Pance Final Exam Dermatology And Heent Questions & Answers
A 34-year-old woman presents to the clinic with complaints of intermittent flushing and blushing that
started 3 to 4 weeks ago. Since then, she has noticed several inflammatory papules on the cheeks, nose, and
chin. Upon exam, you notice an overall rosy hue to the face and the absence of any comedones. Which of the
following would be the best course of topical therapy at this time?
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in
this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin
is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has
not been shown to be effective for rosacea.
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 is noted from the oral mucosa. Her past medical
history includes asthma. What diagnostic test would you perform to confirm your diagnosis?
The history and physical are consistent with oral thrush. A wet mount potassium hydroxide preparation will
reveal fungal spores and nonseptated mycelia. A culture and sensitivity is used for suspected bacterial
infections. A gram stain is used to identify whether a bacterial pathogen is gram positive 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 from medium brown to black.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 this is a rarely occurringmelanoma, a biopsy should be done and any pigmented oral lesionshould
be excised. Areas which are raised within the lesion usuallyindicate sites of invasion.
What is the 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
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
,amoxicillin. Erythromycin is fourth line treatment for all age groups. Ceftriaxone is first line for patients with
nervous system involvement. (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 so that the functionof the digit is not impaired.
A 12-year-old male presents with hyperkeratoticpapules located on both hands. What is the causative
organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There is a
predilection for the hands and fingers.
A 12-year-old male presents with hyperkeratoticpapules located on both hands. What is the causative
organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There is a
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 is the most likely diagnosis, represented as follows?
Oral leukoplakia cannot be removed from the 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
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
,A 54 year old male presents with dark thickened skin and soft pedunculated papules around his neck. 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 acanthosis nigricans. The papules are acrochordons (or
skin tags). Both conditions are associated with metabolic syndrome. (Wolff & Johnson, p231)
A 45-year-old male presents with purulent discharge from his right ear for three weeks. He states that
despite being treated by his family doctor for an ear infection one month ago, the problem continues to get
worse. Upon exam, you note purulent discharge in the ear canal, an erythemic tympanic membrane, and a
possible perforation. What are the pathogens most likely to culture positive?
he clinical vignette describes a chronic otitis media. Usually, this refers to a complication of acute otits
media with perforation. Pathogens that culture from these 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. A KOH is negative. 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 two weeks of topical treatment, treatment with an oral
antibiotic such as Keflex is usually successful. Treatment with a topical steroid may worsen the infection.
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 admits that the patient has a history of primary
hyperparathyroidism. What laboratory results would be most consistent with her diagnosis of
hyperparathyroidism?
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
, The hallmark of primary hyperparathyroidism is a high serum calcium and high intact PTH. A low intact PTH
is consistent with hypoparathyroidism. The urine serum calcium is usually high in primary
hyperparathyroidism. Cortisol is related to endocrine 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 exam you notice a diffusely injected conjunctiva and an outwardly tilted lower eyelid.
What is the 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 from protecting the eye, and frequently results in exposure conjunctivitis and
keratitis. Treatment is surgical.
A patient presents with epistaxis from the 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 and momentasone are nasal steroids used for allergic rhinitis. Cromolyn
sodium is 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?
This patient presents with a generalized form of granuloma annulare(GA). Generalized GA can 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 from the sun. Unlike ephiledes, they do not fade once exposure
to the sun has stopped. There is no risk of malignancy associated with solar lentigines.
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
A 34-year-old woman presents to the clinic with complaints of intermittent flushing and blushing that
started 3 to 4 weeks ago. Since then, she has noticed several inflammatory papules on the cheeks, nose, and
chin. Upon exam, you notice an overall rosy hue to the face and the absence of any comedones. Which of the
following would be the best course of topical therapy at this time?
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in
this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin
is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has
not been shown to be effective for rosacea.
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 is noted from the oral mucosa. Her past medical
history includes asthma. What diagnostic test would you perform to confirm your diagnosis?
The history and physical are consistent with oral thrush. A wet mount potassium hydroxide preparation will
reveal fungal spores and nonseptated mycelia. A culture and sensitivity is used for suspected bacterial
infections. A gram stain is used to identify whether a bacterial pathogen is gram positive 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 from medium brown to black.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 this is a rarely occurringmelanoma, a biopsy should be done and any pigmented oral lesionshould
be excised. Areas which are raised within the lesion usuallyindicate sites of invasion.
What is the 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
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
,amoxicillin. Erythromycin is fourth line treatment for all age groups. Ceftriaxone is first line for patients with
nervous system involvement. (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 so that the functionof the digit is not impaired.
A 12-year-old male presents with hyperkeratoticpapules located on both hands. What is the causative
organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There is a
predilection for the hands and fingers.
A 12-year-old male presents with hyperkeratoticpapules located on both hands. What is the causative
organism?
This patient has verruca vulgaris orthe common wart. The causative organism is the human
papillomavirus(HPV). They can affect patients of any age and can occur on anyskin surface. There is a
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 is the most likely diagnosis, represented as follows?
Oral leukoplakia cannot be removed from the 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
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
,A 54 year old male presents with dark thickened skin and soft pedunculated papules around his neck. 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 acanthosis nigricans. The papules are acrochordons (or
skin tags). Both conditions are associated with metabolic syndrome. (Wolff & Johnson, p231)
A 45-year-old male presents with purulent discharge from his right ear for three weeks. He states that
despite being treated by his family doctor for an ear infection one month ago, the problem continues to get
worse. Upon exam, you note purulent discharge in the ear canal, an erythemic tympanic membrane, and a
possible perforation. What are the pathogens most likely to culture positive?
he clinical vignette describes a chronic otitis media. Usually, this refers to a complication of acute otits
media with perforation. Pathogens that culture from these 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. A KOH is negative. 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 two weeks of topical treatment, treatment with an oral
antibiotic such as Keflex is usually successful. Treatment with a topical steroid may worsen the infection.
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 admits that the patient has a history of primary
hyperparathyroidism. What laboratory results would be most consistent with her diagnosis of
hyperparathyroidism?
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
, The hallmark of primary hyperparathyroidism is a high serum calcium and high intact PTH. A low intact PTH
is consistent with hypoparathyroidism. The urine serum calcium is usually high in primary
hyperparathyroidism. Cortisol is related to endocrine 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 exam you notice a diffusely injected conjunctiva and an outwardly tilted lower eyelid.
What is the 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 from protecting the eye, and frequently results in exposure conjunctivitis and
keratitis. Treatment is surgical.
A patient presents with epistaxis from the 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 and momentasone are nasal steroids used for allergic rhinitis. Cromolyn
sodium is 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?
This patient presents with a generalized form of granuloma annulare(GA). Generalized GA can 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 from the sun. Unlike ephiledes, they do not fade once exposure
to the sun has stopped. There is no risk of malignancy associated with solar lentigines.
metronidazole gel
Metronidazole is the topical treatment of choice for rosacea, which is consistent with the clinical findings in this 34-year-old female patient. Mupirocin ointment is a treatment option for impetigo, whereas permethrin is indicated for scabies. Tretinoin is effective and is indicated for comedonal acne. Topical hydrocortisone has____________________@.......................................................#
