Dermatology Finals (1st Shifting A.Y.

2014-2015)
Section C Batch 2016

Dermatology Finals September 2014

Case: A 50 yr old obese vendor from Marikina was referred because of an 8x10cm red plaque on the left
lower leg.

1. You noticed that it has a red streak adjacent to the well demarcated plaque. The patient grimaces as
you touch the warm leg and tells you it happened 3 days ago. What is your diagnosis?
a. Cellulitis
b. Erysipelas
c. Hansen’s disease TT-BT
d. Angioedema

2. You suspect Hansen’s disease. Which of the following will give you a stronger clinical suspicion for
the disease?
a. Mildly moist skin surrounding the lesion
b. Enlarged non-tender movable left inguinal lymph nodes
c. Enlarged popliteal nerve
d. Exaggerated heat perception

3. After biopsy, patient was diagnosed to have Hansen’s BT-BB. What is your full diagnosis if the
patient’s lesion is warm and tender with no lesions involved after 6 weeks on multi drug therapy?
a. Hansen’s BT-BB with secondary cellulitis
b. Hansen’s BT-BB in type 1 reaction
c. Hansen’s BT-BB in ENL reaction
d. Hansen’s BT-BB with angioedema due to drug

Explanation: Type 1 and type 2

Both appear after drug therapy (exaggeration of skin lesions)
Look for new lesions
Just 1 lesion- TT to BT (paucillary)
Type 2 (ENL) is multibacillary, increases in number
Type 1 typically acts only in the existing lesion, no new lesion

4. What is/are the drugs of choice for Hansen’s TT?

a. rifampicin and dapsone
b. clofazimine with dapsone- not use clo on paucibacillary
c. minocycline with rifampicin- minocyclin is only an alternative
d. dapsone and clofazimine and rifampicin- 3 drugs at the same time not for used for paucibacillary

5. 25 yr old medical student has erythematous scaly macules and patches which started since he
entered med school 3 years ago. What would be your most plausible diagnosis for this patient if the
lesions are found over his hairy back and chest, external ear canal and eyebrows?
a. Atopic dermatitis
b. Tinea
c. Seborrheic dermatitis
d. Psoriasis

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

6. 34 yr old female came because of ugly nails of 3rd, 4th, and 5th fingers of both hands. If this is a case of
psoriasis, which would be the best nail change to back up your diagnosis?
a. Salmon colored spots
b. Longitudinal ridges
c. Distal onycholysis
d. Periungal swelling

7. What is the reason behind the numerous small pits we see in psoriatic patients’ typical nail changes?
a. The P. ovale invaded the nail bed
b. Proximal matrix is affected
c. The nail plate is undergoing rapid keratin change
d. The nail plate has lifted from the bed in different areas

8. A 23 yr old female came because of erythematous patches over the cheeks, forehead, ears, nape, V
neck of chest. There is no scaling noted. Which of the following is most important to ask the patient to
arrive at the diagnosis?
a. If she is recently stressed out
b. If she was exposed to hot and spicy foodstuff
c. If she had recent sun exposure----bec we see areas of sun exposure
d. If she lives in a small cramped dusty place

9. A 5 yr old was recently brought to ER straight a from children’s party because of multiple
erythematous, edematous itchy plaques over the body, face and extremities of 4 hrs duration
accompanied by low grade fever, cough, colds of 2 days duration. What would be the most probable
cause of her skin lesion?—URTICARIA
a. Over eating of KFC fried chicken- her favorite
b. Upper respiratory tract infection- etiology of urticaria may also be an ifxn
c. Her use of newly washed Cinderella outfit
d. Antibiotic taken last month

10. A 45 yr old housewife has had a 2 yr old recurring erythematous periungal swelling of right fingers
with loss of cuticle and brown discoloration of her nails. Which of the following will be the mainstay
advice? -CANDIDA
a. Minimize her wetwork for life
b. Topial Antifungal and topical steroids for the next 3 mos
c. Avoid handling irritants all together
d. A and c

