Med Dermatology Questions-75

2010 American Board of Dermatology Recertification Examination Study Guide: Medical Dermatology Module

For each example of bias in a study, select the most accurate description (A-E). (A) (B) (C) (D) (E)

Detection bias Misclassification bias Recall bias Response bias Withdrawal bias

1.

Health-conscious people are more likely to attend skin cancer screenings.

2.

The patients in poorest health drop out of a melanoma trial.

3.

Patients who see dermatologists are more likely than patients who see primary care physicians to have the diagnosis of seborrheic keratosis in their medical records.

4.

Patients who have melanoma are more likely to remember blistering sunburns than control subjects without melanoma.

5.

A study reviewing medical records for exposures to a new "black-box" labeled drug fails to include 5% of patients who were importing the medicine from Mexico without a prescription.

1


For each systemic disease, select the most likely cutaneous disorder or disease (A-E). (A) (B) (C) (D) (E)

Acute febrile neutrophilic dermatosis Cuticular erythema Pinched purpura of the eyelids Pyoderma gangrenosum of the lower limbs Ulcerations secondary to mixed cryoglobulinemia

6.

Acute myelogenous leukemia

7.

Systemic amyloidosis

8.

Hepatitis C

9.

Dermatomyositis

10. Crohn's disease

2


11. Which of the following is a relative contraindication to beginning etanercept therapy? (A) (B) (C) (D) (E)

Family history of retinitis pigmentosa History of chronic renal failure History of congestive heart failure (stage III) History of positive PPD test and treatment with isoniazid History of unexplained anemia

3


12. Which of the following immunosuppressive medications is most appropriate for a patient with Kaposi sarcoma who has undergone a solid organ transplantation? (A) (B) (C) (D) (E)

Azathioprine Cyclosporine Mycophenolate mofetil Sirolimus Tacrolimus

4


13. Which of the following immunosuppressive agents inhibits purine biosynthesis? (A) (B) (C) (D) (E)

Cyclosporine Hydroxyurea Mycophenolate mofetil Tacrolimus Thalidomide

5


14. Which of the following medications can cause mast cell degranulation and histamine release without requiring specific immunologic antigen-IgE complexes? (A) (B) (C) (D) (E)

Codeine Enalapril Griseofulvin Itraconazole Niacinamide

6


15. Concurrent use of which of the following herbal supplements is most likely to decrease the efficacy of oral contraceptives? (A) (B) (C) (D) (E)

Garlic Ginkgo biloba Hawthorn Peppermint St. John's wort

7


16. Which of the following complications is more likely with oral prednisone 20 mg daily than with oral prednisone 40 mg every other day? (A) (B) (C) (D) (E)

Adrenal crisis Aseptic necrosis Cataracts Glaucoma Osteoporosis

8


17. A 60-year-old man develops a generalized bullous eruption one week after undergoing coronary artery bypass grafting. His current medications include quinidine, vancomycin, digoxin, and furosemide. Histologic examination of a biopsy specimen of affected skin shows a subepidermal bulla with neutrophils and linear deposition of IgA at the basement membrane zone. Which of the following is the most appropriate next step in the management of this eruption? (A) (B) (C) (D) (E)

Continue current medications and add dapsone Continue current medications and add a high-dose corticosteroid Discontinue furosemide Discontinue quinidine and add sulfapyridine Discontinue vancomycin

9


18. Which of the following medications is most likely to cause acute generalized exanthematous pustulosis? (A) (B) (C) (D) (E)

Bupropion Erythromycin Hydrochlorothiazide Omeprazole Phenytoin

10


19. Which of the following drugs is most likely to induce subacute cutaneous lupus erythematosus? (A) (B) (C) (D) (E)

Cephalexin Furosemide Isoniazid Propranolol Terbinafine

11


20. Which of the following medications is most likely to cause a hypersensitivity syndrome with systemic symptoms in a patient who is seropositive for HIV? (A) (B) (C) (D) (E)

Abacavir Dapsone Efavirenz Saquinavir Zidovudine (AZT)

12


21. A 42-year-old man with rheumatoid arthritis has the rapid appearance of multiple small nodules on his fingers. Biopsy specimen of a nodule shows a palisaded granuloma with a dense central neutrophilic infiltrate. Which of the following drugs is the most likely cause of this eruption? (A) (B) (C) (D) (E)

