8/10/2019 MED LE2 26-41_KIM
1/5
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-08/10/2019 MED LE2 26-41_KIM
2/5
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.pdf8/10/2019 MED LE2 26-41_KIM
3/5
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
8/10/2019 MED LE2 26-41_KIM
4/5
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?
8/10/2019 MED LE2 26-41_KIM
5/5
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
Top Related