Practice questions, skin tumors 1
Practice
questions, skin tumors 1
© Jun Wang, MD, PhD
1. Use this
image for the question. A 41-year-old woman presents with a slowly growing painless
mass at her leg. She has a history of multiple skin warts. Physical examination
reveals a light tan nodule with greasy scaly surface. A shave biopsy is
performed and an image is shown. What is the diagnosis?
(Image: Ed Uthman from Houston, TX, USA [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)])
A. Actinic keratosis
B. Merkel cell carcinoma
C. Seborrheic keratosis
D. Squamous cell carcinoma
E. Verruca vulgaris
2. Use this
case and this image for the next two questions. A 59-year-old man presents
with suddenly appeared skin lesions on his back. He has had dysphagia and a 15
pound weight loss for the last three months. He has a history of Barrett’s
esophagus. Pictures of the skin lesion and microscopic examination are shown.
What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
(Image: James Heilman, MD [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Guttate psoriasis
B. Leser-Trelat syndrome
C. Neurofibromatosis 1
D. Nevoid basal cell carcinoma syndrome
E. Sezary syndrome
3. A 59-year-old man presents with suddenly appeared
skin lesions on his back. He has had dysphagia and a 15 pound weight loss for
the last three months. He has a history of Barrett’s esophagus. Pictures of the
skin lesion and microscopic examination are shown. What is likely associated with
these skin lesions?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
(Image: James Heilman, MD [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Abnormal keratinocyte turnover
B. Human papilloma virus infection
C. GI tract malignancy
D. NF 1 mutation
E. UV light
4. Use this
image for the question. A 45-year-old woman presents with brownish skin changes
of her left axilla. She is otherwise asymptomatic. She has a history of type 2
diabetes and obesity. She had ductal carcinoma in situ of her left breast 2
years ago and was treated with lumpectomy. Physical examination reveals a
slightly thickened area as shown. No lymphadenopathy is noted. What is most
likely associated with these changes?
(Image: Madhero88 [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Acute bacterial infections
B. Fungal infection
C. Insulin resistance
D. Melanocytic proliferation
E. Metastatic breast cancer
5. Use this
image for the question. A 35-year-man presents with approximately 15 painless
polypoid growths at his face and neck. His past medical history and family history
are unremarkable. The lesions are firm and up to 3 mm in greatest dimension. An
image of the microscopic examination is shown. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Acrochordon
B. Dermatofibroma
C. Dermatofibrosarcoma protuberans
D. Neurofibroma
E. Schwannoma
6. Use this
image for the question. A 25-year-old man presents with a 2.3 cm slowly
growing soft lump at his left forearm. He has a history of type 1 diabetes. The
mass is resected and grossly it has a cystic appearance with soft greasy yellowish
contents. An image of the microscopic examination is shown. What is the
diagnosis?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Dermatophytosis
B. Epidermal cyst
C. Pilar cyst
D. Pilomatrixoma
E. Teratoma
7. Use this
image for the question. A 39-year-old woman presents with a 1.5 cm firm
painless lump at her left scalp. He has a history of type 1 diabetes. The mass
is resected and grossly it has solid homogenous appearance. An image of the microscopic
examination is shown. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Epidermal cyst
B. Pilar cyst
C. Pilomatrixoma
D. Squamous cell carcinoma
E. Teratoma
8. Use this
image for the question. A 77-year-old woman presents with a 0.4 cm firm
painless nodule at her left palm. She has history of multiple basal cell
carcinoma and squamous cell carcinoma of skin. An image of the biopsy is shown.
