IHUMAN CASE STUDY WEEK #2 14-YEAR-OLD
PATIENT WITH FACIAL BUMPS STUDY GUIDE
2026 – COMPLETE CONCEPT REVIEW &
PRACTICE MATERIALS (LATEST EDITION)
iHuman Case Study: 14-Year-Old Patient with Facial Bumps
Concept Review & Practice MCQs
Topic Overview: This case focuses on a common adolescent presentation—acne vulgaris. Key
concepts include pathophysiology (hormonal influence on pilosebaceous units, C. acnes role),
diagnosis (grading, lesion types), differential diagnosis (rosacea, folliculitis, etc.), treatment
(topical retinoids, antibiotics, benzoyl peroxide, hormonal therapy), and patient-centered
communication/education.
Question 1: Pathophysiology & Diagnosis
A 14-year-old patient presents with comedones, inflammatory papules, and pustules primarily
on the forehead, cheeks, and chin. This distribution is most directly attributed to the increased
density and activity of which of the following?
• A. Eccrine sweat glands
• B. Apocrine sweat glands
• C. Pilosebaceous units
• D. Sebaceous glands alone
Answer Options:
• A. Eccrine sweat glands – Incorrect. Eccrine glands are widespread and involved in
thermoregulation, not primarily in acne pathogenesis.
• B. Apocrine sweat glands – Incorrect. These are found in axillary and anogenital regions
and become active at puberty, but are associated with body odor, not facial acne.
• C. Pilosebaceous units – CORRECT. Acne vulgaris is a disorder of the
pilosebaceous unit, which consists of a hair follicle and its associated sebaceous gland.
, The face, chest, and back have a high density of these units, and they become highly
responsive to androgens during adolescence.
• D. Sebaceous glands alone – Incorrect. While sebaceous gland hyperplasia and
increased sebum production are key factors, the pathology involves the entire follicular
unit, including abnormal keratinization and inflammation.
Question 2: First-Line Topical Therapy
For a patient with mild to moderate mixed comedonal and inflammatory acne, what is the most
appropriate first-line single topical agent that addresses multiple pathogenic factors?
• A. Clindamycin 1% gel
• B. Benzoyl peroxide 5% wash
• C. Tretinoin 0.025% cream
• D. Salicylic acid 2% cleanser
Answer Options:
• A. Clindamycin 1% gel – Incorrect. This is an antibiotic effective against C. acnes and
reduces inflammation, but it does not treat comedones and risks bacterial resistance if
used alone.
• B. Benzoyl peroxide 5% wash – Incorrect. It is antimicrobial and anti-inflammatory, but
as a wash with short contact time, it is less effective for comedolysis than leave-on
products. Often used in combination therapy.
• C. Tretinoin 0.025% cream – CORRECT. A topical retinoid is the first-line
cornerstone therapy for acne. It normalizes follicular keratinization, reduces
microcomedone formation (treating and preventing comedones), and has some anti-
inflammatory properties.
• D. Salicylic acid 2% cleanser – Incorrect. It is a mild comedolytic available over-the-
counter, but its efficacy is generally inferior to topical retinoids for prescription
management.
Question 3: Counseling & Medication Safety
,When prescribing oral doxycycline for moderate inflammatory acne, what is the MOST critical
counseling point to prevent a serious adverse effect?
• A. "Take this medication with a full glass of water and remain upright for 30 minutes."
• B. "You must use a reliable form of contraception while on this medication."
• C. "This medication will make your skin very sensitive to the sun; you must use
sunscreen daily."
• D. "Do not take this with dairy products or antacids, as they will reduce its absorption."
Answer Options:
• A. "Take this medication with a full glass of water and remain upright for 30
minutes." – CORRECT. This is the most critical point to prevent pill-induced
esophagitis and ulceration, a serious and specific adverse effect of tetracycline-class
antibiotics like doxycycline. While other points are important, this addresses a serious
safety risk.
• B. "You must use a reliable form of contraception while on this medication." –
Incorrect. This is crucial for isotretinoin (Accutane), not doxycycline. Doxycycline is not a
proven teratogen like isotretinoin.
• C. "This medication will make your skin very sensitive to the sun..." – Incorrect. This is
an important point (photosensitivity) but is generally not as immediately serious as
esophageal injury.
