Pance Dermatology
Final Test Review
Qns & Ans
2025
A 26-year-old female presents with a whitish coating on her tongue and lips. When you attempt to rub the
plaque with a tongue depressor, a small amount of bleeding isnoted fromthe oral mucosa. Her past medical
history includes asthma. What diagnostic test would youperformto confirmyour diagnosis?
The history and physical are consistent with oral thrush. Awet mount potassiumhydroxide preparation will
reveal fungal spores and nonseptated mycelia. A culture and sensitivity is used for suspected bacterial
infections. Agramstain is used to identify whether a bacterial pathogen is grampositive or gram negative.
Which of the following is the third component of the atopic triad, besides allergic rhinitis and asthma?
Atopic dermatits, or eczema, is the third chronic finding, along with asthma and allergic rhinitis, in patients who
are atopic. Urticaria are common in acute and chronic allergies.
A 63-year-old male presents with an asymptomaticlesion in his mouth that was discovered by his dentist at a
check-up.It is ill marginated with pigment ranging frommediumbrown toblack.Parts of the lesion are raised.
What is the next appropriate stepin management?
Oropharyngeal melanoma is characterized by varying pigment occurringin an irregularly shaped lesion.
Although thisis a rarely occurringmelanoma, a biopsy should bedone and any pigmented oral lesionshould be
excised. Areaswhichareraised within thelesionusuallyindicate sitesof invasion.
What isthe appropriate first line treatment of lyme disease in a non-pregnant adult female with erythema
migrans and no other symptoms of lyme disease and no known drug allergies?
In patients over the age of 9 exhibiting skin or joint manifestations of lyme disease, the first line treatment is
Doxycycline 100 mg bid. Patients less than 9 or those who are allergic to Doxycycline should be treated with
amoxicillin. Erythromycin isfourth line treatment for all age groups. Ceftriaxone is first line for patientswith
nervous systeminvolvement. (Wolff & Johnson, pg 691)
,A two-year-old male presents with a noduleon the side of his index finger. His mother states that he has
hadthis nodule on one prior occurrence during infancy, and it resolved onits own. What is the most likely
diagnosis?
This child has a recurrent digital fibroma. It is a smooth, firm,pink nodule that occurs on the fingers and toes up
through earlychildhood. Surgical excision is recommended sothat the functionof the digit is not impaired.
A12-year-old male presentswith hyperkeratoticpapuleslocated on both hands. What is the causative
organism?
Thispatient has verruca vulgaris orthe common wart. The causative organismis the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There isa predilection
for the hands and fingers.
A12-year-old male presentswith hyperkeratoticpapuleslocated on both hands. What is the causative
organism?
Thispatient has verruca vulgaris orthe common wart. The causative organismis the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There isa predilection
for the hands and fingers.
A 60-year-old male presents with complaints of irritation and a white plaque on his tongue. He denies pain.
During physical exam you are unable to remove the white plaque from the mucosa with a tongue depressor.
What isthemost likely diagnosis, represented asfollows?
Oral leukoplakia cannot be removed fromthe mucosa using a tongue depressor like oral thrush can. Lichen
planus can mimic candidiasis, squamous cell carcinoma, or hyperkeratosis, and requires a biopsy to diagnose.
Glossitis is a generalized inflammation, and loss of papillae of the tongue is caused by vitamin deficiencies,
medication reactions, auto immune reactions, or psoriasis. Geographic tongue is an asymptomatic serpiginous
area of atrophy and erythema of the anterior tongue. The condition is self-limiting.
Digital Fibroma
Acanthosis nigricans
A 54 year old male presentswith dark thickened skin and soft pedunculated papulesaround hisneck. He states
that the lesions are asymptomatic. What disease process are the findings commonly associated with?
