DISkO Exam 2 Practice Q's

A 54-year-old man develops a pyogenic infection along the suture line after knee surgery. The laboratory gives a preliminary report of β-hemolytic, catalase- positive, coagulase-positive, gram-positive cocci. Which of the following is the most likely causative agent?

Staphylococcus aureus

A 57-year-old male presents to the hospital with unexplained bleeding and bruising. He states that he was recently discharged from the hospital with osteomyelitis and was placed on a 4 week course of antibiotics, which he recently finished taking. Which of the following medications is most likely responsible?

Linezolid

A 78-year-old female is re-hospitalized on post-operative day seven following a total knee replacement after she develops a wound infection at the operative site. She has a known allergy to cephalosporins. The site is debrided, and intravenous clindamycin therapy is begun. On day three of admission, the patient develops voluminous, foul-smelling diarrhea, fever, and abdominal pain. Which of the following is the most appropriate treatment to begin at this point?

Oral vancomycin

An 85-year-old female nursing home resident is brought to the emergency department with a fever, swollen leg, and a deep pressure sore on her heel. The contents of the wound are sent for culture and sensitivity, which reveals methicillin-resistant Staphylococcus aureus. Which of the following is most associated with the most appropriate antibiotic therapy?

Infusion-related flushing

A 25-year-old Peace Corps volunteer returns from Brazil with sudden high fever, severe myalgias, retro-orbital pain, and a diffuse rash. Two days later, he develops petechiae and hypotension. Which of the following is the most likely diagnosis?

Dengue fever

A 32-year-old pregnant woman recently returned from Honduras. She reports low-grade fever, conjunctivitis, arthralgia, and a pruritic rash. Ultrasound of her fetus shows microcephaly and intracranial calcifications. Which of the following infections is most likely?

Zika virus infection

A 40-year-old man develops abrupt onset of fever and severe, symmetric joint pain after traveling to the Caribbean. He reports that the joint pain is so disabling he cannot grip objects, although his rash and fever have resolved. Symptoms persist for weeks. Which virus is most likely responsible?

Chikungunya virus infection

A traveler from Ghana presents with fever, jaundice, and hematemesis (“black vomit”). Labs show elevated AST/ALT. Liver biopsy reveals apoptotic hepatocytes. Which of the following viruses is the most likely cause?

Yellow fever

A 28-year-old man develops low-grade fever, conjunctivitis, and rash after returning from Puerto Rico. His symptoms resolve in a few days. Several months later, his cousin who was pregnant at the same time is found to have delivered a baby with microcephaly and intracranial calcifications. Which virus most likely caused this illness?

Zika virus infection

A 20-year-old runner complains of painful nodules on the soles of her feet. On exam, firm keratotic papules with small black dots (thrombosed capillaries) are seen. What is the most likely diagnosis?

Plantar wart

A newborn develops vesicular skin lesions 5 days after birth, followed by seizures. The mother had a history of recurrent genital ulcers. Which virus is most likely responsible?

HSV-2

A 7-year-old presents with dome-shaped, pearly papules with central umbilication on the trunk. Which of the following is the causative virus?

Poxvirus

A 9-year-old boy develops a bright red rash on his cheeks followed by a lacy rash on his arms. Which of the following complications is most likely in a child with sickle cell anemia?

Aplastic crisis

A 6-year-old develops fever followed by a vesicular rash that begins on the trunk and spreads to the face and extremities. Lesions are in different stages (vesicles, pustules, crusts). Which virus is responsible?

VZV

A 5-year-old unvaccinated child presents with fever and a vesicular rash. All the lesions appear to be in the same stage of development and are concentrated on the face and extremities. Which diagnosis is most consistent?

Smallpox

A 3-year-old presents with fever, cough, coryza, and conjunctivitis. Oral exam reveals small white spots with bluish centers on the buccal mucosa. Which of the following is the most likely diagnosis?

Measles

A 15-year-old girl presents with numerous small, smooth, slightly raised, flesh-colored papules on her forehead and cheeks. The lesions have persisted for months but are not painful. Which is the most likely diagnosis?

Flat warts

A 24-year-old pregnant woman presents with a mild fever, posterior auricular lymphadenopathy, and a pink maculopapular rash spreading from her face downward. What is the most serious potential outcome of this infection?

