Vesicular and Bullous Dermatosis MCQs

1
A 29 year old female patient is diagnosed with fogo selvagem. The likely possibility that this person
with die within two years is :
1

90%
2

70%
3

40%
4

20%
5

10%
Q/Q(M)-482895 Report a Problem
A 29 year old female patient is diagnosed with fogo selvagem. The likely possibility that this person
with die within two years is :
3

40%
Patients with fogo selvagem have a 40% of dying within 2 years with they do not receive treatment.
These patient have burning lesions that is denuded with roll of pushed back upper epidermis at
periphery. Patients can also develop erythroderma

The rate limiting step in the porphyria pathway is mediated by the enzyme:
1

Ferrochetalase
2

ALA dehydratase
3

ALA synthase
4

Uroporphyrinogen decarboxylase
5

Porphobilinogen deaminase
The rate limiting step in the porphyria pathway is mediated by the enzyme:
3

ALA synthase
ALA synthase mediates the first and rate-limiting step in the heme synthesis pathway. This step occurs
in the mitochondria and allows for the conversion of Succinyl coA + glycine to delta aminolevilinic
acid.
The most common cause of contact dermatitis in the United States is:
1

Hair dyes
2

Nickel
3

Nail lacquers
4

Toxicodendrons
5

Rubber

The most common cause of contact dermatitis in the United States is:
2

4

Toxicodendrons
The most common cause of contact dermatitis in the USA are (in order of most to least common):
toxicodendrons (poison ivy, oak, or sumac), nickel, fragrance, thimerosal, quarternium-15, neomycin,
formaldehyde and the formaldehyde-releasing preservatives, bacitracin, and rubber compounds.

Which of the following allergens is a non-formadelhyde releasing preservative with a low sensitization
potential?
1

Methylisothiazolone
2

Paraben
3

Bronopol
4

Quternium-15
5

DMDM hydantoin

Which of the following allergens is a non-formadelhyde releasing preservative with a low sensitization
potential?
2

Paraben
Paraben mix is a non-mercurial, non-formaldehydge releasing preservative with low sensitization
potential. Methylisothiazolone is a non-formaldehydge releasing preservative found in wash-on/wash-
off products. The others are formaldehyde-releasing preservatives.

Which of the following is the most common photoallergen?
1

octyl dimethyl PABA
2

Dihydroxyacetone
3

Benzophenone
4

Oxybenzone
5

glyceryl thioglycolate

Which of the following is the most common photoallergen?
4

Oxybenzone
Oxybenzone is a UVA sunscreen and is the most common photoallergen. Octyle dimethyl PABA
(Padimate O) and benzophenone are also sunscreen agents, and both can also cause contact dermatitis.
Dihydroxyacetone is a sunless-tanning agent and glyceryl thioglycolate is found in permanent wave
solutions.
3

The lamina densa is primarily composed of?
1

Connexins
2

Plectin
3

Collagen XVII
4

Collagen VII
5

Collagen IV

The lamina densa is primarily composed of?
5

Collagen IV
Collagen IV is located in the dermal matrix and forms the anchoring plaque. The anchoring plaque
serves to anchor the lamina densa to the dermis via collagens 1,3 & 5.

Allergic contact dermatitis is characterized histologically by:
1

Psoriasiform dermatitis
2

Lichenoid infiltrate
3

Spongiosis
4

Parakeratosis
5

Granuloma

Allergic contact dermatitis is characterized histologically by:
3

Spongiosis
Spongiosis refers to the accumulation of edema fluid between keratinocytes, in some cases progressing
to vesicle formation. The epidermis acquires a "spongy" appearance. This histopathologic pattern of
inflammation is usually accompanied by an infiltrate of lymphocytes within the epidermis and around
superficial vessels. In addition to spongiosis, allergic contact dermatitis is typically accompanied by
eosinophils.

The primary autoantigen in pemphigoid gestationis is
1

Desmoplakin
2

BPAG1
3

BPAG2
4

Plakoglobin
4

5

Anchoring fibrils

The primary autoantigen in pemphigoid gestationis is
3

BPAG2
Herpes gestationsis is an autoimmune blistering disorder of pregnancy. It is characterized by urticarial
plaques and tense bullae. Antibodies to BPAG2 are thought to form as a result of an aberreant response
to MHC antigens on the placenta. The maternal health is generally not affected, but infants are more
commonly born premature. Remission is common following delivery, but it may recur with OCP's,
menstruation, and subsequent pregnancies.

Which type of porphyria disease is most likely to be associated with cholelithiasis?
1

Acute intermittent porphyria
2

Congenital erythropoeitic porphyria
3

Hereditary coproporphyria
4

Erythropoetic protoporphyria
5

Variegate porphyria

Which type of porphyria disease is most likely to be associated with cholelithiasis?
4

Erythropoetic protoporphyria
Erythropoeitic protoporphyria is caused by a defect in the enzyme ferrrochetalase. Patients present with
immediate photosensitivity and subsequently develop waxy scarring on the face, hands and knuckles. In
addition to abdominal pain, cholelithiasis and liver disease may also occur. The porphyria diseases
associated with abdominal pain are acute intermittent porphyria, hereditary coproporphyria and
variegate porphyria. Congenital erythropoeitc porphyria is associated with splenomegaly.

The genetic predisposition for patients with pemphigus vulgaris is:
1

HLA-DRQ402
2

HLA-DR3
3

HLA-DR4
4

HLA-0505
5

HLA-Bw3

The genetic predisposition for patients with pemphigus vulgaris is:
1

HLA-DRQ402
Patients with HLA-DRQ402 can be predisposed to the development of pemphigus vulgaris. Pemphigus
vulgaris is a severe potentially fatal disease with blister formation on the skin and the mucosa
5


A patient who works in a photography developing lab complains of eczematous dermatitis on his hands.
Which one of the following chemicals is he most likely allergic to?
1

Mercaptobenzothiazole
2

Lanolin
3

Epoxy resin
4

Parapheylenediamine
5

Colophony

A patient who works in a photography developing lab complains of eczematous dermatitis on his hands.
Which one of the following chemicals is he most likely allergic to?
4

Parapheylenediamine
Photography solutions often contain parapheneylenediamine, or PPD. Mercaptobenzothiazole is a rubber
accelerator found in shoes, rodenticides, and insecticides, and is the most common allergen of health
care workers. Lanolin is a moisturizer found in cosmetics including aquaphor and eucerin. Epoxy resin
is found in glues and marine cement and, if positive, has a high degree of clinical relevance. Colophony
has the active ingredient of abietic acid and is found in pine rosin, violins, soaps, and adhesives.

Characteristic eosinophilic abscesses are seen in:
1

Bullous drug
2

Pemphigus vegetans
3

Herpes gestationis
4

Incontinentia pigmenti
5

Paraneoplastic pemphigus
Characteristic eosinophilic abscesses are seen in:
2

Pemphigus vegetans
Eosinophilic abscesses with minimal to no spongiosis in a hyperplastic epidermis are characteristic of
pemphigus vegetans.

Antibodies in some forms of Stevens-Johnson bind to:
1

Desmoplakin I
2

Desmoglein 1
3

Desmoglein 3
6

4

Plakoglobin
5

Desmoplakin I and desmoglein 3

Antibodies in some forms of Stevens-Johnson bind to:
1

Desmoplakin I
Antibodies against desmoplakin I and II have been found in Stevens-Johnson.

This is found in both desmosomes and adherens junctions:
1

Alpha-catenin
2

Desmoglein 3
3

Desmoglein 1
4

Plakoglobin
5

Lamin

This is found in both desmosomes and adherens junctions:
4

Plakoglobin
Plakoglobin is a plaque protein of the armadillo family that is found in desmosomes; it can also
substitute for beta-catenin in adherens junctions. Plakoglobin co-precipitates with desmogleins. It is 85
kDa.

The dimethylglyoxime test is used to detect the presence of:
1

Gold
2

Silver
3

Mercury
4

Nickel
5

Latex

The dimethylglyoxime test is used to detect the presence of:
4

Nickel
1% dimethylglyoxime is added to to the metal. If a red precipitate forms, there is >1:10000 nickel
content.

Which pair is incorrect?
1

Desmoglein 1 : 160 kDa
7

2

Desmoplakin I : 250 kDa
3

Type VII collagen : 290 kDa
4

Type XVII collagen: 180 kDa
5

Envoplakin : 190 kDa

5

Envoplakin : 190 kDa
Envoplakin is 210 kDa. Periplakin is 190 kDa.

Drugs that are associated with the exacerbation of pemphigus foliaceus include :
1

Captopril
2

Metoprolol
3

Fluconazole
4

Calcium channel blockers
5

Statins

1

Captopril
Pemphigus foliaceus is a form of pemphigus with superficial blisters. The autoantibodies are against
Dsg1. Medications associated with the exacerbation of pemphigus foliaceus is sulfhydryl groups such as
captopril, penicillamine and piroxicam. Metroprolol can exacerbate psoriasis.

A 60 year old gentleman presents with a recurrent pustular eruption. Biopsy demonstrates subcorneal
pustules with abundant neutrophils and a serum protein electrophoresis shows a monoclonal IgA
gammopathy. The autoantigen responsible for this condition:
1

Desmoglein I
2

Desmocollin I
3

Desmoplakin
4

Plakoglobin
5

Beta 4 integrin

A 60 year old gentleman presents with a recurrent pustular eruption. Biopsy demonstrates subcorneal
pustules with abundant neutrophils and a serum protein electrophoresis shows a monoclonal IgA
gammopathy. The autoantigen responsible for this condition:
2

Desmocollin I
8

Sneddon-Wilkenson (subcorneal pustular dermatosis) is a variant of IgA pemphigus. Clinically, patients
have pustules arranged in annular and serpiginous pattern on the abdomen, axilla, and groin. The antigen
is desmocollin 1 and 2. Treatment options include acitretin and dapsone.

Patients with latex allergy are LEAST LIKELY to develop a reaction to:
1

Cashew
2

Avocado
3

Chestnut
4

Banana
5

Kiwi

Patients with latex allergy are LEAST LIKELY to develop a reaction to:
1

Cashew
Although rare, cross-reactivity in latex-allergic patients has been demonstrated to banana, kiwi, avocado,
passion fruit, and chestnut. Cross-reaction to cashew has NOT been reported.

Fiberglass dermatitis can be prevented by:
1

Water
2

Acetic acid 5%
3

Sodium chloride
4

Alkali
5

Talcum powder

Fiberglass dermatitis can be prevented by:
5

Talcum powder
Talcum powder application causes fiberglass spicules to slide off skin.

