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26.

All of the following can lead to Staphylococcal infection EXCEPT:

a.

Virulent bacterial strains

b.

Abnormality in neutrophil chemotaxis

c.

Deficiency in intracellular killing

d.

Porphyrin accumulation

RATIONALE: Porphyrin accumulation is a heme problem not an immune system problem as in choices A,

B and C are. Porphyrins are cyclic compounds that readily bind metal ionsusually Fe2+ or Fe3+. The

most prevalent metalloporphyrin in humans is heme. Defects of enzymes needed at various steps of

heme synthesis result in distinct clinical syndromes known as porphyrias. Porphyrins are precursors of

heme, a part of the hemoglobin molecule.https://www.inkling.com/read/illustrated-reviews-biochemistry-harvey-5th/chapter-21/ch21-section-0

http://emedicine.medscape.com/article/1389981-overview

27.

Collarette patch can be seen in which disease?

a.

Pityriasis rosea

b.

Pityriasis versicolor

c.

Tinea capitis

RATIONALE:

Pityriasis ROSACEA(+)

reddish brown discrete

macules and collarettescaling

Pityriasis/Tinea versicolor superficial yeast

infection present with hypo or

hyperpigmented lesions that start out asrashes and eventually dry out and result in

scaling

Tinea capitis

annular/ring-like lesions

Harrisons 18th

Ed

https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/tinea-versicolor/signs-symptoms

http://dermnetnz.org/fungal/pityriasis-versicolor.html

28.

A 50 yr old female complained of an ulcer on the right medial malleolus of 5 months duration.

Inspection of the leg revealed varicosities. What type of ulcer is this?

a.

Arterial

b.

Decubitus

c.

Neuropathic

d.

VenousRATIONALE:

VENOUS ARTERIAL Decubitus ulcers Neuropathic ulcers

Lower 1/3 of leg

Pretibial Area

Anterior to medial

malleoulus

Uneven edges without

Tips of toes or

between toes

Over phalangeal heads

Above laterial

malleolus, over

generally form on

areas of unrelieved

pressure over a

defined area, usually

over a bony

typically located on

weight-bearing

surfaces s.a. plantar

surface of foot),

metatarsal heads, and

https://www.inkling.com/read/illustrated-reviews-biochemistry-harvey-5th/chapter-21/ch21-section-0https://www.inkling.com/read/illustrated-reviews-biochemistry-harvey-5th/chapter-21/ch21-section-0http://emedicine.medscape.com/article/1389981-overviewhttp://emedicine.medscape.com/article/1389981-overviewhttps://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/tinea-versicolor/signs-symptomshttps://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/tinea-versicolor/signs-symptomshttp://dermnetnz.org/fungal/pityriasis-versicolor.htmlhttp://dermnetnz.org/fungal/pityriasis-versicolor.htmlhttp://dermnetnz.org/fungal/pityriasis-versicolor.htmlhttps://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/tinea-versicolor/signs-symptomshttp://emedicine.medscape.com/article/1389981-overviewhttps://www.inkling.com/read/illustrated-reviews-biochemistry-harvey-5th/chapter-21/ch21-section-0

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necrotic tissue metatarsal heads on

the side or sole of feet

Well defined edges

WITH necrotic tissue

prominence heels, all of which are

sites of painless and

minor repetitive

trauma.http://www.viha.ca/NR/rdonlyres/18FC0E44-7476-4D4E-8118-263EC684AF87/0/Chapter7NeuropathicUlcers.pdf

http://emedicine.medscape.com/article/190115-overview

29.

Gottron's papules are seen in patients with

a.

Dermatomyositis

b.

Rheumatoid Arthritis

c.

Scleroderma

d.

Steven Johnsons Syndrome

RATIONALE:

a.

DermatomyositisGottrons= flat-topped violaceous papules over knuckles

b.

Rheumatoid Arthritis - general inflammation of joints

c.

Sclerodermaatrophic lesions

d.

Steven Johnsons SyndromeNikolskys sign, pemphigus vulgaris , bullous pemphigoidhttp://www.uihealthcare.org/2column.aspx?id=237258

http://www.arthritis.co.za/raskin.html

30.

