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Question 1 of 31
1. Question
A 2-week-old boy has an elevated lesion over the genital area as seen in the image below:
Which of the following is the most likely natural course of this lesion?
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Question 2 of 31
2. Question
A 58-year-old man comes to the office for evaluation of a foot wound. The patient noticed a small ulcer on the bottom of his right foot a week ago but recalls no significant foot injury. He has been applying antiseptics, but the wound has failed to heal. The patient has a 15-year history of type 2 diabetes mellitus and is nonadherent to medical therapy. He has smoked a pack of cigarettes daily for 20 years. Temperature is 37.1 C (98.8 F), blood pressure is 140/80 mm Hg, and pulse is 72/min. Right lower extremity examination shows a 1-cm (0.39-in) plantar ulcer under the first metatarsal head. There are no other lesions, and the tibial and dorsalis pedis pulses are normal. Which of the following is the strongest contributing factor underlying the development of this patient’s foot ulcer?
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Question 3 of 31
3. Question
A 45-year-old woman is brought to the emergency department after a generalized tonic-clonic seizure. She reports no prior history of seizures, but she has noticed right arm weakness over the last week. Her family history is significant for her mother’s death from skin cancer. Physical examination shows a skin lesion measuring 13 mm on her back, as shown in the image below.
This lesion most likely originated from which of the following embryologic derivatives?
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Question 4 of 31
4. Question
A 2-year-old boy is brought to the office by his mother due to a rash that started 3 days ago. A similar red, itchy rash on the cheeks, trunk, and arms has occurred intermittently since infancy. The mother had thought that the rashes were related to the consumption of certain foods, but elimination of cow’s milk and fruits did not improve the rash. The patient has had a few upper respiratory infections but no major illnesses. Vaccinations are up to date, and he takes no medications. He attends a day care facility. Vital signs are within normal limits. The rash on the patient’s back is shown in the exhibit. Similar findings are observed on the cheeks and proximal upper extremities. The diaper area is clear, and no mucosal lesions are present. This patient’s current condition increases his risk of developing which of the following additional disorders?
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Question 5 of 31
5. Question
A 10-year-old boy is brought to clinic for evaluation of excessive sunburns. The patient has recently been spending more time outside due to school sports. He applies sunscreen before going outside, but often forgets to reapply it during prolonged outdoor periods. He states that he sunburns easily and has never been able to suntan like his peers. The patient has otherwise been healthy. Temperature is 37.1 C (98.8 F), blood pressure is 110/70 mm Hg, pulse is 90/min, and respirations are 20/min. Examination of exposed surfaces of the skin shows patches of tender, erythematous skin without blistering, findings consistent with a sunburn. The remainder of the skin is milky white without bruises, rashes, or freckling. The hair is diffusely white. Examination of the eyes shows sensitivity to light. Which of the following is the most likely mechanism underlying this patient’s skin condition?
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Question 6 of 31
6. Question
A 46-year-old man comes to the office due to intermittent, bloody diarrhea and abdominal pain for the past month. The patient has lost 12 lb (5.4 kg) during this period. He was diagnosed with HIV 5 years ago but has been inconsistent with his antiretroviral medications. Current CD4 count is 50/mm3 and plasma HIV viral load is 650,000 copies/mL. Colonoscopy reveals multiple hemorrhagic, polypoidal lesions. Biopsy of these lesions reveals a proliferation of spindle-shaped cells and small blood vessels. Which of the following is the most likely cause of this patient’s diarrhea?
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Question 7 of 31
7. Question
An 8-week-old boy is evaluated for nystagmus first noted 2 weeks ago. The patient was born at 37 weeks gestation with no complications during delivery. He has been exclusively breastfed. Vital signs are normal. Weight and height are at the 50th percentile. On examination, iris transillumination is present, and there are no apparent foveae on funduscopic examination. Optic nerves are small and gray. The anterior fontanelle is open and soft with overlying fine, white hair. This patient’s condition is most likely due to a defect in which of the following enzymes?
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Question 8 of 31
8. Question
A 4-month-old girl is brought to the clinic by her parents for a well-child check. She was evaluated 2 weeks ago for a rash in the diaper area. At that visit, the patient was found to have erythematous papules in the diaper area that spared the skin folds. Her symptoms improved with use of a petrolatum barrier ointment with every diaper change. Today, vital signs and physical examination are normal. Which of the following most likely contributed to this patient’s prior skin findings?
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Question 9 of 31
9. Question
A 26-year-old woman comes to the office due to a skin condition. The patient has had dry, flaky skin since childhood, but it has worsened in recent years. Symptoms are typically worse in the winter but improve as the weather warms in the spring. The patient has a family history of asthma; both parents also have chronically dry skin. Examination shows diffuse scaling of the skin that is most notable on the extremities, as shown in the exhibit. Which of the following is most likely contributing to this patient’s condition?
