26.

All of the following can lead to Staphylococcal infection EXCEPT:

a. Virulent bacterial strains
b. Abnormality in neutrophil chemotaxis
c. Deficiency in intracellular killing
d. Porphyrin accumulation
RATIONALE: Porphyrin accumulation is a heme problem not an immune system problem as in choices A,
B and C are. Porphyrins are cyclic compounds that readily bind metal ionsusually Fe2+ or Fe3+. The
most prevalent metalloporphyrin in humans is heme. Defects of enzymes needed at various steps of
heme synthesis result in distinct clinical syndromes known as porphyrias. Porphyrins are precursors of
heme, a part of the hemoglobin molecule.
https://www.inkling.com/read/illustrated-reviews-biochemistry-harvey-5th/chapter-21/ch21-section-0
http://emedicine.medscape.com/article/1389981-overview

27. Collarette patch can be seen in which disease?

a. Pityriasis rosea
b. Pityriasis versicolor
c. Tinea capitis
RATIONALE:

Pityriasis ROSACEA (+)

reddish brown discrete
macules and collarette
scaling

Pityriasis/Tinea versicolor superficial yeast

infection present with hypo or
hyperpigmented lesions that start out as
rashes and eventually dry out and result in
scaling

Tinea capitis
annular/ring-like lesions

Harrisons 18th Ed
https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/tinea-versicolor/signs-symptoms
http://dermnetnz.org/fungal/pityriasis-versicolor.html

28. A 50 yr old female complained of an ulcer on the right medial malleolus of 5 months duration.
Inspection of the leg revealed varicosities. What type of ulcer is this?
a. Arterial
b. Decubitus
c. Neuropathic
d. Venous
RATIONALE:
VENOUS
ARTERIAL
Decubitus ulcers
Neuropathic ulcers
Lower 1/3 of leg
Tips of toes or generally form on typically located on
Pretibial Area
between toes
areas of unrelieved weight-bearing
Anterior to medial Over phalangeal heads pressure
over
a surfaces s.a. plantar
malleoulus
Above
laterial defined area, usually surface of foot),
Uneven edges without malleolus,
over over
a
bony metatarsal heads, and

necrotic tissue

metatarsal heads on prominence

the side or sole of feet
Well defined edges
WITH necrotic tissue

heels, all of which are

sites of painless and
minor repetitive
trauma.

http://www.viha.ca/NR/rdonlyres/18FC0E44-7476-4D4E-8118-263EC684AF87/0/Chapter7NeuropathicUlcers.pdf
http://emedicine.medscape.com/article/190115-overview

29. Gottron's papules are seen in patients with

a. Dermatomyositis
b. Rheumatoid Arthritis
c. Scleroderma
d. Steven Johnsons Syndrome
RATIONALE:
a. Dermatomyositis Gottrons = flat-topped violaceous papules over knuckles
b. Rheumatoid Arthritis - general inflammation of joints
c. Scleroderma atrophic lesions
d. Steven Johnsons Syndrome Nikolskys sign, pemphigus vulgaris , bullous pemphigoid
http://www.uihealthcare.org/2column.aspx?id=237258
http://www.arthritis.co.za/raskin.html

30. A 65 year old woman presented with periorbital confluent erythema and edema for months. She has
had arthritis for years and recently had weakness of the arms. She has difficulty with shampooing
and recently with combing her hair. She also has violaceous papules over distal phalangeal joints
and grossly visible telangiectasias. What is the most sensitive and specific laboratory indicator for
this condition?
a. Lactic Dehydrogenase
b. Serum aldolase
c. Serum creatine kinase
d. Transaminases (AST, ALT)
RATIONALE:
This is classic dermatomyositis, a connective tissue disease that presents with proximal muscle
weakness which is accompanied by INCREASED serum creatine kinase. (+) Heliotrope rash
http://emedicine.medscape.com/article/332783-overview
http://www.nlm.nih.gov/medlineplus/ency/article/000839.htm

31. A 22 year old female went to the UERM Hospital due to a lesion in the right thigh and right leg for 2
years. PE showed the lesion to have erythema, non-pruritic plaque with distinct border, hyposthesia
and decreased sweating. What is your clinical impression?
a. Borderline Leprosy
b. Erythema Nodosum Leprosum
c. Tuberculoid Leprosy
d. Lepromatous Leprosy
RATIONALE:
Erythema Nodosum
Tuberculoid Leprosy
Lepromatous Leprosy
Reaction to infection:
Few, well-defined,
Symmetric, skin-colored /slightly
Painful, nodular lesions on
hypopigmented
erythematous papules/ nodules
anterior shins (usual site)
(whitish), hypoesthetic
on earlobes, face, arms, butt,
color change similar to bruise
( some loss of sensation)
trunk, and lower extremities, (+)
macules/patches with raised
Loss of hair, (+) Leonine facies

