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DNPCB Dermatology Certified Nurse Practitioner
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Question: 1
A 35-year-old woman presents with a sudden onset of painful, grouped vesicles on an erythematous base, affecting the left side of her face. She also reports a prodromal phase of burning and tingling sensation in the same area. What is the most likely diagnosis?
erpes simplex virus infection mpetigo
rysipelas wer: A
anation: The patient's clinical presentation is consistent with herpes z gles), a viral infection caused by the reactivation of the varicella-zost Herpes zoster typically presents as painful, grouped vesicles on an ematous base, following a dermatomal distribution. The prodromal p urning and tingling sensation is characteristic of herpes zoster. Herpes lex virus infection typically presents as grouped vesicles on an ematous base, but it is not typically dermatomal. Impetigo presents w y-colored crusts and vesicles, commonly affecting the face. Erysipela erial infection characterized by well-demarcated, raised, erythematous ues with a shiny appearance.
stion: 2
Herpes zoster (shingles)
H
I
E
Ans
Expl oster
(shin er
virus.
eryth hase
of b simp
eryth ith
hone s is a
bact plaq
Que
A 35-year-old female presents with a pruritic rash on her hands. She works as a hairdresser and has been exposed to various chemicals and frequent wet work. On examination, you observe erythematous, scaly, and fissured patches on the dorsal surfaces of her hands and fingers. There are no vesicles or bullae. Which of the following conditions is most likely to be associated with this presentation?
1. Allergic contact dermatitis
2. Dyshidrotic eczema
3. Irritant contact dermatitis
anation: The presentation described is consistent with irritant contact atitis. Irritant contact dermatitis occurs as a result of repeated exposur ting substances, such as chemicals or frequent wet work. It is characte ythematous, scaly, and fissured patches on the affected areas. Allergi act dermatitis, on the other hand, is a delayed hypersensitivity reaction fic allergen and often presents with vesicles or bullae. Dyshidrotic ec ally presents with vesicles or bullae on the palms, soles, or lateral asp
fingers. Tinea manuum, or fungal infection of the hand, may present ematous, scaly patches, but it is less likely in the absence of vesicles o e and a history of exposure to potential fungal sources.
stion: 3
-year-old female presents with erythematous, scaly plaques on her sc nd her ears, and in her retroauricular regions. She complains of itching sional hair loss. On examination, you observe silvery-white scales an ive Auspitz sign. Which of the following is the most likely diagnosis?
Tinea manuum Answer: C
Expl
derm e to
irrita rized
by er c
cont to a
speci zema
typic ects
of the with
eryth r
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Que
A 30 alp,
behi and
occa d a
posit
1. Psoriasis
2. Seborrheic dermatitis
3. Tinea capitis
4. Contact dermatitis Answer: A
al infection of the scalp, may present with scaling and hair loss, but it ikely to have the characteristic silvery-white scales seen in psoriasis. act dermatitis typically occurs in areas of exposure to allergens or irrit ay present with erythema, edema, and vesicles.
stion: 4
-year-old male patient presents with a pruritic rash on his elbows, kne calp. On examination, you observe well-demarcated, erythematous ues with silvery scales. The patient reports that his father also has a si
ondition. What is the most likely diagnosis?
soriasis
topic dermatitis tyriasis rosea inea corporis
wer: A
Explanation: The clinical presentation described is consistent with psoriasis of the scalp. Psoriasis is a chronic inflammatory skin condition characterized by well-demarcated erythematous plaques with silvery scales. Scalp involvement is common and often extends to the retroauricular regions. The presence of silvery-white scales and a positive Auspitz sign (bleeding after removal of scales) are classic features of psoriasis. Seborrheic dermatitis may also involve the scalp but typically presents with greasy, yellowish scales and may involve other seborrheic areas, such as the face and central chest. Tinea capitis, or fung is
less l
Cont ants
and m
Que
A 25 es,
and s
plaq milar
skin c
1. P
2. A
3. Pi
4. T
Ans
Explanation: The clinical presentation described is consistent with psoriasis, a chronic autoimmune skin condition. Psoriasis commonly presents as well- demarcated, erythematous plaques with silver-white scales. It typically affects the extensor surfaces of the elbows and knees, as well as the scalp. Psoriasis has a genetic component and can run in families. Atopic dermatitis (eczema) typically presents with pruritic, erythematous patches and papules in flexural
areas. Pityriasis rosea presents with oval-shaped, erythematous plaques with a collarette of scale, often following a "herald patch." Tinea corporis (ringworm) presents with circular, erythematous patches with raised borders and central clearing.
