Plant and Creature of Dermatological Significance MCQs

8/11/2019 Plant and Creature of Dermatological Significance MCQs

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Identify this caterpillar:

1 Hag moth caterpillar

2 Puss caterpillar

3 Greenback caterpillar

4 Saddleback caterpillar

5 Io caterpillar

Q/Q(M)-474413 Report a Problem

Identify this caterpillar:

4 Saddleback caterpillar

This is the saddleback caterpillar, as it appears that the caterpillar is wearing a saddle.


Capsaicin causes which of the following?

1 Decreased firing of nerve fibers transmitting pain

2 Increased substance P release

3 Decreased substance P release

4 Blocking the influx of sodium ions into the cell

5 Creating a barrier between nerves and their stimuli


Capsaicin causes which of the following?

2 Increased substance P release

Repeated substance P release leads to eventual depletion of this agent which causes pain transmission.


This organism is:

1 Pediculus humanus2 Pulex irritans

3 Chigoe flea


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4 Pediculus capitis

5 Pthirus pubis


This organism is:

5 Pthirus pubis

This is a crab louse. It is shorter and wider than the head and body louse. Note the crab-like claws.


This snake, the coral snake, is a member of what family?

1 Crotalidae

2 Lepidoptera

3 Elapidae

4 Theraphosidae

5 Apiaceae


This snake, the coral snake, is a member of what family?

3 Elapidae

The Crotalidae family includes rattlesnakes and copperheads. Lepidoptera are caterpillars. Theraphosidae

is the scientific name for tarantulas. Apiaceae (Umbelliferae) is a plant family which includes parsley,

celery and fennel. Elapidae is the correct family of snakes, including coral snakes.


A chef presents with bilateral hand cellulitis after several days working with a new raw fish dish.

Cultures grow Streptococcus iniae. What type of fish was he likely working with?

1 Cod

2 Mackerel


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3

3 Tilapia

4 Freshwater salmon

5 Farm salmon


A chef presents with bilateral hand cellulitis after several days working with a new raw fish dish.

Cultures grow Streptococcus iniae. What type of fish was he likely working with?

3 Tilapia

Streptococcus iniae is an important cause of cellulitis, endocarditis, mengingoencephalitis, and

septicemia in fish handlers and cooks. It is found in tilapia, red drum, hybrid striped bass, and rainbow

trout.


Which of the following infections is caused by a gram-negative rod?

1 Malta fever

2 Farcy

3 Bacillary angiomatosis

4 All of these answers are correct

5 None of these answers are correct


Which of the following infections is caused by a gram-negative rod?


Malta fever is another name for Brucellosis, an infection caused by Brucellae (gram-negative rod). Farcy

is another name for Glanders, an infection with the gram-negative rod Pseudomonas mallei. Bacillary

angiomatosis is caused by infection with Bartonella henselae, a gram-negative rod.


The majority of phytophotodermatitis is caused by plants from which family?


2 Apiaceae

3 Liliaceae

4 Alliaceae

5 Compositae


The majority of phytophotodermatitis is caused by plants from which family?

2 Apiaceae

The Apiaceae family (formerly Umbelliferae) includes parsley, celery, parsnip, hogweed, and fennel, andcauses the majority of phytophotodermatitis.



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The majority of naturally-occurring cases of anthrax:

1 Are extra-cutaneous

2 Are acquired through ingestion of spores

3 Are oropharyngeal

4 Are pulmonary5 Are cutaneous


The majority of naturally-occurring cases of anthrax:

5 Are cutaneous

The majority (95%) of naturally-occurring cases of anthrax are of the cutaneous form, acquired from

direct contact with the carcasses of dead sheep, cows, goats, and horses. Naturally-occurring pulmonary,

gastrointestinal (acquired by ingestion of spores) and oropharyngeal infection with anthrax is less

common.

Q/Q(M)-478032 Report a ProblemWhich of the following statements regarding Theraphosidae is correct?

1 Bites do not generally produce any systemic toxicity

2 These creatures possess urticating hairs that are of dermatologic significance

3These creatures can cause visual loss by causing a chronic granulomatous reaction (ophthalmia

nodosa)

4 All of these statements are correct

5 None of these statements are correct

Q/Q(M)-478051 Report a ProblemWhich of the following statements regarding Theraphosidae is correct?

4 All of these statements are correct

Theraphosidae (tarantulas) are large, brown to black, hairy spiders frequently found in the southwest.

They are of dermatologic importance due to urticating hairs. Tarantula bites generally do not produce any

systemic toxicity. The spider releases hairs in the direction of the perceived attacker; hairs can penetrate

the skin as deeply as the reticular dermis. If they injure the cornea, they can cause a chronic

granulomatous reaction (ophthalmia nodosa) and loss of vision.


Which of the following is the most common cause of dermatitis in florists?

1 Calcium oxalate

2 Mechanical dermatitis

3 Tuliposide A

4 Primin

5 Sesquiterpene lactones


Which of the following is the most common cause of dermatitis in florists?

1 Calcium oxalateCalcium oxalate is present in the bulbs and stems of Narcissus (daffodil).



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5

On slide preparation, many organisms were noted on this patient, as well as occasional blue macules on

the buttocks. He most likely has:

1 Sarcoptes scabiei infestation

2 Pediculus humanus infestation

3 Chigoe fleas

4 Pediculus capitis infestation

5 Pthirus pubis infestation


On slide preparation, many organisms were noted on this patient, as well as occasional blue macules on

the buttocks. He most likely has:

5 Pthirus pubis infestation

It is often very easy to find crab lice on physical exam in contrast with scabies. Head lice infestations are

usually limited to the scalp. Body lice are not often found on the patient, more commonly in clothing

seams. Maculae caerulea can be seen in widespread involvement as in this case.


This tick transmits:

1 Lyme

2 Relapsing fever

3 Rocky mountain spotted fever

4 Erlichiosis

5 Babesiosis



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This tick transmits:

3 Rocky mountain spotted fever

This is Dermacentor variabilis which transmits Rocky Mountain Spotted Fever as well as Tularemia.


Which one of the following diseases is not transmitted by the Ixodes tick?

1 Babesiosis

2 Ehrilichiosis

3 Lyme

4 Tick paralysis

5 Rocky Mountain Spotted Fever


Which one of the following diseases is not transmitted by the Ixodes tick?

5 Rocky Mountain Spotted Fever

Babesiosis, ehrlichiosis, Lyme disease, and tick paralysis can all be transmitted by the Ixodes tick. This

tick has three main types: I. pacificus in California, I. ricinus in Europe, and I. scapularis in the eastern

US. Rocky Mountain Spotted Fever is typically transmitted by Amblyoma americanum or Dermacentor

ticks.


When doing patch testing for compositae sensitivity, which of the following substances is used?

1 Colophony

2 Pentadecacatechols

3 Rhus

4 Sesquiterpene lactone mix

5 Tuliposide A


When doing patch testing for compositae sensitivity, which of the following substances is used?

4 Sesquiterpene lactone mix

Colophony cross reacts with turpentine resin, hairpiece adhesive, mascara, dental cement and others.

Pentadecacatechols are in the rhus family and are found in poision ivy, oak and sumac in addition to

cross reacting with mango and cashew. Tuliposide A is found in Peruvian lily (alstomeria), and tulip.


Which of the following plants are members of the family Rutaceae?

1 Burning bush

2 Bergamot orange


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3 Rue




Which of the following plants are members of the family Rutaceae?


The family Rutaceae includes lime, rue, burning bush, bergamot orange, and Hawaiian lei flowers. Plants

from this family commonly cause phytophotodermatitis.


Match the photo to the plant identified:

1 Poison ivy

2 Gingko3 Poison oak

4 Mango leaves

5 Poison sumac



3 Poison oak

Poison oak is identified by leaf shape - irregular lobing and varied leaf size.


Strimmerdermatitis is caused by which of the following?

1 M. marinum

2 Pseudomonas

3 Cryptococcus

4 Chervil

5 Lime



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Strimmerdermatitis is caused by which of the following?

4 Chervil

Strimmer dermatitis is a phytophotodermatitis caused by spray of plant matter when using a weed-

whacker or similar trimming tool.