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Question 10 of 31
10. Question
A 40-year-old man comes to the office due to lesions over his thigh that he first noticed 2 weeks ago. The lesions are neither painful nor itchy. The patient has a history of HIV infection. He has not been compliant with HIV therapy. On physical examination, the patient appears mildly cachectic. Vital signs are normal. There are 2 elliptical, raised, nontender, violaceous lesions on his right thigh. No other skin or mucous membrane lesions are present. There is no lymphadenopathy. CD4 count is 100/mm3. The patient’s skin condition most likely originated from which of the following cells?
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Question 11 of 31
11. Question
A 61-year-old man with a history of chronic obstructive pulmonary disease and HIV infection is evaluated for cough and hemoptysis. CT scan shows multiple bilateral nodular lesions. Bronchoscopy shows a cherry-red, slightly raised lesion. Biopsy of the lesion is shown in the image below:
Which of the following is the most likely diagnosis?
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Question 12 of 31
12. Question
A 12-year-old boy is brought to the office due to a rash on the posterior neck. The patient has had this rash intermittently over the past several years. During the last 2 months, the rash has become increasingly pruritic with the cooler weather, and the patient is constantly scratching his neck. The patient has no other medical conditions and takes no medications. Vital signs are normal. The posterior neck is shown in the image below:
Which of the following is the most likely cause of this patient’s rash?
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Question 13 of 31
13. Question
A 65-year-old man comes to the office due to 2 months of itching, occasional ulceration, and crusting of a skin lesion on his upper chest. A year ago, the patient was diagnosed with squamous cell carcinoma with perineural invasion at the site of the lesion. Surgical resection with clear margins was achieved, followed by adjuvant radiotherapy to the site. He reports no other symptoms. The patient’s lesion is shown in the exhibit. If a biopsy is performed at the periphery of the lesion, which of the following histologic changes is most likely to be seen?
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Question 14 of 31
14. Question
A 14-month-old girl is brought to the clinic by her parents due to sores on her feet. Since she took her first steps 3 months ago, she has had blisters involving the soles of the feet, which subsequently break down and heal slowly. The patient had failure to thrive as an infant due to frequent oral ulcerations but otherwise has been healthy and has achieved normal developmental milestones. Examination shows small bullae at the soles with faint erythema and no scarring. Biopsy taken at the margin of a blister shows an intraepidermal cleavage plane. Which of the following most likely contributes to the pathogenesis of this patient’s condition?
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Question 15 of 31
15. Question
A 45-year-old man comes to the office due to recurrent, painful skin lesions in the right axilla for the past 6 months. The patient has no other medical history and takes no medication. He smokes a pack of cigarettes every day and works as a roofer. Vital signs are normal. Examination reveals tender, subcutaneous nodules in the right axilla and other findings as shown in the exhibit. The remainder of the examination is normal. Which of the following is the most likely cause of the condition?
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Question 16 of 31
16. Question
A 25-year-old woman comes to the office for a routine skin exam. She has had an increasing number of skin-colored papules and nodules over her body since adolescence. Several members of her family have similar skin lesions. Physical examination findings are shown in the exhibit. Abnormal proliferation of cells from which of the following is the most likely cause of this patient’s skin lesions?
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Question 17 of 31
17. Question
A 79-year-old woman comes to the office due to bleeding from an ulcerative lesion on her right nipple that she first noticed several months ago. The lesion is itchy and is slowly increasing in size. Examination shows a crusty, thickened, erythematous, and ulcerated nodule with evidence of hyperpigmentation. Changes extend to the surrounding areola. Excisional biopsy reveals relatively well-circumscribed aggregates of large, polygonal, pleomorphic cells with abundant mitotic activity and surrounding necrosis. S-100 and HMB-45 stains are diffusely positive. Which of the following is the most likely diagnosis?
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Question 18 of 31
18. Question
A 42-year-old woman comes to the clinic due to a lesion on the left side of her chest. The lesion first appeared several months ago and is slowly enlarging and occasionally oozing blood. The patient underwent a living-donor kidney transplant 5 years ago for end-stage renal disease due to IgA nephropathy. She also has hypothyroidism due to Hashimoto thyroiditis. Medications include tacrolimus, mycophenolate, low-dose prednisone, and levothyroxine. Vital signs are normal. On physical examination, a 1 × 2 cm crusted lesion is noted over the midsternal area. Biopsy of the lesion is performed; histopathology findings are shown in the exhibit. Which of the following most likely contributed to the development of this patient’s skin lesion?
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Question 19 of 31
19. Question
A 47-year-old man comes to the office due to a white patch on the inside of his lower lip. It is painless and does not bleed. The patient has used smokeless tobacco for the past 20 years. He drinks on average 5 beers a week. On physical examination, a 3.5-cm flat, white patch is seen on the inside of the lower lip, reflecting onto the gingival surface of the lower teeth. There is no cervical adenopathy. Biopsy of the mucosal lesion is shown in the image below:
Which of the following is most likely to occur if this patient’s condition is left untreated?
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Question 20 of 31
20. Question
A 2-month-old girl is brought to the office for a follow-up examination. The parents are concerned about a red bump that first appeared on her scalp at age 3 weeks. The lesion has since grown significantly in size. The child’s growth and development are appropriate for age. A photograph of the lesion is shown in the exhibit. Examination shows no other abnormalities. This child’s lesion is most likely primarily composed of which of the following?
