DIRECTIONS

DIRECTIONS: (Items 1-40): Each of the slides you will see is associated with a question or incomplete statement followed by five suggested answers or completions. Select the ONE that is BEST in each case, and completely fill in the circle containing the corresponding letter on the answer sheet. You will be given one minute to view each slide and choose your answer.

1. Which of the following is the most likely cause of this eruption?

A. Sesquiterpene lactone

B. Glyceryl thioglycolate

C. Acrylate resin

D. Colophony

E. Thiourea

2. This lesion is most closely associated with mutations in which of the following genes?

A. NF-1

B. p53

C. Sonic hedgehog

D. p16/CDKN24

E. C-fos

3. Which of the following best describes the histologic features of these lesions?

A. Amorphous eosinophilic material surrounding superficial vessels

B. Cystic cavities eosinophilic material surrounding superficial vessels

C. A cystic cavity whose wall is composed of small cuboidal cells

D. Nodular infiltrates of epitheliod and giant cells with central necrosis

E. Superficial aggregates of macrophages filled with lipid droplets

4. Which of the following organisms is the most likely cause of this clinical pitcture?

A. Staphylococcus epidermidis

B. Corynebacterium minutissisum

C. Micrococcus sedentarius

D. Candida albicans

5. What hair shaft defect is shown on this photomicrograph?

A. Monilethrix

B. Trichorrhexis nodosa

C. Trichorrhexis invaginata

D. Pili Torti

E. Pili Canaculi

6. The pigmented suggests

A. tuberous sclerosis

B. acanthosis nigricans.

C. Peutz-Jeghers syndrome.

D. neurofibromatosis.

E. LEOPARD syndrome.

7. The most likely diagnosis for this lesion in an 18-year-old woman is

A. nevus spilus

B. dysplastic or Clark's nevus.

C. accrolentiginous melanoma.

D. nevus anemicus.

E. café au lait macule.

8. The 44-year-old hairdresser has noted discoloration of her fingernails with tenderness of the nail bed over the previous year. The most likely causative organism os

A. Trichophyton mentagrophytes

B. Pseudomonas aeruginosa.

C. Corynebacterium tenuis.

D. Staphylococcus pyogenes.

E. Streptococcus pyogenes.

9. A patient taking multiple medications presents with the rash shown here Which of the following is most likely responsible?

A. Tretinoin cream

B. Benzoyl peroxide

C. Diphenhydramine cream

D. Bethamethasone valerate cream

E. Ketoconazole 2% cream

10. A 22-year-old man presents with perianal irritation. The best initial treatment for this condition is

A. Ketoconazole 2% cream

B. hydrocortisone 2% cream

C. imiquimod 1% gel

D. CO2 Laser vaporization

E. benzathine penicillin.

12. The characteristic histologic features of these lesions include

A. fibrosis with plump interstitial fibrocytes.

B. interstitial histiocytes and perivascular lymphocytes.

C. Touton giant cells and interstitial histiocytes.

D. sarcoidal granulomas and perivascular lymphocytes.

E. interstitial lymphocytes and perivascular histiocytes.

13. This appearance of the tongue is seen in which of the following?

A. Moynahan's syndrome

B. Melkersson-Rosenthal syndrome

C. Muckle-Wells syndrome

D. Refsum's syndrome

E. Mucosal endothelial neoplasia syndrome

14. Which hair shaft defect is depicted in this phtomicrograph?

A. Monilethrix

B. Trichorrhexis nodosa

C. Trichorrhexis invaginata

D. Pili torti

E. Pili canaliculi

15. The organism in this periodic acid-Schiff stained specimen is

A. Blastomycytes dermatidis

B. Prototheca wickerhamii.

C. Cryptococcus neoformans

D. Paracoccidioides brasiliensis

E. Rhinosporidium seeberi.

16. Which of the following organisms is the most likely cause of these lesions in a healthy child?

A. Streptococcus pyogenes

B. Staphylococcus aureus

C. Pseudomonas aeruginosa

D. Pitytrosporum spp.

E. Candida albicans

17. The abnormality associated with the disorder that produces the changes seen in this biopsy specimen is

A. hypercalcemia.

B. anemia

C. hyponatremia

D. hypokalemia.

E. decreased production of growth hormone.

18. The most appropriate therapy for this child is

A. methotrexate.

B. dapsone

C. pulse methylprednisolone

D. erythromycin.

E. tetracycline

19. The lining of this lesion is composed of

A. keratinizing epithelium with a granular layer.

B. keratinizing epithelium with no granular layer.

C. an eosinophilic cuticle with sebaceous glands within the wall.

D. cartilage.

E. fat.

20. This condition can be treated effectively with which of the following?

A. Oral aspirin

B. Botulinum toxin

C. Topical terbinafine cream

D. Cold water

E. Topical corticosteroids.

21. This patient demonstrates characteristic clinical features pf

A. methotrexate mucositis.

B. Behcet's disease.

C. herpetic gingivostomatitis.

D. diphenylhydantoin mucosal hypertrophy.

E. pyostomatitis vegetans.

22. This patient demonstrates characteristics clinical features of

A. amniotic band syndrome.

B. aplasia cutis congenita.

C. lipoatrophia semicircularis.

D. proteus syndrome.

E. localized lipohyperthropy.

23. This condition was caused by the ingestion of a

A. mango

B. cashew nut.

C. raw oyster

D. blue fish

E. blow fish

24. This condition is most typical of

A. discoid lupus erythematosus.

B. aplasia cutis congenital.

C. tinea capitis.

D. tufted folliculitis.

E. alopecia areata.

25. Skin biopsy of this patient demonstrates.

A. increased mucopolysaccharide levels.

B. epidermolytic hyperkeratosis.

C. an absence of eccrine sweat glands.

D. macromelanosomes.

E. interface dermatitis

26. This disorder is characterized histologically by

A. a cyst producing laminated keratin.

B. a cyst with an eosinophilic cuticle lining the wall.

C. normal fat cells surrounded by a thin connective tissue capsule.

D. faintly eosinophilic, thin, wavy fibers in loosely textured strands—large, uniform, oval, spindle-shaped nuclei.

E. spindle-shaped cells with blunt abnd rounded tips.

27. The most likely diagnosis for this 44-year-old woman with circulating autoantibodies directed against aminoacyl t-RNA synthetases is

