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Chapter 3. Skin

MULTIPLE CHOICE

1. When a patient presents with a skin-related complaint, it is important to first:

A. Fully inspect all skin lesions before asking the patient how the lesion in question
developed
B. Obtain a full history about the development of the skin lesion prior to the physical
examination
C. Complete a full physical examination of the body prior to inspecting the skin
lesion
D. Examine the skin lesion without hearing a health history in order to not prejudice
the diagnosis
ANS: B
When a patient presents with a skin-related complaint, there is an inclination to immediately
examine the skin, as the lesion or change is often readily observable. However, it is crucial
to obtain a history before proceeding to the examination in order to understand the
background of the problem. A thorough symptom analysis is essential.

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2. Jaundice is a state of high bilirubin in the bloodstream. It is most commonly seen first in the:
A. Sclera
B. Nail beds
C. Palms of the hands
D. Unexposed skin areas
ANS: A
Jaundice indicates an elevation in bilirubin and often is evident in the sclera and mucous
membranes before it is obvious in the skin.

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3. Skin turgor is best assessed by pinching skin over the:

A. Forehead
B. Forearm
C. Knees
D. Dorsum of the hand
ANS: B

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The skin overlying the forehead or dorsal hand is more likely to provide a false impression
of tenting or decreased elasticity; therefore, turgor should be tested by gently pinching a fold
of skin over the abdomen, forearm, or sternum.

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4. What kind of lesions are caused by the herpes simplex virus?

A. Scales
B. Vesicles
C. Plaques
D. Urticaria
ANS: B
The skin lesions of herpes consist of multiple vesicles that cluster and are usually preceded
by an area of tender erythema. The vesicles erode, forming ulcerations.

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5. A patient presents with vesicles on a reddened base in a symmetrical pattern on the lower
neck and upper back, stating that he had noticed discomfort prior to the onset of the rash.
Which of the following should be considered in your differential diagnosis?
A. Dermatitis herpetiformis
B. Herpes zoster TESTBANKSELLER.COM
C. Dyshidrosis
D. Contact dermatitis
ANS: A
Pruritus, burning, or stinging at the site often precedes the development of skin lesions. The
lesions consist of clustered vesicles on a reddened base. The lesions have a herpetiform
configuration, and the distribution is symmetrical. The extensor surfaces of the knees and
elbows are often affected, as are the posterior scalp, neck, back, and thighs.

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6. Herpetic whitlow is commonly located on:

A. The eyelid
B. The scalp
C. A finger
D. The lip
ANS: C
Herpetic whitlow, a herpetic lesion on the finger, is usually a result of self-contamination of
an infected patient to a skin break on the finger.

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7. Which type of lesion is referred to as resembling a dewdrop on a rose petal?

A. Varicella zoster
B. Measles
C. Rubella
D. Tinea
ANS: A
Similar to other herpes lesions, varicella lesions progress from an area of redness to form a
vesicle, then become pustular, and finally ulcerate. The vesicles look like a dewdrop on a
rose petal.

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8. Which lesions are typically located along the distribution of dermatome?

A. Scabies
B. Herpes zoster
C. Tinea
D. Dyshidrosis
ANS: B
The distribution of herpesTEzoster
STBlesions
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LLalong
ER.C aO
dermatome
M and is typically unilateral.
There are many variations of the condition, depending on the affected dermatome. The
healing of the lesions is frequently followed by development of postherpetic neuralgia.

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9. Folliculitis is most commonly due to:

A. Contact dermatitis
B. Varicella zoster
C. Dermatophytes
D. Staphylococcal infection
ANS: D

Folliculitis is an inflammation of the hair follicles and is typically associated with

staphylococci. Other microorganisms and causes include pseudomonas (associated with hot
tubs), Candida, tinea barbae, and herpes.

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10. A patient presents with polymorphous lesions consisting of small red papules and vesicles,
with a few eroded and crusted lesions. Your differential diagnosis should include all of the
following except:
A. Herpes simplex
B. Varicella
C. Bacterial folliculitis
D. Contact dermatitis
ANS: C
While all of the conditions listed may progress from papules to erosive crusted lesions,
folliculitis is associated with pustules, rather than vesicles.

