ROSH REVIEW Dermatology | Questions & Answers (100 %Score) Latest Updated
2024/2025 Comprehensive Questions A+ Graded Answers | With Expert Solutions
An 18-year-old man is diagnosed with condyloma acuminatum in the genital area.
Which of the following physical exam findings is most consistent with this diagnosis?
Flesh-colored, exophytic lesions
Painless ulceration
Shallow, painful ulcerations
Umbilicated, dome-shaped lesions - Correct Answer ( A )
Explanation:
Condyloma acuminata, commonly known as genital warts, can appear as flesh-colored,
exophytic lesions or can appear as small bumps that are flat, pedunculated, verrucous,
or papilliform. Condyloma acuminatum is caused by an infection with the human
papillomavirus (HPV) types 6 and 11. It is a sexually transmitted infection that can be
prevented with vaccination. All girls and boys who are 11 or 12 years old should get the
recommended series of HPV vaccine regardless of sexual history. HPV is strongly
associated with the development of genitourinary and rectal cancer. The infection can
affect the vagina, cervix, vulva, oropharynx, perineum, and perianal areas. Treatment
includes trichloroacetic acid solution, podophyllin, cryosurgery, surgical excision, or
imiquimod cream application.
One Step Further
Question: Where are the most commonly involved sites of HPV infection in men? -
Answer: The penis and scrotum.
A 54-year-old woman presents to the ED with a painful rash. She experienced severe
mouth sores and pain with swallowing for the past week and then developed this rash.
Physical exam is shown above. Nikolsky sign is positive. Which of the following
conditions is commonly associated with this disease process?
Idiopathic thrombocytopenic purpura
Myasthenia gravis
Sarcoidosis
Wegener's granulomatosis - Correct Answer ( B )
Explanation:
This patient is exhibiting symptoms and physical exam findings consistent with
pemphigus vulgaris. Pemphigus vulgaris is a potentially life-threatening autoimmune
mucocutaneous intraepithelial bullous disease. It has a higher prevalence in Jewish and
Mediterranean populations. It is often associated with myasthenia gravis and thymoma.
Pemphigus vulgaris is caused by IgG autoantibodies against keratinocytes and their
desmosomes that causes acantholysis, or loss of cell-to-cell adhesion. Signs and
symptoms include early mucous membrane lesions preceding skin lesions, most
commonly oral and esophageal involvement leading to dysphagia, hoarse voice, and
dehydration, and the classic bullous rash. The bullae are painful, flaccid, and easily
,rupture. Patients have a positive Nikolsky sign as well as a positive Asboe-Hansen sign,
where gentle lateral pressure on the bullae spreads the fluid into neighboring unaffected
skin. Diagnosis is by skin biopsy to differentiate pemphigus vulgaris from Stevens-
Johnson syndrome or bullous pemphigoid. Treatment is with steroids and
immunomodulators such as azathioprine, cyclosporine, or methotrexate. These patients
should be admitted as there is a high mortality rate without treatment. Mortality even
with treatment remains as high as 5-15%.
24-year-old man presents for evaluation of a rash. The patient reports a mildly pruritic
rash on his back and trunk that progressively spread over the last week. You examine
and note the rash seen above. Which of the following historical elements is most likely
to be obtained upon further questioning?
A larger 2 to 5 cm erythematous patch preceded the diffuse rash
Fever preceded the onset of rash
Oral mucosal lesions preceded the onset of rash
Travel to the Southeast USA occurred a week before the rash - Correct Answer ( A )
Explanation:
This patient has pityriasis rosea. This is a mild skin eruption that is self-limited usually
lasting 4 to 7 weeks. There is no clear etiology of the rash although infection with
Herpesvirus 7 or a fungus is suspected. Prior to the onset of the diffuse rash, patients
may recall a herald patch described as a 2 to 5 cm erythematous oval plaque similar to
the smaller more diffuse lesions. The rash is described as following a "Christmas tree"
pattern on the trunk, classically following the skin cleavage lines. There is no indicated
treatment for pityriasis rosea other than antihistamines for symptomatic relief if the rash
is pruritic.
A history of travel to the Southeast USA (D) before the onset of rash should raise an
index of suspicion for an infectious etiology to the rash like Rocky Mountain Spotted
fever, a tick-borne illness caused by Rickettsia rickettsii. This illness occurs most
commonly in late spring and early summer and is characterized by a rash that starts
distally and spreads to the core.
One Step Further
Question: Is the rash of pityriasis rosea contagious? - Answer: No, the rash cannot be
spread by direct contact.
A 55-year-old man presents with right sided chest pain and a rash for 4 days as seen
above. What management should be initiated?