,The thick dark plaque around the patient's neck is acanthosisnigricans. The papulesare acrochordons (or skin
tags). Both conditions are associated with metabolic syndrome. (Wolff & Johnson, p231)
A45-year-old male presents with purulent discharge fromhis right ear for three weeks. He states that despite
being treated by his family doctor for an ear infection one month ago, the problemcontinues to get worse. Upon
exam, you note purulent discharge in the ear canal, an erythemic tympanic membrane, and a possible
perforation. What are thepathogensmost likely toculture positive?
he clinical vignette describes a chronic otitis media. Usually, this refers to a complication of acute otits media
with perforation. Pathogens that culture fromthese infections are usually pseudomonas, proteus, or
staphylococcus aureus. Strep pneumoniae is often seen in acute otitis media. E.coli is a urinary tract pathogen.
Candida albicans is a cause of vaginitis, and mycoplasma is a respiratory pathogen.
A six-month-old male has recurrent diaper rashes, which are not responding to ketoconazole cream or zinc
oxide diaper creams. Physical exam shows well demarcated perianal erythema, with scattered red papules on
the buttocks. AKOHisnegative. What would appropriate management include?
This rash is consistent with a perianal staph or strep infection. This bacterial infection is easily treated with
topical mupirocin. If the rash does not resolve after twoweeks of topical treatment, treatment with an oral
antibiotic such asKeflex isusually successful. Treatment with a topical steroid may worsen theinfection.
Tretinoin is a topical retinoid indicated to treat acne, and is not appropriate for this patient. Lotrisone is a
combination medication that includes an antifungal and a topical steroid, neither of which is indicated in this
patient.
You are evaluating an 80-year-old female for the first time. She has a history of mild Alzheimer's disease, for
which she takes Aricept. She states that she feels fine but her daughter feels she is depressed and has been
complaining of not feeling well. Her daughter admitsthat the patient hasa history of primary
hyperparathyroidism. What laboratory results would be most consistent with her diagnosis of
hyperparathyroidism?
, The hallmark of primary hyperparathyroidismis a high serumcalciumand high intact PTH. Alowintact PTH is
consistent with hypoparathyroidism. The urine serumcalciumis usually high in primary
hyperparathyroidism. Cortisol isrelated toendocrine conditions affecting the adrenal cortex.
A 65-year-old female presents with a red irritation in her right eye. She states that this has been occurring
intermittently for about two years. She also states that her eyelids are "droopy," and that she needs plastic
surgery. On physical examyou notice a diffusely injected conjunctiva and an outwardly tilted lower eyelid.
What isthe most likely diagnosis for the abnormal physical finding?
Ectropion
Ageing causes a relaxation of the obicularis oris muscle, and will cause the lower eyelid to sag outwardly. This
prevents the lower lid fromprotecting the eye, and frequently results in exposure conjunctivitis and keratitis.
Treatment is surgical.
A patient presents with epistaxis fromthe right nares, along with direct pressure to the nares and elevation of
the head. Which of the following is an appropriate initial treatment?
Phenylephrine is a topical decongestant, and acts as a vasoconstrictor to aid in stopping minor anterior
septal epistaxis. Triamcinolone andmomentasone are nasal steroids used for allergic rhinitis. Cromolyn
sodiumis a mast cell stabilizer, and azelastine is a topical H1 selective antihistamine, used for allergic
rhinitis.
Keflex
Cephalexin is a cephalosporin antibiotic used to treat certain infections caused by bacteria such as
pneumonia and bone, ear, skin, and urinary tract infections. Antibiotics will not work for colds, flu, or other
viral infections.
A 15-year-old obese male presents with annularlyconfigured lesions in a generalized distribution. They are
asymptomatic.What can these lesions be associated with?
Thispatient presentswith a generalized formof granuloma annulare(GA). Generalized GAcan be associated with
diabetes mellitus.
A 25 year old female presents with multiple irregular brown macules on her upper back. They are
asymptomatic. She has worked as a lifeguard for the past 7 years. She reports a couple of blistering sunburns
and admits to maintaining a "healthy tan". What is the most likely diagnosis?
Solar lentigines are a result of skin damage fromthe sun. Unlike ephiledes, they donot fade once exposure to
the sun has stopped. There is no risk of malignancy associated with solar lentigines.