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Question 21 of 31
21. Question
A 59-year-old man comes to the office for evaluation of a sore on his ear. The lesion has been present for the past 4 months and has shown little change. Physical examination reveals a 1-cm firm, scaly, pink nodule over the right pinna. Biopsy of the lesion shows numerous dysplastic eosinophilic keratinocytes spanning the full thickness of the epidermis and dermis. Which of the following is the most likely diagnosis?
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Question 22 of 31
22. Question
A 62-year-old man comes to the office due to worsening difficulty with swallowing food over the last 3 months. He has smoked a pack of cigarettes daily for the past 45 years. On examination, there is a firm, palpable mass at the base of tongue. Cervical lymph nodes are also palpable. Which of the following histologic features is most likely to be seen on biopsy of the tongue lesion?
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Question 23 of 31
23. Question
A 47-year-old woman comes to the office due to an itchy rash. For the last 3 months, she has had a gradual onset of multiple pruritic lesions at her wrists, legs, and ankles. The patient tried treating the lesions with emollients and topical over-the-counter hydrocortisone but had no relief. Examination shows scattered, scaly, pink papules and plaques as shown in the exhibit. Which of the following is the most likely diagnosis?
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Question 24 of 31
24. Question
A 62-year-old man comes to the office due to an intensely pruritic facial rash for the past 3 days. The patient uses no facial cosmetic products but has frequently dyed his hair during the past year; he last dyed his hair 5 days ago and also recalls developing a similar rash the previous time he used hair dye. The patient has a history of asthma, hypertension, and diabetes mellitus. He does not use tobacco, alcohol, or illicit drugs. Vital signs are within normal limits. Physical examination findings are shown in the exhibit. Which of the following are primarily involved in the pathogenesis of this patient’s rash?
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Question 25 of 31
25. Question
A 50-year-old woman comes to the office for evaluation of a mole on her back. The mole has been present for several years, but her daughter is concerned that it might have grown larger lately. The patient has no other medical conditions but had frequent sunburns during childhood. Dermoscopic examination of the lesion is shown in the image below.
The lesion has multiple color variations, including dark brown, pink, red, and whitish areas. Excisional biopsy of the lesion is performed. The whitish areas (arrows) seen on histologic examination most likely represent which of the following underlying processes?
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Question 26 of 31
26. Question
A 4-month-old girl is brought to the office due to a rash on her cheeks for the past 2 weeks. The rash has not spread, and the patient is often seen scratching her face. There have been no changes in bath soaps and detergents; no animals or plants are in the house. Vaccinations are up to date. The patient is exclusively breastfed, with height and weight tracking along the 50th percentiles. Vital signs are normal. Skin examination is shown in the exhibit. The remainder of the examination is unremarkable. Which of the following conditions is this patient at increased risk for developing?
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Question 27 of 31
27. Question
A 24-year-old woman comes to the office with a pruritic rash on her arms and legs; it has been present on and off for most of her life. Examination of the posterior left leg reveals erythematous patches and papules, as shown in the exhibit. A similar rash is present on the right leg and bilateral antecubital fossae. Which of the following cytokines primarily initiated her current exacerbation?
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Question 28 of 31
28. Question
A 24-year-old man burns his hand after grasping the handle of a hot pan while preparing a meal. Several minutes later, both the initial burn and the area around it are red without blistering. When he presses on the burn, the tissue blanches. Which of the following is most likely contributing to the reaction observed in this patient?
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Question 29 of 31
29. Question
A 22-year-old man comes to the office due to progressive skin lesions. The patient noticed a nonpainful, nonpruritic skin bump on his right knee 3 months ago, which progressively increased in size and number. He has no prior health issues and takes no medications. The patient is outdoors frequently for work and recreational activities. He is sexually active. Physical examination findings are shown in the exhibit. Which of the following microbial organisms is most likely responsible for this patient’s current condition?
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Question 30 of 31
30. Question
A 30-year-old man comes to the office with a rash on his left wrist for the past 3 weeks. The rash is associated with an itching and burning sensation. The patient has not used any new skin care products but has been wearing a watch he bought during a recent vacation. Medical history is unremarkable, and he takes no medications. The patient does not use illicit drugs. Temperature is 36.9 C (98.4 F), blood pressure is 118/76 mm Hg, pulse is 64/min, and respirations are 12/min. Skin examination findings are shown in the image below:
There are no other skin lesions or lymphadenopathy. Histologic examination would most likely reveal which of the following?
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Question 31 of 31
31. Question
A 17-year-old boy comes to the office due to a facial lesion. The patient noticed a small area of rough skin on his lower lip several weeks ago, which has progressively enlarged. He reports no pain or itching. The patient had eczema during early childhood but has had no other chronic medical conditions. Vital signs are within normal limits. Physical examination findings are shown in the exhibit. There are no other skin rashes, oral lesions, or enlarged lymph nodes. Which of the following histopathological findings are most likely present in this patient’s skin lesion?
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