11. A 20 yr old male came because of erythematous warm stinging and occasionally well defined raised
vesicopapular lesions and exudative plaques over extensive surface of the lef and right hands and
forearms for 2 days. What is your diagnosis? R arms and forearms----sun exposed areas with eczema
a. Angioedema
b. Erysipelas
c. Phototoxic dermatitis
d. Photoallergic dermatitis

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

CASE: A 2mos old baby was referred due to erythematous scaly patches over her trunk and extremities.
12. What are the lesions called if they are also noted over the scalp, axilla, and groin?
a. Atopic dermatitis
b. Seborrheic dermatitis
c. Nummular eczema
d. Infectious eczematoid

13. If baby had atopic dermatitis, where would dry scaly patches be seen?
a. Cheeks, antecubital fossa, popliteal fossa
b. Scalp, cheeks, inguinal folds
c. Neck, umbilicus, intergluteal folds
d. Behind ears, scalp, popliteal fossa

14. Which of the following is the therapeutic drug of choice for a 35 yr old female with erythematous
papulovesicular scattered lesions some coalescing into oval and round moist plaques over the lower
extremities and anterior trunk?
a. Antihistamines
b. Topical corticosteroids
c. A and B
d. Oral terbinafine

CASE: A 22 yr old female came because of few erythematous 1x1 and 2x2 round moist patches with
darkened centers.

15. These lesions were noted to occur in upper lip and lower abdomen recurring in the same spot for
past 2 mos occurring during the time near her menses. What will you ask the patient?
a. Are there any change in the pattern of her menstrual cycle?
b. Is there any accompanying coughs and colds?
c. Are there bruises accompanying her menstrual period
d. Is she taking any pain meds during menses

16. Upon further exam you noticed a darkened center with pale surrounding and erythematous
peripheral ring. What is the most associated dx accompanying this case? ---target lesions=EM most
common etiology for EM—HERPES
a. Few clustered vesicles on red based lip
b. Dermatomal clustered vesicles at left T4-T5
c. Few vesicopustules scattered on the periphery scattered of red patch of inframammary area
d. Few eroded vesicles with dark ring crust on lower leg

17. Upon further examination, px noted very tiny closely set vesicles with moist surface and scaling with
intense itchiness found over the lower extremities. This was further aggravated with very itchy scattered
papulovesicles over the arms and hands which appeared recently. What is your diagnosis?
a. Herpes Simplex disseminated
b. Nummular eczema with id eruption
c. Herpes Zoster with dissemination
d. Infectious eczematoid dermatitis---there was an infection as the source

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

CASE: A 21 year old male presents with erythematous papulo-vesicular lesions.

18. Px noted a few closely set lesions to be itchy, edematous with a central vesicles that easily erodes
once scratched found on his lower leg, what is your dx?
a. Beginning scabies
b. Insect bite hypersensitivity---punctum
c. Nummular eczema
d. Impetigo contangioisa

19. The patient noted the lesions to first occur in periumbilical area, spreading to wrist and the
intergluteal area. What else should you look for to clinche the diagnosis of scabies?
a. Vesicles in soles
b. Secondary excoriations in fingers
c. Papules in axilla
d. Papulovesicles eruption at waist

20. Lesions found over the scrotum that he often scratch at night. Which among these will strengthen
the dx for scabies?
a. If he is not sexually active for the past 6 weeks
b. Improve with use of emollients
c. Wakes up at night to scratch lesions
d. Itch worsens when he is not stressed out

21. Itchy red scaly lichenoid papules and plaques with excoriations and erosions. If this is found round
plaques over several knuckles on the finger the most probable diagnosis is?
a. Nummular eczema
b. Allergic contact dermatitis
c. Atopic dermatitis
d. Irritant dermatitis

22. If they are found on dorsum of hands, fingertips, sparing the palm, dx?
a. Photocontact dermatitis
b. Irritant contact dermatitis
c. Tinea manum
d. Prurigo mitis

