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Dermatology

Dermatology Final Questions (2010-2012)


WAHIDA

1) 25 years old, with scaly ill-defined lesion, it is most likely to be:


+Eczema

Scaly: mindmap pge 4 red rash


-ill defined: eczema
-welldefined: unilateral (fungal) bilateral (psoriasis, LP,
pityriasis)

2) 9 months child, presented with itchy scaly lesion over the


face, cubitals, and popliteals. The patient is at risk to develop:
1- Herpes simplex
2- Skin cancer
3- +Atopic dermatitis

Atopic dermatitis: HUNTER 4th edition pge 93


ECZEMA & DERMATITIS
-infant: facial lesions
-older child: lesions in elbow(cubital), knee flexures
(popliteal), wrists and ankles

3) 20 years old medical student, presented with single annular itchy


plaque over his right arm of) 1 week duration. His sister last week
brought a nice cat to home. The test used to help confirming his
diagnosis is:
1- Patch test
2- Prick test

SINGLE ANNULAR(well-defined) Itchy


PLAQUE (scaly) UNILATERAL

3- Tzank smear

=Fungal infx= KOH & Microscopy

4- +KOH & microscopy


5- Woods light

MINDMAP pge 3, 4
INVESTIGATION , RED RASH

4) Which is type IV hypersensitivity reaction?


1- Pemphigus (type II)
2- ICD (irritant contact dermatitis) (type I)
3- Vasculitis (type III)
4- Urticaria (type I)
5- +Photosensitivity

TYPE IV HYPERSENSITIVITY:
-allergic contact dermatitis
-granulomas
-delayed hypersensitivity reactions
(sunsensitivity)

5) One is not true about seborrheic dermatitis:


1- +Seborrhea plays major role
2- Affects males mostly
3- Predisposed by pityrosporum
4- Require antifungal as long term treatment
5- Intertriginous type is complicated
6- Candidal super-infection is possible

-not obviously related to


Seborrhea
-most common in adult males(
puberty)
-intertriginous lesions- added
candida infx
MINDMAP PGE 10
ECZEMA TYPES

6) One is not a feature of acute eczema:


1- Weeping
2- Crusting
3- +Lichenification
4- Vesicles
5- Bulla

ACUTE ECZEMA CLINICAL APPEARANCE:


-weeping & crusting
-blistering( vesicles)
-redness, papules and swelling
-scaling
CHRONIC ECZEMA:
-Lichenification
MINDMAP PGE 8 (eczema)

7) One is not caused by staph:


1- +Erysipelas
2- Impetigo
3- Boils (furunculosis)
4- Scalded skin syndrome
5- Toxic shock syndrome
6- Ecthyma

Staphylococcal infections:
-impetigo
-ecthyma
-furuncolosis(boils)
-carbuncle
-toxic shock syndrome
-scalded skin syndrome

Streptococcal infx:
-erysipelas
-cellulitis
-necrotizing fasciitis
MINDMAP PGE 11
bacterial infx

8) Localized scarring alopecia is caused by all of the


following, except:
1- Kerion
2- Favus
3- Lichen planus
4- +Black dot head

LOCALIZED SCARRING:
-kerion
-favus
-carbuncles
-lichen planus
-cicacitrial BCC
-SLE
-sarcoidosis
MINDMAP PGE 28, alopecia

LOCALIZED NON-
SCARRING:
-alopecia arreata
-hairpulling habit
-traction alopecia
-non-inflammatory
tinea capitis( BLACK
DOTS)

9) 9 years old presented with common warts over his hands, never
treated before, best 1

st

line treatment is: 1) wart paint (salicylic acid & keratolytic)

1- Cryotherapy

2) apply at least 3mths


3) except on face and genital area

2- +Paste over warts containing


salicylic acid

MINDMAP PGE 15
viral warts

10) One is not infectious:

Pityriasis versicolor
-fungal infx: pityrosporum
-not harmful or passed on through
touching (contagious)

1- +Pityriasis versicolor
2- HSV
3- Molluscum contagiosum

MINDMAP PG 17
FUNGAL INFX
mindma

11) All are true about shingles, except:


1- Pain precedes rash

2- +Rash is bilateral symmetrical involving single dermatome


3- Caused by varicella zoster
4- Caused by activation of dormant virus

MINDMAP PG 13
HERPES ZOSTER

12) One can affect male genitalia:

MINMD

1- HSV-1

-Hsv type 1: extragenitalia


-Hsv type II: genitalia
-Psoriasis: flexure pattern (anogenital)
-Lichen Planus: genital skin

2- Lichen planus
3- Psoriasis
4- +All are true

MINDMAP PG 14.19.21
HERPES simplex,

13) All play a role in STD, except:


1- Pubic lice
2- +Body lice (mostly)

3- Scabies
4- HIV
5- HBV

Shingles:
-unilateral rash

Body lice:

spread via close person-to-person contact or


through used bed linens, towels and clothing.
In general, infestations of body lice are limited
to people who live in unhygienic or crowded
conditions and who do not have access to
clean clothing.
MINDMAP PG 30 (infestations)
HERPES ZOSTER

14) Most common fungal infection in adults is:


1- +Tinea pedis
2- Tinea capitis
3- Tinea cruris

Mindmap pg 16
Dermatophyte infx (Tinea)

Tinea pedis (Athletes Foot)
most common fungal infx, sharing wash places/ swimming
pool

15) Child presented with patchy hair loss, lesions are scaly. All
are considered in management, except:

Mindmap pg 16
Tinea capitis
1- Topical & oral antifungal
-patchy of red scaly non-scarring hair los
2- +Topical antifungal
-TT systemic (for tinea scalp and nails):
(tinea capitis always systemic treatment)
a) terbinafine (fungicidal)
3- Woods light
b) itraconazole (fungistatic)
c) griseofulvin (DOC tinea capitis)
4- KOH
d) WOODS L: green fluorescent
5- Brother wearing cap is prohibited e) KOH- see hyphae & spores
f) family cannot wear same cap/hats


16) Child presented with patchy hair loss, opening
of hair follicles

can be seen, lesions are scaly. Mostly, the cause of hair loss is:
Mindmap pg 16, 28
Tinea capitis
-patchy of red scaly non-scarring hair los
2- +Tinea capitis
-disease of children
Alopecia arreata:
-non scarring hair loss

17) 50 years teacher presented with generalized
itchy skin. Also his

1- Alopecia areata

wife & son were itching. Which physical finding confirms diagnosis?

1- Excoriation
2- +Rubbery genital nodule

18) Treated with permethrin and

Mindmap pg 31

scabies (Burrows only in scabies)
-after 4-6 weeks, experienced severe itching
-site of burrows: sides of fingers, finger webs, wrist,
nipples& genitals, infancy (affect face)
-On genitals: erythematous rubbery nodules
: family as prescribed. After 6
all

days following treatment, itch was worse. Next management is:


1- +Treat with antihistamine only
2- Treat patient alone
3- Retreat whole family
4- Wash all cloth with antisepti

MINDMAP PG 31, SCABIES


itch usually persists for up to a few
weeks, even if the treatment worked
Antihistamines and steroids
orally or topically will help make it
more tolerable

19) Woods light is useful for which:


1- Pityriasis rosea
2- +Pityriasis versicolor

Mindmap pg 3
Dermatology investigations:
Woods light:
-P.versicolor (fungal) golden yellow
-P. rosea (HHV 6&7): clinical dx,
investigations are not normally needed

20) One of papulosquamous disease is self-limited within 3 months:


1- +Pityriasis rosea
2- Pityriasis versicolor
3- Nail psoriasis
4- Scalp psoriasis

Papulosquamous disease:
-P. rosea: eruption last 2-10wks (self-limited,
resolves spontaneously)

5- Lichen planus

MINDMAP PG 33,
PEMPHIGOID
-AUTOIMMUNE IgG +
21) All are true about pemphigoid, except: C3 (direct
immunofluorescence)
-elderly
1- Affect elderly
-affect flexures
2- Tense bullae
-good health
3- General health not affected

PEMPHIGUS
4- IgG & C3 deposits along basement membrane

PEMPHIGUS
-poor health
-trunks and
flexures

DERMATITIS
HERPETIFORMIS
-elbow, knees and
buttocks

5- +Predilection for elbows, knees & buttocks


https://books.google.jo/books?id=W69YBQAAQBAJ&pg=PA114&dq=pemphigoid+Predil
ection+for+elbows,+knees+%26+buttocks&hl=en&sa=X&ei=14YaVbvbO4v-
UoiyhKgK&ved=0CCcQ6AEwAg#v=onepage&q=pemphigoid%20Predilection%20for%20
elbows%2C%20knees%20%26%20buttocks&f=true

22) Patient with scars & papules, your treatment is:


1- Oral retinoid, oral antibiotics
2- +Oral retinoid, oral antibiotics, laser (mostly)
3- Oral antibiotics, topical retinoid
4- Topical retinoid, topical antibiotics, laser

23) Patient with papules, few pustules & comedones.

