PANCE Dermatology 2 — Questions and Answers
Question 1: A 45-year-old woman presents with a salmon-colored, well-demarcated plaque with silvery scale on her elbows and knees. Which finding would most likely be seen on biopsy?
- Acanthosis with parakeratosis and Munro microabscesses (Correct answer)
- Spongiosis with eosinophilic infiltrate
- Interface dermatitis with vacuolar change
- Perivascular lymphocytic infiltrate with plasma cells
Correct answer: Acanthosis with parakeratosis and Munro microabscesses
Psoriasis classically shows acanthosis, parakeratosis, and Munro microabscesses (neutrophils in the stratum corneum).
Question 2: A 30-year-old man develops a targetoid lesion with a central blister after starting sulfonamide antibiotics. The lesion is localized to the palms. What is the most likely diagnosis?
- Stevens-Johnson syndrome
- Erythema multiforme (Correct answer)
- Toxic epidermal necrolysis
- Fixed drug eruption
Correct answer: Erythema multiforme
Erythema multiforme presents with classic targetoid (iris) lesions, often triggered by drugs or HSV, and is typically limited to acral surfaces.
Question 3: A 70-year-old farmer presents with a pearly, rolled-edge nodule with telangiectasias on his nose that occasionally bleeds. What is the first-line treatment?
- Topical imiquimod
- Mohs micrographic surgery (Correct answer)
- Cryotherapy
- Punch biopsy and observe
Correct answer: Mohs micrographic surgery
Basal cell carcinoma on high-risk areas like the nose is best treated with Mohs surgery to achieve clear margins while sparing maximal tissue.
Question 4: A 25-year-old woman has an intensely pruritic, vesicular rash on the extensor surfaces of her elbows and knees. IgA deposits are found at the dermal-epidermal junction. What is the associated systemic condition?
- Systemic lupus erythematosus
- Celiac disease (Correct answer)
- Crohn disease
- Type 1 diabetes mellitus
Correct answer: Celiac disease
Dermatitis herpetiformis with IgA deposits is strongly associated with celiac disease (gluten-sensitive enteropathy).
Question 5: An 8-year-old child presents with honey-crusted erosions around the nares and mouth. Gram stain shows gram-positive cocci in clusters. What is the most appropriate treatment?
- Oral acyclovir
- Topical mupirocin or oral cephalexin (Correct answer)
- Oral fluconazole
- Topical hydrocortisone
Correct answer: Topical mupirocin or oral cephalexin
Impetigo caused by Staphylococcus aureus is treated with topical mupirocin for localized disease or oral cephalexin for widespread infection.
Question 6: A 55-year-old man presents with dark, velvety thickening of the skin in the axillae and posterior neck. He also reports 20 lb weight loss over 2 months. What is the most important next step?
- Start topical retinoids
- Evaluate for underlying malignancy (Correct answer)
- Test for insulin resistance
- Perform skin biopsy
Correct answer: Evaluate for underlying malignancy
Acanthosis nigricans with rapid onset and weight loss suggests malignant acanthosis nigricans, most commonly associated with GI adenocarcinoma.
Question 7: A 40-year-old woman with butterfly-shaped erythema across her cheeks and nose presents after sun exposure. Her ANA is positive with anti-dsDNA antibodies. Which skin finding would be considered discoid lupus?
- Malar rash sparing nasolabial folds
- Scarring plaques with follicular plugging and dyspigmentation (Correct answer)
- Non-scarring diffuse alopecia
- Livedo reticularis on the extremities
Correct answer: Scarring plaques with follicular plugging and dyspigmentation
Discoid lupus erythematosus features scarring plaques with follicular plugging, central atrophy, and dyspigmentation, potentially causing permanent hair loss.
PANCE Dermatology 2
A 45-year-old woman presents with a salmon-colored, well-demarcated plaque with silvery scale on her elbows and knees.
Which finding would most likely be seen on biopsy?