23. Lesions are chronic and relapsing for the past 4 yrs affecting nape, periorbital skin, forehead,
antecubital fossa of arms and legs. The 1st line DOC? ----atopic
a. Antibiotic clindamycin
b. Antihistamine round the clock—supportive only
c. Topical mupiracin on the nares
d. Topical corticosteroids

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

24. 44 yr old tennis enthusiast came because of smarting red shiny slightly rough surface oval patch
found on the forehead and cheeks after playing tennis 2 days ago. What will be the most important
thing to manage this patient?
a. Avoid sun exposure
b. Apply strong topical corticostreoids
c. Topical antihistamine
d. Stop his anti-hypertensive

25. A 67 yr old male came because of edematous red painful left lower third of his leg. Which of the ffg
is a predisposing factor of his condition?
a. He applied alcohol for past 6 mos
b. He has a venous insufficiency
c. Hypertension past 10yrs
d. Psoriasis tx with phototherapy

26. Antifungal best given for distal subungal onychomycosis

a. Oral fluconazole out of market
b. Oral griseofulvin too long to give
d. Oral ketoconazole
e. Oral terbinafine

27. Which of the following changes in the nail will help in dx non-dermatophyte onychomycosis
a. Onycholysis
b. Whitish powdery spots on the nail plate
c. Yellow- Brown dystrophic discoloration of nail
d. Greenish blue brittle nail- pseudomonas

28. 5 yr old female came because of multiple rain drop size erythematous scaly papules noted over
trunk, elbows with diffuse white scales 1 week duration not responsive to antihistamine, which is highly
related to her skin prob?---psoriasis
a. Exposure of sun during playtime
b. Playmates with similar lesions
c. Allergic rhinitis and asthma
d. Step growth infection- guttate psoriasis assoc

29. 27 yr old female presents with erythematous dark centered plaque surrounded by a paler ring and
outer red ring found over the arms trunk. What is the strongest relevance?
a. Itchy erythematous patches over the antecubital fossa
b. Clustered vesicular eruption with red base over the left buttock –herpes simplex
c. Intake of lamotrigine over past 2 yrs
d. usually there is no asstd disease with this

30. 1st line DOC for erythematous itchy evanescent plaques over the body of adult ---urticaria
a. 2nd gen anti histamine
b. 1st gen antihistamine
c. IV antihistamine
d. Oral corticosteroids

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

CASE: A 25 y/o Female with itchy pubic area.

31. What is your dx if there are small erosions with yellowish crust
a. Bullous impetigo- yellow
b. Ecthyma – dark crust
c. Pediculosis pubis- nits
d. Prurigo minis- not much scaling

32. If you see a brown nits on pubic area what would still be a definitive part of the plan for the px ---
pediculosis cruris
a. Look for crab louse to substantiate dx
b. Encourage tx for sexual partner----kung mahal pa daw nya haha
c. Work up for mother possible STDs
d. B and c

CASE: 45 yr old with erythematous scaly plaques over the scapula, nape , elbows and knees of 3 weeks
durations on further exam you also noted on the intergluteal a red patch with few erythematous
patches lesions on the scalp, the scales were silvery white----typical psoriasis on trauma areas.

33. Which of the ffg problem is significantly related to the skin prob of the px
a. CBC with lekopenia shift to the left
b. Obese and BP of 150/100
c. Ovarian tumor on UTZ
d. A and B only ---on recent studies increased bp, obesity and DM, cardiovascular are related to psoriasis

34. Which is NOT a treatment option that you will offer the px
a. Oral retinoid
b. Topical Vitamin D analogue such as calcitriol
c. IM steroid once a month- no systemic for psoriasis or else pustular psoriasis, topical steroids are 1st
line
d. Phototherapy for 3x a week for 4 mos

35. Female laundrywoman said that 7/10 of her nails are looking dystrophic, yellowish and brittle.
Quickest way to dx fungal infection
a. KOH
b. PAS- stain histopath
c. DTM- 1 month
d. Mycosel culture- months

