1

2011 American Board of Dermatology Recertification

Examination Study Guide: Medical Dermatology Module

1

1. Which of the following is a relative contraindication to

beginning etanercept therapy? (A) Family history of retinitis pigmentosa

(B) History of chronic renal failure

(C) History of congestive heart failure (stage III)

(D) History of positive PPD test and treatment with isoniazid

(E) History of unexplained anemia

2

2. A 25-year-old woman is being evaluated because of fever,

headache, and a generalized rash. Physical examination shows a

papulovesicular eruption and an eschar on her arm. She says that she sees mice in her apartment. Which of the following is the

most likely diagnosis?

(A) Anthrax

(B) Chickenpox

(C) Q fever

(D) Rickettsialpox

(E) Scrub typhus

3

3. Which of the following medications can cause mast cell

degranulation and histamine release without requiring specific immunologic antigen-IgE complexes?

(A) Codeine

(B) Enalapril

(C) Griseofulvin

(D) Itraconazole

(E) Niacinamide

4

4. Which of the following medications is most likely to cause

acute generalized exanthematous pustulosis? (A) Bupropion

(B) Erythromycin

(C) Hydrochlorothiazide

(D) Omeprazole

(E) Phenytoin

5

5. A patient will begin intravenous immunoglobulin (IVIG)

therapy for pemphigus vulgaris. Which of the following

laboratory tests is most important before beginning this therapy? (A) Complete blood cell count

(B) Hepatic function panel

(C) HIV antibody

(D) Serum IgA level

(E) Urinalysis

6

6. Antibodies to type VII collagen within anchoring fibrils are

most closely associated with which of the following

diseases?

(A) Bullous pemphigoid

(B) Chronic bullous disease of childhood (C) Dermatitis herpetiformis

(D) Bullous lupus erythematosus

(E) Subacute cutaneous lupus erythematosus

7

7. A 35-year-old woman has the onset of proximal muscle

weakness and a heliotrope rash. Serum creatine kinase activity

is greater than 3000 U/L. This patient is most likely to have a

malignancy at which of the following sites?

(A) Breast (B) Colon

(C) Lung

(D) Ovary

(E) Stomach

8

8. A 52-year-old woman has had the gradual development of

generalized pruritus, xerostomia, urticarial lesions, purpuric

macules on her legs, and dyspareunia over the past month.

Histologic evaluation of an urticarial lesion shows

leukocytoclastic vasculitis. Which of the following studies in serum is most likely to confirm this diagnosis?

(A) cANCA assay

(B) p-ANCA assay

(C) Protein electrophoresis

(D) Ro (SS-A) antibody assay

(E) Thyroid-stimulating hormone level

9

9. A 55-year-old woman has numerous acral keratoses and skin-

colored verrucous papules around facial orifices.

Histologic examination of a biopsy specimen of a lesion shows a trichilemmoma. In addition to breast carcinoma, this

patient is at greatest risk for developing which of the following

types of cancer?

(A) Hepatocellular carcinoma

(B) Ovarian carcinoma

(C) Thyroid carcinoma

(D) Transitional cell carcinoma of the bladder

(E) Uterine carcinoma

10

10. A 33-year-old man is being evaluated because of multiple skin tags and flesh-colored papules. Histopathologic

examination shows fibrofolliculomas. This patient has the

greatest risk for which of the following disorders?

(A) Atherosclerosis

(B) Cushing disease

(C) Lymphoma

(D) Renal cell carcinoma

(E) Testicular carcinoma

2

11

11. A 57-year-old woman who has been taking prednisone for

six months for dermatomyositis now has worsening pain in

her right hip during activity. Which of the following is the most

appropriate test to evaluate her pain?

(A) Biopsy (B) Bone scan

(C) CT scan

(D) MRI

(E) Radiograph

12

12. Patients with a deficiency of which of the following

enzymes have an increased risk for severe bone marrow

suppression with the use of azathioprine?

(A) Alanine aminotransferase (B) Gamma-glutamyl transpeptidase

(C) Lactic dehydrogenase

(D) Methylene tetrahydrofolate reductase

(E) Thiopurine methyltransferase

13

13. Which of the following allergens presents the highest risk of

sensitization from the patch test procedure?