MINDMAP PG 25
Moderate acne:
papules &pustules
-topical AB, systemic:
AB, ocp,metformin
(PCOS)


Chronic: scars, nodules
and cyst
-isotritenoin
Treatment
is:

+Oral antibiotics, topical preparation

Mild & moderate acne

Topical AB: CEZ


-clindamycin
-erythromycin
-zinc & erythromycin

24) Not used as topical agent for acne:


1- Erythromycin
2- +Neomycin

25) Patient with rash & redness. Which is most important to


confirm diagnosis?
1- +Fixed erythematous cheeks
2- Fixed telengectesia
3- Pustules & papules

Dx: rosacea or SLE


MINDMAP PG 27 (ROSACEA)
site of rash n red: cheeks, nose, chin,
periorbital or perioral areas

26) A 50 year old male patient comes with hyper-pigmentation over


his skin and oral mucosa. The most likely diagnosis:
1- +Addison's disease
2- Thyrotoxicosis
3- Lichen planus
4- Cushing syndrome

ADDISON
-overproduction of ACTH
-generalized or limited to skin folds, creases of
palms, scars and buccal (oral) mucosa
Hunters pg 287

27) Patient was pregnant, has pigmentation, now is lactating and on


OCP. All for treatment, except:
1- +Stop lactating
2- Stop OCP
3- Use sunscreen
4- Clothes protection

Hunters pg 286
CHLOASMA / MELASMA:
-hypermelanosis on sun exposed skin
-Risk factors: sunlight, pregnancy, estroges &
OCP, scented cosmetics, thyroid dysfx

28) Rash on hands, non-scaly, blanchable, for 6 days all lesions are
persistent:
1- Erythema nodusum (<24hrs)
2- +Erythema multiforme (acrofacial distribution) (1-2 weeks)
3- Urticaria (4-6wks)

29) Patient developed painful tender nodules. 2 days prior to that


he had an URI and treated with ampicillin and fever 38.6. Now
the best treatment is:
1- Oral steroid
2- +Oral NSAID
3- IV antibiotics
4- Doppler U/S
5- Incision and drainage

Erythema Nodules:
-tender red nodule, URTI can cause it, painful
joints, fever
-tt:
identify and eliminate the cause
bed rest, leg elevation
NSAIDS
Antibiotic
MINDMAP PG 7
REACTIVE ERYTHEMA

30) Known cause of erythema nodosum:

1- +TB- Erythema nodosum may be the first sign of a systemic disease


such as tuberculosis

2- Staph

31) Child with abdominal pain, red urine, had history of URI, now
has painful non-blanchable nodules, your diagnosis is:
1- +Vasculitis (HSP)
2- Urticaria
3- Erythema nodosum
4- Erythema multiforme

Hunters pg 113
-HSP: small vessel vasculitis, ass with 3P
-painful palpable purpura
-arthritis, abd pain often precede by URTI in
children mostly

32) Most typical for psoriatic arthropathy:


1- +Distal interphalangeal arthritis
2- Large joints arthritis
3- Arthritis mutilans

MINDMAP pg 18
complications of psoriasis:
arthropathy:
-distal (most characteristic)
-oligoarthritis(most common)
-polyartritis

33) The most important antigen-presenting cell in the epidermis:


1- Keratinocytes
2- +Macrophages
3- Fibroblasts

APC most important:


-Macrophage
-Langerhan cells
Hunters pg 30

34) All are side effects of psoriasis treatment, except:


1- Biological agents >> reactivation of TB
2- Methotrexate >> hepatic fibrosis (liver failure)
3- +Azathioprine >> pulmonary fibrosis (cancer and anemia)
4- Ciclosporin >> renal toxicity (renal failure & HTN)
Mindmap pg 20, for psoriasis treatment

35) Mobile dendritic cell is:


1- +Langerhans
2- Melanocyte
3- Keratocyte

Dendritic cells in tissue are active in the


capture, uptake and processing of
antigens (wiki)

4- Merkel cell

36) Most important in dermis is:


1- +Collagen type 1
2- Elastin
3- Fibroblast

Hunters pg 19 and slide intro


COLLAGEN TYPE 1: predominant type
COLLAGEN TYPE 2: only in 1/10th of dermis
main cell in dermis: fibroblast
COLLAGEN makes up 70-80% of dermis
if theres defect in enzymes making up collagen will lead
to EHLER DANLOS SYNDROME and others

37) Odland bodies present in:


1- +Granular layer
2- Prickle cell layer-desmosomes

Slide intro:
granular layer:
1) keratohylin (Ptn)
2) Odland granules (Lipids and hydrolytic
enzymes)

38) The thickest layer on the back is:


1- Stratum corneum
2- +Prickle cell layer (sratum spinosum)
3- Horney layer
4- Basal layer
http://sketchymedicine.com/wp-content/uploads/2012/11/epidermis.jpg

39) Acantholysis occurs as destruction of:

Slide intro:
in prickle cell layer in epidermis:
-desmosomes separation ->
acantholysis

+Desmosomes

40) Laminin V present in:


+Lamina lucida (layer between epidemis and dermis)
not in slide/ book
http://www.ufrgs.br/imunovet/molecular_immunology/basement.jpg

41) All are considered as scarring alopecia, except:


1- +Alopecia areata
2- Keroin
3- Favus
4- Lichen planus
5- Lupus

NON SCARRING LOCALIZED:


Alopecia areata
androgenetic
hair pulling habit
traction alopecia
non inflammatory tinea capitis
MINDMAP PG 28 (ALOPECIA)

42) Recurrent erythema multiforme is due to:


1- +HSV
2- Herpes zoster

EM: MINDMAP PG 7
viral infx (most common):
-Herpes simplex
-Hep a, b , c

43) All are primary lesions, except:


+Lichenification ( SECONDARY LESIONS)
MINDMAP PG 2
44) Not consistent with urticaria in patient with URI:
1- +Single lesion lasts 5-6 days
2- Swollen lips
3- Itchy
4- Bulla

URTICARIA
lesions LAST <24 hrs only

EM: 1-2 WEEKS
EN: 4-6 WEEKS

45) Not sub-epidermal bulla:


1- Pemphigoid (subepidermal blister)
2- +Pemphigus vulgaris
Mindmap pg 33, 34

46) Sebaceous glands are controlled by:


1- +Androgens in males & females
2- Androgens in males & estrogen in females
3- Androgens & ANS

47) All are poor prognostic factors in alopecia areata, except:


1- Atopy/ downs syndrome
2- Onset at 5 yrs (onset before puberty)
3- Involvement of scalp margin
4- +Presence of exclamation (for diagnostic)

Additions:
-recurrent
-more than 3 mths
-nail involvement

Mindmap alopecia pg 28

48) All cause general pruritis, except:


1- Lymphoma
2- Hypothyroidism
3- +Pulmonary fibrosis
4- Liver failure

Underlying Causative Disease:


renal pruritus,
cholestatic pruritus (arrest of flow of bile)
hematologic pruritus (polycythemia vera, iDA)
endocrine pruritus, (Hyper and hypothyroidism,
DM)
pruritus related to malignancy (Hodgkin, carcinoid)
idiopathic generalized pruritus.

5- Renal failure

49) 70 years old man with generalized itching. Which lab


investigation is not important to exclude systemic cause?

1- LFT
2- KFT
3- TFT
4- +ANA- for SLE (age of onset 15-45) children and teens
5- CBC

50) Used for treatment of chronic eczema:


1- +Ointment
2- Lotion (acute weeping eczema)
3- Cream

Tt:
topical steroids,
systemic antibiotics,
ointment to lubricate the skin

4- Emollient

51) Using Woods light, the pink color is most likely related to:
1- +Erythrasma
2- Tinea capitis green on hair shaft
3- Tinea pedis -no
4- Pityriasis versicolor golden yellow
Mindmap investigations pg 3

52) Blindness is a complication of:


1- +Rosacea
2- Pemphigoid

Mindmap rosacea pg 27
*eye-blepharitis, conjunctivitis, keratitis
*rhinophyma
*lymphadema below eyes or forehead
*rebound flare of pustules

53) Infection common in atopics:


+Staph (bacteria)

54) First line treatment of seborrhoeic dermatitis:


+Topical imidazole

Mindmap eczema pg 10
tt: suppressive, topical IMIDAZOLE,
topical LI

55) Pemphigus vulgaris treatment is:


+High dose steroids with azathioprine (immunosuppressive)
Mindmap pg 34 (pemphigus)

HANIM
57) Most common in psoriatic nails:
+Pitting (others: onycholysis, subungual hyperkeratosis, oil
drop sign, splinter haemorrhage)

58) A cause of scarring alopecia:


+Lichen planus (others: burns, radiodermatitis, aplasia
cutis, kerion, carbuncle, cicatricial basal cell carcinoma,
lupus erythematosus, sarcoidosis)

59) Boy with scalp itching, the cause behind that is:
+Scalp lice-peak between ages of 4 to 11 (ddx: recurrent
impetigo, crusted eczema)

60) Oral abrasion important to be recognized in:


+Lichen planus (lacy lines, dots, white plaques, ulcers-SCC)

61) Diascopy is used for:


+Vasculitis (others reactive erythemas: EM, EN, urticaria,
bleeding disorder)

62) All cause facial flush, except:


+Pityriasis rosea
Table 11.4 Causes of flushing.
Physiological Emotional
Menopausal
Foods Hot drinks
Spicy foods
Additives (monosodium glutamate)

Alcohol (especially in Oriental people)


Drugs Vasodilatators including nicotinic
acid
Bromocriptine
Calcium channel blockers including
nifedipine
Disulfiram
Chlorpropamide + alcohol (diabetics)
Pathological Rosacea (p. 156)
Carcinoid tumours with asthma and
diarrhoea
Phaeochromocytoma (type producing
adrenaline)awith episodic headaches
(caused by transient hypertension)
and palpitations

63) All of the following have oral manifestation, except:


1- +Seborrhoiec eczema (hair area only)
2- Pemphigus vulgaris (most patients develop the mouth lesion
1st)
3- Bullous pemphigoid
4- Herpes simplex
5- Lichen planus

