PANCE Dermatology 4

Question 1

A 3-year-old presents with vesicles on an erythematous base in a dermatomal distribution on the trunk. The child's mother has active chickenpox. What is the most likely diagnosis?

Accepted Answer

Primary varicella (chickenpox)

Answer

A young child exposed to varicella presenting with vesicles on an erythematous base is most consistent with primary varicella (chickenpox), not zoster (which requires prior VZV infection).

Question 2

A 45-year-old man with HIV (CD4 count 80 cells/μL) presents with painless, papular, violaceous lesions on his lower extremities and oral mucosa. What is the causative organism?

Accepted Answer

Human herpesvirus 8 (HHV-8)

Answer

Kaposi sarcoma in HIV-infected individuals is caused by HHV-8 (KSHV) and presents as violaceous vascular tumors, particularly at low CD4 counts.

Question 3

A 16-year-old girl presents with pruritic vesicles on her fingers, palms, and soles that seem to 'taper' deep into the skin. The condition worsens in summer. What is the diagnosis?

Accepted Answer

Dyshidrotic eczema (pompholyx)

Answer

Dyshidrotic eczema (pompholyx) presents with intensely pruritic, deep-seated vesicles on the palms, soles, and lateral fingers, often triggered by heat and sweating.

Question 4

A 68-year-old woman presents with tense bullae on an erythematous base on her trunk and proximal extremities. Direct immunofluorescence shows linear IgG and C3 at the dermal-epidermal junction. What is the diagnosis?

Accepted Answer

Bullous pemphigoid

Answer

Bullous pemphigoid features tense bullae (not flaccid), linear IgG/C3 at the BMZ on DIF, and anti-BP180/BP230 antibodies targeting hemidesmosomes.

Question 5

A 55-year-old man presents with red, scaling patches in the groin and axillae with central clearing. KOH preparation is positive for branching hyphae. What is the most appropriate treatment?

Accepted Answer

Topical clotrimazole

Answer

Tinea cruris (dermatophyte infection of the groin) is treated with topical antifungals such as clotrimazole or terbinafine; oral therapy is reserved for resistant or extensive cases.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Dermatology 4