A. CREST syndrome

B. dermatomyositis

C. progressive systemic sclerosis

D. Sjogren syndrome

E. subacute cutaneous lupus erythematosus

28. The most likely diagnosis is

A. dermatofibrosarcoma protuberans.

B. atypical fibroxanthoma.

C. microcystic adnexal carcinoma.

D. cutaneous leiomyosarcoma.

E. Merkel cell carcinoma.

29. This lesion is best characterized as

A. Bowen's disease.

B. lentigo maligna

C. pigmented basal cell carcinoma.

D. ochronosis.

E. melasma

30. Based on these dermatoscopic findings, this lesion is a

A. dermatofibroma

B. melanoma

C. cherry angioma

D. pigmented basal cell carcinoma

E. seborrheic keratosis

31. The black sap shown contains

A. frullanolide.

B. parthenolide.

C. parthenin.

D. pentadecatechol.

E. primin.

32. Which of the following is least likely to cause this condition?

A. Furosemide

B. Indomethacin

C. Naproxen

D. Tetracycline

E. Chlorpromazine

33. The most likely diagnosis is

A. calciphylaxis

B. warfarin necrosis.

C. Wegener's granulomatosis.

D. purpura fulminans.

E. toxic epidermal necrolysis.

34. The most likely cause of this condition is

A. minocycline.

B. ethinyl estradiol.

C. bleomycin

D. hydroxychloroquine.

E. amiadarone.

35. The gland of origin in this condition is

A. eccrine.

B. apocrine.

C. sebaceous

D. lacrimal

E. parotid.

36. The most likely diagnosis for this 25-year-old, HIV-positive man is

A. molluscum contagiosum

B. zygomycosis

C. cryptococcosis

D. varicella-zoster

E. bacillary angiomatosis

37. This carcinoembryonic-antigen-positive tumor is

A. extramammary Paget's disease.

B. Bowen's disease.

C. bowenoid papulosis.

D. basal cell carcinoma.

E. amelanotic melanoma.

38. This nail change is known as

A. Beau's lines

B. elkonyxis

C. Mee's lines

D. onychoschizia

E. trachyonchia

39. This insect, which is a common cause of intense pruritus, is

A. Anthrocoris kingi

B. Cimex lectularius.

C. Dufouriellus ater.

D. Haematosiphon inodorus.

E. Lytocoris campestris.

40. This congenital lesion of the neck is a

A. melanocytic nevus.

B. wattle.

C. throglossal duct cyst and sinus.

D. cutaneous calculus.

E. Spitz nevus.

DIRECTIONS: (Items 41-50): Each of the slides shows a dermatologic disorder. From the following list of 26 items (A-Z), choose the one answer that best describes the clinical findings, and completely fill in the circle containing the corresponding letter on the answer sheet. You will be given 1 1/2 minutes to view each slide and choose your answer.

A. Ulerythema ophrygenes

B. Accesory auricle

C. Impetigo

D. Neurofibroma

E. Dermatitis herpetiformis

F. Stellate pseudoscar

G. Actinic keratosis

H. Juvenile xanthogranuloma

I. Nevus sebaceous

J. Eczematous dermatitis

K. Psoriasis

L. Basal cell carcinoma

M. Lichen amyloidosus

N. Nodular scabies

O. Favus

P. Pseudoporphyria

Q. Blue rubber bleb nevus

R. Lichen aureus

S. Pitted keratolysis

T. Glomus tumor

U. Cutaneous T-cell lymphoma

V. Melanoma

W. Herpes simplex

X. Morphea

Y. Herpes zoster

Z. Cylindroma

DIRECTIONS: (Items 51-60): Each of the slides shows a photomicrograph of a histologic section. From the following list of 26 items (A-Z), choose the one answer that best describes the pathologic findings, and completely fill in the circle containing the corresponding letter on the answer sheet. You will be given 1 ½minutes to view each slide and choose your answer.

A. Verruca vulgaris

B. Actinic keratosis

C. Lupus erythematosus (discoid)

D. Porphyria cutanea tarda

E. Dermatitis herpetifomis

F. Tinea corporis

G. Basal cell carcinoma

H. Melanocytic nevus

I. Psoriasis

J. Granuloma annulare

K. Syringoma

L. Basal cell carcinoma

M. Melanoma in situ

O. Herpes simplex

P. Seborrheic keratosis

Q. Blastomycosis

R. Pemphigus vulgaris

S. Pyogenic granuloma

T. Juvenile xanthogranuloma

U. Bullous pemphigoid

V. Pilomatrixoma

W. Lichen sclerosus er atrophicus

X. Pitytriasis rosea

Y. Lymphocytoma cutis

Z. Cutaneous T-cell lymphoma

61. The application of heat is preferred in the treatment of vesicant infiltration with

A. flourouracil.

B. daunorubicin.

C. bleomycin.

D. vinca alkaloids.

E. cisplatin

62. What is the mechanism of action of botulinum toxin?

A. Blockage of acetycholine binding to a presynaptic vesicle

B. Blockage of acetycholine binding to a postsynaptic vesicle

C. Blockage of epinephrine binding to a postsynaptic vesicle

D. Blockage of epinephrine binding to a postsynaptic vesicle

E. Blockage of norepinephrine binding to a presynaptic vesicle

63. Which of the following is associated with ultraviolet recall?

A. Tetracycline

B. Doxorubicin

C. Mitomycin C

D.Hydrochlorothiazide

E. Methotrexate

64. Which of the following basement membrane proteins shares significant amino acid sequence homology with type XVII collagen?

A. Bullous pemphigoid antigen-1 (BP230)

B. Alpha 6, beta 4 integrin

C. Laminin 5

D. Plectin

E. Linear IgA disease antigen

65. Which of the following drug classes is most often associated with acquired angioedema?

A. Beta blockers

B. ACE inhibitors

C. Non-sedating antihistamines

D. Salicylates

E. Azole antifungals

66. What is the most likely site for the primary malignancy in a woman with cutaneous metastases?

A. Lung

B. Colon

C. Kidney

D. Breast

E. Liver

67. Retention of primary teeth is characteristic of which of the following?

A. Nevoid basal cell carcinoma syndrome

B. Anhidrotic ectodermal dysplasia

C. Incontinentia pigmenti

D. Hyper IgE syndrome

E. Dyskeratosis congenital

68. Absence of the thymic shadow on chest x-ray is a feature of

A. chronic granulomatous disease.

B. severe combined immunodeficiency.

C. Leiner's disease.

D. hyper IgE syndrome.

E. Wiskott- Aldrich syndrome.

69. Perianal pseudoverrucous papules and nodules in children are associated with

A. sexual abuse.

B. pinworm infection.

C. diaper dermatitis

D. maternal human papillomavirus infection.

E. lichen simplex chronicus

70. Which of the following therapies is most appropriate for stage T1 (< 10% body surface area) mycosis fungoides?

A. Photopheresis

B. Total skin electron beam radiotherapy

C. Intralesional interferon

D. Class I topical corticosteroids

E. Calcipotriene 0.005% ointment

71. Which of the following substances is an inhibitor of cytochrome P450?

A. Omeprazole

B. Rifampin

C. Tobacco

D. Carbamazepine

E. Grapefruit juice

72. One hour after slamming his hand in a car door, a patient presents with a throbbing distal right index finger. The nail bed appears black and has periungual erythema. The best treatment is

A. immediate trephination of the nail bed.

B. trephination after 24 hours of oral antibiotics.

C. oral antibiotic therapy and nonnarcotic analgesics

D. avulsion of the nail plate.

E. partial phenol-alcohol nail matrixectomy.

73. The ideal patient for laser hair removal jas

A. blond, rapidly growing hair.

B. type 1 skin and dark hair.

C. tanned type 2 skin.

D. type 5 skin and slow hair growth.

E. fewer than 100 hairs/cm2.

74. Intravenous immunoglobulin administration may be beneficial in the management of toxic epidermal necrolysis by

A. inhibiting natural killer cell activity.

B. blocking Fas Fas- L interactions on keratinocytes.

C. stabilizing desmosomal connections.

D. preventing secondary pseudomonas infection.

E. down- regulating endothelial ICAM-1 expression.

75. The portion of an antibody molecule that determines antigen-specific binding is the

A. Fc portion.

B. idiotype.

C. isotype

D. haplotype.

E. joining region.

76. The mechanism of action of mycophenolate mofetil is inhibition of

A. the interlukin-2 response to T-cell activation.

B. dihyfrofolate reductase.

C. DNA polymerase.

D. purine biosynthesis.

E. actin polymerization.

77. The treatment of choice for bacillary angiomatosis is

A. ciprofloxacin

B. clindamycin.

C.erythromycin.

D. sulfamethoxazole/ trimethoprim.

E. dicloxacillin.

78. The vector of trench fever/ urban trench fever is a

A. flea.

B. human body louse.

C. tick.

D. mite.

E. mosquito.

79. Which of the following types of pseudolymphoma is B-cell origin?

A. tattoo-induced lymphocytoma cutis

B. Actinic reticuloid

C. Lymphomatoid papulosis type B

D. Nodular scabies

E. Anticonvulsant- induced pseudolymphoma syndrome

80. Behcet's disease is associated with which of the following HLA types?

A. B51

B. DR1

C. B27

D. B19

E. DQW1

81. Wiskott- Aldrich syndrome is characterized by

A. an autosomal recessive pattern of inheritance.

B. Thrombocytosis.

C. lichenoid dermatitis.

D. enlarged lymphocytes.

E. a high risk of malignancy in childhood.

82. Which of the following is a single stranded DNA virus?

A. Adenovirus

B. Parvovirus

C. Herpesvirus

D. Parvovirus

E. Togavirus

83. The most common adverse reaction from mycophenolic acid therapy for severe psoriasis is

A. genitourinary urgency.

B. gastrointestinal disturbances.

C. anemia.

D. herpes zoster infection.

E. tinnitus

84. Clonal populations of mononuclear cells infiltrating the lesional epidermis in psoriasis are predominantly

A. CD 4+

B. CD 8+

C. CD 9+

D. CD 16+

E. CD 20+

85. The most likely cause of drug-induced pemphigus is

A. diphenylhydantoin.

B. furosemide.

C. dapsone.

D. cantropil.

E. trimethoprim sulfamethaxazole.

86. FDA-approved adjuvant therapy for high risk, stage IIB and III melanoma includes

A. interlukin-2

B. interferon-alpha 2b

C. interferon-beta

D. interferon-gamma

E. interlukin-6

87. Imipramine- induced hyperpigmentation is asscociated with

A. onset within the first 2 months of treatment.

B. delayed-type hypersensitivity reactions

C. photodistribution.

D. hepatotoxicity.

E. lipid granules within the dermis

88. The antiviral effectsof imiquimod are mediated by

A. induction of apoptosis.

B. induction of interferon-alpha

C. chemoattraction of CD8 T lymphocytes

D.inhibition of viral DNA synthesis.

E. elicitation of a delayed-type hypersensitivity reaction.

89. A patient in the third trimester of pregnancy has severe pruritus (worse at night), fatigue, nausea, and vomiting. Skin examination reveals erosions consistent with excoriations. The most likely diagnosis is

A. impetigo herpetiformis.

B. herpes gestationis.

C. pruritic urticarial papules and plaques of pregnancy.

D. cholestasis of pregnancy (prurigo gravidarum).

E. scabies.

90. Garciclovir is more effective than acyclovir for the treatment of cytomegalovirus disease because of

A. greater oral bioavailability.

B. longer intracellularhal-life of the triphosphate form.

C. longer plasma half-life of the parent drug

D. superior DNA chain termination

E. preferential binding to CMV-encoded phosphotransferase.

91. Breslow's thickness (thickness of invasive melanoma) is measured from the

A. granular cell layer to the deepest level of invasion.

B. stratum corneum to the deepest level of invasion.

C. basal cell layer to the deepest level of invasion.

D. most superficial melanocyte to the deepest level of invasion

E. stratum cormeum to the deepest level of extension along a hair follicle.

92. Which of the following features most strongly suggests an underlying myeloproliferative disorder in an individual who presents with Sweet's syndrome?