Congenital rubella syndrome

A 68-year-old man presents with severe burning pain followed by a vesicular rash limited to the right thoracic dermatome. Which complication is most likely?

Post-herpetic neuralgia

A 42-year-old man from Nepal presents with multiple nodular skin lesions on his face and extremities. He reports progressive loss of sensation in both hands and muscle weakness. Physical exam reveals thickened peripheral nerves and diffuse skin infiltration giving him a leonine facial appearance. Skin biopsy demonstrates numerous acid-fast bacilli within macrophages. Which of the following immune responses best explains the pathogenesis of this patient’s disease?

Strong Th2 response with ineffective antibody production

A 21-year-old college student presents with hypopigmented patches on his chest and upper back. The lesions are mildly scaly and more noticeable after tanning. KOH prep of skin scrapings is shown in the image. Which of the following is the most likely etiologic agent?

Malassezia furfur

A 7-year-old boy is brought to clinic for scaly patches of hair loss on the scalp. Physical exam shows circular lesions with broken hairs and erythematous borders. KOH preparation of affected hairs reveals septate hyphae. Which of the following is the most likely diagnosis?

Tinea capitis

A 33-year-old landscaper presents with multiple ulcerating nodules along his right forearm. He recalls a puncture injury from a rose thorn several weeks earlier. The nodules started at the site of injury and progressed proximally in a linear distribution along lymphatic channels. Which of the following is the most likely cause of this patient’s infection?

Sporothrix schenckii

A 28-year-old farmer presents with a slowly progressive lesion on his foot. The lesion is verrucous, cauliflower-like, and associated with mild itching. Biopsy of lesion scrapings reveals thick-walled, pigmented fungal cells with both transverse and longitudinal septa. Which of the following conditions best matches this description?

Chromoblastomycosis caused by Fonsecaea spp.

A 32-year-old woman presents with pain and swelling around the fingernail of her right index finger. She works as a dishwasher at a local restaurant and reports that her finger has been chronically exposed to water and detergents. Physical examination shows erythema, tenderness, and swelling of the nail fold with a small amount of purulent drainage. KOH preparation of the drainage reveals cells shown in the image. Which of the following is the most likely diagnosis?

Paronychia caused by Candida albicans

A 34-year-old male presents to the emergency department with fever, intense headache, shaking chills, nausea, vomiting, and diarrhea. He also has a petechial rash that began on his wrists and ankles but has spread to the rest of his body, including his palms and soles. The patient indicates that he was hunting about 1 week before symptoms started. He does not recall being bitten by any insects. A photograph of his rash is obtained, as shown in the exhibit. Lab values are listed below.

Urinalysis reveals both elevated protein and red blood cells. The most likely etiology of the patient's condition is:

Rickettsia rickettsi

41-year-old male with a history of colon cancer presents with the following hyperpigmented macules on his oral mucosa. What gene is most likely affected?

STK11

A 28-year-old female with a history of a biopsy proven plexiform neurofibroma presents for her annual physical. Exam findings pictured. What other extracutaneous finding may be present?

Lisch nodules

Which of the following best describes a systemic bacterial infection that is caused by the release of the toxins edema factor (EF) and lethal factor (LF) that is encoded on the organism’s pXO1 plasmid?

Anthrax

Which of the following is the most definitive when it comes to diagnosing Lyme disease?

Erythema migrans

Which of the following is the causative agent of gas gangrene?

Clostridium perfringins

Which of the following represents the change that distinguishes methicillin-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA)?

The acquisition of the mecA locus

A 6-year-old boy presents with multiple skin papules on his legs. History reveals that the papules were noticed by his parents 2 months ago, which were small in size and not associated with any pain or discomfort. Physical examination reveals skin lesions shown in the attached image. The surface of the lesions appeared smooth, round, blanched and pinkish with a dimple in the middle, and they were soft in consistency and non-tender. A purulent substance is expressed from the center of one of the lesions. Which of the following are most likely to be found within the purulent material upon cytological examination?

Intracytoplasmic inclusions

A 48-year-old HIV positive male presents with a 3-day history of periodic sharp, burning pain in his left lower back that radiates to his flank and, sometimes, all the way around to his abdomen. He reports no recent back injury and has no history of back issues. He is sent back with a nonsteroidal anti-inflammatory drug for the pain, after his physical examination is normal. The next day, he returns with a rash development in the area where he had the pain. What is the most likely cause of his symptoms?

