyxoedema waxy papules in face upper back, what to treat a. Rituximab b. Thalidoamide 2 c. IVIG 1 45. Infant 3 months with low weight and multiple, brown lesions did Xray and found osteolytic lesions ,chondroitin, what is the ttt a. Methotrexate b. Cyclosporin c. Vincristin 46. Case of mastocytosis the least organ affection a. Heart b. Lung c. Git ----the most frequent +/BM/LN/liver/spleen (the most) d. CNS + genitourinary 47. Patient complaining from recurrent abdominal pain since childhood a. Steroid b. Hydroxychloroquine c. Dapsone d. Colchicine if FMF 20 Prometric MCQ March 2020 Metabolic Disorder 48. End stage renal with perforating dis best treatment : a. NBUVB b. Path PUVA c. Oral PUVA 49. Child 7 years with one skin colored papule in lower eye lid with a photo ask about expected a. Decrease muscle power b. increase muscle power c. seizures 50. Photo of neurofibromatosis and ask about association a. Xanthogranulom. 51. Case of Wilson what will you expect to find in the epidermis. a. Elastic fiber. 52. Photo of calcinosis cutis in index ask about association a. Systemic sclerosis b. SLE c. Dermatomyositis d. Limited scleroderma 53. Scenario of pxe ask about association no claudication in choices a. Peripheral vascular disease 54. Case of ulcer in the thigh in end stage renal dis pt ask about treatment a. Wrafarin b. Na thiosulfate 55. Fabry's disease (Male has erythematous purple papules in the lower abdomen and inner thigh his brother too what is depsitted or accumulating substances: a. Ceramide (globotriasylceramid) b. Mucopolysacaride c. Glactoaminoglyacn 21 Connective Tissues Prometric MCQ March 2020 Connective Tissue Connective Tissue 1. Case of photosensitivity what is the prophylactic treatment a. Steroid b. Carotene 3 c. Phototherapy 1 d. Hydroxychloroquine 2 2. Case of granuloma with few lymphocytes, describe patient complain erythematous plaque treatment (all biologic) (sarcoidosis) a. Infliximab b. Adalimumab c. Etanercept d. Rituximab 3. Patient with dermatomyositis controlled on prednisolone and MTX intake started for one week of myopathy what is next a. Decrease steroid b. Increase steroid 4. Sclerodactyly, Raynaud's phenomenon, Photosensitivity investigations (Mixed connective tissue disease) a. U1RNP b. Double strand DNA c. SCL 70 topoisomerase d. ANA 5. Familial SLE what c deficiency (C1, C2 and C4, causes SLE) a. 3 b. 5 c. 9 d. 1 6. Picture like Gottron rash on both hand and rash on ear what is treatment a. Cortisone b. Dapsone c. Azathioprine 7. Case of small ulcer on digit, photosensitivity, fibrosis, pigmentation investigations a. ANA b. Ds DNA 22 Prometric MCQ March 2020 Connective Tissue 8. Picture of calcinosis cutis in thigh in renal patient investigations a. X ray b. Angiography 9. Case of photosensitivity investigations a. ANA b. Ds DNA c. Anti SCL70 10. Description of JXG association (Juvenile xantho-granuloma) a. Neurofibromatosis ✓ Note: ass NF1/CML ✓ Investigations: biopsy tutton giant foamy histocytes CD68/ HMA56/ factor 13a/ S100 11. Type of light chain in systemic amyloidosis a. Kappa b. Lambda 12. JXG refer to a. Ophthalmologist b. Neurologist 13. Histopathological features of lesion showing epidermal atrophy, edematous hyalinized superficial dermis with vascular dilatation and lichenoid band like lymphocytic infiltrate with epidermal atrophy and upper dermal fibrosis what is diagnosis a. Lichen sclerosis et atrophicus 14. Describing disease (may be subacute le ??) associated with photosensitivity and giving investigations of CT diseases what is associated 15. Picture of female finger with exophytic lesion asking about treatment (Acquired digital fibrokeratoma) a. Surgical removal 16. Patient with dermatomyositis controlled on prednisolone and MTX intake started for one week of myopathy what is next a. Decrease steroid b. Increase steroid 23 Prometric MCQ March 2020 Connective Tissue 17. Girl with itchy hyperpigmented patch on trunk histopathology of amyloidosis refer to a. Neuro b. Endocrinologist 18. Generalized superficial nodule with atrophied surface and surface telangiectasia on its Diagnosis a. Disseminated DLE 1 b. Multiple BCC c. LE panniculitis 2 19. Another question is investigations needed a. ds DNA 20. Case of lichen sclerosis et atrophicus a. Topical steroid (clobetasol) b. Tacrolimus 0.3 c. Tacrolimus 1 21. Scleroderma + lung fibrosis a. AD b. AR c. XLR d. XLD ✓ Note: (Topoisomerase I antibodies (formerly Scl-70)) 22. Steroid induced myalgia: a. Decrease steroid dose 23. Description of case of popular sarcoidosis investigations: ✓ Note: hypercalcemia / hypercalciuria / increase amyloid A / vit d / kevim test / ACE level increase in monitoring treatment 24. Description of case of scleroderma investigations: a. ANA b. Topoisomerase if