1. The pathogenesis of bullous pemphigoid is [1]:

   A. Autoantibodies binding to hemidesmosomes stimulate leukocyte infiltrates forming subepidermal blisters
   B. Delayed type hypersensitivity reaction (DTH) to specific dermal allergens
   C. Mast cell infitration of subepithelial region due to unknown stimulus
   D. Absence of complement down regulating proteins including decay accellerating factor
   E. Type I hypersenstivity reaction with IgE antibodies to dermal cytokeratins

2. A 27 year old man with a long history of schizophrenia has been institutionalized in a chronic mental care facility for 6 months. He presents with 1 week of progressively pruritic linear breaks in his skin, initially on his hands, now in his genital region and scalp. Examination shows gray-white fissures on between his fingers, on his palms, back of his neck, and genital region. Some of the lesions between the fingers have small (1mm) vesicles associated with the fissures. Except for interruptions by frequent scratching, his physical exam is unremarkable. The patient switched from resperidone (Respirdal®) to olanzapine (Zyprexa®) two weeks ago for treatment of his schizophrenia. The most likely diagnosis is [2]:

   A. Atopic Dermatitis
   B. Dermatitis herpetiformis
   C. Drug Reaction
   D. Lice
   E. Scabies

3. The most effective treatment for the patient in question 2 above is [3]:

   A. High dose oral predisone
   B. Hydroxychloroquine (Plaquenil®)
   C. Permethrin
   D. Valacyclovir (Valtrex®)
   E. Dapsone

4. A 52 year old, fair skinned man presents with new pustules over his face which have not improved with "acne soap." He has noted increasing dilated blood vessels over his face and neck, and he thinks his "nose might be getting bigger." His face has a red hugh and he has smoked 2 packs of cigarrettes per day for the past 2 years. The most likely diagnosis is [4]:

   A. Herpes simplex virus (oral)
   B. Acne Vulgaris
   C. Dermatitis Herpetiformis
   D. Pyoderma gangrenosum
   E. Acne Rosacea

5. All of the following are true concerning suncreens EXCEPT [5]:

   A. Sunscreens reduce UVB much more than UVA effects
   B. Use clearly reduces sunburn, photoaging, actinic keratoses
   C. Inorganic physical sunblocks (titanium dioxide, zinc oxide) scatter radiation
   D. Use clearly reduces both squamous and basal cell carcinomas of the skin
   E. Use may reduce melanoma risk

6. All of the following are characteristics of psoriasis EXCEPT [6]:

   A. Epidermal hyperproliferation with thickening and overlying scale
   B. CD8+ T lymphocytes predominate in epidermis and interact with Langerhans cells
   C. IFNg causes hyperkeratosis, parakeratosis and loss of granular cell layer
   D. Th1 type CD4+ T cells predominate in dermis and probably drive the pathogenesis
   E. Tumor necrosis factor alpha and interferon gamma levels are reduced in psoriatic lesions

7. All of the following are true concerning treatment of onychomycosis (fungal nail infection, paronychia) except [7]:

A. Oral griseofulvin (Fulvicin®) is the drug of choice
B. Rarely responds completely to topical therapy used alone
C. Itraconazole is often effective and is generally well tolerated
D. Oral terbinafine (Lamisil®) works rapidly and is well tolerated
E. Topical mycocide NS or topical terbinafine have reasonable activity and may be used in mild disease or in patients wishing to avoid systemic therapy

8. All of the following are true concerning androgenic alopecia (male common baldness) EXCEPT [8]:

   A. Affects about two-thirds of all men
   B. Androgenic alopecia is common in polycystic ovary syndrome
   C. Topical minoxidil, which directly reduces local androgen levels, is often helpful
   D. With high testosterone exposure, hair follicles undergo miniaturization and produce small, finer hairs over time
   E. Finasteride, a 5-alpha-reductase inhibitor, has shown some efficacy

9. A 46 year old overweight woman presents with 2-month onset of very tender erythematous, mildly blanchable, nodules over both of her legs. Some of the lesions have gotten larger, and others have flattened. None of the lesions have ulcerated. She reports no other symptoms. Her medical history is significant for mild hypertension and type 2 diabetes mellitus controlled with metformin (Glucophage®). Three months ago she was treated with oral trimethoprim/sulfamethoxazole (Bactrim®) for 7 days for a urinary tract infection. She has normal vital signs and her physical exam is as described. The most likely diagnosis is [9]:

   A. Pyoderma gangrenosum
   B. Atopic Dermatitis
   C. Erythema multiforme
   D. Erythema nodosum
   E. Stevens-Johnson's Syndrome

10. Which ONE of the following statements is true concerning atopic dermatitis

    A. There is little genetic contribution to development of atopic dermatitis
    B. T helper lymphocyte type 2 (Th2) biased cells producing IL4 and IL5 are major initiators
    C. Type I (IgE mediated) hypersensitivity plays little role in disease
    D. Interferon gamma levels are high in lesions in affected individuals
    E. Immune complex deposition in subepithelial region is commonly found

Answers

1. A
2. E
3. C
4. E
5. D (Basal cell carcinoma risk appears not to be reduced with sunscreen use.)
6. E
7. A
8. C (Minoxidil does not affect androgen levels.)
9. D
10. B