1- Question: 74-2003
You are asked to evaluate a 1-day-old healthy term infant who has a rash. The physical examination demonstrates erythematous macules; in the center of each macule is a solitary papule or occasionally a vesicle.
Of the following, the MOST likely diagnosis is
A. candidiasis
B. erythema toxicum
C. herpes simplex virus infection
D. Staphylococcus aureus folliculitis
E. transient neonatal pustular melanosis
2- Question: 85-2003
You are seeing an 8-month-old girl for the first time. Her parents are concerned about a red, rubbery nodule on her back that has grown in size over the past 5 to 6 months.
Of the following, the MOST appropriate treatment of this lesion is
A. alpha interferon
B. intralesional steroids
C. laser therapy
D. observation
E. systemic steroids
3- Question: 90-2003
An African-American newborn has pustules without surrounding erythema on the trunk and forehead and small (2 mm) hyperpigmented macules, some of which have peripheral scale.
Of the following, the MOST appropriate management is to
A. administer acyclovir intravenously
B. administer cephalexin orally
C. advise no therapy
D. apply mupirocin topically
E. apply nystatin topically
4- Question: 106-2003
You are asked to evaluate a healthy 8-year-old boy who has a rash of several weeks' duration. The physical examination reveals several erythematous plaques surmounted by a thick adherent scale. On the surface of some lesions, you observe pinpoint areas of hemorrhage. Areas of thick scale are observed in the scalp.
Of the following, the MOST likely diagnosis is
A. impetigo
B. nummular eczema
C. pityriasis rosea
D. psoriasis
E. tinea corporis
5-Question: 122-2003
A healthy 14-year-old boy complains of a mildly pruritic eruption of 2 weeks' duration. Findings on physical examination are limited to numerous erythematous, oval, thin plaques with central scale distributed symmetrically on the trunk. The long axes of lesions are parallel to lines of skin stress. The extremities, including the palms and soles, are spared.
Of the following, the MOST likely diagnosis is
A. nummular eczema
B. pityriasis rosea
C. secondary syphilis
D. tinea corporis
E. tinea versicolor
6-Question: 218-2003
An 18-month-old boy presents with a 2-month history of a recurring pruritic eruption. The parents report that each outbreak lasts 1 to 2 weeks. No one else in the home is similarly affected. Physical examination reveals clustered erythematous papules measuring 4 to 6 mm in diameter. Several papules have a central punctum.
Of the following, the MOST likely diagnosis is
A. atopic dermatitis
B. impetigo
C. molluscum contagiosum
D. papular urticaria
E. scabies
7-Question: 41-2003
A 10-year-old girl presents with fever, myalgias, and joint swelling of 4 weeks' duration. Physical examination reveals erythematous lesions on the palate. The white blood cell count is 3.5 x 10^3/mcL (3.5 x 10^9/L).*
Of the following, the MOST helpful laboratory finding to confirm the diagnosis is an elevated
* The ^ character denotes superscript
A. anti-double-stranded DNA titer
B. antistreptolysin titer
C. C3 complement titer
D. C-reactive protein concentration
E. proteinuria
8- Question: 101-2003
A 3-year-old boy presents with a 2-day history of pain in both knees and a rash. He has been afebrile. Physical examination reveals abdominal tenderness, decreased range of motion and mild edema of the knees, and a purpuric rash over the lower extremities.
Of the following, the MOST likely cause for these findings is
A. child abuse
B. Henoch-Schِnlein purpura
C. inflammatory bowel disease
D. juvenile rheumatoid arthritis
E. meningococcemia
9- Question: 19-2003
A 7-year-old girl presents with a 2-week history of daily fevers to 101°F (38.3°C). On physical examination, her oral temperature is 101.6°F (38.7°C), she has a faint erythematous rash on her trunk, and she is tachycardic. Other findings are normal. Her parents report that her appetite is poor, she has little energy, and she seems stiff when she initially awakens.
Of the following, the MOST likely diagnosis for this child's illness is
A. acute lymphocytic leukemia
B. cytomegalovirus infection
C. Epstein-Barr virus infection
D. juvenile rheumatoid arthritis
E. lupus erythematosus
10- Question: 42-2004
An 7-year-old girl presents for evaluation of a pruritic rash on the feet of 4 months' duration. Physical examination reveals erythema, minimal scaling, thickening of the skin, and hyperlinearity of the distal soles. The interdigital webs are normal.
Of the following, the MOST appropriate therapy is topical
A. aluminum chloride
B. calcipotriene
C. clindamycin
D. miconazole nitrate
E. triamcinolone
11- Question: 181-2004
A 16-year-old girl presents with a 1-week history of a lacy, reticular rash on her trunk and extremities and the acute onset of pain and swelling in both knees.