Leiner's disease (erythroderma desquamativum) is associated with:
1

C5-9 deficiency
2

Numerous infections
3

Diarrhea
4

Numerous infections and diarrhea
5

All of these answers are correct
9


Leiner's disease (erythroderma desquamativum) is associated with:
4

Numerous infections and diarrhea
Leiner's disease is associated with deficient C5 and possibly C3. Babies with this disease are prone to
diarrhea, infections (sepsis), anemia, and a generalized seborrheic dermatitis-like rash.

1

Captopril
2

Metoprolol
3

Fluconazole
4

Calcium channel blockers
5

Statins

1

Captopril
Pemphigus foliaceus is a form of pemphigus with superficial blisters. The autoantibodies are against
Dsg1. Medications associated with the exacerbation of pemphigus foliaceus is sulfhydryl groups such as
captopril, penicillamine and piroxicam. Metroprolol can exacerbate psoriasis.

The picture shown is considered to be diagnostic for what type of epidermolysis bullosa
1

Junctional epidermolysis bullosa- Non Herlitz type
2

Junctional epidermolysis bullosa- Herlitz type
3

Dowling-Meara form of Epidermolysis Bullous simplex
4

Dominant dystrophic epidermolysis bullosa
5

Recessive dystrophic epidermolysis bullosa

The picture shown is considered to be diagnostic for what type of epidermolysis bullosa
10

5

Recessive dystrophic epidermolysis bullosa
The picture is shown is know as "mitten hands" and is diagnostic for recesseive type of dystrophic
epidermolysis bullosa. RDEB have the Hallopeau-Siemens type, a severe life-altering bullous disease
characterized by widespread dystrophic scarring and deformity and by severe involvement of mucous
membranes. Much less commonly, RDEB may manifest as the non-Hallopeau-Siemens types, a mild
localized form (mitis), and an inverse variant (recessive epidermolysis inversa). In the Hallopeau-
Siemens form of RDEB, erosions and blisters are usually manifested at or shortly after birth. Blisters
may appear to occur spontaneously, but most seem to arise at sites of pressure or trauma. Nikolsky sign
is often positive. The hands and lower aspects of the legs are particularly susceptible to severe blistering
and scarring. The fingers and toes may become fused, with resultant pseudosyndactyly, in which the
digits become bound together by a glove-like epidermal sac, with resulting claw-like clubbing or mitten-
like deformities as shown in the image.

Common drugs causing SJS/TEN include all except:
1

Sulfonamides
2

Carbamazepime
3

Allopurinol
4

Oxicam
5

Colchicine

Common drugs causing SJS/TEN include all except:
5

Colchicine
NSAIDs, anticonvulsants, allopurinol, and sulfa drugs are common inciting agents of SJS/TEN.

Bullous pemphigoid antigen 1 (BPAg1) is a member of this family:
1

Cadherin
2

Integrin
3

Intermediate filament
4

Plakin
5

Selectin

Bullous pemphigoid antigen 1 (BPAg1) is a member of this family:
4

Plakin
The plakin family includes desmoplakin I and II, BPAg1, envoplakin, periplakin.

What is the most common allergen causing allergic contact dermatitis?
1

Nickel
11

2

Bacitracin
3

Formaldehyde
4

Quaternium-15
5

Neomycin

What is the most common allergen causing allergic contact dermatitis?
1

Nickel
Nickel is the most common contact allergen, found in costume jewelry, alloys, pigments orthopedic
appliances, scissors, razors and many other metal coated objects. Bacitracin and neomycin are
commonly used topical antibiotic agents that many are allergic to. Neomycin is the most common
topical antibiotic allergen found in testing. Quaternium-15 is a formaldehyde-releasing preservative
found in many topical products. It can cross react with formaldehyde, but not all patients will react to
formaldehyde on testing. While it is a common allergen, it is not the most common cause of ACD.

The ocular form of cicatricial pemphigoid is most likely to be associated with antibodies to:
1

Beta-4-integrin
2

Laminin 5
3

BPAg1
4

BPAg2-NC16A
5

Plectin

The ocular form of cicatricial pemphigoid is most likely to be associated with antibodies to:
1

Beta-4-integrin
Antibodies to beta-4-integrin are associated with ocular cicatricial pemphigoid. Laminin 5 is associated
a variant of cicatricial pemphigoid that is associated with malignancy. BPAg1 is the antigen in bullous
pemphigoid, while BPAg2-NC16A is associated with both bullous pemphigoid and herepes gestationis.
Mutations in plectin are associated with epidermolysis bullosa acquisita with muscular dystrophy.

Mutations in beta-catenin are most commonly associated with:
1

Naxos disease
2

Bullous pemphigoid
3

Pilomatricomas
4

Ectodermal dysplasia with skin fragility
5

Ocular cicatricial pemphigoid

12

Mutations in beta-catenin are most commonly associated with:
3

Pilomatricomas
The armadillo family of proteins constitute of group of proteins which function in cellular adhesion.
These include beta catening, plakoglobin and plakophilins. Mutations in beta-catenin have been
associated with some pilomatricdomas and colorectal carcinomas. Naxos disease has been linked to a
mutation in plakoglobin, while ectodermal dysplasia with skin fragility has beenlinked to a mutation in
plakophilin 1. Ocular cicatricial pemphigoid is associated with antibodies to beta4-integrin.

Pemphigus erythematosus:
1

Is also called Hallopeau syndrome
2

May be an abortive form of subcorneal pustulosis
3

Is often in a malar/seborrheic distribution
4

Does not have linear IgG and C3 at the basement membrane zone
5


Pemphigus erythematosus:
3

Is often in a malar/seborrheic distribution
Pemphigus erythematosus, or Senear Usher syndrome, presents like pemphigus foliaceus and lupus
erythematosus with very superficial erosions and erythematous/hyperkeratotic facial/chest lesions. DIF
reveals intercellular IgG and linear IgG at the dermoepidermal junction.

Which of the following is LEAST LIKELY to cross react with Toxicodendron plant dermatitis?
1

Japanese lacquer tree
2

Cashew nut
3

Mango rind
4

Gingko tree
5

Kiwi

Which of the following is LEAST LIKELY to cross react with Toxicodendron plant dermatitis?
5

Kiwi
The Toxicodendron group of plants is the #1 cause of contact dermatitis in North America. This group
of plants includes poison ivy, poison oak, and poison sumac. Because the Toxicodendron plants belong
to the Anacardiaceae family, cross reactions can occur with related plants and substances such as
braqzilian pepper, cashew nut, cashew oil, gingkgo tree, Indian marking nut, Japanese lacquer tree,
mango, and Rengas tree. Kiwi can cross react with patients who are latex-allergic.
13

Patients with this disorder may develop exaggerated reactions to insect bites:
1

Chronic lymphocytic leukemia
2

Bullous pemphigoid
3

Lupus erythematosus
4

Atopic dermatitis
5

Incontinentia pigmenti

Patients with this disorder may develop exaggerated reactions to insect bites:
1

Patients with chronic lymphocytic leukemia may develop exaggerated reactions to insect bites, including
bullous reactions.

Pinus palustris is the source of:
1

Urea
2

D-limonene
3

Quinones
4

Lactones
5

Abietic acid

Pinus palustris is the source of:
5

Abietic acid
Abietic acid is the allergenic component of rosin (colophony). D-limonene is found in tea tree oil.
Primin is a quinone; it is found in the primrose (Primula obconica). Abietic acid is found in rosin.

Papillary dermal deposits of IgA and a papillary dermal infiltrate of neutrophils is diagnostic of:
1

Sweet's syndrome
2

Leukocytoclastic vasculitis
3

Dermatitis herpetiformis
4

Linear IgA dermatosis
5

Bullous pemphigoid

Papillary dermal deposits of IgA and a papillary dermal infiltrate of neutrophils is diagnostic of:
14

3

Dermatitis herpetiformis
Dermatitis herpetiformis is an uncommon chronic, pruritic papulovesicular dermatitis occurring most
commonly in young to middle-aged adults. Common sites of predilection include the buttocks, elbows,
knees, scapula and scalp. Typical histologic features include accumulation of neutrophils at the tips of
dermal papillae, sometimes admixed with eosinophils. Direct immunoflorescence (DIF) reveals granular
deposits of IgA within the dermal papillae. As the name implies, linear IgA disease is characterized by
linear IgA deposition along the basement membrane zone with DIF in 100% of cases. The pattern of
direct immunoflorescence in bullous pemphigoid is linear C3 deposition at the dermoepidermal junction
in nearly 100% of cases and IgG in 65-95% of cases. Sweet's syndrome is not characterized by a pattern
with DIF. Under light microscopy, a dense perivascular infiltrate of neutrophils is seen assuming a
bandlike pattern throughout the papillary dermis associated with prominent dermal edema.
Leukocytoclastic vasculitides are characterized by a perivascular neutrophilic infiltration with
karyorrhexis, leukocytoclasis, fibrinoid degeneration, and endothelial swelling.

Which of the following proteins is a 160kDa cadherin?
1

Desmoglein 3
2

Desmoglein 1
3

Desmoplakin I
4

Envoplakin
5

Plectin

Which of the following proteins is a 160kDa cadherin?
2

Desmoglein 1
Desmogleins and desmocollins belong to the cadherin family of proteins, which are calcium-dependent
adhesion molecules. Desmoglein I is a 160kDa cadherin, while Desmoglein 3 is a 130 kDa cadherin.
Desmoplakin, envoplakin, and plectin belong to the plakin family of adhesion proteins.

1

Dermatitis herpetiformis : granular IgA
2

Lichen planus : linear C3
3

Bullous pemphigoid : linear C3
4

Systemic lupus erythematosus : linear IgG
5

IgA pemphigus: intercellular IgA

2

Lichen planus : linear C3
The colloid bodies in lichen planus can trap IgM and C3; this can be seen on DIF as globs. There is
no linear pattern.
15


What is the enzyme defect in Gunther's disease?
1

Porphobilinogen deaminase
2

Uroporphyrinogen synthetase III
3

Uroporphyrinogen decarboxylase
4

Ferrochetalase
5

Protoporphyrinogen oxidase

What is the enzyme defect in Gunther's disease?
2

Uroporphyrinogen synthetase III
Gunther's disease (also known as congenital erythropoietic porphyhria) is caused by a defect in
uroporphyrinogen synthetase II, the enzyme which responsible for the conversion of
hydroxymethylbilane to uroporphyriogen III. Patients present with red teeth and immediate
photosensitivy during infancy. There is severe photophobia and late skin manifestations include
mutilating scarswith scarring alopecia, and sclerodermoid changes.

