April 2015 Minnesota Dermatological Society Meeting: Medical Dermatology MOC

28 Questions | By MNDERM | Updated: Mar 22, 2022 | Attempts: 241

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1.

A 32 year old female presents with a 10 year history of persistent tender, scaly plaques affecting her scalp and pubic area. Review of systems reveals a long history of polydipsia and polyuria. Skin biopsy shows a dermal and epidermal infiltration of large polygonal histiocytes with eccentric nuclei. What stains are most helpful in confirming the diagnosis?
- A.
  
  A. CD3 and CD8
- B.
  
  B. S-100 and MART-1
- C.
  
  C. S-100 and CD1a
- D.
  
  D. CD163 and CD68
- E.
  
  E. CK20 and chromogranin
2.

A 3 year old boy with failure to thrive, progressive hearing loss, polyuria and polydipsia presents with extensive eczematous scaling in a seborrhea-like distribution. Skin pathology shows large abnormal histiocytes with reniform nuclei that stain positive for S100 and CD1a. Furthermore, genetic testing reveals a V600E BRAF mutation. What does he have?
- A.
  
  A. Urticaria pigmentosa
- B.
  
  B. Li-Fraumeni syndrome
- C.
  
  C. Cowden Syndrome
- D.
  
  D. Familial melanoma syndrome
- E.
  
  E. Erdheim Chester disease
3.

3. A 57 year old Caucasian male with history of hepatitis C and resultant cirrhosis was complicated by acute renal failure requiring dialysis after transplant. He received Galolinium magnetic resonance cholangiopancreatography during this time and subsequently rapidly developed indurated, erythematous plaques on trunk and extremities.Which immunohistochemical staining pattern would provide most support for the most likely clinical diagnosis?
- A.
  
  A. CD 34 positive lymphocytes
- B.
  
  B. CD 34 positive spindle shaped cells
- C.
  
  C. CD 134 positive lymphocytes
- D.
  
  D. CD 134 positive spindle shaped cells
- E.
  
  E. CD 134 negative spindle shaped cells
4.

A 60 year old Caucasian female developed sudden onset edema, pain and sclerosis with subsequent contractures of bilateral hands and feet. This was accompanied by significant fatigue as well as debilitating polyarthralgia and muscle weakness. ANA shows low titer. Incidentally, an ovarian carcinoma was identified.Which of the following findings best differentiates paraneoplastic Palmar Fasciitis and Polyarthritis Syndrome from Systemic Scleroderma?
- A.
  
  A: Presence of joint pains
- B.
  
  B: Severe mobility difficulty flexing and extending all fingers
- C.
  
  B: Severe mobility difficulty flexing and extending all fingers C: Swelling of dorsum hand
- D.
  
  D: Lack of Raynaud’s phenomenon
- E.
  
  E: Presence of muscle weakness
5.

Lenalidomide is a thalidomide derivative that has been shown in select case reports to be efficacious in treating severe, refractory prurigo nodularis. Its side effect profile includes which of the following:
- A.
  
  A. Risk for fetal limb defects
- B.
  
  B. Thrombocytosis
- C.
  
  C. Deep venous thrombosis
- D.
  
  D. A & B
- E.
  
  E. A & C
6.

Which of the following areas are least likely to be affected by the orodynia of burning mouth syndrome?
- A.
  
  A. Anterior two thirds of the tongue
- B.
  
  B. Buccal mucosa
- C.
  
  C. Lower lip
- D.
  
  D. Palate
- E.
  
  E. Tonsil
7.

Often times, contributing factors are identified in patients with burning mouth syndrome. Which of the following is most likely to contribute to increased symptoms in burning mouth syndrome?
- A.
  
  A. Depression
- B.
  
  B. Zinc deficiency
- C.
  
  C. Thiamine deficiency
- D.
  
  D. History of dental caries
- E.
  
  E. Gluten sensitive enteropathy
8.

A 15 year old male presents for evaluation of painful calluses on his feet and thick toenails. Further physical examination reveals white patches on the oral mucosa and cystic lesions on the axilla. What is the most likely diagnosis?
- A.
  
  A. Steatocytoma multiplex
- B.
  
  B. Pachyonychia congenita treatment is necessary
- C.
  
  C. Clouston Syndrome
- D.
  
  D. Olmsted syndrome D. Olmsted syndrome
- E.
  
  E. Vörner keratoderma
9.

A 13 year old boy develops a well demarcated verrucous plaque that grows over a one week period. He lives in Indiana and has animals including a horse, dog, and cat at home. He denies any constitutional symptoms including or any bone pain or hemoptysis. A biopsy of the plaque shows broad based budding yeast forms on GMS. Which of the following is his most likely diagnosis?
- A.
  