What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Actinic keratosis
B. Basal cell carcinoma
C. Cylindroma
D. Eccrine poroma
E. Squamous cell carcinoma
9. Use this
case and this image for the next two questions. A 33-year-old woman
presents with multiple firm tumors up to 3.5 cm in greatest dimension at her
left scalp. She has family history of similar growth. An image of the biopsy is
shown. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Basal cell carcinoma
B. Cylindroma
C. Eccrine poroma
D. Squamous cell carcinoma
E. Syringoma
10. A 33-year-old woman presents with multiple firm tumors
up to 3.5 cm in greatest dimension at her left scalp. She has family history of
similar growth. An image of the biopsy is shown. Mutation of what gene is
likely associated with these findings?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Beta-catenin
B. BRAF
C. CYLD
D. MSH2
E. PTCH
11. Use this
image for the question. A 47-year-old woman presents with multiple firm papules
at her lower eyelids. The papules has light yellowish hue and are up to 3 mm in
greatest dimension. She has a history of left invasive ductal carcinoma with
axillary lymph node metastasis and was treated with lumpectomy, axillary lymph
node dissection and local radiation therapy. An image of the biopsy is shown.
What is the diagnosis?
(Image: Ed Uthman from Houston, TX, USA [CC BY 2.0
(https://creativecommons.org/licenses/by/2.0)])
A. Cylindroma
B. Eccrine poroma
C. Metastatic invasive ductal carcinoma
D. Sebaceous adenoma
E. Syringoma
12. Use this
case and this image for the next two questions. A 65-year-old woman
presents with a firm tumor at her left face. She has a history of hypertension and
diabetes for 20 years. She had colectomy at age 35 due to well differentiated sigmoid
colon adenocarcinoma. Her family history is positive for colorectal carcinoma
and endometrial carcinoma. An image of the biopsy is shown. What is the
diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Brooke-Spiegler syndrome
B. Cowden syndrome
C. Muir-Torre Syndrome
D. Neurofibromatosis 2
E. Nevoid basal cell carcinoma syndrome
13. A 65-year-old woman presents with a firm tumor at
her left face. She has a history of hypertension and diabetes for 20 years. She
had colectomy at age 35 due to well differentiated sigmoid colon
adenocarcinoma. Her family history is positive for colorectal carcinoma and
endometrial carcinoma. An image of the biopsy is shown. Mutation of what gene
is likely associated with these findings?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Beta-catenin
B. BRAF
C. CYLD
D. MSH2
E. PTCH
14. Use this
image for the next question. A 5-year-old boy presents with a firm tumor at
his left fact. He is otherwise healthy. An image of the biopsy is shown. What
is the diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Cylindroma
B. Pilar cyst
C. Pilomatricoma
D. Sebaceous adenoma
E. Syringoma
15. Use this
image for the next question. An 11-year-old boy presents with a slowly
growing tumor at his forehead. He is otherwise healthy. An image of the biopsy is shown. What is the
diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Basal cell carcinoma
B. Cylindroma
C. Epidermal cyst
D. Pilomatricoma
E. Trichoepithelioma
16. Use this
image for the next question. A 33-year-old woman presents with a slowly
growing warty papule at her face. An image of the biopsy is shown. What is the
diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Basal cell carcinoma
B. Cylindroma
C. Eccrine poroma
D. Trichoepithelioma
E. Tricholemmoma
17. Use this
image for the next question. A 27-year-old woman presents with a slowly
growing nodule at her left leg. Her past medical history is unremarkable.
Physical examination reveals a 1.2 cm firm nodule with smooth unremarkable skin
surface. An image of the biopsy is shown. Per immunohistochemistry studies,
this lesion is positive for factor XIIIa and negative for cytokeratin, desmin, S100
and CD34. What is the diagnosis?