systemic c. Anticentromere if limited ‫حسب السؤال‬ 25. Scenario of limited scleroderma ask about investigation a. Anticentromere 24 Prometric MCQ March 2020 Connective Tissue 26. Discoid lupus with follicular plugging asking for investigations ANA a. Tacrolimus b. Hydroxychloroquine c. Mometasone d. Camoflash 27. Type of secretion of moll's gland modified apocrine sweat gland in eyelid secret sebum by a. Decapitation 28. gland secretion by decapitation: a. Zeis b. Moll c. Montenegro d. Meobian 29. Picture case have small papule at side of eye 😊brit huge dube synd. a. Renal 30. Annular scaly lesion in extremities of old patient ‫صوره ست كبير‬ a. Phototherapy 31. Picture hyperpigmented patch in cubital fossa, what is diagnosis? a. Steroid b. Tacrolimus c. Minocycline d. Phototherapy 32. Case of EhlerDanol syndrome hyperextensibility skin of the neck defect in collagen, type 1 in COL5A1 and COL5A2 has what joint complication? a. Joint Hypermobility b. Hip dislocation 33. Cause of discoid lupus have persistent scar for 3 years treatment a. Camouflage b. Tacrolimus c. Steroid d. Hydroxychloroquine if active e. No treatment 25 Prometric MCQ March 2020 Connective Tissue 34. Asymptomatic maculopapular lesion in the left arm, treatment a. Symptomatic b. Steroid c. Phototherapy d. MTX 35. Asymptomatic skin rash on the upper and lower limbs with atrophic center a. Generalized tumid lupus 36. Erythematous plaque on nose and has pustules on plaque. What is treatment and diagnosis a. Rifampicin and retinoid b. Minocycline c. Acitretin d. Rifampicin and dapsone 37. Picture of morphea 10 years ago, treatment is? a. Steroid b. Tacrolimus c. Mofetil d. MTX 38. Female with genital plaque and asymptomatic (Lichen sclerosis) what treatment a. Steroid 39. Cutis laxa (Picture) mutation periorbital edema and sagged cheeks a. Fibulin 5 40. Pseudoxanthoma elasticum What is the protective to treatment a. Aspirin sometimes say stop smoking b. Simvastatin (for treatment not protective) 41. pseudoxanthoma elasticum complication a. Peripheral Arterial disease b. Cardiomyopathy 42. Pt with yellow plaque in his leg with telangiectasia and same lesion on chest Pathology > granuloma with plasma cells no cholesterol clef What is investigation? Necrobiosis lipodicuim a. Blood glucose 26 Prometric MCQ March 2020 Connective Tissue 43. Lupus pernio picture. what you expect in this patient after 10 years a. Shortness of breath b. Palpitation c. Liver problem 44. female patient her hand hurt with warmth and decrease with cold (erythromelalgia), What investigation u will do? a. ANA b. Scl-70 c. CBC … thrombocytosis 45. Hypertrophic DLE (interface dermatitis & thickening basement membrane) a. HIV b. Muntgaro test c. Fungal culture d. WBCs 46. DLE picture clinical + histo description + patient asymptomatic what to do a. Assurance b. Hydroxychloroquine c. Mometasone furate 47. Picture of child with exanthema lacy rash on face and lower limb EBV what next investigation a. ANA b. Reticulocyte 48. Discerption of case [SCLE] investigation a) Ro b) La 49. Pt with SLE on hydroxychloroquine since 2 years‫بدا ميستجبش ليه‬ a. Add acitretin b. Add cyclosporine c. Shift to rituximab d. Stop treatment 27 Prometric MCQ March 2020 Connective Tissue 50. DLE in face (picture) What is the maximum dose of the drug of choice (hydroxychloroquine) a. 5 mg ideal body weight b. 5 mg real body weight new guidelines 2016 c. 6.5 mg ideal body weight 51. Pt with cyanosis in fingers (Reynaud’s)and edematous with C3and c4 Low, ANA +ve, what is best treatment? a. Hydroxychloroquine b. MTX c. Cyclosporine 52. Description of lesion in vagina, investigation (Lichen sclerosus et atrophicus) a. CT b. X ray c. Mammogram d. Thyroid scan 53. Annular lesion dorsum of hand (picture) treatment a. Steroid if granuloma annulare b. Terbinafine - ‫الباقي‬antifungal 54. Lens dislocation ✓ Anterior dislocation in PXE, Marfan ✓ Posterior dislocation in homocystinuria ✓ Yellow brown ring in eye in Wilson dis 55. Sclerodactyly, Raynaud photosensitivity investigation needed: a. U RNP 56. Child with encoupe de Sabre best treatment a. Subcutaneous MTX 57. Case picture of parrot and ridges in nail caused by: a. Rheumatoid arthritis b. Systemic sclerosis if not present osteoarthritis 58. 65 y female on renal dialysis complaining from ulcer on tendoacahilis, what is suitable treatment a. Prednisolone b. Hyperic oxygen c. Warfarin d. Na thiosulfate 28 Prometric MCQ March 2020 Connective Tissue 59. 