Shingles

A 4-year-old girl is brought to her pediatrician's office with high fever and a maculopapular rash on her forehead. Mother reveals that the child has been experiencing high fever, cough and conjunctivitis for the past 3 days with the rash appearing the previous night. Physical examination reveals a temperature of 102°F (38.9°C), flat red spots on the face and hairline and tiny white spots inside her mouth (please see attached image). The child is not up-to-date on her vaccines. Within the last week, the following relatives have visited her.

Her 85-year-old grandfather

Her 70-year-old grandmother

Her 18-year-old aunt

Her 35-year-old uncle

Her 6-month-old cousin

If all the relatives were up-to-date on their recommended vaccinations, which relative would have the highest risk of developing similar disease after coming into contact with the sick girl?

Cousin

A 3-year-old girl presents to the clinic with the complaint of a recurrent abscess on her buttock. The area has been indurated for 3 to 4 days, but the mother reports that purulent drainage began last night. On physical examination, the girl is afebrile and has an erythematous, indurated area on her right buttock of approximately 2 cm in diameter. With pressure, it drains purulent material. Of the following, in addition to incision and drainage and antibiotics, the best additional step is:

observation

An 8-week-old infant who was the product of an uneventful pregnancy and delivery is taken into your office for evaluation of a rash. Her mother reports that she had no infections during the pregnancy. The infant spent 5 days in the nursery for phototherapy. Since discharge, the infant has done well, but over the past day she has developed blisters in her diaper area. She has had no fever and continues to eat well. Physical examination shows a well-appearing infant who has several 1-cm bullae over the lower abdomen, buttocks, and round crusted erosions with a rim of scale. The MOST appropriate management for this infant is to:

initiate oral clindamycin after obtaining a culture of the fluid.

A 54-year-old male admitted to the hospital 7 days prior develops a fever with increased dyspnea and shortness of breath. A chest X-ray is obtained and is shown in the attached image. Blood cultures drawn 24 hours ago show preliminary gram-positive cocci. Which of the following medications should be avoided in this patient?

Daptomycin

A 57-year-old is admitted to the hospital due to a purulent infection on his left hand. Additionally, the patient has a mild fever, and an elevated WBC count. Past medical history is significant for allergies to sulfa drugs (rash) and tetracyclines (rash). After incision and drainage, the laboratory identifies the organism as MRSA. Given the limited oral options, susceptibility testing for clindamycin is performed. In the attached image, provided by the lab, clindamycin is on the right and erythromycin is on the left. The most likely mechanism of resistance involves:

methylation of the 50s ribosome binding site

A 16-year-old adolescent boy presents to the emergency department for evaluation of a painful skin lesion on his left lower extremity that has been progressing over the last 3 days. Three days ago, he scratched his left lower calf while climbing over a fence in the playground. The next day, he noticed some redness surrounding the scratch site, but he did not seek medical attention. Over the next 24 hours, he noted a marked increase in pain (9 out of 10) at the site. He also began to feel warm, had a decrease in appetite, and complained of diffuse achiness and malaise. He has been previously well and is not taking any medication. Vitals reveal T 39.2°C, HR 110 bpm, BP 120/76 mm Hg, and RR 22 rpm. Physical examination in the emergency department shows an illappearing adolescent. The left lower extremity has a 4 × 5 cm erythematous area surrounding a scratch mark with bluish discoloration. The area is exquisitely sensitive to touch. There is no swelling or discharge at the site. The remainder of the examination findings are unremarkable. The most likely cause of this lesion is infection with:

Group A Streptococcus

A fully immunized 11-year-old girl is seen in the office 2 days after stepping on a nail while playing in her yard. She was wearing tennis shoes at the time of the injury. The nail punctured her heel and produced mild bleeding. Her mother washed her foot well with soap and water and covered it with a clean bandage. Today, her heel appears red and swollen. She is having difficulty walking due to heel pain. An antibiotic with coverage for methicillin-resistant Staphylococcus aureus is prescribed, and follow-up is scheduled for tomorrow. Of the following, the best addition to this girl’s management is an administration of:

oral fluoroquinolone

An 8-year-old African American female presents with right lower extremity pain and fever. Her pain started 6 days ago and has progressively worsened. She denies trauma to the leg. Her past medical history is significant for 2 episodes of painful swelling of her fingers and toes 3 years ago. Her older brother has had several pain crises and suffered from a stroke at age 10 years. The patient’s vital signs are significant for a temperature of 38°C (100.4°F), heart rate of 120/min, respiratory rate of 28/min, and oxygen saturation of 96% on room air. Physical exam reveals an antalgic gait and tenderness to palpation over the right anterolateral distal lower extremity. A plain film radiograph is ordered of the right leg, as shown in the exhibit. This patient’s presentation is most likely caused by which of the following organisms?

