American Board of Dermatology (ABD) APPLIED Certification Exam — Questions and Answers

Question 1: An itchy child has burrows in the finger webs and family members with similar pruritus. What is the treatment of choice?

Oral acyclovir
Topical corticosteroid
Topical mupirocin
Permethrin 5% cream (Correct answer)

Correct answer: Permethrin 5% cream

Scabies is treated with topical permethrin 5%, with treatment of household contacts.

Question 2: A patient reports metallic taste, perioral numbness, and tinnitus after injection. This suggests?

Local anesthetic systemic toxicity (Correct answer)
Normal anesthetic effect
Vasovagal syncope
Allergic reaction

Correct answer: Local anesthetic systemic toxicity

Early CNS signs like perioral numbness and tinnitus indicate local anesthetic systemic toxicity.

Question 3: What type of reading helps dermatologists stay current with FDA-approved treatments?

Patient blogs
Social media posts
Official drug updates and journals (Correct answer)
Product advertisements

Correct answer: Official drug updates and journals

To stay current with FDA-approved treatments, dermatologists must consult official sources such as drug updates from regulatory bodies like the FDA, and reputable medical journals. These sources provide accurate, timely, and evidence-based information on new medications, indications, dosages, and safety profiles, which is crucial for safe and effective prescribing.

Question 4: Before starting TNF-alpha inhibitor therapy, patients must be screened for:

Osteoporosis
Hyperlipidemia
Latent tuberculosis (Correct answer)
Glaucoma

Correct answer: Latent tuberculosis

TNF inhibitors can reactivate latent tuberculosis, so screening is required first.

Question 5: A vascular dermal proliferation of spindle cells with slit-like spaces, extravasated red cells, and HHV-8 positivity is characteristic of which tumor?

Kaposi sarcoma (Correct answer)
Hemangioma
Angiosarcoma
Pyogenic granuloma

Correct answer: Kaposi sarcoma

Kaposi sarcoma shows slit-like vascular spaces, spindle cells, extravasated erythrocytes, and is HHV-8 positive.

Question 6: Which of the following genodermatoses is characterized by a defect in nucleotide excision repair (NER), leading to extreme photosensitivity, a vastly increased risk of cutaneous malignancies at a young age, and, in some cases, progressive neurologic degeneration?

Cockayne Syndrome
Xeroderma Pigmentosum (Correct answer)
Bloom Syndrome
Rothmund-Thomson Syndrome

Correct answer: Xeroderma Pigmentosum

Xeroderma pigmentosum (XP) is the quintessential disorder of defective nucleotide excision repair (NER). This autosomal recessive condition results from mutations in genes essential for NER, the primary mechanism for repairing DNA damage caused by ultraviolet (UV) radiation. The inability to repair UV-induced photoproducts leads to extreme photosensitivity, poikiloderma in sun-exposed areas, and a more than 1,000-fold increased risk of skin cancers. Neurologic degeneration is a feature in a subset of XP complementation groups.

Question 7: UV-triggered lupus erythematosus flares are mediated through which mechanism?

Visible light activation of porphyrins
UVC-induced direct protein denaturation only
UVB and UVA-induced keratinocyte apoptosis exposing nuclear antigens (Correct answer)
Infrared-mediated heat shock protein release

Correct answer: UVB and UVA-induced keratinocyte apoptosis exposing nuclear antigens

Both UVB and UVA trigger lupus flares by inducing keratinocyte apoptosis, which translocates nuclear antigens (Ro/SSA, La/SSB) to the cell surface, amplifying autoimmune responses.

Question 8: Which histologic subtype of basal cell carcinoma carries the highest risk of subclinical extension and local recurrence?

Infiltrative/morpheaform (Correct answer)
Superficial
Nodular
Pigmented

Correct answer: Infiltrative/morpheaform

Infiltrative and morpheaform BCCs have aggressive growth patterns with poorly defined margins and high recurrence risk.

Question 9: Isotretinoin is contraindicated in pregnancy because it is:

Hepatotoxic
A potent teratogen (Correct answer)
Ototoxic
Nephrotoxic

Correct answer: A potent teratogen

Isotretinoin is a powerful teratogen requiring iPLEDGE contraception monitoring.

Question 10: Why is critical reading important in reviewing clinical trial results?

To rewrite the content in lay terms
To find spelling errors
To evaluate study validity and relevance (Correct answer)
To memorize the author’s name

Correct answer: To evaluate study validity and relevance

Critical reading of clinical trial results is essential for dermatologists to assess the quality, methodology, and statistical significance of the research. This allows them to determine if the study's findings are valid, reliable, and applicable to their patient population, ensuring that clinical decisions are based on sound evidence rather than flawed or irrelevant data.

Question 11: Chronic actinic dermatitis (CAD) is characterized by which predominant lymphocyte subset on histopathology?

