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An elaborate quiz on skin from the creighton university. Try to get all the answers right below.
Questions and Answers
1.
A KOH (potassium hyroxide) solution is least helpful in the diagnosis of which of the following?
A.
Yeast infection
B.
Fungal infection
C.
Bacterial infection
D.
Mites
E.
Scabies
Correct Answer
C. Bacterial infection
Explanation A 10% KOH solution is used to dissolve keratin. This allows for easy identification of yeast and hyphae, fungus, and parasites such as mites or scabies. A Gram stain is most appropriate for bacteria.
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2.
A 16 year old patient presents complaining of a rash. On examination, he has numerous red papules on his trunk and extremities, parts of which appear dry and silver in color. Which of the following most likely caused his rash?
A.
Recent withdrawal from systemic steroids
B.
Recent treatment with nystatin
C.
Recent streptococcal infection
D.
Frequent bathing
Correct Answer
C. Recent streptococcal infection
Explanation This pattern is Guttate psoriasis. It commonly occurs after a strep infection. Withdrawal of systemic steroids may induce pustular psoriasis. Nystatin can cause a delayed type IV hypersensitivity reaction, but the rash would appear as erythematous, weeping skin with vesicles. Frequent bathing may cause eczema.
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3.
Hemangioma of infancy is characterized by all of the following except:
A.
It often shrinks after the first year
B.
It is far more likely to affect females
C.
It is the most common tumor of infancy
D.
It is made of benign proliferation of blood vessels
E.
It is premalignant
Correct Answer
E. It is premalignant
Explanation Hemangiomas are common, benign tumors that tend to affect females. They tend to regress after the first year. They require close monitoring, although they do not become malignant.
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4.
Which of the following is not associated with an increased risk of skin cancer?
A.
Organ transpantation
B.
Chronic, non-healing wounds
C.
AIDS
D.
Tattoos
E.
Xenoderma pigmentosum
F.
Tanning beds
G.
Sunlight
H.
HPV
Correct Answer
D. Tattoos
Explanation Tattoos have no association with skin cancer. Tanning beds have been conclusively shown to increase risk for melanoma.
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5.
Which correctly pairs the cancer with an appropriate underlying mutation:
A.
Merkel cell carcinoma, ICAM-1
B.
Squamous cell carcinoma, p53
C.
Basal cell carcinoma, BRAF
D.
Melanoma, ras
Correct Answer
B. Squamous cell carcinoma, p53
Explanation SCC is better associated with p53 mutations. BRAF mutations are more characteristic of melanoma (in addition to CDKN2A).
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6.
Which sunscreen is best at blocking UVA1, UVA2, and UVB?
A.
PABA
B.
Cinoxate (a type of cinnamate)
C.
Titanium dioxide
D.
Oxybenzone (a type of benzophenone)
Correct Answer
C. Titanium dioxide
Explanation The physical sunscreens such as titanium dioxide and zinc oxide are those that reflect light across the spectrum. Cinnnamtes and PABA are for UVB. Benzophenones are for UVB and UVA2.
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7.
When treating a severe case of psoriasis in a patient with decreased kidney function, which of the following should be avoided?
A.
Acitretin
B.
Cyclosporine
C.
Methotrexate
D.
Alefacept
Correct Answer
B. Cyclosporine
Explanation Renal toxicity is associated with cyclosporine. Acitretin, as with most retinoids, should be avoided in pregnant women. Methotrexate is a folic acid analog that causes antimitotic effects. Alefacept blocks T cells via the CD2 receptor.
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8.
Which wavelength of UV radiation is most likely to pass through the atmosphere to reach the surface of the earth?
A.
350 nm
B.
300 nm
C.
250 nm
D.
All of the above are equally likely to pass through the atmosphere
Correct Answer
A. 350 nm
Explanation UVA light has the longest wavelength, the lowest energy, and the best chance to penetrate the atmosphere. Answer B is UVB light, which is partially blocked. Answer C is UVC light which is almost entirely blocked.
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9.
After DNA damage, which proteins are involved in stopping the cell cycle to facilitate repair?
A.
P53
B.
ATR
C.
P16 (ink4a)
D.
All of the above
E.
Both A and B
F.