64) 42 years old male with facial erythema, most important to


notice is:
1- Papules and pustules
2- Fixed erythema
3- Telangiectasia-rosacea
4- Scar

65) Wrong match:


+Balsam of peru scents (oil herb-cheq pun xpsti soklan ni
nk tanye pasaipa)

66) About hair, one is wrong:


+In hirsutism, terminal become villous (hirsutism-vellus to
terminal hairs, malepattern alopecia-terminal convert to
vellus hairs)

67) Not an infection of head and neck:


+Scabies (sides of fingers, finger webs, sides of the hand,
flexural aspect of wrists, elbows, ankles, feet, nipples and
genitals, only in infancy affect the face)

68) Loss of horny & granular layers is called:


1- Ulcer (the whole of epidermis and at least the upper part of
dermis, may extend to subcutaneous fat)
2- +Erosion

69) Not of ciclosporin side effects:


1- Hypertension
2- Renal failure
3- +Hepatic fibrosis (true answer:hepatic impairment)
4- Gingival stomatitis

(other S/E: gut upset, hypertrichosis, , tremor, hyperkalemia, hypercholesterolemia,


hypomagnesemia, occasionally facial edema, fluid retention and convulsions)

70) Elevated primary lesion more than 3 cm diameter without depth:


1- Macule
2- Papule
3- +Plaque
4- Nodule
5- Patch

71) Woods light test is useful in all of the following, except:


1- Tinea capitis (green)
2- +Tinea corporis
3- Vitiligo (milky white)
4- Post inflammatory hypo-pigmentation (to differentiate with
vitiligo)
5- Pityriasis versicolor (golden yellow)

72) Type 4 hypersensitivity reaction:


1- Vasculitis (type 3)
2- Pemphigus (type 2)
3- Irritant contact dermatitis
4- +Allergic contact dermatitis
5- Urticaria and angioedema (type 1)

73) Smoking is associated with which type of psoriasis:


1- Plaque
2- Guttate
3- Palmoplantar
4- Scalp
5- +Pustular psoriasis

74) Most infectious type of warts is:


+Genital warts (STDs)

75) Which one of the following is not produced by keratinocytes?


1- IL-1
2- +IL-2 (produced by T-lymphocytes)
3- IL-8
4- IL-10
*Interleukins produced by keratinocytes are: IL 1, 3, 6, 8, 10,
12 (not IL 2 & 4)

76) Patient with diffuse hair loss and free edges of his nails become
yellow & crumbly with cuticle loss. The least likely diagnosis is:

1- Severe alopecia areata


2- Iron deficiency anemia
3- +Chronic paryonychia
4- Telogen effluvium
(others: hypopituitarism, hypo/hyperthyroidism,
hypoparathyroidism, high androgenic states, severe chronic
illness, malnutrition, drugs-antimitotic, retinoids, anticoagulants,
vit A excess, OCP)

77) Man with acne, and you want to prescribe him isotretinoin, all
of the following apply, except:
1- His wife reported he had mode change (depression)
2- He may have poor night vision
3- He has to check his lipid profile (hyperlipidemia)
4- He has to decrease exercise (muscle aches)
5- +Tell him that his wife must take contraception
method, because isotretinoin has teratogenic effect
(other S/E: hepatotoxicity, teratogenic, dryness of mm and skin,
hair loss, hearing loss, headache, increase ICP)
78) False about management of scabies:
1- +Dry clean bed sheet with sun heat
2- Treat all family (itching or not)
3- Dry clean clothes with iron heat
4- Treat all body (exclude face; whether itching or not)
5- Will have pruritus even after successful treatment, so given
antihistamine
79) Most common bullous disease:
1-+Bullous pemphigoid
2- Pemphigus vulgaris
3- Dermatitis herpetiformis

80) All are in the pathogenesis of acne, except:


1- Sebum production
2- Propionibacterium acne
3- Obstruction (poral occlusion)
4- Dermal Inflammation
5- +Demodex mite (may cause rosacea)

81) All are true about scabies, except:


1- +Adult mite are 3-4 mm long (true: 0.3-0.4mm)
2- Females produce 2-3 oval eggs per day
3- Transmitted by closely body contact
4- Female mite burrow through stratum corneum 2 mm per day
5- It is found on sides of fingers & wrist

82) All are side effects of steroid, except:


1- +Eczema
2- Rosacea
3- Vascular fragility
4- Thinning skin
5- Secondary bacterial infection
83) Warts at hand, what is the treatment?
1- +Wart paint for 3 months, if not improved then
cryotherapy
2- Wart paint for 1 month, if not improved then cryotherapy 3Wart paint for 6 month, if not improved then cryotherapy 4Wart paint for 1 month, if not improved then electrosurgery
5- Wart paint for 3 months, if not improved then electrosurgery
84) A 24 year old patient comes to emergency room, presented with
generalized skin rash and shivering. The most likely diagnosis is:

1- Drug eruption
2- Cutaneous T cell lymphoma
3- Psoriasis
4- +Erysipelas

85) A patient comes with erythematous swelling over his left leg
with well-defined advancing edge. The other leg is normal. The
most likely causative agent:
1- Staphylococcus aureus
2- +Group A streptococcus
*Here they are talking about Erysipelas indirectly; most common cause is
strep.

86) Lipid cement in corneal layer originates from:


1- +Odland bodies
2- Keratohyaline (contain proteins including involucrin, loricrin
and profilaggrin)
87) A patient comes with skin rashes at presternal and
interscapular areas. What is the most likely diagnosis?
1- Rosacea (face)
2- Pityriasis versicolor (upper trunk, unilateral)
3-+Seborrheic dermatitis (bilateral n symmetrical)
88) A patient comes with skin rashes at presternal and
interscapular areas. What is the appropriate treatment?

1- Topical steroid
2- Topical metronidazole
3- +Topical imidazole, suppressive, topical Li
89) All are treatment for genital warts, except:
1- Imiquimoid
2- Podophyllotoxin
3- Cryotherapy
4- Electrosurgery
5- +Wart paint (for other types of warts)

90) All are true about Shingles, except:


1- Caused by herpes virus varicella zoster
2- An attack is a result of reactivation of a dormant virus
3- +Caused by primary infection of herpes virus varicella
zoster and characterized by bilateral symmetrical vesicles
over a dermatome (true:unilateral)
4- The incidence is highest in old age, Hodgkins disease, HIV
and leukemia
5- Usually preceded by pain
91) Female has done appendectomy, developed itching under
the plaster. In patch test, the material that caused this is:
1- +Colophony
2- Nickel
3- Rubber mix
92) One is true about eczema:
1- +Chronic itching is a must to diagnose atopic dermatitis
2- Gravitational eczema is always associated with venous
insufficiency (often but not always associated with
venous insufficiency)
3- Eczema in flexures is a must to diagnose atopic dermatitis
(minor criteria)

93) All of the following skin lesions should be covered, except:


1- +Psoriasis
2- Lichen planus
3- Seborrhic dermatitis
4- Urticarial vasculitis
5- Urticaria

94) Least likely to involve in endogenous pathology of eczema:

1- Seborrheic dermatitis
2- +Irritant dermatitis (exogenous)
3- Pompholyx
4- Allergic dermatitis
5- Discoid eczema
95) Adult male came complaining of dry red scaly rash on his
chest & interscapular area for 4 months. How do you treat him?
1- Topical weak steroid
2- Topical potent steroid
3- +Topical antifungal (pityriasis versicolor)
4- Topical antibiotic

96) Female with typical history for PCOS (hair loss,


hirsutism, central obesity, irregular menses). We do all of
the following investigations, except:
1- Abdomen US
2- +Chest CT
3- LH:FSH
4- Serum testosterone
(others:dehhydroepiandrosterone sulphate, androstenedione,)

97) Female with typical history for androgen secreting tumor


(breast atrophy, clitoromegaly, very high serum testosterone).
What to do for her?
1- Refer to endocrinologist (androgen secreting tumors)
2- Abdomen CT

98) One is true about ecthyma (staphylococcal):


1- Most cases treated as inpatient
2- Heal without scarring
3- Need biopsy for diagnosis
4- +It is full thickness lesion in epidermis, crust is blackish

99) Most common cause of autoimmune bullous diseases is:


1- DM bullous
2- Pemphigus vulgaris
3- +Bullous pemphigoid
4- Dermatitis herpetiformis

100) All are considered as ciclosporin side effects, except:


1- +Benign intracranial hypertension
2- Hypertension
3- Gingival hyperplasia
4- Reactivation of TB
5- Nephrotoxicity

101) Tzank smear is used in diagnosis of:


1- Pityriasis versicolor (woods light)
2- +Herpes
102) Staph aureus is least likely to cause:
1- Folliculitis
2- Furunculosis
3- Bullous impetigo
4- +Cellulitis(strep

103) 85% of skin is composed of collagen:


1- +Type 1
2- Type 2
3- Type 3
4- Type 4
104) Lymphedema is a complication of:
1- +Erysipelas
2- Toxic shock syndrome
3- Herpes infection
105) Cuticle adherent to the nail plate and grow out of it is called:
1- +Pterygium
2- Beaus lines (a transverse furrow, across all nails, due to slow
growth during a severe illness)
106) Characteristic of chronic eczema:
1- Weeping
2- +Fissure (others: less vesicular and exudative, more scaly,
pigmented and thickened, lichenification)
3- Scaling
4- Vesicles

Acute: weeping and crusting, blistering vesicles, redness, papules and swelling,
scaling

107) Not produced by keratinocytes:


