Practice question Acute inflammatory dermatosis

Practice question

Acute inflammatory dermatosis

Updated: 01/08/2020

© Jun Wang, MD, PhD

1. Use this image and this case for the next three questions. A 29-year-old presents with recurrent elevated skins lesions with itching and burning sensation for 3 months. These lesions are usually at her face, neck, and arms, and last for a few hours. She denies fever, chills and other constitutional symptoms. Her past medical history is unremarkable. She does not have any known drug allergy. Physical examination reveals lesion as shown. What is the most likely diagnosis?

(Image credit: Enochlau [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)])

A. Allergic contact dermatitis

B. Atopic dermatitis

C. Erythema multiformes

D. Guttate psoriasis

E. Urticaria

2. A 29-year-old presents with recurrent elevated skins lesions with itching and burning sensation for 3 months. These lesions are usually at her face, neck, and arms, and last for a few hours. She denies fever, chills and other constitutional symptoms. Her past medical history is unremarkable. She does not have any known drug allergy. Physical examination reveals lesion as shown. What is the most likely cause of these findings?

(Image credit: Enochlau [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)])

A. Chronic rubbing

B. Desmosome damage

C. Hemidesmosome damage

D. Increased vascular permeability

E. Lymphocytes mediated keratinocyte injury

3. A 29-year-old presents with recurrent elevated skins lesions with itching and burning sensation for 3 months. These lesions are usually at her face, neck, and arms, and last for a few hours. She denies fever, chills and other constitutional symptoms. Her past medical history is unremarkable. She does not have any known drug allergy. Physical examination reveals lesion as shown. What cell is likely associated with initiating these symptoms?

(Image credit: Enochlau [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)])

A. Eosinophils

B. Fibroblasts

C. Lymphocyte

D. Mast cells

E. Neutrophils

4. Use this image and this case for the next three questions. A 3-year-old boy presents with fever, fatigue, myalgias, painful oral ulcer and painless reddish skin lesions at his upper and lower extremities for 2 days. He has had a cold 2 weeks ago. His past medical history include herpes infections. Physical examination reveals a temperature of 38.5 degree Celsius, heart rate of 110 bpm, blood pressure 115/85 mmHg. Multiple skin lesions are seen as shown in the image. These skin lesions have a relatively symmetrical distribution, involving his upper and lower extremities. A few erosions with crusts are seen in the buccal mucosa. No other abnormalities are noted. What is most likely the diagnosis?

(Photo Credit: Puppy123456 [Public domain])

A. Dermatophytosis

B. Erythema multiforme major

C. Erythema multiforme minor

D. Guttate psoriasis

E. Stevens Johnson syndrome

5. A 3-year-old boy presents with fever, fatigue, myalgias, painful oral ulcer and painless reddish skin lesions at his upper and lower extremities for 2 days. He has had a cold 2 weeks ago. His past medical history include herpes infections. Physical examination reveals a temperature of 38.5 degree Celsius, heart rate of 110 bpm, blood pressure 115/85 mmHg. Multiple skin lesions are seen as shown in the image. These skin lesions have a relatively symmetrical distribution, involving his upper and lower extremities. A few erosions with crusts are seen in the buccal mucosa. No other abnormalities are noted. What is most likely cause of these findings?

(Photo Credit: Alborz Fallah [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])

A. Autoantibodies against BP180

B. Cornificaiton defects

C. Disseminated fungal infection

D. Sweat gland dysfunction

E. T-cell mediated epidermis damage

6. A 3-year-old boy presents with fever, fatigue, myalgias, painful oral ulcer and painless reddish skin lesions at his upper and lower extremities for 2 days. He has had a cold 2 weeks ago. His past medical history include herpes infections. Physical examination reveals a temperature of 38.5 degree Celsius, heart rate of 110 bpm, blood pressure 115/85 mmHg. Multiple skin lesions are seen as shown in the image. These skin lesions have a relatively symmetrical distribution, involving his upper and lower extremities. A few erosions with crusts are seen in the buccal mucosa. No other abnormalities are noted. What is most likely associated with these presentations?

