Block 7 Skin Creighton Univ W Xpl Prt 1
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mostly from creighton but some from academic success.
- 1.
INTEGUMENTARY EMBRYOLOGY Melanocytes are found in which epidermal layer?
- A.
Stratum basale
- B.
Stratum corneum
- C.
Stratum granulosum
- D.
Stratum lucidum
- E.
Stratum spinosum
Correct Answer
A. Stratum basaleExplanation
Melanocytes are found in the stratum basale, the deepest layer of the epidermis, at the dermoepidermal junction.Rate this question:
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- 2.
A young black girl shows isolated patches of skin and hair that lack melanin pigment. In addition, other skin lesions are observed that look suspiciously like a malignant melanoma. What is the most likely diagnosis?
- A.
Type I oculocutaneous albinism
- B.
Type II oculocutaneous albinism
- C.
Piebaldism
- D.
Ichthyosis
- E.
Psoriasis
Correct Answer
C. PiebaldismExplanation
Piebaldism is an autosomal dominant disorder and is basically a localized albinism.Rate this question:
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- 3.
A young infant shows extremely stretchable and fragile skin, hypermobile joints, and cigarette-paper scars over the knees. What is the most likely diagnosis?
- A.
Ehlers-Danlos syndrome
- B.
Junctional epidermolysis bullosa
- C.
Psoriasis
- D.
Lchthyosis
- E.
Piebaldism
Correct Answer
A. Ehlers-Danlos syndromeExplanation
Ehlers-Danlos syndrome is an autosomal dominant disorder involving the gene for peptidyl
lysine hydroxylase.Rate this question:
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- 4.
A young infant shows skin blisters over the entire body with generalized skin erosion. Pathology indicates a cleft between the epidermis and dermis. What is the most likely diagnosis?
- A.
Psoriasis
- B.
Junctional epidermolysis bullosa
- C.
Ichthyosis
- D.
Ehlers-Danlos syndrome
- E.
Type II Oculocutaneous albinism
Correct Answer
B. Junctional epidermolysis bullosaExplanation
Junctional epidermolysis bullosa refers to a group of autosomal recessive disorders caused
by a mutation in the gene for laminin 5.Rate this question:
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- 5.
The administration of which of the following agents may result in discoloration of both deciduous and permanent teeth?
- A.
Cephalosporin
- B.
Chloramphenicol
- C.
Erythromycin
- D.
Penicillin
- E.
Tetracycline
Correct Answer
E. TetracyclineExplanation
Tetracyclines are bound to calcium in newly formed teeth both in utero and in young children. They may cause discoloration and enamel dysplasiaRate this question:
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- 6.
Which of the following cell types is normally not found in the epidermis?
- A.
Keratinocyte
- B.
Melanocyte
- C.
Langerhans cell
- D.
Merkel cell
- E.
Dendrocyte
Correct Answer
E. DendrocyteExplanation
Dendrocytes are found in the dermisRate this question:
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- 7.
Bullus pemphigoid is an autoimmune disorder that attacks the basement membrane between the epidermis and the dermis via IgG antibodies. Between what two layers would the IgG be deposited?
- A.
Stratum basale and reticular dermis
- B.
Stratum basale and papillary dermis
- C.
Stratum spinosum and reticular dermis
- D.
Stratum spinosum and papillary dermis
- E.
Stratum spinosum and stratum basale
Correct Answer
B. Stratum basale and papillary dermisExplanation
The correct answer is "stratum basale and papillary dermis". Bullous pemphigoid is an autoimmune disorder that targets the basement membrane between the epidermis and the dermis. In this condition, IgG antibodies are deposited between the stratum basale (the deepest layer of the epidermis) and the papillary dermis (the upper layer of the dermis). This deposition leads to the formation of blisters and bullae in the affected area.Rate this question:
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- 8.
A patient presents with a 3 month history of progressive weakness. On physical examination, you find bilateral decreases in strength in the legs and back. In addition, she has a rash surrounding both eyes. Laboratory values are significant for elevated LDH and CPK, and a positive ANA. What is the diagnosis?
- A.
SLE
- B.
Myasthenia gravis
- C.
Lambert-Eaton syndrome
- D.
Scleroderma
- E.