Cicatricial pemphigoid can be induced by:
1

Aminoglycosides
2

Benzene
3

Clonidine
4

Vancomycin
5

Ciprofloxacin

Cicatricial pemphigoid can be induced by:
3

Clonidine
Clonidine is a cause of drug-induced cicatricial pemphigoid. Other common causes includee sulfa drugs
and thiol-containing drugs.

Which of the following concerning Degos' Disease is true?
1

After undergoing multiple stages, it resolves without scarring
2

It affects women more than men
3

Gatrointestinal involvement is a poor prognosis
4

Glucocorticoids are standard of treatment
16

5

Lab results indicate a low plasma fibrinogen level and decreased platelet aggregation

Which of the following concerning Degos' Disease is true?
3

Gatrointestinal involvement is a poor prognosis
Dego's Disease (Malignant Atrophic Papulosis): It most frequently affects men and is a potentially fatal
obliterative arteritis. After undergoing multiple stages, the patient is left with varicelliform scars. Later,
anemic infarcts involve the intestines to produce acute abdominal symptoms of epigastric pain, fever,
and hematemesis. Death is usually due to fulminating peritonitis caused by multiple perforations of the
intestines. GI involvement is a poor prognosis. Lab results indicate a high plasma fibrinogen level and
increased platelet aggregation. Administration of corticosteroids has not been beneficial.

In Brunsting-Perry pemphigoid, the recrurrent crops of blisters are most likely to appear on:
1

Genitals
2

Palms and soles
3

Umbilicus
4

Head and neck
5

Buttocks

In Brunsting-Perry pemphigoid, the recrurrent crops of blisters are most likely to appear on:
4

Head and neck
Brunsting-Perry pemphigoid is a variant of cicatricial pemphigoid in which there are no mucosal lesions.
The most common site of blisters is the head and neck, resulting in scarring alopecia. The antigens in
cicatricial pemphigoid include BPAg2 and epiligrin.

Which type of porphyria manifests with peripheral neuropathy, colicky abdominal pain, but NO
cutaneous symptoms?
1

Acute Intermittent Porphyria
2

Gunther's disease
3

Variegate porphyria
4

Hereditary Copropophyria
5

Erythropoietic protopophyria

Which type of porphyria manifests with peripheral neuropathy, colicky abdominal pain, but NO
cutaneous symptoms?
1

Acute Intermittent Porphyria
17

Acute intermittent pophyria is caused by a defect in the enzyme porphobilinogen deaminase. Patients
present with peripheral neuropathy and occasionally seizures, abdominal pain, and tachycardia. There
are no skin changes as no dermal porphyrins are found.

Bullous lupus erythematosus is most commonly associated with antibodies to:
1

Type XII collagen
2

Type VII collagen
3

Plectin
4

Desmoglein I
5

Laminin 5

Bullous lupus erythematosus is most commonly associated with antibodies to:
2

Type VII collagen
Type VII collagen is found in the sublamina densa and patients with bullous lupus erythematosus have
been found to have antibodies to this protein. The histology can resemble that of dermatitis
herpetiformis and DIF shows linear IgG, IgM, IgA and C3.

What is the most common site of involvement of this autoimmune blistering disease?
1

Oral mucosa
2

Eyes
3

Skin
4

Genitalia
5

Nasopharyngeal mucosa

What is the most common site of involvement of this autoimmune blistering disease?
1

Oral mucosa
Cicatricial pemphigoid is a heterogeneous group of diseases with characteristic involvement of the oral
mucosa, eyes, skin. Rarely, it can also involve the nasopharyngeal mucosa, external genitalia,
esophagus, and anus. The oral mucosa is the most common site of involvement.
18

Which of the following substances is known to cause a delayed positive patch test reaction?
1

Gold
2

Nickel
3

Bacitracin
4

Fragrance mix
5

Rosin

Which of the following substances is known to cause a delayed positive patch test reaction?
1

Gold
Gold is known to cause a delayed patch test reading. Patients allergic to gold often also react to nickel
and cobalt. Bacitracin is a frequent contact allergen that often coexists with an allergy to
neomycin. Fragrance mix contains cinnamic alcohol and aldehyde, hydroxycitronellel, isoeugenol,
eugenol, oak moss absolute, alpha-amyl cinnamic aldehyde, geraniol. Rosin (colophony) is found in
adhesive tape, cosmetics, glossy papers, violin bows, and chewing gum.

The antigen in linear IgA is:
1

BPAg1
2

Plectin
3

97kDa part of BPAg2
4

Laminin 5
5

Alpha-6, beta integrin

The antigen in linear IgA is:
3

97kDa part of BPAg2
The antigen in linear IgA and its variant, chronic bullous disease of childhood, is the 97kDa part of
BPAg2. BPAg1 is the antigen in bullous pemphigoid. Plectin is defective in EB simplex with muscular
dystrophy. Laminin 5 is defective in junctional EB and alpha 6, beta integrin is defective in junctional
EB with pyloric atresia.

Th2-related cytokines include:
1

IL10
2

IFNgamma
3

IFNalpha
4

IL10 and IFNgamma
5

19


Th2-related cytokines include:
1

IL10
Atopic dermatitis is considered a disease in which a Th2 pattern predominates, especially early on. Th2
cytokines are IL4, IL5, IL6, IL10, IL13.

The epidermolysis bullosa acquisita antigen is:
1

A transmembrane protein
2

An intracellular protein
3

A desmosomal protein
4

Located in the lamina lucida
5

An anchoring fibril

The epidermolysis bullosa acquisita antigen is:
5

An anchoring fibril
Epidermolysis bullosa acquisita is a rare autoimmune disorder with an estimated incidence of 0.25 per
million. In the classic form, it is characterized by non-inflammatory bulla with a prediliction for
traumatized sites. The autoantigen is type VII collagen, which is an anchoring fibril located in the
sublamina densa. Following salt split skin, the type VII collagen can be localized at the base.

A child has a defect in type VII collagen and presents with acral blisters which heal with milia and
scarring. What is the diagnosis?
1

Albopapuloid/Pasini variant of dystrophic epidermolysis bullosa
2

Bart's syndrome
3

Cockayne-Touraine disease
4

Epidermolysis bullosa acquisita
5

Weber-Cockayne

A child has a defect in type VII collagen and presents with acral blisters which heal with milia and
scarring. What is the diagnosis?
3

Cockayne-Touraine disease
This patient has Cockayne-Touraine disease which is characterized by a defect in type VII collagen and
presents with acral blisters which heal with milia and scarring. The albopapuloid variant of dystrophic
epidermolysis bullosa presents with flesh-colored, scar-like papules and dystrohpic nails. Bart's
syndrome is associated with aplasia cutis congenita usually on the extremities. Weber-Cockayne does
20

have acral lesions but it is associated with a defect in keratins 5 and 14. The pathogenesis of
epidermolysis bullosa acquisita involves autoimmunity to collagen VII, not a defect in it.
Which of the following is true of herpes gestationis?
1

Demonstrates antibodies to the C-terminal domain of BPAg2
2

Has higher frequency in females with HLA-DQ2
3

Is associated with Grave's disease
4

Usually occurs in the first trimester of pregnancy
5

Shows subepidermal bullae mostly with neutrophils

Which of the following is true of herpes gestationis?
3

Is associated with Grave's disease
Herpes gestationis is associated with Grave's disease. It is more common with patients with HLA-DR3
and DR4 and most often occurs between 4-7 months of pregnancy. The antibodies are against the NC
16-A portion of BPAg2. Histology shows subepidermal bullae with mostly eosinophils.

A 59-year old female has erythema and vesiculation in an area of application of tincture of benzoin.
Which allergen is she also most likely allergic to?
1

Ammonium persulfate
2

Black rubber mix
3

Balsam of Peru
4

Eugenol
5

Epoxy resin

A 59-year old female has erythema and vesiculation in an area of application of tincture of benzoin.
Which allergen is she also most likely allergic to?
3

Balsam of Peru
This patient who has a contact dermatitis to tincture of benzoin is probably reacting to its allergenic
ingredient Balsalm of Peru which has healing and antibacterial properties. Ammonium persulfate is a
bleaching agent for hair and flour, not to be confused with ammonium thioglycolate, a perming agent.
Black rubber mix can produce unique lichenoid and purpuric reactions. Eugenol is found in cloves.
Epoxy resin is found in glues and plastics.

Which of the associated antigens for this condition has been associated with colon cancer?
1

Anti-epiligrin
2

97 kD linear IgA dermatosis antigen
3

Desmoplakin
21

4

Bullous pemphigoid antigen 2
5

Beta-4 integrin

Which of the associated antigens for this condition has been associated with colon cancer?
1

Anti-epiligrin
While the oral mucosa is the most common site for cicatricial pemphigoid, ocular involvement is very
common. Clinical manifestations may include shortened fornices, symblephera, ankyloblephera. The
majority of of ocular antigens are thought to reside in the cytoplasmic domain of beta-4 integrin.

Bullous lesions are seen in:
1

Congenital syphilis
2

Primary syphilis
3

Secondary syphilis
4

Tertiary syphilis
5

Bullous lesions are seen in:
1

Congenital syphilis
Congenital syphilis, but not other forms of syphilis, can occasionally present with bullae.

A 35 year-old dentist presents with tingling in his fingertips. What allergen is most likely to cause this
dermatitis?
1

Methyl methacrylate
2

Paraphenylenediamine
3

Colophony
4

Thiuram mix
5

Ethylenediamine dihydrochloride
22

A 35 year-old dentist presents with tingling in his fingertips. What allergen is most likely to cause this
dermatitis?
1

Methyl methacrylate
Methyl methacrylate is found in synthetic resins, dentures, artificial, nail adhesives, and acrylic bone
cement. This allergen may penetrate through the gloves to the fingertips and most often affects the first
three fingers. In addition to dermatitis, it also causes a peripheral neuropathy.

At what level is the blister separation plane in linear IgA dermatosis?
1

Granular layer
2

Suprabasal layer
3

Basal layer
4

Lamina lucida
5

Lamina densa

At what level is the blister separation plane in linear IgA dermatosis?
4

Lamina lucida
The cleavage in linear IgA dermatosis (LAD) typically occurs in the lamina lucida as the target antigen
is the 97 kD cleaved portion of bullous pemphigus antigen II (BPAgII). A variant of LAD may separate
in the sublamina densa, with a target antigen of the type VII collagen in the anchoring fibrils. This
condition may also be induced by ingestion of certain medications including vancomycin, lithium and
diclofenac.