65 years female complaining from sudden waxy brown papules on the trunk the most associated cancer (Laser trait) a. Lung b. Stomach c. Liver d. Pancreas 60. Female patient with brown macular rash on the cubital fossa best treatment a. Phototherapy b. Cyclosporine c. Topical steroid d. Antibiotic 61. Erythema, edema, induration of whole face, Stiffness of both LL Photo of a finger with periungual erythema a. Pentoxyphillin b. Steroids c. Colchicine d. Slidnafine 62. Which manifestation not associated with subacute LE a. Scarring b. Photosensitivity c. Joint affection 63. Pt with erythema, edema and induration of the whole face with stiffness of both LL and photo of a finger with periungual erythema. Treatment a. Pentoxyphiline b. Steroids c. Colchicine d. Sildenafil 64. Photo of linear morhea in 10 y old child what treatment will you combine with steroid a. NBUVB b. MTX c. Mofetil 65. Eruptive skin colored papules with hardness in the face and upper back treatment a. Thalidomide b. Rituximab ‫الباقى كلهم بيولوجك‬ 29 Prometric MCQ March 2020 Connective Tissue 66. Atrophic lesions with telangiectasia on surface investigations a. ANA b. Skin biopsy then DIF then ANA c. Note: Skin biopsy then DIF then ANA, Respectively. 67. The most common site for that disease a. Face b. Trunk 30 Surgery Prometric MCQ 2020 Surgery Surgery 1. Picture of Pyoderma gangrenosum (heavy discharge) ulcer with yellowish discharge dressing a. Alginate b. Hydrocolloid c. Hydrogel d. Vaseline dressing 2. The most organ affected in liposuction a. Arm b. Back c. Leg 3. Surgical thread 4.0 less than 5.0 in a. Increase knot strength b. Increase tensile strength c. Smaller needle 4. Patient made excision of tumor beside eye and left for secondary intension Dressing used a. Alginate b. Gauze c. Hydrocolloid d. Hydrogel 5. Patient made excision of tumor beside eye and left for secondary intension after 2 weeks copious exudates dressing used a. Alginate b. Gauze c. Hydrocolloid d. Hydrogel 6. Picture of rounded part removed from nose and other picture of suture and flap in middle of nose a. Advancement b. Transposition c. Bilobed 31 Prometric MCQ 2020 Surgery 7. Suture in nasolabial fold linear type of flap a. Transposition flap 8. Picture of cyanotic foot after cardio angiography what drug do this ✓ Note: if asking about cause arterial embolism by cholesterol blog dislodgment 9. Picture of big toe cyanotic or cyanotic feet patient have catheterization what can a. Lymphocytosis b. Neutrophilia c. Neutropenia d. Eosinophilia or Eosinophilura 10. Painful ulcer with yellowish discharge what is dressing (according to exudate quantity) a. Alginate b. Hydrogel c. Hydrocolloid 11. Child with periauricular cyst for excision best antiseptic as he has hearing problems a. Chlorohexidine b. Iodine c. Alcohol d. Hexachlorophene 12. Patient make surgery in ear complain of hear loss what type of dressing a. Alginate b. Hydrocolloids c. Hydrogel d. Vaseline dressing 13. Patient removed tumor beside medial canthus and reached the infra orbital conjunctiva reconstruction from lateral canthus to infra orbital conjunctiva what type of flap a. Mustrade flap 14. Periauricular lesion for surgical removal the patient had deafness what type of antiseptic contraindicated a. Ethanol b. Chlorohexidine c. Bovidine iodine 32 Prometric MCQ 2020 Surgery 15. A case of burn and CBC shows decrease Hb what to avoid a. Silver sulphadiazine cause neutropenia etas2019 b. Mupirocin c. Bacteriocin 16. Type of antiseptic solution before face procedure a. Alcohol b. Ethanol c. Chlorohexidine d. Iodine 17. Clinical case of two large masses on sole after excision what source of them a. Eccrine b. Apocrine c. Hair follicle d. Keratinocyte 18. What site of flap to put after Moh's microsurgery to BCC beside nose? a. Cheeks 19. Type of flap used beside nose a. Rotational b. Rhomboidal 20. Picture of foot this lesion appeared after angiography which of the following may be elevated a. Creatine kinase b. Transferrin glutamase c. Alkaline phosphatase d. Eosinophilia 21. Periauricular lesion near hair line for surgical removal what type of anesthesia should be used a. Chlorohexidine 22. Deep cutting lesion in mm of mouth type of suture a. Nylon b. Silk 23. Deep lesion in back sutures used a. Silk b. Nylon c. Prolene d. Polycarpone ✓ Note: 1st choice is vicryl (polyglactine) but if not present we choice prolene 33 Prometric MCQ 2020 Surgery 24. Blue leg after cardiac angiography a. Arterial embolism b. Venous embolism c. Cryoglobeanimea 25. Female patient make liposuction in arms thigh back, buttocks most frequent complication: a. Compartimental syndrome 26. Female patient make liposuction in all body what site of numbness a. Back b. Thigh c. Arm 27. Male patient with trigeminal rhinotomy which is the remaining part a. Alanasi b. Tip of nose 28. Nasolabial which type of flap a. Transposition 29. Cut wound in lower lip from inside what type of suture a. Nylon b. Silk c. Prolene 30. Rhomboid flap 31. Island Pedicled flap 34 Prometric MCQ 2020 Surgery 32. Type of dressing in patient with secondary intention a. Alginate dressing b. Hydrocolloid dressing c. Hydrogel dressing ✓ Note: gauze then foam is the best 33. Pyoderma gangrenosum treatment a. Cyclosporine but if systemic steroid is in answers it is the first option b. Infliximab ✓ Note: Biologic (infliximab, adalimumab, etanercept and ustekinumab) off label. 