Question: 5
mination, you observe erythematous papules, vesicles, and scaling invo ateral aspects of her fingers and the web spaces. She works as a nurse uently washes her hands. Which of the following is the most likely nosis?
llergic contact dermatitis yshidrotic eczema
ritant contact dermatitis cabies infestation
wer: B
anation: The clinical presentation described is consistent with dyshidr ma, also known as pompholyx. Dyshidrotic eczema is a type of eczem atitis characterized by pruritic, erythematous papules, vesicles, and sc e lateral aspects of the fingers and in the web spaces. It iscommonly ciated with frequent hand washing and exposure to irritants. Allergic act dermatitis may present with a similar appearance but is usually
A 35-year-old female presents with a pruritic rash on her hands and fingers. On exa lving
the l and
freq diag
1. A
2. D
3. Ir
4. S
Ans
Expl otic
ecze atous
derm aling
on th asso cont
localized to the areas of contact with the allergen. Irritant contact dermatitis can also present with similar findings but is typically more diffuse and involves areas exposed to irritants. Scabies infestation usually presents with burrows, papules, and excoriations in interdigital spaces, wrists, and other areas where mites burrow.
yoderma gangrenosum rterial insufficiency ulcer iabetic foot ulcer
enous stasis ulcer wer: D
anation: The clinical presentation described is highly suggestive of a us stasis ulcer. Venous stasis ulcers typically occur in the lower leg, cularly around the medial or lateral malleolus, in patients with chronic us insufficiency. They have a punched-out appearance with undermin
and a necrotic base. The surrounding skin may exhibit signs of veno ficiency, such as edema, hyperpigmentation, and venous stasis dermat erma gangrenosum is a rare ulcerative condition characterized by pai
ulcers with undermined violaceous edges. Arterial insufficiency ulcers are lly located on the lower extremities and are associated with peripheral disease. Diabetic foot ulcers are common in patients with diabetes a
occur at pressure points on the foot.
A 65-year-old male presents with a non-healing ulcer on his lower leg. The ulcer has a punched-out appearance with undermined edges and a necrotic base. The surrounding skin shows signs of chronic venous insufficiency, including edema, hyperpigmentation, and venous stasis dermatitis. Which of the following is the most likely diagnosis?
P
A
D
V
Ans Expl
veno parti
veno ed
edges us
insuf itis.
Pyod nful
usua
artery nd
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Question: 7
A 40-year-old man presents with multiple hyperpigmented macules on his face. He reports that the lesions have been present since childhood and have remained stable in size and shape. On examination, you observe well- demarcated, light-brown macules distributed symmetrically on the cheeks,
1. Lentigines
2. Melasma
3. Cafe-au-lait macules
anation: The clinical presentation described is consistent with lentigin h are benign, well-demarcated, light-brown macules that commonly a un-exposed areas. Lentigines usually emerge during childhood or earl hood and remain stable in size and shape. Melasma presents as rpigmented patches on the face, often associated with sun exposure an monal changes. Cafe-au-lait macules are light-brown macules that may ent at birth or develop in childhood, but they are typically larger and h ular borders. Post-inflammatory hyperpigmentation occurs following mmation or injury to the skin, resulting in localized areas of increased
entation.
stion: 8
-year-old man presents with a solitary, pigmented lesion on his back. mination, you observe a macule with an irregular border, variegated co symmetric shape. The lesion measures 8 mm in diameter. What is the
appropriate initial management?
Post-inflammatory hyperpigmentation Answer: A
Expl es,
whic ppear
on s y
adult
hype d
hor be
pres ave
irreg infla pigm
Que
A 65 On
exa lors,
and a most
1. Excisional biopsy
2. Shave biopsy
3. Observation with serial monitoring
4. Cryotherapy
stion: 9
-year-old woman presents with an intensely pruritic rash on her wrists es. On examination, you observe linear burrows, vesicles, and excoriat ese areas. What is the most likely diagnosis?
cabies
ontact dermatitis rythema multiforme emphigus vulgaris
wer: A
anation: The clinical presentation described is consistent with scabies, sitic infestation caused by the Sarcoptes scabiei mite. Scabies presents sely pruritic linear burrows, vesicles, and excoriations, commonly
ting the wrists, hands, and interdigital spaces. Contact dermatitis may
Explanation: The clinical presentation described raises concern for melanoma, a potentially aggressive form of skin cancer. The most appropriate initial management for a suspicious pigmented lesion is excisional biopsy, which involves complete removal of the lesion for histopathological evaluation. Shave biopsy or observation with serial monitoring are not recommended as initial management for suspected melanoma. Cryotherapy is typically used for benign lesions or superficial non-melanoma skin cancers.
