CMN 577 - Fall 2021 Final Exam
An 8-year boy presents to the clinic with 8 light-brown, oval macule lesions on his
skin. One of those lesion measures 1.6 cm. What is the child at risk for?
a. Normal finding
b. Neurofibromatosis
c. Melanoma
d. Tinea versicolor - CORRECT ANSWER-b. Neurofibromatosis
Rationale: Described above is Café au Lait Macule. If a patient has 6 or more or
larger than 1.5 cm the patient is at high risk for Neurofibromatosis.
Isotretinoin (Accutane) is commonly used for the treatment of severe cystic acne
that has not responded to standard treatment. Which of the following
considerations is not true for prescribing Isotretinoin?
a. Isotretinoin can be prescribed by any healthcare provider.
b. Isotretinoin is a category X drug and requires 2 forms of contraception, one of
which can be abstinence.
c. Before use of Isotretinoin, the patient must sign an informed consent and
become enrolled in a monitoring program called iPledge.
d. If a patient's acne relapses on Isotretinoin, then they may complete a second
round of the therapy. - CORRECT ANSWER-a. Isotretinoin can be prescribed by
any healthcare provider.
Rationale: Isotretinoin (Accutane) can only be prescribed by providers who are
registered with the iPledge program. Providers must be aware of all the potential
serious side effects and monitoring that is required for this treatment.
A 1-month-old female presents to your clinic with her mother for a well child
check. The mother reports a bright red, rubbery appearing bump that is located
on her daughter's neck. She says that it started out as a flat red area, but now it
has grown and is sticking out. This most likely represents which type of
birthmark:
,a. Mongolian spot
b. Port-wine stain
c. Hemangioma
d. Melanocytic nevi - CORRECT ANSWER-c. Hemangioma
Rationale: Hemangiomas are often present at birth as a blanched area on the
skin, then within a few weeks to a month starts to turn into a vascular, red,
rubbery nodule. Mongolian spots are usually found on the low back near the
pelvis and are a dark blue/black. Port-wine stains are a darker red and are flat.
Melanocytic nevi are a very dark brown and are flatter than hemangiomas.
You are seeing a 6-year-old male who was brought in by his mother. The mother
reports they recently took a family vacation last week and stayed in a few
different hotels. He developed significant itching and a rash the day of returning
home. He is noted to continuously scratch during the visit. The father and older
sister also have a similar rash that developed at the same time. On exam, you
note linear burrows around his wrists, ankles, in the webbing of his fingers, and
axillary folds with excoriations present. There is no facial involvement. He has
never had anything like this before. The most likely diagnosis would be:
a. Atopic Dermatitis
b. Impetigo
c. Molluscum Contagiosum
d. Scabies - CORRECT ANSWER-d. Scabies
Rationale: Scabies classically presents with linear burrows at the wrists, ankles,
webbing of fingers, areola, axillary folds, and genital area and typically does not
involve the face except in infants. Excoriations are also a common finding with
this. The history of recently travel and other family members with similar
presentation also supports scabies as the leading choice. All other choices are
commonly occurring rashes in pediatrics but have different presentations.
A 16-year-old female presents to clinic accompanied by her mother. She has a
rash that appears as erythematous plaques with thick, white, silvery overlying
scales on her elbows, knees, and umbilicus. She reports this has been going on
for about 2 years and tends to come and go. The mother reports her father has
psoriasis. The patient is not on any medications and she is not currently treating
,her rash with anything. She has tried various moisturizers in the past but has
never had a prescription to treat this. She weighs 130 pounds and has no
allergies. You diagnose her with psoriasis with body surface area involvement
less than 10%. Which is the best option as first line therapy?
a. Ketoconazole (Nizoral) 2% cream
b. Clobetasol (Temovate) 0.05% ointment
c. Over the counter hydrocortisone (Cortizone-10) 1% cream
d. Oral prednisone 40 mg x 3 days, 30 mg x 3 days, 20 mg x 3 days, 10 mg x 3
days - CORRECT ANSWER-b. Clobetasol (Temovate) 0.05% ointment
Rationale: Potent topical corticosteroids like clobetasol are first line treatment for
psoriasis. This is needed to penetrate through the plaques which occur because
of epidermal cell proliferation beyond normal turnover. Ketoconazole is not a
topical steroid. Hydrocortisone 1% is a topical steroid but is low potency.