erythematous/purple border
enlarging peripherally
32. A 65 year old male complained of painful group of vesicles on his right anterior and posterior chest
area of 24 hours duration, accompanied by headache, malaise and fever. What medicine should you
give?
a. Acyclovir
b. Foscarnet
c. Prednisone
d. Paracetamol
RATIONALE:
Antiviral therapy with Acyclovir initiated within 48-72 hours of rash onset is effective in managing active
disease and post-herpetic neuralgia. Use of corticosteroids for reducing inflammation is still subject to
debate.
33. A 28 year old man has maculopapular rashes on palm and sole. He admits to being sexually active
and having a painless ulcer on penile area. What is the likely diagnosis?
a. Behcets disease
b. Pityriasis rosacea
c. Secondary syphilis
RATIONALE:
Behcets Disease
Pityriasis rosacea
Secondary Syphilis
Painful ulceration of oral and
Reddish brown discrete macules Sexual history + Lesions on palms
genital regions with eye and
and collarette scaling usually
and soles = HIGHLY SUGGESTIVE
joint involvement
found at shoulders and back
34. A 37 year old bank executive has Psoriasis. What secondary lesion will be present?
a. Plaque
b. Scales
c. Papule
RATIONALE:
Scales are secondary lesions characteristic of Psoriasis. Plaques and papules are primary lesions.
35. A 27 year old female medical resident presents with hair loss of 2 months duration. Past medical
history indicates that she had a normal delivery 3 months prior. What is the cause?
a. Alopecia Areata
b. Androgenic Alopecia
c. Anagen Effluvium
d. Telogen Effluvium
RATIONALE:
Alopecia Areata
Androgenetic Alopecia
Anagen Effluvium
Telogen Effluvium
Clearly demarcated
Genetic condition seen
Profound hair loss
Hormone-related
round or oval patches
among MALES
shedding of hair
of hair loss usually
Usu with pts
Usu with high grade
affecting young adults
undergoing
fever/viral
and children
radio/chemotx
infxn/POSTPARTUM

Normally appears very

clean (no visible scaling
or inflammation)

36. A 60 year old patient taking anti-arrhythmic drug for a month complained about his bluish-gray rash
on his face. Which of the following drug have caused this change?
a. Amiodarone
b. Flecainide
c. Procainamide
d. Sotalol
RATIONALE:
Clofazimine Dark brown
Quinacrine Yellow without eye involvement
Amiodarone Bluish tinge of FACE
Minocycline Bluish, bruise-like lesions on body and extremities due to drug accumulation
37. In a patient with scabies, what is the secondary lesion?
a. Crust
b. Erosion
c. Excoriation
d. Ulcer
RATIONALE: Excoriations which are superficial excavations of the epidermis are secondary to chronic
scratching in scabies, a lesion that may be followed by crusting. Erosion and ulceration, which usually
involves destruction of epidermis and even the dermis are highly unlikely to manifest with scabies.
38. A 35-year old male is being treated with radiotherapy for nasopharyngeal carcinoma complains of
massive hair loss. What is your diagnosis?
a. Anagen Effluvium
b. Androgenetic Alopecia
c. Diffuse Alopecia
d. Telogen Effluvium
RATIONALE:
Alopecia Areata
Androgenetic Alopecia
Anagen Effluvium
Telogen Effluvium
Clearly demarcated
Genetic condition seen
Profound hair loss
Hormone-related
round or oval patches
among MALES
shedding of hair
of hair loss usually
Usu with pts
Usu with high grade
affecting young adults
GRADUAL onset of hair undergoing
fever/viral
and children
line recession and
radio/chemotx
infxn/postpartum
shedding
Normally appears very
clean (no visible scaling
or inflammation)

39. A 30 year old female consults because of malar rash, joint pains, oral ulcers, and anemia. Physical
examination of the scalp reveals hair loss on red to purple plaques with hyperkeratotic scales. What
is your diagnosis?

a. Alopecia Areata
b. Moth-eaten
c. Scarring alopecia
d. Traumatic alopecia
RATIONALE:
Data indicative of systemic scarring alopecia associated with Chronic cutaneous erythematosus as in
Discoid lupus erythematosus. Note mention of malar rash and joint pains.
Alopecia Areata
Scarring Alopecia
Usu affects young adults and children
Usu affects females
Clearly demarcated round/oval patches of hair loss
reddish to purplish plaque, elevated and
hyper keratinosis
EXCLAMATION POINT HAIRS
(+) scarring which causes irreversible hair loss
in affected areas
40. Which of the following is a nail manifestation in psoriasis?
a. Half and half nail
b. Koilonychia
c. Onycholysis
RATIONALE:
Half and half nails
Koilonychia
Renal disease
Hemochromatosis
proximal white & distal pink
Spoon nails
(caucasians) or brown
abnormal thinness and
(Malay)
concavity of fingernails
Secondary to faulty iron
metabolism

Onycholysis
Psoriasis vulgaris
oil spots, loosening of nail,
crumbling of nail
painless separation of nail plate
from nail bed

41. A 22 year old male consults of fever and painful, minute, fluid filled lesions on the right angle of the
mouth of 2 days duration. What is the primary lesion?
a. Bulla
b. Papule
c. Pustule
d. Vesicle
RATIONALE:
Herpes Labialis - Herpetiform lesions due to HSV-1 are usually asymmetric fluid-filled vesicles with
erythematous base that coalesce in the mucocutaneous angle of the mouth