Dermatomyositis
Correct Answer
E. DermatomyositisExplanation
These are typical findings for the CD8+ T cell mediated injury to myofibers in dermatomyositis. If there were no rash, polymyositis would be likely. Additional tests to diagnose include EMG of the muscles, and biopsy.Rate this question:
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- 9.
A 70 year old man presents with discomfort in his thigh for 2 months. X ray revealed a radiolucent mass without any calcification. Biopsy of the tissue showed a pinwheel pattern of fibroblasts. Which soft tissue tumor does he most likely have?
- A.
Liposarcoma
- B.
Fibrosarcoma
- C.
Malignant fibrous histiocytoma
- D.
Lipoma
Correct Answer
C. Malignant fibrous histiocytomaExplanation
The real tipoff here is that the biopsy has a pinwheel patten. Dr. Hunter describes it as 'storiform'. Malignant fibrous hisiocytoma is the most common sarcoma of the elderly
(60s & 70s). Not only is it common, but it's deadly since it metastasizes up to 50% of the time.Rate this question:
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- 10.
Rhabdomyosarcoma is the most common soft tissue tumor of which age group?
- A.
0-15
- B.
15-30
- C.
30-50
- D.
50-70
- E.
70+
Correct Answer
A. 0-15Explanation
Rhabdomyosarcoma (malignant skeletal muscle tumor) is a small blue cell tumor and is the most common soft tissue sarcoma in children. It comes in three types, perhaps the most important is embryonal. It may present as a grape-like mass protruding from the vagina. Knowing this rather distinct presentation should be easy points on a test.Rate this question:
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- 11.
A 50 year old man has had a painless, slowly enlarging mass in his arm for the past 2 years. A biopsy reveals a herringbone pattern. What is the most likely diagnosis?
- A.
Liposarcoma
- B.
Fibrosarcoma
- C.
Malignant fibrous histiocytoma
- D.
Lipoma
Correct Answer
B. FibrosarcomaExplanation
Like question 33, the real tipoff is knowing that cellular pattern on the biopsy. Fibrosarcoma looks like a herrigbone patten. This tumor commonly presents as a slow growing painless mass in the upper extremity. Here's what the biopsy would look like. Below it is what a herringbone pattern looks likeRate this question:
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- 12.
Small vessel vasculitic myopathy best describes which of the following?
- A.
Kearns-Sayre syndrome
- B.
Becker muscular dystrophy
- C.
Polymyositis
- D.
Dermatomyositis
- E.
Nemaline myopathy
Correct Answer
E. Nemaline myopathyExplanation
Dermatomyositis is a complement mediated, small vessel vasculitic myopathy that results in perifascicular atrophy. Dr. Brumback made a point to repeat that statement. Polymyositis differs grossly in that it does not involve a rash and microscopically in that lymphocytes invade the muscle fibers. Both polymyositis and dermatomyositis result in proximal muscle weakness (ie trouble getting out of a chair) and elevated plasma muscle enzymes (CKP, myoglobin). Kearns-Sayre syndome is one of many mitochondrial myopathies. This presents as eye muscle paralysis. Leber's optic atrophy results in blindness.Rate this question:
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- 13.
You are looking at a biopsy specimen from a suspicious skin lesion. The tissue consists mainly of spindle cells in a storiform pattern, and it stains with CD34. What is the most appropriate statement to tell the patient?
- A.
This is characteristic of basal cell carcinoma, which rarely metastasizes.
- B.
This is characteristic of dermatofibrosarcoma, a rare but treatable skin cancer.
- C.
This is characteristic of actinic keratosis, a precursor to squamous cell carcinoma
- D.
This is characteristic of keratoacanthoma, a neoplasm that heals spontaneously
Correct Answer
B. This is characteristic of dermatofibrosarcoma, a rare but treatable skin cancer.Explanation
The storiform patten of spindle cells is most characteristic of dermatofibrosarcoma. The other lesions tend to involve keratinocytes. Another reasonable answer for this biopsy would be Kaposi sarcoma, especially if we knew that the patient was immunosuppressed.Rate this question:
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- 14.
A 45 year old patient presents to you with dozens of velvety pigmented papules on his trunk and extremities that appear stuck on. He is concerned since he had very few nevi before 3 months ago. Which of the following aspects of his history is most relevant to his current lesions:
- A.
He works as a charter fishing guide in Florida
- B.
He has a 40 pack/year history of smoking
- C.