CD8+ cytotoxic T cells (Correct answer)
B cells (CD20+)
Regulatory T cells (Tregs)
CD4+ T-helper cells

Correct answer: CD8+ cytotoxic T cells

CAD characteristically shows a CD8+ cytotoxic T-cell predominant infiltrate, which distinguishes it from other eczematous dermatoses that are predominantly CD4+.

Question 12: Muir-Torre syndrome links sebaceous neoplasms with an increased risk of which internal malignancy?

Prostate cancer
Colorectal and other Lynch-spectrum cancers (Correct answer)
Pancreatic adenocarcinoma
Thyroid carcinoma

Correct answer: Colorectal and other Lynch-spectrum cancers

Muir-Torre is a variant of Lynch syndrome with mismatch-repair defects predisposing to colorectal and genitourinary cancers.

Question 13: A 10-year-old presents with well-demarcated erythematous plaques with silvery scale on the elbows and knees, plus pinpoint nail pitting. What is the diagnosis?

Atopic dermatitis
Seborrheic dermatitis
Lichen planus
Psoriasis vulgaris (Correct answer)

Correct answer: Psoriasis vulgaris

Silvery-scaled plaques on extensor surfaces with nail pitting are characteristic of psoriasis.

Question 14: A patient with psoriasis develops new plaques along a linear scratch mark. This phenomenon is termed:

Auspitz sign
Pathergy
Koebner phenomenon (Correct answer)
Wickham striae

Correct answer: Koebner phenomenon

The Koebner phenomenon is the appearance of lesions at sites of skin trauma.

Question 15: Which lesion is considered pre-malignant?

Seborrheic keratosis
Skin tag
Actinic keratosis (Correct answer)
Cherry angioma

Correct answer: Actinic keratosis

Actinic keratosis (AK) is considered a pre-malignant lesion, meaning it has the potential to develop into skin cancer. These rough, scaly patches typically appear on sun-exposed areas and are caused by chronic ultraviolet radiation damage. If left untreated, AKs can progress to invasive squamous cell carcinoma, making early detection and treatment crucial for prevention.

Question 16: Cryosurgery destroys tissue primarily through?

Radiation
Intracellular ice crystal formation (Correct answer)
Heat coagulation
Chemical cautery

Correct answer: Intracellular ice crystal formation

Rapid freezing causes intracellular ice crystals that rupture cell membranes.

Question 17: An infant presents with a rapidly enlarging strawberry-red plaque on the face. Which complication warrants urgent systemic beta-blocker therapy?

Isolated truncal location
Cosmetic disfigurement only
Slow spontaneous involution
Periocular location threatening the visual axis (Correct answer)

Correct answer: Periocular location threatening the visual axis

Periocular infantile hemangiomas obstructing the visual axis risk amblyopia and require prompt propranolol treatment.

Question 18: Sézary syndrome is defined by mycosis fungoides plus which additional feature?

Large-cell transformation
Bone marrow blasts
Nodal involvement only
Erythroderma with circulating atypical T-cells (Correct answer)

Correct answer: Erythroderma with circulating atypical T-cells

Sézary syndrome is the leukemic variant of CTCL with erythroderma and clonal Sézary cells in blood.

Question 19: Which oral antifungal is required for tinea capitis because topical agents cannot penetrate the hair follicle adequately?

Oral acyclovir
Nystatin
Griseofulvin or terbinafine (Correct answer)
Topical clotrimazole

Correct answer: Griseofulvin or terbinafine

Tinea capitis requires systemic therapy such as griseofulvin or terbinafine to reach the intrafollicular fungus.

Question 20: An infant presents with well-demarcated erythema in the inguinal folds with satellite pustules. What is the most likely cause?

Seborrheic dermatitis
Psoriasis
Candida albicans (Correct answer)
Irritant contact dermatitis

Correct answer: Candida albicans

Candidal diaper dermatitis characteristically involves the skin folds with satellite pustules, unlike irritant dermatitis which spares folds.

Question 21: A dermatologist maintaining board certification demonstrates lifelong learning primarily through:

Ongoing CME and periodic knowledge assessment (Correct answer)
Attending unrelated conferences only
No further education after residency
A single exam taken decades ago

Correct answer: Ongoing CME and periodic knowledge assessment

Continuing certification requires ongoing CME and periodic assessments.

Question 22: Merkel cells in the epidermis primarily function as:

Pigment producers
Mechanoreceptors for touch (Correct answer)
Antigen-presenting cells
Barrier lipid secretors

Correct answer: Mechanoreceptors for touch

Merkel cells act as slow-adapting mechanoreceptors associated with sensory nerve endings.

Question 23: A dermatologist prescribes topical 5-fluorouracil (5-FU) cream for a patient with multiple actinic keratoses on the face. What is the primary mechanism of action of this agent?

It acts as a Toll-like receptor 7 (TLR7) agonist, inducing a local immune response.
It binds to tubulin, preventing microtubule formation and arresting cells in metaphase.
It functions as a pyrimidine analog that inhibits thymidylate synthase, disrupting DNA synthesis. (Correct answer)
It inhibits dihydrofolate reductase, blocking the synthesis of purines.