(A) Mercaptobenzothiazole

(B) Nickel

(C) Paraben mix (D) Paraphenylenediamine

(E) Quaternium-15

14

14. A patient with phenytoin hypersensitivity syndrome has the

greatest risk for which of the following sequelae?

(A) Anemia

(B) Diabetes mellitus

(C) Hypertension

(D) Hypothyroidism (E) Sensory neuropathy

15

15. Which of the following corticosteroid-sparing agents should

be included in the initial therapeutic regimen of a patient

with ocular cicatricial pemphigoid?

(A) Azathioprine

(B) Cyclosporine

(C) Cyclophosphamide

(D) Methotrexate (E) Mycophenolate mofetil

16

16. A 37-year-old man has biopsy-proven sebaceous adenomas

on his face. Several family members have died of cancer.

Which of the following is the most appropriate next diagnostic

study in the evaluation of this patient?

(A) Bone marrow biopsy (B) Colonoscopy

(C) CT scan of the chest

(D) Digital rectal examination

(E) Serum protein immunoelectrophoresis

17

17. Infection with which of the following viruses typically

results in an acute exanthem in young children and a symmetric,

often prolonged, arthropathy in adults?

(A) Coxsackievirus A16 (B) Enterovirus 71

(C) Epstein-Barr virus

(D) Human herpesvirus 6

(E) Parvovirus B19

18

18. A 44-year-old woman has the acute onset of pain, warmth,

swelling, and erythema of the skin of her hands and feet that

is worse at night. She says that she has had difficulty sleeping

because of the burning sensation, and that her symptoms

improve by cooling the hands and feet. Which of the following is the most likely diagnosis?

(A) Erythroderma

(B) Erythromelalgia

(C) Livedo reticularis

(D) Raynaud phenomenon

(E) Thromboangiitis obliterans

19

19. A 14-year-old boy who is being treated for acne vulgaris

develops fatigue and dyspnea on exertion. Laboratory studies show profound anemia, neutropenia, and low serum copper

level. The most likely cause of these findings is an

excessively high dose of which of the following medications?

(A) Beta carotene

(B) Doxycycline

(C) Erythromycin

(D) Niacinamide

(E) Zinc

3

20. A 45-year-old African American woman is evaluated in the

hospital because of a one-day history of facial edema,

severe arthralgias, and a widespread morbilliform eruption

without ocular or mucosal involvement. One month ago,

she began taking carbamazepine for treatment of trigeminal

neuralgia. Five days ago, she was admitted to the hospital because of fever and pain over the right upper quadrant of the

abdomen. On admission, medications included

lisinopril, metformin, and carbamazepine. She had no facial pain

on admission and carbamazepine was discontinued.

Evaluation at that time disclosed mild gastritis. Three days ago,

treatment with cephalexin and pantoprazole was

initiated. Cephalexin was discontinued one day ago. During the

past five days, she has had temperatures to 39.4°C

(103.0°F), serum AST and ALT levels that are approximately

three times greater than normal, and a peripheral blood

eosinophil count of 18%. Physical examination today discloses edema and a widespread erythematous desquamative

eruption over the trunk. Which of the following drugs is the

most likely cause of this eruption?

(A) Carbamazepine

(B) Cephalexin

(C) Lisinopril

(D) Metformin

(E) Pantoprazole

21. A 50-year-old man develops this eruption seven weeks after

starting oral terbinafine 250 mg daily for onychomycosis.

Which of the following antibody tests is most likely to be positive?

(A) Anti-nDNA

(B) Anti-Ro/SSA

(C) Anti-Sm

(D) Anti-ssDNA

(E) Anti-U1RNP

22. A 50-year-old woman comes to the office because of the

widespread eruption shown. She has no other skin

abnormalities. In the past 12 months, she has had three transient

ischemic attacks. Which of the following is the most likely diagnosis?

(A) Cholesterol emboli

(B) Livedoid vasculopathy

(C) Microscopic polyarteritis

(D) Sneddon syndrome

(E) Wegener granulomatosis

23. A 50-year-old man has the onset of the single cutaneous

lesion shown 12 hours after taking an opioid analgesic that

was prescribed following a facial surgical procedure. He reports

that he had an identical lesion at the same site after administration of other analgesic drugs in the past. Which of the

following is the most likely diagnosis?