1- IFN alpha
2- +IFN beta
3- IFN gamma
4- TNF
Other cytokines produced by keratinocytes: IL-1, 3, 6, 8, 10, 12, GM-CSF, G-CSF,
M-CSF, TGF

108) Does not exacerbate psoriasis:


1- Alcohol
2- Propranolol
3- +Thiazide
4- Lithium
5- Chloroquine
109) Scales result from:
1- Loss of keratinocytes
2- +Hyper-proliferation of basal layer
110) One of the following resolves spontaneously after 2-10 weeks:
1- Pityriasis versicolor
2- +Pityriasis rosea
3- Roscea
4- Lichen planus
5- Plaque psoriasis
111) All are complications of herpes zoster, except:
1- Corneal ulcer
2- +Hepatitis (lichen planus)
3- Secondary bacterial infection
4- Preceded by pain
5- Post herpetic neuralgia
112) The layer of skin that is responsible for regeneration is:
1- Prickle cell layer
2- Horny layer
3- Granular layer
4- +Basal layer

SYIFAA
113) All are treated by local antifungal, except:

1- Tinea pedis
2- Tinea corporis
3- +Tinea of the nail
4- Tinea mannum
5- Pityriasis versicolor

114) One is not a feature of acute eczema:


1- Weeping
2- Crusting
3- +Thickening of skin

Acute Eczema

Chronic Eczema

-weeping & crusting

-less vesicular, exudative

-vesicle & blistering

-more scaly, pigmented, -thickened

-redness, papules, swelling


-scaling

-lichenification
-more likely to fissure

4- Vesicles
5- Bulla

115) Diascopy is used for:


Diascopy: to see if the red rash is blanchable or not

1- Pityriasis versicolor


Blanchable red rash:

2- Pityriasis rosea

-Urticaria
-Erythema Multiforme

3- +Urticaria
4- Psoriasis
5- Lichen planus

116) The most common cause of cuticle loss of the nail is:
1- +Chronic paronychia
2- Alopecia areta
3- Lichen planus
4- Eczema
5- Psoriasis

Presentation of Chronic Paronychia:


-loss cuticular seal
-tender nail
-swollen nail
-pus discharge
-ridged/discoloured nails

117) Which is not a characteristic of Linchen Planus?


1- Hyperkeratosis
2- +Diminished granular layer
3- Basal cells degeneration
4- Sawtooth appearance
5- Colloid bodies

118) Vitamin D synthesis is in:


Pg. 15
Chapter 2

1- Melanocytes

Hunter

2- +Keratinocytes

th

4 Edition

3- Langerhans cells
4- Merkel cells

Page 10, Chapter 2, Hunter 4th


edition
Table 2.1 Functions of skin
(Memorize the table!!)
Vit D synthesis = Keratinocytes

119) Onycholysis can be found in all of following, except:


Pg. 189

1- Thyrotoxicosis

Onycholysis: detachment of the nail from the nail bed,


usually starting at the tip and/or sides. The most
common cause is psoriasis.

Chapter 13

2- +Lichen planus

Hunter

3- Psoriasis

4th Edition

4- Local trauma

Causes of onycholysis:
-fungal infection

5- Fungal infection

-over thyroid function


-trauma
-skin disease: psoriasis
-medication+expose nail to sun: TCA, fluoroquinolone

120) Generalized pruritis is a symptom of:


Pruritus is a symptom not a disease J
Pg. 332
Chapter 21
Hunter

1- +Polycythemia rubra vera

Underlying causes for generalized pruritus:


1. Liver disease (biliary obstruction)
2. Chronic renal failure
3. Iron deficiency
4. Polycythaemia
5. Thyroid disease
6. Diabetes (rare)
7. Internal malignancy
8. Neurological disease
9. Diffuse scleroderma
10. Skin of elderly

2- Diabetes mellitus

th

4 Edition

3- Leprosy
4- Cutaneous vasculitis

11.Pregnancy

12. Drugs

121) Grouped lesions are found in all, except:


Herpes zoster: grouped vesicles
Herpes simplex: grouped vesicles

1- Herpes zoster

Discoid lupus erythromatous: grouped patch

2- Herpes simplex

Urticaria: grouped wheals


3- +Insect bites
4- Discoid lupus erythromatosus
5- Urticaria

122) An elevation less than 0.3 cm in diameter without depth is:


Small (<0.5 cm)

Pg. 35

1- +Papule

Chapter 3
Hunter

2- Patch

4th Edition

3- Macule
4- Plaque
5- Nodule

Large (>0.5 cm)


Nodule ( witdh&depth)

Elevation, solid

Papule
Plaque (w/o substantial depth)

Flat area, alter in color


or texture

Macule

Patch

Fluid filled blister

Vesicles

Bulla

Pus filled lesion

Pustule

Abscess/Furuncles

Petechiae (pinhead)

Ecchymosis

Purpura (up to 2mm)

Haematoma

Wheal (any size)

Angioedema

Extravasation of blood
into skin
Accumulation of
dermal edema

123) All the following can be detected with direct immunefluorescence, except:

Direct IM: detect Ab in patients skin

Pg. 121
Chapter 9

Indirect IM: detect Ab in patients serum

1- Pemphigus vulgaris

Hunter
4th Edition


P. Vulgaris: intercellular epidermal deposits

2- Bullous pemphigoid

B. pemphigoid: linear band deposits at BM


Cutaneous vasculitis: direct IM seldom performed
Discoid LE: deposits of IgG, IgM, IgA & C3 at BM

3- +Steven Johnson syndrome


Pg. 115
Chapter 8
Hunter
4th Edition

4- Cutaneous vasculitis
5- Discoid lupus erythromatosus

124) Not a papulosquamous:


Papulosquamous disorders:

Pg. 71
Chapter 6
Hunter 4th
Edition

1- Pityriasis rosea
2- Lichen planus
3- Psoriasis
4- Nummular eczema
5- +Erythema multiforme

-psoriasis
-pityriasis rosea
-lichen planus
-pityriasis rubra pilaris
-parapsoriasis and premycotic eruption
-pityriasis lichenoides
-discoid lupus erythematosus => C10
-fungus infection => C16
-seborrheic and nummular discoid eczema => C7
-secondary syphilis => C16

125) All are poor prognostic factors of alopecia areata, except:


Pg. 180
Chapter 13
Hunter 4th
Edition

1- Atopy

Poor prognostic of alopecia areata:

2- +Thyroid disease
3- Downs Syndrome

1. onset before puberty


2. ass. with atopy/Downs syndrome
3. unusual widespread

4. involvement of scalp margins (Ophiasiform type), esp at


the nape of neck

4- Ophiasiform type

126) Not innervated by Autonomic Nervous System:


Autonomic nerves supply:

Pg. 162,
Chapter 12
Hunter 4th
Edition

1- Apocrine glands (pg. 176)

-blood vessels
-sweat glands (eccrine, apocrine)

2- Eccrine glands (pg. 173)

-arrector pili muscles

3- +Sebaceous glands (pg. 162)


4- Arrector pili muscle (pg. 21)

Sebaceous gland stimulated by:


Androgenic hormones

127) Cohesion between corneocytes is maintained by:

Pg. 13
Chapter 2
Hunter 4th
Edition

Odland granules = Lamellar granules = keratinosomes

1- Hemidesmosomes
2- Desmosomes
3- Keratohyalin granules


Odland granules contains lipids & hydrolytic enzymes
-lipid cements between corneocytes provides barrier
-hydrolytic enzymes dissolve lipid leading to desquamation
of old corneocytes

4- +Odland granules

128) About Langerhans cells, one is true:


Melanocytes:
Pg. 16

-dendritic

Chapter 2
Hunter 4th
Edition

1- Non-dendritic cell

-synthesis melanin

2- Migrates from neural crest to basal ectoderm

-migrate from neural crest


into basal layer of
ectoderm

3- Transducer of fine touch

-seen as early 8 weeks


gestational age

4- +Contains tennis racket like granules


5- Like keratinocytes it has desmosomes
Langerhans cell: for immune reaction
-dendritic cells at suprabasal
-no desmosomes and tonofibrils
-has lobulated nucleus
- specific granules:

looks tennis racket (in 2D in EM)


looks like sycamore seed (in 3D)

- plate like, with rounded bleb protruding from the surface


- come from a mobile pool of precursor originating in bone marrow

Merkel cells:
-transducer for fine touch
-non-dendritic at basal layer of epidermis
-has desmosomes


129) Which is not a systemic drug used in psoriasis?


Systemic treatment for psoriasis:
Pg. 66

1- Retinoids

Chapter 5

2- Cyclosporine

-Retinoids

Hunter

3- Mycofenolate Mefotil

-Methotrexate

4- +Steroids

-Ciclosporin

th

4 Edition

-PUVA

Never use systemic


steroids for psoriasis!!

-Antimetabolites: Mycophenolate mofetil, hydroxyurea,


sulfasalazine

130) What is the component of adhesive plaster?