• D. "Do not take this with dairy products..." – Incorrect. This is true for tetracycline, but
doxycycline absorption is not significantly impaired by dairy. This is a common distractor
testing precise drug knowledge.
Question 4: Differential Diagnosis
The patient reports that the "bumps" are persistently red and are triggered by hot drinks, spicy
food, and emotional stress. Physical exam shows erythema, telangiectasias, and papules but no
comedones. This presentation is most consistent with:
• A. Acne vulgaris
• B. Rosacea
• C. Bacterial folliculitis
, • D. Keratosis pilaris
Answer Options:
• A. Acne vulgaris – Incorrect. Acne typically features comedones and is not
characteristically triggered by the specific factors mentioned. Telangiectasias are also not
a hallmark.
• B. Rosacea – CORRECT. This classic description fits rosacea: triggered by
heat/spicy foods/stress, persistent central facial erythema, telangiectasias, and
papules/pustules without comedones. It can occur in adolescents.
• C. Bacterial folliculitis – Incorrect. Presents as pustules centered on hair follicles, often
itchy or tender, but lacks the persistent background erythema, telangiectasias, and
specific triggers of rosacea.
• D. Keratosis pilaris – Incorrect. Presents as rough, gooseflesh-like papules on cheeks,
upper arms, and thighs. It is not inflammatory, triggered by specific factors, nor
associated with telangiectasias.
Question 5: Hormonal Therapy Consideration
For a female patient with acne that is severe, refractory to standard therapy, and shows a
premenstrual flare, which of the following treatments works primarily by suppressing ovarian
androgen production?
• A. Spironolactone
• B. Combined oral contraceptive pills (OCPs)
• C. Oral prednisone
• D. Isotretinoin
Answer Options:
• A. Spironolactone – Incorrect. It is an anti-androgen that works primarily by blocking
androgen receptors at the pilosebaceous unit and inhibiting adrenal androgen
production, not primarily ovarian suppression.
• B. Combined oral contraceptive pills (OCPs) – CORRECT. Combined OCPs
suppress ovarian androgen production by inhibiting ovulation and reducing LH-driven
theca cell androgen synthesis. They also increase sex hormone-binding globulin (SHBG),
reducing free testosterone.
PATIENT WITH FACIAL BUMPS STUDY GUIDE
2026 – COMPLETE CONCEPT REVIEW &
PRACTICE MATERIALS (LATEST EDITION)
iHuman Case Study: 14-Year-Old Patient with Facial Bumps
Concept Review & Practice MCQs
Topic Overview: This case focuses on a common adolescent presentation—acne vulgaris. Key
concepts include pathophysiology (hormonal influence on pilosebaceous units, C. acnes role),
diagnosis (grading, lesion types), differential diagnosis (rosacea, folliculitis, etc.), treatment
(topical retinoids, antibiotics, benzoyl peroxide, hormonal therapy), and patient-centered
communication/education.
Question 1: Pathophysiology & Diagnosis
A 14-year-old patient presents with comedones, inflammatory papules, and pustules primarily
on the forehead, cheeks, and chin. This distribution is most directly attributed to the increased
density and activity of which of the following?
• A. Eccrine sweat glands
• B. Apocrine sweat glands
• C. Pilosebaceous units
• D. Sebaceous glands alone
Answer Options:
• A. Eccrine sweat glands – Incorrect. Eccrine glands are widespread and involved in
thermoregulation, not primarily in acne pathogenesis.
• B. Apocrine sweat glands – Incorrect. These are found in axillary and anogenital regions
and become active at puberty, but are associated with body odor, not facial acne.
• C. Pilosebaceous units – CORRECT. Acne vulgaris is a disorder of the
pilosebaceous unit, which consists of a hair follicle and its associated sebaceous gland.
, The face, chest, and back have a high density of these units, and they become highly
responsive to androgens during adolescence.
• D. Sebaceous glands alone – Incorrect. While sebaceous gland hyperplasia and
increased sebum production are key factors, the pathology involves the entire follicular
unit, including abnormal keratinization and inflammation.
Question 2: First-Line Topical Therapy
For a patient with mild to moderate mixed comedonal and inflammatory acne, what is the most
appropriate first-line single topical agent that addresses multiple pathogenic factors?