Azathioprine Celecoxib Hydroxychloroquine Methotrexate Sulfasalazine

13


22. A 60-year-old man has had a pruritic erythematous papular eruption on the trunk, arms, and legs for the past month. He had similar reactions after taking hydrochlorothiazide and after taking trimethoprim–sulfamethoxazole. Which of the following medications is the most likely cause of the dermatitis? (A) (B) (C) (D) (E)

Celecoxib Fluconazole Hydrocodone Levofloxacin Spironolactone

14


23. A 40-year-old woman has a six-month history of tense vesicles and bullae on the dorsa of the hands that resolve with scars. Serum, urine, and stool examinations are negative for detectable porphyrins. Biopsy specimen of a new vesicle shows a cell-poor subepidermal blister. Which of the following drugs is the most likely cause of the lesions? (A) (B) (C) (D) (E)

Amiodarone Captopril Naproxen Penicillamine Vancomycin

15


24. A 6-year-old child has the onset of a rash and fever three weeks after starting treatment with oral phenytoin. Laboratory findings include leukocytosis and serum transaminase activity consistent with acute hepatitis. This child is most likely to have a similar reaction to which of the following drugs? (A) (B) (C) (D) (E)

Carbamazepine Cotrimoxazole Ethambutol Midazolam Valproic acid

16


25. A 40-year-old man is being evaluated because of symptoms of porphyria cutanea tarda. He has normal hepatic enzyme activities and is found to be homozygous for mutations in HFE C282Y. Which of the following is the most appropriate treatment? (A) (B) (C) (D) (E)

Following a diabetic diet Hydroxychloroquine therapy Phlebotomy to maintain a serum ferritin level below 20 µg/L Monitoring of liver enzyme activities every three months Sunscreen use

17


26. Which of the following agents is most likely to induce a cutaneous sarcoidal reaction? (A) (B) (C) (D) (E)

Etanercept Interferon alfa Interleukin-2 Nelfinavir Thalidomide

18


27. A 45-year-old woman is being evaluated because of a three-month history of a papular eruption on her knees. Examination shows multiple erythematous papules on the knees. Histopathologic examination of lesional skin obtained on biopsy shows multiple noncaseating granulomata with minimal lymphocytic inflammation; polarizable foreign material is also noted. Staining for fungi and acid-fast bacilli is negative. Which of the following findings is most likely on radiography of the chest? (A) (B) (C) (D) (E)

Bilateral hilar lymphadenopathy only Bilateral hilar lymphadenopathy with parenchymal fibrosis Parenchymal fibrosis only Unilateral hilar adenopathy No abnormalities

19


28. A patient will begin intravenous immunoglobulin (IVIG) therapy for pemphigus vulgaris. Which of the following laboratory tests is most important before beginning this therapy? (A) (B) (C) (D) (E)

Complete blood cell count Hepatic function panel HIV antibody Serum IgA level Urinalysis

20


29. Which of the following diseases is most frequently associated with small bowel lymphoma? (A) (B) (C) (D) (E)

Atopic dermatitis Dermatitis herpetiformis Erythema multiforme Pemphigus vulgaris Psoriasis vulgaris

21


30. Which of the following medications is the most appropriate initial treatment of a patient with linear IgA disease? (A) (B) (C) (D) (E)

Azathioprine Cyclophosphamide Dapsone Methotrexate Tetracycline

22


31. Antibodies to type VII collagen within anchoring fibrils are most closely associated with which of the following diseases? (A) (B) (C) (D) (E)

Bullous pemphigoid Chronic bullous disease of childhood Dermatitis herpetiformis Bullous lupus erythematosus Subacute cutaneous lupus erythematosus

23


32. A 45-year-old woman who smokes one pack of cigarettes daily is diagnosed with cutaneous lupus erythematosus. The efficacy of which of the following medications is most likely to be adversely affected by her smoking? (A) (B) (C) (D) (E)

Azathioprine Chloroquine Dapsone Etanercept Methotrexate

24


33. Which of the following is the most common clinical course of neonatal lupus in infants? (A) (B) (C) (D) (E)

Complete resolution only with administration of a systemic corticosteroid Frequent relapses and remissions Healing of lesions with significant scarring Progression to systemic disease Spontaneous resolution in 6 to12 months

25


34. A 35-year-old woman has the onset of proximal muscle weakness and a heliotrope rash. Serum creatine kinase activity is greater than 3000 U/L. This patient is most likely to have a malignancy at which of the following sites? (A) (B) (C) (D) (E)