Furocoumarins, such as 5-methoxypsoralen or 8-methoxypsoralen:

1Cause a photoallergic reaction after contact with the skin, followed by exposure to ultraviolet light

in the 320-400nm range

2 Cause a type IV delayed hypersensitivity reaction after exposure to all wavelengths of UV light

3Cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light in

the 280-320nm range

4Cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light in

the 320-400nm range

5Cause a photoallergic reaction after contact with the skin, followed by exposure to ultraviolet light



Furocoumarins, such as 5-methoxypsoralen or 8-methoxypsoralen:

4Cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light


Unlike photoallergic reactions, which involve the immune system (type IV or delayed hypersensitivity),

phytophotodermatitis is non-immunologic. Photoallergic reactions are more frequently caused by other,

non-plant sources. Furocoumarins, such as 5-methoxypsoralen or 8-methoxypsoralen, cause a phototoxic

reaction after contact with the skin, followed by exposure to ultraviolet light in the UVA range (320 to

400nm).


A 22 year-old man presents with an irregular laceration on the dorsal metacarpals following a fist fight in

which he struck someone in the mouth. The tissue surrounding the wound is erythematous, edematous,

indurated, warm, and tender. There is some purulence of the wound. You consider infection with:

1 Pasteurella multocida

2 Eikenella corrodens

3 Capnocytophaga

4 Erysipelothrix rhusiopathiae

5 Pasteurella canis


A 22 year-old man presents with an irregular laceration on the dorsal metacarpals following a fist fight in

which he struck someone in the mouth. The tissue surrounding the wound is erythematous, edematous,

indurated, warm, and tender. There is some purulence of the wound. You consider infection with:

2 Eikenella corrodens

Human bites may result in infection with Eikenella corrodens, a gram-negative bacillus that is part of the

normal flora of the human mouth. This infection can follow fist fights with blows to the mouth.Q/Q(M)-478035 Report a Problem


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This creature can do the following EXCEPT:

1 Be used as a natural control for the tick population

2 Cause anaphylaxis

3 Transmit Yersinia pestis

4 Cause a painful sting

5 Build large characteristic mounds


This creature can do the following EXCEPT:

3 Transmit Yersinia pestis

This is a fire ant. In some parts of the world, they are used as a natural tick control as they are scavengers

and consumers of tick eggs. They can cause anaphylaxis in an allergic person. They do not transmit

disease. The mounds are characteristic in appearance.


Name this creature:

1 Demodex folliculorum

2 Ornithonyssus sylviarum

3 Pthirus pubis

4 Pediculus capitis

5 Pediculus humans corporis



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Name this creature:

5 Pediculus humans corporis

This is the body louse, or Pediculus humanus var. corporis. The pubic louse (pthirus pubis) is shorter, and

squatter. The head louse (pediculus capitis) has a narrow body.


This is a:1 Moth caterpillar

2 Puss caterpillar

3 Woolybear caterpillar

4 Brownbear caterpillar

5 Furrybear caterpillar


This is a:

3 Woolybear caterpillar

This is a woolybear caterpillar.


Onions and chives:

1 Contain diallyl disulfide

2 Are members of the family Anacardiacea

3 Contain pentadecylcatechol

4 Are members of the same family as Gingko

5 Cross-react with artichoke in sensitized patients


Onions and chives:

1 Contain diallyl disulfideOnions, garlic, and chive are members of the family Alliaceae and contain diallyl disulfide (also

allylpropyl disulfide, allicin).



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Which of the following is not a hallmark of allergic contact dermatitis?

1 Eosinophils

2 CD4+ Lymphocytes

3 Langerhans cells

4 Neutrophils5 Vesicles


Which of the following is not a hallmark of allergic contact dermatitis?

4 Neutrophils

Langerhans cells present the antigens to CD4+ lymphocytes in the dermis and after traveling through

lymphatics to regional lymph nodes. Eosinophils may also be present. Neutrophils are not characteristic

of this reaction.Q/Q(M)-474701 Report a Problem

A patient works selling gourmet cheeses and complains of an urticarial and vesicopapular eruption.

Which of the following organisms is most implicated in his condition?

1 Acarus

2 Glyciphagus

3 Pyemotes

4 Dermanyssus

5 Ornithonyssus


A patient works selling gourmet cheeses and complains of an urticarial and vesicopapular eruption.

Which of the following organisms is most implicated in his condition?

2 Glyciphagus

Food and grain mites can cause papular urticaria or vesicopapular eruptions. Glyciphagus, Acarus, and

Pyemotes are the cheese, grain, and straw itch mites respectively. Dermanyssus and Ornithonyssus are

fowl mites which most often affect office workers, homemakers, and bird fanciers.



1 Alliaceae

2 Primulaceae

3 Anacardiacea

4 Compositae

5 Alstromeria



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5 Alstromeria

Alstromeria is pictured.


A patient develops a chronic granulomatous reaction of the eye after a spider bite near the cornea. The

patient was most likely bitten by which spider?

1 Theraphosidae

2 Lactrodectus mactans

3 Loxosceles reclusa

4 Tegenaria agrestis

5 Lycosidae


A patient develops a chronic granulomatous reaction of the eye after a spider bite near the cornea. The

patient was most likely bitten by which spider?

1 Theraphosidae

Theaphosidae, or the tarantulas, is a hairy spider that has urticating hairs and can cause ophthalmia

nodosa and blindness if it injures the cornea. Lactrodectus mactans, or the black widow spider, possesses

alpha lactrotoxin that leads to symptoms of systemic toxicity, abdominal pain, paralysis, vomiting, etc.

Loxosceles reclusa, also known as the brown recluse spider, contains sphingomelinase which leads to

extensive gangrene and necrosis. Tegenaria agrestis is the hobo spider which is the leading cause of

necrotic arachnidism in the Pacific Northwest. The Lycosidea spiders, or wolf spiders, cause painful bites

that may lead to lymphangitis or an eschar.


Lipase is a notable active component of the venom of which of the following spiders?

1 Lycosidae

2 Lactrodectus

3 Hidippus

4 Chiracanthium

5 Loxosceles



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Lipase is a notable active component of the venom of which of the following spiders?

4 Chiracanthium

The venom of Chiracanthium (sac spiders) contains lipase. The venom of Lycosidae (wolf spiders) is

notable for histamine; Lactrodectus (black widow spiders) for alpha lactrotoxin; Hidippus (jumping

spiders) for hyaluronidase; and Loxosceles (brown recluse spiders) for sphingomyelinase-D.

Q/Q(M)-478049 Report a ProblemWhich of the following mites is also known as the chigger and often causes intense pruritus on the

ankles, legs, or belt line?

1 Ornithonyssus

2 Glyciphagus

3 Demodex

4 Allodermanyssus sanguineus

5 Trombicula alfreddugesi


Which of the following mites is also known as the chigger and often causes intense pruritus on the

ankles, legs, or belt line?

5 Trombicula alfreddugesi

Trombicula alfreddugesi (chigger mite, harvest mites) frequently causes intense pruritus on the ankles,

legs, or belt line. Contact occurs during summer and fall. In sensitized individuals, papular urticaria,

vesiculation, or a granulomatous reaction with fever and lymphadenopathy may occur. Allodermanyssus

sanguineus (house mouse mite) is the vector of rickettsial pox. Demodex folliculorum is a mite that can

live within the sebaceous glands of hair follicles and may be important in some subsets of patients withacne rosacea, as well as patients with HIV infection and folliculitis. Glyciphagus (cheese mite) is the

cause of grocer's itch. Ornithonyssus (fowl mite) can carry Western equine encephalitis.


Ehrlichiosis is classified in two primary forms. These are:

1 Monocytic and granulocytic

2 Endemic and epidemic

3 Intracellular and extracellular

4 Primary and secondary



Ehrlichiosis is classified in two primary forms. These are:

1 Monocytic and granulocytic

Ehrlichiosis comes in two forms: monocytic, which invades mononuclear WBCs, and granulocytic, in

which peripheral PMNs show intracytoplasmic inclusions. Patients present with fever, chills, headache,

and myalgias, along with leukopenia, anemia, and thrombocytopenia.



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A patient who experiences an allergic contact dermatitis in reaction to an extract from the Pinus palustris

tree may also be sensitized to:

1 Rosin


3 Varnish

4 Mascara5 All of these answers are correct


A patient who experiences an allergic contact dermatitis in reaction to an extract from the Pinus palustris

tree may also be sensitized to:


Colophony, derived from the Pinus palustris tree, may cross react with rosin, medications, mascara,

adhesives, bandages, varnish, wax, paper products, and dental cement.