Que
A 50 and
ankl ions
in th
1. S
2. C
3. E
4. P
Ans
Expl a
para with
inten affec
present with a rash in exposed areas, but it does not typically have the characteristic burrows seen in scabies. Erythema multiforme presents with target-like lesions with central dusky erythema and surrounding rings. Pemphigus vulgaris is an autoimmune blistering disorder characterized by flaccid bullae and erosions on the skin and mucous membranes.
cne vulgaris osacea
eborrheic dermatitis erioral dermatitis
wer: B
anation: Rosacea is a chronic inflammatory skin condition that primar ts the central face. The clinical presentation typically includes erythe les, pustules, and telangiectasias. In contrast to acne vulgaris, rosacea nvolve the nasolabial folds or periocular area. Seborrheic dermatitis ally presents with erythematous plaques with greasy scales, commonl ting the scalp, face, and central chest. Perioral dermatitis is characteri ythematous papules and pustules around the mouth, sparing the vermi er.
Mary Anderson, a 45-year-old woman, presents to your clinic with a complaint of a rash on her face. She reports that the rash started a few weeks ago and has been progressively worsening. On examination, you note erythematous papules and pustules, along with comedones, primarily affecting the central face, including the forehead, nose, and cheeks. There is no involvement of the nasolabial folds or periocular area. Based on the clinical presentation, what is the most likely diagnosis?
1. A
2. R
3. S
4. P
Ans
Expl ily
affec ma,
papu does
not i
typic y
affec zed
by er llion
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Question: 11
A 30-year-old male patient presents to your clinic with a pruritic rash on his hands. He works as a florist and frequently handles flowers and plants. On examination, you observe erythematous, vesicular lesions on the dorsal aspects of his hands and fingers. The lesions are arranged in a linear pattern. Which of the following is the most likely diagnosis?
1. Contact dermatitis
2. Scabies
3. Dyshidrotic eczema
anation: The patient's occupation as a florist and the presence of a pru n the hands suggest contact dermatitis, which is an inflammatory ski ition caused by exposure to irritants or allergens. The linear arrangem vesicular lesions is consistent with a contact allergen. Scabies prese urrows, papules, and vesicles in interdigital spaces, wrists, axillae, a
Dyshidrotic eczema typically presents with pruritic vesicles on the s, lateral fingers, and soles. Herpes simplex virus infection commonly ents as grouped vesicles on an erythematous base, typically affecting t ocutaneous junctions.
stion: 12
-year-old male presents with a pruritic rash on the extensor surfaces o ws and knees. The rash consists of well-demarcated erythematous pla
ilvery scales. On examination, you also notice pitting and ridging of Which of the following conditions is most likely to be associated wit resentation?
Herpes simplex virus infection Answer: A
Expl ritic
rash o n
cond ent
of the nts
with b nd
groin. palm
pres he
muc
Que
A 45 f his
elbo ques
with s his
nails. h
this p
1. Psoriasis
2. Atopic dermatitis
3. Contact dermatitis
4. Seborrheic dermatitis Answer: A
itant. Seborrheic dermatitis typically affects areas with high sebaceou activity, such as the scalp, face, and central chest, and is characteriz ematous plaques with greasy scales.
stion: 13
-year-old male presents with a non-healing ulcer on his lower leg. Th is irregularly shaped with a necrotic base and surrounding erythema. rts a history of peripheral artery disease and intermittent claudication. ch of the following is the most likely underlying cause of this ulcer?