A. Anemia

B. Neutrophil count >

C. Sustained fever of greater than 72 hours duration

D. Eosinophil count > 1,000

E. More than 20 lesions

93. Which of the following disorders manifests as reticulated hyperpigmentation in the axillae and groin?

A. Dowling- Degos disease

B. Fox-Fordyce disease

C. Vogt-Koyanagi syndrome

D. Dyskeratosis congenital

E. Francheschetti-Jadassohn-Naegali syndrome

94. What is the most basis of cutaneous ulcerations associated with interferon-beta therapy?

A. Direct collagen necrosis

B. Thrombosis

C. Immune complex deposition

D. Nonsterile injection technique

E. Polyarteritis

95. Green hair discoloration in swimmers is due to

A. chlorine binding

B. matrix damage with bubble formation.

C. copper deposition

D. low-level algae contamination

E. chelation of shampoo additives.

96. Which of the following is associated with drug-induced pemphigus?

A. Trimethoprim sulfamethoxazole

B. Captopril

C. Lisinopril

D. Furosemide

E. Naproxen

97. Superficial trauma is most closely related to development of a lesion of

A. linear focal elastosis.

B. elastosis perforans serpiginosa

C. perforating collagenosis.

D. Kyrle's disease.

E. perforating folliculitis.

98. Which of the following vascular disorders is most closely associated with Kasabach-Merritt syndrome?

A. Strawberry hemangioma

B. Angiolymphoid hyperplasia

C. Kaposiform hemangioenthelioma

D. Cutis marmorata telangiectatica congenital

E. Port-wine satin

99. The characteristic histologic features of cutaneous malacoplakia are

A. early lesions with leukocytes vasculitis.

B. factor XIIa-positive histiocytes in skin lesions.

C. numerous eosinophils between histiocytes.

D. grains formed of bacteria and immunoglobulin.

E. intracellular calcified lamellated bodies.

100. Basophilic deposits of calcium in necrotic fat cells are characteristic of which form of panniculitis?

A. Erythema nodosum

B. Pancreatic panniculitis

C. Lupus profundus

D. Cytophagic histiocytic panniculitis

E. Alpha-1 antitrypsin-deficiency-associated panniculitis

101.The differential diagnosis of diffuse palmoplantar keratoderma includes

A. secondary syphilis

B. acrodermatitis chronica atrophicans.

C.pachydermodactyly

D. colloid milium

E. Dowling- Degos disease.

102. A Warthin-Starry stain identifies the organism discovered by

A. Leishman

B. Wucherer

C. Burgdorfer

D. Langenback

E. Pasteur

103. Poliosis is a clinical finding in

A. anhidrotic ectodermal dysplasia.

B. oral digital facial syndrome.

C. vitiligo

D. proteus syndrome

E. nevoid basal cell carcinoma syndrome.

104. Un the United States, the plant family most often responsible for contact urticuria is

A. urticaceae (nettle family)

B. H (water leaf family).

C. loassaceae (loasa family)

D. euphorbiaceae (spurge family)

E. araceae (dumb cane)

105. Intravenous 5-flouracil therapy may result in

A. serpentine supravenous hyperpigmentation

B. neutrophilic eccrine hidradenitis

C. red man syndrome

D. Raynaud's phenomenon

E. flagellate hyperpigmentation

106. To which FDA pregnancy-use category does topical tretinoin belong?

A. Category A

B. Category B

C. Category C

D. Category D

E. Category X

107. A newborn infant has localized hypertrichosis of the skin overlying the midline lumbar spine. What is the most appropriate next step in management?

A. X-rays of the spine

B. Myelofram

C. Observation only if the neuromuscular examination is normal

D. MRI of the spine

E. Excision of the localized hypertrichosis

108. The protein that is deficient in all subtypes of junctional epidermolysis bullosa is

A. laminin 5

B. alpha 6, beta 4 integrin

C. uncein (19-DEJ)

D. BP2Ag.

E. keratin

109. Which of the following conditions has the highest risk for spinal dysraphism?

A. Large Mongolian spot on the sacrum

B. Cafe au lait macule overlying the gluteal cleft

C. Ulcerated hemangioma on the left buttock

D. Port-wine stain over the gluteal cleft

E. Lipoma of the sacrum

110. Which of the following is most likely to cause a fixed eruption?

A. Trimethroprim sulfamethoxazole

B. Docusate

C. Ferrous sulfate

D. Aminophylline

E. Chondroitin sulfate

111. The region of the body with the greatest percutaneous absorption of chemical agents is

A. eyelids

B. scrotum

C. mucous membranes.

D. face.

E. neck.

112. The most common pattern of psoriatic arthritis is

A. symmetric oligoarthritis of small joints.

B. asymmetric oligoarthritis of small joints.

C. ankylosing spondylitis.

D. arthritis mutilans.

E. oligoarthritis of large joints.

113. An otherwise healthy 18-year old man presents with fever, chills, arthritis, and six discrete vesicles and pustules or an erythematous base on the palm and fingers. The treatment of choice is

A. tetracycline.

B. ceftriaxone.

C. penicillin.

D. isotretinoin.

E. prednisone.

114. A decreased thiopurine methyltransferase level is associated with toxicity to

A. cyclophosphamide.

B. cyclosporine.

C. dapsone

D. azathioprine.

E. chroquine.

115. The prophylatctic therapy of choice in patients with frequent and or severe attacks of hereditary angiodema is

A. prednisone

B. danazol.

C. C1-INH concentrate

D. fresh frozen plasma

E. diphenhydramine.

116. The most common associated finding in alkaptonuriasis is

A. renal disease.

B. retinopathy

C. cardiovascular disease.

D. hepatitis.

E. arthropathy

117. Which of the following chemicals best absorbs ultraviolet B?

A. Dioxybenzone

B. Oxybenzone

C. Sulisobenzone

D. Amyl p-dimethylaminobenzoate

E. Methyl anthranilate

118. A patient with severe psoriasis is to begin treatment with cyclosporine. Which of the following medications should be discontinued?