34. Type of dressing a. Hydrocolloid b. Hydrogel c. Alginate d. Gauze 35. Type of flap on picture a. Island pedicle flap b. Rotational flap c. Skin graft 36. Case of cardiac patient with pacemaker make operation using: a. Electrocautery 37. Poliglecaprone 15 is a. Absorbable suture 38. Z-plasty a. Reorient scar b. Decrease length of scar 39. Type of suture in deep wound in lower lip in child cut in an accident a. Silk b. Nylon c. Polyglactin 9/10 35 Prometric MCQ 2020 Surgery 40. Surgical thread 4.0 has more advantage than 5.0 in a. Increase knot strength b. Increase tensile strength c. Smaller needle 41. Cyanotic leg questions? a. Drug causing it: capecitabine/ Doxorubicin b. Type of cryoglobulin 1 c. Cause: cholesterol arterial emboli 42. Topical anesthesia not used in ear surgery a. Prilocaine b. Bupivacaine 43. Topical anesthesia in child having ear problem to use a. Prilocaine 44. Male has this lesion for more than 3 months. He is on hydrochlorothiazide. asking about treatment? a. Intralesional steroid. b. Intralesional 5 fluorouracil. c. Surgery d. Interferon 45. Same previous lesion on thumb only, asking about treatment? a. Intralesional steroid. b. Intralesional 5 fluorouracil. c. No need d. Interferon 46. Peri auricular surgery with vestibular abnormalities, tinnitus, vertigo, what is note suitable antiseptic a. Chlorohexidine 36 Prometric MCQ 2020 Surgery Dressing: 1. Alginate if heavy exudates 2. Hydrocolloid if moderate 3. Hydrogel for dry Suture: 1. Face a. Deep suture vicryl [polyglactin], poliglecaprone are nonabsorbable suture b. Superficial suture nylon, polypropylene is nonabsorbable suture 2. Mucosa a. Deep suture none b. Surface suture silk, polyester nonabsorbable suture 3. Back. Deep suture: vicryl (polyglactin) absorbable 4. Trunk, Neck, limbs all same as face Notes: 1. M plasty used to shorten scar 2. Z plasty used to reorient scar, lengthen contracted scar, and relieve tension. 3. S plasty used over convex area 37 Bullous disease Prometric MCQ March 2020 Bullous diseases Bullous disease 1. Pregnant female case bulla on trunk, flanks, umbilical, abdomen type of Ig (H. gestationus) a. IgG b. IgM c. C3 2. Pemphigus erythematosus positive ANA, C3&C4 what treatment? a. HCQ b. Colchicine c. MTX ✓ Note: if steroid is mentioned will be the correct choice 3. Pemphigus vulgaris with clefts and protruding villi with high creatinine a. Steroid b. Cyclo c. Methotrexate 4. Pemphigus vulgaris desmoglien 3 &1 positive and CD20 is zero what the ideal time for contraception in weeks: a. 6 b. 9 c. 24 d. 48 5. Picture of newly born with umbilical cord stump still present and bullae around it what type of toxin a. Systemic toxin b. Local toxin 6. Lamina densa defect in collagen a. Type 4 and anchoring fibrils ////////type 7 and dermal microfibrils 7. DIF in PG a. IgG b. IgA c. IgM d. C3 38 Prometric MCQ March 2020 Bullous diseases 8. Patient with vesicles and blisters hands for 8 years and in lower limb and hypertrichosis what is treatment (PCT) a. Phlebotomy b. Hydroxychloroquine c. Steroid d. Dapsone e. Cyclosporine 9. Differences between HG and PUPP a. Pruritis b. Urticarial c. Recurrent after subsequence pregnancy 10. Desmoglin 3 positive antibodies + multiple bullous eruption +oral treatment (??Pemphigus vulgaris) a. Prednisolone / or prednisolone +rituximab 11. Patient 60 year with tense bullae no mucous membrane affection with subepidermal bullae IgG in floor what is next: a. Gastroendoscopy EBA…. Inflammatory bowel disease b. X ray 12. A. Histopathology of blistering with IgA and neutrophil treatment a. Dapsone 13. Histopathology of blistering with IgA and neutrophil with DM ،HTN ‫و‬AF a. Dapsone b. Steroid c. Azathioprine d. IVIG 14. Pregnant female with bullous pemphigoid takes 1 mg /kg of prednisolone with no improvement a. Delivery b. Increase dose to 2 mg/kg c. Azathioprine 15. Antigen of cicatricial pemphigoid a. BPAG 2 col 17 laminin 5 epiligrin, alpha 6, beta 4 integrin ✓ Note: direct immune IgG, C3 linear on BM zone – indirect roof if BpAg2 floor if anti laminin 5 39 Prometric MCQ March 2020 Bullous diseases 16. Cicatricial pemphigoid…………underlying malignancy a. type of Ag: Laminin 332 17. Cell with halo a. Merkel cell 18. Lamina lucida a. Palm 19. Anchoring filaments a. Lamina lucida 20. Para neoplastic pemphigus associated with a. AML b. ALL c. CML d. CLL 21. The most common is if in choices a. Non-Hodgkin lymphoma b. CLL c. Castleman’s disease 22. Common antigen in paraneoplastic pemphigus a. BPAG 1 ✓ Plectin, Desmoplakin I, Desmoplakin II, BPAG1, Envoplakin and Periplakin. 