ROSH REVIEW Dermatology UPDATED ACTUAL Questions and CORRECT
Answers
1. An 18-year-old man pain with swallowing
is diagnosed with
condyloma acumina-
tum in the genital
area. Which of the fol-
lowing physical exam
findings is most con-
sistent with this diag-
nosis?
Flesh-colored, exo-
phytic lesions
Painless ulceration
Shallow, painful ulcer-
ations
Umbilicated,
dome-shaped lesions
2. One Step Further
Question: Where are
the most commonly
involved sites of HPV
infection in men?
3. A 54-year-old woman
presents to the ED
with a painful rash.
She experienced se-
vere mouth sores and
, :
C
Condyloma acuminata, commonly known as genital warts, can appear
o
as flesh-colored, exophytic lesions or can appear as small bumps that
r
are flat, pedunculated, verrucous, or papilliform. Condyloma acuminatum
r
is caused by an infection with the human papillomavirus (HPV) types 6
e
and 11. It is a sexually transmitted infection that can be prevented with
c
vaccination. All girls and boys who are 11 or 12 years old should get
t
the recommended series of HPV vaccine regardless of sexual history.
HPV is strongly associated with the development of genitourinary and
A
rectal cancer. The infection can affect the vagina, cervix, vulva, oropharynx,
n
perineum, and perianal areas. Treatment includes trichloroacetic acid
s
solution, podophyllin, cryosurgery, surgical excision, or imiquimod cream
w
application.
e
r
(
A
Answer: The penis and scrotum.
)
E
x
p
l Correct Answer ( B )
a Explanation:
n This patient is exhibiting symptoms and physical exam findings consistent
a with pemphigus vulgaris. Pemphigus vulgaris is a potentially life-threat-
t ening autoimmune mucocutaneous intraepithelial bullous disease. It has
i a higher prevalence in Jewish and Mediterranean populations. It is often
o
n
, for the past week and associated with myasthenia gravis and thymoma. Pemphigus vulgaris is
then developed this caused by IgG autoantibodies against keratinocytes and their desmo-
rash. Physical exam issomes that causes acantholysis, or loss of cell-to-cell adhesion. Signs
shown above. Nikol- and symptoms include early mucous membrane lesions preceding skin
sky sign is positive. lesions, most commonly oral and esophageal involvement leading to
Which of the follow- dysphagia, hoarse voice, and dehydration, and the classic bullous rash.
ing conditions is com-The bullae are painful, flaccid, and easily rupture. Patients have a positive
monly associated with Nikolsky sign as well as a positive Asboe-Hansen sign, where gentle lateral
this disease process? pressure on the bullae spreads the fluid into neighboring unaffected
skin. Diagnosis is by skin biopsy to differentiate pemphigus vulgaris
Idiopathic thrombocy- from Stevens-Johnson syndrome or bullous pemphigoid. Treatment is
topenic purpura with steroids and immunomodulators such as azathioprine, cyclosporine,
Myasthenia gravis or methotrexate. These patients should be admitted as there is a high
Sarcoidosis mortality rate without treatment. Mortality even with treatment remains as
Wegener's granulo- high as 5-15%.
matosis
4. 24-year-old man pre- Correct Answer ( A )
sents for evaluation Explanation:
of a rash. The pa- This patient has pityriasis rosea. This is a mild skin eruption that is self-lim-
tient reports a mild- ited usually lasting 4 to 7 weeks. There is no clear etiology of the rash
ly pruritic rash on his although infection with Herpesvirus 7 or a fungus is suspected. Prior to
back and trunk that the onset of the diffuse rash, patients may recall a herald patch described
progressively spread as a 2 to 5 cm erythematous oval plaque similar to the smaller more diffuse
over the last week. lesions. The rash is described as following a "Christmas tree" pattern on
You examine and note the trunk, classically following the skin cleavage lines. There is no indicated
the rash seen above. treatment for pityriasis rosea other than antihistamines for symptomatic
, Which of the following relief if the rash is pruritic.
historical elements is
most likely to be ob- A history of travel to the Southeast USA (D) before the onset of rash should
tained upon further raise an index of suspicion for an infectious etiology to the rash like Rocky
questioning? Mountain Spotted fever, a tick-borne illness caused by Rickettsia rickettsii.
This illness occurs most commonly in late spring and early summer and is
A larger 2 to 5 cm characterized by a rash that starts distally and spreads to the core.
erythematous patch
preceded the diffuse
rash
Fever preceded the
onset of rash
Oral mucosal lesions
preceded the onset of
rash
Travel to the South-
east USA occurred a
week before the rash
5. One Step Further Answer: No, the rash cannot be spread by direct contact.
Question: Is the rash
of pityriasis rosea con-
tagious?
6. A 55-year-old man Correct Answer ( B )
presents with right Explanation:
sided chest pain and a This patient presents with herpes zoster (shingles) and should have ap-
rash for 4 days as seen propriate pain control started. Herpes zoster results from the reactivation
above. What manage- of dormant variclla zoster virus developing in patients with a history of
ment should be initiat- chickenpox. Typically, pain in a dermatomal distribution precedes the
ed? eruption of grouped vesicles on an erythematous base in the same der-
matome. The vesicles are cloudy at first and progress to crust formation
Answers
1. An 18-year-old man pain with swallowing
is diagnosed with
condyloma acumina-
tum in the genital
area. Which of the fol-
lowing physical exam
findings is most con-
sistent with this diag-
nosis?