A. Triamterene

B. Hydrochlrothiazide

C. Furosemide

D. Bumetanide

E. Erthacrynic acid

119. Patients treated with vancomycin are at risk for developing

A. bullous pemphigoid

B. cicatricial pemphigoid.

C. epidermolysis bullosa acquisita.

D. linear IgA bullous dermatosis

E. pemphigus foliaceus.

120. Patients with triangular lunulae are likely to have

A. corneal opacities

B. diabetes mellitus

C. an oral white sponge nevus

D. seizures.

E. unstable knees.

121. Circulating autoantibodies to type XVII collagen are most characteristic of

A. cicatricial pemphigoid

B. epidermolysis bullosa acquisita.

C. herpes gestations.

D. linear IgA bullous disease.

E. paraneoplastic pemphigus

122. Offspring of consanguineous matings are predisposed to the development of

A. Darier's disease.

B. epidermolytic hyperkeratosis

C. itchyosis vulgaris

D. nonbullous itchyosiform erythroderma

E. steroid sulfatase deficiency

123. Which keratins are predominantly expressed by basal keratinocytes?

A. 1 and 10

B. 3 and 12

C. 5 and 14

D. 6 and 16

E. 7 and 1

124. Cholinergic urticaria is triggered by

A. cold

B. vibration

C. heat

D. pressure

E. water.

125. Which body part is relatively spared in Gianotti-Crosti syndrome?

A. Arms

B. Buttocks

C. Face

D. Feet

E. Trunk

126. The most likely diagnosis for a child with high fever for 5 days, inguinal erythema and cervical lymphadenopathy is

A.Kawasaki disease.

B. rubella.

C. rubeola.

D. staphylococcal scalded skin syndrome.

E. toxic shock syndrome.

127. In the normal epidermis, mitotic activity occurs predominantly in which compartment?

A. Basal cell layer

B. Stratum, corneum

C. Granular cell layer

D. Stratum lucidum

E. Stratum spinosum

128. Patients with familial lipoprotein lipase deficiency (type I) develop eruptive xanthomas and

A. premature atherosclerosis.

B. pancreatitis.

C. obesity

D. glucose intolerance.

E. hyperuricemia.

129. Which of the following is a good prognostic sign in a patient with melanoma?

A. Older age

B. Location on the head and neck

C. Presence of ulceration

D. Evidence of regression

E. Female sex

130. Of the following, patients with hirsutism are most likely to have

A. increased serum prolactin levels.

B. decreased serum luteinizing hormone/follicle stimulating hormone ratios.

C. decreased 5-alpha-reductase activity.

D. increased serum testosterone levels.

E. decreased serum 17-OH progesterone levels.

131. A 68-year-old man presents with a 1-year history of a verrucous plaque on the left leg. A skin biopsy shows round, thick-walled, brown cells in the dermis. Which is the most likely etiologic agent?

A. Forsecaea pedrosoi

B. Coccidioides immitis

C. Sporothrix schenckii

D. Blastomyces dermatitidis

E. Pseudallescheria boydii

132. What topical agent is most effective in lichen sclerous et atrophicus?

A. Triamcinolone

B. Pramoxine

C. Clobetasol

D. Doxepin

E. Testosterone

133. Which of the following is a double stranded DNA virus?

A. Rubella

B. Hepatitis C

C. Molluscum contagiosum

D. Measles

E. Erythema

134. A 58-year old man had excision of a 3-cm basal cell carcinoma 1 1/2 cm lateral to the left outer canthus. Postoperatively, the patient has difficulty raising his eyebrow.

Injury to which nerve is most likely?

A. Supraorbital

B. Zygomatic

C. Temporal

D. Infraorbital

E. Supratrochlear

135. Sebaceous carcinoma positively with

A. toluidine blue.

B. alcian blue.

C. Brown-Brenn.

D. periodic acid-Schiff with diastase.

E. oil red O.

136. For infants with large facial hemangiomas, the study most likely to demonstrate an abnormality is an

A. echocardiogram

B. brain MRI

C. hepatic ultrasound

D. ocular tonometry

E. platelet count.

137. Wound eversion is best produced with which of the following suture techniques?

A. Simple interrupted suture

B. Vertical mattress suture

C. Locked suture

D. Running subcuticular suture

E. Loop stitch

138. The most likely cause of allergic contract dermatitis in a formaldehyde-allergic patient is

A. 100% polyester

B. 100% silk.

C. 100% wool.

D. polyester-cotton blend.

E. 100% nylon

139. Pruritic urticarial papules and plaques of pregnancy is characterized by

A. development in the second trimester.

B. fetal compromise.

C. initial appearance on extremities.

D. presence in striae distensae.

E. presence of linear band immunoflorescence.

140. Which is the most common cutaneous tumor in patients with neurofibromatosis 2?

A. Neurofibroma

B. Neurofibrosarcoma

C. Palisaded encapsulated neuroma

D. Leimyoma

E. Schwannoma

141. The figure-of-eight- suture is useful to

A. approximate the tip of a flap.

B. produce wound eversion.

C. close a wound under tension.

D. tie off a bleeding vessel.

E. close a wound without causing "railroad tracking".

142. The most common location for development of sebaceous carcinoma is the

A. eyelid.

B. ear.

C. nose.

D. lip.

E. axilla.

143. Perineural involvement is most common in which of the following tumors?

A. nodular basal cell cancer

B. Microcystic adnexal carcinoma

C. Leimyosarcoma

D. Melanoma

E. Merkel cell carcinoma

144. Zafirlukast (Accolate) inhibitis production of

A. arachidonic acid.

B. prostaglandis

C.leukotrienes

D. interferons

E. histamine

145. A 52-year-old woman who underwent mitral valve replacement 2 years earlier presents for surgical removal of an eroded basal cell carcinoma. The most appropriate time for prophylactic antibiotic administration is

A. 6 hours preoperatively.

B. 2 hours preoperatively.

C.at the time of excision.