Systemic steroids like prednisone can cause severe rebound in psoriasis and are
not appropriate.
A 3-year-old-boy presents to clinic with his mother with honey-colored crusted
sores around his mouth and nose. The mother states her son started attending
daycare a couple of weeks ago and noticed the sores starting to develop earlier
this week. Which highly contagious childhood illness do you suspect?
a. Impetigo
b. Varicella
c. Herpes Simplex
d. Molluscum contagiosum - CORRECT ANSWER-a. Impetigo
Rationale: Macules, vesicles, pustules, that are often honey-colored and crust
over are the tell-tale sign of
impetigo. This highly contagious infection is caused by staphylococcus and
streptococci and is common in infants and children as it is spread by skin-to-skin
contact.
Blepharitis that occurs in children has a strong correlation with which disease?
a. Rosacea
, b. Eczema
c. Psoriasis
d. Pityriasis rosea - CORRECT ANSWER-a. Rosacea
Rationale: Blepharitis is an inflammatory condition that effects the eyelids, usually
caused by an overgrowth of bacteria, specifically staphylococci. Meibomian
glandular dysfunction is another cause of blepharitis,
which is strongly correlated with rosacea. Symptoms of blepharitis include
redness, tearing, photophobia,
and a foreign body sensation that feels dry and gritty. Treatment usually consists
of good eyelid hygiene
and washing the eyelids with baby shampoo.
A child with Sturge-Weber Syndrome (SWS) will most likely have what finding on
the physical exam?
a. Port wine nevus on the face
b. Mongolian spot
c. Allergic shiners
d. Retractions - CORRECT ANSWER-a. Port wine nevus on the face
Rationale: Port wine nevus on the face is correct and usually a feature of SWS.
Mongolian spot is incorrect and is a benign darkening of the skin (most often on
the buttocks) found in Asian and African descent infants. This is not associated
with SWS. Allergic shiners are dark areas under the eyes usually seen with
allergic rhinitis.
Retractions is incorrect as this indicates an acute respiratory issue.
What skin disorder is seen with short hyphae and yeast on microscopic
examination of scales?
a. Tinea Versicolor
b. Pityriasis Rosea
c. Psoriasis
d. Atopic Dermatitis - CORRECT ANSWER-a. Tinea Versicolor
An 8-year boy presents to the clinic with 8 light-brown, oval macule lesions on his
skin. One of those lesion measures 1.6 cm. What is the child at risk for?
a. Normal finding
b. Neurofibromatosis
c. Melanoma
d. Tinea versicolor - CORRECT ANSWER-b. Neurofibromatosis
Rationale: Described above is Café au Lait Macule. If a patient has 6 or more or
larger than 1.5 cm the patient is at high risk for Neurofibromatosis.
Isotretinoin (Accutane) is commonly used for the treatment of severe cystic acne
that has not responded to standard treatment. Which of the following
considerations is not true for prescribing Isotretinoin?
a. Isotretinoin can be prescribed by any healthcare provider.
b. Isotretinoin is a category X drug and requires 2 forms of contraception, one of
which can be abstinence.
c. Before use of Isotretinoin, the patient must sign an informed consent and
become enrolled in a monitoring program called iPledge.
d. If a patient's acne relapses on Isotretinoin, then they may complete a second
round of the therapy. - CORRECT ANSWER-a. Isotretinoin can be prescribed by
any healthcare provider.
Rationale: Isotretinoin (Accutane) can only be prescribed by providers who are
registered with the iPledge program. Providers must be aware of all the potential
serious side effects and monitoring that is required for this treatment.
A 1-month-old female presents to your clinic with her mother for a well child
check. The mother reports a bright red, rubbery appearing bump that is located
on her daughter's neck. She says that it started out as a flat red area, but now it
has grown and is sticking out. This most likely represents which type of
birthmark:
,a. Mongolian spot
b. Port-wine stain
c. Hemangioma
d. Melanocytic nevi - CORRECT ANSWER-c. Hemangioma
Rationale: Hemangiomas are often present at birth as a blanched area on the
skin, then within a few weeks to a month starts to turn into a vascular, red,
rubbery nodule. Mongolian spots are usually found on the low back near the
pelvis and are a dark blue/black. Port-wine stains are a darker red and are flat.
Melanocytic nevi are a very dark brown and are flatter than hemangiomas.
