FMCLA Dermatology 2 — Questions and Answers
Question 1: The ABCDE criteria for melanoma screening include all of the following EXCEPT:
- Asymmetry
- Border irregularity
- Color variation
- Elevation (Correct answer)
Correct answer: Elevation
The ABCDE criteria are Asymmetry, Border, Color, Diameter (>6 mm), and Evolution; 'Elevation' is not one of the five criteria.
Question 2: A 70-year-old farmer presents with a pearly, translucent nodule with rolled borders and central ulceration on the nose. The most likely diagnosis is:
- Squamous cell carcinoma
- Actinic keratosis
- Basal cell carcinoma (Correct answer)
- Merkel cell carcinoma
Correct answer: Basal cell carcinoma
Basal cell carcinoma classically presents as a pearly, translucent papule with rolled telangiectatic borders and central ulceration, most commonly on sun-exposed areas of the face.
Question 3: A 65-year-old presents with a firm, indurated nodule with overlying crust on the lower lip and palpable cervical lymphadenopathy. The most likely diagnosis is:
- Basal cell carcinoma
- Squamous cell carcinoma (Correct answer)
- Keratoacanthoma
- Sebaceous cyst
Correct answer: Squamous cell carcinoma
Squamous cell carcinoma on the lip (a high-risk sun-exposed site) can metastasize to regional lymph nodes, unlike basal cell carcinoma which rarely metastasizes.
Question 4: A patient presents with greasy, yellowish scales on the scalp, eyebrows, and nasolabial folds with underlying erythema. The most likely diagnosis is:
- Scalp psoriasis
- Seborrheic dermatitis (Correct answer)
- Tinea capitis
- Atopic dermatitis
Correct answer: Seborrheic dermatitis
Seborrheic dermatitis characteristically involves sebaceous gland-rich areas (scalp, eyebrows, nasolabial folds) with greasy, yellowish scales on an erythematous base.
Question 5: A 30-year-old develops widespread urticaria, throat tightness, and hypotension minutes after taking ibuprofen. The immediate first-line treatment is:
- Oral cetirizine 10 mg
- Epinephrine 0.3 mg IM in the anterolateral thigh (Correct answer)
- IV methylprednisolone 125 mg
- Diphenhydramine 50 mg IV
Correct answer: Epinephrine 0.3 mg IM in the anterolateral thigh
Epinephrine IM is the first-line treatment for anaphylaxis because it rapidly reverses bronchoconstriction, vasoconstriction, and urticaria through alpha and beta-adrenergic effects.
Question 6: A patient on trimethoprim-sulfamethoxazole develops a blistering eruption with mucosal involvement and >30% body surface area detachment. The diagnosis is:
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis (Correct answer)
- Bullous pemphigoid
- Erythema multiforme major
Correct answer: Toxic Epidermal Necrolysis
Toxic Epidermal Necrolysis (TEN) is defined by skin detachment >30% BSA, while Stevens-Johnson Syndrome involves <10% BSA; both require immediate discontinuation of the offending drug.
Question 7: A 68-year-old presents with a painful vesicular eruption along a dermatomal distribution on the left chest wall. Which of the following antiviral regimens is appropriate for treatment within 72 hours?
- Topical acyclovir cream twice daily
- Oral valacyclovir 1 g TID for 7 days
- Oral famciclovir 500 mg TID for 7 days
- Either oral valacyclovir or oral famciclovir is appropriate (Correct answer)
Correct answer: Either oral valacyclovir or oral famciclovir is appropriate
Both valacyclovir and famciclovir are FDA-approved oral antivirals for herpes zoster with superior bioavailability compared to acyclovir; either is an appropriate first-line choice.
FMCLA Dermatology 2
The ABCDE criteria for melanoma screening include all of the following EXCEPT: