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?


    2018_Q10_Granuloma Faciale vs Eosinophilic Angiocentric Fibrosis

    Multiple choice question

    How does Granuloma Faciale differ from Eosinophilic Angiocentric Fibrosis?

    2018_Q9_Adult Onset Still's Disease

    Multiple choice question

    Clinical and Histological Findings:

    A 40 year old female presents with a combination of evanescent urticarial-like lesions admixed with a few hyperpigmented linear lesions which were more persistent. In addition, she had fevers, arthralgia, and hyperferritinemia. A biopsy was performed on one of the more persistent lesions and showed the following histological findings:

    What is the most likely diagnosis?


    2018_Q8_Argyria

    Multiple choice question

    Clinical and histological findings:

    A patient presents with a slight bluish gray discoloration of her face with a blue band on the superior aspect of the luna of her nails. A punch biopsy was performed, and on low power no significant abnormalities were appreciated (i.e. and invisible dermatosis); however on closer evaluation, unusual pigment deposits were seen in the dermis.

    What is the most likely diagnosis?


    2018_Q7_Envoplakin and Periplakin

    Multiple choice question

    Which autoantibodies are most common in the condition described in Question 5 and 6?

    2018_Q6_Paraneoplastic Pemphigus

    Multiple choice question

    The patient described in Question 5 presented a few days later, and now complains of erosive mucosal lesions and injected conjunctiva. Therefore, another biopsy was done for DIF and showed the following findings:

    What is the best diagnosis now?


    2018_Q5_Erythema Multiforme

    Multiple choice question

    Questions 5-7 all pertain to the following patient:

    A 55 year old female with a history of chronic lymphocytic lymphoma initially presented with multiple scattered erythematous plaques with a dusky central region that were located on her trunk. Biopsy was performed and showed the following histological findings:

    What is the best diagnosis?


    2018_Q4_Alopecia Areata

    Multiple choice question

    Clinical and Histological Information:

    As mentioned previously in Q1, the above patient also had focal areas of hair loss, and the epidermis in these areas was distinctively different from the patient's other cutaneous lesions in that there were no significant epidermal changes other than complete focal hair loss. A biopsy was performed and showed the following histological findings.

    What is the most likely diagnosis for the alopecia?


    2018_Q3_Hypertrophic Lupus Erythematosus

    Multiple choice question

    A biopsy was also performed from a verrucous papule on the arm of the patient described in Q1, and showed pseudo-epitheliomatous hyperplasia of the epidermis which was concerning for squamous cell carcinoma.

    Which IHC stain could be used to better differentiate the hypertrophic variant of the condition described above from squamous cell carcinoma (SCC)?

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