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ROSH REVIEW Dermatology Questions and Answers 2024/2025 | Already Passed
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ROSH REVIEW Dermatology Questions and Answers 2024/2025 | Already Passed
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©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AMROSH REVIEW Dermatology Questions and
Answers 2024/2025 | Already Passed
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.
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
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
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
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
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, ©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
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 complete resolution in most patients. An
important goal of treatment is to control pruritus, which may be severe; zinc oxide, calamine
lotion, topical steroids, and oral antihistamines are usually helpful. Systemic steroids are
generally not recommended. Patients should be reassured about the self-limited nature of
pityriasis rosea. Persistence of the rash or pruritus beyond 12 weeks should prompt
reconsideration of the original diagnosis, consideration of biopsy to confirm the diagnosis, and
questioning the patient again about use of medications that may cause a rash similar to that of
pityriasis rosea.
A 16-year-old boy is in the clinic with his father for a sports physical examination. He
participates in wrestling in school. He eats a healthy diet. Family history is negative for heart
disease or sudden death in a relative younger than 50 years of age. He denies shortness of breath,
chest pain, palpitations, or loss of consciousness. On physical examination, heart rate is 75 beats
per minute, respiratory rate is 16 cycles per minute, temperature is 36.5 oC, body mass index is
at the 87th percentile, clear breath sounds, no murmur, soft abdomen. On skin examination, there
is an annular plaque with central clearing and a raised border measuring about 5 cm in diameter.
There are fine scales present. Which of the following is the most likely diagnosis?
Granuloma annulare
Nummular eczema
Subacute cutaneous lupus erythematosus
Tinea corporis - ✔️✔️Correct Answer ( D )
Explanation:
The boy has skin examination findings consistent with tinea corporis. Tinea corporis is a
cutaneous dermatophyte infection occurring in sites other than the feet, groin, face, or hand.
Trichophyton rubrum is the most common cause of tinea corporis. Acquisition of infection may
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