(A) Bullous erythema multiforme

(B) Bullous fixed drug eruption

(C) Bullous lichen planus

(D) Interstitial granulomatous dermatitis

(E) Leukocytoclastic vasculitis

24

24. Which of the following immunosuppressive medications is

most appropriate for a patient with Kaposi sarcoma who

has undergone a solid organ transplantation?

(A) Azathioprine (B) Cyclosporine

(C) Mycophenolate mofetil

(D) Sirolimus

(E) Tacrolimus

25

25. Concurrent use of which of the following herbal

supplements is most likely to decrease the efficacy of oral

contraceptives?

(A) Garlic (B) Ginkgo biloba

(C) Hawthorn

(D) Peppermint

(E) St. John's wort

26

26. Which of the following medications is most likely to cause a

hypersensitivity syndrome with systemic symptoms in a

patient who is seropositive for HIV?

(A) Abacavir

(B) Dapsone (C) Efavirenz

(D) Saquinavir

(E) Zidovudine (AZT)

27

27. A 40-year-old woman has a six-month history of tense

vesicles and bullae on the dorsa of the hands that resolve with

scars. Serum, urine, and stool examinations are negative for

detectable porphyrins. Biopsy specimen of a new vesicle

shows a cell-poor subepidermal blister. Which of the following drugs is the most likely cause of the lesions?

(A) Amiodarone

(B) Captopril

(C) Naproxen

(D) Penicillamine

(E) Vancomycin

28

28. Which of the following diseases is most frequently

associated with small bowel lymphoma? (A) Atopic dermatitis

(B) Dermatitis herpetiformis

(C) Erythema multiforme

(D) Pemphigus vulgaris

(E) Psoriasis vulgaris

4

29. A 45-year-old woman who smokes one pack of cigarettes

daily is diagnosed with cutaneous lupus erythematosus. The

efficacy of which of the following medications is most likely to

be adversely affected by her smoking?

(A) Azathioprine

(B) Chloroquine (C) Dapsone

(D) Etanercept

(E) Methotrexate

30

30. A 30-year-old woman is being evaluated shortly after having

a stroke. Physical examination shows livedo reticularis

and an ulcer on the left medial lower leg. The skin changes had

developed before she had the stroke. Which of the

following laboratory tests is most useful in establishing the diagnosis?

(A) Anti-dsDNA test

(B) Antineutrophilic cytoplasmic antibody test

(C) Antiphospholipid antibody panel

(D) Rocky Mountain spotted fever assay

(E) Serum protein electrophoresis

31

31. An otherwise healthy 34-year-old woman has palpable

purpura, sinusitis, pulmonary infiltrates, and rapidly progressing

renal failure. She has no history of asthma. Skin biopsy shows perivascular granulomatous inflammation. Positive

results are most likely on which of the following serologic tests?

(A) Anti-Ro(SS-A) antibody

(B) Anti-topoisomerase I (Scl-70) antibody

(C) Anti-U1RNP antibody

(D) cANCA

(E) Cryoglobulin

32. A 72-year-old man with esophageal carcinoma has red scaly

plaques on the ears, hands, and feet. Which of the following is the most likely diagnosis?

(A) Acanthosis nigricans

(B) Bazex syndrome

(C) Dermatomyositis

(D) Necrolytic migratory erythema

(E) Sweet syndrome

33

33. Which of the following adverse effects is more likely during

infliximab therapy than during therapy with etanercept? (A) Demyelinating disease

(B) Drug-induced lupus erythematosus

(C) Human anti-chimera antibodies (HACAs)

(D) New-onset congestive heart failure

(E) Pancytopenia

34

34. Which of the following is an example of a drug-induced

idiosyncratic adverse effect?

(A) Agranulocytosis with dapsone

(B) Hepatotoxicity with methotrexate (C) Hypercalcemia with topical calcipotriene

(D) Hypertension with cyclosporine

(E) Nausea with oral methoxsalen

35

35. Hydroxychloroquine is most likely to cause a

hypersensitivity rash when used to treat which of the following

conditions?