Babesia microti:

1 Is pathogenic in an infection that is endemic on Martha's Vineyard

2 Is an intracellular parasite

3 Is transmitted by Ixodes dammini




Babesia microti:


Babesiosis is caused by an intracellular RBC parasite, Babesia microti. It is transmitted by the larvae of

Ixodes dammini. This disease is endemic in eastern Long Island, Martha's Vineyard, and Nantucket, and

carries an increased risk in those with T-cell depression or after splenectomy. The condition is associated

with fever, drenching sweats, myalgias, and hemolytic anemia.


Cantharadin is derived from:

1 Ranunculaceae

2 Pentadecacatechol

3 Solanaceae

4 Compositae

5 Lytta vesicatoria


Cantharadin is derived from:

5 Lytta vesicatoria

Ranunculaceae (buttercup) causes irritant dermatitis. Pentadecacatechol is the rhus antigen found in


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poison ivy, oak and sumac. Solanaceae (chili pepper) contains capsaicin. Pyrethrin is derived from

compositae (chrysanthemum flower). Lytta vesicatoria (spanish fly) is a blister beetle from which

cantharadin is made.


Which of the following infections is commonly known to occur from contact with infected sheep?

1 Infectious pustular dermatitis

2 Cutaneous anthrax

3 Oculoglandular syndrome of Parinaud

4 Erysipeloid

5 Infectious pustular dermatitis and cutaneous anthrax


Which of the following infections is commonly known to occur from contact with infected sheep?

5 Infectious pustular dermatitis and cutaneous anthrax

Infectious pustular dermatitis is another name for orf, or ecthyma contagiosum. It is transmitted to

humans by a parapoxvirus in sheep, goats, and reindeer. Cutaneous anthrax is also called "woolsorter's

disease" and is caused by Bacillus anthracis, a gram-positive rod transmitted from contact with carcasses

of infected sheep, cows, goats, and horses. The oculoglandular syndrome of Parinaud is the combination

of granulomatous conjunctivitis and preauricular lymphadenopathy seen in cat-scratch disease.


A goat farmer presents with fever and flu-like symptoms, as well as violaceous papulonodules on thetrunk and lower extremities. You consider Malta fever in your differential diagnosis. Which of the

following statements regarding this diagnosis is correct?

1 Treatment is with doxycycline

2 Treatment is with rifampin

3 Skin lesions are infrequently seen




A goat farmer presents with fever and flu-like symptoms, as well as violaceous papulonodules on the

trunk and lower extremities. You consider Malta fever in your differential diagnosis. Which of the

following statements regarding this diagnosis is correct?


Malta fever is another name for Brucellosis. This infection is caused by ingesting raw goat milk and

unpasteurized goat cheese infected with Brucellae (gram-negative rods). It is infrequent in the US,

occurring mainly in veterinarians and farmers. Acute brucellosis has very non-specific features and

presents as a flu-like illness. Skin lesions are infrequent (20% of cases) but are usually violaceouspapulonodules on the trunk and lower extremities. Treatment is with doxycycline or rifampin.



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16

Phytophotodermatitis is caused by which of the following wavelengths of light?

1 100-200 nm

2 200-290 nm

3 290-320 nm

4 311 nm

5 320-400 nm


Phytophotodermatitis is caused by which of the following wavelengths of light?

5 320-400 nm

UVA rays are responsible for the phototoxic reaction which occurs with phytophotodermatitis.


Which of the following contains significant levels of naturally occurring psoralens?

1 Potatos

2 Parsnips

3 Carrots

4 Tomatoes

5 Peas


Which of the following contains significant levels of naturally occurring psoralens?

2 Parsnips

Significant quantities of psoralens are present in fruits and vegetables such as limes, lemons, figs, and

parsnips. Other furocoumarine(psoralen)-containing plants that can produce phytophotodermatitis are

celery, dill, lime bergamot,parsley, meadow grass, mokihana (Pelea anisata) berries, mustard, and St.

John's wort


Which snake is part of the Crotalidae family?

1 Rattlesnake

2 Garden snake

3 Water snake

4 Coral snake

5 Cobra


Which snake is part of the Crotalidae family?

1 RattlesnakeThe Crotalidae family includes rattlesnakes and copperheads. The coral snake is part of the elapidae

family.


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17


Which of the following infections is caused by a gram-positive rod?

1 Erysipeloid of Rosenbach

2 Brucellosis

3 Cat-scratch disease

4 Glanders

5 Milker's nodule


Which of the following infections is caused by a gram-positive rod?

1 Erysipeloid of Rosenbach

Erysipeloid of Rosenbach is an infection with Erysipelothrix insidiosa or Erysipelothrix rhusiopathiae,

gram-positive rods. Brucellosis is caused by infection with Brucellae (gram-negative rod). Cat-scratch

disease is caused by infection with Bartonella henselae, a gram-negative rod. Glanders is caused byinfection with Pseudomonas mallei, a gram-negative rod. Milker's nodule is caused by the paravaccinia

viurs, a parapoxvirus related to the orf virus.


Ananas comosus causes an irritant dermatitis attributed to which irritant?

1 Phorbol esters

2 Capsaicin

3 Thiocyanates

4 Bromelin

5 Ranunculin


Ananas comosus causes an irritant dermatitis attributed to which irritant?

4 Bromelin

Ananas comosus is the pineapple. Pineapples contain the irritants bromelin (a proteolytic enzyme) and

calcium oxalate (which causes fissures that grant bromelin access to dermal vessels). Capsaicin is found

in chili peppers. Phorbol esters are found in spurges, crotons, poinsettas, and machineel trees.

Thiocyanates are found in garlic, mustard, and radishes. Ranunculin is found in buttercups.


When bitten with the spider in the photograph, the active agent in the venom is:

1 Alpha lactrotoxin

2 Histamine

3 Hyaluronidase

4 Lipase

5 Sphingomyelinase-D



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When bitten with the spider in the photograph, the active agent in the venom is:

1 Alpha lactrotoxin

This is a black widow spider which can be identifiec by its shiny black body with characteristic white

hourglass marking on the abdomen.


Mechanical irritant dermatitis can be caused by:

1 Glochids

2 Stinging nettles

3 Bromelin

4 Capsacin



Mechanical irritant dermatitis can be caused by:

1 Glochids

Mechanical irritant dermatitis can be caused by the direct effects of thorns and barbs. Small glochids

(barbed hairs or brisles) or large thorns (on cacti for example) can become imbedded into the skin

causing injury and resultant dermatitis. Secondary infection can be caused by microorganism inoculation.


Which of the following plants are members of the Solanaceae family?

1 Prickly pear

2 Chili pepper

3 Garlic

4 Radish

5 Crotons


Which of the following plants are members of the Solanaceae family?

2 Chili pepper

Chili peppers belong to the Solanaceae family. Prickly pears (Opuntia vulgaris), crotons (Euphorbiaceae

family), garlic (Alliaceae family), and radishes (Brassicaceae family) are not members of this family.



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This patient complains of intense itching at this site. KOH examination is negative. She denies any recent

travel, however does take her 2 year old to the local playground where there is a sandbox. Which of the

following is appropriate?

1 Obviously this is dermatophyte despite a negative KOH. Treat with topical antifungals

2 Inform the patient she is contagious and should isolate herself from her children

3 Slowly extract the organism

4 Give her clobetasol ointment

5 Treat with po ivermectin


This patient complains of intense itching at this site. KOH examination is negative. She denies any recent

travel, however does take her 2 year old to the local playground where there is a sandbox. Which of the

following is appropriate?

5 Treat with po ivermectin

This is hookworm, or cutaneous larva migrans; systemic ivermectin or topical thiobendazole would be

appropriate treatments. The causative organism is the larvae of Ancylostoma braziliensis or A. canium.Q/Q(M)-474964 Report a Problem

Which of these mites is the most likely cause of a pruritic papulovesicular eruption in a baker?

1 Dermatophagoides

2 Dermanyssus

3 Acarus

4 Cheyletiella

5 none of the above


Which of these mites is the most likely cause of a pruritic papulovesicular eruption in a baker?

3 Acarus

Acarus (grain mite) causes so-called "baker's itch." Dermatophagoides (dust mite) causes allergic

reactions, Dermanyssus (fowl mite) causes equine encephalitis, and Cheyletiella causes walking dandruff

in dogs and cats.