You are seeing a 6-year-old male who was brought in by his mother. The mother
reports they recently took a family vacation last week and stayed in a few
different hotels. He developed significant itching and a rash the day of returning
home. He is noted to continuously scratch during the visit. The father and older
sister also have a similar rash that developed at the same time. On exam, you
note linear burrows around his wrists, ankles, in the webbing of his fingers, and
axillary folds with excoriations present. There is no facial involvement. He has
never had anything like this before. The most likely diagnosis would be:
a. Atopic Dermatitis
b. Impetigo
c. Molluscum Contagiosum
d. Scabies - CORRECT ANSWER-d. Scabies
Rationale: Scabies classically presents with linear burrows at the wrists, ankles,
webbing of fingers, areola, axillary folds, and genital area and typically does not
involve the face except in infants. Excoriations are also a common finding with
this. The history of recently travel and other family members with similar
presentation also supports scabies as the leading choice. All other choices are
commonly occurring rashes in pediatrics but have different presentations.
A 16-year-old female presents to clinic accompanied by her mother. She has a
rash that appears as erythematous plaques with thick, white, silvery overlying
scales on her elbows, knees, and umbilicus. She reports this has been going on
for about 2 years and tends to come and go. The mother reports her father has
psoriasis. The patient is not on any medications and she is not currently treating
,her rash with anything. She has tried various moisturizers in the past but has
never had a prescription to treat this. She weighs 130 pounds and has no
allergies. You diagnose her with psoriasis with body surface area involvement
less than 10%. Which is the best option as first line therapy?
a. Ketoconazole (Nizoral) 2% cream
b. Clobetasol (Temovate) 0.05% ointment
c. Over the counter hydrocortisone (Cortizone-10) 1% cream
d. Oral prednisone 40 mg x 3 days, 30 mg x 3 days, 20 mg x 3 days, 10 mg x 3
days - CORRECT ANSWER-b. Clobetasol (Temovate) 0.05% ointment
Rationale: Potent topical corticosteroids like clobetasol are first line treatment for
psoriasis. This is needed to penetrate through the plaques which occur because
of epidermal cell proliferation beyond normal turnover. Ketoconazole is not a
topical steroid. Hydrocortisone 1% is a topical steroid but is low potency.
Systemic steroids like prednisone can cause severe rebound in psoriasis and are
not appropriate.
A 3-year-old-boy presents to clinic with his mother with honey-colored crusted
sores around his mouth and nose. The mother states her son started attending
daycare a couple of weeks ago and noticed the sores starting to develop earlier
this week. Which highly contagious childhood illness do you suspect?
a. Impetigo
b. Varicella
c. Herpes Simplex
d. Molluscum contagiosum - CORRECT ANSWER-a. Impetigo
Rationale: Macules, vesicles, pustules, that are often honey-colored and crust
over are the tell-tale sign of
impetigo. This highly contagious infection is caused by staphylococcus and
streptococci and is common in infants and children as it is spread by skin-to-skin
contact.
Blepharitis that occurs in children has a strong correlation with which disease?
a. Rosacea
, b. Eczema
c. Psoriasis
d. Pityriasis rosea - CORRECT ANSWER-a. Rosacea
Rationale: Blepharitis is an inflammatory condition that effects the eyelids, usually
caused by an overgrowth of bacteria, specifically staphylococci. Meibomian
glandular dysfunction is another cause of blepharitis,
which is strongly correlated with rosacea. Symptoms of blepharitis include
redness, tearing, photophobia,
and a foreign body sensation that feels dry and gritty. Treatment usually consists
of good eyelid hygiene
and washing the eyelids with baby shampoo.
A child with Sturge-Weber Syndrome (SWS) will most likely have what finding on
the physical exam?
a. Port wine nevus on the face
b. Mongolian spot
c. Allergic shiners
d. Retractions - CORRECT ANSWER-a. Port wine nevus on the face
Rationale: Port wine nevus on the face is correct and usually a feature of SWS.
Mongolian spot is incorrect and is a benign darkening of the skin (most often on
the buttocks) found in Asian and African descent infants. This is not associated
with SWS. Allergic shiners are dark areas under the eyes usually seen with
allergic rhinitis.
Retractions is incorrect as this indicates an acute respiratory issue.
What skin disorder is seen with short hyphae and yeast on microscopic
examination of scales?
a. Tinea Versicolor
b. Pityriasis Rosea
c. Psoriasis
d. Atopic Dermatitis - CORRECT ANSWER-a. Tinea Versicolor