Pg. 89

1- +Colophony

Chapter 7
Hunter

2- Cobalt

Colophony:

Colophony:

-naturally occurring and found in pine sawdust

- cause of sticking plaster allergy

-used as an adhesive in sticking plasters bandages

- dermatitis of the hands of

-also found in various varnishes, paper and rosin

violinists who handle rosin

th

4 Edition

131) History of patchy hair loss with -ve Wood's light test, spores
are visible inside hair shaft by KOH. Most appropriate treatment:
Pg. 251

Systemic treatment:

Chapter 16
Hunter

1- Local antifungal
2- Oral fluconazole

4th Edition

3- +Oral griseofulvin

-for tinea capitis & tinea unguim


-Terbinafine
-Itraconazole
-Griseofulvin (DOC for tinea capitis)

4- Antibiotics

132) About treatment of chronic paronychia, one is false:


-kept hand warm and dry as possible
-folds with imidazole cream several times per day

Pg. 192
Chapter 13
Hunter

1- Keep hands as dry as possible

-highly potent corticosteroid applied for 3 weeks


-if swab +ve Candida: give 2 weeks itraconazole

2- Topical antifungal
3- If culture is +ve for candida, give a course of itraconazole
4- +A course of systemic antibiotics

133) History typical for rosacea with red eyes, most appropriate
treatment for the eyes:
Pg. 172
Chapter 12
Hunter

Erythromatotelangiectatic type:

1- Isotretinoin

1-
2-
3-
4-
5-

2- +Metronidazole

6-

th

4 Edition

3- Topical chloramphenicol

Phymatous type:
1-

Ablative lasers

2-

Electrosurgery

Ocular type:
Oral doxycycline, Artifical
tears, Lid cleansing

Topical metronidazole
Topical azeleic acid
Decrease flushing
Cover-up makeup
Colour-correcting gels
(green)
Pulsed dye laser and intense
pulsed light

Papulospustular type:
-Combination of topical agent
with oral antibiotic
-Topical metronidazole
-Topical azeleic acid
-Topical sulfacetamide/sulfur
-Oral tetracyclines

134) Ground substance is produced by:


Pg. 18
Chapter 2

Functions:

1- Keratinocytes

1.
2.
3.
4.
5.

Hunter

2- Melanocytes

4th Edition

3- Langerhans cell

Keratinocytes: Vitamin D synthesis


Melanocytes: Synthesis melanin, protect skin from UV
Langerhans cell: Key role in immunity
Merkel cell: Transducer for fine touch
Fibroblast: Synthesis of collagen, elastin, ground substances

4- Merkel cell
5- +Fibroblasts

135) Elevated skin lesion, less than 0.5 cm, filled with fluid is called:
Pg. 35
Chapter 3

1- Papule

Hunter

Small (<0.5 cm)

Large (>0.5 cm)


Nodule ( witdh&depth)

4th Edition

2- Macule
3- +Vesicle

Elevation, solid

Papule
Plaque (w/o substantial depth)

Flat area, alter in color


or texture

Macule

Patch

Fluid filled blister

Vesicles

Bulla

4- Bulla

136) History typical of vitiligo. It can be associated with all, except:

Pg. 281
Chapter 19
Hunter
4th Edition

Generalized vitiligo ass. with autoimmune diseases like:

1- Pernicious anemia
2- Hypothyroidism

-DM
-thyroid disorders
-pernicious anemia
-Addisons => decrease melanocytes in hair bulbs (white hair)

3- Addison's disease
4- DM
5- +IDA

137) History typical of pemphigoid. Next step in management:


Pemphigoid:
Pg. 123
Chapter 9
Hunter
th

4 Edition

-autoimmune disease

1- Dapsone is drug of choice

-chronic, itchy blister

2- Admission and high dose of steroids

-elderly
-no precipitating factors

3- Start glutein-free diet

-flexures affected, mm not affected

4- Niklosky sign is likely to be +ve


5- +Take a biopsy from the bullous and normal skin
to confirm the diagnosis
Investigations: BIOPSY
Treatments:
Mild potent topical steroid
Acute prednisolone/prednisone
Immunosuppressize agent azathioprine
TCA, niacinamide

-Nikolsky test: -ve


-Direct IM: linear band IgG & C3 at basement membrane
-Indirect IM: IgG antibody at basement membrane
-peripheral blood eosinophilia

Biopsy: intra epidermal blister

138) In pemphigus vulgaris, we can find:

Direct IM: Intercellular epidermal deposits


of IgG & C3
Indirect IM & ELISA: Ab bind to desmogleins

Pg. 121
Chapter 9

1- Linear IgG deposits along basement membrane

Hunter
4th Edition

2- Linear IgA deposits along basement membrane


3- +Intercellular IgG deposits
4- Granular IgG deposits in dermal papillae
5- Granular IgA deposits in dermal papillae

139) 17 years old male with history of pustules, comedons and papules
over the face and shoulder. Most appropriate investigation:
Acne:

Pg. 166
Chapter 12
Hunter

1- Lipid profile
2- Liver function

th

4 Edition

3- CBC

-no need further investigation


-test for lipid profile, LFT & CBC
only done if we want to
prescribe the patient with
Isotretinoin ;)

4- +No further investigation

140) Adult male with history of brown macules and patches in the
groin, well-defined wrinkled with fine sales. The patient is diabetic.
Most likely diagnosis:
Erythrasma: Overgrowth of aerobic diphtheroids
Pg. 221
Chapter 16
Hunter
4th Edition

-macular wrinkled slightly scaly pink

1- Atopic eczema

-brown or macerated white areas


-in armpits, groins, between toes
-in DM: larger area like trunk

2- Seborrheic dermatistis
3- Psoriasis
4- +Erythrasma

141) Most common presentation of scabies:


Presentation of scabies:
Pg. 262
Chapter 17
Hunter
4th Edition

1- Burrows
2- +Excoriations

-first infestation: 4-6 weeks no itching, bad at night, affects others


-2nd attack: itchy within day or two
-excoriated, eczematized or urticarial papules (on trunk)
-looks for burrow (where female mites lay their eggs) on fingers

Scabies:
-Sarcoptes scabiei Hominis
-transferred from person to person by CLOSE BODILY CONTACT
-itchiness

Management of scabies:

142) About scabies treatment, one is false:


Pg. 265

-treat all family members


-scabicide (malathion, permethrin):
apply weekly
-residual itchy: calamine lotion

Chapter 17

1- Mites die in unworn clothes after 1 week

Hunter

-ordinary laundry
-mites die in unworn clothes for 1 week

4th Edition

2- We reapply permethrin after 1 week and this is mainly to


cover areas that were missed in first application
3- Ordinary laundry of bed covers and sheets is enough
4- +Sometimes there will be residual itching for several days
or weeks which may require reapplication of scabicidal

143) A child with history of skin rash covering the trunk mainly and
consisting of papules, vesicles and pustules. His sister developed
the same rash 2 weeks ago. The most important complication of this
condition involves:
1- +Lung

Pg. 239
Chapter 16

2- CNS

Hunter
4th Edition

3- GIT

This is a case of Chickenpox (Varicella):


-malaise
-papules clear vesicles pustules umbilicate
-after few days: crust & leaves white depressed scar
-itchy
-profuse on trunk

4- Kidney

-complications: Pneumonitis, scarring, 2nd infxn of skin,


haemorrhagic chickenpox

144) Not a cause of localized scarring alopecia:

Pg. 179
Chapter 13
Hunter

1- Kerion
2- Carbuncle

th

4 Edition

3- +Androgenic alopecia

4- Lichen planus

145) Mitosis in skin occurs in:

Pg. 10
Chapter 2
Hunter
th

1- All epidermal layers but more in basal layer


2- +Basal layer only

4 Edition

In normal skin some 30%of basal cells are preparing for

3- Basal and prickle

division (growth fraction). Following mitosis, a cell enters


the G1 phase, synthesizes RNA and protein, and grows in
size (Figure 2.3).

Pg. 10

146) One is false about normal skin:

Chapter 2

+Growth fraction is 60%

In normal skin some 30%of basal cells are preparing


for division (growth fraction). Following mitosis, a cell
enters the G1 phase, synthesizes RNA and protein,
and grows in size (Figure 2.3).

Hunter
4th Edition

147) We should perform diascopy when we suspect:


Diascopy: name given to the technique in which

Pg. 39

a glass slide or clear plastic spoon is pressed on vascular

Chapter 3
Hunter

1- Eczema
2- Herpes simplex

th

4 Edition

3- +Vasculitis

lesions to blanch them and verify that their redness


is caused by vasodilatation and to unmask their underlying
colour. To confirm the presence of extravasated blood in the
dermis (i.e. petechia and purpura, the appearance of which do
not change on pressure).

4- Disciod lupus

148) A child with history of URI with abdominal pain and red urine
and palpable skin rash on legs and buttock, most likely diagnosis:
Pg. 113
Chapter 8

1- Erythema multiforme

Hunter

2- Erythema nodosum

th

4 Edition

HSP = small vessel vasculitis


-ass. with palpable purpura, arthritis, abd.pain
-preceded by URTI

3- +Vasculitis

-most common affect children

4- Eczema

149) 14 years old girl presented with skin rash, one of the following
doesn't occur in urticaria:

-non scaly

Pg. 104
Chapter 8
Hunter
th

4 Edition

Urticaria:

-blanchable

1- Lesions are blanchable

-individual wheals: last less than 24 hours


-pink, itchy or burning swellings (wheals)
occur anywhere on the body
-angioedema: variants of urticarial that affects
subcutaneous tissues

2- +Single lesion lasts for 4-5 days


3- Lip swelling
4- Itching

150) Ulcer under crusted skin lesion:


Pg. 223
Chapter 16
Hunter
4th Edition

1- Impetigo

Ecthyma:
-ulcers forming under a crusted surface infection

2- +Ecthyma

-insect bite or of neglected minor trauma bacterial


pathogens and their treatment are similar to those of
impetigo

3- Boil

-in impetigo the erosion is at the stratum


corneum, in ecthyma the ulcer is full thickness, and
thus heals with scarring.