The reaction caused by this plant is mediated by:

1 Langerhans cells


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2 Eosinophils

3 IgE

4 Mast cells

5 Histamine


The reaction caused by this plant is mediated by:

1 Langerhans cells

This is ragweed, which causes allergic contact dermatitis. Mast cells, IgE and histamine are characteristic

of contact urticaria. Allergic contact dermatitis is caused by langerhans cells presenting antigen to CD4+

lymphocytes leading to a cell-mediated delayed hypersentitivity reaction.


Patients with an allergy to the compositae family may have an allergic reaction to which of the following

drugs?

1 Pyruvic acid

2 Pyrethrins

3 Psoralens

4 Propylene glycol

5 Pseudoephedrine


Patients with an allergy to the compositae family may have an allergic reaction to which of the following

drugs?

2 Pyrethrins

Pyrethrins are derived from chrysanthemum flowers. Patients with allergy to these flowers or ragweed

may experience allergic symptoms after using pyrethrins.


Which of the following statements regarding Megalopyge opercularis is correct?

1 Are also called "bed bugs" by lay people

2Contact with this creature often causes immediate pain, urticaria, and erythematous papules or

purpura in a tram-track pattern

3 Bites are usually asymptomatic, initially, but then form linear purpuric macules

4 These creatures can be vectors of many diseases from typhus to plague


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5These creatures, found in Hawaii, are nocturnal carnivores that produce painful wounds by

discharging venom


Which of the following statements regarding Megalopyge opercularis is correct?

2Contact with this creature often causes immediate pain, urticaria, and erythematous papules or

purpura in a tram-track pattern

Megalopyge opercularis (puss caterpillar) is one of the most widespread causes of caterpillar dermatitis.

Contact with this creature often causes immediate pain, urticaria, and erythematous papules or purpura in

a tram-track pattern. Bites of Cimicidae (bedbugs) are usually asymptomatic, initially, but then form

linear purpuric macules. Fleas can be vectors of many diseases from typhus to plague. Chilopoda

(centipedes) are nocturnal carnivores that produce painful wounds by discharging venom. Scolopendra is

a species of centipede found in Hawaii.


A butcher presents with numerous verrucous papules of the hands and fingers. Based on her occupation,

you consider a diagnosis of infection with which HPV types?

1 HPV 16 and 18

2 HPV 1 and 2

3 HPV 2 and 7

4 HPV 6 and 8

5 HPV is not associated with this condition


A butcher presents with numerous verrucous papules of the hands and fingers. Based on her occupation,

you consider a diagnosis of infection with which HPV types?

3 HPV 2 and 7

Meat, fish, and poultry handlers often suffer from hand and finger verrucae, usually caused by human

papilloma virus types 2 and 7.


A 52 year-old gardener presents with innumerable linear hyperpigmented streaks across the chest and

arms. He states that several weeks previously he had a painful, erythematous, blistering eruption at the

same site. The most likely botanical cause for this eruption is:

1 Hogweed

2 Peruvian lily

3 Plants of the Alliaceae family

4 Ragweed

5 Lime


A 52 year-old gardener presents with innumerable linear hyperpigmented streaks across the chest and

arms. He states that several weeks previously he had a painful, erythematous, blistering eruption at the

same site. The most likely botanical cause for this eruption is:


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1 Hogweed

The gardener has so-called "strimmer dermatitis." The use of a weed-whacker may result in a spray of

weeds (such as cow parsley, wild chervil, and hogweed) leading to this phytophotodermatitis on exposed

areas such as the chest and arms.


Leishmania donovani is transmitted by:1 Callitroga americana

2 Phlebotomus

3 Glossina

4 Attagenus megatoma

5 Anopheles


Leishmania donovani is transmitted by:2 Phlebotomus

Leishmania donovani is transmitted by Phlebotomid sandflies. Callitroga americana is the most important

cause of cutaneous myiasis in the United States. Glossina, the tsetse fly, transmits sleeping sickness.

Attagenus megatoma is a carpet beetle, the larvae of which can cause an allergic contact dermatitis.

Anopheles mosquitoes transmit malaria.


A previously healthy 25-year-old man presents to the ER 8 hours after experiencing an extremely painful

spider bite. The bite site is erythematous and indurated, without necrosis or eschar. The patient is

vomitting and experiencing chills, violent cramps, and abdominal pain and rigidity. The surgicalconsultant suspects an acute abdomen. You correctly propose that:

1 The patient needs anti-venom after a likely Lactrodectus bite

2 The patient has likely experienced a hobo spider bite

3 The patient needs anti-venom after a likely Phidippus formosus bite

4 The patient has a likely Lycosidae bite and needs supportive care

5 The patient has a likely Loxosceles bite and should go to the OR for excision and debridement


A previously healthy 25-year-old man presents to the ER 8 hours after experiencing an extremely painful

spider bite. The bite site is erythematous and indurated, without necrosis or eschar. The patient is

vomitting and experiencing chills, violent cramps, and abdominal pain and rigidity. The surgical

consultant suspects an acute abdomen. You correctly propose that:

1 The patient needs anti-venom after a likely Lactrodectus bite

The patient has signs and symptoms a black widow spider bite, caused by Lactrodectus. Anti-venom may

be helpful up to 90 hours after the bite.


Insects from the species pictured:

1 Transmit malaria


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2 Trasmit yellow fever

3 Transmit dengue fever

4 Transmit malaria and yellow fever

5 Trasmit yellow fever and dengue fever


Insects from the species pictured:

5 Trasmit yellow fever and dengue fever

The insect pictured is an Aedes mosquito. Aedes transmits yellow fever and dengue fever. Anopheles

mosquitoes transmit malaria.


Solenopsin D is a:

1 Hemolytic factor

2 Phospholipase

3 Piperdine derivative

4 Histamine-releaser

5 Hemolytic factor, piperdine derivative, histamine-releaser


Solenopsin D is a:

5 Hemolytic factor, piperdine derivative, histamine-releaser

Solenopsin D is a venom which is a hemolytic factor, a piperidine derative and leads to histamine release.

The venom from honeybeeds contains phospholipase A .


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A butchers nodule is caused by which of the following?

1 HPV 24

2 HPV 16, 18

3 HPV 1

4 HPV 2, 7

5 HPV 13, 32


A butchers nodule is caused by which of the following?

4 HPV 2, 7

HPV 24 causes common warts. HPV 16 and 18 are found in genital warts; 1 is for plantar warts and types

13 and 32 are seen in Hecks Disease (focal epithelial hyperplasia).


A 45-year old man had exposure to an exotic pet and afterwards develops fevers and a rash. He is

diagnosed with epidemic typhus. Which of the following animals did he most likely come in contact

with?

1 Hedgehog

2 Iguana

3 Chinchilla

4 Cockatoo

5 Flying squirrel


A 45-year old man had exposure to an exotic pet and afterwards develops fevers and a rash. He is

diagnosed with epidemic typhus. Which of the following animals did he most likely come in contact

with?

5 Flying squirrel

Flying squirrels can be carriers of many infections including Toxoplasma gondii, Staphylococcus, and

Rickettsia prowazekki, the latter of which causes epidemic typhys. African and European hedgehogs

have been known to transmit salmonella and Mycobacterium marinum, respectively. Iguanas have been

demonstrated to be carriers of Serratia marcescens, a herpes-type virus, and salmonella. Chinchillas are

frequently colonized with Trichophyton mentagrophytes and gram-negative bacteria like Klebsiella

pneumoniae which can be dangerous especially in immunocompromised patients. Cockatoos and pigeons

can transmit Cryptococcus neoformans.


Sharp hairs on plants of the Urticaceae family contain which of the following toxins that are released into

the skin causing rapid edema, pruritus, and burning?

1 Histamine

2 Serotonin


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3 Acetylcholine


5 Histamine and acetylcholine


Sharp hairs on plants of the Urticaceae family contain which of the following toxins that are released intothe skin causing rapid edema, pruritus, and burning?


Sharp hairs on plants such as stinging nettles (Urticaceae family) contain toxins (histamine, serotonin,

and acetylcholine) which are released into the skin causing rapid edema, pruritus, and burning.