Salmonella enteritidis

A 22-year-old woman visiting South America develops sudden high fever, debilitating headache, myalgia, and gastrointestinal upset. She also reports a diffuse rash and severe, symmetrical polyarthralgia that makes ambulation difficult. She recalls multiple mosquito bites, while sleeping outdoors 2 weeks earlier. On exam, her temperature is 40 °C, and she has a maculopapular rash with tender swollen joints. Laboratory studies show lymphopenia and thrombocytopenia. RT-PCR is positive for the causative agent. Which of the following is the most likely diagnosis?

Chikungunya virus infection

A 28-year-old man presents to the emergency department in Afghanistan with severe abdominal pain and bleeding from the nose and gums. His illness began 4 days ago with fever up to 40 °C, headache, myalgia, arthralgia, and vomiting. Two days prior to symptom onset, he had returned from his rural hometown, where he assisted his family in selling livestock and slept outdoors near the cattle. He has no prior medical history. Which of the following is the most likely mechanism by which this patient acquired his infection?

Bite of a Hyalomma tick

A 25-year-old man returns from a trip to the Brazilian rainforest. One week later, he develops fever, headache, and myalgia that improve with ibuprofen. The following day, however, he presents to the emergency department with jaundice, acute kidney injury, mucosal bleeding, and hematemesis. Which of the following viruses is the most likely cause of his illness?

Yellow fever virus

A 16-year-old high school football player presents with pruritic, peeling skin between his toes and on the dorsum of his left foot (see attached image). The toenails appear normal. KOH preparation of skin scrapings reveals branching fungal hyphae. Which of the following best describes this clinical condition?

Tinea pedis

A 28-year-old farmer presents with progressively enlarging papulonodular lesions on the sole of his right foot over the past several weeks (see attached image). He recalls no trauma, but reports frequently walking barefoot in fields. Which microscopic finding is most characteristic of the causative organism in this condition?

Muriform cells

A 51-year-old patient presents with 1 day of orange urine. Past medical history reveals Leprosy, for which they are currently being treated. A urinalysis reveals reddish-orange urine that is otherwise negative for abnormality. Physical exam is unremarkable. The doctor suspects this patient’s finding to be an adverse reaction to which most likely medication?

Rifampin

A 7-year-old female presents to the clinic for evaluation of photosensitivity and mild ataxia. Patient is at the 55th percentile for both weight and height. Physical exams reveal skin freckling over most areas of the skin exposed to the sun. Several hyperpigmented regions are also noted. Biopsy of two regions on the face are positive for basal cell carcinoma. Genetic testing reveals a mutation in a gene that codes for a protein with helicase activity. Mutation of which of the following genes is most likely in this patient?

XPB

The enzyme deficiency responsible for oculocutaneous albinism type 1 has its greatest effects on which of the steps shown in the attached figure?

C

A 7-year-old male of Nigerian descent is evaluated by a pediatrician for his first wellness check. The office collects photos of all new patients and the photo is shown in the included image. The most likely gene mutation in this child is in a gene that codes for:

P protein

A 12-month-old female is brought to the pediatrician's office by her parents with a complaint of failure to reach appropriate milestones. Physical exam reveals a child at the 10th percentile for height and weight and head size. Vision and hearing both appear to be affected. The parents describe extreme sensitivity to sun exposure with easy burning. MRI of the head suggests cerebral atrophy. Mutation in a gene involved in which of the following processes is most likely present?

Transcription-coupled repair

Which of the following is the most frequently diagnosed skin cancer?

Basal cell

Which melanoma type is most common in people of Asian or African descent?

