SKIN- CASE STUDY Q AND A

SKIN- CASE STUDY Q AND A


Avb63-year-
oldvbmanvbcomesvbtovbthevbdermatologyvbclinicvbbecausevbofvbrapidlyvbprogressingvbskinvbrednessvbwhichvbh
asvbcoveredvbmostvbofvbhisvbbody.vbHevbhasvbcoronaryvbarteryvbdiseasevbwithvbavb3-
vesselvbCABG,vbhypertension,vbandvbpsoriasis.vbHisvbmedicationsvbincludevbavbbeta-
blocker,vbaspirin,vbACE-
inhibitor,vbstatin,vbandvbtopicalvbclobetasol.vbHevbhasvbnotvbhadvbanyvbrecentvbchangesvbtovbhisvbmedications
.vbHisvbtemperaturevbisvb38.8°Cvb(101.8°F),vbpulsevbisvb115/min,vbrespirationsvbarevb16/
min,vbandvbbloodvbpressurevbisvb95/68vbmmvbHg.vbHisvbO2vbsaturationvbisvb97%vbonvbroomvbair.vbHevbisvbinvbno
vbacutevbdistress,vbbutvbhevbisvbshivering.vbOnvbexamination,vbhisvboropharynxvbisvbclearvbwithoutvbmucousvb

membranevbinvolvement.vbHisvbskinvbexamvbshowsvbdiffusevberythemavbwithvbanvboverlyingvbscalevbcoverin
gvbovervb90%vbofvbhisvbbodyvbsurfacevbarea.vb
Whichvbofvbthevbfollowingvbisvbthevbmostvblikelyvbdiagnosis?

A.vbContactvbdermatitis
B.vbCutaneousvbT-cellvblymphoma
C.vbDrug-relatedvberythroderma
D.vbErythrodermicvbpsoriasis
E.vbIdiopathicvberythrodvb-vbanswer--D.vbErythrodermicvbpsoriasis

Avb25-
yearvboldvbwomanvbcomesvbtovbthevbclinicvbbecausevbofvbavbwhitevbcoatingvbonvbhervbtongue.vbShevbwasvbrec
entlyvbdiagnosedvbwithvbacquiredvbimmunevbdeficiencyvbsyndrome.vbPhysicalvbexaminationvbshowsvbavbcle
arlyvbevidentvbfungalvbinfectionvbofvbhervbmouth.vb
Whichvbofvbthevbfollowingvbfungivbisvbthevbmostvblikelyvbcausevbofvbthisvbpatient'svbcondition?
A.vbCandidavbalbicans
B.vbEpidermophytonvbfloccosum
C.vbMalassezia
D.vbTrichophytonvbinterdigitale
E.vbTrichophytonvbrubrumvb-vbanswer--A.vbCandidavbalbicans

Avb37-year-
oldvbmanvbcomesvbtovbthevbclinicvbbecausevbofvbavbdarkvbspotvbonvbhisvbuppervbbackvbthatvbhasvbrecentlyvbcha
ngedvbinvbshape.vbHevbisvblight-
skinnedvbwithvbmanyvbfrecklesvbandvbsaysvbthatvbhevbsufferedvbfromvbfrequentvbseverevbsunburnsvbasvbavbchi
ld.vbOnvbhisvbrightvbshouldervbisvbanvbasymmetric,vbrelativelyvbflatvbplaquevbwithvbirregularvbmarginsvbandvbvar
iegatedvbbrownvbtovbblackvbpigmentationvbmeasuringvb8vbmmvbatvbitsvblongestvblength.vbSkinvbbiopsyvbofvbthe
vbmolevbshowsvbavbpagetoidvbpatternvbofvbatypicalvbmelanocytesvbwithinvbthevbepidermisvbandvbsuperficialvbp

apillaryvbbodyvbofvbthevbdermis.vb
Whichvbofvbthevbfollowingvbmayvbhavevbbeenvbthevbprecursorvbtovbthisvblesion?