Which neoplasm is the most common cause of paraneoplastic pemphigus?
1

Thymoma
2

CLL
3

Castleman's disease
4

Retroperitoneal sarcoma
5

Non-Hodgkin's lymphoma

Which neoplasm is the most common cause of paraneoplastic pemphigus?
5

All of the above have been associated with paraneoplastic pemphigus with non-Hodgkin's lymphoma
being the most common. Castlemans's disease is most common in children with paraneoplastic
pemphigus.
23


Irritation of the hand produced by capsaicin can be relieved by application of
1

Water
2

Acetic acid 5%
3

Sodium chloride
4

Alkali
5

Talcum powder

Irritation of the hand produced by capsaicin can be relieved by application of
2

Acetic acid 5%
Burning secondary to capsaicin can be relieved by vinegar (acetic acid 5%) as the capsaicin is soluble in
vinegar (but not water).

Which of the following contains the same allergen as poison sumac?
1

Mango fruit
2

Brazilian Pepper Tree
3

Balsam of Peru
4

Ragweed
5

Artichoke

Which of the following contains the same allergen as poison sumac?
2

Brazilian Pepper Tree
The rhus family (poison ivy, poison oak, poison sumac) contain urushiol (a pentadecacatechol). This
allergen is also associated with contact allergy to Cashew nut, Japanese laquer tree, Mango rind (not
fruit), Gingko, Brazilian pepper tree, Pepeo tree of Venezuela, El litre tree of Chile and the Rengas
(black varnish) tree.

Circulating autoantibodies to type XVII collagen are most characteristic of which disease?
1

Epidermolysis bullosa accquisita
2

Herpes gestationis
3

Pemphigus vulgaris
4

Pemphigus foliacious
5

24

Circulating autoantibodies to type XVII collagen are most characteristic of which disease?
2

Herpes gestationis
Type XVII collagen or BPAG2 is a transmembrane protein found in the hemidesmosome.
Autoantibodies to type XVII collagen are important in the pathogenesis of cicatricial pemphigoid,
bullous pemphigoid, and herpes gestationis.

1

Wrinkle-resistance : formaldehyde
2

Chewing gum : colophony
3

Parabens : artichokes
4

Glyceryl thioglycolate : acid permanent wave
5

Permethrin : chrysanthemum

3

Parabens : artichokes
Wrinkle-resistant clothing is treated with formaldehyde. Chewing gum contains rosin (colophony).
Parabens are preservatives. Artichokes are a member of the family Asteraceae (formerly Compositae).
Glyceryl thioglycolate and methylchloroisothiazolinone are found in acid permanent wave products.
Permethrins are synthetic pyrethroids that are similar to pyrethrins derived from the Asteraceae family.
Permethrins can cross-react with allergy to chrysanthemums.

Paraneoplastic pemphigus:
1

Is characterized by a pathognomonic 250 kDa antigen
2

Is most often seen in association with lung cancer
3

Does not remit even if the cancer is excised completely
4

May be caused by a benign neoplasm
5


Paraneoplastic pemphigus:
4

May be caused by a benign neoplasm
Paraneoplastic pemphigus can be caused by lymphoma as well as other malignancies. It can also be
secondary to benign thymomas and Castleman's disease. Numerous antigens have been found, including
desmoplakin I and II. Desmoplakin I and II may be antigenic in Stevens-Johnson syndrome.

Gallstones are associated with:
25

1

Erythropoietic protoporphyria
2

Hepatoerythropoietic porphyria
3

Variegate porphyria
4

Coproporphyria
5

Harderoporphyria

Gallstones are associated with:
1

Erythropoietic protoporphyria
Gallstones and liver failure can complicate erythropoietic protoporphyria.

Ocular cicatricial pemphigoid has antibodies against:
1

Gamma-catenin
2

Peripherin
3

Beta4-integrin
4

Kalinin
5

Vinculin

Ocular cicatricial pemphigoid has antibodies against:
3

Beta4-integrin
Ocular cicatricial pemphigoid (CP) has autoantibodies against beta4-integrin. CP associated with
malignancy has autoantibodies against epiligrin (laminin 5). CP with mucous membrane and skin
findings often has autoantibodies against BPAg2.

The most common malignancy associated with paraneoplastic pemphigus is:
1

2

3

Multiple myeloma
4

Acute myelocytic leukemia
5

Hodgkin's lymphoma

The most common malignancy associated with paraneoplastic pemphigus is:
1

Paraneoplastic pemphigus is associated with various benign as well as malignant internal tumors, with
the most common being non-Hodgkin's lymphoma.
26


Which of the following is not a formaldehyde-releasing preservative?
1

Bronopol
2

Methylchloroisothiazinolone
3

Quaternium-15
4

Imidazolidinyl urea
5

DMDM hydantoin

Which of the following is not a formaldehyde-releasing preservative?
2

Methylchloroisothiazinolone
Methylchloroisothiazinolone, also known as Kathon CG, is the only non-formaldehyde releasing
preservative. It is found in cosmetics, skin/hair products, "acid" permanent waves, soaps, latex
emulsions, and biocides. All the others are formaldehyde-releasing preservatives.

Patients with Senear-Usher syndrome are most likely to present with:
1

Erythematous papules and plaques around the umbilicus
2

Transient vesicles on the oral mucosa
3

Severely pruritic grouped vesicles symmetrically distributed primarily on extensor surfaces
4

Erythema multiforme-like oral ulcerations which are severe
5

Erythematous crusts and hyperkeratotic lesions on the nose, ears, cheeks, scalp, and chest

Patients with Senear-Usher syndrome are most likely to present with:
5

Erythematous crusts and hyperkeratotic lesions on the nose, ears, cheeks, scalp, and chest
Senear-Usher syndrome, also known as pemphigus erythematosus, is thought to be an overlap between
lupus erythematosus and pemphigus foliaceous. The histology resembles that of pemphigus foliaceous
with linear IgG at the dermoepidermal junction. 80% of patiens have a positive lupus band.
The vector of fogo selvagem may be:
1

Triatoma
2

Simulium
3

Cimex
4

Ornithodorus
5

Mus

27

The vector of fogo selvagem may be:
2

Simulium
Fogo selvagem is considered to be an endemic form of pemphigus foliaceus, first described in Brazil, in
rural areas where Simulium (black fly) is often found. Subsequently, other rural South American areas
have had clusters of affected patients.

Each of the following is true about anti-p200 pemphigoid except:
1

Responsive to dapsone
2

Subepidermal bullae
3

200-kd antigen
4

features of linear IgA disease
5

mucosal involvement

Each of the following is true about anti-p200 pemphigoid except:
5

mucosal involvement
Anti-p200 pemphigoid is an autoimmune blistering disorder. These autoantibodies bind to a 200-kD
antigen found at the lamina lucida-lamina densa interface, thereby causing a subepidermal bullae.
Clinical features of this disease are similar to bullous pemphigoid, dermatitis herpetiformis and linear
IgA disease. In the case reported by Egan, et.al., the patient responded well to steroids and dapsone and
did not have mucosal lesions.
A patient develops erythema and vesiculation on his dorsal foot that spares the toewebs and soles after
buying a new pair of shoes. What is the most likely allergen?
1

Thiuram mix
2

Carbamates
3

Latex
4

5

Formaldehydge

A patient develops erythema and vesiculation on his dorsal foot that spares the toewebs and soles after
buying a new pair of shoes. What is the most likely allergen?
4

This patient has allergic shoe dermatitis. The number one cause is mercaptobenzothiazole, a rubber
accelerator. Other rubber accelerators include carbamates--found in bleached fabrics like waistbands and
consumer rubber products such as condoms, swimwear etc--and thiuram mix, found in almost all rubber.
Of note thiuram is also present in antiscabies medication and the disulfiram.
28


Patients with Duhring's disease are most likely to have:
1

Mutations in plectin
2

Mutations in laminin 5
3

Mutations in transglutaminase I
4

Antibodies to transglutaminase 3
5

Antibodies to BPAg2

Patients with Duhring's disease are most likely to have:
4

Antibodies to transglutaminase 3
Duhring's disease is also known as dermatitis herpetiformis. Antibodies are found to transglutaminase 3,
and the direct immunofluorescent studies show granular IgA and C3 in the dermal papillae. Mutations in
plectin are found in EBS with muscular dystrophy. Mutations in laminin 5 are found in patients with
JEB,Herlitz type. Mutations in transglutaminase I are found in pateints with lamellar ichthyosis and non
bullous congenital ichthyosiform erythroderma.

Common causes of drug-induced linear IgA:
1

Vancomycin
2

Penicillin
3

Cephalosporins
4

Captopril
5


Common causes of drug-induced linear IgA:
5

Linear IgA disease that is induced by drugs is most commonly secondary to vancomycin. Other
implicated drugs include other antibiotics and captopril.

Which association is incorrect?
1

Epidermolysis bullosa acquisita : inflammatory bowel disease
2

Dermatitis herpetiformis : small bowel lymphoma
3

Paraneoplastic pemphigus : Castlemans
4

Herpes gestationis : menopause
5

Porphyria cutanea tarda : hemochromatosis

29

Which association is incorrect?
4

Herpes gestationis : menopause
Herpes gestationis is an immunoblistering disease of pregnancy. Unlike pruritic urticarial papules and
plaques of pregnancy, it recurs with successive pregnancies. It is associated with Grave's disease and
choriocarcinoma.

The C-terminal domain of BPAg2 is targeted in:
1

Bullous pemphigoid
2

Cicatricial pemphigoid
3

IgA pemphigus
4

Duhrings disease
5

Pemphigoid gestationis

The C-terminal domain of BPAg2 is targeted in:
2

The C-terminal domain of BPAg2 is targeted in cicatricial pemphigoid. The NC16A domain of BPAg2
is targeted in bullous pemphigoid.

Patients with pemphigus vulgaris have lesions that start in the mouth in approximately :
1

70% of patients
2

50% of patients
3

30% of patients
4

20% of patients
5

10% of patients

Patients with pemphigus vulgaris have lesions that start in the mouth in approximately :
1

70% of patients
In 70% of patients, pemphigus vulgaris starts in the mouth and other mucosal surfaces can also be
involved.

