Q 1:
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 on the leg and ankle . 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. pityriasis alba
D. progressive systemic sclerosis
E. vitiligo
Answer:
B
Scleroderma is a rare connective tissue disease that is believed to have an autoimmune cause.
It may be categorized as localized and systemic, with the localized form predominating.
Localized scleroderma begins as areas of indurated skin that have violaceous borders. Over
time, the violaceous color is lost, and the skin takes on a waxy, ivory appearance. As the
disease remits, affected areas become atrophic and hypo- or hyperpigmented. Three clinical
patterns of localized scleroderma exist: linear scleroderma, morphea, and generalized morphea.
In linear scleroderma, as exhibited by the patient described in the vignette, lesions appear in a
bandlike distribution, typically are unilateral, and usually involve the extremities.
The abnormal tissue may span joints, resulting in diminished range of motion or deformity, and
may extend to soft tissue, muscle, or bone. In morphea, one or two discrete areas are affected,
often on the trunk. Generalized morphea is characterized by the presence of widespread or
coalescent lesions.
The treatment of localized scleroderma is difficult and may include the application of potent
topical corticosteroids or topical calcipotriene.
-----------------------------------------------------
Q 2:
A 13-year-old boy requests treatment for his acne. He is using no medications and has no known drug allergies. Physical examination of the face reveals a few small inflammatory papules and numerous blackheads and whiteheads; there is no scarring . No acne lesions are present on the chest and back. Of the following, the MOST appropriate treatment is
A. benzoyl peroxide topically
B. benzoyl peroxide topically and tetracycline orally
C. benzoyl peroxide topically and tretinoin topically
D. clindamycin topically
E. tretinoin topically
Answer
C
The patient described in the vignette has facial acne characterized by a few small inflammatory lesions and numerous obstructive lesions (ie, blackheads and whiteheads) . As a result, he requires treatment with two agents, one to control inflammatory lesions and one to control obstructive lesions. Because the inflammatory component of his acne is mild and limited to the face, it may be treated topically with benzoyl peroxide applied each morning.
Alternatives might include a topical combination product (eg, benzoyl peroxide combined with either clindamycin or erythromycin) or possibly a topical antibiotic alone (although bacterial resistance to these agents when they are used without benzoyl peroxide is common).
Answer:
B
Scleroderma is a rare connective tissue disease that is believed to have an autoimmune cause.
It may be categorized as localized and systemic, with the localized form predominating.
Localized scleroderma begins as areas of indurated skin that have violaceous borders. Over
time, the violaceous color is lost, and the skin takes on a waxy, ivory appearance. As the
disease remits, affected areas become atrophic and hypo- or hyperpigmented. Three clinical
patterns of localized scleroderma exist: linear scleroderma, morphea, and generalized morphea.
In linear scleroderma, as exhibited by the patient described in the vignette, lesions appear in a
bandlike distribution, typically are unilateral, and usually involve the extremities.
The abnormal tissue may span joints, resulting in diminished range of motion or deformity, and
may extend to soft tissue, muscle, or bone. In morphea, one or two discrete areas are affected,
often on the trunk. Generalized morphea is characterized by the presence of widespread or
coalescent lesions.
The treatment of localized scleroderma is difficult and may include the application of potent
topical corticosteroids or topical calcipotriene.
-----------------------------------------------------
Q 2:
A 13-year-old boy requests treatment for his acne. He is using no medications and has no known drug allergies. Physical examination of the face reveals a few small inflammatory papules and numerous blackheads and whiteheads; there is no scarring . No acne lesions are present on the chest and back. Of the following, the MOST appropriate treatment is
A. benzoyl peroxide topically
B. benzoyl peroxide topically and tetracycline orally
C. benzoyl peroxide topically and tretinoin topically
D. clindamycin topically
E. tretinoin topically
Answer
C
The patient described in the vignette has facial acne characterized by a few small inflammatory lesions and numerous obstructive lesions (ie, blackheads and whiteheads) . As a result, he requires treatment with two agents, one to control inflammatory lesions and one to control obstructive lesions. Because the inflammatory component of his acne is mild and limited to the face, it may be treated topically with benzoyl peroxide applied each morning.
Alternatives might include a topical combination product (eg, benzoyl peroxide combined with either clindamycin or erythromycin) or possibly a topical antibiotic alone (although bacterial resistance to these agents when they are used without benzoyl peroxide is common).
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