• A. Clindamycin 1% gel
• B. Benzoyl peroxide 5% wash
• C. Tretinoin 0.025% cream
• D. Salicylic acid 2% cleanser
Answer Options:
• A. Clindamycin 1% gel – Incorrect. This is an antibiotic effective against C. acnes and
reduces inflammation, but it does not treat comedones and risks bacterial resistance if
used alone.
• B. Benzoyl peroxide 5% wash – Incorrect. It is antimicrobial and anti-inflammatory, but
as a wash with short contact time, it is less effective for comedolysis than leave-on
products. Often used in combination therapy.
• C. Tretinoin 0.025% cream – CORRECT. A topical retinoid is the first-line
cornerstone therapy for acne. It normalizes follicular keratinization, reduces
microcomedone formation (treating and preventing comedones), and has some anti-
inflammatory properties.
• D. Salicylic acid 2% cleanser – Incorrect. It is a mild comedolytic available over-the-
counter, but its efficacy is generally inferior to topical retinoids for prescription
management.
Question 3: Counseling & Medication Safety
,When prescribing oral doxycycline for moderate inflammatory acne, what is the MOST critical
counseling point to prevent a serious adverse effect?
• A. "Take this medication with a full glass of water and remain upright for 30 minutes."
• B. "You must use a reliable form of contraception while on this medication."
• C. "This medication will make your skin very sensitive to the sun; you must use
sunscreen daily."
• D. "Do not take this with dairy products or antacids, as they will reduce its absorption."
Answer Options:
• A. "Take this medication with a full glass of water and remain upright for 30
minutes." – CORRECT. This is the most critical point to prevent pill-induced
esophagitis and ulceration, a serious and specific adverse effect of tetracycline-class
antibiotics like doxycycline. While other points are important, this addresses a serious
safety risk.
• B. "You must use a reliable form of contraception while on this medication." –
Incorrect. This is crucial for isotretinoin (Accutane), not doxycycline. Doxycycline is not a
proven teratogen like isotretinoin.
• C. "This medication will make your skin very sensitive to the sun..." – Incorrect. This is
an important point (photosensitivity) but is generally not as immediately serious as
esophageal injury.
• D. "Do not take this with dairy products..." – Incorrect. This is true for tetracycline, but
doxycycline absorption is not significantly impaired by dairy. This is a common distractor
testing precise drug knowledge.
Question 4: Differential Diagnosis
The patient reports that the "bumps" are persistently red and are triggered by hot drinks, spicy
food, and emotional stress. Physical exam shows erythema, telangiectasias, and papules but no
comedones. This presentation is most consistent with:
• A. Acne vulgaris
• B. Rosacea
• C. Bacterial folliculitis
, • D. Keratosis pilaris
Answer Options:
• A. Acne vulgaris – Incorrect. Acne typically features comedones and is not
characteristically triggered by the specific factors mentioned. Telangiectasias are also not
a hallmark.
• B. Rosacea – CORRECT. This classic description fits rosacea: triggered by
heat/spicy foods/stress, persistent central facial erythema, telangiectasias, and
papules/pustules without comedones. It can occur in adolescents.
• C. Bacterial folliculitis – Incorrect. Presents as pustules centered on hair follicles, often
itchy or tender, but lacks the persistent background erythema, telangiectasias, and
specific triggers of rosacea.
• D. Keratosis pilaris – Incorrect. Presents as rough, gooseflesh-like papules on cheeks,
upper arms, and thighs. It is not inflammatory, triggered by specific factors, nor
associated with telangiectasias.
Question 5: Hormonal Therapy Consideration
For a female patient with acne that is severe, refractory to standard therapy, and shows a
premenstrual flare, which of the following treatments works primarily by suppressing ovarian
androgen production?
• A. Spironolactone
• B. Combined oral contraceptive pills (OCPs)
• C. Oral prednisone
• D. Isotretinoin
Answer Options:
• A. Spironolactone – Incorrect. It is an anti-androgen that works primarily by blocking
androgen receptors at the pilosebaceous unit and inhibiting adrenal androgen
production, not primarily ovarian suppression.
• B. Combined oral contraceptive pills (OCPs) – CORRECT. Combined OCPs
suppress ovarian androgen production by inhibiting ovulation and reducing LH-driven
theca cell androgen synthesis. They also increase sex hormone-binding globulin (SHBG),
reducing free testosterone.
