PANRE Dermatology 5 — Questions and Answers
Question 1: A 20-year-old male athlete presents with a cluster of painful vesicles on an erythematous base on his upper thigh after wrestling. Culture grows HSV-1. What is this condition called?
- Herpes gladiatorum (Correct answer)
- Eczema herpeticum
- Herpes zoster
- Herpetic whitlow
Correct answer: Herpes gladiatorum
Herpes gladiatorum is HSV-1 infection acquired through skin-to-skin contact during contact sports like wrestling, commonly affecting the face, neck, and extremities.
Question 2: A 48-year-old woman with fair skin presents with multiple open and closed comedones on the nose and cheeks, intermittent facial flushing, and telangiectasias. She denies acne history. What is the most likely diagnosis?
- Acne vulgaris
- Rosacea (Correct answer)
- Perioral dermatitis
- Sebaceous hyperplasia
Correct answer: Rosacea
Rosacea is characterized by central facial erythema, flushing, telangiectasias, and papulopustules in adults; true comedones can appear in phymatous rosacea.
Question 3: A 5-year-old child develops multiple 2–5 mm umbilicated, flesh-colored papules on the trunk and extremities without surrounding inflammation. The child is otherwise healthy. What is the treatment of choice?
- Oral acyclovir for 5 days
- Watchful waiting (self-limited) (Correct answer)
- Topical imiquimod 5% daily
- Cryotherapy immediately
Correct answer: Watchful waiting (self-limited)
Molluscum contagiosum in immunocompetent children is self-limited, typically resolving in 6–18 months, and watchful waiting is the preferred management to avoid painful procedures.
Question 4: A 62-year-old man presents with grouped, crusted vesicles in the L3 dermatomal distribution 2 weeks after resolution of his acute zoster rash. He reports burning pain 8/10 in the same area. What is this complication called?
- Ramsay Hunt syndrome
- Post-herpetic neuralgia (Correct answer)
- Zoster sine herpete
- Disseminated zoster
Correct answer: Post-herpetic neuralgia
Post-herpetic neuralgia is defined as pain persisting more than 90 days after the onset of herpes zoster and is the most common complication, especially in elderly patients.
Question 5: A 35-year-old man presents with a new 7 mm pigmented lesion with asymmetry, irregular borders, two colors (brown and black), and recent size change. The ABCDE criteria suggest malignancy. What is the next best step?
- Shave biopsy with 1 mm margins
- Excisional biopsy with 1–3 mm margins (Correct answer)
- Punch biopsy of the darkest area only
- Topical imiquimod and recheck in 6 weeks
Correct answer: Excisional biopsy with 1–3 mm margins
Excisional biopsy with narrow margins (1–3 mm) is preferred for suspected melanoma to provide accurate Breslow thickness measurement for staging and prognosis.
Question 6: A 45-year-old woman develops painful, red nodules on her shins bilaterally that are warm and tender on palpation. She recently had a streptococcal pharyngitis. The lesions do not ulcerate. What is the diagnosis?
- Pyoderma gangrenosum
- Erythema nodosum (Correct answer)
- Cellulitis
- Lipodermatosclerosis
Correct answer: Erythema nodosum
Erythema nodosum presents as painful, non-ulcerating nodules on the shins representing a hypersensitivity panniculitis commonly triggered by streptococcal infection, sarcoidosis, or medications.
Question 7: A 3-year-old with atopic dermatitis and egg allergy develops widespread vesicular lesions over pre-existing eczematous skin. Tzanck smear shows multinucleated giant cells. What is the most serious complication to monitor for?
- Secondary bacterial superinfection with MRSA
- Kaposi varicelliform eruption causing herpetic encephalitis (Correct answer)
- Scarring alopecia at scalp sites
- Corneal dendritic ulcers
Correct answer: Kaposi varicelliform eruption causing herpetic encephalitis
Eczema herpeticum (Kaposi varicelliform eruption) can disseminate to the CNS causing herpetic encephalitis, which is a life-threatening complication requiring prompt IV acyclovir.
PANRE Dermatology 5
A 20-year-old male athlete presents with a cluster of painful vesicles on an erythematous base on his upper thigh after wrestling.
Culture grows HSV-1.
What is this condition called?