The vector for Babesia microti is also a vector for:



3 Francisella tularensis

4 Rickettsia rickettsii

5 Borrelia burgdorferi


The vector for Babesia microti is also a vector for:

5 Borrelia burgdorferi

The vector for Babesia microti, the pathogenic organism of babesiosis, is Ixodes dammini, which is also a

vector for Borrelia burgdorferi, the pathogenic organism of Lyme borreliosis. Francisella tularensis (the

pathogenic organism of tularemia) is transmitted by Dermacentor andersoni and Dermacentor variabilis.

Rickettsia rickettsii (the pathogenic organism of Rocky Mountain Spotted Fever) is transmitted by

Dermacentor andersoni, Dermacentor variabilis, and Amblyomma americanum.


The necrosis and hemolysis that can result from a brown recluse spider bite may be attributed to which of

the following toxins?

1 Alpha lactrotoxin

2 Sphingomyelinase-D

3 Histamine

4 Hyaluronidase

5 Lipase


The necrosis and hemolysis that can result from a brown recluse spider bite may be attributed to which of

the following toxins?2 Sphingomyelinase-D

The brown recluse spider (Loxosceles reclusa) is a tan spider with a violin-shaped marking on the


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abdomen. Its bite may be painless, however the patient may develop erythema, a vesicle, and eventual

necrosis. This may result in the "red, white, and blue sign." Systemic reactions (viscerocutaneous

loxoscelism) may occur. The venom contains several toxins, however sphingomyelinase D seems to be

causative of the necrosis and hemolysis.


Ticks of the species shown:

1 Can transmit Lyme borreliosis and tularemia

2 Can transmit Lyme borreliosis but not Rocky Mountain Spotted Fever or tularemia

3 Can transmit Rocky Mountain Spotted Fever and Lyme borreliosis

4 Can transmit Rocky Mountain Spotted Fever and tularemia

5 Can transit tularemia but not Rocky Mountain Spotted Fever


Ticks of the species shown:

4 Can transmit Rocky Mountain Spotted Fever and tularemia

The tick pictured is a male Dermacentor variabilis tick. Dermacentor variabilis can transmit Rocky

Mountain Spotted Fever and tularemia. Lyme borreliosis is transmitted by Ixodes dammini, Ixodes

pacificus, and Amblyomma americanum.


Which of the following plants contains thiocyanates that can cause an irritant dermatitis?

1 Garlic

2 Mustard

3 Radish

4 Plants of the Brassicaceae family



Which of the following plants contains thiocyanates that can cause an irritant dermatitis?



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Thiocyanates are found in garlic (Alliaceae family), mustard, and radish (Brassicaceae family).


All of the following plants commonly cause a phytophotodermatitis except:

1 Hawaiian lei flowers

2 Ficus carica

3 Celery

4 Myroxylon balsamum

5 All of these plants commonly cause a phytophotodermatitis


All of the following plants commonly cause a phytophotodermatitis except:


Myroxylon balsamum is the source of Balsam of Peru, a common sensitizer of allergic contact dermatitis.Hawaiian lei flowers, Ficus carica (fig tree), and celery all are known to commonly cause

phytophotodermatitis.


If suspicious for scabies infestation, which of the following areas is least likely to be involved?

1 Fingerwebs

2 Nipples

3 External genitalia

4 Occipital scalp

5 Umbilicus


If suspicious for scabies infestation, which of the following areas is least likely to be involved?

4 Occipital scalp

Erythematous papules and burrows are commonly seen in webspaces, nipples, external genitalia,

umbilicus and axilla in sarcoptes scabiei infestation.


Ophthalmia nodosa may result following injury by which of the following creatures?

1 Theraphosidae

2 Chironex

3 Lactrodectus

4 Cheyletiella

5 Loxosceles


Ophthalmia nodosa may result following injury by which of the following creatures?


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1 Theraphosidae

Tarantulas are relatively large, hair spiders belonging to the Theraphosidae family. Many are kept as

household pets given their longevity (they may live to 20 years or more) and slow-moving, relatively

sedentary lifestyle. However, when agitated, tarantulas may engage in rubbing their hind legs against

their abdomen, resulting in release of numerous urticating, barbed hairs. These projectile hairs may then

lodge in the conjunctiva, cornea, iris, or even retina, resulting in multifocal and chronic granulomatous

inflammation known as ophthalmia nodosa. Similar reactions may be seen secondary to ocular

penetration of the sensory setae of caterpillars.


Flying squirrels can carry many infections, including which of the following?

1 Epidemic typhus

2 Staphlyococcus sp

3 Toxoplasma gondii

4 none of these infections are correct

5 all of these infections are correct


Flying squirrels can carry many infections, including which of the following?

5 all of these infections are correct

Flying squirrels can carry many infections, including Toxoplasma gondii, Staphylococcus sp., and

Rickettsia prowazekii (via the body lous, causing epidemic typhus).


A 54 year-old man with psoriatic arthritis on methotrexate and infliximab calls you after he is bitten

deeply on the ankle by his daughter's 2 year-old Chihuahua. He is concerned that his

immunocompromised status puts him at risk for infection and potential complications from this bite. You

correctly tell him:

1 As long as the dog has been vaccinated, he need not worry about serious infections

2 Capnocytophaga from dog bites can cause sepsis in immunocompromised victims

3 Eikenella corrodens is the most common cause of infection following dog bites

4 Pasteurella multocida infection is frequent after dog bites but not cat bites5 Rickettsial pox can be seen after dog bites


A 54 year-old man with psoriatic arthritis on methotrexate and infliximab calls you after he is bitten

deeply on the ankle by his daughter's 2 year-old Chihuahua. He is concerned that his

immunocompromised status puts him at risk for infection and potential complications from this bite. You

correctly tell him:

2 Capnocytophaga from dog bites can cause sepsis in immunocompromised victimsLocal infection and cellulitis is a concern following domesticated animal bites; vaccination may prevent

against rabies, but not other infections. Cat bites most frequently result in Pasteurella multocida

infections, while dog bites result in Pasteurella canis. However, most bites are polymicrobial with mixed


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aerobes and anaerobes. Infrequently systemic infections may result in brain or lung abscess, endocarditis,

or sepsis. Sepsis is more frequent in immunocompromised victims and may be due to Capnocytophaga or

Pasteurella.


All of the following are food mites except:

1 Acarus

2 Tyrophagus

3 Glyciphagus

4 Dermatophagoides

5 All of the listed answers are food mites


All of the following are food mites except:

4 Dermatophagoides

Acarus (grain mite), Tyrophagus (grocery mite), and Glyciphagus (cheese mite) are all food mites that

ingest foodstuffs. They can produce papular urticaria or vesicopapular eruptions. Dermatophagoides is

the dust mite, and causes environmental allergic reactions.


Which of the following contains active furocoumarins?

1 Lichens

2 Chrysanthemum

3 Fig

4 Mango

5 Primrose


Which of the following contains active furocoumarins?

3 Fig

The fig tree may cause a phytophotodermatitis.


Which creature is a human flea that can also be seen on dogs?

1 Pulex irritans

2 Ctenocephalides canis

3 Lytta vesicatoria

4 Liponyssoides sanuineus

5 Pediculus humanus



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Which creature is a human flea that can also be seen on dogs?

1 Pulex irritans

Pulex irritans is the human flea; it can also be seen on dogs. More frequent infestations on domestic

animals are by Ctenocephalides felis and canis (on cats and dogs respectively). Lytta vesicatoria is a

blister beetle from which cantharadin is derived. Pediculus humanus var. corporis is the human body

louse.


Which family of plants is most commonly implicated in phytophotodermatitis caused by furocoumarins?

1 Apiaceae

2 Rutaceae

3 Moraceae

4 Papilonaceae

5 Compositae


Which family of plants is most commonly implicated in phytophotodermatitis caused by furocoumarins?

1 Apiaceae

The Apiaceae (formerly umbelliferae) family is the most common cause of phytophotodermatitis. The

members of this family include cow parsley, celery, wild parsnip, false bishop's weed, giant hogweed,

angelica, meadow grass, fennel, wild carrot, caraway, and coriander.


The insect pictured is:

1 A vector of relapsing fever

2 A vector of Lyme borreliosis

3 A vector of babesiosis

4 The cause of maculae cerulea

5 Ornithonyssus



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The insect pictured is:

2 A vector of Lyme borreliosis

The insect pictured is a female Amblyomma americanum tick. This tick can serve as a vector for Lyme

borreliosis and Rocky Mountain Spotted Fever. Relapsing fever is transmitted by Ornithodoros moubata.

