2018_Q1_Discoid Lupus

    Multiple choice question

    Questions 1-4 all pertain to information on the below patient:

    Clinical Information:

    A 45 year old female presented with erythematous plaques within her conchal bowls associated with overlying scale which exhibited carpet tack sign. In addition, she had scattered indurated papules on her arms, as well as a few focal areas of hair loss on her scalp; however, the epidermis on the scalp looked relatively normal other than almost complete absence of hair (i.e. these areas resembled a cue ball).

     A biopsy from the conchal bowls was obtained and showed the following:

    Based upon the clinical history and below histological findings, what is the most likely diagnosis for the lesions within the conchal bowls?



    2018_Q40_CK15 Bulge

    Multiple choice question

    Which portion of the hair remains intact during all cycles of the hair and contains stem cells capable of regenerating the hair?

    2018_Q39_Onaychomatricoma

    Multiple choice question

    Clinical history and pathological findings:

    A patient presents with a markedly thickened and yellow nail that when cut appeared to have tunnel-like grooves. The nail and tumor below were removed and showed the following features:

    What is the best diagnosis?

    2018_Q38_Erythema Nodosum

    Multiple choice question

    Clinical history and pathological findings:

    A 30 year old female presented with multiple tender nodules on her anterior lower legs a few months after starting oral birth control pills. A biopsy was taken and showed the following findings:


    What is the most likely diagnosis?

    2018_Q37_Sweets Syndrome

    Multiple choice question

    Clinical history and pathological findings: 

    A 37 year old woman with IBS presented with an erythematous indurated plaque on her cheek. The patient was febrile on presentation and had an elevated WBC with a left shift. A biopsy was taken and showed the below findings:


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

    2018_Q36_Calciphylaxis

    Multiple choice question

    Clinical history and pathological findings:

    A 72 year old obese man with end stage renal disease presented with an erythematous indurated plaque on his abdomen. A biopsy was done and showed the following findings:

    What is the best diagnosis?

    2018_Q35_Clinical Pathological Correlation

    Multiple choice question

    Clinical history and pathological findings:

    A 45 year old female was diagnosed with AML FAB-5 and received an unrelated bone marrow transplant. Initially the patient was doing well but then developed CMV gastroenteritis and was placed on Gancyclovir, and forcarnet, and developed a maculopapular rash. The transplant team had dermatology do a biopsy to rule out graft-vs-host disease (GVHD), viral eruption, or drug eruption and you got the below biopsy.


    What features can best differentiate GVHD, from a viral or drug induced eruption?

    2018_Q34_Hypertrophic Lichen Planus

    Multiple choice question

    Clinical history and pathological findings:

    A 72 year old woman presented with several hyperkeratotic nodules on her lower legs, a biopsy was performed on two of the lesions which showed identical findings.

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


    2018_Q33_Drug Rash with Eosinophilia

    Multiple choice question

    Clinical history and pathological findings:

    A 52 year old Asian male started taking carbamazepine and within a few weeks, developed a maculopapular eruption that progressed to erythroderma. In addition, he had fever, lymphadenopathy, and leukocytosis with atypical lymphocytes, as well as elevated LFTs. A biopsy was obtained and showed the following:

    Based upon the clinical history and histological findings, what is the most likely diagnosis?

    2018_Q32_Gnathostomiasis

    Multiple choice question

    A patient from Mexico presented with migratory erythematous edematous area on her abdomen. The patient mentioned that a few weeks prior to the eruption they were at a party and ate ceviche and sushi.

    Which of the following is the most likely diagnosis?

    2018_Q31_Anagen Effluvium

    Multiple choice question

    What is the most common type of alopecia seen with use of Taxanes?

    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 of 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.

    WWhat is the best explanation for the above histological findings?

    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?



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