Correct answer: It functions as a pyrimidine analog that inhibits thymidylate synthase, disrupting DNA synthesis.

5-fluorouracil is a pyrimidine analog that, once converted to its active metabolite fluorodeoxyuridine monophosphate (FdUMP), forms a stable complex with the enzyme thymidylate synthase. This action blocks the synthesis of thymidine, a necessary component of DNA, leading to cell death in rapidly proliferating cells such as those in actinic keratoses.

Question 24: A dermatologist participating in a clinical trial must ensure that:

IRB approval can be skipped
Participants give voluntary informed consent with IRB oversight (Correct answer)
Consent is optional for trials
Data may be altered to fit hypotheses

Correct answer: Participants give voluntary informed consent with IRB oversight

Ethical research requires informed consent and IRB oversight.

Question 25: Hailey-Hailey disease (benign familial pemphigus) is caused by mutations in which gene?

DSG3 (desmoglein-3)
ATP2A2 (SERCA2)
DSP (desmoplakin)
ATP2C1 (hSPCA1) (Correct answer)

Correct answer: ATP2C1 (hSPCA1)

Hailey-Hailey disease is caused by loss-of-function mutations in ATP2C1 encoding hSPCA1, a Golgi calcium/manganese ATPase pump.

Question 26: A child with a sore throat develops a diffuse sandpaper-like erythematous rash with accentuation in skin folds (Pastia's lines). What is the cause?

Epstein-Barr virus
Group A Streptococcus (Correct answer)
Staphylococcus aureus
Adenovirus

Correct answer: Group A Streptococcus

Scarlet fever results from group A streptococcal erythrogenic toxin, producing a sandpaper rash and Pastia's lines.

Question 27: Which stain is most useful for highlighting mucin deposition in the dermis, as seen in lupus erythematosus?

Fite stain
Congo red
Colloidal iron (or Alcian blue) (Correct answer)
PAS with diastase

Correct answer: Colloidal iron (or Alcian blue)

Colloidal iron and Alcian blue stain acid mucopolysaccharides, highlighting dermal mucin.

Question 28: Which sign describes a subungual longitudinal pigmented band that extends onto the proximal nail fold, raising concern for melanoma?

Koebner phenomenon
Darier sign
Hutchinson sign (Correct answer)
Nikolsky sign

Correct answer: Hutchinson sign

Hutchinson sign is periungual pigment extension and is an ominous indicator of subungual melanoma.

Question 29: Corps ronds and grains, reflecting abnormal keratinization with acantholytic dyskeratosis, are seen in which disorder?

Bowen disease
Darier disease (Correct answer)
Pemphigus vulgaris
Warty dyskeratoma only

Correct answer: Darier disease

Corps ronds and grains are the characteristic dyskeratotic cells of Darier disease (keratosis follicularis).

Question 30: A dermal spindle-cell tumor stains diffusely positive for S-100 and SOX10 and shows wavy nuclei. Which tumor is most likely?

Neurofibroma (Correct answer)
Kaposi sarcoma
Leiomyoma
Dermatofibroma

Correct answer: Neurofibroma

S-100/SOX10-positive spindle cells with wavy 'comma-shaped' nuclei indicate neural differentiation, as in neurofibroma.

Question 31: A 5-year-old child presents with a history of generalized blistering since birth, particularly over trauma-prone areas. The blisters heal with significant atrophic scarring, milia formation, and have resulted in mitten-like deformities of the hands (pseudosyndactyly). A mutation in the gene encoding which of the following structural proteins is responsible for this condition?

Keratin 5 or 14
Type VII collagen (Correct answer)
Plectin
Laminin 332

Correct answer: Type VII collagen

The clinical presentation of severe blistering with significant scarring, milia, and pseudosyndactyly is classic for severe recessive dystrophic epidermolysis bullosa (RDEB). This condition is caused by mutations in the COL7A1 gene, which encodes type VII collagen. Type VII collagen is the primary component of anchoring fibrils, which secure the basement membrane to the underlying dermis. Its absence or dysfunction leads to a cleavage plane in the sublamina densa, resulting in the deep, scarring blisters characteristic of DEB. Mutations in keratin 5 or 14 cause EB simplex, laminin 332 mutations cause junctional EB, and plectin mutations cause EB simplex with muscular dystrophy.

Question 32: Direct immunofluorescence showing granular IgA deposits in the dermal papillae supports which diagnosis?

Linear IgA disease
Bullous pemphigoid
Dermatitis herpetiformis (Correct answer)
Pemphigus foliaceus

Correct answer: Dermatitis herpetiformis

Granular IgA in the dermal papillary tips is the hallmark of dermatitis herpetiformis.

American Board of Dermatology (ABD) APPLIED Certification Exam

The ABD APPLIED Exam certifies dermatologists by testing clinical application of knowledge across medical dermatology, pediatric dermatology, dermatologic surgery, and dermatopathology. It consists of 200 multiple-choice questions administered in four timed sections.

Questions

35 min

Time Limit

70%

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