SKIN PRACTICE TEST QUESTIONS: ACNE, ROSACEA, ECZEMATOUS
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
case 17.08 Graber Family medicine
Question 1:
A 15-year-old male presents to your office complaining of "zits" on his face and back. He has several
scattered comedones on his face and several deep nodules on his back. He also has some papulopustular
lesions on his chin. You diagnose him with acne vulgaris.
Which of the following is NOT TRUE about acne?
A
Noncomedonal acne is an inflammatory process
B
It commonly presents first in adolescence
C
It may first appear in adulthood
D
It is more severe in females than in males
E
The incidence is lower in Asians and Africans than in Caucasians - (ANSWER)The correct answer is D.
Explanation:
Acne is an inflammatory process that involves the pilosebaceous units of the face and trunk. It can be
comedonal, papulopustular, or nodulocystic in presentation. It typically presents first in adolescence with
girls developing it from age 10 to 17 years and boys from 14 to 19 years. However, it may not appear
,SKIN PRACTICE TEST QUESTIONS: ACNE, ROSACEA, ECZEMATOUS
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
until early adulthood. It is more severe in males than in females (thus "D" is not true), and it is less
prevalent among Asians and Africans.
Question 2:
Your patient has heard many things about acne and wonders if they are true.
Regarding acne, all of the following are true EXCEPT:
A
Acne is not caused by medications
B
Acne can be caused by industrial exposures such as cutting oils, aromatic hydrocarbons, and petroleum-
based products
C
Infrequent facial cleansing does not cause acne
D
Emotional stress affects the course of acne
E
Acne can present at any age - (ANSWER)The correct answer is A.
Explanation:
,SKIN PRACTICE TEST QUESTIONS: ACNE, ROSACEA, ECZEMATOUS
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
Acne can be caused by many medications including oral steroids, EGFR inhibitors, lithium, isoniazid
(INH), and phenytoin. Medication-induced acne presents as monomorphic papules on the face, chest,
and back. Exposure to industrial chemicals that occlude the follicle can also lead to an acneiform
eruption. Neither infrequent washing nor chocolate (or any other foods) cause acne—no matter what
your mother told you. However, stress (like that homecoming dance in high-school) can often flare acne.
There are different types of acne that can affect individuals at various stages of life. Neonatal acne
presents shortly after birth and is transient. Infantile acne presents at 6 to 12 months of age and resolves
within 1 to 2 years. The most common time to develop acne is around puberty; however, women in their
30s and 40s can also experience acne flares with hormonal fluctuations. As an aside, oral contraceptives
(OCPs) go both ways with regard to acne: several OCPs are marketed to treat acne, but they have been
reported to worsen acne in some patients. The result of OCPs may depend on the hormonal milieu of
the specific patient (women with hyperandrogenism may benefit) and the type of progestin in the OCP.
Acne is often improved in the summer months and worse in the fall and winter. Many women also tend
to flare up right before menses.
Question 3:
For acne, which of the following treatment principles is correct?
A
Treatment can often lead to initial worsening of lesions
B
Therapeutic response often takes several months
C
Mild acne can be treated with topical medications
D
, SKIN PRACTICE TEST QUESTIONS: ACNE, ROSACEA, ECZEMATOUS
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
Often times, two or more therapeutic agents must be combined for effective treatment
E
All of the above are correct - (ANSWER)The correct answer is E.
Explanation:
Topical retinoids, topical antibiotics, and benzoyl peroxide are the first-line agents and can be titrated as
needed. Retinoids should be applied at bedtime. The main oral antibiotic agents are tetracyclines and
should be used as add-on therapy to topical agents for moderate-to-severe inflammatory acne. OCPs
with low androgenic progesterones can also be helpful. Since acne lesions may take up to 2 months to
resolve, one may not notice a therapeutic response for several months (once the current crop of lesions
resolve).
Question 4:
After a few months of topical benzoyl peroxide wash and topical clindamycin cream, you add topical
retinoic acid. Your patient returns with persistent lesions, including mild scarring and cystic lesions. You
are considering referral for isotretinoin, which is indicated for severe, recalcitrant, nodular acne.
Which of the following is FALSE regarding the use of isotretinoin?
A
Two methods of contraception are required in all reproductive age women along with frequent
pregnancy tests
B
It should not be used with tetracycline
C
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
case 17.08 Graber Family medicine
Question 1:
A 15-year-old male presents to your office complaining of "zits" on his face and back. He has several
scattered comedones on his face and several deep nodules on his back. He also has some papulopustular
lesions on his chin. You diagnose him with acne vulgaris.