(Image: Ed Uthman from Houston, TX, USA [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)])
A. Dermatofibroma
B. Dermatofibrosarcoma protuberans
C. Leiomyoma
D. Melanoma
E. Neurofibroma
18. Use this
case and this image for the next two questions. A 65-year-old man presents
with a firm tumor at his back. His past medical history is unremarkable. Physical
Examination reveals a 5.5 cm firm irregular mass at his left upper back. The skin
covering has erythematous changes, but no ulceration is noted. An image of the biopsy
is shown. Per immunohistochemistry studies, this lesion is positive for CD34 and
negative for cytokeratin, desmin, S100 and factor XIIIa. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Dermatofibroma
B. Dermatofibrosarcoma protuberans
C. Leiomyoma
D. Melanoma
E. Neurofibroma
19. A 65-year-old man presents with a firm tumor at his
back. His past medical history is unremarkable. Physical Examination reveals a
5.5 cm firm irregular mass at his left upper back. The skin covering has
erythematous changes, but no ulceration is noted. An image of the biopsy is shown.
Per immunohistochemistry studies, this lesion is positive for CD34 and negative
for cytokeratin, desmin, S100 and factor XIIIa. Abnormality of what gene is
most likely seen?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Beta-catenin
B. BRAF
C. CYLD
D. PDGFB
E. PTCH
20. Use this
case and these images for the next two questions. A 44-year-old man
presents with multiple pedunculated skin polyps on his back. His past medical
history is unremarkable. Physical Examination reveals numerous rubbery polypoid
growth on his back. The skin covering is unremarkable. In addition, 3 irregular
slight brown macules are seen on his right shoulder, and left abdomen. Images
of his eye and biopsy of the skin lesions are shown. Per immunohistochemistry studies,
this lesion is positive for S100 and negative for cytokeratin, desmin, CD34 and
factor XIIIa. What is the diagnosis of the skin lesion?
(Image: Dimitrios Malamos [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)],
and Calicut Medical College [CC BY-SA 4.0
(https://creativecommons.org/licenses/by-sa/4.0)])
A. Dermatofibroma
B. Dermatofibrosarcoma protuberans
C. Leiomyoma
D. Neurofibroma
E. Skin tags
21. A 44-year-old man presents with multiple
pedunculated skin polyps on his back. His past medical history is unremarkable.
Physical Examination reveals numerous rubbery polypoid growth on his back. The skin
covering is unremarkable. In addition, 3 irregular slight brown macules are
seen on his right shoulder, and left abdomen. Images of his eye and biopsy of
the skin lesions are shown. Per immunohistochemistry studies, this lesion is positive
for S100 and negative for cytokeratin, desmin, CD34 and factor XIIIa. Mutation
of what gene is likely associated with these findings?
(Image: Dimitrios Malamos [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)],
and Calicut Medical College [CC BY-SA 4.0
(https://creativecommons.org/licenses/by-sa/4.0)])
A. BRAF
B. Merlin
C. Neurofibromin
D. PDGFB
E. PTCH
22. Use this
case and these images for the next two questions. A 51-year-old man
presents with progressive headache for 6 months. His past medical history is
unremarkable. Physical Examination reveals an irregular slight brown macule at his
right chest. Head CT reveals a 2.5 cm mass near his pons. Images of his skin
macule and biopsy of the brain lesion are shown. What is the diagnosis of the brain
lesion?
(Image: Accrochoc at fr.wikipedia [CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0/)], and jensflorian [CC BY-SA
3.0 de (https://creativecommons.org/licenses/by-sa/3.0/de/deed.en)])
A. Fibrosarcoma
B. Leiomyoma
C. Meningioma
D. Neurofibroma
E. Schwannoma
23. A 51-year-old man presents with progressive
headache for 6 months. His past medical history is unremarkable. Physical
Examination reveals an irregular slight brown macule at his right chest. Head CT
reveals a 2.5 cm mass near his pons. Images of his skin macule and biopsy of
the brain lesion are shown. Mutation of what gene is likely associated with
these findings?
(Image: Accrochoc at fr.wikipedia [CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0/)], and jensflorian [CC BY-SA
3.0 de (https://creativecommons.org/licenses/by-sa/3.0/de/deed.en)])
A. BRAF
B. Merlin
C. Neurofibromin
D. PDGFB
E. PTCH
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