You are consulted on this patient who has just undergone an orthopedic spinal procedure. What is true of
this patient?
1

She should avoid bananas
30

2

She is allergic to betadine
3

She is most likely having an allergic response to an antibiotic
4

She has miliaria crystallina
5

This is not related to her procedure

You are consulted on this patient who has just undergone an orthopedic spinal procedure. What is true of
this patient?
1

She should avoid bananas
This patient had an allergic contact dermatitis to latex products used during the procedure. Latex cross-
reacts with bananas, avocados, kiwis and chestnuts. The linear and geometric distribution is a clue to the
diagnosis.

"Oriental" tiger balm cross-reacts with:
1

Balsam of Peru
2

Ylang-Ylang oil
3

Neomycin
4

Lanolin
5

Rosin

"Oriental" tiger balm cross-reacts with:
1

Balsam of Peru
"Oriental" tiger balm is a popular Chinese proprietary ointment used to relieve aches and pains. Patients
who develop allergic contact dermatitis to this agent have also been shown to have cross-reactions with
balsam of Peru. A similar substance known as "Bavarian" tiger balm has been reported to cross react
with rosin.

Direct immunofluorescent studies in a patient with bullous pemphigoid is most likely to show:
31

1

Linear IgA at the basement membrane
2

Linear C3 at the basemement membrane
3

Granular IgA in dermal papillae
4

Intercellular IgG4 throughout the epidermis
5

C3 in the dermal papillae

Direct immunofluorescent studies in a patient with bullous pemphigoid is most likely to show:
2

Linear C3 at the basemement membrane
In bullous pemphigoid, the antigenic targets are believed to be BPAg1 and BPAg2-NC16A domain.
These proteins are located in the hemidesmosome. Direct immunofluorescent studies reveal linear
basement membrane C3in approximately 95% of patients, and IgG4 in approximately 80%. Linear IgA
is found in linear IgA and chronic bullous deiseasaeof childhood. Granular IgA and C3 in the dermal
papillae is found in dermatitits herpetiformis. Intercellular IgG4 throughout the epidermis is found in
pemphigus vulgaris.

Which autoantibodies would most likely be found in an individual with eye findings without any
cutaneous involvement?
1

Alpha 6 beta 4 integrin
2

3

4

Desmocollin
5

Laminin 5

Which autoantibodies would most likely be found in an individual with eye findings without any
cutaneous involvement?
1

Alpha 6 beta 4 integrin
Cicatricial pemphigoid is a rare, heterogeneous group of blistering diseases with predilection for mucous
membranes. It may involve the eyes, oral mucosa, genital/anal mucosa, and skin. The ocular form of
cicatricial pemphigoid without cutaneous findings is usually associated with circulating autoantibodes to
alpha 6 beta 4 integrin.

Which of the following is associated with dermatitis herpetiformis?
1

Gluten-sensitive enteropathy
2

Inflammatory bowel disease
3

Autoimmune hepatitis
32

4

Herpes labialis
5

Rheumatoid arthritis

Which of the following is associated with dermatitis herpetiformis?
1

Gluten-sensitive enteropathy
Gluten-sensitive enteropathy or Celiac disease is demonstrated on small bowel biopsy of all patients
with dermatitis herpetiformis. However, most of these patients do not demonstrate symptoms of
gastrointestinal disease. Dermatitis herpetiformis (DH) is not associated with inflammatory bowel
disease, autoimmune hepatitis, herpes labialis, or rheumatoid arthritis.

Epidermolysis bullosa simplex is caused by mutations in:
1

Keratins 1&10
2

Keratins 1&9
3

Keratins 5&14
4

Keratins 6a &16
5

Keratins K2e&10

Epidermolysis bullosa simplex is caused by mutations in:
3

Keratins 5&14
EB Simplex is caused by mutations in keratins 5 &14. Mutations in Keratins 1&10 are associated with
epidermolytic hyperkeratosis ande Unna-thost. Mutations in keratins 1&9 are associated with
epidermolytic palmoplantar keratoderma. Mutations in Keratins 6a and 16 are associated with
Pachyonychia congenital. Mutations in K2e and 10 are associated with Icthyosis bullosa of Siemens.

Which of the following is the most common cause of contact dermatitis due to a formaldehyde releasing
preservative?
1

Paraben mix
2

Thimerosal
3

Quaternium 15
4

Imidazolidinyl urea
5

Paraphenylenediamine

Which of the following is the most common cause of contact dermatitis due to a formaldehyde releasing
preservative?
3

Quaternium 15
33

Quaternium 15 is the primary cause of contact dermatitis among formaldehy-releasing preservatives.
Other formaldehyde-releasing preservatives include imidazolidinyl urea, diazolidinyl urea, DMDM
hydantoin, Bronopol, Cyanobutane, Ethyleneurea melamine formaldehy resin (found in permanent press
clothing), and dimethylol dihydroxyethyleneurea. Paraben mix (#1 preservative in topicals), thimerosal
(a type of mercurial antiseptic), and paraphenylenediamine (hair dye) are non-formaldehyde releasing
preservatives.

A 20-year-old female presents with an allergic contact dermatitis to a perfume containing Lily of the
valley. What is the causative allergen?
1

Cinnamic acid
2

Vanillin
3

Hydroxycitronellal
4

Atranorin
5

Evernic acid

A 20-year-old female presents with an allergic contact dermatitis to a perfume containing Lily of the
valley. What is the causative allergen?
3

Hydroxycitronellal
The main allergen in Lily of the valley, which is found in perfumes, soaps, cosmetics, eye cream and
aftershaves, is hydroxycitronellal (synthetic). Cinnamic acid and vanillin are present in Balsam of Peru,
while atranorin and evernic acid are allergens in oak moss absolute.

Cleavage of this adhesion molecule is seen in Staphylococcal Scalded Skin Syndrome:
1

Desmoplakin 1
2

Desmoplakin 2
3

Desmoglein 1
4

Desmoglein 3
5

Desmoplakin 1 and desmoplakin 2

Cleavage of this adhesion molecule is seen in Staphylococcal Scalded Skin Syndrome:
3

Desmoglein 1
Desmoglein 1 is cleaved by exfoliative toxin in Staphylococcal scalded skin syndrome.

This is associated with deafness:
1

Claudin
2

Cadherin
34

3

Connexin
4

Desmin
5

Desmoplakin

This is associated with deafness:
3

Connexin
Connexin 26 is associated with PPK and deafness. Mutations in this same connexin is associated with
Vohwinkels and KID syndromes.

Which form of epidermolysis bullosa presents with generalized bullae, absent nails, dysplastic teeth (due
to enamel defects), nonhealing granulation tissue periorally, and is often fatal by age 3-4?
1

Weber-cockayne
2

Herlitz
3

Non-Herlitz
4

Hyperplastic cockayne-touraine
5

Albapapuloid Pasini variant

Which form of epidermolysis bullosa presents with generalized bullae, absent nails, dysplastic teeth (due
to enamel defects), nonhealing granulation tissue periorally, and is often fatal by age 3-4?
2

Herlitz
Junctional EB is an autosomal recessive disorder with a defect in the lamina lujcida; uncein is absent in
all forms. The Herlitz variant is due to mutations in laminin 5 and clinically presents as generalized
bullae (which are non-scarring), nonhealing granulation tissue periorally, absent nails, dysplastic teeth
and enamel defects, anemia, growth retardation and is often fatal by age 3-4 due to low protein, anemia
and infection. The non-Herlitz variant of Junctional EB presents with bullae especially on the
extremities which heal with atrophic scarring; pts improve with age and typically have a normal life
span. Weber-cockayne is a type of EB simplex and presents with palmoplantar bullae and hyperhidrosis.
Hyperplastic cockayne-touraine is a form of dominant dystrophic EB which presents with bullae
localized to extremities. Albapapuloid Pasini variant of dystropohic EB presents with widespread bullae,
atrophy, hypopigmented scar-like white papules on trunk, no miliaar or scarring, and mild oral
involvement.

Which of the following can be responsible for contact dermatitis to K-Y Jelly?
1

Lanolin alcohol
2

Budesonide
3

Alpha tocopherol
4

Propylene glycol
5

Triclosan
35


Which of the following can be responsible for contact dermatitis to K-Y Jelly?
4

Propylene glycol
Propylene glycol is a widely used solvent and humectant found in a variety of products such as
cosmetics, lotions, corticosteroids, antiperspirants, and K-Y jelly. Lanolin is an emollient which comes
from wool wax and is found in adhesives, cosmetics, and topical emollients such as Aquaphor.
Budesonide is a steroid, alpha tocopherol is topical Vitamin E, and Triclosan is a topical antibiotic.

Clumped tonofilaments are seen on electron microscopy in:
1

Dowling-Meara
2

Weber-Cockayne
3

Gunthers
4

Naxos disease
5

Vohwinkels syndrome

Clumped tonofilaments are seen on electron microscopy in:
1

Dowling-Meara
Clumped tonofilaments (keratin intermediate filaments) are seen in EB simplex subtype Dowling-
Meara. Weber-Cockayne is a subtype of EB simplex with trauma-induced blistering on the soles of the
feet and occasionally palms.
Bullous diabeticorum typically presents on the:
1

Face
2

Chest
3

Arms
4

Legs
5

Groin

Bullous diabeticorum typically presents on the:
4

Legs
Bullous diabetocorum presents as tense blisters on the legs. They are typically non-inflammatory and
appear suddenly.
The defect in junctional epidermolysis bullosa occurs at the:
36

1

Granular layer
2

Spinous layer
3

Lamina lucida
4

Lamina densa
5

Sublamina densa

The defect in junctional epidermolysis bullosa occurs at the:
3

Lamina lucida
Junctional epidermolysis bullosa is an autosomal recessive disorder characterized by a defect in the
lamina lucida. The protein uncein, a molecule which binds the gamma chain of laminin and
a6b4/BPAg1, is absent in all forms of junctional EB. Uncein is normally found in the lamina lucida,
along with lamin 1, laminin 5, laminin 6m, heparan sulfate proteoglycan, and fibronectin.

Epidermolysis bullosa simplex with muscular dystrophy is associated with a mutation in:
1

Laminin 5
2

Plectin
3

collagen VII
4

uncein
5

alpha 6 beta integrin

Epidermolysis bullosa simplex with muscular dystrophy is associated with a mutation in:
2

Plectin
EB Simplex is an autosomal dominant disorder caused by mutations in keratins 5 &14, leading to
intraepidermal bullae. A subtype of EBS patients have muscular dystrophy due to a defect in plectin.
Laminin 5 mutations are associated with junctional EB. Collagen VII mutations are associated with
dystrophic EB. Uncein is a protein in the lamina lucida which is found to be absent in junctional EB.
Mutations in alpha6-beta4 integrins are associated with JEB with pyloric atresia.