23. Bullous pemphigoid treatment biologic a. Rituximab 24. Patient with bullous pemphigoid (investigation& ‫ (وصف الحالة‬on treatment, then on investigation, elevated urea and creatinine a. Stop drug b. Add biologic c. IVIG d. Continue as before 25. Most safe biologic during pregnancy treatment a. Infliximab b. Certolizumab c. Adalimumab d. Ustkinomab 40 Prometric MCQ March 2020 Bullous diseases 26. Scenario of recurrent abdominal pain since childhood & picture of face & ears (EBA with Chron’s disease) a. Colchicine b. Dapsone c. Steroid d. Rivaroxaban 27. Male pt with tensile bulla on arm with no mucosal lesion (EBA)since many years. Which organ will be affected (associated cancer)? a. Lung b. Stomach c. Liver d. Pancreas 28. Pt developed bullae on arm after 3 days from starting sulfasalazine DIF –VE a. Acute generalized exanthem pustulosis b. Linear IgA c. Sneddon d. Sub-corneal pustular dermatosis 29. Case DH on treatment, patient become sick with Hb=6 what type of investigation we will a. G6PD b. Reticulocyte count c. Cryoglobulin 30. Salt split test separate skin at a. LL b. Lamina densa 31. Case ------ epidermolysis bullosa Acustica---- associated with a. Hematological malignancy b. Pregnancy 32. Case of Hailey Hailey disease mother and her daughter with axillary erosions and bad smell what treatment? a. Steroid b. Minocycline c. Others may be biologic or retinoids 41 Prometric MCQ March 2020 Bullous diseases 33. Granular deposition of IgA in dermal papillae along basement membrane (DH) what treatment a. Dapsone 34. Bullous pemphigoid treatment biologic a. Rituximab 35. Case of itchy skin several years lesion clinically will be a. Bull b. Plaque c. Papules d. Papulovesicular hp show acantholysis with no dyskeratosis ask about 36. Painful blisters, generalized, WBCs 18000 CBC: neutrophilia treatment: a. Cyclosporine b. Steroid 37. Case- child with bulla on extremities heal with scar defect where?? a. Sub-lamina lucida b. Sub-lamina densa c. Sub-corneal ✓ N.B. Casecokynetourain---- collagen 7 42 Hair and Pigmentary Prometric Images March 2020 Hair and Pigmentary Hair and pigmentary 1. Type of Keratin in hair follicle a. K 81 2. Diameter length of hair increase by day in mm a. 0.3 b. 1 3. Picture of androgenic alopecia in pregnant female stop drug before a. 1 month b. 6 months 4. Picture of large area of alopecia in child scalp what is the management a. PUVA b. Intralesional steroid c. Minoxidil 5. Female 3 years with female pattern hair loss take ttt preconception period of drug she takes is (note: minoxidil 2 weeks- spironolactone 1 month) a. 2m b. 4m c. 6m 6. Area of loss of hair in the scalp with loss of follicular ostia and pustulosis ttt a. Isotretinoin + Rifampicin b. Isotretinoin and Dapsone c. Dapsone + Rifampicin d. Clindamycin + Rifampicin 7. Child with large area of alopecia what type of ttt a. PUVA b. Injection steroid c. Minoxidil 8. Picture of brittle hair ttt or picture of 7 years girl with brittle hair a. Minoxidil b. Iron c. Ca gluconate 43 Prometric Images March 2020 Hair and Pigmentary 9. Hair epithelium stem cells (regenerating epithelium) a. Pulge b. Infundibulum c. Inner root sheath 10. Photo mostly trichotilomania what found beside hair follicle a. Hemorrhage b. Lymphocytosis c. Eosinophils d. Neutrophils 11. 2 photos of hair follicle female patient year complaing from receeding of frontal hair lines tt a. Steroid 2nd option b. hydroxychloroquine 1st option c. Minoxidil 12. Swollen hair picture a. Iron b. Zinc c. MTX d. Cu (Menkes Syndrome) Twisted hair pilitorti 13. Case of scarring alopecia with pustule best ttt: a. Rifampicin b. Tetracycline 14. Dissecting cellulitis: follicular occlusion triad or tetrad with acne conglobate + hidradenitis + pilonidal sinus a. Ttt is isotretinoin 15. case of scaring alopecia with pustules (folliculitis declvans)ttt: a. Rifampicin + Clindamycin. b. Isotretinoin + Rifampicin. c. Isotretinoin + Clindamycin. d. Isotretinoin + Dapsone. 