Breast Colon Lung Ovary Stomach

26


35. A 41-year-old woman with a 10-year history of severe Raynaud phenomenon has had the recent onset of "spider veins" on the face and hardening of the skin of the hands. Examination shows perioral furrowing and sclerosis of the neck, forearms, and hands; there is no sclerosis on the trunk. Serum assay for ANA is positive with a nucleolar pattern (dilution 1:640). The most appropriate management is periodic monitoring with which of the following studies? (A) (B) (C) (D) (E)

CT scan of the chest Electromyography Pulmonary function testing Serum assay for anti-centromere antibody Serum creatinine level

27


36. A 30-year-old woman is being evaluated shortly after having a stroke. Physical examination shows livedo reticularis and an ulcer on the left medial lower leg. The skin changes had developed before she had the stroke. Which of the following laboratory tests is most useful in establishing the diagnosis? (A) (B) (C) (D) (E)

Anti-dsDNA test Antineutrophilic cytoplasmic antibody test Antiphospholipid antibody panel Rocky Mountain spotted fever assay Serum protein electrophoresis

28


37. Direct immunofluorescence performed on a biopsy specimen from a patient with multiple purpuric lesions reveals IgA deposition in the cutaneous vasculature. This finding best supports which of the following diagnoses? (A) (B) (C) (D) (E)

Henoch-Schönlein purpura Mixed cryoglobulin-associated vasculitis Rheumatoid factor-associated vasculitis Urticarial vasculitis Wegener granulomatosis

29


38. A 52-year-old woman has had the gradual development of generalized pruritus, xerostomia, urticarial lesions, purpuric macules on her legs, and dyspareunia over the past month. Histologic evaluation of an urticarial lesion shows leukocytoclastic vasculitis. Which of the following studies in serum is most likely to confirm this diagnosis? (A) (B) (C) (D) (E)

cANCA assay p-ANCA assay Protein electrophoresis Ro (SS-A) antibody assay Thyroid-stimulating hormone level

30


39. An otherwise healthy 34-year-old woman has palpable purpura, sinusitis, pulmonary infiltrates, and rapidly progressing renal failure. She has no history of asthma. Skin biopsy shows perivascular granulomatous inflammation. Positive results are most likely on which of the following serologic tests? (A) (B) (C) (D) (E)

Anti-Ro(SS-A) antibody Anti-topoisomerase I (Scl-70) antibody Anti-U1RNP antibody cANCA Cryoglobulin

31


40. A 22-year-old woman has acne, acanthosis nigricans, hirsutism, and oligomenorrhea. This patient has an increased likelihood of developing which of the following conditions? (A) (B) (C) (D) (E)

Autoimmune glomerulonephritis Insulin-resistant diabetes mellitus Intraductal breast carcinoma Pulmonary fibrosis Uterine leiomyomas

32


41. A 55-year-old woman has numerous acral keratoses and skin-colored verrucous papules around facial orifices. Histologic examination of a biopsy specimen of a lesion shows a trichilemmoma. In addition to breast carcinoma, this patient is at greatest risk for developing which of the following types of cancer? (A) (B) (C) (D) (E)

Hepatocellular carcinoma Ovarian carcinoma Thyroid carcinoma Transitional cell carcinoma of the bladder Uterine carcinoma

33


42. A 72-year-old man with esophageal carcinoma has red scaly plaques on the ears, hands, and feet. Which of the following is the most likely diagnosis? (A) (B) (C) (D) (E)

Acanthosis nigricans Bazex syndrome Dermatomyositis Necrolytic migratory erythema Sweet syndrome

34


43. Compared with a healthy patient, a patient with a family history of familial melanoma syndrome has an increased risk for which of the following neoplasms? (A) (B) (C) (D) (E)

Astrocytoma Hodgkin lymphoma Medulloblastoma Pancreatic carcinoma Small cell lung carcinoma

35


44. A 33-year-old man is being evaluated because of multiple skin tags and flesh-colored papules. Histopathologic examination shows fibrofolliculomas. This patient has the greatest risk for which of the following disorders? (A) (B) (C) (D) (E)

Atherosclerosis Cushing disease Lymphoma Renal cell carcinoma Testicular carcinoma

36


45. A 40-year-old man who is seropositive for HIV begins thalidomide therapy for prurigo nodularis. Which of the following studies at regular intervals is the most appropriate follow-up care? (A) (B) (C) (D) (E)

Electrocardiography Examination of the stool for occult blood Hearing test Neurologic examination Urinalysis