A.vbActinicvbkeratosis
B.vbBasalvbcellvbcarcinoma
C.vbDysplasticvbnevus

, D.vbJunctionalvbnevus
E.vbSeborrheicvbkeratosisvb-vbanswer--C.vbDysplasticvbnevus

Avb13-year-
oldvbgirlvbcomesvbtovbthisvbclinic,vbwithvbhervbmother,vbbecausevbofvbavbnewvbskinvblesion.vbHervbmothervbisvbw
orriedvbaboutvbthevblesionvbthatvbappearedvbonvbhervbdaughter'svbthighvbonevbmonthvbago.vbItvbhasvbgrownvbra
pidlyvbovervbthevbpastvbfewvbweeks.vbTherevbhasvbbeenvbnovbitching,vbbleedingvborvbsurroundingvbskinvbchan
ges.
Physicalvbexaminationvbshowsvbavbwell-demarcated,vbdome-
shaped,vb1cmvbdiameter,vbredvbnodulevbonvbthevbchild'svbleftvbthigh.vbExcisionalvbbiopsyvbconfirmsvbthevbdiag
nosisvbofvbavbspitzvbnevus.vb
Whichvbofvbthevbfollowingvbisvbtruevbaboutvbthisvbcondition?

A.vbPatientsvbwhovbdevelopvbavbspitzvbnevusvbhavevbavbhighervbriskvbofvbdevelopingvbavbmalignantvbmelanom
avbelsewherevbonvbtheirvbbody.
B.vbContinuedvbgrowthvbofvbthevblesionvbisvbexpectedvbtovboccurvbindefinitely,vbnecessitatingvbpromptvbsurgic
alvbexcision.
C.vbIndividualsvbwhovbpresentvbwithvbthisvbconditionvbusuallyvbalreadyvbhavevbdistantvbmetastasesvbpresent.
D.vbItvbisvbmostvbcommonlyvbseenvbinvbpatientsvbwhovbarevbyoungervbthanvbtwentyvbyearsvbold.
E.vbItvbisvboftevb-vbanswer--
D.vbItvbisvbmostvbcommonlyvbseenvbinvbpatientsvbwhovbarevbyoungervbthanvbtwentyvbyearsvbold.

Avb49-year-
oldvbwomanvbcomesvbtovbthevbofficevbbecausevbofvbnewvbskinvblesionsvbonvbhervbelbowsvbforvbavbweek.vbShevb
describesvbwell-marginated,vberythematousvbplaquesvbwithvbsilvery-
whitevbscalesvbonvbthevbextensorvbsurfacevbofvbhervbelbows.vbShevbstatesvbthatvbshevbhasvbhadvbavbrashvblikevb
thisvbbefore,vbthatvbresolvedvbonvbitsvbown.vbHervbfathervbalsovbhasvbavbsimilarvbcondition.vbExaminationvbsho
wsvbfurthervblesionsvbonvbhervbkneesvbandvbheels,vbasvbshownvbinvbthevbexhibit.vb
Whichvbofvbthevbfollowingvbisvbavbnailvbabnormalityvbmostvbcommonlyvbassociatedvbwithvbthisvbpatient'svbcon
dition?

A.vbKoilonychia
B.vbOnycholysis
C.vbOnychorrhexis
D.vbParonychia
E.vbPterygiumvb-vbanswer--B.vbOnycholysis

Avb65-year-
oldvbmanvbcomesvbtovbthevbclinicvbbecausevbofvbavbmolevbthatvbhasvbbeenvbgrowingvbonvbhisvbrightvbarm.vbPhy
sicalvbexaminationvbshowsvbanvb8vbmmvbblack-
brownvbasymmetricalvblesionvbwithvbanvbirregularvbsurfacevbandvbborder.vbAvbskinvbbiopsyvbofvbthevblesionvbs
howsvbproliferationvbofvbatypicalvbmelanocytesvbthatvbhavevbinvadedvbthevbepidermisvbandvbdermis.vbBiopsy
vbofvbthevbsentinelvblymphvbnodesvbisvbpositivevbforvbmetastasis.



Whichvbofvbthevbfollowingvbproteinsvbwouldvbyouvbexpectvbtovbbevbelevatedvbinvbthevbserumvbofvbthisvbpatient
vb

?

A.vbα-fetoprotein
B.vbβ2-microglobulin
C.vbCarcinoembryonicvbantigen
D.vbFolatevbreceptorvb1