151) In allergic contact dermatitis, the allergen in plaster is:


Pg. 87
Chapter 7
Hunter

1- Nickel
2- +Colophony

4th Edition

Nickel: in cheap jewellery, jean studs


Cobalt: contaminat of nickel
Chrome: in cement, anti rust paints, tattoos & leathers
Colophony: adhesive in plasters & bandages, varnishes, paper, rosin

3- Cement

152) Most common cell type in the dermis:

The main cells of the dermis are fibroblasts, but there are

1- Lymphocytes

Pg. 19
Chapter 2
Hunter
4th Edition

2- Keratinocytes
3- +Fibroblasts

also small numbers of resident and transitory mononuclear


phagocytes, lymphocytes, dermal dendritic cells and
mast cells. Other blood cells (e.g. polymorphs) are seen
during inflammation.

4- Microphages

153) In cutaneous vasculitis, we investigate the patient for all


the following, except:

-Immune complexes may lodge in the walls of blood vessels,


activate complement and attract polymorphonuclear leucocytes

Pg. 108

-Enzymes released from these can degrade the vessel wall.

Chapter 8

-Antigens in these immune complexes include drugs,


autoantigens, and infectious agents such as viruses

1- Hepatitis B

and bacteria.

Hunter
5th Edition

2- Malignancy

-In the absence of other signs of systemic


disease or malignancy, one should consider whether the

3- +DM

onset of the vasculitis is precipitated by a drug or bug.

154) About chronic paronychia treatment, all apply, except:


Pg. 193
Chapter 13
Hunter

1- +Systemic antibiotic for 1 week


2- Topical antifungal cream

4th Edition

3- Itraconazole for 2 weeks


4- Keep hand dry and warm

Treatment for Chronic Paronychia:

-kept hand warm and dry as possible


-folds with imidazole cream(antifungal) several
times per day
-highly potent corticosteroid applied for 3 weeks
-if swab +ve Candida: give 2 weeks itraconazole

155) A patient with scaly lesion, violacous in color, all are true
about the disease except:

Pg. 72

+2% of patient's have oral lesions (it's 50%)

Chapter 6
Hunter
4th Edition

Lichen Planus:
-violaceous/lilac coloured
-intensely itching

-White asymptomatic lacy lines, dots,


and occasionally small white plaques,
are also found in the mouth,
particularly inside the cheeks, in about
50% of patients (Figure 6.4),

-flat-topped papules arise on extremities


-Wickham striae

Erythrasma:
-Overgrowth of aerobic diphtheroids

156) One is a wrong match:

-macular wrinkled slightly scaly pink

Pg. 221
Chapter 16

+Erythrasma >> streptococcus

-brown or macerated white areas


-in armpits, groins, between toes

Hunter

-in DM: larger area like trunk

4th Edition

-Woods light: coral pink

157) Tzanck smear is used in all of the following,


except:
-Tt: topical fusidic acid or miconazole
1- Pemphigous

Pg. 41

2- Pemphigoid

Chapter 3
Hunter
4th Edition

Cytology (tzanck smear) can aid the diagnosis of


1. Viral infections (herpes simplex and zoster)
multinucleated giant cell
2. Bullous diseases such as pemphigus, pemphigoid
acantholytic cells

3- HSV
4- VZS
5- +Tinea corporis

158) Most important in pathogenesis of acne:

Pg. 163
Chapter 12
Hunter
4th Edition

1- +Sebum
2- Obstruction of pilosebaceous duct
3- Propionibacterium acnes
4- Cosmetics

159) One is tetracycline used in RF:

http://www.
drugs.com/di
sease-
interactions/t
etracycline.ht
ml

1- Tetracycline
2- +Doxycycline
3- Monocycline

Tetracyclines (except doxycycline) are eliminated by the kidney to


various extent. Patients with renal impairment may be at greater
risk for tetracycline-associated hepatic and/or renal toxicity
(increased BUN with consequent azotemia, hyperphosphatemia,
and acidosis) due to decreased drug clearance.

160) One of the following is a component of keratinocyte envelope &


cross linked in the stratum granulosum by transglutaminase enzyme:
Pg. 13
Chapter 2
Hunter

1- Desmin
2- Keratin

4th Edition

3- +Involucrin

As keratinocytes migrate out through the outermost layers, their


keratohyalin granules break up and their contents are dispersed
throughout the cytoplasm. Filaggrin peptides aggregate the keratin
cytoskeleton, collapsing it, and thus converting the granular cells to
flattened squames. These make up the thick and tough peripheral
protein coating of the horny envelope. Its structural proteins include
loricrin and involucrin, the latter binding to ceramides in the
surrounding intercellular space under the influence of
transglutaminase. Filaggrin, involucrin and loricrin can all be detected
histochemically and are useful as markers of epidermal differentiation.

161) DM for 2 years, on insulin injection, presented with pain in left


leg. On examination there was redness in left leg & swelling involving
lower third. All are steps in management, except:
Pg. 225
Chapter 16

1- CXR
2- Continue insulin injection

Hunter
4th Edition

3- IV penicillin injection
4- +NSAID injection

I dont know the exact case, it maybe a case of


urticarial or erysipelas or cellulitis:
-we can give all of the following except the NSAID
bcoz the NSAID will worsen the swelling if the
patient has pharmacological urticaria that will
cause angioedema.

162) Best treatment for acute paronychia:


Pg. 192
Chapter 13
Hunter

1- +Incision & drainage and antibiotic against staph


2- Incision & drainage and antibiotic against strep

4th Edition

163) All are true about stem cells, except:


Pg. 11
Chapter 2

1- +Can be found in suprabasal layers in hair follicles

Hunter

2- Can be found on bulge of hair follicle

4th Edition

3- Ability to differentiate

*Stem cells are found in 3 places: bulge of hair, basal layer, & outer root
sheath of hair. They have ability to differentiate & have unlimited
capacity to renew themselves.

Acute paronychia
-staphylococci
-formation of pus in the nail fold or under the nail
-systemic treatment with flucloxacillin, cephalexin or erythromycin
-surgical drainage
-recurrent acute paronychia: herpes simplex virus infection.

--Notes:
*Tinea corporis:
days-weeks, itchy, unilateral, expanding scale with central clearing.
*Pityriasis rosea:
2-10 weeks, asymptomatic or itchy, mother plaque then few days
the rest of the oval plaques, well-defined.
*Psoriasis:
years, well defined, symmetrical, salmon coloured plaques,
silver scales.
*Lichen planus:
1-2 years, symmetrical, purple flat topped papules, wickham's stria,
well defined, volar wrists and feet, very itchy, leaves brown patches
after healing.
*Pityriasis versicolor:
few weeks-months, asymptomatic or slightly itchy, fine
scales, relatively well defined or well defined.

--Modalities used in vitiligo treatment:


topical steroid, topical calcineurin inhibitors, phototherapy or PUVA,
stem cell transplant, and sun protection.

--Nail changes:
*Psoriasis:
pitting, oil spots, splinter hemorrhage, subungual hyperkeratosis,
onycholysis.
*Lichen planus:
most common (nail thinning), most specific (pterygium), longitudinal
ridging.
*Chronic paronychia:
loss of cuticle, crumbling, yellow discoloration, subungual
hyperkeratosis, ridging, tender swollen nail folds.

--Hypersensitivity reactions:

*Type I (immediate): urticaria, angioedema

*Type II (humeral): autoimmune diseases; like bullous pemphigoid


and pemphigus vulgaris
*Type III (immune complex mediated): vasculitis

*Type IV (delayed): allergic contact eczema, granulomas

*About irritant contact eczema, it's not immune mediated; it is external


irritation, so it's excluded from this classification. And atopic eczema
isn't classified here either.

HAYAT Dermatology Final Questions (2013)


Note: The exam was 60 questions, 70 minutes, 1 form.

Pg. 28
Chapter 2
Hunter
4th Edition

1. Pemphigus vulgaris is an example of hypersensitivity reaction


type:
A. I
HSR type I: Urticaria and Anaphylaxis
B. +II
C. III
HSR type II: Pemphigus and Bullous Pemphigoid
D. IV
HSR type III: Vasculitis and Immune complex disease

HSR type IV: Allergic Contact Dermatitis, Granulomas

Pg. 10
Chapter 2
Hunter

2. Which of the following is true regarding the skin?



A. +Mitosis occurs
only in the basal layer of normal skin
B. Langerhans cells are non-dendritic
C. Merkel cells are found in the dermis and responsible for fine touch

4th Edition

3. Regarding melanocyates, which statement is false?


Pg. 16
Chapter 2
Hunter
4th Edition
Pg. 10
Chapter 2

A. Sun exposure is the most important stimulus for melanin production


B. They are dendritic cells
C. They are found in the basal layers of epidermis
D. +Each melanocytes connects with 3-5 keratinocytes
E. Injects melanin into keratinocytes
4. Which cell is responsible for vitamin D production?
A. +Keratinocytes
B. Langerhans cells

Hunter
4th Edition
Pg. 13
Chapter 2
Hunter
4th Edition

5. The barrier function of the skin is mainly the responsibility


of which layer?
A. Basal layer
The horny layer (stratum corneum) is made of piled-up layers of
flattened dead cells (corneocytes) the bricks separated by lipids
B. Prickle cell layer
the mortar in the intercellular space. Together these provide an
C. Granular layer
effective barrier to water loss and to invasion by infectious agents and
toxic chemicals
D. +Horney layer
E. Reticular layer