(A) Dermatomyositis

(B) Discoid lupus erythematosus (C) Rheumatoid arthritis

(D) Subacute cutaneous erythematosus

(E) Systemic lupus erythematosus

36

36. A 55-year-old man has the onset of symmetric brawny

plaques on the trunk and legs. He has diabetes mellitus with

chronic renal insufficiency and recently began hemodialysis.

During the ensuing weeks, the plaques develop an

indurated, woody consistency. Which of the following is the

most likely diagnosis? (A) Diabetic dermopathy

(B) Lipodermatosclerosis

(C) Nephrogenic systemic fibrosis

(D) Scleromyxedema

(E) Shulman syndrome

37

37. Evaluation of a patient with complex aphthous ulcers should

include screening for a deficiency of which of the

following vitamins? (A) A

(B) B12

(C) C

(D) D3

(E) E

38

38. One week after cleaning a fish tank, a 24-year-old woman

develops an ulcer on her hand and lymphangitis. Which of

the following antimicrobial agents is the most appropriate first choice for the treatment of this condition?

(A) Ciprofloxacin

(B) Clarithromycin

(C) Erythromycin

(D) Minocycline

(E) Potassium iodide

5

39. A patient with which of the following neoplasms should be

evaluated for POEMS syndrome?

(A) Desmoid tumor

(B) Glomeruloid hemangioma

(C) Psammomatous melanotic schwannoma

(D) Sebaceous adenoma (E) Trichodiscoma

40. A 58-year-old man is being evaluated because of a flare-up

of psoriasis. He has been treated with PUVA therapy for

flare-ups for more than five years. He has also been treated for

several actinic keratoses over the past year; none are

seen on current examination. Which of the following treatments

increases the risk of non-melanoma skin cancer in this

patient?

(A) Oral acitretin

(B) Oral cyclosporine (C) Oral methotrexate

(D) Topical calcipotriene

(E) Topical tazarotene cream

41. Which of the following agents is most likely to result in

systemic allergic contact dermatitis?

(A) Balsam of Peru

(B) Cocamidopropyl betaine

(C) Thiuram

(D) Toluene sulfonamide formaldehyde resin

(E) Xylocaine

42. A patient with chronic dermatitis is patch test-positive to

hydrocortisone-17-butyrate. To which of the following

corticosteroids is she most likely allergic?

(A) Amcinonide

(B) Budesonide

(C) Fluocinonide

(D) Halcinonide

(E) Triamcinolone diacetate

43. This condition responds best to therapy with which of the

following? (A) Betamethasone dipropionate 0.05% cream

(B) Clotrimazole

(C) Minocycline

(D) Narrowband UVB

(E) Oral isotretinoin

44. These lesions are most likely to be seen in patients with

which of the following diagnoses?

(A) Alkaptonuria

(B) Cushing's disease

(C) Diabetes mellitus (D) Netherton syndrome

(E) Osteogenesis imperfecta

45. Development of peripheral atherosclerotic vascular disease

is most commonly associated with which of the following

cutaneous disorders?

(A) Atopic dermatitis

(B) Dermatomyositis

(C) Generalized granuloma annulare (D) Psoriasis vulgaris

(E) Subacute cutaneous lupus erythematosus

46

46. A 40-year-old man who is seropositive for HIV begins

thalidomide therapy for prurigo nodularis. Which of the

following studies at regular intervals is the most appropriate

follow-up care?

(A) Electrocardiography

(B) Examination of the stool for occult blood (C) Hearing test

(D) Neurologic examination

(E) Urinalysis

47

47. Which of the following immunosuppressive agents inhibits

purine biosynthesis?

(A) Cyclosporine

(B) Hydroxyurea

(C) Mycophenolate mofetil

(D) Tacrolimus (E) Thalidomide

48

48. A 60-year-old man develops a generalized bullous eruption

one week after undergoing coronary artery bypass grafting.

His current medications include quinidine, vancomycin,

digoxin, and furosemide. Histologic examination of a biopsy

specimen of affected skin shows a subepidermal bulla with

neutrophils and linear deposition of IgA at the basement

membrane zone. Which of the following is the most appropriate next step in the management of this eruption?