Which of the following is NOT TRUE about acne?
A
Noncomedonal acne is an inflammatory process
B
It commonly presents first in adolescence
C
It may first appear in adulthood
D
It is more severe in females than in males
E
The incidence is lower in Asians and Africans than in Caucasians - (ANSWER)The correct answer is D.
Explanation:
Acne is an inflammatory process that involves the pilosebaceous units of the face and trunk. It can be
comedonal, papulopustular, or nodulocystic in presentation. It typically presents first in adolescence with
girls developing it from age 10 to 17 years and boys from 14 to 19 years. However, it may not appear
,SKIN PRACTICE TEST QUESTIONS: ACNE, ROSACEA, ECZEMATOUS
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
until early adulthood. It is more severe in males than in females (thus "D" is not true), and it is less
prevalent among Asians and Africans.
Question 2:
Your patient has heard many things about acne and wonders if they are true.
Regarding acne, all of the following are true EXCEPT:
A
Acne is not caused by medications
B
Acne can be caused by industrial exposures such as cutting oils, aromatic hydrocarbons, and petroleum-
based products
C
Infrequent facial cleansing does not cause acne
D
Emotional stress affects the course of acne
E
Acne can present at any age - (ANSWER)The correct answer is A.
Explanation:
,SKIN PRACTICE TEST QUESTIONS: ACNE, ROSACEA, ECZEMATOUS
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
Acne can be caused by many medications including oral steroids, EGFR inhibitors, lithium, isoniazid
(INH), and phenytoin. Medication-induced acne presents as monomorphic papules on the face, chest,
and back. Exposure to industrial chemicals that occlude the follicle can also lead to an acneiform
eruption. Neither infrequent washing nor chocolate (or any other foods) cause acne—no matter what
your mother told you. However, stress (like that homecoming dance in high-school) can often flare acne.
There are different types of acne that can affect individuals at various stages of life. Neonatal acne
presents shortly after birth and is transient. Infantile acne presents at 6 to 12 months of age and resolves
within 1 to 2 years. The most common time to develop acne is around puberty; however, women in their
30s and 40s can also experience acne flares with hormonal fluctuations. As an aside, oral contraceptives
(OCPs) go both ways with regard to acne: several OCPs are marketed to treat acne, but they have been
reported to worsen acne in some patients. The result of OCPs may depend on the hormonal milieu of
the specific patient (women with hyperandrogenism may benefit) and the type of progestin in the OCP.
Acne is often improved in the summer months and worse in the fall and winter. Many women also tend
to flare up right before menses.
Question 3:
For acne, which of the following treatment principles is correct?
A
Treatment can often lead to initial worsening of lesions
B
Therapeutic response often takes several months
C
Mild acne can be treated with topical medications
D
, SKIN PRACTICE TEST QUESTIONS: ACNE, ROSACEA, ECZEMATOUS
DERMATITIS (ATOPIC DERMATITIS), SHINGLES (HERPES ZOSTER
VIRUS), PSORIASIS, PITYRIASIS ROSEA, TINEA CORPORIS,
CONTACT DERMATITIS, SEBORRHEIC DERMATITIS,
Often times, two or more therapeutic agents must be combined for effective treatment
E
All of the above are correct - (ANSWER)The correct answer is E.
Explanation:
Topical retinoids, topical antibiotics, and benzoyl peroxide are the first-line agents and can be titrated as
needed. Retinoids should be applied at bedtime. The main oral antibiotic agents are tetracyclines and
should be used as add-on therapy to topical agents for moderate-to-severe inflammatory acne. OCPs
with low androgenic progesterones can also be helpful. Since acne lesions may take up to 2 months to
resolve, one may not notice a therapeutic response for several months (once the current crop of lesions
resolve).
Question 4:
After a few months of topical benzoyl peroxide wash and topical clindamycin cream, you add topical
retinoic acid. Your patient returns with persistent lesions, including mild scarring and cystic lesions. You
are considering referral for isotretinoin, which is indicated for severe, recalcitrant, nodular acne.
Which of the following is FALSE regarding the use of isotretinoin?
A
Two methods of contraception are required in all reproductive age women along with frequent
pregnancy tests
B
It should not be used with tetracycline
C