A 65 year old woman presented with periorbital confluent erythema and edema for months. She has

had arthritis for years and recently had weakness of the arms. She has difficulty with shampooing

and recently with combing her hair. She also has violaceous papules over distal phalangeal joints

and grossly visible telangiectasias. What is the most sensitive and specific laboratory indicator for

this condition?

a.

Lactic Dehydrogenase

b.

Serum aldolase

c.

Serum creatine kinase

d.

Transaminases (AST, ALT)

RATIONALE:This is classic dermatomyositis, a connective tissue disease that presents with proximal muscle

weakness which is accompanied by INCREASED serum creatine kinase. (+) Heliotrope rashhttp://emedicine.medscape.com/article/332783-overview

http://www.nlm.nih.gov/medlineplus/ency/article/000839.htm

31.

A 22 year old female went to the UERM Hospital due to a lesion in the right thigh and right leg for 2

years. PE showed the lesion to have erythema, non-pruritic plaque with distinct border, hyposthesia

and decreased sweating. What is your clinical impression?

a.

Borderline Leprosy

b.

Erythema Nodosum Leprosum

c.

Tuberculoid Leprosy

d.

Lepromatous LeprosyRATIONALE:

Erythema Nodosum Tuberculoid Leprosy Lepromatous Leprosy

Reaction to infection:

Painful, nodular lesions on

anterior shins (usual site)

color change similar to bruise

Few, well-defined,

hypopigmented

(whitish), hypoesthetic

( some loss of sensation)

macules/patches with raised

Symmetric, skin-colored /slightly

erythematous papules/ nodules

on earlobes, face, arms, butt,

trunk, and lower extremities, (+)

Loss of hair, (+) Leonine facies

http://www.viha.ca/NR/rdonlyres/18FC0E44-7476-4D4E-8118-263EC684AF87/0/Chapter7NeuropathicUlcers.pdfhttp://www.viha.ca/NR/rdonlyres/18FC0E44-7476-4D4E-8118-263EC684AF87/0/Chapter7NeuropathicUlcers.pdfhttp://emedicine.medscape.com/article/190115-overviewhttp://emedicine.medscape.com/article/190115-overviewhttp://www.uihealthcare.org/2column.aspx?id=237258http://www.uihealthcare.org/2column.aspx?id=237258http://www.arthritis.co.za/raskin.htmlhttp://www.arthritis.co.za/raskin.htmlhttp://emedicine.medscape.com/article/332783-overviewhttp://emedicine.medscape.com/article/332783-overviewhttp://www.nlm.nih.gov/medlineplus/ency/article/000839.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000839.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000839.htmhttp://emedicine.medscape.com/article/332783-overviewhttp://www.arthritis.co.za/raskin.htmlhttp://www.uihealthcare.org/2column.aspx?id=237258http://emedicine.medscape.com/article/190115-overviewhttp://www.viha.ca/NR/rdonlyres/18FC0E44-7476-4D4E-8118-263EC684AF87/0/Chapter7NeuropathicUlcers.pdf

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erythematous/purple border

enlarging peripherally

32.

A 65 year old male complained of painful group of vesicles on his right anterior and posterior chest

area of 24 hours duration, accompanied by headache, malaise and fever. What medicine should you

give?

a. Acyclovir

b.

Foscarnet

c.

Prednisone

d.

Paracetamol

RATIONALE:

Antiviral therapy with Acyclovirinitiated within 48-72 hours of rash onset is effective in managing active

disease and post-herpetic neuralgia. Use of corticosteroids for reducing inflammation is still subject to

debate.

33.

A 28 year old man has maculopapular rashes on palm and sole. He admits to being sexually active

and having a painless ulcer on penile area. What is the likely diagnosis?

a.

Behcets diseaseb.

Pityriasis rosacea

c.

Secondary syphilis

RATIONALE:

Behcets Disease Pityriasis rosacea Secondary Syphilis

Painful ulceration of oral and

genital regions with eye and

joint involvement

Reddish brown discrete macules

and collarette scaling usually

found at shoulders and back

Sexual history + Lesions on palms

and soles = HIGHLY SUGGESTIVE

34.

A 37 year old bank executive has Psoriasis. What secondary lesion will be present?

a. Plaque

b. Scalesc. Papule

RATIONALE:

Scales are secondary lesions characteristic of Psoriasis. Plaques and papules are primary lesions.

