Section 2.

Skin Problems

MULTIPLE CHOICE

1. Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown
of his head. How do you respond when he asks you the cause?
A. “You must be under a lot of stress lately.”
B. “It is hereditary. Did your father experience this also?”
C. “The cause is unknown, but we suspect it is due to an immunological mechanism.”
D. “We’ll have to do some tests.”
ANS: C PTS: 1

2. Gillian presents with a sudden onset of 102°F fever, emesis, tingling in the hands and feet,
fatigue, and weakness. What is the potential diagnosis of this presentation?
A. Urticaria
B. Toxic shock syndrome
C. Scabies
D. Pediculosis
ANS: B PTS: 1

3. Which of the following describes a bulla?

A. Results from a defect in the dermoepidermal junction
B. Interfaces between the epidermis and the dermis
C. A small crusty plaque
D. A dime-sized purulent pustule on the buttocks
ANS: A PTS: 1

4. An example of ecchymosis is:

A. A hematoma
B. A keloid
C. A bruise
D. A patch
ANS: C PTS: 1

5. Francine presents with a total loss of skin color in patchy areas of her body. What are the
potential causes?
A. Zidovudine
B. Chlorpromazine
C. Vitiligo
D. Addison’s disease
ANS: C PTS: 1

6. When looking under the microscope to diagnose an intravaginal infection, you see a cluster of
small and oval-to-round shapes. What do you suspect they are?
A. Spores
B. Leukocytes
 C. Pseudohyphae
D. Epithelial cells
ANS: A PTS: 1

7. Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the
following is the most appropriate treatment?
A. Terbinafine 250 mg once daily  12 weeks
B. Noxafil 100 mg oral suspension  2 daily
C. Griseofulvin 500 mg once daily  2 to 4 weeks
D. Metronidazole 2% cream 5 g intravaginally  7 days

ANS: D PTS: 1

8. Tinea unguium is also known as:

A. Onychomycosis
B. Tinea versicolor
C. Tinea manuum
D. Tinea corporis
ANS: A PTS: 1

9. Sally, age 25, presents with impetigo that has been diagnosed as infected with Staphylococcus.
The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash
that is ulcerating. Her recent treatment has not been adequate. Which type of impetigo is this?
A. Bullous impetigo
B. Staphylococcal scalded skin syndrome (SSSS)
C. Nonbullous impetigo
D. Ecthyma
ANS: D PTS: 1

10. Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus
due to gas production by which anaerobic bacteria?
A. Staphylococcus aureus
B. Clostridium perfringens
C. S. pyogenes
D. Streptococcus
ANS: B PTS: 1

11. When using the microscope for an intravaginal infection, you see something translucent and
colorless. What do you suspect?
A. A piece of hair or a thread
B. Hyphae
C. Leukocytes
D. Spores
ANS: B PTS: 1

12. What should be the initial management for a new wart?

A. Tretinoin cream
 B. Liquid nitrogen cryotherapy
C. Salicylic acid
D. Watchful waiting
ANS: D PTS: 1

13. Stacy has a verruca plana and she is using tretinoin cream. Which of the following is true?
A. It should be applied at bedtime over the entire area that is affected.
B. It should be applied twice daily for 1 week.
C. It is not normal to have a fine scaling when using this medication.
D. It is not normal to have erythema when using this medication.
ANS: A PTS: 1

14. Of the following types of cellulitis, which is a streptococcal infection of the superficial layers
of the skin that does not involve the subcutaneous layers?
A. Necrotizing fasciitis
B. Periorbital cellulitis
C. Erysipelas
D. “Flesh-eating” cellulitis
ANS: C PTS: 1

15. Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was
sexually transmitted and discuss that:
A. HPV 16 and 18 usually cause anogenital warts.
B. Penetrative intercourse is necessary to transmit anogenital warts.
C. Anogenital warts are transmitted genital to genital.
D. OTC home-based cryotherapy is a good choice for treatment.
ANS: C PTS: 1

16. Jeffrey has atopic dermatitis. You are prescribing a low-dose topical corticosteroid for him.
Which would be a good choice?
A. Betamethasone dipropionate 0.05%
B. Hydrocortisone base 2.5%
C. Halcinonide 0.1%
D. Desonide 0.05%
ANS: B PTS: 1

17. Harvey has a rubbery, smooth, round mass on his chest that is compressible and has a soft-to-
very-firm texture. What do you diagnose this as?
A. A lipoma
B. A nevus
C. A skin tag
D. A possible adenoma
ANS: A PTS: 1