Final Test Review
Qns & Ans
2025
A 26-year-old female presents with a whitish coating on her tongue and lips. When you attempt to rub the
plaque with a tongue depressor, a small amount of bleeding isnoted fromthe oral mucosa. Her past medical
history includes asthma. What diagnostic test would youperformto confirmyour diagnosis?
The history and physical are consistent with oral thrush. Awet mount potassiumhydroxide preparation will
reveal fungal spores and nonseptated mycelia. A culture and sensitivity is used for suspected bacterial
infections. Agramstain is used to identify whether a bacterial pathogen is grampositive or gram negative.
Which of the following is the third component of the atopic triad, besides allergic rhinitis and asthma?
Atopic dermatits, or eczema, is the third chronic finding, along with asthma and allergic rhinitis, in patients who
are atopic. Urticaria are common in acute and chronic allergies.
A 63-year-old male presents with an asymptomaticlesion in his mouth that was discovered by his dentist at a
check-up.It is ill marginated with pigment ranging frommediumbrown toblack.Parts of the lesion are raised.
What is the next appropriate stepin management?
Oropharyngeal melanoma is characterized by varying pigment occurringin an irregularly shaped lesion.
Although thisis a rarely occurringmelanoma, a biopsy should bedone and any pigmented oral lesionshould be
excised. Areaswhichareraised within thelesionusuallyindicate sitesof invasion.
What isthe appropriate first line treatment of lyme disease in a non-pregnant adult female with erythema
migrans and no other symptoms of lyme disease and no known drug allergies?
In patients over the age of 9 exhibiting skin or joint manifestations of lyme disease, the first line treatment is
Doxycycline 100 mg bid. Patients less than 9 or those who are allergic to Doxycycline should be treated with
amoxicillin. Erythromycin isfourth line treatment for all age groups. Ceftriaxone is first line for patientswith
nervous systeminvolvement. (Wolff & Johnson, pg 691)
,A two-year-old male presents with a noduleon the side of his index finger. His mother states that he has
hadthis nodule on one prior occurrence during infancy, and it resolved onits own. What is the most likely
diagnosis?
This child has a recurrent digital fibroma. It is a smooth, firm,pink nodule that occurs on the fingers and toes up
through earlychildhood. Surgical excision is recommended sothat the functionof the digit is not impaired.
A12-year-old male presentswith hyperkeratoticpapuleslocated on both hands. What is the causative
organism?
Thispatient has verruca vulgaris orthe common wart. The causative organismis the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There isa predilection
for the hands and fingers.
A12-year-old male presentswith hyperkeratoticpapuleslocated on both hands. What is the causative
organism?
Thispatient has verruca vulgaris orthe common wart. The causative organismis the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There isa predilection
for the hands and fingers.
A 60-year-old male presents with complaints of irritation and a white plaque on his tongue. He denies pain.
During physical exam you are unable to remove the white plaque from the mucosa with a tongue depressor.
What isthemost likely diagnosis, represented asfollows?
Oral leukoplakia cannot be removed fromthe mucosa using a tongue depressor like oral thrush can. Lichen
planus can mimic candidiasis, squamous cell carcinoma, or hyperkeratosis, and requires a biopsy to diagnose.
Glossitis is a generalized inflammation, and loss of papillae of the tongue is caused by vitamin deficiencies,
medication reactions, auto immune reactions, or psoriasis. Geographic tongue is an asymptomatic serpiginous
area of atrophy and erythema of the anterior tongue. The condition is self-limiting.
Digital Fibroma
Acanthosis nigricans
A 54 year old male presentswith dark thickened skin and soft pedunculated papulesaround hisneck. He states
that the lesions are asymptomatic. What disease process are the findings commonly associated with?