Of the following, the MOST likely pathogen is
A. adenovirus
B. enterovirus
C. hepatitis C
D. parvovirus B19
E. rubella virus
12- Question: 10-2004
You are asked to evaluate a 5-year-old boy for dry skin that has been present since infancy and has been resistant to treatment with emollients. The boy's father also has dry, scaly skin and allergic rhinitis. The physical examination demonstrates generally dry skin, with thin scales that have a "pasted-on" appearance on the extensor surfaces of the legs and buttocks.
Of the following, the MOST appropriate therapy is
A. ammonium lactate topically
B. cephalexin orally
C. isotretinoin orally
D. tacrolimus topically
E. triamcinolone topically
13- Question: 58-2004
A parent requests advice about routine skin care for her daughter, who has atopic dermatitis.
Of the following, the statement that you are MOST likely to include in your discussion is that
A. fragrances rarely precipitate pruritus
B. overheating may precipitate pruritus
C. soaps should not be used when bathing
D. the frequency of bathing has no impact on atopic dermatitis
E. wearing clothing made of synthetic fabrics is preferred
14- Question: 90-2004
A 4-year-old boy has a 2-day history of a rash that appeared on the third day of amoxicillin therapy for otitis media. Physical examination reveals an afebrile, well-appearing child. Concentrated on the distal extremities are erythematous macules and papules ranging from 0.5 to 1 cm in diameter. Some lesions have a central vesicle or appear dusky. There are two erosions on the buccal mucosa.
Of the following, the MOST likely diagnosis is
A. erythema multiforme minor
B. morbilliform amoxicillin eruption
C. Stevens-Johnson syndrome
D. toxic epidermal necrolysis
E. urticaria
15- Question: 122-2004
A 7-year-old girl presents for evaluation of fever and a rapidly spreading rash on the leg. Physical examination demonstrates an ill- appearing child who has a temperature of 102.2°F (39°C). On the right thigh is a well-demarcated 8 x 10 cm slightly elevated area of erythema and induration within which are several bullae. The area is tender to palpation.
Of the following, the MOST appropriate initial therapy is
A. cefadroxil orally
B. cefazolin intravenously
C. ceftazidime intravenously
D. ceftriaxone intravenously
E. cephalexin orally
16- Question: 138-2004
You diagnose tinea capitis in a 5-year-old African-American girl who has a scaling patch of alopecia within which are black dot hairs.
Of the following, the MOST appropriate initial therapy is
A. clotrimazole topically
B. fluconazole orally
C. griseofulvin orally
D. selenium sulfide topically
E. terbinafine orally
17- Question: 186-2004
A 9-month-old girl who has atopic dermatitis has a 2-day history of fever and blisters on the skin. Physical examination reveals a well-appearing infant who has a temperature of 101.1 ؛F (38.4 ؛C). There are areas of active atopic dermatitis on the trunk and extremities; within these areas are numerous, often grouped, 2- to 3-mm vesicles and crusted erosions.
Of the following, the MOST appropriate therapy is
A. acyclovir orally
B. cefazolin intravenously
C. hydroxyzine orally
D. prednisone orally
E. varicella-zoster immune globulin intramuscularly
18- Question: 234-2004
You are discussing contact dermatitis due to plants with a group of medical students.
Of the following, the statement that you are MOST likely to include in your discussion is that
A. desensitization is available and effective for patients who have recurrent plant contact dermatitis
B. it is safe to handle poison ivy plants during the winter months
C. patients who have severe or extensive disease should be treated for 3 days with prednisone
D. the rash of poison ivy may be spread by fluid from within vesicles
E. washing the skin after contact with poison ivy may lessen the severity of the eruption
20- Question: 248-2004
You are evaluating an infant who recently developed several brown spots on the skin. His mother reports that the lesions occasionally become red and swollen. On physical examination, you note multiple hyperpigmented macules on the trunk. Rubbing one of the macules causes it to become erythematous and elevated.
Of the following, the MOST likely diagnosis is
A. Langerhans cell histiocytosis
B. neurofibromatosis type 1
C. papular urticaria
D. postinflammatory hyperpigmentation
E. urticaria pigmentosa
21- Question: 5-2004
A 10-year-old girl of normal stature presents with a complaint of pain in her knees after cheerleading practice. There is no history of easy bruising or other skin abnormalities. Physical examination of her knees reveals hypermobility, but no articular swelling. Findings on the remainder of the examination are normal, except for multiple hyperextensible joints.
