Dermatology Quiz

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July 14,
2015

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Put your knowledge of skin pathology to the test with this dermatology quiz. Check out our
guide to taking a dermatological history here.

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Dermatology quiz
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Question 1

An elderly lady presents to her doctor with a raised, round discoloured plaque, ‘stuck on
appearance’ on her face. What skin condition is this?

A Rubella

1/10
 B Seborrheic
keratosis

C Basal cell carcinoma

D Melasma

Question 1 Explanation:
Seborrheic keratosis is a benign squamous proliferation and is seen frequently in the
elderly.

Question 2

What disorder is characterised by an initial ‘herald patch’ which is then followed by scaly
erythematous plaques usually in a ‘Christmas tree’ distribution?

A Pityriasis rosea

B Herpes

C Varicella zoster virus

D Erysipelas

Question 2 Explanation:
Pityriasis rosea classically presents with a salmon coloured solitary patch ‘herald patch’
which enlarges over a few days followed by generalised bilateral and symmetric macules
with collarette scale. Pruritus is sometimes present. It self resolves within 6 – 8 weeks.

Question 3

Do people with albinism have an increased risk of skin cancer?

A True

B False

Question 3 Explanation:
Albinism is the congenital lack of pigmentation. Melanin is protective against UVB, thus
persons afflicted with the disorder would be more susceptible to UVB induced DNA damage,
increasing the risk of basal cell carcinoma, squamous cell carcinoma and melanoma.
2/10
 Question 4

What condition is associated with acanthosis nigricans?

A Type 2 diabetes and gastric adenocarcinoma

B Rubella

C Varicella zoster

D Basal cell carcinoma

Question 4 Explanation:
Acanthosis nigricans is epidermal hyperplasia with darkening of the skin, especially in the
axilla, neck or groin. It is associated with malignancy especially GIT adenocarcinoma or
insulin resistance as seen in type 2 diabetes and metabolic syndrome.

Question 5

What is the best indicator of prognosis for a melanoma?

A Asymmetry

B Colour

C Diameter

D Invasion of the
dermis

Question 5 Explanation:
Invasion/ depth of extension measured by Breslow thickness is the most significant
prognostic factor in predicting metastasis. Asymmetry, border irregularity, colour variation
and diameter (>6mm) are known as the ‘ABCD’ criteria for describing melanomas.

Question 6

What skin condition is caused by poxvirus?

A Verruca

3/10
 B Molluscum
contagiosum

C Impetigo

D Cellulitis

Question 6 Explanation:
Molluscum contagiosum is an umbilicated papule. It is commonly seen in children and
sexually transmitted in adults.

Question 7

What is the pathogenesis of vitiligo?

A Congenital lack of pigmentation

B Increase in the number of melanosomes

C Autoimmune destruction of melanocytes

D Benign proliferation of melanocytes

Question 7 Explanation:
Vitiligo is the localised loss of skin pigmentation due to the autoimmune destruction of
melanocytes. Melanocytes synthesise melanin in melanosomes. Thus, if melanocytes are
destroyed, melanin cannot be produced.

Question 8

What is the pathogenesis of pemphigus vulgaris?

A IgG antibody against desmoglein

B IgG antibody against hemidesmosome components

C Autoimmune deposition of IgA at tips of dermal

D Enzyme defect in tyrosinase

4/10
Question 8 Explanation:
Desmosomes are located in the stratum spinosum between keratinocytes. Antibodies
against the desmoglein component result in painful flaccid bullae or blisters that rupture
easily on both skin and oral mucosa. It is treated with corticosteroids.

Question 9

What are the histological findings of psoriasis?

A Inflammation of the dermal-epidermal junction

B Peripheral palisading of basal cells

C Acanthosis, Parakeratosis and Munro

D Keratin pseudocysts

Question 9 Explanation:
Psoriasis is as a result of increased keratinocyte proliferation. It presents as salmon
coloured papules and plaques with silvery scaling, especially on extensor surfaces and scalp.
On histology, there is epidermal hyperplasia (acanthosis), hyperkeratosis with retention of
nuclei in stratum corneum (parakeratosis) and groups of neutrophils in the stratum
corneum (Munro microabscesses).

Question 10

What is the infective agent implicated in acne?

A Staphylococcus aureus

B Streptococcus pyogenes

C Staphylococcus epidermidis

D Propionibacterium acnes

Question 10 Explanation:
Propionibacterium acnes infection produces lipases resulting in inflammation and
breakdown of sebum, leading to pustule formation.