35.

A 27 year old female medical resident presents with hair loss of 2 months duration. Past medical

history indicates that she had a normal delivery 3 months prior. What is the cause?

a.

Alopecia Areata

b.

Androgenic Alopecia

c.

Anagen Effluvium

d.

Telogen Effluvium

RATIONALE:

Alopecia Areata Androgenetic Alopecia Anagen Effluvium Telogen Effluvium

Clearly demarcated

round or oval patches

of hair loss usually

affecting young adults

and children

Genetic condition seen

among MALES

Profound hair loss

Usu with pts

undergoing

radio/chemotx

Hormone-related

shedding of hair

Usu with high grade

fever/viral

infxn/POSTPARTUM

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Normally appears very

clean (no visible scaling

or inflammation)

36.

A 60 year old patient taking anti-arrhythmic drug for a month complained about his bluish-gray rash

on his face. Which of the following drug have caused this change?

a. Amiodarone

b.

Flecainide

c.

Procainamide

d.

Sotalol

RATIONALE:

ClofazimineDark brown

QuinacrineYellow without eye involvement

AmiodaroneBluish tinge of FACE

MinocyclineBluish, bruise-like lesions on body and extremities due to drug accumulation

37.

In a patient with scabies, what is the secondary lesion?a.

Crust

b.

Erosion

c. Excoriation

d.

Ulcer

RATIONALE: Excoriationswhich are superficial excavations of the epidermis are secondary to chronic

scratching in scabies, a lesion that may be followed by crusting. Erosion and ulceration, which usually

involves destruction of epidermis and even the dermis are highly unlikely to manifest with scabies.

38.

A 35-year old male is being treated with radiotherapy for nasopharyngeal carcinoma complains of

massive hair loss. What is your diagnosis?

a.

Anagen Effluviumb.

Androgenetic Alopecia

c.

Diffuse Alopecia

d.

Telogen Effluvium

RATIONALE:

Alopecia Areata Androgenetic Alopecia Anagen Effluvium Telogen Effluvium

Clearly demarcated

round or oval patches

of hair loss usually

affecting young adults

and children

Normally appears very

clean (no visible scaling

or inflammation)

Genetic condition seen

among MALES

GRADUAL onsetof hair

line recession and

shedding

Profound hair loss

Usu with pts

undergoing

radio/chemotx

Hormone-related

shedding of hair

Usu with high grade

fever/viral

infxn/postpartum

39.

A 30 year old female consults because of malar rash, joint pains, oral ulcers, and anemia. Physical

examination of the scalp reveals hair loss on red to purple plaques with hyperkeratotic scales. What

is your diagnosis?

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a.

Alopecia Areata

b. Moth-eaten

c.

Scarring alopecia

d.

Traumatic alopecia

RATIONALE:

Data indicative of systemic scarring alopecia associated with Chronic cutaneous erythematosus as in

Discoid lupus erythematosus.Note mention of malar rash and joint pains.

Alopecia Areata Scarring Alopecia

Usu affects young adults and children

Clearly demarcated round/oval patches of hair loss

EXCLAMATION POINT HAIRS

Usu affects females

reddish to purplish plaque, elevated and

hyper keratinosis

(+) scarring which causes irreversible hair loss

in affected areas

40.

Which of the following is a nail manifestation in psoriasis?

a.

Half and half nail

b.

Koilonychia

c.

Onycholysis

RATIONALE:

Half and half nails Koilonychia Onycholysis

Renal disease

proximal white & distal pink

(caucasians) or brown

(Malay)

Hemochromatosis

Spoon nails

abnormal thinness and

concavity of fingernails

Secondary to faulty iron

metabolism

Psoriasis vulgaris

oil spots, loosening of nail,

crumbling of nail

painless separation of nail plate

from nail bed

41.

A 22 year old male consults of fever and painful, minute, fluid filled lesions on the right angle of the

mouth of 2 days duration. What is the primary lesion?

a.

Bulla

b.

Papule

c.

Pustule

d. Vesicle

RATIONALE:

Herpes Labialis -Herpetiform lesions due to HSV-1 are usually asymmetric fluid-filled vesicleswith

erythematous base that coalesce in the mucocutaneous angle of the mouth