16. Folliculitis decalvans ttt a. Dapsone and rifampicin b. Isotretinion and rifampcin 44 Prometric Images March 2020 Hair and Pigmentary 17. Hair lipid: eicosanoic ✓ Fatty acids then phytosphingosine then ceramide 18. type of acid in hair sebum a. Sapeinic 19. keratin type in hair a. Cystien 20. what makes up the majority of protein envelop of keratinocyte a. Loricrin b. Involucrin c. Fillaggrin d. Envoplakin 21. Picture of hair and case of pilli torti association a. Deafness b. Atopic 22. Type of lipid in sebum when increase sebum increse a. Cholesterol b. Squalene c. Sebolic acid d. wax esters 23. ttt of trichotillomania: a. N-acetyl cysteine 24. Pili torti (trichscopy of twisted hair ) treatment a. Copper b. Zinc c. Iron 25. Female 45years suffer from recession of frontal hair line what dose of 1st line of Ttt a. 5mg b. 1 mg c. 2 mg d. 3 mg 45 Prometric Images March 2020 Hair and Pigmentary 26. Case of folliculitis decalvans (increase urea + increase creatinine , normal CBC a. Minocycline b. Doxycycline c. Rifampicin d. Isotretinoi 27. Female with androgenetic alopecia with high DAHEA, high testosterone and rest is normal what to suspect a. Adrenal tumor b. Ovarian tumor c. Thyroid tumor 28. FFA the best ttt: a. Minoxidil b. Prednisone c. Hydroxychloroquine 29. History of 3 years duration in 50yrs female with oral dyschromia with Hyperkeratotic lesions on hands and Hypopigmented trunk lesions a. Contaminated well water b. Hydrocarbon 30. Picture of female with androgenetic alopecia and high DHEA and high testosterone and the rest are normal a. Adrenal tumor b. Ovarian tumor 31. Female with hair line recession, Ttt a. Cyclosporin b. Acitirin c. Hydroxychloroquine 32. Picture of area of scalp beside ear with scales (no loss of hair & erythema) a. Psoriasis b. Tinea capitis c. Irritated atopic dermatitis d. Seborrheic dermatitis 46 Prometric Images March 2020 Hair and Pigmentary 33. Photo of twisted hair ask about disease …pili torti a. Menkes disease b. Bjornstand syndrome 34. Picture of hair collected as tuft (pityriasis amantacia) but with pus: a. Psoriasis b. Seborrheic dermatitis c. Tinea capitis 47 Genodermatoses Prometric Images March 2020 Genodermatoses Genodermatoses 1. Female child with dermoid cyst: a. If in midline--------------MRI b. If in lateral eyebrow-----------no investigation 2. Picture of female child looks old the defect is (AR if cockyne and AD if progeria) a. AD b. AR c. XLD d. XLR ✓ Note: microcephaly is cockayne / large head is progeria ✓ Progeria…AD …. LMNA gene ✓ cockayne…AR……ercc8, ercc6 3. Old featured girl picture gene mutation a. Fibulin 5in cutislaxa b. fibroblast growth factor 4. Scaly erythematous ski lesions+ hair defect distal enter in proximal gene defect (Netherton) a. SPINK 5 or LEKT1 ‫األجابه الى تيجى صح‬ b. FAID H 5. Patient had defect SPRED1 most common (Legius syndrome) a. Neurofibroma b. Optic glioma c. Renal cell carcinoma d. Macrocephaly ✓ Note: if lipoma present 6. Lesion in child head small as aplasia cutis what the defect a. Brain ectopic tissue/ neural tube defect 48 Prometric Images March 2020 Genodermatoses 7. Multiple yellowish papule in neck and axilla and angoidstreaks (PXE) a) Aspirin b) Simvastatin ttt if CVS involved c) Steroid d) Stop smoking prophylactic CVS not involved may be right 8. Cancer colon in father and 2 sons and one son is normal incidence a. Zero b. 25% c. 50% d. 100% 9. Picture of AR inheritance with lentigo which syndrome?? a. Tays AR (Like TTD without photosensitivity and normal gonads) b. Carney c. Pinpk syndrome d. Blender syndrome AD 10. Picture of striated nail (darrier) a. AD b. AR c. XLD d. XLR 11. Darrier exacerbated by a. Lithium 12. Ichthyosis +MR + deafness (Mednik Syndrome) ✓ Keratitis with KID syndrome but no MR 13. Enteropathy + peripheral neuropathy ✓ MEDNIK (MR-enteropathydeafness-neuropathy-ichthyosis-keratoderma) 49 Prometric Images March 2020 Genodermatoses 14. Father + Mother are normal but baby has syndrome incidence a. Zero b. 25% c. 75% d. 100% 15. Pigmentation in all body not in mucous membrane what syndrome a. Peutzjeugher b. Cornhite Canada Syndrome (pigmentation all body + mm + Git polyposis) c. Huziquer syndrome d. Leopard syndrome if not present Cowden syndrome ‫تصحيح‬ 16. Ichthyosis with low estradiol a. AR b. AD c. XLD d. XLR 17. Papule on mandibulae investigations (popular sarcoidosis) a. Ca b. ACEI 18. Lamellar ichthyosis a. AR 19. Picture of axillary erythematous skin papules associated with a. Medulloblastoma b. Cardiac problems ✓ If like picture Gorlin syndrome 20. PXE associated with a. Cardiomyopathy b. Peripheral vascular disease c. Peripheral claudication 21. PPK+ cancer mucous membrane affection (Howel Evans syndrome) a. XLR b. XLD c. AD d. AR 50 Prometric Images March 2020 Genodermatoses 22. Hailey and Hailey: a. Diagnosis (case of erythematous vesicular lesion with acantholysis mother & daughter with bad odor in intertriginous, flaccid vesicles) b. Investigations histopathology (acantholysis with supra-basal cleft and depilated brick wall, mild dyskeratosis &DIF is negative) c. Management…Minocycline 23. Picture of nails hyperkeratotic with history of father and daughter what ttt: a. Acitretin b. Topical steroid 24. Picture of a man with café au lait macules + lesion on scapula the most associated anomalies (Mccune Albright syndrome) a. Scoliosis b. Lung deformity 25. Creatine kinase enzyme found in a. Dermatomyositis 