Both A and C
Correct Answer
D. All of the above
Explanation After DNA damage, various proteins are involved in stopping the cell cycle to allow for repair. The p53 protein is a key regulator that can halt the cell cycle and initiate DNA repair mechanisms. ATR, another protein, is also involved in detecting DNA damage and activating cell cycle checkpoints to prevent further progression until repair is complete. Additionally, the p16 (ink4a) protein plays a role in cell cycle arrest and acts as a tumor suppressor. Therefore, all of the mentioned proteins (p53, ATR, and p16) are involved in stopping the cell cycle after DNA damage to facilitate repair.
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10.
An elevated skin lesion that measures 7mm in size is best described as a :
A.
Macule
B.
Papule
C.
Patch
D.
Plaque
E.
Vesicle
Correct Answer
B. Papule
Explanation Macule (1cm) are flat. Papules (1cm) are raised (ie palpable). Vesicles (0.5cm) are fluid-filled blisters.
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11.
Rheumatoid arthritis is the same type of hypersensitivity reaction as
A.
Contact dermatitis to nickel earrings
B.
SLE
C.
Uticaria in response peanuts
D.
Bullous pemphigoid
E.
Erythema multiforme
Correct Answer
B. SLE
Explanation Both rheumatoid arthritis and SLE are type III hypersensitivity reactions (immune complex). Answer A is type IV, C is type I, D and E are type II.
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12.
Which of the following is a feature of lichen planus not found in psoriasis?
A.
Appears as white over a pink papule
B.
Arthritis
C.
Often affects both the skin and mucosae
D.
More commonly found on elbows and knees
Correct Answer
C. Often affects both the skin and mucosae
Explanation Psoriasis does not affect the mucosae, but up to 70% of patients with lichen planus are affected on the mucosae. Answer A is a feature of both diseases, and B and D are characteristic of psoriasis alone. Dr. Shehan describes lichen planus as "pruitic, purple, polygonal papules".
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13.
Which of the following does not produce a rash on the palms and/or soles?
A.
Syphilis
B.
Rocky Mountain spotted fever
C.
Erythema multiforme
D.
Reiter's arthritis
E.
All produce rashes on the palms and/or soles
Correct Answer
E. All produce rashes on the palms and/or soles
Explanation Not an all-inclusive list, but these are some key ones we've covered.
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14.
Which of the following correctly orders the layers of skin from the outside inward?
A.
S. corneum, s. granulosum, s. spinosum, s. basale, papillary dermis, reticular dermis
B.
S. corneum, s. spinosum, s. granulosum, s. basale, papillary dermis, reticular dermis
C.
S. corneum, s. granulosum, s. spinosum, s. basale, reticular dermis, papillary dermis
D.
S. corneum, s. granulosum, s. spinosum, s. basale, reticular dermis, papillary dermis
Correct Answer
A. S. corneum, s. granulosum, s. spinosum, s. basale, papillary dermis, reticular dermis
Explanation The correct answer correctly orders the layers of skin from the outside inward. The layers of the skin, listed in order, are: stratum corneum, stratum granulosum, stratum spinosum, stratum basale, papillary dermis, and reticular dermis.
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15.
Which of the following best describes an ointment?
A.
Powder in water
B.
Water in oil
C.
Oil in water emulsion
Correct Answer
B. Water in oil
Explanation Lotion is answer A.
Cream is answer C.
Ointments are mostly oil, which makes them best for dry skin.
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16.
In the treatment of moderate to severe psoriasis, which is least appropriate?
A.
Retinoids
B.
Systemic corticosteroids
C.
Anti-mitotic agents
D.
Vitamin D3 analogs
Correct Answer
B. Systemic corticosteroids
Explanation Dr. Shehan was very clear in his lecture to not give systemic steroids because upon withdrawal the psoriasis may get worse.
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17.
In which of the following diseases are you most likely to see granular deposits of IgA at the tips of dermal papillae?
A.
Bullus pemphigoid
B.
Pemphigus vulgaris
C.
Dermatitis hermetiformis
D.
Acanthosis nigricans
E.
None of the above
Correct Answer
C. Dermatitis hermetiformis
Explanation Both answers A and B are from IgG antibodies. Acanthosis nigricans is hyperpigmentation, often in the axilla, and may be associated with visceral malignancy.
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