Flesh-colored, exo-
phytic lesions
Painless ulceration
Shallow, painful ulcer-
ations
Umbilicated,
dome-shaped lesions
2. One Step Further
Question: Where are
the most commonly
involved sites of HPV
infection in men?
3. A 54-year-old woman
presents to the ED
with a painful rash.
She experienced se-
vere mouth sores and
, :
C
Condyloma acuminata, commonly known as genital warts, can appear
o
as flesh-colored, exophytic lesions or can appear as small bumps that
r
are flat, pedunculated, verrucous, or papilliform. Condyloma acuminatum
r
is caused by an infection with the human papillomavirus (HPV) types 6
e
and 11. It is a sexually transmitted infection that can be prevented with
c
vaccination. All girls and boys who are 11 or 12 years old should get
t
the recommended series of HPV vaccine regardless of sexual history.
HPV is strongly associated with the development of genitourinary and
A
rectal cancer. The infection can affect the vagina, cervix, vulva, oropharynx,
n
perineum, and perianal areas. Treatment includes trichloroacetic acid
s
solution, podophyllin, cryosurgery, surgical excision, or imiquimod cream
w
application.
e
r
(
A
Answer: The penis and scrotum.
)
E
x
p
l Correct Answer ( B )
a Explanation:
n This patient is exhibiting symptoms and physical exam findings consistent
a with pemphigus vulgaris. Pemphigus vulgaris is a potentially life-threat-
t ening autoimmune mucocutaneous intraepithelial bullous disease. It has
i a higher prevalence in Jewish and Mediterranean populations. It is often
o
n
, for the past week and associated with myasthenia gravis and thymoma. Pemphigus vulgaris is
then developed this caused by IgG autoantibodies against keratinocytes and their desmo-
rash. Physical exam issomes that causes acantholysis, or loss of cell-to-cell adhesion. Signs
shown above. Nikol- and symptoms include early mucous membrane lesions preceding skin
sky sign is positive. lesions, most commonly oral and esophageal involvement leading to
Which of the follow- dysphagia, hoarse voice, and dehydration, and the classic bullous rash.
ing conditions is com-The bullae are painful, flaccid, and easily rupture. Patients have a positive
monly associated with Nikolsky sign as well as a positive Asboe-Hansen sign, where gentle lateral
this disease process? pressure on the bullae spreads the fluid into neighboring unaffected
skin. Diagnosis is by skin biopsy to differentiate pemphigus vulgaris
Idiopathic thrombocy- from Stevens-Johnson syndrome or bullous pemphigoid. Treatment is
topenic purpura with steroids and immunomodulators such as azathioprine, cyclosporine,
Myasthenia gravis or methotrexate. These patients should be admitted as there is a high
Sarcoidosis mortality rate without treatment. Mortality even with treatment remains as
Wegener's granulo- high as 5-15%.
matosis
4. 24-year-old man pre- Correct Answer ( A )
sents for evaluation Explanation:
of a rash. The pa- This patient has pityriasis rosea. This is a mild skin eruption that is self-lim-
tient reports a mild- ited usually lasting 4 to 7 weeks. There is no clear etiology of the rash
ly pruritic rash on his although infection with Herpesvirus 7 or a fungus is suspected. Prior to
back and trunk that the onset of the diffuse rash, patients may recall a herald patch described
progressively spread as a 2 to 5 cm erythematous oval plaque similar to the smaller more diffuse
over the last week. lesions. The rash is described as following a "Christmas tree" pattern on
You examine and note the trunk, classically following the skin cleavage lines. There is no indicated
the rash seen above. treatment for pityriasis rosea other than antihistamines for symptomatic
, Which of the following relief if the rash is pruritic.
historical elements is
most likely to be ob- A history of travel to the Southeast USA (D) before the onset of rash should
tained upon further raise an index of suspicion for an infectious etiology to the rash like Rocky
questioning? Mountain Spotted fever, a tick-borne illness caused by Rickettsia rickettsii.
This illness occurs most commonly in late spring and early summer and is
A larger 2 to 5 cm characterized by a rash that starts distally and spreads to the core.
erythematous patch
preceded the diffuse
rash
Fever preceded the
onset of rash
Oral mucosal lesions
preceded the onset of
rash
Travel to the South-
east USA occurred a
week before the rash
5. One Step Further Answer: No, the rash cannot be spread by direct contact.
Question: Is the rash
of pityriasis rosea con-
tagious?
6. A 55-year-old man Correct Answer ( B )
presents with right Explanation:
sided chest pain and a This patient presents with herpes zoster (shingles) and should have ap-
rash for 4 days as seen propriate pain control started. Herpes zoster results from the reactivation
above. What manage- of dormant variclla zoster virus developing in patients with a history of
ment should be initiat- chickenpox. Typically, pain in a dermatomal distribution precedes the
ed? eruption of grouped vesicles on an erythematous base in the same der-
matome. The vesicles are cloudy at first and progress to crust formation