26. Child with atopy + developmental retardation + ichthyosis what is the syndrome a. Sjogren Larsson b. Netherton 27. Child with Langerhans cell histiocytosis refer to a. Ophthalmologist b. Neuro c. Pediatric d. Orthopedic 28. Description of a case ???Grover’s disease asks about type of lesion a. Popular b. Papulovesicular c. Vesicular 29. Sjogren Larsson syndrome (MR + ichthyosis + spastic paraplegia) Sjogren Larsson Netherton syndrome 51 Prometric Images March 2020 Genodermatoses 30. Picture of hand with PPK type of keratin a. K9 b. K10 c. K5 31. Type of cataract in atopic dermatitis a. More common post subcapsular b. More specific ant subcapsular 32. Stimulation of KCs cycle a. IL1 b. TNF 33. Case of Hailey-Hailey disease (mother and her daughter with axillary erosion and bad smell), what is histopathology? a. Acantholysis with dyskeratosis if Grover’s disease b. Acantholysis without dyskeratosis 34. Case of multiple bcc with milia: a. Gorlin b. Rombo c. Basex (milia with trichoepithelioma and hypohydrosis) 35. PPK (focal+ mucous patches on mouth and tongue) what’s inheritance? a. AD 36. Tumor on nose as SCC or keratoacanthoma (Muir Torre syndrome)/ Mismatch repair gene: a. 1 b. 2 c. 3 d. 4 37. Picture of small girl has small yellow nodule on scalp, what is another site for this lesion? a. Eye b. Liver c. Brain d. Lung 52 Prometric Images March 2020 Genodermatoses 38. Picture of old man has multiple brown patches on back and hyper keratotic palmoplantar and oral. a. Gorlin b. Darrier 39. Picture of palms [PPK] since birth what type of keratin a. K6 b. K1 c. K9 40. Skin lesion described (hyperpigmentation) with polyposis in colon no mm affection a. Cowden disease 41. The parent’s phenotype appears normal and the son has a disease ratio of occurrence in other siblings a. 25 % b. 50 % 42. Picture mutation gene periorbital edema and sagged cheeks a. Fibulin 5 if Cutis laxa b. ABCC6 gene if PXE 43. Yellowish discoloration of all toe nail associated with a. Liver disease b. Lung disease c. GIT disease d. Renal e. Eye 44. Girl with dark pigmentation on lip and his father and two sisters has history of colon cancer and one sister is normal what percentage of transmission to her siblings: a. 0 % b. 50 % c. 100 % d. 10 % 53 Prometric Images March 2020 Genodermatoses 45. Ichthyosis since birth + mental retardation = a. If with atopy / Netherton syndrome b. If with spastic paraplegia / Sjogren Larsson syndrome c. If with enteropathy + neuritis / MEDNIK syndrome 46. Hailey-Hailey disease histopathology discerption: acantholysis with dyskeratosis most common site a-Axilla 47. Female with bifid upper 3 rib and hemivertebra in upper 3, What is the gene defect? a. Gorlin-Goltz syndrome /PTCH1 /AD Ch9 48. Picture of the baby 8 months with syndrome & developmental delay (Netherton syndrome) will have a. Food allergy. if erythematous it is Netherton b. Keratitis (if with Dry or scratching & MR it might be Sjogren Larsson syndrome.) c. Muscle weakness ✓ N.B no atopy or hair abnormalities were in answers 49. Child has syndrome and his father and mother are normal percentage of his brother has same lesion (AR) a. 0 b. 25 c. 50 50. A girl with lesion beside lat canthus associated with a. Developmental delay b. Tonic clinic convulsions c. Contralateral motor seizure d. Decreased IQ 54 Prometric Images March 2020 Genodermatoses 51. Male patient 44 years old has dark red itchy lesion on arms and buttocks what is the cause a. AIDS b. Wilson disease c. Cokayne syndrome d. Vit A deficiency 52. Female with uterine bleeding this lesion is desmin and smooth muscle positive: gene defect a. Telomer b. Krebs cycle c. Enzyme 53. Baby having hypotrichosis and atopy and scaly skin his parents are normal what are the chances that the NEXT sibling while be diseased??? a. zero b. 25 c. 50 54. Gingival papules of Cowden investigation a. Neck exam or thyroid scan ✓ Note: if not mentioned choose breast 55. Type of renal cancer in birt hug dube a. Chromophobe 56. Rash and cardiomegaly biologic hypereosinophilic syndrome a. Imatinib 57. histopathological picture of steatocytoma ass with a. Pachyonychia congenita 58. Subungual hyper keratosis of toe nail and focal PPK and mucous patch on tongue. (pachyonychia congenita) a. AD b. AR c. XLR d. XLD 55 Prometric Images March 2020 Genodermatoses 59. Picture of nail in boy and similar condition in his sister with high TSH and low T3, T4 asking about TTT a. Acitretin b. Fluconazole ✓ Note: if diagnosis is chronic mucocutaneous candidiasis with hypothyroidism (AR) so ttt is antifungal ✓ Other possible diagnosis: Hyperhidrotic ectodermal dysplasia with hypothyroidism and ciliary dyskinesia is a rare condition characterized by alopecia (hair loss); nail dystrophy (abnormal development of the nails); ophthalmic complications; (primary hypothyroidism); hypohidrosis;(freckles); enteropathy, and respiratory tract infections due to ciliary dyskinesia. it is thought to be inherited in an autosomal recessive manner. Treatment is generally symptomatic and supportive. 