(A) Continue current medications and add dapsone

(B) Continue current medications and add a high-dose

corticosteroid

(C) Discontinue furosemide

(D) Discontinue quinidine and add sulfapyridine

(E) Discontinue vancomycin

49. A 42-year-old man with rheumatoid arthritis has the rapid

appearance of multiple small nodules on his fingers. Biopsy

specimen of a nodule shows a palisaded granuloma with a dense central neutrophilic infiltrate. Which of the following

drugs is the most likely cause of this eruption?

(A) Azathioprine

(B) Celecoxib

(C) Hydroxychloroquine

(D) Methotrexate

(E) Sulfasalazine

6

50

50. A 40-year-old man is being evaluated because of symptoms

of porphyria cutanea tarda. He has normal hepatic enzyme

activities and is found to be homozygous for mutations in HFE

C282Y. Which of the following is the most appropriate treatment?

(A) Following a diabetic diet

(B) Hydroxychloroquine therapy

(C) Phlebotomy to maintain a serum ferritin level below 20

μg/L (D) Monitoring of liver enzyme activities every three months

(E) Sunscreen use

51

51. Which of the following medications is the most appropriate

initial treatment of a patient with linear IgA disease?

(A) Azathioprine (B) Cyclophosphamide

(C) Dapsone

(D) Methotrexate

(E) Tetracycline

52

52. Which of the following is the most common clinical course

of neonatal lupus in infants?

(A) Complete resolution only with administration of a systemic

corticosteroid

(B) Frequent relapses and remissions (C) Healing of lesions with significant scarring

(D) Progression to systemic disease

(E) Spontaneous resolution in 6 to12 months

53

53. Direct immunofluorescence performed on a biopsy

specimen from a patient with multiple purpuric lesions reveals

IgA

deposition in the cutaneous vasculature. This finding best

supports which of the following diagnoses? (A) Henoch-Schönlein purpura

(B) Mixed cryoglobulin-associated vasculitis

(C) Rheumatoid factor-associated vasculitis

(D) Urticarial vasculitis

(E) Wegener granulomatosis

54

54. A 22-year-old woman has acne, acanthosis nigricans,

hirsutism, and oligomenorrhea. This patient has an increased

likelihood of developing which of the following conditions? (A) Autoimmune glomerulonephritis

(B) Insulin-resistant diabetes mellitus

(C) Intraductal breast carcinoma

(D) Pulmonary fibrosis

(E) Uterine leiomyomas

55

55. Compared with a healthy patient, a patient with a family

history of familial melanoma syndrome has an increased risk

for which of the following neoplasms?

(A) Astrocytoma (B) Hodgkin lymphoma

(C) Medulloblastoma

(D) Pancreatic carcinoma

(E) Small cell lung carcinoma

56

56. Which of the following diseases is most closely associated

with multiple dermatofibromas?

(A) Amyloidosis

(B) Generalized eruptive histiocytosis (C) Lichen planus

(D) Psoriasis

(E) Systemic lupus erythematosus

57

57. Concomitant use of which of the following antibiotics is

most likely to decrease the efficacy of oral contraception in

women?

(A) Cephalexin

(B) Doxycycline

(C) Erythromycin (D) Rifampin

(E) Trimethoprim–sulfamethoxazole

58

58. Which of the following laboratory tests should be performed

on all patients prior to starting long-term therapy with

methotrexate?

(A) Cryoglobulin assay

(B) Dihydrofolate reductase level

(C) Hepatitis C antibody assay (D) Rheumatoid factor assay

(E) Thiopurine methyltransferase level

59

59. A 22-year-old woman who began taking a new medication

for acne three months ago has had fevers, weight loss, and

joint pain since beginning the new medication. Laboratory

findings include an ANA titer of 1:5120 and a positive

antihistone

antibody titer. Which of the following is the most likely cause of these findings?

(A) Amoxicillin

(B) Erythromycin

(C) Isotretinoin

(D) Minocycline

(E) Trimethoprim–sulfamethoxazole

7

60. A pregnant woman with which of the following dermatoses

is most likely to develop Graves' disease?