IRA
6. Scales
indicate
problem
in
which
layer?
(scalessecondary lesions, a flake arising from the horny layer,
seen in psoariasis, lichen planus, from mind map)
A. +Basal layer single layer, columnar, here the normal skin mitosis
happens
B. Granular layer containing two types of granules, keratohylin and
odland granules
C. Prickle cell layer spinous, squamous, several layers of cells, tightly
boundedby desmosomes---any prob : acantholysis (pemphigus)
7. All of the following are recognized causes of generalized pruritis,
except:
(hunter, page 323)
Genelized pruritis can be caused by (1) liver disease (2) CRF (3)
iron deficiency (4)Polycythermia (5)thyroid disease (6)diabetes
(7)internal malignancy like Hodgkin disesase (8) neuro like MS and
neurofibromatosis
(9)
diffuse
scleroderma
(10)
elderly
(11)pregnancy (12) drugs
A. Myelodysplasia
B. Hodgkins lymphoma
C. Cholestatic jaundice
D. +Systemic lupus erythematosus
8. An 8 year old boy has yellowish crusted lesions around his mouth.
His mother has asthma and is on inhaler. Which of the following is
used to treat the child? (hunter page 222, case of impetigo)
A. Topical moisturizer
B. Topical steroid
C. +Topical antibiotic
9. A car mechanic is susceptible to which of the following?
A. +Allergic contact dermatitis delayed type 4 HSR,most common to
cause ACD is nickel
B. Irritant contact dermatitis most common type of contact dermatitis
C. Atopic dermatitis exuberant production of IgE occur as a response
to common environmental allergen(hygiene hypothesis)
10. Which of the following is a type IV hypersensitivity reaction?

A. Vasculitis type 3, immune complex disease, IgG directed bind to


circulating antigens +/- other antibody, leaving immune complex
deposits
B. Urticaria Type 1, immediate type, antigen interact with IgE(which is
on mast cell), to release histamine and other mediators.
C. +Photosensitive dermatitis
D. Atopic dermatitis Type 1 immediate HSR
11. Which of the following doesnt have scalp manifestations?
A. +Rosacea centre of forehead, cheeks, nose, chin (sparing periorbital
and perioral)mind map
B. Psoriasis distribution--extensor
C. Lichen planus distribution--flexor

12. Which of the following is mismatched?


A. +Non-inflammatory tinea capitis ---- topical antifungals
*indications for systemic antifungal are tinea capitis, tinea od nails,
widespread infection and resistant infections (mindmap)
B. Seborrheic dermatitis --- topical antifungal
C. Chicken pox ---- oral Acyclovir
D. Impetigo ---- cephalaxin caps
13. A 14 year old known case of DM type 1, on regular insulin
injections. He presented with nodules on thighs bilaterally. No
other medications. Pus is expressed when the nodules are incised.
What is the most probable cause?
(teenager, DM, pus, nodules, regular injectioncould be furunculosis
or carbuncle, both by staph infection)
A. Foreign body granuloma at injection sites
B. Streptococcal infection
C. +Staphylococcal infection Not sure
D. Side effect of injection
14. What is the most common sign in scabies patients?
(HUNTER page 263)
A. Burrow mostly on the sides of fingers, finger webs, sides of the hand
and on flexural aspects of wrist.
B. +Excoriation usually on the trunk

15. What is the most common finding in scabies patients?


A. Burrow grey white, slightly scaly, linear/curvilinear papule (mindmap)
B. +Excoriation
16. Woods light is useful in the diagnosis of all of the
following, except
A. Tinea capitis green on hair shaft
B. +Melasma hyperpigmentation, symmetrical hypermelanosis mainly on
sun exposed skin (face), common in women, due to pregnancy,sunlight,
OCP, thyroid dysfunction, photosensitizing drug. Treatment by
hydroquinone.
C. Pityriasis versicolor golden yellow
D. Pseudomonas infection blue

17. Which of the following is a secondary skin lesion?


(HUNTER page 37)
A. +Lichenification definition : area of thickened skin with increase
markingsseen in eczema
B. +Ulcer area of skin from which the whole of epidermis and at least
upper part of dermis has been lost.may extend to subcu fat and heal
with scarring
C. +Erosion area of skin denuded by complete or partial loss of only the
epidermis, heal without scarring
D. Nodule elevated solid lesion, >0,5cm in both width and depth

18. A 42 year old female came with erythematous cheeks. She used
topical steroid creams which helped a little. Her history reveals
bilateral knee pain related to osteoarthritis. Which of the following
is the best to do to reach the diagnosis?
A. Anti-dsDNA
B. +Clinical evaluation (history and examination)
C. Urine metabolites
*not sure about the diagnosis but it could be erythrodermic psoariasis,
due to previous history of topical steroid use, which could be a
treatment for preexisting psoariasis (hence the osteoarthritis)
(HUNTER page 59)
19. A 67 year old male patient has hemorrhagic bullae. He has been
having several skin lesions and went to many doctors and was told he
has late-onset atopic dermatitis resistant to treatment. He has
hypertension and diabetes. Which of the following is false regarding
his condition?
*hemorrhagic bullae differential diagnosis necrotizing fasciitis,
scalded skin syndrome, herpes zoster, bullous pemphigoid,
pemphigoid vulgaris, contact dermatitis
A. His prognosis is good
B. +Indirect immunofluorescence is essential for diagnosis
C. Oral steroids should be prescribed
D. Coagulation profile will be normal
20. A patient who had dental extraction 10 days ago came to you with
non-scaly red rash distributed over the face, trunk and extremities.
Its itchy, appears to almost disappear during the day but recurs at
night. He was on ibuprofen and erythromycin for the last 5 days,
and the rash started 1 day after he stopped them. He didnt have
any problem with these medications before. The rash is blanchable on
diascopy. Which of the following is the likely cause?
A. Reaction to local anesthetic (type 1 hypersensitivity)
B. +Reaction to ibuprofen (other drug that can cause urticarial are aspirin,
nsaids, ACE inhibitor, morphine)
C. Reaction to erythromycin
D. Dental infection
21. An 8 year old female has recurrent impetigo and furunculosis.
She is otherwise normal with no important past history. What is the

most likely cause?


A. +Pediculosis (complication of pediculosis is secondary bacterial
infectionsuspected if theres history of recurrent impetigo and
crusted eczema)
B. Seborrheic eczema of the scalp affecting hair areas, greasy yellowish
scales,3 types (1) red scaly (2)dry scaly (3)intertriginous lesions. The
complications are furunculosis and candida infections(in intertriginous
type)
C. Immune deficiency

22. All of the following are complications of severe psoriasis, except:


(Answers in mind map)
A. DM
B. Ischemic heart disease
C. Small joint arthropathy
D. Depression
E. +Cutaneous lymphoma
23. A 54 year old who has psoriatic lesions covering 28% of his body
surface area. He has uncontrolled hypertension and diabetes. What is
the first line medication to prescribe?
A. Ciclosporine (side effects are renal failure and hypertension
contrainidicated!)
B. +Methotrexate (side effect : liver failure)
C. Anti-TNF drugs *use this if unresponsive to other therapies (HUNTER
page 69)
D. Steroids never use systemic steroids for psoriasis (mind map), also
steroid can increase BP
24. Which of the following is not used as systemic treatment of
severe psoriasis?
A. +Steroids
B. Ciclosporin
C. Anti-TNF agents
25. A patient who had psoriasis on hands, knees and elbows. He was
treated and now presents with pale lesions over these areas, whats
the likely cause?
A. Vitiligo
B. Autoimmune
C. +Post-inflammatory hypo-pigmentation (other psoariasis complications
are psoriatic atropathy and erythrodermic psoriasis)
26. Which of the following is not a complication of lichen planus?
A. Oral erosions
B. Nail matrix damage and scarring
C. +Hypo-pigmentation
D. Bullous and ulcerative types
*other lichen planus complications squamos cell CA, liver disease (asso
with hepatitis C infection)

27. A 30 year old female who has given birth to a boy 4 months
ago. She has diffuse hair loss. She remembers she was admitted to
the hospital before delivery and received anticoagulation. What is
the likely cause of hair loss?
A. +Telogen effluvium
B. Anticoagulation
C. Alopecia areata
D. Androgenetic alopecia
Telogen effluvium *triggered by (1) bouts of fever (2) hemorrhage (3)
childbirth (4) severe diet.
28. A 12 year old has three patches of hair loss for 2 weeks. On
examination the lesions are non-scaly with visible open hair
follicles. What is true regarding this condition?
*visible open hair follicle means non scaring
*case of alopecia areata
A. +Topical steroid cream can be used for treatment high potency
B. He should not go to school because its infectious
C. Oral antifungals should be started
D. Woods light can be used to show yellowish lesions
29. Very similar case as above (alopecia areata). Which is true?
*cause : immune basis, asso with automimmune thyroid disease,
vilitgo, atopy,inherited (HLADQ3, DR11, DR4) , can also be
triggered by environmental factors
A. KOH can be used for diagnosis
B. +Its non-infectious
C. He shouldnt go to school
30. Regarding scabies, which is true?
A. +All family members should be treated even if they are asymptomatic
B. Its caused by brief close contact
C. Can be transmitted from humans to animals but not vice versa
*treatment of scabies: permethrin, malathion. Second application is a
week after the first (mind map)

30.
A 17 year old who has bilateral facial lesions including
comedones, pustules and papules. What is the best treatment?
*this is moderate acne (pustules, papules). Treatment is well
listed in mind map (:
A. Topical antibiotics
B. Oral isotretinoin
(severe cases)
C. +Oral doxycycline with topical retinoids
D. Topical retinoids only