18. Which of the following statements is accurate when you are removing a seborrheic keratosis
lesion using snip excision?
A. Do not use lidocaine as it may potentiate bleeding.
 B. Pinch the skin taut together.
C. Use gel foam to control bleeding.
D. This should be performed by a dermatologist only.
ANS: C PTS: 1

19. The “B” in the ABCDEs of assessing skin cancer represents:

A. Biopsy
B. Best practice
C. Boundary
D. Border irregularity
ANS: D PTS: 1

20. Gary has been diagnosed with HSV-2 genital herpes and is wondering what to expect. Which
of the following is a credible teaching point?
A. HSV-1 genital herpes occurs more frequently than HSV-2 genital herpes.
B. The HSV lesions will never occur near the initial infection site.
C. Burning and tingling at the site of initial infection can signal recurrence.
D. Each recurrent HSV infection will be worse than the initial infection.
ANS: C PTS: 1

21. Eighty percent of men have noticeable hair loss by what age?
A. 35
B. 50
C. 70
D. 85
ANS: D PTS: 1

22. Prevalence of psoriasis is highest in which group?

A. Scandinavians
B. African Americans
C. Asians
D. Native Americans
ANS: A PTS: 1

23. The most common precancerous skin lesion found in Caucasians is:
A. A skin tag
B. Actinic keratosis
C. A melanoma
D. A basal cell lesion
ANS: B PTS: 1

24. Ian, age 62, presents with a wide, diffuse area of erythematous skin on his lower left leg that is
warm and tender to palpation. There is some edema involved. You suspect:
A. Necrotizing fasciitis
B. Kaposi’s sarcoma
C. Cellulitis
D. A diabetic ulcer
 ANS: C PTS: 1

25. Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition?
A. There are round, hypopigmented macules on his back.
B. Josh has red papules on his face.
C. There are crusted plaques in Josh’s groin area.
D. There are white streaks on his neck.
ANS: A PTS: 1

26. Tori is on systemic antifungals for a bad tinea infection. You are aware that the antifungals
may cause:
A. Renal failure
B. Skin discoloration
C. Breathing difficulties
D. Hepatotoxicity
ANS: D PTS: 1

27. Which scalp problem can be caused by a fever and certain drugs?
A. Telogen effluvium (TE)
B. Trichotillomania
C. Psoriasis
D. Alopecia areata
ANS: A PTS: 1

28. Which of the following is a strong risk factor associated with increased melanoma risk?
A. Patient had a 15 mm nevus.
B. Patient has a history of multiple blistering sunburns in their teenage years.
C. Patient’s uncle had melanoma.
D. Patient is of African American descent.
ANS: B PTS: 1

29. Which statement is true regarding chloasma, the “mask of pregnancy”?

A. It is caused by a decrease in the melanocyte-stimulating hormone during
pregnancy.
B. This condition only occurs on the face.
C. Exposure to sunlight will even out the discoloration.
D. It is caused by increased levels of estrogen and progesterone.
ANS: D PTS: 1

30. A patient presents with xerosis. What do you tell the patient about this condition?
A. Daily hot baths can help to soothe the skin.
B. Using a strong deodorant can improve the condition.
C. It can be a side effect of depigmentation creams.
D. It is uncommon in the elderly.
ANS: C PTS: 1
31. Which medication used for scabies is safe for children 2 months and older?
A. Permethrin cream
B. Lindane
C. Crotamiton lotion and cream
D. Ivermectin
ANS: A PTS: 1

32. Which of the following is an infraorbital fold skin manifestation in a patient with atopic
dermatitis?
A. Keratosis pilaris
B. Dennie’s sign
C. Keratoconus
D. Pityriasis alba
ANS: B PTS: 1

33. Which of the following statements about performing cryosurgery for actinic keratosis is true?
A. It is better to slightly overfreeze the area, so you only have to do it once.
B. Using liquid nitrogen, freeze each lesion for at least 30 seconds.
C. Every lesion should be biopsied after using liquid nitrogen.
D. The “freeze balls” should be approximately one-and-a-half times as wide as they
are deep.
ANS: D PTS: 1

34. Gerald presents with a very dark color on his right pinkie finger. What is the health-care
provider’s next care step?
A. Referral to a dermatologist for a nail biopsy
B. Watchful waiting
C. Discussing that the condition is benign and the patient can ignore it
D. Follow up in 2 weeks to see if there is any change
ANS: A PTS: 1

35. Which statement regarding necrotizing fasciitis is true?

A. The hallmark of this infection is its slow and steady progression.
B. Once the border of the infection is “established,” it does not spread.
C. This is a medical emergency and gangrene can develop.
D. The lesion is most dangerous, because it is painless.
ANS: C PTS: 1