Question 11
5/10
What childhood infection is associated with Koplik spots?

A Measles

B Rubella

C Varicella

D Fifth disease

Question 11 Explanation:
Measles is a paramyxovirus. Koplik spots are small bright red spots with a white centre on
the buccal mucosa that precede the measles rash by 1-2 days and are pathognomonic for
measles. Measles present initially with cough, coryza and conjunctivitis then the Koplik
spots. Eventually a maculopapular rash develops, beginning at the head/neck and spreading
downwards.

Question 12

What is the most common mole found in adults?

A Junctional nevus

B Compound nevus

C Intradermal nevus

D Congenital nevus

Question 12 Explanation:
A mole/nevus is a benign neoplasm of melanocytes. It can be congenital or acquired. If
acquired, it progresses from a junctional nevus (most common in children) to a compound
nevus and eventually to an intradermal nevus. Note that the mole can undergo dysplasia
and the dysplastic nevus is a precursor to melanoma.

Question 13

What condition is associated with this presentation? – A pink pearly nodule with
telangiectasias, ulceration and rolled borders on the upper lip.

6/10
 A Squamous cell carcinoma

B Basal cell carcinoma

C Melanoma

D Eczema

Question 13 Explanation:
This is a classical presentation of basal cell carcinoma, a malignant proliferation of basal
cells and the most common skin cancer. Risk factors include excessive sunlight exposure,
xeroderma pigmentosum and albinism. Treatment is surgical excision.

Question 14

How does lichen planus present clinically?

A Salmon coloured plaques with silvery scale

B Pruritic, red, oozing rash with edema

C Golden coloured crusts

D Pruritic, purple, polygonal, planar papules and plaques

Question 14 Explanation:
Learn the 6 P’s of lichen planus. It also often occurs with reticular white lines on the mucosal
surfaces (Wickham striae). There is an association with hepatitis C.

Question 15

How does impetigo present?

A Golden honey coloured crust over an erythematous

B Salmon coloured plaque with silvery scale

C Comedones, pustules and nodules

D Flesh coloured papule with a rough surface

7/10
Question 15 Explanation:
Impetigo is a superficial skin infection caused by Staph aureus or Strep pyogenes. It
frequently affects children. It is treated with penicillin and topical preparations e.g.
mupirocin.

Question 16

What is Leser-Trélat sign?

A Sudden appearance of multiple seborrheic keratosis and is an indicator of a

B A left supraclavicular node associated with gastric carcinoma

C Metastasis of gastric carcinoma to the periumbilical region

D Metastasis of gastric carcinoma to the bilateral ovaries

Question 16 Explanation:
Note that the presentation of gastric carcinoma can include Leser-Trélat sign, Virchow node,
Sister Mary Joseph nodule and Krukenberg tumour.

Question 17

What disease is associated with dermatitis herpetiformis?

A Herpes

B Coeliac disease

C Atopic dermatitis

D Melanoma

Question 17 Explanation:
In coeliac disease, there are IgA antibodies against gluten that cross react with reticulin
fibres that anchor the basement membrane to the dermis. Thus, IgA is deposited at the tips
of dermal papillae, presenting as grouped pruritic vesicles, papules or bullae. Usually found
on elbows.

Question 18

8/10
What type of melanoma is often seen in dark skinned individuals?

A Superficial spreading

B Lentigo maligna melanoma

C Nodular

D Acral lentiginous

Question 18 Explanation:
The acral lentiginous variant of melanoma arises in dark skinned individuals on their palms
or soles. It is not linked to UVB induced DNA damage unlike the other types (this was the
disease that caused the death of Bob Marley).

Question 19

What is a precursor to squamous cell carcinoma (SCC)?

A Keratoacanthoma

B Actinic keratosis

C Leser-Trélat sign

D Measles

Question 19 Explanation:
Actinic keratosis is a premalignant lesion to SCC, caused by prolonged sun exposure. It
presents as scaly, rough, erythematous and small plaques, most commonly on the face,
back or neck.

Question 20

What is the most common causative agent of erythema multiforme (EM)?

A Penicillin and sulphonamides

B Systemic lupus erythematosus

C HSV infection

9/10
 D Malignancy

Question 20 Explanation:
HSV is the most common etiologic agent of EM, which presents as a targetoid rash and
bullae. All the other options are also associated with the disorder, but less commonly.
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