(Photo Credit: Alborz Fallah [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])

A. Chemical irritation

B. Drug reaction

C. Fungal infection

D. UV-light damage

E. Viral infection

7. Use this case for the next two questions. A 41-year-old man presents with fever, diffuse body pain and sloughing of skin, a day after he was treated with valproic acid for seizure. He had a brain trauma due to automobile accident. He has shingle and type 2 diabetes. Physical examination reveals diffuse erythematous changes and erosion involving his oral cavity, eyes, face, trunk and extremities. There are irregular dull red macules and papules, some have concentric ring appearance. Blistering changes are seen predominantly at his face and trunk. The skin sloughing is estimated to be around 5% of total body surface area. What is most likely the diagnosis?

A. Bullous pemphigoid

B. Erythema multiforme major

C. Erythema multiforme minor

D. Stevens Johnson syndrome

E. Toxic epidermal necrolysis

8. A 41-year-old man presents with fever, diffuse body pain and sloughing of skin, a day after he was treated with valproic acid for seizure. He had a brain trauma due to automobile accident. He has shingle and type 2 diabetes. Physical examination reveals diffuse erythematous changes and erosion involving his oral cavity, eyes, face, trunk and extremities. There are irregular dull red macules and papules, some have concentric ring appearance. Blistering changes are seen predominantly at his face and trunk. The skin sloughing is estimated to be around 5% of total body surface area. What is most likely associated with these presentations?

A. Brain trauma

B. Chemical irritation

C. Drug reaction

D. Hemidesmosome demage

E. Viral infection

9. Use this image and this case for the next two questions. A 35-year-old man presents with pruritic blisters at his forearms after cleaning his backyard. He denies other symptoms. His past medical history is unremarkable. Physical examination reveals blisters up to 2.5 cm in greatest dimension in his forearms as shown in the image. Biopsy of the lesions reveal marked spongiosis with intraepidermal vesicles, and diffuse lymphocytic and eosinophilic infiltrate. No acantholysis is seen. What is most likely the diagnosis?

(Image credit: Joelloughead [Public domain])

A. Allergic contact dermatitis

B. Bullous pemphigoid

C. Dermatitis herpetiformis

D. Lichen planus, bullous type

E. Pemphigus vulgaris

10. A 35-year-old man presents with pruritic blisters at his forearms after cleaning his backyard. He denies other symptoms. His past medical history is unremarkable. Physical examination reveals blisters up to 2.5 cm in greatest dimension in his forearms as shown in the image. Biopsy of the lesions reveal marked spongiosis with intraepidermal vesicles, and diffuse lymphocytic and eosinophilic infiltrate. No acantholysis is seen. What is the cause of these findings?

(Image credit: Joelloughead [Public domain])

A. Autoantibodies against desmoglein 1 or 3

B. Autoantibodies against BP180 or BP230

C. Fungal infection

D. IgM containing immunocomplex deposit at dermoepidermal junction

E. T-cell mediated keratinocytes injury

11. Use this image and this case for the next three questions. A 2-month-old boy presents with itchy skin rash on his face and chest. He was born full term with unremarkable prenatal and delivery courses. Physical examination reveals scaly rash as shown in the image. The rash involves majority of the face but not the nose. No other abnormalities are noted. What is likely the diagnosis?

(Image credit: Gzzz [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)])

A. Allergic contact dermatitis

B. Atopic dermatitis

C. Dermatitis herpetiformis

D. Pemphigus erythematosus

E. Systemic lupus erythematosus

12. A 2-month-old boy presents with itchy skin rash on his face and chest. He was born full term with unremarkable prenatal and delivery courses. Physical examination reveals scaly rash as shown in the image. The rash involves majority of the face but not the nose. No other abnormalities are noted. What is the cause of these presentations?

(Image credit: Gzzz [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)])

A. Autoantibody against phospholipid

B. Cornification defect

C. Drug reaction

D. Fungal infection

E. Skin barrier defect

13. A 2-month-old boy presents with itchy skin rash on his face and chest. He was born full term with unremarkable prenatal and delivery courses. Physical examination reveals scaly rash as shown in the image. The rash involves majority of the face but not the nose. No other abnormalities are noted. What disorder he likely to develop in the future?

(Image credit: Gzzz [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)])

A. Allergic disorders

B. Basal cell carcinoma

C. Infections

D. Malabsorption

E. Squamous cell carcinoma

14. Use this image and this case for the next three questions. A 35-year-old woman presents with an intermittent pruritic skin lesion at her antecubital fossae for 2 months. She does not have other symptoms. She has a history of asthma since age 8. Physical examination is unremarkable except the skin lesion shown in the image. Per palpation, this lesion has a rubbery consistency. Biopsy of the lesion reveals hyperkeratosis, parakeratosis, epidermal hyperplasia with elongated rete ridges and mild spongiosis. Special stains are negative for fungal hyphae. What is the diagnosis?