Acral lentiginous

A 9-month-old female infant with “spots” on her skin is being evaluated as a new patient. A few spots were present at birth but they have increased in number since. The girl is an only child. Her mother is unaware of family members with similar spots. Physical examination findings are remarkable only for the lesions shown. Of the following, the BEST referral to make to further confirm the suspected diagnosis in management for this infant is:

Ophthalmology

A 7-year-old boy is being evaluated for “white spots” on his face that developed 6 weeks ago. He has no associated symptoms and has been in good health. The physical examination findings are notable only for the lesions shown in the attached image. Of the following, the most appropriate treatment is:

Emollient topically.

An otherwise healthy child visits your office for evaluation of hypopigmented areas on both knees that are nonpruritic, sharply demarcated, and non-scaly. The mother reports that his father has similar lesions. The family requests a skin biopsy to confirm the diagnosis. A skin biopsy on this child would MOST likely demonstrate:

absence of melanocytes

A 17-year-old adolescent is seen for a health supervision visit. She is planning a trip to Florida for spring break and was advised by a friend to start using a tanning bed weekly to prepare for the trip. She asks about the best way to decrease the likelihood that she will experience a sunburn in Florida. Of the following, the most appropriate advice is that she should:

apply a sunblock containing SPF-30 or higher before sun exposure

A 60-year-old white male presents with complaints of a diffuse erythematous pruritic rash over the majority of the body. On physical exam, there is diffuse lymphadenopathy and erythroderma involving more than 90% of the skin surface. Biopsy reveals the findings in the attached image. What is the most likely diagnosis?

Sezary Syndrome

A 55-year-old male presents with a slightly itchy rash on his anterior chest and abdomen (see attached image), which has persisted for the past two years. He does not have extensive involvement of other areas of the body, and does not have erythema. Which of the following is the most likely diagnosis?

A slowly progressing T-cell cutaneous lymphoma

A 45-year-old patient presents with a solitary nodule on their left shin. The nodule is pale pink and smooth. When pinched, there is dimpling of the skin around the lesion. Which of the following does this finding describe?

Fitzpatrick Sign

A 55-year-old male presents with numerous golden brown, stuck-on appearing lesions on his back that he can flake off. He notes that the number of lesions has increased dramatically in the past three months. Evaluation for which of the following malignancies is warranted based on this clinical scenario?

Adenocarcinoma of the colon

You are speaking with the mother of a newborn at 18 hours after birth. She is worried about the pustules on her son’s neck and upper chest. She has read about methicillin-resistant Staphylococcus aureus on the Internet and is concerned that he has this infection. Upon physical examination, the alert and active infant has multiple milky white pustules that are 2-mm in diameter on the neck and upper chest; there is no warmth or erythema around the lesions. In addition, there are several faint brownish macules, many of which have a rim of scale. Of the following, the most likely diagnosis is:

Transient neonatal pustular melanosis

A 3-day-old, full-term female newborn is brought to the office for a scheduled visit. The mother’s pregnancy, labor, and delivery were uncomplicated, and the infant was discharged from the hospital 24 hours after birth. Her parents report that she has been doing well, with normal feeding and stooling patterns. However, today they noticed a red “blotchy” rash on her body. The rash seems to come and go. On physical examination, you note an erythematous macular eruption with a few 1- to 2-mm papules and pustules, mostly on the face and trunk (see attached image). The examination is otherwise unremarkable. The most likely cytologic finding associated with this rash is:

eosinophils on Wright stain preparation

A 3-month-old female infant is seen for a bump on her upper eyelid. Her mother first noticed an area of redness on the eyelid 3 weeks ago, which has progressively become darker and is now raised and firm. The infant was born at term without complications, has been growing appropriately, and has no other systemic symptoms. She is alert and has normal tone and neurological examination findings. There is a red, well-demarcated, raised plaque on the upper eyelid, which is causing mild ptosis. Pupils are round, equal, and reactive to light with a normal red reflex. Extraocular movements are intact. Of the following, the MOST likely diagnosis is:

hemangioma

A 66-year-old male farmer presents with a skin lesion on his neck. The lesion has been present for several years but has recently thickened, enlarged, and ulcerated. Biopsy of the lesion reveals that the normal epidermis is replaced by epithelial cells with somewhat enlarged, hyperchromatic, irregular nuclei, intercellular bridges, occasional mitotic figures, and some individual apoptotic or hyperkeratinized cells. A photomicrograph of the representative area is obtained as shown in the exhibit. The precursor lesion was most likely:

Actinic keratosis

A 65-year-old male presents with a slowly growing, painless, pearly nodule on the face that has central ulceration and rolled borders. The lesion has telangiectatic vessels on the surface, and the patient reports no significant discomfort. A biopsy is performed, and histopathological examination reveals nests of cells with a peripheral palisading arrangement and retraction of the surrounding stroma. Which other histopathologic change would help clarify the definitive diagnosis in this case?