D. 2 hours postoperatively.

E. 6 hours postoperatively.

146. The parotid duct crosses which of the following structures?

A. Platysma

B. Internal jugular artery

C. Sternocleidomastoid muscle

D. Facial nerve trunk

E. Masseter muscle

147. Acquired itchyosis is associated with which of the following?

A. Barbiturates

B. Nafcillin

C. Sulfonamides

D. Nicotinic acid

E. Nalidixic acid

148. Which of the following is an example of a rotation flap?

A. Bilobed

B. O to T

C. V to Y

D. Island pedicle

E. O to Z

149. Which of the following is associated with arthritis?

A. Sinus histiocytosis with massive lymphadenopathy

B. Generalized eruptive histiocytosis

C. Multicentric reticulohistiocytosis

D. Necrobiotic xanthogranuloma

E. Xanthoma disseminatum

150. Which of the following cutaneous tumors typically stains with antibodies against cytokeratin in a paranuclear dot-like pattern ("capping")?

A. Squamous cell carcinoma

B. Sebaceous carcinoma

C. Merkel cell carcinoma

D. Atypcical fibroxanthoma

E. Microcystic adnexal carcinoma

151. Loss of sensation occurs with inadvertent sectioning of which of the following nerves?

A. Spinal accesory

B. Mental

C. Zygomatic

D. Marginal mandibular

E. Maxillary

152. A condition characterized by a decreased number of melanocytes is

A. albinism.

B. melasma

C. tinea versicolor

D. piebaldism.

E. pityriasis alba.

153. Oral manifestations of Darier's disease include

A. gingival hemorrhage.

B. cobblestoning of buccal mucosa

C. dental caries.

D. oral erosions.

E. enamel pits.

154. The Splendore-hoeppli phenomenon identifies clusters of organisms surrounded by an eosinophilic border in

A. chromoblastomycosis.

B. sporotrichosis.

C. actinomycosis.

D. rhinomycosis.

E. bacillary angiomatosis.

155. The most common form of leishmaniasis likely to be acquired in Texas is

A. visceral leishmaniasis caused by Leishmania donovani.

B. cutaneous leishmaniasis caused by L. Tropica.

C. mucotaneous leishmaniasis caused by L. Braziliensis.

D. cutaneous leishmaniasis caused by L. Mexicana.

E. visceral leishmaniasis caused by L. braziliensis.

156. The primary antigen in pemphigoid gestationis is

A. desmoplakin.

B. bullous pemphigoid antigen-1,230 kd.

C. bullous pemphigoid antigen- 1,180 kd.

D. plakoglobin.

E. anchoring fibrils.

157. Mutation of which gene is associated with oculocutaneous albinism?

A. Tyrosinase gene

B. P-gene

C. Tyrosinase-related protein 1 gene

D. PAX 3 gene

E. KIT gene

158. The active ingredient in sun-free tanning products is

A. diacyglycerol.

B. avobenzone

C. anthranilate

D. dihydroxyacetone

E. paraaminobenzoic

159. A sunscreen containing which ingredients would afford the broadest photoprotection against ultraviolet A?

A. p-Aminobenzoic acid

B. Dioxybenzone

C. Methyl anthranilate

D. Red veterinary petrolatum

E. Titanium dioxide

160. To which FDA pregnancy-use category does isotretinoin belong?

A. Category A

B. Category B

C. Category C

D. Category D

E. Category X

161. The mother of a 7-year old boy with a lace-like, reticulated erythema of the extremities is in her second trimester of pregnancy. She is at risk for development of which of the following fetal abnormalities?

A. Aplasia cutis

B. Cataracts

C. Choriotinitis

D. Hydrops fetalis

E. Limb hypoplasia

162. Lichen planus is most closely associated with

A. cytomegalovirus infection.

B. hepatitis C infection.

C. shigella infection.

D. disseminated zoster.

E. acute graft-versus-host disease.

163. Levels of which muscle enzyme are most elevated in dermatomyositis?

A. Aldolase

B. Aspartate aminotransferase

C. Lactic dehydrogenase

D. Creatine kinase

E. Serum glutamic oxaloactedic transaminase

164. Which laser is the best choice for treating red tattoo pigment?

A. Nd: YAG

B. Ruby

C. Flashlamp-pumped, pulsed dye

D. Alexandrite

E. Frequently-doubled Nd: YAG

165. Which of the following is potentially nephrotoxic?

A. Phenol

B. Resorcinol

C. Trichloroacetic acid

D. Salicylic acid

E. Glycolic acid

166. The most useful immunohistochemical marker for Merkel cell carcinoma os

A. vimentin

B. neuron-specific enolase.

C. chromogranin

D.S-100 protein.

E. leukocyte common antigen.

167. Endogenous ochronosis is caused by a deficiency of which of the following enzymes?

A. Homogentistic acid oxidase

B. Tyrosinase

C. p-Hydroxyphenyypyruvic oxidase

D. Tyrosine aminotransferase

E. Pumarylacetoacetic acid hydrolase

168. Which of the following lasers is most likely to cause scarring?

A. Flashlamp-pumped, pulsed dye

B. Alexandrite

C. Nd: YAG

D. Argon

E. Ruby

169. Microcystic adnexal carcinoma is characterized by which of the following?

A. Perineural involvement

B. Negative staining for carcinoembryonic antigen

C. Sebaceous differentiation

D. Frequent mitoses

E. Squamous eddles

170. Which of the following stains calcium?

A. Verhoeff

B. Alcian blue

C. Alizarin red S

D. Geimsa

E. Toluidine blue

171. The fungus that commonly causes proximal white onchomycosis in HIV-positive patient is

A. Trichophyton rubrum

B. T. mentagrophytes.

C. T. verrucosum.

D. Epidermophyton floccosum.

E. Microsporum canis.

172. Systemic Interferon-alpha therapy for life-threatening hemanglomas has been associated with which of the following complications?

