2018_Q30_Taxane Induced Dermatotoxicity

    Multiple choice question

    Clinical history and pathological findings:

    A 40 year old female presents with diffuse hair loss, onycholysis and a papulopustular eruption on trunk after starting taxane therapy for her breast cancer. A biopsy was performed on one of the papules on her leg which was suggestive of folliculitis; however, focally in the dermis there were islands of squamous cells that contained scattered starburst mitoses. Similar findings were also seen in the follicular epithelium. Because of the unusual histological findings, and the fact that a malignancy was not clinically suspected, two other papules were biopsied, but these showed similar findings.

    What is the best explanation for the above histological findings?

    2018_Q29_Ofuji Disease

    Multiple choice question

    Clinical history and pathological findings:

    An Asian woman presented with itchy papules and pustules on her cheeks that she believes occurred after she waxed her facial hairs. A biopsy was performed for H & E and also sent for tissue culture, but the latter was negative.

    What is the best diagnosis?

    2018_Q28_Collagenous Vasculopathy

    Multiple choice question

    Clinical history and pathological findings:

    A 42 year old woman with lupus presented for evaluation of a telangiectatic eruption on her lower extermities that had been present for approximately 10 years and had progressed to cover larger areas. Her past medical history was significant for a recent hip replacement which required her to be on coumadin. A biopsy was performed on a telangiectatic mat on her thigh and showed the following findings:

     


    What is the best diagnosis?

    2018_Q27_Macular Lymphocytic Arteritis

    Multiple choice question

    Clinical and pathological findings:

    A 52 year old woman who is otherwise healthy presents with scattered hyperpigmented macules and reticulated patches on her lower legs. There was no history of trauma or recent illness and her laboratory evaluation was within normal limits (CBC, Chem 18, ANA, PT/PTT). A biopsy was performed and showed the following findings:

    What is the best diagnosis?


    2018_Q26_Vasculitis DF

    Multiple choice question

    Where should a punch biopsy be performed if vasculitis is suspected for direct flourescence?

    2018_Q25_Bullous Pemphigoid

    Multiple choice question

    A 67 year old man presents with a six-week history of numerous bullae on the trunk and extremities. Biopsy specimens are obtained for direct and indirect immunoflourescence (IF). Direct IF shows linear IgG and C3 at the basement membrane zone. Indirect IF, utilizing salt-split skin shows linear IgG a the roof of the split. Which of the following is the most likely diagnosis?

    2018_Q24_Tumor Response on PD-1 Inhibitors

    Multiple choice question

    Tumors that respond best to PD-1 inhibitors exhibit which of the following features?

    2018_Q23_Scabies

    Multiple choice question

    Clinical and Histological Information:

    You receive a biopsy from a 63 year old patient who is immunocompromised. The patient presents due to significant pruritus and on exam has multiple excoriated papules along the waistline, lower back, and arms. The biopsy shows the following:

    Based on the clinical history and pathological findings, what is the most likely diagnosis?



    2018_Q22_Evaluating Alopecia

    Multiple choice question

    To properly evaluate alopecia, hair counts are done on horizontal sections of 4mm at the level of the isthmus. Hair counts vary by race, please select which race has the highest normal hair count:


    2018_Q21_Keratosis Lichenoides Chronica

    Multiple choice question

    Clinical and Pathological Information:

    A 15 year old boy presents with a seborrheic dermatitis-like facial eruption and confluent violaceous papules on the extremities and trunk arranged in a linear and reticulate pattern. A biopsy was performed from a hyperkeratotic papule on the arm and showed the following findings.

    Based upon the clinical and histological finding, what is the best diagnosis?


    2018_Q20_Pyoderma Gangrenosum

    Multiple choice question

    Which of the following is helpful in differentiation between pyoderma gangrenosum and infectious process

    2018_Q19_Lichen Planus Pigmentosus

    Multiple choice question

    Clinical and Pathological Information:

    A 45 year old Indian female presents with a mild pruritic reticulated eruption on her neck which was cosmetically distressing, and a biopsy was performed to determine the etiolgy. Below are the clinical pictures of the patient's neck and photos of the biopsy. 

    What is the most likely diagnosis?



    2018_Q18_Guttae Psoriasis

    Multiple choice question

    Clinical and Pathological Information:

    A patient presents with multiple small erythematous indurated plaques on his trunk and extremities that appeared after receiving a shot of Penicillan-G to treat his strep throat. The biopsy showed the following: Mild Spongiosis and Acanthosis of the Epidermis with overlying mounds of parakeratosis containing collections of neutrophils. Within the dermis the superficial blood vessels were dilated and surrounded by scattered erythrocytes. All special stains were negative.

    Based upon the clinical history and histopathological findings, what is the best diagnosis?


    2018_Q17_Non-Scarring Alopecia Feature

    Multiple choice question

    What feature in a scalp biopsy is most consistent with a diagnosis of non-scarring alopecia?

    2018_Q16_Pitted Keratolysis

    Multiple choice question

    Clinical History and Pathological Findings:

    A patient presents with extremely malodorous feet with distinct punched out regions on the soles of his feet. A biopsy was performed; however, histologically other than diffuse hyperkeratosis consistent with acral skin minimal changes were appreciated on low power (i.e. invisible dermatoses). But being the good pathologist that you are, you take a closer look at the specimen.

    Based upon the clinic description and histological findings, what is the best diagnosis?


    2018_Q15_Mercury Granuloma

    Multiple choice question

    You get the following biopsy with no clinical history, and on histological evaluation you see suppurative granulomatous process that contains numberous neutrophils, vacant spaces and dark globules of varying sizes.

    Based upon the histological findings, what is the best diagnosis?


    2018_Q14_Sensitivity of Anti-Treponemal IHC

    Multiple choice question

    A 40 year old male with HIV presented with a diffuse erythematous maculopapular rash on his face, trunk, palms and soles. You suspect the patient has syphillis but the lab ran out of all serologic tests for syphillis. You suggest doing a biopsy since you know that the lab has anti-treponemal IHC. What is the sensitivity of this test?

    2018_Q13_TNF-Inhibitor Induced Psoriatic Alopecia

    Multiple choice question

    Clinical and Pathological Information:

    Because the patient's Crohn's disease was poorly controlled, his gastroenterologist put him on TNF-alpha inhibitors. Although his diarrhea and prior skin lesions described in Question 12 improved, a few months later he presented again due to erythematous scaly plaques on his scalp associated with hair loss. A biopsy was obtained to determine the cause and showed the following:

    What is the most likely cause of the hair loss?


    2018_Q12_Acquired Acrodermatitis Enteropathica

    Multiple choice question

    Clinical and Pathological Information:

    A 35 year old male with a long standing history of Crohn's disease presents with a several month history of 10lbs weight loss which he attributes to chronic diarrhea and poor diet. In addition, he compained of a diffuse rash. On examination the patient had edema of his feet with deep seated blisters on the plantar surface, erythematous erosive lesions in his inguinal region, and chelitis. A biopsy was obtained from the inguinal regions and showed the following:

    What is the most likely cause of this patient's cutaneous lesions?


    2018_Q11_Prurigo Pigmentosa

    Multiple choice question

    Clinical and Pathological Information:

    A 35 year old female presents with scattered pruritic papules on her chest that were resistant to topical corticosteroids. Although the lesions eventually and spontaneously resolved, they left behind focal areas of hyperpigmentation that in some areas, appeared somewhat reticulated. Two biopsies were taken, one from an earlier papule, and another from an erythematous plaque within the reticulated region.

    What is the best diagnosis?


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