37


46. Which of the following diseases is most closely associated with multiple dermatofibromas? (A) (B) (C) (D) (E)

Amyloidosis Generalized eruptive histiocytosis Lichen planus Psoriasis Systemic lupus erythematosus

38


47. A 57-year-old woman who has been taking prednisone for 6 months for dermatomyositis now has worsening pain in her right hip during activity. Which of the following tests is the most appropriate to evaluate her pain? (A) (B) (C) (D) (E)

Biopsy Bone scan CT scan MRI Radiograph

39


48. Which of the following adverse effects is more likely during infliximab therapy than during therapy with etanercept? (A) (B) (C) (D) (E)

Demyelinating disease Drug-induced lupus erythematosus Human anti-chimera antibodies (HACAs) New-onset congestive heart failure Pancytopenia

40


49. Concomitant use of which of the following antibiotics is most likely to decrease the efficacy of oral contraception in women? (A) (B) (C) (D) (E)

Cephalexin Doxycycline Erythromycin Rifampin Trimethoprim–sulfamethoxazole

41


50. Patients with a deficiency of which of the following enzymes have an increased risk for severe bone marrow suppression with the use of azathioprine? (A) (B) (C) (D) (E)

Alanine aminotransferase Gamma-glutamyl transpeptidase Lactic dehydrogenase Methylene tetrahydrofolate reductase Thiopurine methyltransferase

42


51. Which of the following is an example of a drug-induced idiosyncratic adverse effect? (A) (B) (C) (D) (E)

Agranulocytosis with dapsone Hepatotoxicity with methotrexate Hypercalcemia with topical calcipotriene Hypertension with cyclosporine Nausea with oral methoxsalen

43


52. Which of the following laboratory tests should be performed on all patients prior to starting longterm therapy with methotrexate? (A) (B) (C) (D) (E)

Cryoglobulin assay Dihydrofolate reductase level Hepatitis C antibody assay Rheumatoid factor assay Thiopurine methyltransferase level

44


53. Which of the following allergens presents the highest risk of sensitization from the patch test procedure? (A) (B) (C) (D) (E)

Mercaptobenzothiazole Nickel Paraben mix Paraphenylenediamine Quaternium-15

45


54. Hydroxychloroquine is most likely to cause a hypersensitivity rash when used to treat which of the following conditions? (A) (B) (C) (D) (E)

Dermatomyositis Discoid lupus erythematosus Rheumatoid arthritis Subacute cutaneous erythematosus Systemic lupus erythematosus

46


55. A 22-year-old woman who began taking a new medication for acne three months ago has had fevers, weight loss, and joint pain since beginning the new medication. Laboratory findings include an ANA titer of 1:5120 and a positive anti-histone antibody titer. Which of the following is the most likely cause of these findings? (A) (B) (C) (D) (E)

Amoxicillin Erythromycin Isotretinoin Minocycline Trimethoprim–sulfamethoxazole

47


56. A patient with phenytoin hypersensitivity syndrome has the greatest risk for which of the following sequelae? (A) (B) (C) (D) (E)

Anemia Diabetes mellitus Hypertension Hypothyroidism Sensory neuropathy

48


57. A 55-year-old man has the onset of symmetric brawny plaques on the trunk and legs. He has diabetes mellitus with chronic renal insufficiency and recently began hemodialysis. During the ensuing weeks, the plaques develop an indurated, woody consistency. Which of the following is the most likely diagnosis? (A) (B) (C) (D) (E)

Diabetic dermopathy Lipodermatosclerosis Nephrogenic systemic fibrosis Scleromyxedema Shulman syndrome

49


58. A pregnant woman with which of the following dermatoses is most likely to develop Graves' disease? (A) (B) (C) (D) (E)

Cholestasis of pregnancy Pemphigoid gestationis Prurigo gravidarum Pruritic folliculitis of pregnancy Pruritic urticarial papules and plaques of pregnancy

50


59. Which of the following corticosteroid-sparing agents should be included in the initial therapeutic regimen of a patient with ocular cicatricial pemphigoid? (A) (B) (C) (D) (E)

Azathioprine Cyclosporine Cyclophosphamide Methotrexate Mycophenolate mofetil

51


60. Which of the following factors is the most common predictor of severe acne in adolescent girls? (A) (B) (C) (D) (E)

Bitemporal alopecia Hirsutism Increased serum testosterone level Onset of acne before menarche Premature thelarche

52


61. Evaluation of a patient with complex aphthous ulcers should include screening for a deficiency of which of the following vitamins? (A) (B) (C) (D) (E)

