Answer and Explanation 9

9.  D is the correct answer.  Pityriasis Rosea typically has a herald patch like seen in the photograph and gives a christmas tree like appearance.  Patients typically will not have any associated symptoms and just notice a rash when they come in.  Some of them may have some associated itching.  Psoriasis does not have this appearance.  It is typically scaly and is more of a thicker continuous plaque.  It is seen more of areas of trauma.  Erythema nodosum is usually painful nodules seen on the extensor surfaces of the body.  Erythema multiforme is target shaped red lesions seen on the body.

Question 9

9.  Your patient is a 25 year old male that presents with this diffuse rash on his trunk that he has no associated symptoms with.

Based upon the picture as well as the above information, what is most likely diagnosis?

A. Psoriasis

B.  Erythema Nodosum

C.  Erythema Multiforme

D.  Pityriasis Rosea

Answer and Explanation 8

8.  C is the correct answer.  Psoriasis typically gives you the whitish, gray, or silver flaky plaques over areas of trauma and is often symmetrical.  It typically burns or itches. Commonly we ill see patients with the pits in their fingernails.  Approximately 7% of the patients who have psoriasis can have arthritis associated with it.  Numular eczema and contact dermatitis typically do not have that thick of a plaque and that flaky appearance.  Discoid Lupus typically affects the face, ears, and scalp but can involve any area of the body.  The lesions are typically red, scaly, with a crusty appearance.  The central area may look lighter in color.

Question 8

8.  Your patient is a 45 year old female who presents with the rash below.  She has also noted that the rash burns and itches at times.  She also has noted pits in her fingernails develop over the last several months. She notes this rash on both of her elbows.

Based upon the above data, what is the diagnosis?

A.  Discoid Lupus

B.  Contact Dermatitis

C.  Psoriasis

D.  Numular Eczema

Answer and Explanation 7

7.  The correct answer is B.  Chronic Venous Stasis Dermatitis typically has that symmetrical brownish discoloration of the bilateral lower extremities from the poor venous return.  They may also have some ulcers, dry skin, or loss of hair associated with it.  While cellulitis can be bilateral, it is unusual and it is more of a deep red color.  Psoriasis typically is seen over joints like the elbows and knees but can occur anywhere.  It is usually more of a dry flaky appearance and can sometimes be white or gray.  While patients with SLE can have renal dysfunction, this type of rash is not considered to be part of the diagnostic criteria.

Question 7

7.  Your patient is a 67 year old female hemodialysis who presents with a rash on her bilateral lower legs shown below.   She also states she has noticed this getting progressively worse over the last year.

Based upon the data above.  Which of the following is the most likely diagnosis?

A.  Cellulitis

B.  Venous Stasis Dermatitis

C.  Psoriasis

D.  Systemic Lupus Erythematous

Answer and Explanation 6

6.  D is the correct answer.  Polyarthritis is not one of the 5 P's of Lichen Planus.  The 5 P's of Lichen Planus are planar, polygonal, pruritic, purple, and papular.

Question 6

6.  Which of the following is not one of the 5 P's of Lichen Planus?

A.  Planar

B.  Purple

C. Pruritic

D.  Polyarthritis

Answer and Explanation 5

5.  The correct answer is B systemic lupus erythematous.  This clinical presentation is consistent with SLE.  The fact that she has this malar (butterfly shaped) rash along with the other constellation of symptoms including arthritis, oral ulcers, as well as photosensitivity means she meets diagnostic criteria for SLE.  In order for a patient to meet diagnostic criteria for SLE they have to meet 4 of 11 criteria which include:  malar rash, discoid rash, photosensitivity, oral ulcers, serositis, or a positive ANA.  SLE can also give you disorders of the following systems: renal, neurological, hematologic, or immunologic systems.  Rosacea  can give you a similar rash on the face but there is typically not systemic symptoms.  There  is typically not nasal labial sparing with the rash either.  You can also get arthritis with psoriasis but typically do not get oral ulcers and the rest of the systemic symptoms especially photosensitivity.

Question 5

5.  Your patient is a 45 year old female who presents with the rash on her face listed below.  She is also complaining of diffuse arthritis as well as oral ulcers.  She has also noted with any sort of sun exposure she has what she feels is a hyperactive response to her skin.

Based ou this information.  What is your most likely diagnosis?

A.  Psoriasis

B.  Systemic Lupus Erythematous

C.  Rosacea

D.  Numular Eczema