(A) Cholestasis of pregnancy

(B) Pemphigoid gestationis

(C) Prurigo gravidarum

(D) Pruritic folliculitis of pregnancy (E) Pruritic urticarial papules and plaques of pregnancy

61. A 45-year-old woman with a history of uterine fibroids has

cutaneous leiomyomas. This patient has an increased risk

for which of the following types of cancer?

(A) Breast cancer

(B) Non-Hodgkin lymphoma

(C) Renal cell cancer

(D) Thyroid cancer

(E) Uterine sarcoma

62. A patient is undergoing evaluation for a presumed bullous

skin disease. Which of the following is the most appropriate

site for obtaining a biopsy specimen for direct

immunofluorescence?

(A) Intact vesicle

(B) Perilesional skin

(C) Ruptured vesicle

(D) Sun-exposed normal skin

(E) Sun-protected normal skin

63. A 60-year-old man has had a pruritic erythematous papular eruption on the trunk, arms, and legs for the past month. He

had similar reactions after taking hydrochlorothiazide and after

taking trimethoprim–sulfamethoxazole. Which of the

following medications is the most likely cause of the dermatitis?

(A) Celecoxib

(B) Fluconazole

(C) Hydrocodone

(D) Levofloxacin

(E) Spironolactone

64

64. Which of the following tick-born illnesses is most likely to

result in heart conduction abnormalities?

(A) Babesiosis

(B) Ehrlichiosis

(C) Lyme disease

(D) Rocky Mountain spotted fever

(E) Tick paralysis

65 65. Patients taking drugs containing sulfhydryl groups are at

increased risk for developing which of the following bullous

disorders?

(A) Bullous pemphigoid

(B) IgA pemphigus

(C) Linear IgA dermatosis

(D) Pemphigus foliaceus

(E) Pemphigus vegetans

66. When applied to clothing, which of the following agents is

most likely to provide the best protection against tick bites?

(A) Citronella

(B) IR 3535

(C) Permethrin

(D) Soybean oil (E) 10% Sulfa

67

67. A 60-year-old man has retiform purpura in the distal lower

extremities. Which of the following laboratory

abnormalities is most suggestive of the presence of cholesterol

emboli?

(A) Eosinophilia

(B) Lymphocytosis

(C) Neutropenia (D) Polycythemia

(E) Thrombocytopenia

68

68. A 35-year-old woman has had this rash for the past six

months. Which of the following is the most likely causal drug?

(A) Captopril

(B) Cyclophosphamide

(C) Hydrochlorothiazide

(D) Simvastatin

(E) Terbinafine

69. In a patient who has received a Bacillus Calmette-Guérin

(BCG) vaccination, which of the following is the most

sensitive screening test for latent tuberculosis?

(A) Purified protein derivative (PPD) skin test

(B) Radiography of the chest

(C) Single sputum acid-fast bacilli smears

(D) T-cell interferon gamma release assay

(E) Tine test

70

70. Which of the following is the most effective agent for both

the gastrointestinal and skin disease in this patient?

(A) Adalimumab

(B) Alefacept

(C) Etanercept

(D) Interferon alfa

(E) Rituximab

71

8

For each example of bias in a study, select the most accurate

description (A-E).

(A) Detection bias

(B) Misclassification bias

(C) Recall bias

(D) Response bias (E) Withdrawal bias

71. Health-conscious people are more likely to attend skin

cancer screenings.

72. The patients in poorest health drop out of a melanoma trial.

73. Patients who see dermatologists are more likely than

patients who see primary care physicians to have the diagnosis

of

seborrheic keratosis in their medical records.

74. Patients who have melanoma are more likely to remember

blistering sunburns than control subjects without melanoma. 75. A study reviewing medical records for exposures to a new

"black-box" labeled drug fails to include 5% of patients who

were importing the medicine from Mexico without a

prescription.

72

For each systemic disease, select the most likely cutaneous

disorder or disease (A-E).

(A) Acute febrile neutrophilic dermatosis

(B) Cuticular erythema

(C) Pinched purpura of the eyelids (D) Pyoderma gangrenosum of the lower limbs

(E) Ulcerations secondary to mixed cryoglobulinemia

76. Acute myelogenous leukemia

77. Systemic amyloidosis

78. Hepatitis C

79. Dermatomyositis

80. Crohn's disease