36. Which of the following meds is a tx of choice for SJS or TEN

a. Systemic steroids
b. Cyclosporin
c. IV Ig
d. No tx is better that the other

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

37. 6 mos old baby boy referred due to lesions in neck, flexures, scalp, and groin. Px present with thick
yellow brown scaling on the scalp moist skin patches over the mentioned area. What is the dx
a. Seborrheic dermatitis
b. Psoriasis
c. Atopic dermatitis
d. Scabies

38. Dry scaly scalp with red patches on the cheek, the neck, antecubital fossa
a. Seborrheic dermatitis
b. Psoriasis
c. Atopic dermatitis
d. Scabies

39. Itchy papules and excoriated vesicles over the cheek, neck, axilla, trunk, intergluteal fold, and penile
shaft
a. Seborrheic dermatitis
b. Psoriasis
c. Atopic dermatitis
d. Scabies

CASE: Family of 3, father, mother, 3 yr old son with similar itchy papules of 1 to 2 mos duration.

40. What will be the DOC if lesions also found of the wrist, waist, and inner thighs and groin?
a. Lindane
b. Permethrin
c. Miconazole
d. petroleujm jelly

41. If found on nape, occiput with nits on hairshaft?

a. Lindane
b. Permethrin
c. Miconazole
d. petroleujm jelly

42. Med student came to ER due to dry itchy erythematous evanescent papules and plaques with 2 hrs
duration. Which is not useful in arriving at the etiology of the skin dx?
a. Recent exposure to px that are immunocompromised at the CA center
b. Taking of pain relievers for headache
c. Fever cough colds
d. New skin care product over body—contact urticaria

43. Which tx is correct and best fit the term koebner phenomenon?
a. It is found in mostly infectious dermatological dx that the spread is though autoinoculation
b. Seen in psoriasis, molluscum, and verruca plana traumatized area
c. It involves the naturally cyclical appearance of crops of lesions such as H. simplex
d. It is the pushing of the epidermis leading to slouching off the epidermis

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

44. Which of the ff istrue of Hansen’s dx in the country

a. it is best to give the ROM therapy (rifampicin, ofloxacin, minocycline) as dapsone and clofazimine is
hard to procure in our country.
b. dx is best clinically without lab proof
c. Referral to health centers for monitoring and tx of DOH can be done
d. Refer to DOH so that px can be brought them to Culion island

45. 1st line of tx for stasis dermatitis

a. Topical corticosteroids- bec dermatitis so itchyyy
b. Compression stocking- no bec if px has arterial problem, stocking might kill px
c. Vein stripping
d. Sclerotherapy

46. 45 yr old security guard came because of erythematous edematous left lower leg. Which exam
should you not forget to do? ---look for tinea pedis
a. Look at the webs of his feet to check for scaling and vesicles
b. Check the appearance of black brown papules over affected area
c. Look at nails and check dystrophic nail
d. Accompanying arthritic pain

47. A 30 yr old fish vendor came because of swollen periungal folds, loss of cuticle with brown
discoloration over nail plates. She is saddened by the state of her nails, what would be the tx?---candida
a. Minimize exposure to wet work and manicure
b. Topical clotrimazole cream
c. Oral fluconazole
d. A and C

48. Which of the ffg can be used for antifungal tx?

a. Proximal subungal onycholysis
b. Topical subungal onycholysis
c. Distal subungal onycholysis covering half of the nail
d. White superficial onycholysis

CASE: A 34 yr old male had a target looking lesions on his inner thighs.
49. The lesion had a dark center with lighter erythematous rim appearing everytime he takes a Chinese
herbal medication, what is the tx?
a. Topical steroids
b. Oral antihistamine
c. Stop the Chinese herbal
d. All of the above

50. The lesions are 3 ringed target lesion, what is the most probable and common etiology - EM
a. Herpes zoster
b. Herpes simplex
c. Eczema herpeticum
d. A medication taken

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

Case: 3rd year medical student consulted due to an acute eruption of multiple pustules on the leg which
she noted after she shaved her leg daily for a week.