enous stasis ulcer
rterial insufficiency ulcer iabetic foot ulcer
ressure ulcer wer: B
Explanation: The presentation described is classic for psoriasis. Psoriasis is a chronic inflammatory skin condition characterized by well-demarcated erythematous plaques with silvery scales. The extensor surfaces of the elbows and knees are commonly affected. Nail involvement, characterized by pitting and ridging, is also common in psoriasis. Atopic dermatitis is characterized by pruritic, erythematous, and scaly patches, typically seen in flexural areas. Contact dermatitis presents as a localized rash in response to a specific allergen or irr s
gland ed by
eryth
Que
A 55 e
ulcer He
repo Whi
1. V
2. A
3. D
4. P
Ans
Explanation: The clinical presentation described is consistent with an arterial insufficiency ulcer. Arterial insufficiency ulcers typically occur in patients with peripheral artery disease and are often located on the lower extremities, especially the lower leg and foot. These ulcers are irregularly shaped, have a necrotic base, and are associated with surrounding erythema. Patients may also report symptoms of peripheral artery disease, such as intermittent claudication. Venous stasis ulcers, on the other hand, are typically located around the medial
or lateral malleolus and are associated with edema and hemosiderin deposition. Diabetic foot ulcers are common in patients with diabetes and are often located on pressure points of the foot. Pressure ulcers result from prolonged pressure on bony prominences and are commonly seen in immobile or bedridden patients.
Question: 14
le on her nose. On examination, you observe a translucent, pearly pap rominent telangiectasias. There is a central depression and rolled, rai
ers. What is the most likely diagnosis?
asal cell carcinoma quamous cell carcinoma elanoma
eborrheic keratosis wer: A
anation: The clinical presentation described is highly suggestive of ba arcinoma (BCC), the most common type of skin cancer. BCC typical ents as a pearly papule or nodule with telangiectasias. It often has a ce ession and rolled, raised borders. Squamous cell carcinoma (SCC) ma ent as a scaly, erythematous plaque or a rapidly growing, tender nodul noma is characterized by an asymmetric mole with irregular borders, tion, and a diameter larger than 6 mm. Seborrheic keratosis are benig
A 55-year-old woman presents with a gradually enlarging, painless, pinkish nodu ule
with p sed
bord
1. B
2. S
3. M
4. S
Ans
Expl sal
cell c ly
pres ntral
depr y
pres e.
Mela color
varia n
lesions that present as sharply demarcated, waxy, stuck-on plaques with a "stuck-on" appearance.
Question: 15
A 28-year-old female presents with a facial rash consisting of papules, pustules, and comedones. She reports a worsening of symptoms in response to sunlight
exposure. On examination, you note erythematous papules and pustules on her cheeks and nose, with some areas of comedonal acne. She does not have a history of flushing or telangiectasias. Which of the following is the most likely diagnosis?
1. Acne vulgaris
2. Acne rosacea
erioral dermatitis wer: B
anation: The presentation described is consistent with acne rosacea. A cea is a chronic inflammatory skin condition that primarily affects the al face, including the cheeks, nose, chin, and forehead. It is characteri ythematous papules, pustules,and sometimes comedones. Unlike acne aris, acne rosacea is typically not associated with significant involvem trunk or back. One distinguishing feature is the worsening of sympt sponse to sunlight exposure. Flushing and telangiectasias may also be
ent in rosacea, but they are not mentioned in the question stem. Acne aris, on the other hand, typically presents with comedones, papules, an ules on the face, chest, and back. Seborrheic dermatitis commonly affe
reas of the skin, such as the scalp, face, and central chest, and is acterized by erythematous plaques with greasy scales. Perioral dermati ents as erythematous papules and pustules around the mouth, sparing t illion border.
Seborrheic dermatitis
3. P
Ans
Expl cne
rosa
centr zed
by er
vulg ent
of the oms
in re pres
vulg d
pust cts
oily a
char tis
pres he
verm
Question: 16
A 55-year-old male presents with a new growth on his nose. On examination, you observe a pearly, translucent papule with telangiectasias and a rolled, elevated border. There is no pain or bleeding associated with the lesion. Which
of the following is the most likely diagnosis?
1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Malignant melanoma
anation: The clinical presentation described is consistent with basal ce noma (BCC). BCC is the most common type of skin cancer and often rs in sun-exposed areas, such as the face. It typically presents as a pea lucent papule with telangiectasias (tiny blood vessels) and a rolled, ated border. BCC is usually painless and does not bleed easily. Squam arcinoma may also occur on the nose but is more commonly associat
a crusted, scaly plaque or nodule. Malignant melanoma often presents ymmetric, pigmented lesion with irregular borders. Actinic keratosis i ancerous lesion that appears as a rough, scaly patch and is not typicall y or translucent.
Actinic keratosis Answer: A
Expl ll
carci
occu rly,
trans
elev ous
cell c ed
with as
an as s a
prec y
pearl

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