Diphenhydramnine
Pain control
Topical antibiotics
Topical corticosteroids - Correct Answer ( B )
Explanation:
,This patient presents with herpes zoster (shingles) and should have appropriate pain
control started. Herpes zoster results from the reactivation of dormant variclla zoster
virus developing in patients with a history of chickenpox. Typically, pain in a dermatomal
distribution precedes the eruption of grouped vesicles on an erythematous base in the
same dermatome. The vesicles are cloudy at first and progress to crust formation later
in the course. The pain associated with the disease is often severe and debilitating.
Patients may have chronic post-herpetic neuralgia as well. The mainstay of treatment is
control of pain to make the patient comfortable. Orally administered corticosteroids are
commonly used in the treatment of herpes zoster, even though clinical trials have
shown variable results. Prednisone used in conjunction with acyclovir has been shown
to reduce the pain associated with herpes zoster
One Step Further
Question: What complication should herpes zoster lesions at the tip of the nose alert the
clinician to? - Answer: Ocular herpes zoster is correlated with lesions at the tip of the
nose - called Hutchinson's sign.
An 18-year-old obese woman presents to your office with a complaint of redness and
pain in her right axilla. Physical exam reveals a solitary nodule, approximately 2 cm in
size, with surrounding inflammation and erythema. She tells you that she's had similar
"boils" in the past. Which of the following is the most likely diagnosis?
Contact dermatitis
Dermoid cyst
Granuloma inguinale
Hidradenitis suppurativa - Correct Answer ( D )
Explanation:
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes
scarring, keloids, contractures and immobility. Originally believed to be caused by a
defect in the apocrine glands, it may also be due to a defect in the follicular epithelium.
HS begins in adolescence or adulthood in otherwise healthy individuals. Risk factors for
the development of HS include obesity, genetics, smoking, diet and mechanical stress
on the skin. Onset is insidious, with the first presentation generally being erythema in an
intertriginous skin area, most commonly the axilla. As the disease progresses, formation
of sinus tracts, multiple open comedomes and scarring occur. The initial presentation
can mimic other disorders and individuals often are diagnosed incorrectly with recurrent
furunculosis. Diagnosis is a clinical one. Treatment includes medical management in the
early stages and surgical intervention after the formation of abscesses or sinus tracts.
One Step Further
Question: What is the other name for hidradenitis suppurativa? - Answer: Acne inversa.
A 60-year-old man with a history of diabetes presents to your office with a complaint of
thickened and discolored toenails. He tells you that his toenails have had this
appearance for over a year, and now he is experiencing discomfort when wearing tight-
fitting shoes. Physical exam reveals hyperkeratosis and onycholysis of bilateral great
, and second toes. Which of the following is the most appropriate next step in
management?
Begin treatment with oral terbinafine
Check serum aminotransferases
Potassium hydroxide examination of toenail scrapings
Watchful waiting - Correct Answer ( C )
Explanation:
Onychomycosis is a fungal infection of the toenails or fingernails that can involve any
part of the nail including the plate, bed or matrix. There are several subtypes of
onychomycosis, with the most common being distal subungual onychomycosis. This
type presents with the great toe being the first affected. A white, yellow or brown
discoloration can be seen that eventually spreads to the entire nail. Onycholysis, the
separation of the nail from the plate, may also be seen. Onychomycosis is initially a
cosmetic concern, however with time it can cause pain, disfigurement, and decreased
quality of life. Other nail dystrophies can present similarly to onychomycosis, therefore
establishing the presence of a fungal etiology is recommended prior to initiation of
treatment. Diagnosis is with potassium hydroxide (KOH) examination of nail scrapings.
Patients who are immunocompromised or who have diabetes mellitus are at an
increased risk of bacterial infections due to onychomycosis. Treatment should be
considered in these patients to avoid sequelae.
Once a fungal etiology has been determined, first-line treatment is with oral antimycotic
agents such as terbinafine (A). Terbinafine can cause hepatotoxicity, so pretreatment
serum aminotransferases (B) should be measured prior to initiating therapy and then
monitored during the course of treatment.
One Step Further
Question: What is the most common etiology of onychomycosis? - Answer:
Dermatophyte infection.
A 18-year-old woman presents with a diffuse papulosquamous rash. The rash began
one month prior when she noticed a large patch on her neck that was followed by the
diffuse papulosquamous rash. You inform the patient that the rash will last 5-8 weeks
and prescribe her cetirizine. Which of the following is the most likely diagnosis?
Contact dermatitis
Pityriasis rosea
Scabies
Tinea versicolor - Correct Answer ( B )
Explanation:
Pityriasis rosea is a common acute eruption usually affecting children and young adults;
the cause is unknown. It is characterized by the formation of an initial herald patch,
followed by the development of a diffuse papulosquamous rash. Pityriasis rosea is
difficult to identify until the appearance of characteristic, smaller, secondary lesions that
follow Langer's lines. The rash of pityriasis rosea typically lasts 8 to 12 weeks, with