A. Weight gain

B. Hypertension

C. Spastic diplegia

D. Bleeding diathesis

E. Glaucoma

173. Infants with hemangiomas in the so-called "beard" distribution should be evaluated for involvement of the

A. subglottic region

B. oral cavity

C. middle ear.

D. parotid salivary gland.

E. posterior fossa.

174. Which of the following enzymes is directly involved in cellular senescence?

A. Topoisomerases

B. Kinases

C. Telomerases

D. Phosphodiesterases

E. Helicases

175. Which of the following has the poorest prognosis?

A. Classic Kaposi's sarcoma

B. Kimura's disease

C. Daska's tumor

D. Retiform hemagioendothelioma

E. Angiosarcoma associated with lymphedema

176. What autoantigen is seen in patients with IgA pemphigus of the subcorneal pustular dermatosis type?

A. Desmoglein 1

B. Desmoglein 3

C. Desmocollin 1

D. Desmoplakin I

E. Desmoplakin II

177. Eosinophilic spongiosis is often seen in

A. subcorneal pustular dermatosis.

B. bullous pemphigoid

C. Wegener's granulomatosis

D. dermatitis herpetiformis

E. spider bite reactions.

178. The most common locations for a Becker's nevus is the

A. forehead

B. shoulder

C. scalp

D. forearm

E. thigh

179. Delayed tanning

A. is induced primarily by ultraviolet A.

B. is associated with increased tyrosinase levels.

C. is characterized histologically by erythrophagocytosis.

D. occurs 10-14 days after exposure.

E. persists for 48 to 72 hours.

180. Which of the following drugs causes photo-induced hyperpigmentation?

A. Bleomycin

B. Rifampin

C. Dapsone

D. Chlorpromazine

E. Quinacrine

181. Which of the following drugs commonly produces blue-gray pigmentation in sunlight-exposed areas?

A. Mninoxidil

B. Amidarone

C. Hydralazine

D. Cyclosporine

E. Ranitidine

182. Macromelanosomes (melanin macroglobules) are a characteristic histiologic feature of

A. ephelides

B. café au lait spots

C. congenital nevi.

D. incongenita pigmenti

E. cellular blue nevi

183. In normal skin, the c-kit proto-oncogene encodes a receptor tyrosine kinase that is expressed by

A. melanocytes

B. langerhans cells.

C. sebaceous gland epithelial cells.

D. basal keratinocytes.

E. suprabasal keratinocytes

184. Which of the following cytokines is a growth factor for both mast cells and melanocytes?

A. Tumor necrosis factor-alpha

B. Insulin-like growth factor-1

C. Stem cell factor

D. Interlukin-8

E. Interlukin-10

185. The most likely diagnosis in a 52-year-old, uncircumcised man with a 2-year history of a solitary, smooth, shiny, red-orange and "cayenne pepper" spotted plaque of the glans penis and prepuce is

A. psoriatic balanitis.

B. lichen sclerous et atrophicus.

C. plasma cell balanitis.

D. circinate balanitis.

E. lichen planus.

186. Matrix metalloproteinase primarily degrade

A. transmembrane proteins.

B. keratin filaments.

C. membrane phospholipids.

D. elastic fibers.

E. collagen fibers.

187. Lamellar itchyosis has been associated with loss of

A. involucrin

B. transghitaminase

C. loricrin

D. keratohyaline granules.

E. steroid sulfatase

188. The protein deficiency specific to pyloric atresia-associated junctional epidermolysis

bullosa is

A. laminin 5

B. keratin 5

C. alpha 6 beta 4 integrin

D. type IV collagen

E. type XVII collagen

189. Pemphigoid gestationis antigen is

A. a transmembrane protein

B. an intracellular

C. a demosomal protein

D. analogous to the 230-kd bullous pemphigoid antigen

E. located in the base of a salt split skin specimen

190. The predominant ultraviolet- B induced DNA photoproduct is the

A. cyclobutane pyrimidine dimer

B. 6-4 pyrimidine pyrimidine dimer

C. 5-6 dipyrimidine dimer

D. purine dimmer

E. pyrimidine-purine dimmer

191. The antibiotic reported to be effective in the treatment of confluent and reticulate papillomatosis is

A. sulfamethoxazole

B. amoxacillin

C. cephalexin

D. minocycline

E. ciprofloxacin

192. Lupus rephritis is associated with increasing titers of which of the following autoantibodies?

A. Anti-Ro (SSA)

B. Anti-Jo-1

C. Anti-double stranded DNA

D. Anti-histone

E. Anti-reticulin

193. Which of the following antinuclear antibody patterns is most closely associated with systemic sclerosis?

A. Homogeneous

B. Peripheral

C. Nucleolar

D. Speckled

E. Particulate

194. The leading cause of death in patients with mutations of the fibrillin (FBN-1) gene is

A. pulmonary emphysema

B. myocardial infarction

C. a gastrointestinal neoplasm

D. a dissecting aortic aneurysm

E. a strangulated hernia

195. Which of the following is associated with Reiter's syndrome?

A. Staphylococcus aureus

B. Pseudomonas aeruginosa

C. Mycobacterium smegmatis

D. Chlamydia trachomatis

E. Candida albicans

DIRECTIONS: : Each group of questions below consists of five lettered headings followed by a list of five numbered words or phrases. For EACH numbered word or phrase, select the one lettered heading that is most closely associated with it, and completely fill in the circle containing the corresponding letter on the answer sheet. Each lettered heading may be selected once, more than once, or not at all.

ITEMS 1-5:

For each form of figurate erythema (196-201), select the classic feature (A-E).

(A) Koebner phenomenon

(B) Rapid migration

(D) Glossitis and acral lesions

(E) Tick bite at the center of the primary ring

1. Erythema annulare centrifugum

2. Erythema gyratum repens

3. Erythema marginatum

4. Erythema migrans

5. Necrolytic migratory erythema

ITEMS 6-10:

For each disease (6-10), select the correct Bartonella organism (A-E).

(A) Bartonella talpae

(B) Bartonella henselae

(D) Bartonella elizabetheae

(E) Bartonella bacilliformis

6. Cat scratch disease

7. Verruga peruana

8. Trench fever

9. Oroya fever

10. Bacillary angiomatosis

ITEMS 11-15:

For each of porphyria (11-15), select the corresponding enzyme defect (A-E)

(A) Uroporphyrinogen III cosynthase

(B) Ferrochelatase

(D) Protophyrinogen oxidase

(E) Porphobilinogen deaminase

11. Porphyria cutanea tarda.

12. Variegate porphyria

13. Hepatocrythropoietic protoporphyria

14. Erythropoietic protoporphyria

15. Congenital erythropoietic porphyria

ITEMS 16-20:

For each tumor (16-20), select the immunohistochemical stain (A-E) with which positive staining is most important in diagnosis.