1

Eyedrops : thimerosal
2

Ear drops : neomycin
3

Theophylline : ethylenediamine
4

Antabuse : thiuram
5

Cobalamin : balsam
37

5

Cobalamin : balsam
Cobalamin is Vitamin B12; cobalt is a component of Vitamin B12. Balsam of Peru is found in
fragrances.

Herpes gestationis is most commonly associated with:
1

Grave's
2

Hashimoto's
3

Diabetes
4

Lupus
5

Rheumatoid arthritis

1

Grave's
Autoimmune diseases are associated with herpes gestationis; Grave's disease is the most common
association.

What is the antigen associated with dermatitis herpetiformis?
1

Tissue transglutaminase
2

Epilegrin
3

Desmocollin
4

Desmoglein 3
5

Periplakin

What is the antigen associated with dermatitis herpetiformis?
1

Tissue transglutaminase
Dermatitis herpetiformis is an autoimmune blistering disease associated with intense pruritus.
Classically, it involves the extensor aspects of the body. Antibodies to tissue transglutaminase (anti-
endomesial, anti-gliadin, anti-reticulin) can be found. It is associated with celiac sprue. 50% have
thyroid disease.

Gap junctions consist of:
1

Laminin
2

Plectin
3

Uncein
38

4

Filagrin
5

Connexins

Gap junctions consist of:
5

Connexins
Gap junctions are protein channels that allow for communcation between cells. A connexon of one cell
is joined to that of an adjacent cell to form an intercellular channel consisting of 12 connexin subunits.
Each intercellular channel provides a channel that interconnects the cytoplasm of the apposed cell
directly and permits the passage of ion and other small molecules between adjacent cells. These protein
channels that make up the gap junctions consist of two hemi-channels or connexons. One connexon
resides in the membrane of one cell and it aligns and joins the connexon of the neighboring cell, forming
a continuous aquaeous pathway by which these ions and small molecules can freely pass from one cell
to the other. Each hemi-channel or connexon consist of six proteins ( hexamer) called connexins.

In penicillamine-induced pemphigus, the split is most often:
1

Subcorneal
2

Intraspinous
3

Suprabasal
4

Intraepidermal and subepidermal
5

Subepidermal

In penicillamine-induced pemphigus, the split is most often:
1

Subcorneal
Penicillamine is the most common cause of drug-induced pemphigus, and the split is more often
subcorneal (pemphigus foliaceus-like) than suprabasal (pemphigus vulgaris-like).

A one-day old infant presents with papules and pustules on the face, trunk, and proximal extremities.
Palms and soles are spared. The patient is otherwise doing well. A biopsy shows numerous eosinophils.
The diagnosis is:
1

Acropustulosis of infancy
2

Herpes infection
3

Erythema toxicum neanotorum
4

Scabies
5

Transient neonatal pustular melanosis

A one-day old infant presents with papules and pustules on the face, trunk, and proximal extremities.
Palms and soles are spared. The patient is otherwise doing well. A biopsy shows numerous eosinophils.
The diagnosis is:
39

3

Erythema toxicum neanotorum
Papule and pustules on an erythematous base appear on a healthy infant within 48 hours, and typically
last 2-3 days in erythema toxicum neanotorum. The lesions may occur anywhere, but usually spare the
palms and soles. Gram stain reveals numerous eosinophils. A 1 day-old infant would not have had a
chance to acquire a scabies infestation. Acropustulosis of infancy typically presents at 3-4 months and
the pathology shows vesicles with many neutrophils. A herpes infection would not show eosinophils.
Transient neonatal pustular melanosis shows sterile sub corneal pustules.

Which of the following adhesion molecules are important for maintaining adhesion between
keratinocytes?
1

Selectins
2

Integrins
3

Cadherins
4

Glycans
5

Immunoglobulin superfamily

Which of the following adhesion molecules are important for maintaining adhesion between
keratinocytes?
3

Cadherins
Cadherins mediate cell adhesion and play a fundamental role in normal development. Calicum is
required for the normal function of these adhesion molecules. There are two main subclasses, classic (E-
, P-, N-) and desmosomal (desmoglein and desmocollin).

Which of the following is true of a phototoxic reaction?
1

Requires prior sensitization of photoallergen in susceptible individuals
2

Photoallergen must bind to carrier protein
3

Develops after repeated exposures
4

Produces an eczematous reaction
5

Results in direct tissue injury

Which of the following is true of a phototoxic reaction?
5

Results in direct tissue injury
Phototoxic reactions result in direct tissue injury when the phototoxic agent interacts with light energy to
form reactive oxygen species. It is characterized by an eruption similar to a sunburn.

This medicine causes degranulation of mast cells
40

1

NSAIDs
2

ASA
3

opiates
4

polymixin B
5


This medicine causes degranulation of mast cells
5

Mast cell degranulators include NSAIDs, ASA, opiates, polymixin B, radiocontrast, tubocurarine,
succinylcholine, and others.

1

Lymphoma
2

Multiparity
3

Grave's disease
4

Inflammatory bowel disease
5

Lupus

3

Grave's disease
Herpes gestationis (HG) typically occurs in the second or third trimester, and clinically presents as
urticarial papules and plaques around the umbilicus which progress to involve the rest of the body. HG
has been associated with Grave's disease.

Direct immunofluorescent studies in chronic bullous disease of childhood is most likely to show:
1

Iga depostion in the superficial blood vessels
2

Linear IgG at the basement membrane
3

4

Granular IgG
5

Linear C3 at the basement membrane

Direct immunofluorescent studies in chronic bullous disease of childhood is most likely to show:
3

Chronic bullouse disease of childhood is believed to be a variant of linear IgA bullous disease, since
disease are characterized by antibodies to the 97kDa antigen that is a part of BPAg2. Children present
with extremely pruritic blisters in circular arrangements. Pathology shows a subepidermal bullae with
41

neutrophils at the dermo-epidermal junction; the DIF shows IgA deposition at the basement membrane
in a linear fashionl.

In staphylococcal scalded skin syndrome, the exfoliative toxin cleaves:
1

Desmoglein 1
2

Desmoglein 3
3

Desmocollin 1
4

Desmocollin 3
5

BpAg2

In staphylococcal scalded skin syndrome, the exfoliative toxin cleaves:
1

Desmoglein 1
Staphylococcal scalded skin syndrome is caused by Staphylococci group 2, phage typ 71, which
produces an exofliative toxin that cleaves desmoglein 1. Clinically, this results in a subcorneal
separation of keratinocytes, leading to skin tenderness, erythema, and superficial desquamatioin of skin.

Common cause(s) of drug-induced pemphigus foliaceus:
1

Captopril
2

Penicillamine
3

Captopril and penicillamine
4

Methotrexate
5

Dilantin

Common cause(s) of drug-induced pemphigus foliaceus:
3

Captopril and penicillamine
Penicillamine and captopril are common causes of drug-induced pemphigus.

IgA pemphigus is a pustular acantholytic dermatosis with intracellular IgA deposition. The most
common target on keratinocytes with patients with IgA pemphigus is:
1

Desmocollin1
2

Dsg2
3

IgG
4

C3
5

IgM
42


IgA pemphigus is a pustular acantholytic dermatosis with intracellular IgA deposition. The most
common target on keratinocytes with patients with IgA pemphigus is:
1

Desmocollin1
IgA pemphigus is a pustular acantholytic dermatosis that targets desmocollin 1. Other targets can
include Dsg1 and Dsg3. The pathogenesis of IgA pemphigus is unknown but can be associated with
gammopathy.

Latex allergy can cross-react with all except:
1

Avocado
2

Banana
3

Kiwi
4

Chestnut
5

Artichoke

Latex allergy can cross-react with all except:
5

Artichoke
Latex allergy can cross-react with avocados, bananas, kiwis, chestnuts, and other foods. Artichokes are a
member of the Asteraceae (formerly Compositae) family.

What percentage of dermatitis herpetiformis patients are asymptomatic but have findings consistent with
celiac sprue on gastrointestinal biopsy?
1

5%
2

15%
3

40%
4

70%
5

95%

What percentage of dermatitis herpetiformis patients are asymptomatic but have findings consistent with
celiac sprue on gastrointestinal biopsy?
5

95%
Most patients with dermatitis herpetiformis have findings consistent with celiac disease on biopsy, but
not all of them are symptomatic.

The best first line treatment for dermatitis herpetiformis is:
1

Methotrexate
43

2

Dapsone
3

Colchicine
4

Prednisone
5

IVIG

The best first line treatment for dermatitis herpetiformis is:
2

Dapsone
The most effective drug for dermatitis herpetiformis is dapsonel. The dose varies between 50 and 300mg
daily. Side effects include hemolytic anemia, leukopenia, methemoglobinemia, and rarely
agranulocytosis or peripheral neuropathy. Sulfapyridine is also a very effective treatment for dermatitis
herpetiformis.

Antibodies to which antigen are most likely responsible for this disease?
1

Bullous pemphigoid antigen II
2

Desmoglein I
3

Desmocollin
4

Keratin 5
5

Plakoglobin

Antibodies to which antigen are most likely responsible for this disease?
1

Bullous pemphigoid antigen II
The clinical appearance of tense bullae and urticarial plaques is suggestive of bullous pemphigoid.
Bullous pemphigoid antigen II is a transmembrane protein in the hemidesmosome. Antibodies to this
antigen are pathogenic in bullous pemphigoid.

The most important group of disease linked with the pathogenesis of paraneoplastic pemphigus in adults
is
44

1

Lymphoproliferative disorders
2

Colerectal adenocarcinoma
3

Breast Cancer
4

Sarcomas
5

Melanoma

The most important group of disease linked with the pathogenesis of paraneoplastic pemphigus in adults
is
1

Lymphoproliferative disorders
The most important group of disease linked witht eh pathogenesis of pareneoplastic pemphigus is
Lymphoproliferative disorders. Most commonly non-Hodgkin's lymphoma, CLL, Castleman's tumor,
sarcoma, and thymoma.

Which of the following agent(s) has been most effective in treating severe ocular cicatricial
pemphigoid?
1

Cyclophosphamide
2

Mycophenolate mofetil
3

Cyclophosphamide + corticosteroids
4

Cyclosporin
5

Azathioprine

Which of the following agent(s) has been most effective in treating severe ocular cicatricial
pemphigoid?
3

Cyclophosphamide + corticosteroids
Cicatricial pemphigoid is a heterogeneous group of subepithelial blistering diseases involving the
mucous membranes and skin. The treatment of cictracial pemphigoid is predicated upon the extent,
severity, and location of disease. Most regimens used are empiric and are based on clinical experience.
With severe ocular involvement, most experts recommend aggressive treatment with the combination of
cyclophosphamide and steroids.