51. if there were very few pustules on top of erythematous warm tender nodules , the dx is
a) Furuncle
b) Impetigo contangiosa
c) Ecthyma
d) Prurigo nodularis

52. There were several 0.2-0.3 cm superficial pustules with pale center. The diagnosis is
a) Ecthyma
b) Impetigo contangiosa
c) folliclulitis
d) furuncle

53. If px was a school aged child who presented with an acute eruption of few vesicles which evolved
into pustules located on her face. The pustules rapidly dried up with subsequent formation of golden
yellow crust. The diagnosis is
a. molluscum contagiosum
b) folliculitis
c) Impetigo contangiosa
d) ecthyma

54. What is the best tx for school aged child presenting with golden crust on the face?
b) mupiracin-for few impetigo
c) calcipotriol
d) sertoconazole
e) tretinoin

55. the patient had Large fragile bullae located at axillae and groin, a few on the hands. weepy, circinate
crusted lesions after the bullae ruptured were formed. These would occur when the climate was warm.
What is the dx?
b) Miliaria cryastallina
c) Bullous impetigo
d) Millaria sudamina
e) Herpes zoster

CASE: UST college athlete consulted because of 2 mos duration of erythematous patches on inguinal
area

56. Multiple satellite papules beyond erythematous lesions are found. What is your primary dx
a) Tinea cruris
b) Intetriginous candidiasis
c) Intertrigo
d) Psoriasis

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

57. If a patch had a progressive central clearing with a well defined elevated border topped with
erythematous papules and vesicle what is your primary ddx?
a) Tinea cruris
b) Intertrigous candida
c) Intertrigo
d) Proraisis

58. To confirm a primary diff dx for annular patch on inguinal area what is the dx procedure to do that
would reveal result is a few mins ?
a) Tzanck smear
b) Grams stain
c) Skin punch biopsy
d) KOH

59. Results from microscopic examination showed tinea cruris. You would expect
a) Pseudohyphae with spores
b) Short thick hyphae with spores
c) Long hyphae with spores
d) Spaghetti and meatballs

60. Consistent with intertriginous candida

a) pseudohyphae with spores
b) short branching, septated hyphae with spores
c) long branching, septated hyphae with spores
d) spaghetti and meatsauce

CASE: A px with 6 week old duration of multiple scaling edematous papules and plaques on the trunk.
61. HPI revealed that patient developed first a solitary erythematous patch with collarette scaling at
periphery then after 2 days more eryhtematous papules are seen at the trunk. The dx is?
a) Tinea corporis
b) Tinea versicolor
c) Ptyriasis rosea
d) Psoriasis

62. If papules and plaques this time are topped with thick whitish scales on similar lesions are found on
elbows and knees dx is
a) Tinea corporis
b) Tinea versicolor
c) Pityriasis rosea
d) psoriasis

63. lesions were prurtitic and the PE showed annular patches with well defined elevated border topped
with papules. The most probable dx
a) Tinea corporis
b) Tinea versicolor
c) Pityriasis rosea
d) Psoriasis

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

64. PE of trunk showed hyperpigmented macules and patches with thin furfuracious scales. Dx
a) Tinea corporis
b) Tinea versicolor
c) Pityriasis rosea
d) Psoriasis

65. microscopic exam of tinea vesicolor

a) Pseudohyphae with spores
b) Short hyphae with spores
c) Long hyphae with spores
d) Spaghetti and meatsauce

CASE: Young child consulted due to 3 mo duration of few discrete papules on the trunk.