Of the following, the MOST appropriate next step in the management of this patient is
A. collagen analysis
B. echocardiography
C. measurement of plasma amino acids
D. measurement of rheumatoid factor
E. no further testing
22- Question: 120-2004
A 10-year-old boy presents for evaluation following his father's recent diagnosis of Marfan syndrome. The boy has been evaluated by a pediatric cardiologist, who diagnosed mild aortic root dilatation at the sinuses of valsalva. Results of an ophthalmologic examination are normal.
Of the following, the finding(s) that would allow a firm diagnosis of Marfan syndrome in this child is (are)
A. height greater than the 95th percentile
B. mitral valve prolapse
C. pectus excavatum requiring surgery
D. positive thumb and wrist signs
E. stretch marks without weight change
23- Question: 121-2004
An 8-year-old boy has been awakened three nights in the past month with lower leg pain. He describes the pain as deep in the calf muscle. There is no history of joint pain or joint swelling. During the daytime, he is active and has no complaints. Physical examination results are normal.
Of the following, the MOST appropriate next step is to
A. obtain a creatine kinase level
B. obtain an erythrocyte sedimentation rate
C. obtain an ionized serum calcium measurement
D. provide reassurance
E. recommend treatment with ibuprofen nightly
24- Question: 170-2004
A 12-year-old girl presents for evaluation of areas of skin thickening, tightness, and discoloration that developed 2 months ago. Physical examination reveals shiny, hypopigmented patches with brown borders that are located in a linear distribution on the right upper extremity. The affected skin is immobile, firm, and has a "bound-down" feeling.
Of the following, the MOST likely diagnosis is
A. lichen sclerosus et atrophicus
B. linear scleroderma
C. postinflammatory hypopigmentation
D. progressive systemic sclerosis
E. vitiligo
25- Question: 69-2003
A mother brings in her 4-month-old boy for evaluation of a bulge in the groin that increases in size with crying and straining and extends into the scrotum. You find no abnormalities on physical examination of the genitalia.
Of the following, the MOST likely diagnosis is
A. acute epididymitis
B. acute hydrocele
C. inguinal hernia
D. testicular torsion
E. torsion of the appendix testis
26- Question: 222-2004
A 3-year-old girl, whose brother has vesicoureteral reflux (VUR), has had voiding cystourethrography (VCUG) performed because of the occasional familial incidence of VUR. The study reveals no evidence of VUR, but it does document a narrowed urethra and normal urine stream after bladder filling.
You advise the child's parents that she needs
A. intravenous pyelography
B. no further therapy
C. prophylactic antibiotics
D. referral to urologist
E. repeat of the VCUG
27- Question: 208-2004
A 2-month-old infant presents with a mass in the diaper area that his mother noted yesterday. The child has been in no distress and continues to take his normal feedings every 4 hours. There has been no vomiting or diarrhea. Physical examination reveals a soft, fluctuant, nontender mass in the inguinal region that extends into the right scrotum. Testes are palpable bilaterally and are also nontender. A light source placed behind the scrotum transmits light through the scrotum without significant obstruction.
Of the following, the MOST likely cause of this mass is
A. hematoma
B. hydrocele
C. inguinal hernia
D. testicular torsion
E. tumor
28- Question: 218-2005
You are examining a 2-week-old male infant for the first time and note an undescended right testicle. His mother asks when is the optimal time to correct this problem.
The MOST appropriate time at which to recommend surgical repair for this infant if spontaneous descent has not occurred is
A. 6 months
B. 12 months
C. 24 months
D. 36 months
E. 48 months
29- Question: 191-2005
An 8-year-old girl is sent home from school for head lice infestation. The school district has a “no nit policy.” She recently was treated with topical pediculicides. No live lice were observed, but countless nits were visible 1 inch or greater from the scalp.
Of the following, the BEST intervention for this patient is
A. oral trimethoprim/sulfamethoxazole
B. scalp shaving for louse eradication
C. serial topical pediculicide application
D. thorough removal of nits
E. treatment of the entire family with a pediculicide
30- Question: 205-2005
A 5-month-old infant has red, moist skin erosions on the distal extremities, hands, feet, and perioral and perineal areas. The lesions appeared after weaning from breastfeeding to cow milk.
Of the following, these findings are MOST consistent with
A. congenital syphilis
B. impetiginized eczema
C. Langerhans cell histiocytosis
D. protein-calorie malnutrition
E. zinc deficiency
31- Question: 201-2005
An 11-year-old girl has experienced progressive muscle pain, weakness, and malaise accompanied by anorexia and low-grade fever during the past few weeks. She used to run from the bus stop to her home, but now she must stop and rest when walking. Findings on physical examination include erythematous plaques with a fine scale and red papules over her knuckles. Muscle enzyme levels are elevated.