Patients with epidermolysis bullosa acquisita have:
1

A defect in plectin
2

A defect in collagen XVII
3

Antibodies to collagen XVII
4

Antibodies to collagen VII
5

A defect in laminin 5

45

Patients with epidermolysis bullosa acquisita have:
4

Antibodies to collagen VII
Epidermolysis bullosa acquisita (EBA) classically presents in adulthood as noninflammatory trauma-
induced bullae that heal with scarring, especially on the hands and feet. Histology shows a subepidermal
blister (usually pauci-inflammatory); DIF shows linear IgG at the basememt membrane; salt-split skin
shows antibodies at the "floor". Patients hae antibodies to type VII collagen.

This is derived from Myroxylon pereirae:
1

Thimerosol
2

Aniline dyes
3

Balsam of Peru
4

Colophony
5

Thiuram

This is derived from Myroxylon pereirae:
3

Balsam of Peru
Balsam of Peru is derived from the Myroxylon pereriae tree. Thimerosal is a questionable cause of
allergic contact dermatitis; it is found in vaccines and contact lens solutions.

Which of the following forms of epidermolysis bullosa is autosomal recessive?
1

Weber-Cockayne
2

Dowling-Meara
3

Junctional EB with pyloric atresia
4

EB simplex with muscular dystrophy
5

Hyperplastic cockayne-touraine

Which of the following forms of epidermolysis bullosa is autosomal recessive?
3

Junctional EB with pyloric atresia
The forms of junctional epidermolysis bullosa are inherited in an autosomal recessive fashion. These
include Herlitz, non-Herlitz, JEB with pyloric atresia, JEB inversa, and GABEB. Recessive dystrophic
EB (Hallopeau-Siemens) is also a recessive subtype of dystrophic EB. EB simplex is typically inherited
in an autosomal dominant fashion. Hyperplastic cockayne-touraine is a subtype of dominant dystrophic
EB.

Etyhlenediamine dihydrochloride is known to cross-react with all the following substances except?
1

Neomycin
46

2

Aminophylline
3

Promethazine
4

Meclizine
5

Hydroxyzine

Etyhlenediamine dihydrochloride is known to cross-react with all the following substances except?
1

Neomycin
Ethylenediamine dihydrochloride is a stabilizer found in aminophylline, theophylline, antihistamine
creams, and Mycolog cream (nystatin/triamcinolone). It is also used in synthetic coolants, rubber
accelerators, insecticides, and fungicides. It is not known to cross react with neomycin.

Formaldehyde releasers include all except:
1

Methylchoroisothiazolinone
2

Germall
3

Quaternium 15
4

Dowicil
5

DMDM hydantoin

Formaldehyde releasers include all except:
1

Methylchoroisothiazolinone
Methylchloroisothiazolinone is also known as Kathon CG and it is a preservative. Germall, quaternium
15 (dowicil 200), DMDM hydantoin, and others are formaldehyde-releasing preservatives.

An elderly gentleman with a history of hypertension and a thymoma, presents to the Emergency Room
with oral and conjunctival erosions and hemorrhagic bullae on his hands and feet. These finds are seen
in:
1

2

Sweets syndrome
3

Toxic epidermal necrolysis
4

5

Erythema multiforme

An elderly gentleman with a history of hypertension and a thymoma, presents to the Emergency Room
with oral and conjunctival erosions and hemorrhagic bullae on his hands and feet. These finds are seen
in:
4

47

Paraneoplastic pemphigus is usually associated with cancers of lymphoid origin, including lymphoma,
leukemia, thymomas, Castlemans tumor. Clinically, this condition may present with intractable
staomatitis, severe painful oral and conjunctival erosions.

Which of the following is known as "prickly heat"?
1

Miliaria crystallina
2

Miliaria rubra
3

Miliaria profunda
4

Grover's disease
5

Fox-Fordyce disease

Which of the following is known as "prickly heat"?
2

Miliaria rubra
Miliaria are caused by occusion of ecrine sweat glands. Miliaria crystalina are clear minute subcorneal
vesicles with no inflammation. Miliaria rubra are red papules subepidermal vesicles with inflammation.
Miliaria rubra is known as "prickly heat" as it presents after sweating, heat exposure, fever or occlusion.
Miliaria profunda or pustulosa are red nodules or pustules with deeper inflammation. Fox-Fordyce
disease is apocrine miliaria that is very pruritic and presents in axilla and anogenital area of women.
Grover's disease is a papulovesicular eruption of the trunk that is pruritic and can occur after sun
exposure or in bedridden patients with occluded backs. Histologically Grover's disease presents with
small foci of acantholytic dyskeratotic cells in the suprabasal region.

What is the antigen found in the variant of cicatrical pemphigoid that is associated with internal
malignancies?
1

BPAg1
2

BPAg2
3

Type VII collagen
4

Epiligrin
5

Keratins 5 & 14

What is the antigen found in the variant of cicatrical pemphigoid that is associated with internal
malignancies?
4

Epiligrin
Individuals with anti-epiligrin cicatricial pemphigoid are thought to be at an increased risk for solid
internal malignancies.

Nickel can be detected in jewelry by applying:
48

1

Dimethylglyoxime
2

Methylchloroisothiazolinone
3

Dowicil
4

Quinone
5

Thiocyanate

Nickel can be detected in jewelry by applying:
1

Dimethylglyoxime
Dimethylglyoxime application to metals containing nickel will show a pink color.
Methylchloroisothiazolinone is Kathon CG, a preservative. Dowicil is a formaldehyde-releasing
preservative. Primin is a type of quinone, and it is the allergen in primrose (Primula obconica).
Thiocyanates are the irritating substances in garlic.

Perioral exuberant granulation tissue is sometimes seen in:
1

2

Herlitz
3

Duhring's
4

Weber-Cockayne
5

Stevens-Johnson
Perioral exuberant granulation tissue is sometimes seen in:
2

Herlitz
The Herlitz form of junctional EB sometimes presents with excessive granulation tissue periorally, in
the axillary/neck area.

Which type of epidermolysis bullosa has the greatest risk of developing squamous cell carcinomas?
1

Weber-Cockayne
2

Dowling-Meara
3

Herlitz
4

EB Simplex with muscular dystrophy
5

Hallopeau-Siemens type of recessive dystrophic EB

Which type of epidermolysis bullosa has the greatest risk of developing squamous cell carcinomas?
5

Hallopeau-Siemens type of recessive dystrophic EB
49

Dystrophic EB is due to a defectin collagen 7, leading to decreased or absent anchoring fibrils in the
sublamina densa. The three types of dominant dystrophic EB include Hyperplastic cockayne-Touraine,
Albopapuloid Pasini, and Bart's. The Recessive form of dystrophic EB is also known as Hallpeau
Siemens and patients present at birth owith generalized bullae which lead to erosions and atrophic
scarring, mitten deformities, flexion contractures, oral and esophageal scarring and strictures and
dysplastic teeth. There is an increased risk of squamous cell carcinomas.
Herpes gestationis is exacerbated by:
1

Oral contraceptives
2

Menstruation
3

Third trimester
4

Postpartum state
5


Herpes gestationis is exacerbated by:
5

Herpes gestationis has also been associated with choriocarcinoma in several case reports.

Which of the following immunosuppressive agents has been most effective in cicatricial pemphigoid?
1

Cyclophosphamide
2

Azathioprine
3

Mycophenolate mofetil
4

Cyclosporine
5

Methotrexate

Which of the following immunosuppressive agents has been most effective in cicatricial pemphigoid?
1

Cyclophosphamide
Cicatricial pemphigoid is a heterogeneous group of subepithelial blistering diseases involving the
mucous membranes and skin. The treatment of cictracial pemphigoid is predicated upon the extent,
severity, and location of disease. Most regimens used are empiric and are based on clinical experience.
With severe ocular involvement, most experts recommend aggressive treatment with the combination of
cyclophosphamide and steroids.

A patients with a history of leukemia that had severe, persistent painful stomatitis extending from the
lips into the pharynx, larynx and esophagus. Conjunctival involvement may lead to blindness. The
cutaneous changes are polymorphic, ranging from erythematous macules to lichenoid papules to blisters
and erosions. This patient most likely has:
50

1

2

Erythema multiforme
3

4

Chemotherapy induced stomatitis
5

Persistent herpes simplex

A patients with a history of leukemia that had severe, persistent painful stomatitis extending from the
lips into the pharynx, larynx and esophagus. Conjunctival involvement may lead to blindness. The
cutaneous changes are polymorphic, ranging from erythematous macules to lichenoid papules to blisters
and erosions. This patient most likely has:
1

This patient has paraneoplastic pemphigus. It is an uncommon blistering disease with a variety of
clinical patterns and target antigens associated with underlying malignancy. It is most likely associated
with lymphoma, leukemia, Castleman tumor, or thymoma. Diagnosis is by indirect immunofluorescence
is positive on rat bladder epithelium.

Antibodies in chronic disease of childhood disease, map to the:
1

Basal layer
2

Lamina lucida
3

Lamina densa
4

Sublamina densa
5

Lamina lucida and sublamina densa
Antibodies in chronic disease of childhood disease, map to the:
5

Lamina lucida and sublamina densa
Immunoelectron mapping of chronic disease of childhood has shown binding within the lamina lucida as
well as in the sublamina densa. This correlates with the finding of the 97-kDa antigen that is
homologous to a portion of the BPAg2 molecule as well as a 280-290 kDa antigen in this disease. Some
have suggested that the 280-290 kDa antigen is type VII collagen, but the former does not co-migrate
with type VII collagen on Western blots.

Dermatitis herpetiformis is associated with:
1

HLA-Cw6
2

HLA-B27
3

HLA-DR4
4

HLA-DQ1
5

HLA-DR3
51


Dermatitis herpetiformis is associated with:
5

HLA-DR3
HLA DR3 and DQ2 are associated with dermatitis herpetiformis. HLA B27 is associated with psoriasis
with spondylarthropathy, while HLA Cw6 is associated with psoriasis.

Which steriod screening agent should be used when an allergic contact dermaititis is suspected to
hydrocortisone?
1

Glutaral
2

Tixocortol-21-pivalate
3

Budesonide
4

Hydrocortisone-17-butyrate
5

Benzalkonium chloride

Which steriod screening agent should be used when an allergic contact dermaititis is suspected to
hydrocortisone?
2

Tixocortol-21-pivalate
Tixocortol-21-pivalate is a group A steroid and screens for allergies to hydrocortisone, prednisone, and
methylprednisolone. Budesonide screens for groups B and D steroids, and hydrocortisone-17-butyrate
screens for group D steroids.