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11. Which of the following has been associated with cervical and anal cancer?
A. Secondary syphilis
B. Human papilloma virus
C. Herpes simplex
D. Epstein-Barr virus
ANS: B
Human papilloma virus (HPV) is a viral cause of wart formation. In the perineal area, these
are known as genital warts and can lead to cancer of the cervix or anus.

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12. During a routine examination, you notice a 5 mm lesion on the right medial cheek. The
border is raised and pearlescent in color, and the area is crusted. The patient admits that it
has been present for several months and has only recently become tender with the
development of the crusting. This is most likely:
A. Squamous cell carcinoma
B. Epidermoid cyst
C. Basal cell carcinoma
D. Actinic keratosis
ANS: C
Basal cell carcinoma is the most common form of human malignancy and involves
sun-exposed skin. This malignancy is generally very slow growing. However, it can become
quite destructive and invasive if not diagnosed and treated in a timely manner. The typical
complaint is of a nonhealing sore located on the face, ear, or other sun-exposed area.
Although the lesions can vary, the typical lesion has a waxy/pearly appearance with a
central indentation.

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13. A patient has a tender, firm, nodular cystic lesion on his scalp that produces cheesy
discharge with foul odor. This is most likely:
A. Bacterial folliculitis
B. Basal cell carcinoma
C. Bullous impetigo
D. An epidermoid cyst
ANS: D
With an epidermoid cyst, the patient complains of a cystic lesion that produces cheesy
discharge with foul odor. The lesion is sometimes tender or painful. The lesion is nodular,
round and firm, and subcutaneous; thus, it is flesh colored. The most common sites include
the face, scalp, neck, upper trunk, and extremities.

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14. Which of the following is not associated with development of erythema multiforme?
A. Herpes virus
B. Mycoplasma infections
C. Medications
D. Trauma
ANS: D
Erythema multiforme major usually occurs in association with herpes or mycoplasma
infection, or in response T
toEmedications,
STBANKSEalthough
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OM of infections is implicated.
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15. Your patient complains of a progressive loss of pigment in various patches on the body.
Affected skin surfaces are otherwise normal (i.e., no scaling, vesicles, elevation, or other
changes). The most likely cause is:
A. Vitiligo
B. Acanthosis nigricans
C. Psoriasis
D. Pityriasis alba
ANS: A
With vitiligo, the patient often describes a history of the progressive development of small,
multiple areas of depigmentation that, over time, become larger and confluent. There is no
overlying scale or vesicle development. Any area of skin can be involved. The hair in the
affected area may also lose pigmentation. There is a higher incidence of vitiligo in patients
with autoimmune disorders, particularly those affecting the endocrine system, including
hypothyroidism, diabetes mellitus, and Addison’s disease.

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16. A patient has an irregularly shaped, brown to black lesion on the upper arm that has changed
color recently. The widest diameter is 6 mm. You should:
A. Measure and record the dimensions and schedule follow-up to repeat measurement
in 2 weeks
B. Biopsy the lesion
C. Obtain skin scraping for dermatophytes
D. All of the above
ANS: B
In malignant melanoma there is usually a history of a changing mole or other area of
hyperpigmentation. The lesion is usually greater than 0.5 cm in diameter and has notched or
irregular edges, irregular pigmentation, and asymmetry of shape. Like other skin disorders,
there are variations in appearance, and there should be a high suspicion for melanoma in any
changing pigmented skin lesion. Biopsy is diagnostic.

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17. Which of the following skin disorders is associated with diabetes?

A. Acanthosis nigricans
B. Vitiligo
C. Impetigo
D. Folliculitis
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ANS: A
Acanthosis nigricans is associated with insulin resistance. It is most prevalent in individuals
who are obese and in African Americans and Hispanics. Onset is usually in youth. It is an
area of darkly pigmented skin, often within the skinfolds.

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18. Which of the following disorders often presents in patients with café au lait spots?
A. Diabetes
B. Malignancy
C. Neurofibromatosis
D. Autoimmune disease
ANS: C
Café au lait spots are caused by increased melanin content and are associated with
neurofibromatosis. The lesions vary in appearance and size, with color ranging from tan to
brown. Frequently, there is a history of a variety of developmental and congenital
conditions. The lesions are asymptomatic. They range in size from millimeters to over 10
cm and are usually flat macules or patches. Although the color varies, most are coffee
colored.