,The thick dark plaque around the patient's neck is acanthosisnigricans. The papulesare acrochordons (or skin
tags). Both conditions are associated with metabolic syndrome. (Wolff & Johnson, p231)
A45-year-old male presents with purulent discharge fromhis right ear for three weeks. He states that despite
being treated by his family doctor for an ear infection one month ago, the problemcontinues to get worse. Upon
exam, you note purulent discharge in the ear canal, an erythemic tympanic membrane, and a possible
perforation. What are thepathogensmost likely toculture positive?
he clinical vignette describes a chronic otitis media. Usually, this refers to a complication of acute otits media
with perforation. Pathogens that culture fromthese infections are usually pseudomonas, proteus, or
staphylococcus aureus. Strep pneumoniae is often seen in acute otitis media. E.coli is a urinary tract pathogen.
Candida albicans is a cause of vaginitis, and mycoplasma is a respiratory pathogen.
A six-month-old male has recurrent diaper rashes, which are not responding to ketoconazole cream or zinc
oxide diaper creams. Physical exam shows well demarcated perianal erythema, with scattered red papules on
the buttocks. AKOHisnegative. What would appropriate management include?
This rash is consistent with a perianal staph or strep infection. This bacterial infection is easily treated with
topical mupirocin. If the rash does not resolve after twoweeks of topical treatment, treatment with an oral
antibiotic such asKeflex isusually successful. Treatment with a topical steroid may worsen theinfection.
Tretinoin is a topical retinoid indicated to treat acne, and is not appropriate for this patient. Lotrisone is a
combination medication that includes an antifungal and a topical steroid, neither of which is indicated in this
patient.
You are evaluating an 80-year-old female for the first time. She has a history of mild Alzheimer's disease, for
which she takes Aricept. She states that she feels fine but her daughter feels she is depressed and has been
complaining of not feeling well. Her daughter admitsthat the patient hasa history of primary
hyperparathyroidism. What laboratory results would be most consistent with her diagnosis of
hyperparathyroidism?
, The hallmark of primary hyperparathyroidismis a high serumcalciumand high intact PTH. Alowintact PTH is
consistent with hypoparathyroidism. The urine serumcalciumis usually high in primary
hyperparathyroidism. Cortisol isrelated toendocrine conditions affecting the adrenal cortex.
A 65-year-old female presents with a red irritation in her right eye. She states that this has been occurring
intermittently for about two years. She also states that her eyelids are "droopy," and that she needs plastic
surgery. On physical examyou notice a diffusely injected conjunctiva and an outwardly tilted lower eyelid.
What isthe most likely diagnosis for the abnormal physical finding?
Ectropion
Ageing causes a relaxation of the obicularis oris muscle, and will cause the lower eyelid to sag outwardly. This
prevents the lower lid fromprotecting the eye, and frequently results in exposure conjunctivitis and keratitis.
Treatment is surgical.
A patient presents with epistaxis fromthe right nares, along with direct pressure to the nares and elevation of
the head. Which of the following is an appropriate initial treatment?
Phenylephrine is a topical decongestant, and acts as a vasoconstrictor to aid in stopping minor anterior
septal epistaxis. Triamcinolone andmomentasone are nasal steroids used for allergic rhinitis. Cromolyn
sodiumis a mast cell stabilizer, and azelastine is a topical H1 selective antihistamine, used for allergic
rhinitis.
Keflex
Cephalexin is a cephalosporin antibiotic used to treat certain infections caused by bacteria such as
pneumonia and bone, ear, skin, and urinary tract infections. Antibiotics will not work for colds, flu, or other
viral infections.
A 15-year-old obese male presents with annularlyconfigured lesions in a generalized distribution. They are
asymptomatic.What can these lesions be associated with?
Thispatient presentswith a generalized formof granuloma annulare(GA). Generalized GAcan be associated with
diabetes mellitus.
A 25 year old female presents with multiple irregular brown macules on her upper back. They are
asymptomatic. She has worked as a lifeguard for the past 7 years. She reports a couple of blistering sunburns
and admits to maintaining a "healthy tan". What is the most likely diagnosis?
Solar lentigines are a result of skin damage fromthe sun. Unlike ephiledes, they donot fade once exposure to
the sun has stopped. There is no risk of malignancy associated with solar lentigines.