36. When staging a malignant melanoma using Clark’s levels, which level extends into the
papillary dermis?
A. Level I
B. Level II
C. Level III
D. Level IV
ANS: C PTS: 1

37. Which of these patients is most likely to have acne and resultant scarring?
 A. A 15-year-old Caucasian male
B. A 17-year-old Hispanic female
C. A 20-year-old Asian female
D. A 21-year-old African American male
ANS: B PTS: 1

38. A 20-year-old Hispanic male presents with multiple noninflammatory comedones on his chest
and back with four small papules on his right upper arm. Which diagnosis is accurate?
A. Mild acne
B. Moderate acne
C. Severe acne
D. Nodulocystic acne
ANS: A PTS: 1

39. A 40-year-old woman presents with inflammatory papules on her face, facial flushing when
she drinks a glass of wine, telangiectasias, and dry eyes. Which of the following conditions is
the most likely diagnosis?
A. Acne vulgaris
B. Hot tub folliculitis
C. Rosacea
D. Perioral dermatitis
ANS: C PTS: 1

40. Rachel is a patient complaining of a pruritic erythematous rash on her face and hands that
became apparent this morning. Which of the following questions would help determine
whether she has contact dermatitis?
A. “Do you have a history of itchy rashes?”
B. “Do you have any food allergies?”
C. “Do you have a history of rosacea?”
D. “Have you used any new face wash or soap?”
ANS: D PTS: 1

41. A 70-year-old patient presents with a poorly defined, pink, scaling rash on his face and scalp.
When he asks what he can expect from this condition, you say:
A. “If your rash is itchy, the itching may be worse when you are hot and sweaty.”
B. “This is probably a one-time rash and should not come back.”
C. “This condition does not run in families, so your children are not at risk of
developing it.”
D. “This rash is most common in people that have poor hygiene, so you will have to
shower at least once a day.”
ANS: A PTS: 1

42. Janet has psoriasis that covers 25% of her body. Which of the following treatment options
should be considered?
A. Referral to plastic surgery
B. Methotrexate 10 mg daily
C. Anthralin 0.1% ointment applied once a day
 D. A surgical consult
ANS: B PTS: 1

43. Heidi has a fingerlike, flesh-colored projection emanating from a broad base on her mouth.
Which of the following is the most likely diagnosis?
A. Plantar wart
B. Flat wart
C. Verruca vulgaris
D. Digitate wart
ANS: D PTS: 1

44. Maria had impetigo and is seeing her health-care provider for a follow-up visit. Which of the
following teaching points should the provider discuss?
A. Keeping fingernails short can prevent the spread of impetigo.
B. Impetigo can be prevented in the future by wearing a face mask.
C. If a patient has impetigo in the future, they should clean everything in their home
with bleach.
D. Impetigo is spread by blood, so the patient should avoid donating blood.
ANS: A PTS: 1

45. Jill is a patient complaining of a “bumpy” rash on her neck that is nonpruritic. She was
recently on a ski trip and went in a hot tub. What is the most likely diagnosis?
A. HSV-2
B. Folliculitis
C. Acne vulgaris
D. Actinic keratosis
ANS: B PTS: 1

46. Graham has a single furuncle on his buttocks with no surrounding cellulitis. What is the best
treatment option?
A. Systemic antibiotics
B. Cold compress to the site
C. Incision and drainage
D. Watchful waiting
ANS: C PTS: 1

47. Jack is complaining of an extremely pruritic lesion that is round to a half circle in his genital
area. Which of the following is the most likely diagnosis?
A. Tinea cruris
B. Tinea pedis
C. Tinea versicolor
D. Tinea manuum
ANS: A PTS: 1

48. Which of the following is true of scabies?

A. Scabies is more common in the Caucasian population.
B. Scabies is transmitted through blood.
 C. Scabies is not associated with hygiene.
D. Scabies is transmitted through close personal contact.
ANS: D PTS: 1

49. Which of the following is true of pediculosis?

A. Pruritus occurs before the sensitivity to the head louse.
B. Patients can be asymptomatic or cause few symptoms in the first 2 weeks
following exposure.
C. In a patient’s first infection, they will develop symptoms within 24 to 48 hours.
D. It is transmitted through droplets.
ANS: B PTS: 1

50. How might a rash appear on a patient with a darker skin tone?
A. Dark brown
B. Light pink
C. Bright red
D. Deep purple
ANS: A PTS: 1

51. What of the following is the most common appearance of Paget’s disease?
A. Poorly defined, red, raised plaque on one nipple
B. Scattered white papules on the nipples bilaterally
C. Oval-shaped, erythematous scaling plaque with sharp margins on one nipple
D. Raised, silvery-white patches on the nipples bilaterally
ANS: C PTS: 1