Tumor islands with a fibrotic stroma

Which of the following viruses is most likely associated with this condition?

Human herpes virus 8

A 32-year-old pregnant female presented with this tender papule that progressively grew during her third trimester. Ulceration was noted on physical exam. Biopsy demonstrated a lobulated vascular proliferation. What is the most likely diagnosis?

Pyogenic granuloma

What antibody is most likely associated with this condition?

Anti-Ro/SSA

A 50-year-old female presented with the following cutaneous findings. What condition should this patient be screened for?

Ovarian cancer

A 16-year-old male with a history of seizures presents with the following asymptomatic facial papules. What gene is associated with this condition?

TSC2

A 75-year-old male presents with abrupt onset of these brown “stuck-on” hyperkeratotic papules on his back. Review of systems was positive, unintentional weight loss of 20 pounds within the past 2 months. The patient should be screened for which type of malignancy?

Gastric adenocarcinoma

An 83-year-old patient is seen during clinic for follow up of several skin lesions over her back and neck that are very itchy and scaly. She is being treated with topical aminolevulinic acid. Her daughter accompanying her wants to know what she is being treated for. Given her current treatment regimen, the doctor knows she is being treated for:

Actinic Keratosis

A 5-year-old boy has a history of eczema since infancy. He has been treated with daily emollients and intermittent topical corticosteroids with good response. He is now in kindergarten, and he is brought to you by his parents for evaluation of honeycolored crusted lesions in the antecubital skin regions bilaterally with similar lesions in the popliteal fossae. He has had no fever. You are concerned that his skin lesions are infected. Which of the following pathogens is the most likely cause of the skin infection in this patient?

Staphylococcus aureus

A child presents to a clinic associated with a disaster relief shelter after a hurricane destroys the community. The mother states that they have run out of the creams prescribed for her daughter’s eczema before the storm, and the child is itchy. She is concerned because there are some blisters and crusting in the antecubital fossae and popliteal fossa where the itching is worst. Physical examination reveals erosions and erythema surrounding areas of lichenification, with a few vesicles both in clusters and scattered. Of the following, the MOST likely pathogen involved in this pattern of infection is:

Herpes simplex virus

A 6-year-old girl is brought to your office with an itchy rash. The rash started on her right upper arm 2 days ago and spread to her right lower leg this morning. She was playing outside in the park several days ago. She has had no fevers and has otherwise been well. On examination, your patient has several linear streaks of vesicles on her right arm and right lower leg. Of the following, you are most likely to tell her parents that:

Topical steroids are sufficient treatment

A 15-year-old adolescent boy is being evaluated for light spots on his face, which appeared several weeks ago. The areas are itchy at times and flaky. He also reports flaking of his scalp. The patient is well in other respects and has an unremarkable medical history. The physical examination findings are normal except for the alar creases, which reveal mild erythema, hypopigmentation, and scaling. Of the following, the most likely diagnosis is:

Seborrheic dermatitis

Which of the following is the active phase of hair growth?

Anagen

What physical sign indicates the obliteration of a diamond shaped window on the dorsal aspect of fingers, which can be present in Sarcoid?

Shamroth

A 27-year-old male with a recent history of strep throat, successfully treated with antibiotics, presents with a 3-week onset of a mildly pruritic scaly rash. He admits some moderate joint pain of his hands with associated stiffness and swelling. He denied any history of tuberculosis or hepatitis. Physical exam demonstrated erythematous scaly papules and plaques distributed on his trunk and extremities involving 25% of his body surface area. No mucosal involvement was noted. What medication would be indicated for his condition?

Adalimumab

A 9-year-old female presented to the dermatologist with a rapidly progressive rash on her trunk. Her mother stated it started off as a solitary rash, but became confluent on her chest and back. Her hands and feet were not involved. History was significant for mild upper respiratory symptoms 2 weeks prior. Throat culture was negative. What is the most likely etiologic association?