A B12 C D3 E

53


62. A 45-year-old woman with a history of uterine fibroids has cutaneous leiomyomas. This patient has an increased risk for which of the following types of cancer? (A) (B) (C) (D) (E)

Breast cancer Non-Hodgkin lymphoma Renal cell cancer Thyroid cancer Uterine sarcoma

54


63. A 37-year-old man has biopsy-proven sebaceous adenomas on his face. Several family members have died of cancer. Which of the following is the most appropriate next diagnostic study in the evaluation of this patient? (A) (B) (C) (D) (E)

Bone marrow biopsy Colonoscopy CT scan of the chest Digital rectal examination Serum protein immunoelectrophoresis

55


64. One week after cleaning a fish tank, a 24-year-old woman develops an ulcer on her hand and lymphangitis. Which of the following antimicrobial agents is the most appropriate first choice for the treatment of this condition? (A) (B) (C) (D) (E)

Ciprofloxacin Clarithromycin Erythromycin Minocycline Potassium iodide

56


65. A patient is undergoing evaluation for a presumed bullous skin disease. Which of the following is the most appropriate site for obtaining a biopsy specimen for direct immunofluorescence? (A) (B) (C) (D) (E)

Intact vesicle Perilesional skin Ruptured vesicle Sun-exposed normal skin Sun-protected normal skin

57


66. Infection with which of the following viruses typically results in an acute exanthem in young children and a symmetric, often prolonged, arthropathy in adults? (A) (B) (C) (D) (E)

Coxsackievirus A16 Enterovirus 71 Epstein-Barr virus Human herpesvirus 6 Parvovirus B19

58


67. A patient with which of the following neoplasms should be evaluated for POEMS syndrome? (A) (B) (C) (D) (E)

Desmoid tumor Glomeruloid hemangioma Psammomatous melanotic schwannoma Sebaceous adenoma Trichodiscoma

59


68. Which of the following tick-born illnesses is most likely to result in heart conduction abnormalities? (A) (B) (C) (D) (E)

Babesiosis Ehrlichiosis Lyme disease Rocky Mountain spotted fever Tick paralysis

60


69. A 25-year-old woman is being evaluated because of fever, headache, and a generalized rash. Physical examination shows a papulovesicular eruption and an eschar on her arm. She says that she sees mice in her apartment. Which of the following is the most likely diagnosis? (A) (B) (C) (D) (E)

Anthrax Chickenpox Q fever Rickettsialpox Scrub typhus

61


70. A 58-year-old man is being evaluated because of a flare-up of psoriasis. He has been treated with PUVA therapy for flare-ups for more than five years. He has also been treated for several actinic keratoses over the past year; none are seen on current examination. Which of the following treatments increases the risk of non-melanoma skin cancer in this patient? (A) (B) (C) (D) (E)

Oral acitretin Oral cyclosporine Oral methotrexate Topical calcipotriene Topical tazarotene cream

62


71. Patients taking drugs containing sulfhydryl groups are at increased risk for developing which of the following bullous disorders? (A) (B) (C) (D) (E)

Bullous pemphigoid IgA pemphigus Linear IgA dermatosis Pemphigus foliaceus Pemphigus vegetans

63


72. A 44-year-old woman has the acute onset of pain, warmth, swelling, and erythema of the skin of her hands and feet that is worse at night. She says that she has had difficulty sleeping because of the burning sensation, and that her symptoms improve by cooling the hands and feet. Which of the following is the most likely diagnosis? (A) (B) (C) (D) (E)

Erythroderma Erythromelalgia Livedo reticularis Raynaud phenomenon Thromboangiitis obliterans

64


73. Which of the following agents is most likely to result in systemic allergic contact dermatitis? (A) (B) (C) (D) (E)

Balsam of Peru Cocamidopropyl betaine Thiuram Toluene sulfonamide formaldehyde resin Xylocaine

65


74. When applied to clothing, which of the following agents is most likely to provide the best protection against tick bites? (A) (B) (C) (D) (E)

Citronella IR 3535 Permethrin Soybean oil 10% Sulfa

66


75. A 14-year-old boy who is being treated for acne vulgaris develops fatigue and dyspnea on exertion. Laboratory studies show profound anemia, neutropenia, and low serum copper level. The most likely cause of these findings is an excessively high dose of which of the following medications? (A) (B) (C) (D) (E)

Beta carotene Doxycycline Erythromycin Niacinamide Zinc

67

Med Dermatology Questions-75

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