66. Mother said that the lesion started as a single papule which gradually increased in number. PE, the
papules were dome shaped with umbilicated center. Dx?
a) Verruca vulgaris
b) Verruca plana
c) Molluscum contangiosium
d) Prurigo nodularis

67. If the lesions are limited and the child is cooperative tx?
a) Intralesional steroid
b) curettage
c) HAART
d) Incision and drainage

68. You decided to do a skin punch biopsy on the dome shaped papules with an umbilicated center.
Inclusion bodies are called
a) Target lesions
b) Henderson Paterson bodies
c) Multinucleated giant cells
d) Necrotic keratinocytes

69. Noted a multiple hyperpigmented 2mm flat topped papules grouped on his face and neck. Dx?
a) Verruca vulgaris
b) Verruca plana
c) Molluscum contagiosum
d) Prurigo nodularis

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

Case: 50 yr old male complained of multiple grouped vesicles on erythematous base located on left side
of upper face extending at back of the left…. pain noted on area prior to eruption
Herpes zoster

71. 50 yr old male tx with

Oral acyclovir

72. tzanck

73. recurrent grouped vesicle on the upper lip

Herpes simplex

74. Hx and PE recurrent edematous patches with bullae on the center. These would occur when px takes
NSAIDS
Bullous FDE

75. school aged boy with Vit A deficiency living in crowded house with poor vent presented with
multiple saucer shaped ulcer on both shins interspaced with a few hyperpigmented scars
Ecthyma

76. best tx
Etiology is strep- cloxacillin

77. Etiology of saucer shaped ulcers on both shins

Propionobacterium
Staph
Epidermophyton
Gram neg bacteria

78. What is the predisposing cause of the ulcer

Age
Poor ventilation
malnutrition
Crowded place

79. Mgt of strep skin infection with antibiotic impt to be cautious on complication of
Nephrotic syndrome
Acute glomerulonephritis
Nephritic

80. Black warts are also known as

Verruca plana

81. Involvement of nasociliary branch with vesicle inside tip of nose

hutchingston’s sign

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

82. post herpetic neuralgia is a complication of

Herpes zoster

83. poor prognostic factor for SJS

Greater skin involvement

84. elderly px dx with HZ most troublesome symptom is

Pain

85. Prescribing acyclovir in elderly px which organ will you check before you administer the drug
Liver
Pancreas
Kidney- check crea clearance
skin

86. you diagnosed a px with miliaria crystallina what advice will you tell him
Vesicles will have a long time to resolve
No tx is required
Expect pruritus
Wear thermal clothing

87. necrotic keratinocytes seen in

Herpes zoster
SJS
Bullous impetigo
Miliaria crystallina

88. Involvement of the oral mucosa, eyes, genitalia, eyes are expected of this dx
HZ
SJS
Bullous
Miliaria

89. Dx that appears in areas of trauma are---koebner

P. rosea
Psorias
Lichen simplex chronicus
Prurigo nodularis

90. what factors are involved in etiology of acne

Stress and eating oily food
Prolif of S. aureus causing inflammation
Formation of keratin plug at the eccrine glands
Stimulation of sebaceous gland by androgen hormones

91. what statement is true regarding miliaria pustulosa

Preceded by dermatitis that has produced injury to the sweat duct

Thanks Pawi, Gela and Dave! 

Dermatology Finals (1st Shifting A.Y. 2014-2015)
Section C Batch 2016

92. best tx for miliaria crystallina

No med tx

93. medication with a teratogenic side effect is

Isotretinoin

94. Most effective tx for acne vulgaris

Minocycline

95. Strongly consider prescribing medication to a px with severe acne the patient has limited funds
Tetracycline

96. school aged girl presented with 3 weeks duration of multiple papules scattered over his trunk
interdigital webs armpits and butt wake up at night due to intense prutitus what is true of the dx
In adults face and scalp spared
Sensitization
Dx caused by a tick mite
Dx is self limiting

97. the ffg is true about neonatal acne

Females sex predominance
Ance will not extend in adult life
May clear spontaneously in a few days
Characterized by comedones

98. generally given to px with severe inflammatory acne during the 1st few week of tx with isotretinoid
Dexamethansone
Prednisone
Spinrinolacrone
Clobeatasol

99. true about herpes simplex

Tzanck smear is 95-100%specific
Most lesions are seen in px previously infected with HSV
Potentially infectious even with no clinical signs

100. Diarrhea with green stools can occur in this dermatologic infection
Impetigo contangiosa
Bullous impetigo
Ecthyma
SJS

Thanks Pawi, Gela and Dave! 