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19. The patient presents with the complaint of a swollen node under his arm. The area is tender
and the node has progressed in size over the past few days. Which of the following should
be included in your differential diagnosis?
A. Hidradenitis suppurativa
B. Epidermoid cyst
C. Furuncle
D. Both A and C
ANS: D
Hidradenitis suppurativa involves occlusions of hair follicles, which causes a red, fluctuant
tender lesion. The site is commonly under the breast or in the axillae or groin. The clinician
must differentiate this skin condition from an enlarged lymph node, which can appear
similar. An enlarged lymph node is usually painless, whereas hidradenitis suppurativa is
usually tender. Furuncles are staphylococcal infections of hair follicles or sebaceous glands.
Patients complain of pain, redness, and swelling at the affected site, commonly the axillae
and groin.

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20. Which of the following skin conditions frequently heralds an anaphylactic reaction?
A. Contact dermatitis TESTBANKSELLER.COM
B. Eczema
C. Urticaria
D. Erythema multiforme
ANS: C
Urticaria, also commonly called hives, involves a histamine-mediated response that can be
either acute or chronic. A wide range of situations are associated with hives, including a
variety of infections, allergies to foods and medications, or underlying systemic disease.
Urticaria are pink or red wheals that are very pruritic. Frequently, they are associated with
anaphylaxis and/or angioedema.

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21. A patient with sarcoidosis has firm, tender, reddened nodules along the anterior aspect of the
leg. These lesions are called:
A. Erythema multiforme
B. Erythema nodosum
C. Discoid rash
D. Lichen planus
ANS: B

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Patients with autoimmune disease frequently experience isolated multiple skin lesions that
emerge as firm, tender, reddened nodules, usually along the anterior aspect of the leg,
although other sites can be involved. Over a period of up to 2 weeks, the lesions fade in
color and the degree of firmness decreases.

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22. A patient suffered a laceration of the shin 3 days ago and today presents with a painful,
warm, red swollen region around the area. The laceration has a purulent exudate. The
clinician should recognize that the infected region is called:
A. Contact dermatitis
B. Folliculitis
C. Hidradenitis suppurativa
D. Cellulitis
ANS: D
In cellulitis, a patient often describes a history of a break in the skin from an injury, insect
bite or sting, or previous procedure preceding the onset of redness, swelling, and pain at the
site. The affected area is tender, swollen, reddened, and warm. Streptococcus or
staphylococcal commonly causes the infection. The lower leg is a common site, usually
unilateral.

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23. A woman complains of malaise and arthralgias. You note a butterfly-shaped, macular,
erythematous rash across her cheeks and nose. These conditions are common in:
A. Psoriasis
B. Lichen planus
C. Systemic lupus erythematosus
D. Erythema nodosum
ANS: C
In systemic lupus erythematosus the patient will have a range of symptoms relevant to the
diagnosis, depending on the affected organs. There is often coexisting arthralgia and
malaise. The rash is macular and erythematous. It is described as a butterfly rash because the
distribution resembles a butterfly’s wings overlying the forehead and cheeks.

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24. Which of the following characteristics is not helpful in differentiating between psoriasis and
atopic dermatitis?
A. Distribution
B. Family history
C. Lesion morphology

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D. Chronicity
ANS: D
While patients with psoriasis or atopic dermatitis are often able to provide related family
history and the distribution and appearance of the lesions are different, both conditions tend
to be chronic in nature.

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25. A patient complains of recent onset of aching and malaise followed by the development of a
generalized rash. He denies previous rash, although he does admit that about a month ago he
had an open sore on his right hand that was nonpainful. The examination reveals a
maculopapular rash and lymphadenopathy. This presentation is most consistent with:
A. Pityriasis rosea
B. Secondary syphilis
C. Herpetic whitlow
D. Pyogenic granuloma
ANS: B
The patient may provide the history of a more generalized rash developing 2 or more weeks
following the primary lesion, which may still be evident. The primary lesion is usually an
isolated, single red lesion, which ultimately ulcerates, forming a nontender chancre. There
may be a period of malaise preceding the eruption of secondary lesions. These lesions vary
in appearance and distribution, but the typical finding is of red maculopapular lesions
smaller than 1 cm in diameter.
TESTAnyBANportion
KSELL ofEskin
R.Ccan
OMbe involved, including the scalp,
mucous membranes, perineum, and the soles and palms. There is generalized
lymphadenopathy.

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