Human herpes virus 7

A 55-year-old male with a history of Hashimoto thyroiditis presented with painful oral erosions followed by subsequent development of non-pruritic bullae on this trunk and extremities. Nikolsky sign was positive. What antibody is implicated in this disease process?

Anti-desmoglein

A 32-year-old male with a history of G6PD deficiency presented with multiple pruritic vesicles and papules on his buttocks and extensor extremities. He used over the counter hydrocortisone with no relief. Biopsy revealed a subepidermal vesicle with a dense neutrophilic infiltrate. What would be the first line treatment?

Gluten-free diet

A 17-year-old male presented to clinic with the following presentation for the past 6 months. He admits intermittent fevers and muscle aches. Recent labs demonstrated an elevated ESR and leukocytosis. He is currently using a salicylic acid face wash. Which medication would be initially indicated for his condition?

Prednisone

A 25-year-old female presents for treatment of her acne. Exam is remarkable for multiple comedonal papules, pustules, and residual post-inflammatory hyperpigmentation. She is currently 16-week pregnant. Which of the following medications would be the most appropriate for this patient as monotherapy?

Azelaic acid

A 4-year-old child presents to the ED with burns on his left arm after exposure to scalding water. The affected area is erythematous, weeping and blistered in several places (see attached image). The area is extremely sensitive to the touch. It blanches easily with pressure. What is the most likely classification of the depth of this injury?

Superficial partial thickness

A 55-year-old female presents for complaints of slow wound healing. She underwent an exploratory laparotomy through a midline vertical incision for a gunshot wound 3 months ago. Her immediate and early postoperative care was uncomplicated. At this visit, she is noted to have incomplete closure of the wound, which still exhibits red granulation tissue. Deficiency of which of the following nutrients is most likely responsible for this clinical presentation?

Zinc

A 38-year-old obese female with 20-pack-year history of smoking, presents with recurrent, painful lumps in the axillary and inguinal regions that occasionally drain a foul-smelling fluid. She reports significant scarring and sinus tract formation at the affected sites. Physical exam reveals deep tender nodules with purulent drainage, and several sinus tracts with scarring. Which of the following medical conditions is most commonly associated with her symptoms?

Ulcerative colitis

A 42-year-old patient presents with progressive muscle weakness. Examination reveals frontal balding, and the medical history is significant for cardiac arrhythmias and bilateral cataracts. Genetic testing identifies an expanded tract of approximately 180 CTG repeats in the DMPK gene. Which of the following disorders is the most likely diagnosis?

Myotonic dystrophy type 1

A 25-year-old male presents to the emergency department with complaints of muscle weakness, severe fatigue, and dark-colored urine following a weight training challenge at the school gym. He reports that he recently started an intense workout regimen, but has experienced similar symptoms during physical activity in the past, although milder. His past medical history is unremarkable. Physical examination shows severe proximal muscle tenderness with significant weakness during the exercise bout. Laboratory findings are significant for elevated creatine kinase (CK) and myoglobinuria, but renal function is normal. Further testing reveals normal levels of fatty acyl-Carnitines in blood. This suggests the patient's symptoms may be attributable to a genetic defect in which of the following proteins?

Muscle glycogen phosphorylase

A 38-year-old woman presents with progressive proximal muscle weakness, cataracts noted at age 35, and occasional myotonia (delayed hand relaxation after gripping). She reports that several relatives developed similar symptoms in mid-adulthood, but none experienced the early childhood hypotonia or cognitive impairment often associated with other myotonic dystrophies. Genetic analysis shows a CCTG tetranucleotide repeat expansion in intron 1 of the CNBP (ZNF9) gene on chromosome 3. The patient’s allele contains ~7,000 repeats (normal: <30), confirming a repeat-expansion disorder. Which of the following is the most likely diagnosis?

Mytonic Dystrophy 2 (DM2)

A newborn undergoes genetic screening because both parents have facioscapulohumeral muscular dystrophy (FSHD). Molecular analysis of chromosome 4 reveals the following: D4Z4 repeat contraction: 5 units (normal >10) Allele configuration: 4qB/4qB (homozygous 4qB) No other genetic abnormalities are found. The ordering physician asks whether the infant is at risk of developing FSHD. Which of the following is the most appropriate interpretation of this genetic report?

The infant will likely not develop FSHD1 or FSHD2