He has had 20 lifetime male sexual partners
- D.
He has controlled diabetes
Correct Answer
B. He has a 40 pack/year history of smokingExplanation
He most likely has many seborrhei keratoses. These can develop as an explosion of growth, which is associated with paraneoplastic syndrome. This is called the Leser-Trelat sign. His age and smoking history put him at high risk for lung cancerRate this question:
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- 15.
After walking in the woods while wearing sandals, a 20 year old man develops a weeping erythematous rash with vesicles. Which type of cell is least likely to be involved in this reaction?
- A.
Neutrophil
- B.
Langerhans cell
- C.
CD4+ T cell
- D.
CD8+ T cell
Correct Answer
D. CD8+ T cellExplanation
The delayed type IV hypersensitivity reaction begins when Langerhans cells are exposed to an antigen (such as poison ivy). The antigen is then presented to CD4+ T cells. These T cells are responsible for producing the eczema upon re-exposure. They produce cytokines which attract inflammatory cells such as neutrophils.Rate this question:
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- 16.
Erythema multiforme is a hypersensitivity reaction in the skin characterized by targetoid vesicles. It can be triggered by infection, drugs, and malignancy, among others. How is Stevens-Johnson syndrome different from erythema multiforme?
- A.
Stevens-Johnson syndrome involves mucosal membranes
- B.
Stevens-Johnson syndrome is only involved on the the extremities
- C.
Stevens-Johnson syndrome is a type IV hypersensitivity reaction, not a type II like erythema multiforme
- D.
Stevens-Johnson syndrome is not triggered by drugs
Correct Answer
A. Stevens-Johnson syndrome involves mucosal membranesExplanation
Stevens-Johnson syndrome is a more extensive form of erythema multiform that involves both the skin and the mucosal membranes. Both are type II hypersensitivity reactions.Rate this question:
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- 17.
The H&E of a skin biopsy seen below was most likely taken from a patient with:
- A.
Superficial spreading melanoma
- B.
Squamous cell carcinoma
- C.
Basal cell carcinoma
- D.
Bullus pemphigoid
- E.
Seborrheic keratosis
Correct Answer
C. Basal cell carcinomaExplanation
This is an example of palasading cells. They form a ring around the tumor islands. This is evident in cancers resulting from the basal cell layer in the epidermis.Rate this question:
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- 18.
How would you treat a patient with the lesion seen in this skin biopsy?
- A.
Antibiotics
- B.
Antivirals
- C.
Resection of lesions
- D.
Steroids
- E.
Allopurinol
Correct Answer
D. SteroidsExplanation
This is bullous pemphigoid, a disease caused by IgG antibodies against the basement membrane between the epidermis and dermis. In the picture, the epidermis and dermis have separated. In pemphigus vulgaris, the antibodies are directed against desmosomes within the epidermis. In either case, immunosuppression by steroids is the most effective treatment.Rate this question:
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- 19.
This tissue section came from a skin lesion that is best described as:
- A.
Common, malignant
- B.
Rare, malignant
- C.
Common, benign
- D.
Rare, benign
- E.
Common, precursor of malignancy
Correct Answer
C. Common, benignExplanation
This is seborrheic keratosis. It is a common, benign lesion which exhibits epidermal hyperplasia and horn cystsRate this question:
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- 20.
Your patient has an erythematous, weeping lesion on her face. If you treat this lesion with steroids, which of the following preparations is most appropriate?
- A.
Non-fluorinated ointment
- B.
Non-fluorinated cream
- C.
Non-fluorinated lotion
- D.
Fluorinated ointment
- E.
Fluorinated cream
- F.
Fluorinated lotion
Correct Answer
C. Non-fluorinated lotionExplanation
Don't use a potent steroid on warm, wet areas such as the face, axilla, and groin. Potent steroids tend to be fluorinated. Since the lesion is 'wet' (weeping), it would be better to use a lotion. Lotions, powders, and wet dressing are better for acute inflammation which tends to be wet. Chronic inflammation should be treated with an ointment. For example, an area of severe scaling lichenification would be treated with a fluorinated ointment.Rate this question:
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.JPG "The H&E of a skin biopsy seen below was most likely taken from a patient with:")
.JPG "How would you treat a patient with the lesion seen in this skin biopsy?")
.JPG "This tissue section came from a skin lesion that is best described as:")
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