MCQ Book Questions

Q60802. A 36-year-old woman presents with a pigmented lesion on the posterior aspect of her left calf (shown in the image). An exci- sional biopsy demonstrates a superfi cial spreading type of mel- anoma. Which of the following histologic features has the most important prognostic value in your evaluation of this patient?

Q60803. A 25-year-old man presents with a 1-month history of fatigue, mild fever, and an erythematous scaling rash. His major con- cern is related to the scaling plaques distributed on his knees, buttocks, elbows, scalp, and feet. He also notes some joint pain and swelling, primarily involving the small bones of his fi ngers. Physical examination reveals erythematous plaques with adher- ent silvery scales that induce punctate bleeding points when removed. Biopsy of lesional skin would most likely show an accumulation of which of the following cells in the epidermis?

Q60804. Examination of a 2-day-old neonate reveals numerous blisters on the trunk and extremities. Skin biopsy discloses separation of the basal layer of the epidermis from its basement mem- brane and is devoid of infl ammatory cells. No antibody depos- its are identifi ed by immunofl uorescence microscopy. Which of the following is the most likely diagnosis?

Q60805. A 25-year-old man complains of eruptions of blisters on his scalp and inner surface of the groin and in his mouth. The blis- ters rupture easily and leave large crusted areas. Histologically, the lesions show separation of the stratum spinosum from the basal layer. The results of direct immunofl uorescence micros- copy for IgG are shown. Which of the following proteins is targeted by IgG autoantibody in the skin of this patient?

Q60806. A 3-year-old child has numerous small, white scales covering the extensor surfaces of the extremities, trunk, and face (shown in the image). The child’s mother and grandmother have the same condition. Biopsy of lesional skin shows hyperkeratosis and a thin stratum granulosum. Which of the following is the most likely diagnosis?

Q60807. A 70-year-old woman presents with facial discoloration. The patient is observed to have a fl at, pigmented lesion on the atrophic, sun-damaged skin (shown in the image). Which of the following is the most likely diagnosis?

Q60808. A 65-year-old woman complains of having an itchy rash for the past few months. She said the lesions fi rst appeared as red swollen plaques on her abdomen and fl exor aspect of her forearms. Physical examination reveals urticarial plaques, as well as large bullae on her abdomen and thighs (shown in the image). A skin biopsy shows a positive direct immunofl uores- cence test for IgG antibasement membrane antibody. Which of the following is the appropriate diagnosis?

Q60809. A 15-year-old girl complains of itchy skin lesions of 6 months in duration. Physical examination reveals numerous wheal-like lesions with small vesicles over her elbows and knees. A skin biopsy demonstrates infl ammation in the tips of the dermal papillae and subepidermal vesicles. Which of the following histopathologic fi ndings would provide the best evidence to support a diagnosis of dermatitis herpetiformis in this patient?

Q60810. A 17-year-old woman is brought to the physician by her par- ents because “she has been acting strangely” for a couple of days. Over the past 3 months, she has experienced malaise, joint pain, weight loss, and sporadic fever. The patient appears agitated, with a temperature of 38°C (101°F). Other physical fi ndings include malar rash, erythematous-pink plaques with telangiectatic vessels, oral ulcers, and nonblanching purpuric papules on her legs. Laboratory studies show elevated levels of BUN and creatinine. The anti–double-stranded DNA antibody test is positive. Biopsy of sun-damaged lesional skin would most likely show which of the following histopathologic fi nd- ings in this patient?

Q60811. A 60-year-old former lifeguard presents with several small, pearly nodules on the back of her neck. A biopsy of one of the nodules (shown in the image) reveals buds of atypical, deeply-basophilic keratinocytes extending from the overlying epidermis into the papillary dermis. Which of the following is the appropriate diagnosis?

Q60812. A 10-year-old girl presents with multiple papules on the back of her hand that bleed easily. Histologic examination of a lesion reveals squamous epithelial-lined fronds with fi brovascular cores (shown in the image). Which of the following viruses is most likely responsible for the development of these skin lesions?

Q60813. A 28-year-old woman presents with a 2-day history of dome- shaped erythematous nodules appearing on her skin. She recently had a urinary tract infection for which she was treated with trimethoprim sulfamethoxazole (Bactrim). Biopsy discloses focal hemorrhage, neutrophilic infi ltrates in the subcutaneous fi brous tissue septa, and giant cells at the interface between the septa and the adipose fat tissue. No infectious agents are identi- fi ed. Which of the following is the most likely diagnosis?

Q60814. A 30-year-old woman with chronic hepatitis B presents with numerous red skin lesions that she has had for 5 days. Physical examination reveals multiple, purpuric, 2- to 4-mm papules on the skin (shown in the image). The pap- ules did not blanch under pressure. Biopsy of lesional skin shows necrotizing leukocytoclastic venulitis. Immunofl uo- rescence studies disclose immune complex deposition in vascular walls. Which of the following is the most likely diagnosis?

Q60815. A 20-year-old man presents to his family physician for treat- ment of itching after exposure to poison ivy. The patient’s hands and arms appeared red and were covered with oozing blisters and crusts (shown in the image). Which of the follow- ing represents the most important step in the pathogenesis of the sensitization phase of injury in this patient?

Q60816. A 14-year-old boy presents with a 6-month history of erythematous papules on his face. Physical examination reveals numerous “blackheads” over the forehead and cheeks. Which of the following bacteria is associated with the devel- opment of these lesions?

Q60817. A 30-year-old man presents with fl at-topped papules that have appeared gradually on the fl exor surfaces of his wrists. White streaks and patches are also found on the buccal mucosa of the patient’s mouth. Histologically, the lesions showed hyper- keratosis, thickening of the stratum granulosum, and a band- like infi ltrate of lymphocytes and macrophages in the upper dermis, disrupting the basal layer of the epidermis. Lympho- cytes were mostly of the CD4+ immunophenotype. Which of the following is the appropriate diagnosis?

Q60818. A 66-year-old woman presents with a 5-year history of ery- thematous, scaly patches on her buttocks. Physical exami- nation reveals plaques with telangiectases, atrophy, and pigmentation. Biopsy of lesional skin shows that the epidermis and papillary dermis are expanded by an extensive infi ltrate of atypical lymphocytes. These infi ltrating lymphocytes most likely express which of the following “cluster of differentia- tion” cell surface markers?

Q60819. A 6-year-old boy presents with painful sores on his upper lip. He was seen for a fl u 1 week ago. The lesion appears as 0.2- to 0.4-cm vesicles with focal ulceration. Which of the following is the most likely histologic feature of this skin lesion?

Q60820. A 74-year-old man with a 15-year history of diabetes is hospi- talized because of end-stage kidney disease. His tongue, inner side of the lips, and buccal mucosa are covered with white, slightly elevated, soft patches (shown in the image). What is the most likely diagnosis?

Q60821. A 40-year-old woman is hospitalized because of a massive neck infection that developed over a period of 3 days after extrac- tion of an impacted wisdom tooth. She has a high fever, and her lower jaw and entire neck are swollen, red, and painful. Throat culture reveals a mixed bacterial fl ora, containing both aerobic and anaerobic microorganisms. Which of the following is the most likely diagnosis?