(Image credit: G.steph.rocket [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])

A. Allergic contact dermatitis

B. Atopic dermatitis

C. Dermatophytosis

D. Lichen planus

E. Psoriasis

15. A 35-year-old woman presents with an intermittent pruritic skin lesion at her antecubital fossae for 2 months. She does not have other symptoms. She has a history of asthma since age 8. Physical examination is unremarkable except the skin lesion shown in the image. Per palpation, this lesion has a rubbery consistency. Biopsy of the lesion reveals hyperkeratosis, parakeratosis, epidermal hyperplasia with elongated rete ridges and mild spongiosis. Special stains are negative for fungal hyphae. What blood test is likely to be abnormal?

(Image credit: G.steph.rocket [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])

A. Absolute lymphocytes

B. Absolute neutrophils

C. IgA

D. IgE

E. IgG

16. A 35-year-old woman presents with an intermittent pruritic skin lesion at her antecubital fossae for 2 months. She does not have other symptoms. She has a history of asthma since age 8. Physical examination is unremarkable except the skin lesion shown in the image. Per palpation, this lesion has a rubbery consistency. Biopsy of the lesion reveals hyperkeratosis, parakeratosis, epidermal hyperplasia with elongated rete ridges and mild spongiosis. Special stains are negative for fungal hyphae. What is the cause of skin thickening of this lesion?

(Image credit: G.steph.rocket [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])

A. Chronic rubbing

B. Fungal infection

C. Lymphocytic infiltrate

D. Sweat gland dysfunction
E. Vascular hyperpermiability

17. Use this image for this question. A 7-year-old boy presents with sudden onset of painful vesicles on his face for a day. He has a history of atopic dermatitis and is treated with topical steroids. He does not have fever or other symptoms. Physical examination reveals numerous small vesicles with purulent contents, some have ruptures and are covered yellowish crust. Biopsy reveals findings as shown in the image. What is the diagnosis?

(Image credit: Yale Rosen from USA [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)])

A. Dermatitis herpetiformis

B. Irritant contact dermatitis

C. Kaposi varicelliform eruption

D. Pustular psoriasis

E. Shingle

18. Use this image for this question. A 48-year-old man presents with pruritic visicles at his fingers and palms. He has type 2 diabetes and shingles. Physical examination reveals clusters of small vesicles with clear contents, as shown in the image. No other abnormalities are noted. What is most likely the diagnosis?

Image credit (commonswiki)

A. Allergic contact dermatitis

B. Dermatitis herpetiformis

C. Dyshydrotic eczema

D. Pustular psoriasis

E. Shingles

19. A 15-year-old girl presents with a pruritic skin lesion at the extensor side of her left arm for 6 months. Her past medical history is unremarkable. Physical examination reveals a 1.5 oval shaped plaque with erythematous base and dry, cracked surface with mild scaling at both center and periphery. No other abnormality is noted. What is the diagnosis?

A. Dermatophytosis

B. Dyshidrotic eczema

C. Lichen planus

D. Nummular eczema

E. Psoriasis

20. A 21-year-old man presents with new pruritic rashes at his left leg. He had seborrheic dermatitis 2 weeks ago and was treated with topical steroid. His past medical history is otherwise unremarkable. Physical examination reveals diffuse erythematous papules with yellowish scaling on his left leg. Biopsy of these new lesions reveals parakeratosis and mild spongiosis, that are prominent around hair follicles. No fungal hyphae are seen per special stain. What is the most likely diagnosis?

A. Dermatitis herpetiformis

B. Dermatophytosis

C. ID reaction

D. Kaposi varicelliform eruption

E. Pustular psoriasis

21. A 77-year-old presents pruritic dry skin in both legs for 5 years. The symptoms are more prominent in winter months. He has type 2 diabetes and hypertension. His past medical history is otherwise unremarkable. Physical examination reveals rubbery very dry skin with irregular cracks, fissures and scaling of both legs. No other abnormalities are noted. What is most likely the diagnosis?

A. Atopic dermatitis

B. Dermatophytosis

C. Lichen planus

D. Psoriasis

E. Xerotic eczema

Answers

Back to acute inflammatory dermatosis

Back to contents