Babesiosis is trasnmitted by Ixodes dammini. Maculae cerulea are seen in severe cases of crab lice.

Ornithonyssus is the fowl mite.


Which of the following mites is a cause of "walking dandruff" in dogs and cats?



3 Cheyletiella

4 Acarus

5 Allodermanyssus sanguineus


Which of the following mites is a cause of "walking dandruff" in dogs and cats?

3 Cheyletiella

Cheyletiella mites are harbored by dogs and cats and cause walking dandruff. The pet is asymptomatic,

but people handling the pet may experience pruritus when mites feed on skin. Diagnosis is by

microscopic examination of cellophane tape applied to the pet's skin. Acarus is the grain mite, and causes

baker's itch. Allodermanyssus sanguineus is the house mouse mite, and the vector of rickettsial pox.


Which of these spiders is bright green with red spots, with black spines on its legs?

1 Phidippus formosus

2 Loxosceles reclusa

3 Latrodectus mactans

4 Peucetia viridans

5 Centruroides sculpturatus


Which of these spiders is bright green with red spots, with black spines on its legs?

4 Peucetia viridans

Peucetia viridans (green lynx spider) is common in the southern United States. It is bright green with red

spots; the legs have black spines. The bite is painful, with tenderness and pruritus. Phidippus formosus

(jumping spider) is an aggressive spider with dark body hairs and various white patterns. They are the

most common biting spiders in the United States. Loxosceles reclusa (brown recluse) is a tan spider with

a violin-shaped marking on the abdomen. The bite may be painless, however the patient may develop

erythema, a vesicle, and eventual necrosis. Latrodectus mactans (black widow) is a large, black, shiny

spider with an hourglass shaped white or red marking on the abdomen. Bites are acutely painful, and may

swell but do not cause necrosis; the venom contains neurotoxins. Centruroides sculpturatus is a primary

scorpion species in the U.S.



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Poison sumac is:

1 A member of the Toxicodendron genus

2 A source of tuliposide A

3 The common name for Myroxylon balsamum

4 The common name for Pinus palustris

5 A source of colophony


Poison sumac is:

1 A member of the Toxicodendron genus

Poison ivy, oak, and sumac are members of the Anacardiacea family, Toxicodendron genus. Alstromeria

(Peruvian lily) is the source of tuliposide A. Myroxylon balsamum is the source of Balsam of Peru. The

Pinus palustris tree is the source of colophony.


Identify this insect:

1 Tabanid fly

2 Water flea

3 Tsetse fly

4 Reduviid bug

5 Black fly



1 Tabanid fly

The insect indentified is a fly of the Tabanid family, which encompasses horseflies and deerflies. The

genus Chrysops of this family is the vector for loiasis. Clinical manifestations of this infection include

painful, localized subcutaneous nonpitting edema, calabar swellings and eosinophila. Conjunctival

migrations are common.


Which of the following plant families commonly causes phytophotodermatitis?

1 Rubiaceae


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2 Compositae

3 Urticaceae

4 Ranunculaceae

5 Apiaceae


Which of the following plant families commonly causes phytophotodermatitis?

5 Apiaceae

The Apiaceae family (formerly Umbelliferae) includes parsley, celery, parsnip, hogweed, and fennel, all

potential causes of phytophotodermatitis.


A veterinarian presents with an edematous pustule on the right arm, with nodules along the lymphatic

drainage route. You consider a diagnosis of glanders. What treatment do you recommend?

1Reassurance. No treatment is necessary, as infection is self-limited and should resolve within 6

weeks

2 Antibiotic treatment with streptomycin combined with tetracycline

3 Surgical excision

4 Surgical excision followed by antibiotic treatment with streptomycin combined with tetracycline

5 Surgical excision followed by antibiotic treatment with rifampin and ethambutol


A veterinarian presents with an edematous pustule on the right arm, with nodules along the lymphatic

drainage route. You consider a diagnosis of glanders. What treatment do you recommend?

4Surgical excision followed by antibiotic treatment with streptomycin combined with

tetracycline

Farcy, or glanders, is caused by infection with the gram-negative rod Burkholderia mallei. It most

frequently infects horses, donkeys, and mules; humans can occasionally also be infected. An edematous

nodule, pustule, or vesicle develops at the inoculation site. Nodules are often present along the lymphatic

drainage route and are called "farcy buds." Importantly, nasal ulceration and septum perforation can be

caused by glanders. A chronic form leads to deep, painful abscesses. Treatment is with surgical excision

of the lesion followed by streptomycin combined with tetracycline.

Q/Q(M)-478034 Report a ProblemIdentify this tick:

1 Ixodes dammini

2 Dermacentor andersoni

3 Dermacentor variabilis

4 Amblyomma americanum

5 Rhipicephalus sanguineus



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Identify this tick:


This is Amblyomma americanum which transmits Lyme as well as RMSF.


This patient acquired an infection with a microorganism that may have been inoculated into the skin from

contact with:



3 Grasses

4 Sphagnum moss

5 Rose thorns


This patient acquired an infection with a microorganism that may have been inoculated into the skin from

contact with:


This patient has sporotrichosis, which is caused by Sporothrix schenckii. Sporothrix schenckii can be

inoculated into the skin by grasses, sphagnum moss, and rose thorns.



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Identify this plant:

1 Alstromeria

2 Toxicodentron


4 Ragweed

5 Primrose


Identify this plant:

5 Primrose

This is primrose (primulaceae) a cause of allergic contact dermatitis.


A patient comes to you with complaints of numerous erythematous pruritic papules under her bathing suit

after swimming in the ocean. What is the most likely diagnosis?

1 Swimmers itch

2 Hot tub folliculitis

3 Seabathers eruption

4 Hydrozoa contact

5 Nematocyst stings


A patient comes to you with complaints of numerous erythematous pruritic papules under her bathing suit

after swimming in the ocean. What is the most likely diagnosis?

3 Seabathers eruption

Sea bathers eruption is seen after ocean exposure and can be intensely pruritic. It is due to jellyfish

larvae (Linuche unguiculata) and can be prevented by rinsing off soon after coming out of the water.

Swimmers itch is a cercarial dermatitis caused by avian schistosomes which occurs after freshwater

exposure. It is usually seen on exposed areas. Portuguese man of war (hydrozoa) stings can lead to

hemorrhagic lesions with vesiculations.


Which organism causes peliosis?


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1 Brucellae

2 Pseudomonas mallei

3 Bartonella hensalae

4 Burkholderia pseudomallei

5 Bacillus anthracis


Which organism causes peliosis?

3 Bartonella hensalae

Peliosis hepatitis are seen in bacillary angiomatosis caused by Bartonella henselae which usually occurs

in patients with AIDS. Brucelliosis is also known as Malta fever and is caused by ingesting raw goat mil

and unpasteurized goat cheese; skin lesions occur in 20% of patients as violaceous papulonodules on the

trunk and legs. Burkholderia pseudomallei causes Whitmore disease or meliodosis characterized by

pulmonary disease and septicemia. Anthrax is caused by Bacillus anthracis, a gram-positive rod, and cancause pulmonary, gastrointestinal, or cutaneous disease.


Which of the following statements regarding orf is correct?

1 The papillomatous stage of lesion progression preceeds the regenerative stage

2 Lesions last indefinitely without treatment

3 The papular stage of lesion progression follows the target stage

4 Orf is also known as "pseudocowpox."

5 The virus is very sturdy and survives many months in cold weather


Which of the following statements regarding orf is correct?

5 The virus is very sturdy and survives many months in cold weather

Orf, also known as ecthyma contagiosum or infectious pustular dermatitis, is transmitted to humans by a

parapoxvirus in sheep, goats, and reindeer. This is a self-limited condition with an excellent prognosis

lasting approximately 6 weeks. Lesion morphology changes through a series of stages: papular (red,

elevated) -> target (nodule with red center, white middle ring, red periphery) --> acute (red, weeping) -->

regenerative (thin, dry crust overlying lesion) --> papillomatous --> regressive. The virus is very sturdyand survives many months in cold weather. Milker's nodule, caused by the paravaccinia virus (a

parapoxvirus, related to the orf virus), infects cows and can be transmitted to dairy workers, and is also

known as pseudocowpox.