60. Which of these granulomatous lesions in Not ass with cholesterol clefts? a. Necrobiosis lipoidica and JXG 56 Prometric Images March 2020 Genodermatoses Board vital 1. All of the following conditions contain needle-shaped clefts EXCEPT: a. Subcutaneous fat necrosis of the newborn b. Post-steroid panniculitis c. Cholesterol emboli d. Sclerema neonatorum e. Juvenile xanthogranuloma ➢ Explanation: Juvenile xanthogranulomas are composed of a mixed infiltrate of histiocytes, lymphocytes and eosinophils. Foamy histiocytes and Touton giant cells are characteristic. Fibrosis is prominent in older lesions. They exhibit positive staining of CD68, factor 13a, and HAM56. They do not contain needle shape clefts. All of the other conditions listed contain needle-shaped clefting. 2. Which of the following syndromes is not a consideration for a patient presenting with the findings illustrated below? a. Peutz-Jeghers b. Laugier-Hunziker c. Cronkhite-Canada d. Carney Complex e. LEOPARD Syndrome ➢ Explanation: LEOPARD syndrome (lentigines, EKG abnormalities, ocular hypertelorism, pulmonic stenosis, abnormal genitalia, retardation of growth, and sensorineural deafness), presents with dark 1-5 mm lentigines appear anywhere on the skin, including the palms and sole, with a greater predilection for the neck and upper trunk. These lentigines spare the oral mucosa, thus eliminating LEOPARD syndrome from the differential diagnosis of a patient presenting with oral melanotic macules. 57 Prometric Images March 2020 Genodermatoses 3. In the POEMS syndrome, which skin finding(s) are you likely to encounter? a. Rapid appearance of seborrheic keratosis b. Glomeruloid hemangiomas, hypertrichosis and hyperpigmentation c. Erosive disease of the mucosa d. Large red to violet-brown patch e. Concentric erythematous lesions, often giving the appearance of grains of wood ➢ Explanation: Skin findings in the POEMS syndrome include: glomeruloid hemangiomas, cherry angiomas, sclerodermoid changes, digital clubbing, hypertrichosis, and hyperpigmentation. The POEMS acronym stands for (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes). Osteosclerotic myeloma, Castleman’s disease, and plasmacytomas have been reported in patients with POEMS. The rapid appearance of seborrheic keratosis is called the sign of Leser-Trélat and is controversial. It may be associated with gastric carcinoma. Erosive disease of the mucosa is seen in paraneoplastic pemphigus. A large red to violet-brown patch is seen in AESOP (adenopathy, extensive skin patch overlying (a) plasmacytoma). Concentric erythematous lesions, often giving the appearance of grains of wood are the typical description of erythema gyratum repens, sometimes said to be associated with pulmonary cancer. 4. Histiocytosis are identified with markers, select the combination of positive and negative markers associated with Langerhans cell histiocytosis. a. S100- CD1a- Langerin (CD207)- CD68+ Factor XIIIa+ b. S100+ CD1a- Langerin (CD207)- CD68+ Factor XIIIa+/c. S100+ CD1a+ Langerin (CD207)- CD68+ Factor XIIIa+/d. S100+ CD1a+ Langerin (CD207)+ CD68- Factor XIIIae. S100- CD1a- Langerin (CD207)- CD68+ Factor XIIIa+/➢ Explanation: ✓ Langerhans cell histiocytosis (LCH) is described by an immunophenotype positive for S100, CD1a and Langerin (CD207), and which contain cytoplasmic Birbeck granules. The other profiles correspond to: ✓ S100- CD1a- Langerin (CD207)- CD68+ Factor XIIIa+ for juvenile xanthogranuloma (and other non-Langerhans histiocytosis). ✓ S100+ CD1a- Langerin (CD207)- CD68+ Factor XIIIa+/- is the typical profile for Rosai-Dorfman disease. ✓ S100+ CD1a+ Langerin (CD207)- CD68+ Factor XIIIa+/- is the profile of indeterminate cell histiocytosis. ✓ S100- CD1a- Langerin (CD207)- CD68+ Factor XIIIa+/- is the profile of necrobiotic xanthogranuloma. 58 Prometric Images March 2020 Genodermatoses 5. The lesions depicted below can be associated with which of the following? a. Rombo syndrome b. Brooke-Spiegler syndrome c. Bazex-Dupre-Christol syndrome d. A & B e. All of the above ➢ Explanation: All of the above syndromes can present with trichoepitheliomas. A. Trichoepitheliomas are benign tumors that present as discrete papules along the nasolabial folds. Rombo syndrome presents with trichoepitheliomas in addition to milia, hypotrichosis, basal cell carcinomas and atrophoderma. B. Brooke-Spiegler syndrome presents with multiple trichoepitheliomas and cylindromas. C. Bazex-Dupre-Christol syndrome is an X-linked dominant disor