  A. Histoplasmosis
- B.
  
  B. Mucormycosis
- C.
  
  C. Coccidiomycosis
- D.
  
  D. Sporotrichosis
- E.
  
  E. Candida albicans
10.

A 28 year old male cook from Southern Minnesota developed a cough productive of bloody sputum and a small, pink papule on his left cheek. Within one month, the papule grew into a 4 cm exophytic nodule with a keratotic crust. At the same time he began to develop multiple small, asymptomatic granulomatous pink papules on his lip, arms, and back. These also began to slowly grow. He originally presented to an emergency department where he was prescribed trimethoprim-sulfamethoxazole for ten days, which despite taking the medication as prescribed, had no effect on his papules and nodules. He had no recent travel history and nooutdoor hobbies. A biopsy of one of the nodules shows broad based budding yeast forms on GMS. What is the following best treatment for this patient?
- A.
  
  A. Amphoteracin B, intravenously
- B.
  
  B. Itraconazole 200 mg PO BID
- C.
  
  C. Keflex 500 mg PO QID
- D.
  
  D. Observation
- E.
  
  E. Surgical excision
11.

A 73 year old woman has a several month history of painful upper and lower lip erosions. She endorses five pound unintentional weight loss secondary to pain with eating. She denies intraoral or genital involvement. She denies any changes to her medications or new cosmetic products prior to onset. Her past medical history is significant for hypertension and osteoarthritis. On examination, upper and lower cutaneous lip ulcerations are seen, in addition to faint white linear plaques on her bilateral buccal mucosa. Swab for HSV/VZV is negative.Which of the following is the most likely diagnosis?
- A.
  
  A. Discoid lupus erythematous
- B.
  
  B. Actinic cheilitis
- C.
  
  C. Lichen planus
- D.
  
  D. Contact dermatitis
- E.
  
  E. Steven-Johnson syndrome
12.

Different regimens for treatment of oral lichen planus have been reported. Topical tacrolimus is one such treatment. Which of the following is the most likely side effect of this medication?
- A.
  
  A. Folliculitis
- B.
  
  B. Erythema
- C.
  
  C. Photosensitivity
- D.
  
  D. Burning
- E.
  
  E. Anaphylaxis
13.

A 60 year old male presents with an urticarial eruption, fever, fatigue, and joint pain. Physical examination revealed widespread urticarial plaques, axillary lymphadenopathy and hepatosplenomegaly. Laboratory evaluation revealed a white blood cell count of 25x109/L, an erythrocyte sedimentation rate (ESR) of 118mm/h, and protein electrophoresis revealed an M spike identified as an IgM K protein. Which of the following is an obligate criterion for the diagnosis of this condition?
- A.
  
  A. Joint Pain
- B.
  
  B. Leukocytosis
- C.
  
  C. Elevated ESR
- D.
  
  D. Monoclonal IgM
- E.
  
  E. Fever
14.

Which of the following is the treatment of choice for this condition?
- A.
  
  A. Antihistamines
- B.
  
  B. Intravenous Immunoglobulin
- C.
  
  IL-1 receptor antagonists
- D.
  
  Dapsone
- E.
  
  Systemic corticosteriods
15.

A five year old female presented for evaluation of diffuse hair loss. She was born with normal lanugo hair; however, at two months of life she shed her hair diffusely. She has remained without terminal hair on the body, scalp, eyelashes or eyebrows. Physical examination was notable complete absence of terminal hair across the scalp, face, and trunk. Dentition and fingernails were normal. Miniature follicles were appreciated on the scalp, cheeks, arms and legs. Genetic testing revealed mutation in the hairless (HR) gene.What does this patient have?
- A.
  
  A. Alopecia areata
- B.
  
  B. Woolly hair syndrome
- C.
  
  C. Congenital atrichia
- D.
  
  D. Alopecia universalis
- E.
  
  E. Netherton syndrome
16.

Which of the following histopathologic findings are most compatible with this diagnosis?
- A.
  
  A. Mild peribulbar, lymphocytic inflammation and miniaturization
- B.
  
  B. Absence of normal hair follicle structures with normal sebaceous and eccrine glands.
- C.
  
  C. Empty hair shafts surrounded by mild, granulomatous inflammation and loss of surrounding sebaceous glands.
- D.
  
  D. Miniaturization of follicular units with fibrous tract remnants..
- E.
  
  E. Absence of normal hair follicle structures with normal sebaceous and eccrine glands.
17.

Compared to classic mycosis fungoides, which of the following phenotype is seen most commonly seen in patients with poikilodermatous mycosis fungoides?
- A.
  