Immunologic contact urticaria is frequently caused by:

1 Hevea brasiliensis

2 Plants of the Urticaceae family

3 Plants of the Euphorbiacea family




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Immunologic contact urticaria is frequently caused by:

1 Hevea brasiliensis

Contact urticaria occurs after direct contact, and can be immunologic (IgE) or non-immunologic (toxin-

mediated). Type I hypersensitivity, or IgE mediated reactions, require previous sensitization. Frequentcauses of immunologic eruptions include latex proteins (Hevea brasiliensis). Plants such as stinging

nettles (Urticaceae family) and spurge nettle (Euphorbiaceas) cause nonimmunologic urticaria, which

occurs without previous sensitization in any host.



1 Poison ivy

2 Gingko

3 Poison oak4 Mango leaves

5 Poison sumac



5 Poison sumac

Poison sumac leaves grow in groupings of 7-13 with a single leaf at the tip.


The venom from which of the following creatures contains phospholipase A?

1 Theraphosidae

2 Honeybee

3 Cimicidae


5 Solenopsis invicta


The venom from which of the following creatures contains phospholipase A?

2 Honeybee


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Honeybees (Hymenoptera) leave a barbed ovipositor and paired venom sacs impaled into their victim.

The honeybee dies after stinging, but other hymenoptera do not. The venom from the honeybee contains

phospholipase A. Theraphosidae (tarantulas) are of dermatologic importance due to the presence of

urticating hairs. Cimicidae (bedbugs) cause initially asymptomatic bites that then form linear, purpuric,

pruritic macules and erythematous papules. Ctenocephalides canis is a flea that causes frequent

infestations on dogs. Solenopsis invicta is the imported fire ant, and attacks in groups. Solenopsis inject a

venom that contains a hemolytic factor, solenopsin D.


Unilateral swelling of the eyelid at the site of the bite of the assassin bug is called what?

1 Unilateral Chagas' disease

2 Romana's sign

3 Rothschild's sign

4 Russell's sign

5 Raynaud's sign


Unilateral swelling of the eyelid at the site of the bite of the assassin bug is called what?

2 Romana's sign

Rothschild's sign is alopecia of the lateral 1/3 of the eyebrows secondary to hypothyroidism. Russell's

sign is the development of callouses on the dorsal dominant hand. Raynaud's sign is the development of

acrocyanosis.


A 47 year old park ranger developed a diffuse, erythematous, eczematous eruption after fighting a forest

fire. What is the most likely allergen causing this airborn contact dermatitis?

1 Diallyl disulfide

2 Pyrethrins

3 Alphamethylene

4 Psoralen

5 D-usnic acid


A 47 year old park ranger developed a diffuse, erythematous, eczematous eruption after fighting a forest

fire. What is the most likely allergen causing this airborn contact dermatitis?

5 D-usnic acid

Lichen causes airborne allergic contact dermatitis in lumberjacks, forest workers, and people exposed to

firewood, funeral wreaths, and masculine fragrances. The primary allergen is d-usnic acid.


Cantharidin creates a vesicle by which of the following mechanisms?

1 Disruption of keratinocyte-keratinocyte adhesion

2 Instability of the hemidesmosome


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3 Subcorneal layer separation

4 Antibodies to desmosomal proteins

5 Local recruitment of neutrophils


Cantharidin creates a vesicle by which of the following mechanisms?

1 Disruption of keratinocyte-keratinocyte adhesion

Desmosomal adhesions are interrupted by proteases with eventual tonofilament detachment.


Which species is a human flea that can also be seen on dogs?

1 Pulex irritans

2 Pediculus humanus

3 Liponyssoides sanuineus

4 Lytta vesicatoria



Which species is a human flea that can also be seen on dogs?

1 Pulex irritans

Pulex irritans is the human flea; it can also be seen on dogs. More frequent infestations on domestic

animals are by Ctenocephalides felis and canis (on cats and dogs respectively). Lytta vesicatoria is a

blister beetle from which cantharadin is derived. Pediculus humanus var. corporis is the human bodylouse.


Which of the following may NOT occur after contact with the organism in the photo?

1 Purpura in a tram-track pattern

2 Urticaria

3 Tram-track calcification on skull x-ray

4 Loss of vision

5 PruritusQ/Q(M)-474962 Report a Problem

Which of the following may NOT occur after contact with the organism in the photo?


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3 Tram-track calcification on skull x-ray

The most common response is erythema, pruritus and urticaria. Purpura and hemorrhage in a tram-track

or ladder pattern may be seen as well. Ophthalmia nodosa may occur if hairs injure the cornea. Tram-

track calcification on skull films is seen in Sturge-Weber syndrome.


Phytophotodermatitis caused by skin exposure to limes is caused by:1 Ascorbic acid

2 Tuliposide A

3 Furocoumarin

4 D-limonene

5 Sesquiterpene lactone


Phytophotodermatitis caused by skin exposure to limes is caused by:3 Furocoumarin

Phytophotodermatatitis (phototoxic eruptions from plants) are relatively commonly seen in florists,

nursery personnel, gardeners, and farm workers. Plants that cause this eruption may produce photoxins

such as furocoumarins Fig, fennel, lime, lemon, parsley, celery, dill, and hogweed are all causes of

phytophotodermatitis.


Which of the following is false regarding this image?

1 This is the tsetse fly2 This is a glossina fly

3 A large abscess may occur following a bite

4 This transmits sleeping sickness

5 This transmits trypanosomes


Which of the following is false regarding this image?

3 A large abscess may occur following a bite

Cutaneous reactions tend to be minimal from the bite of the tsetse, or glossina, fly which transmits

trypanosomes and sleeping sickness.



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Thorns and barbs on blackberry bushes have been known to cause secondary infection through

inoculation of:

1 Mycobacterium kansaii

2 Sporothrix schenckii

3 Mycobacterium ulcerans




Thorns and barbs on blackberry bushes have been known to cause secondary infection through

inoculation of:

1 Mycobacterium kansaii

Thorns and barbs on blackberry bushes have been known to cause secondary infection throughinoculation of Mycobacterium kansaii. Sporothrix schenckii can be innoculated by grasses, sphagnum

moss, and rose thorns. Mycobacterium ulcerans has been innoculated by spiky tropical vegetation.



1 Phlebotomous sandfly

2 Tsetse fly

3 Reduviid bug

4 Water flea

5 Mango fly



3 Reduviid bug

This a picture of the reduviid bug, also called the kissing bug or assassin bug. It is the vector for

American Trypanosomiasis (Chagas disease), which is caused by Trypanosoma cruzii. The reduviid bug

prefers to bite at mucocutaneous junctions.


Which of the following is a common cause of seabather's eruption?

1 Edwardsiella lineate


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2 Linuche unguiculata

3 Thimble jelly fish

4 Sea anemone



Which of the following is a common cause of seabather's eruption?


Seabather's eruption (or sea lice) can be sporadic or part of an outbreak. Clinically, it appears as

dermatitis beneath areas covered by swim suits. The geographic distribution is most frequent from the

Caribbean to Bermuda, however there have been three outbreaks at Long Island, NY beaches. A variety

of cnidarian larvae can cause this eruption, including thimble jelly fish (Linuche unguiculata) and sea

anemone (Edwardsiella lineate). Quick removal of bathing suits and rinsing can help with prevention.

Symptom relief is the mainstay of therapy.


Which of the statements regarding Tegenaria agrestis is correct?

1 Stings from this scorpion can produce cardiovascular complications

2Contact with this creature results in erythematous papules, hemorrhage, or purpura in a classic

"tram-track" pattern

3 This creature is the leading cause of necrotic arachnidism in several states of the Pacific Northwest

4 This ant injects a venom that contains a hemolytic factor, solenopsin D

5 None of these answers are correctQ/Q(M)-477750 Report a Problem

Which of the statements regarding Tegenaria agrestis is correct?

3This creature is the leading cause of necrotic arachnidism in several states of the Pacific

Northwest

Tegenaria agrestis (the Hobo spider) is the leading cause of necrotic arachnidism in several states of the

Pacific Northwest. These spiders are large, with a herringbone-striped pattern on the abdomen. Contact

with caterpillars (Lepidoptera) may produce lesions in a classic "tram-track" pattern. Solenopsis (fire

ants) ants inject a venom that contains a hemolytic factor, solenopsin D, that causes a release of histamine

and other vasoactive amines from mast cells.Q/Q(M)-477750 Report a Problem

Sesquiterpene lactones are found in which of the following plants?