(A) Factor XIIIa

(B) CD34

(D) S-100

(E) HMB-45

16. Desmoplastic malignant melanoma

17. Merkel cell tumor

18. Dermatofibroma

19. Fibrous papule of the nose

20. Dermatofibrosarcoma protuberans

ITEMS 21-25:

For each complication, select the most closely associated agent (A-E)

(A) Bleomycin

(B) Cytarabine (Ara C)

(D) Interferon

(E) Hydroxyurea

21. Neutrophilic eccrine hidradenitis

22. Flagellate hyperpigmentation

23. Folliculitis

24. Increased eyelash growth

25. Acral sclerosis

ITEMS 26-30:

For each type of cyst (26-30), select the characteristic histologic feature (A-E)

(A) Presence of a granular layer with without an adnexal structure in the wall

(B) Sebaceous lobules in the wall

(D) Encysted parasite

(E) Tricholemmal keratinization of the cyst wall

26. Epidermal inclusion cyst

27. Pilar cyst

28. Steatocystoma multiplex

29. Dermoid cyst

30. Medial raphe cyst

ITEMS 31-35:

For each phrase (31-35), select the corresponding chemical compound in the heme pathway (A-E).

(A) Delta amino-levulinic acid

(B) Protoporphyrin IX

(D) Coproporphinogen

(E) Uroporphyrinogen

31. Synthesized in the mitochondrion

32. Detected in the urine by the Watson-Schwartz test

33. Not a photosensitizer

34. The only oxidized porphyrin in the heme pathway

35. Tetrapyrrole in the heme pathway.

ITEMS 36-40:

For each disorder of subcutaneous fat (246-250), select the corresponding clinical finding (A-E).

(A) Increased abdominal fat and cushingoid appearance

(B) Painful para-articular lipomatous masses

(D) Painful red plaques with oily drainage

(E) Painful nodules on the lateral thighs of women

36. Protease-inhibitor-induced lipodystrophy

37. Alpha-1-antitrypsin deficiency

38. Equestrial cold panniculitis

39. Multiple symmetrical lipomatoses

40. Dercum's disease

ITEMS 41-45:

For each disorder (41-45), select the ocular finding (A-E)

(A) Ectopia lentis

(B) Spontaneous hyphema

(D) Angioid streaks

(E) "Salt and pepper" retina

41. Ehler's-Danlos syndrome

42. Homocystinuria

43. Cockayne's syndrome

44. Marfan's syndrome

45. Juvenile xanthogranuloma

ITEMS 46-50:

For each disease (46-50), select the corresponding physical finding (A-E).

(A) Dental pits

(B) Follicular hyperkeratosis

(D) Odontogenic cyst

(E) Premalignant leukoplakia

46. Pachyonchia congenital

47. Ehler's-Danlos syndrome

48. Tuberous sclerosis

49. Osteogenesis imperfecta

50. Dyskeratosis congenital

ITEMS 51-55:

For each syndrome (51-55), select the most characteristic hair disorder (A-E).

(A) Pili torti

(B) Trichorrhexis nodosa

(D) Trichoschisis

(E) Pili multigemini

51. Trichothiodystrophy

52. Angionosuccinicaciduria

53. Bjornstad's syndrome

54. Menke's kinky hair syndrome

55. Uncombable hair syndrome

ITEMS 56-60:

For each disorder 56-60, select the corresponding cutaneous manifestation (A-E).

(A) Lentigines

(B) Epidermal cysts

(D) Telangiectasias

(E) Fibrofollieunomas

56. Osler-Weber-Rendu syndrome

57. Louis-Barr syndrome

58. Gardner's syndrome

59. Nevoid basal cell carcinoma syndrome

60. Peutz-leghers syndrome

ITEMS 61-65:

For each source of exposure (61-65), select the corresponding allergen (A-E).

(A) Ethylenediamine

(B) Thimerosal

(D) Chromatos

(E) Chromates

61. Leather

62. Piroxicam

63. Disulfiram

64. Theophylline

65. Cement

ITEMS 66-70:

For each syndrome (66-70), select the commonly associated finding (A-E).

(A) Dandy-Walker malformation

(B) Thrombocytopenia

(D) Enchondromas

(E) Hemihypertrophy

66. Sturge-Weber

67. PHACE

68. Klippel-Trenauney

69. Maffuci's

70. Proteus

ITEMS 71-75:

For each parasitic infestation (71-75), select the mode of transmission (A-E).

(A) Ingestion of larva

(B) Tsetse fly bite

(D) Reduvid bug bite

(E) Soil contact

71. Cutaneous larval migrans

72. American trypanosomiasis

73. Draculasis

74. Spargonosis

75. Trichinosis

ITEMS 76-80:

For each form of itchyosis (76-80), select the corresponding protein abnormality (A-E).

(A) Profillagrin

(B) Transglutaminase

(D) Phytanic acid oxidase

(E) Keratin 1 or 10

76. Itchyosis vulgaris

77. X-linked itchyosis

78. Lamellar itchyosis

79. Bullous congenital itchyosiform erythroderma

80. Refsum's syndrome

ITEMS 81-85:

For each laser (81-85), select the appropriate wavelength (A-E).

(A) 510 nm

(B) 532 nm

(D) 694 nm

(E) 10, 600 nm

81. Carbon dioxide

82. Flashlamp-pumped, pulsed eye

83. Frequency-doubled Nd:YAG

84. Potassium titanyl diphosphate (KTP)

85. Q-switched ruby

ITEMS 86-90:

For each laser (86-90), select the corresponding wavelength (A-E).

(A) 532 nm

(B) 585 nm

(D) 2,940 nm

(E) 10, 600nm

86. Gallium-aluminum-arsenide diode

87. Carbon dioxide

88. Krypton

89. Erbium

90. Nd: YAG