Fecal isocoproporphyrin is seen in:
1

Porphyria cutanea tarda
2

Harderoporphyria
3

Variegate porphyria
4

Acute intermittent porphyria
5

Coproporphyria

Fecal isocoproporphyrin is seen in:
1

Porphyria cutanea tarda
Fecal isocoproporhyrin is characteristic of porphyria cutanea tarda.

The Absoe-Hansen sign as applies to blister formation refers to
1

Lateral slipping of the epidermis when perilesional is rubbed
2

Lateral dissection of the blister when pressure is applied directly to a blister
52

3

Blister formation following stroking of the lesion
4

Blister induction with incised trauma to skin
5

Blister formation after cryosurgery

The Absoe-Hansen sign as applies to blister formation refers to
2

Lateral dissection of the blister when pressure is applied directly to a blister
The Asboe-Hansen sign as applies to blister formation refers to lateral dissection of the blister when
pressure is applied directly to the blister. This is also called, "bulla-spread phenomenon", because
pressure on an inact bulla, genlty forces fluid to wander under the skin away from the pressure site.

What is the most common cause of this entity?
1

Drugs
2

Infections
3

Malignancies
4

Idiopathic
5

UV exposure

What is the most common cause of this entity?
1

Drugs
Stevens-Johnson syndrome (SJS) is an immune-complex-mediated hypersensitivity complex that is a
severe expression of erythema multiforme. Most authors and experts consider SJS and toxic epidermal
necrolysis (TEN) different manifestations of the same disease. The most common cause of recurrent
episodes are erythema multiforme (AKA herpes associated erythema multiforme (HAEM)), whereas
drugs are the most common cause of SJS/TEN.

An older patient with erythema and crusting in a butterfly distribution and seborrheic areas with erosions
is diagnosed with pemphigus erythematosus. The other synonym for pemphigus erythematosus is:
1

Senear-Usher syndrome
2

Wildfire pemphigus
53

3

Fogo Selvagem
4

Acrokeratosis verruciformis Hopf
5

Foliaceus erythematosus
An older patient with erythema and crusting in a butterfly distribution and seborrheic areas with erosions
is diagnosed with pemphigus erythematosus. The other synonym for pemphigus erythematosus is:
1

Senear-Usher syndrome
Pemphigus erythematosus is also known as Senear-Usher syndrome. It is an uncommon variant of
pemphigus foliaceus with additional features of lupus erythematosus. It is most likely triggered by
sunlight or medications than other forms of pemphigus foliaceus.

Which is incorrect?
1

Tulipalin : alstroemeria
2

Urushiol : anacardia
3

Sesquiterpene lactones : artichokes
4

Usnic acid : lichen
5

Diallyl disulfide : fig

Which is incorrect?
5

Diallyl disulfide : fig
Tulipalin A is a byproduct of tuliposide A metabolism, and it is the allergen in alstroemeria, the
Peruvian lily, and tulips. Urushiol is the allergen in Toxicodendron plants as well as several other cross-
reactors including cashew nut shells (Anacardium occidentale). Artichokes are in the family Asteraceae
(formerly Compositae); this family is allergenic secondary to sesquiterpene lactones. Lichens contain
usnic acid. The fig tree is in the family Moraceae, which is one of the plant families that can cause
phytophotodermatitis.

Atopic dermatitis is associated with all except:
1

Lchthyosis hystrix
2

Central facial pallor
3

Pityriasis alba
4

Nipple eczema
5

Hyperlinear palms

Atopic dermatitis is associated with all except:
54

1

Lchthyosis hystrix
Icthyosis vulgaris (not hystrix) is associated with atopic dermatitis as one of the minor criteria of
Hanifin.

This disease is inherited in an X-linked recessive manner:
1

Chronic granulomatous disorder
2

Jobs syndrome
3

Dowling-Meara
4

Mongomerys syndrome
5

Treacher-Collins

This disease is inherited in an X-linked recessive manner:
1

Chronic granulomatous disorder
Chronic granulomatous disorder is inherited in an X-linked recessive manner, as is Wiskott-Aldrich.
Jobs syndrome is autosomal dominant. Dowling-Meara is a subtype of EB simplex, with autosomal
dominant inheritance. Mongomerys syndrome is xanthoma disseminatum. Treacher Collins syndrome
is also known as mandibulo-facial-dysostosis.

A child develops an allergic reaction at the site of an influenza vaccine. To which of the following
substances may she be allergic to?
1

Lanolin
2

Thimerosol
3

Ethylenediamine dichloride
4

Triclosan
5

Gluteraldehyde

A child develops an allergic reaction at the site of an influenza vaccine. To which of the following
substances may she be allergic to?
2

Thimerosol
Thimerosol is a preservatives in vaccines such as the influenza, tetanus, and diphtheria vaccines. It is
also found in antitoxins and immunoglobulins. Thimerosol is a mercury-containing organic compound.
Lanolin is from the sebum of sheep. Ethylenediamine dichloride is a stabilizer in topical creams,
medicines, dyes, insecticides, and fungicides and was previously found in nystatin cream. Triclosan is an
antibacterial agent found in soap, shampoo and mouthwash. Gluteraldehyde is a cold sterilizing solution
used for medical and dental equipment.
55

Antibodies against type VII collagen are seen in:
1

Epidermolysis bullosa simplex
2

Pemphigus erythematosus
3

4

5

Bullous pemphigoid

Antibodies against type VII collagen are seen in:
4

Type VII collagen is present in the basement membrane of stratified squamous epithelia in the anchoring
fibrils. It is the target antigen in several blistering disease including epidermolysis bullosa acquista,
bullous lupus erythematosus, dominant and recessive dystrophic epidermolysis bullosa.

The agent most likely to cause pseudoporphyria is:
1

NSAID's
2

Penicillin
3

Beta-blockers
4

Vancomycin
5

Ace-inhibitors

The agent most likely to cause pseudoporphyria is:
1

NSAID's
NSAIDS,especially naprosyn, are the most common group of drugs implicated in pseudoporphyria.
Other common offenders include lasix, tetracycline, accutane, amiodarone and tanning beds.

Which of the following proteins is typically NOT found to be antigenic in paraneoplastic pemphigus?
1

BPAg1
2

BPAg2
3

Desmoplakin
4

Envoplakin
5

Periplakin

Which of the following proteins is typically NOT found to be antigenic in paraneoplastic pemphigus?
2

BPAg2
56

BPAg2, a 180kDa protein, is typically not found to be antigenic in paraneoplastic pemphigus. The
proteins typically involved are: desmplakin 1 (250kDa) BPAg1 (230 kDa) Envoplakin (210kDa)
Desmoplakin 2(210kDa) Periplakin (190 kDa) Unknown protein (170 kDa) Desmogleins 1& 3 (160 and
130 kDa)

Which of the following chemicals is the most common cause of shoe contact dermatitis?
1

Thiuram mix
2

2-Mercaptobenzothiazole
3

Carba mix
4

Mixed dialkyl thioureas
5

Formaldehyde

Which of the following chemicals is the most common cause of shoe contact dermatitis?
2

2-Mercaptobenzothiazole
2-Mercaptobenzothiazole is found in the soles of shoes, and is the #1 cause of shoe contact dermatitis. It
is also found in rubber accelerators, adhesives/tape, coolants, rubber, flea/tick powder, and support hose.
Thiuram mix, carba mix, and mixed dialkyl thioureas are also rubber sensitizers. Thiuram is the second
most frequent source of shoe contact dermatitis. Formaldehyde is a preservative and not found in shoes.

The croton plant is irritating secondary to:
1

Calcium oxalate
2

Thiocyanate
3

Protoanemonin
4

Phorbol esters
5

Capsaicin

The croton plant is irritating secondary to:
4

Phorbol esters
Irritant contact dermatitis secondary to the croton plant is due to phorbol esters. Calcium oxalate is also
an irritant; it is found in the "dumb caine" plant, a common house plant (Dieffenbachia) as well as in
daffodils. Thiocyanates are irritants found in garlic. Protoanemonins are irritants found in buttercups.

Which pair is not associated with allergic cross-reactivity?
1

Thimerosal : piroxicam
2

Ethylenediamine : hydroxyzine
3

PABA : procaine
57

4

Balsam of Peru : cinnamon
5

Thiuram : sulfa drugs

Which pair is not associated with allergic cross-reactivity?
5

Thiuram : sulfa drugs
Thiurams may cross-react with Antabuse (disulfiram).

A woman in her 2nd trimester of pregnancy presents to clinic with urticarial plaques and papules around
her umbilicus, chest and extremities. Tense vesicles are present within a few of the erythematous
plaques. This womans condition is most commonly associated with:
1

Lymphoma
2

Multiparity
3

Graves Disease
4

Inflammatory Bowel Disease
5

Lupus

A woman in her 2nd trimester of pregnancy presents to clinic with urticarial plaques and papules around
her umbilicus, chest and extremities. Tense vesicles are present within a few of the erythematous
plaques. This womans condition is most commonly associated with:
3

Graves Disease
Herpes gestationis (HG) typically occurs in the second or third trimester, and clinically presents as
urticarial papules and plaques around the umbilicus which progress to involve the rest of the body. HG
has been associated with Grave's disease. Hormonal factors influence the disease manifestation. This
condition can be seen in pregnant women, menstruating women, and women taking oral contraceptives.

Transient bullous disorder of childhood has a defect in:
1

Alpha6-integrin
2

Plectin
3

BPAg2
4

Epiligrin
58

5

Collagen VII

Transient bullous disorder of childhood has a defect in:
5

Collagen VII
Transient bullous dermolysis of the newborn may be a forme fruste/variant of dominant dystrophic EB.
Mutations have been found in type VII collagen.

Chloracne may be secondary to exposure to:
1

Chloroacetophenone
2

Hydrochloric acid
3

Hydrocarbons
4

Dioxin
5

Methylchloroisothiazolinone

Chloracne may be secondary to exposure to:
4

Dioxin
Chlorinated compounds can cause irritant dermatitis and sometimes chloracne. Chlorinated compounds
include chloronaphthalene, chlorodiphenyl, dichlorobenzonitrile, tetrachloroazooxybenzene; dioxin
(exposure in the Vietnam war); and cutting oils. Chloroacetophenone is an irritant in tear gas.

59

Vesicular and Bullous Dermatosis MCQs

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