1 Alstromeria

2 Pinus palustris

3 Artichoke

4 Chive

5 GingkoQ/Q(M)-477939 Report a Problem


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Sesquiterpene lactones are found in which of the following plants?

3 Artichoke

Sesquiterpene lactones are sensitizers found in plants of the Asteraceae (Compositae) family. Members

include ragweed, pyrethrum, chrysanthemum, weeds, feverfew, and artichoke. The sensitzer found in

alstromeria (Peruvian lily) is tuliposide A (a glycoside). The Pinus palustris tree is the source of

colophony. Chives contain diallyl disulfide. Gingko fruit pulp is a sensitizer.


Which disease is transmitted by this insect?

1 Visceral leishmaniasis

2 African sleeping sickness

3 Chagas disease

4 Dracunculiasis

5 Onchocerciasis



5 Onchocerciasis

The insect depicted is the black fly, Simulium species. The black fly is the vector for onchocerciasis,

which is caused by onchocerca volvulus. Clinical manifestation of this disease include atrophy,

depigmentation and thickening of the skin. In addition, the infection may cause "river blindess" and

onchocercomas, which are nodules containing microfilariae.


The female Sarcoptes scabiei var. hominis mite can lay up to 100 eggs. It has an ovoid, flat body and how

many short legs?


2 12

3 6

4 8

5 10



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The female Sarcoptes scabiei var. hominis mite can lay up to 100 eggs. It has an ovoid, flat body and how

many short legs?

4 8

The female Sarcoptes scabiei var. hominis mite has an ovoid, flat body and 8 short legs.


Which chemical is present in large quantities of this insect's venom?1 Sphingomyelinase D

2 Alpha lactrotoxin

3 Histamine

4 Hyaluronidase

5 Lipase


Which chemical is present in large quantities of this insect's venom?

3 Histamine

The spider shown is the Wolf spider (Lycosidae). This Australian spider's bites contains large amounts of

histamine. Bites are painful with edema, erythema and subsequent lymphangitis.


Contact urticaria is a:

1 Type I hypersensitivity

2 Type II hypersensitivity

3 Type III hypersensitivity

4 Type IV hypersensitivity

5 Undetermined hypersensitivity


Contact urticaria is a:

1 Type I hypersensitivityContact urticaria is an example of a type I hypersensitivity reaction. The classic example is a latex

induced contact urticaria. Type I reactions (immediate hypersensitivity reactions) involve

immunoglobulin E (IgE)mediated release of histamine and other mediators from mast cells and


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basophils.


What is the initial treatment of choice for this dermatitis?

1 Observation

2 5% acetic acid

3 Topical steroid

4 Topical antibiotics

5 Warm compresses


What is the initial treatment of choice for this dermatitis?

2 5% acetic acid

The linear appearance of the dermatitis is typical of jellyfish stings. To prevent further nematocyte

activation, 5% acetic acids should be applied for 15-30 minutes. Papain found in meat tenderizers or 70%

isopropyl alcohol may also be applied. Warm compresses are contraindicated as they may increase

systemic absorption of the venom.



1 Alliaceae

2 Primulaceae

3 Toxicodendron

4 Compositae

5 Alstromeria



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4 Compositae

This is ragweed, a member of the compositae (or asteraceae) family.


Snake bite antivenin is derived from:

1 Human antibody

2 Mouse antibody

3 Antigen extracted directly from the attacking snake

4 Horse antibody

5 Pooled IVIg


Snake bite antivenin is derived from:

4 Horse antibody

Following envenomation, antivenins are derived from horses.


Pineapples contain which of the following proteolytic enzymes?



3 Bromelin

4 Phorbol esters

5 Ranunculin


Pineapples contain which of the following proteolytic enzymes?

3 Bromelin

Bromelin is a proteolytic enzyme found in pineapples. It is granted access to dermal vessels by calcium

oxalate-induced fissures. Phorbol esters are found in plants of the Euphorbiaceae family. Ranunculin is

an irritant found in buttercups (Ranunculaceae family).


Necrosis may be seen in which of the following:


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1 Allergic contact dermatitis

2 Contact urticaria

3 Dermatographism

4 Irritant contact dermatitis

5 Acute urticaria


Necrosis may be seen in which of the following:

4 Irritant contact dermatitis

Necrosis may be seen in severe irritant reactions. The other reactions do not involve necrosis.


Allergic contact dermatitis is a:

1 Type I hypersensitivity

2 Type II hypersensitivity

3 Type III hypersensitivity


5 Undetermined hypersensitivity


Allergic contact dermatitis is a:


Allergic contact dermatitis is an example of a Type 4 hypersensitivity reaction (delayed type

hypersensitivity reaction). Type 4 reactions are mediated by T-cells. Other types of hypersensitivity

reactions are described below. Type I reactions (immediate hypersensitivity reactions) involve

IgEmediated release of histamine and other mediators from mast cells and basophils. Type II reactions(cytotoxic hypersensitivity reactions) involve immunoglobulin G or immunoglobulin M antibodies bound

to cell surface antigens, with subsequent complement fixation. Type III reactions (immune-complex

reactions) involve circulating antigen-antibody immune complexes that deposit in postcapillary venules,

with subsequent complement fixation.


Plants from the family Moraceae include which of the following?

1 Ficus carica

2 Fennel

3 Burning bush





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Plants from the family Moraceae include which of the following?

1 Ficus carica

Ficus carica (fig tree) is a member of the family Moraceae and a cause of phytophotodermatitis. Burning

bush is a member of the family Rutaceae. Fennel is a member of the family Apiaceae.


Which of the following vectors transmits Borrelia duttonii?1 Ixodes pacificus

2 Rhipicephalus sanguineus

3 Ornithodoros moubata


5 none of the above


Which of the following vectors transmits Borrelia duttonii?3 Ornithodoros moubata

Borrelia duttonii is a pathogenic organism of relapsing fever. It is transmitted by Ornithodoros moubata.

Ixodes pacificus is one of the vectors of Lyme Borreliosis. Rhipicephalus sanguineus is a vector of

Ehrlichiosis. Amblyomma americanum is a vector of Lyme Borreliosis and Rocky Mountain Spotted

Fever.


The skin lesions with cutaneous larva migrans are typically seen on which body location?

1 Face

2 Scalp

3 Distal lower extremity

4 Perianal area

5 Trunk


The skin lesions with cutaneous larva migrans are typically seen on which body location?

3 Distal lower extremity

Cutaneous larva migrans is usually acquired on sandy beaches. The hookworm can penetrate the human

skin, usually through the foot. A serpiginous inflammatory reaction can be seen highlighting the burrow

of the larvae in the skin. This is a self-limited reaction, however pruritus can be significant, therefore oral

treatment with thiabendazole or ivermectin is often given. Topical 10% thiabendazole also is effective.



1 African sleeping sickness

2 Chagas disease


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3 Dracunculiasis

4 Visceral leishmaniasis

5 Onchocerciasis



2 Chagas disease

This a picture of the reduviid bug, also called the kissing bug or assassin bug. It is the vector for

American Trypanosomiasis (Chagas disease), which is caused by Trypanosoma cruzii. The reduviid bug

prefers to bite at mucocutaneous junctions.


The toxin holothurin, released by which of the following marine creatures, can cause conjunctivitis in

exposed swimmers?


2 Sea cucumber

3 Linuche unguiculata

4 Edwardsiella lineate

5 Chironex fleckeri


The toxin holothurin, released by which of the following marine creatures, can cause conjunctivitis in

exposed swimmers?

2 Sea cucumber

Sea cucumbers are cucumber-shaped bottom-dwellers that can cause conjunctivitis due to release of atoxin called holothurin to which nearby swimmers can be exposed. The larva of Linuche unguiculata

(thimble jelly fish) and Edwardsiella lineate (sea anemone) are causes of seabather's eruption (or sea

lice). Chironex fleckeri is the box jellyfish; its stings are extremely toxic and may lead to shock and

death, especially in small adults and children.


What is cutaneous larva migrans caused by?

1 Ancylostoma caninum and A. Brazilense

2 Toxoplasma gondii

3 Onchocerca volvulus

4 Shistosoma hematobium, S. japonicum & S. mansoni


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5 Strongyloides stercoralis


What is cutaneous larva migrans caused by?

1 Ancylostoma caninum and A. Brazilense

Plant and Creature of Dermatological Significance MCQs

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