32. A 16 year old with facial lesions including comedones, pustules,


1 nodule, no scars. Whats the treatment? Severe
A. Oral isotretinoin only
B. +Oral isotretinoin with topical antibiotics
*can cause increase ICP
C. Oral antibiotics
D. Oral isotretinoin with oral antibiotics
33. A 33 year old female with bilateral cheek hyper-pigmentation.
She is married and recently started taking oral contraceptives. She is
a civil engineer and travels a lot. Which is the most important factor
in her condition?
A. Her sex
B. +Oral contraceptives
C. Sun exposure
*case of melasmaan acquired, symmetrical hypermelanosis on sun
exposed skin mainly the face. Other causes includes pregnancy,
sunlight, OCP, thyroid dysfunction, photosensitizing drug
34. A diabetic patient with bilateral groin rash, pinkish in color with
wrinkled skin. The most likely diagnosis:
A. +Erythrasma overgrowth of porphyrins by diptheroid. Presenting as
macular wrinkled, scaly pink, brown/macerated white areas. Site: armpits,
groin, between toesbut if diabetic it may involve larger areas of the
trunk. Dx: by woods light: coral pink. Tt: fusidic acid(topical), miconazole
(topical)
35. Lymphedema is a well-recognized complication of:
A. +Erysipelas strep infection, acute, started as malaise, shivering and
fever. After few hours, become red plaques, with well defines margins.
May develop blisters. Give systemic penicillin right away. Untreated: fatal.
36. What is the most important factor in the pathogenesis of acne?
(HUNTER page 163)
A. Propionebacterium acnes infection
B. Pilosebaceous duct occlusion
C. Increased secretion of androgens
D. Overgrowth of normal flora
E. +Sebum

37. A patient with slowly growing hyper-pigmented lesion on his arm


(long case suggestive of melanoma). Which of the following is wrong?
(HUNTER page 307)

A. Superficial spreading the most common type


B. Tumor cell depth is the most important factor for prognosis
C. It is resistant to radiotherapy
D. +If malignant melanoma is suspected, an incisional biopsy should be
done
E. All patients with malignant melanoma should have lesion excision with
safe margins

38. A patient with ulcerative lesion on the right side of the face,
rolled-edges, and visible telengectasia. Which of the following is true?
(HUNTER page 301)
case of basal cell carcinoma, with nodulo-ulcerative presentation(most
common type) which includes glistening translucent lesion, umbilicated,
skin colored papule that slowly enlarge, central necrosis, ulcer with rolled
edge and adherent crust and coarse telangiectatic vessel running across
tumor surface.
A. +Lesions should be biopsied prior to treatment
B. You should look of metastasis to internal organs
C. Radiotherapy is used in treatment (used if
surgery is contraindicated)
D. Cryotherapy should be used first, if failed the lesion is biopsied
39. An old man diabetic who had vesicles and bullae on the inferior
surface of the big toe. What is used to confirm the diagnosis?
*herpes zoster. Incidence increase in weaken normal defense
mechanismold age, hodgkins, AIDS, leukemia

A. Tzanck smear
B. +Patch test
C. KOH microscopy
D. Woods light
40. Which of the following is not regulated by the autonomic
nervous system?
A. Eccrine sweat glands
(HUNTER pg 173)
B. Apocrine sweat glands
(HUNTER pg 176)
C. Arrector pili muscle
D. +Sebaceous gland
E.
Superficial
venous
plexus
*serbaceous glands stimulated by androgenic hormones (HUNTER page
162)
41. Tzanck smear is used to investigate for:
A. +Herpes zoster (multinucleated giant cell)
*tzank smear also for pemphigus (acantholysis) ---from mind map

42. A patient had a red scaly plaque on his right flank. 3 days later
many smaller lesions appeared on his trunk. The face and
extremities are spared. He says he had similar condition previously
that resolved in 6 weeks. Which of the following is false?
*case of psoriasis (guttate) (HUNTER pg 57)
A. The diagnosis is likely the same as his previous condition because it can
recur
B. +Oral acyclovir can speed up recovery because Herpes is the
causative agent
C. No need to take precautions in the family because its not infectious
D. Topical antifungals are not useful in treatment
E. Sun exposure may be beneficial considering the distribution of the rash

43. A female who has bilateral leg nodules, fever of 38 C and feels
weak in general. She takes oral contraceptives. Which of the following
is false?
*case of erythema nodosum
A. She should have a throat swab
B. OCPs might be the cause
C. Treated by NSAIDs, and if not effective by steroids
D. +Treated by oral antibiotics, and if not effective by IV antibiotics
(HUNTER pg 113 : systemic steroids usually not needed)
44. Female, takes oral contraceptives, has left leg swelling, fever.
The leg is tender to touch. Whats your next step?
*case of erythema nodosum (HUNTER pg 113)
A. CBC, throat swab,CXR
B. Coagulation profile
C. Skin bacterial swab
D. Admission and IV antibiotics
45. A patient who has multiple skin-colored rough lesions on his hand.
Some lesions have black central head (case suggestive of warts).
*blackness caused by capillary thrombosis, a sign of healing (HUNTER
pg 237)
Whats the first line treatment?
A. +Salicylic acid paint
B. Cryotherapy
C. Cautery
*wart paint contraindicated in facial wart, anogenital wart and adjacent
eczema

46. A child who has recent viral infection comes with palpable
nonblanchable rash on the lower extremities (very obvious).
Whats the diagnosis?
*red non scaly rash divided into 2, blonchable (reactive erythema)
and non blanchable (hemorrhage and vasculitis)
A. +Vasculitis

47. A patient with purulent conjunctivitis. The ophthalmologist


treats him with topical antibiotic. Next day he starts having
generalized pealing of his skin. Whats the diagnosis?
*scalded skin syndrome erythema, tenderness, loosening of large
area of overlying epidermis.
Caused by staph infection elsewhere , like impetigo and conjunctivitis
Infection release exfoliative toxin that cleave superficial skin
adhesion molecule desmoglein 1 to disrupt adhesion high in
epidermis, causing stratum corneum to slough off. (HUNTER page
224)
A. Drug-induced
B. +Scalded-skin syndrome
C. Toxic shock syndrome
*toxic shockif theres
fever, rash, widespread
erythema
(HUNTER
page225)

48. Which of the following has predilection for the distal part of the
nail?
A. Paronychia proximal and lateral nail folds
B. Lichen planus longitudinal grooves, ptyrigium
C. +Onychomycosis
D. Alopecia areata
E. Psoriasis thimble pitting, onycholysis, subungual hyperkeratosis
49. A female patient who started having growth of terminal hair on
the chin and presternal area with deepening of the voice and
breast atrophy. Her menstrual cycle started becoming less
frequent. You should do all the following investigations, except:
*Polycystic ovarian syndrome, (HUNTER page 166) characterized by
elevated testosterone, androstenedione and dehydroepiandrosterone
sulphate levels, a reduced sex hormone binding level and a LH;FSH
ratio greater than 2.5:1
A. +Serum cortisol
B. Androstendione
C. Testosterone
D. Ultrasound for the ovaries
E. CT abdomen for adrenal glands
50. Well-defined scaly lesion on the extremities in middle to old age:
(HUNTER page 99) limbs of mid aged males, multiple lesion, coin
shaped, vesicular or crusted, itchy plaques, less than 5cm across
A. +Discoid eczema

51. A case of red scaly rashes. What is the most important to look
for on examination?
A. +Margins if its ill definedmost likely eczema! (refer to the beautiful
mind map)
B. Distribution
C. Diascopy

52. A case of red non-scaly rash, blanchable. What is the most


important to look for?
A. Duration of the rash
B. Distribution of the rash
C. Margins
D. Auspitz sign
*urticarial <24hours, e.multiforme 1-2 weeks, e.nodosum 4-6 weeks
53. Colarette scales are characteristic of
A. +Pityriasis rosea (HUNTER page 71)

54. All of the following cause allergic contact dermatitis, except:


A. +Detergents
B. Hair dyes
C.
Formaldehyde
*detergents---irritant contact dermatitis
55. Scaly well-defined lesion that has been present for 3 years. The
least likely diagnosis is
A. Psoriasis
B. Atopic eczema
C. Lichen planus
D. +Pityriasis rosea eruption lasting 2-10weeks (mindmap)
56. A patient present with red erythema of the cheeks and marked
telengiectasia, what is the most important complication of her
condition?
*case of rosacea (HUNTER page 171)
A.
+Ocular
involvement
and
blindness blepharitis, conjunctivitis,
keratitis
B. Rhinophyma this complication is
more common in male
57. A 10 year old who had papules, vesicles and pustules on his trunk.
His sister had a similar condition three weeks ago. The most feared
complication of this condition is related to the:
A. CNS
B. +Lungs
C. GIT
E. Kidneys
*pustular, blister suggesting impetigo (complication is acute
glomerulonephritis)
*not sure bout the diagnosis heresorry

58. Diascopy is not used for which of the following conditions:


A. Leukocytoclastic vasculitis
B. Erythema nodosum
C. +Psoriasis
*diascopy is a technique in which a glass slide or clear plastic spoon is
pressed on vascular lesion to blanch them and verify their redness is
caused by vasodilation and to unmask their underlying colour.
blanchable ---reactive erythema
Nonblanchable ---trauma, vessel wall injury (eg : vasculitis)
59. Which of the following is mismatched?
A. +Pityriasis
versicolor
Herald
*herald plaque is a feature of pityriasis ROSEA.
60. Which of the following is a self-limiting condition?
A. +Pityriasis rosea (eruption lasting for 2-10 weeks)

Plaque

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