  A. CD4+
- B.
  
  B. CD8+
- C.
  
  C. CD20+
- D.
  
  D. CD30+
- E.
  
  E. CD2+
18.

A 48 year old male presents with a 10 year history of telangiectatic and reticulated thin plaques on his trunk and extremities. They have been persistent, pruritic, and involve 10% of his body surface area. A biopsy is performed and reveals an atypical T-cell infiltrate with a CD8+ phenotype and epidermotropism. He has no systemic complaints. What would be the most appropriate initial therapy for this patient?
- A.
  
  A. Acitretin
- B.
  
  B. CHOP chemotherapy
- C.
  
  C. Narrowband UVB
- D.
  
  D. Methotrexate
- E.
  
  E. Alpha interferon
19.

A baby is delivered in a collodion membrane. At early childhood he develops large, dark grey or brownish thick scales covering much of the body surface. Associated ectropion and eclabium are noted. Which of the following is the most likely diagnosis?
- A.
  
  A. Anhidrotic ectodermal dysplasia
- B.
  
  B. Lamellar Ichthyosis
- C.
  
  C. Netherton syndrome
- D.
  
  D. Richner-Hanhart syndrome
- E.
  
  E. Olmsted syndrome
20.

In a child with autosomal recessive ichthyosis and the TGM1 mutation, what are the histopathological findings most likely demonstrated?
- A.
  
  A. Lichenoid inflammation and basal vacuolar interface changes
- B.
  
  B. Orthokeratosis and focal parakeratosis with a normal to thickened granular layer
- C.
  
  C. Psudoepitheliomatous hyperplasia with neutrophilic collections in the dermis
- D.
  
  D. Regular acanthosis with clear cell change and peppered neutrophils
- E.
  
  E. Thickened basement membrane with periadnexal and perivascular inflammation
21.

A 2 year old presented with brittle hair. Scanning electron microsopy showed flattened hair shafts that are twisted along the long axis. Further history revealed that she was recently diagnosed with sensorineural hearing loss. A genetic mutation in the BCS1 gene was found. Which of the following is the most likely diagnosis?
- A.
  
  A. Menkes syndrome
- B.
  
  B. GRACILE syndrome
- C.
  
  C. Netherton syndrome
- D.
  
  D. Hay-Wells syndrome
- E.
  
  E. Xeroderma pigments
22.

An infant has a history of abnormal hair growth, early developmental delay, lethargy, and seizures. Prior workup includes a mutation in the ATP7A gene. Abnormalities in what trace element are most important in these patients?
- A.
  
  A. Copper
- B.
  
  B. Iron
- C.
  
  C. Manganese
- D.
  
  D. Selenium
- E.
  
  E. Zinc
23.

In subcutaneous panniculitis-like T cell lymphoma, alpha/beta phenotype, which of the following is the most likely histopathology?
- A.
  
  A. Adipocytes with an atypical lymphoid infiltrate
- B.
  
  B. Lobular panniculitis with neutrophils
- C.
  
  C. Septal pannicultis with eosinophils
- D.
  
  D. Necrosis of adipocytes
- E.
  
  E. Hyalinizing fat necrosis with calcium deposits
24.

When compared with alpha/beta subcutaneous panniculitis like T cell lymphoma, the gamma-delta subtype is more likely to demonstrate which of the following?
- A.
  
  A. Angioinvasion
- B.
  
  B. Lack of infiltration of upper dermis and epidermis
- C.
  
  C. CD34 positivity
- D.
  
  D. Association with hemophagocytic syndrome
- E.
  
  E. A & D
- F.
  
  F. B & C
25.

A 50-year-old male presents to the clinic for evaluation of rapid onset, symmetric and bilateral fibrosis of his extremities. Raynaud’s sign is absent. Laboratory evaluation includes an elevated ESR and eosinophil count,with a normal anti-scl 70 and anti-centromere antibodies. Histopathologic examination of an incisional biopsy shows deep sclerosis including the fascia without eosinophils. Which of the following is the most likely diagnosis?
- A.
  
  A. Porphyria cutanea tarda
- B.
  
  B. Systemic sclerosis
- C.
  
  C. Eosinophilic fasciitis
- D.
  
  D. Discoid lupus
- E.
  
  E. Limited sclerosis