Pathognomic

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Description of the cases

WEB BOX #1 (1-60 cases)

  1. 45-year old female presents with numerous hypopigmented macular lesions  on her back.
  2. Tinea versicolor
  3. Vitiligo
  4. Postinflammatory hypopigmentation
  5. Pityriasis alba
  6. Ashy dermatosis

 

  1. 36 year old female presents with a round slightly elevated lesion on her scalp. The best diagnosis:
  2. Tinea
  3. Discoid lupus erythematosus
  4. Granuloma faciale
  5. Folliculitis
  6. Insect bite reaction

 

3.   42 year-old male presents with a verrucous scrotal papule. The best diagnosis is:

  1. Verruca vulgaris
  2. Verruciform xanthoma
  3. Inlfammatory linear verrucous epidermal nevus (ILVEN)
  4. Molluscum contagiosum
  5. Bowenoid papulosis

 

4.   58 year old female with the history of breast carcinoma presens with a nodule on her back. The best diagnosis is:

  1. Atypical tuberculosis
  2. Follicular lymphoma
  3. Squamous cell carcinoma
  4. Basosquamous cell carcinoma
  5. Metastatic tumor (breast carcinoma)

 

5. 75 year-old male presents with a verrucous nodule on his left shin. The best diagnosis is:

  1. Keratoacanthoma
  2. Squamous cell carcinoma, keratoacanthoma type
  3. Nocardia
  4. Chromoblastomycosis
  5. Prurigo nodularis

 

6. 6 year-old girl presents with her concerned parents with circular patches of hair loss starting 2 months ago. The best diagnosis is:

  1. Tinea capitis
  2. Tinea amiantacea
  3. Central centrifugal scarring alopecia
  4. Trichotillomania
  5. Alopecia areata (AA)

 

7. 59 year-old male presents with a “nevus” on his cheek. The best diagnosis is:

  1. Intradermal nevus (neurotized)
  2. Neurofibroma
  3. Palisaded encapsulated neuroma
  4. Dermatofibroma
  5. Leiomyoma

8. 32 year-old male presents with a right upper arm nodule. It is positive for Factor XIIIa and negative with CD34. The best diagnosis is:

  1. Dermatofibroma
  2. Neurfibroma
  3. Leiomyosarcoma
  4. Dermatofibrosarcoma protuberans
  5. Sclerotic fibroma

9. 56 year-old female presents with numerous small papules mainly affecting the lower eyelids. The largest lesion is biopsied. The best diagnosis is:

  1. Micorcystic adnexal carcinoma
  2. Trichoblastoma
  3. Basal cell carcinoma, clear cell type
  4. Squamous cell carcinoma
  5. Syringoma

10. 31 year-old female presents with several vesicular lesions affecting her lower lip. The best diagnosis is:

  1. Impetigo
  2. Herpes
  3. Pemphigus vulgaris
  4. Darier’s disease
  5. Majocchi’s granuloma

 

11. 3-year old girl presents with a nodule on her forearm. The lesional cells are negative for S100, Melan-A, NKI-C3 and positive for CD68. The best diagnosis is:

  1. Cellular blue nevus
  2. Neurothekeoma
  3. Juvenile xanthogranuloma
  4. Neurofibroma
  5. Spitz nevus

12. 36 year-old female presents with numerous itchy flat topped, purple-colored papules affecting mainly her extremities. The best diagnosis is:

    1. Lupus erythematosus
    2. Erythema multiforme
    3. Pityriasis lichenoides
    4. Psoriasis
    5. Lichen planus

 

13. 57-year old woman presents with a nodule on her forehead. The lesional cells are positive for S100, Melan-A. The best diagnosis is:
A.   Blue nevus
B.   Tattoo
C.   Pigmented DFSP

  1. Desmoplastic melanoma
  2. Deep penetrating nevus

14. A 5-year old boy complains about an oozing lesion on his ankle. According to the history received from the parents he was playing bare footed in the garden. The best diagnosis is:
A.   Atypical mycobacterial infection
B.   Protothecosis
C.   Splinter granuloma

  1. Blastomycosis 
  2. Cryptococcosis

15. 50 year-old female presents with a warty lesion on the scalp. The best diagnosis is:

  1. Clear cell hidradenoma
  2. Eccrine accrospiroma
  3. Spiradenoma
  4. Cylindroma
  5. Syringocystadenoma papilliferum (SCAP)

16. 33-year old male presents with a nodule on his back. The lesional cells are positive for S100, CD34 and negative with Melan-A and FXIIIa stains. The best diagnosis is:

  1. Cellular blue nevus
  2. Neurothekeoma
  3. Juvenile xanthogranuloma
  4. Neurofibroma
  5. Spitz nevus

 

17. 35-year old female with no significant medical history presents with numerous follicular based papules on her chest. The best diagnosis is:
A.   Perforating folliculitis
B.   Pityrosporum folliculits
C.   Kyrle’s disease
D.   Elastosis perforans serpiginosa
E.   Miliaria rubra

 

18. 42 year-old male presents with severely itchy lesions affecting the elbows and the buttocks. A biopsy is taken for direct immunofluorescence examination. The best answer is:
A. Granular deposition of IgG in dermal papillae
B. Granular deposition of IgA along the dermo-epidermal junction and in dermal papillae
C. Intercellular deposition of IgG and complement C3
D. Thick granular band at the dermo-epidermal junction with IgG, IgA, IgM and C3
E. Vascular deposition of IgA

 

19. 88 year-old female presents with a warty lesion on her shin. The best diagnosis is:
A. Melanoma (verrucous)
B. Keratoacanthoma
C. Wart
D. Verrucous psoriasis
E. Warty dyskeratoma

 

20. This oozing nodule has arisen on the forearm of a 31 year old female. The best diagnosis is:

  1. Spindle cell hemangioma
  2. Glomangioma
  3. Kaposi’s sarcoma
  4. Angiosarcoma
  5. Pyogenic granuloma

21. 26-year-old female presents with a scaly, erythematous rash affecting the back in a “Christmas tree” pattern. The best diagnosis is:

  1. Pityriasis rosea (PR)
  2. Verrucous psoriasis
  3. Lichen planus
  4. Discoid lupus erythematosus
  5. Pityriasis lichenoides et varioliformis acuta (PLEVA)

 

22. 48 year-old female presents with erythematous, slightly indurated chest lesion. The best diagnosis is:
A. Reticulated erythematous mucinosis (REM)
B. Arthropod assault
C. Lymphomatoid papulosis (LyP)
D. Diffuse large B-cell lymphoma of leg-type
E. Discoid lupus erythematosus (DLE)

 

23. 47 year-old patient presents with a lesion affecting the right flank. The best diagnosis is:

  1. Leiomyosarcoma
  2. Xanthogranuloma
  3. Leishmaniasis
  4. Granular cell tumor
  5. Necrobiotic xanthogranuloma

24. 60 year-old female presents with a growing nodule on her scalp. The best diagnosis is:
A. Squamous cell carcinoma (KA-type)
B. Epidermal inclusion cyst
C. Pilar cyst
D. Proliferating trichilemmal cyst
E. Dermoid cyst

25. 87 year-old male with the history of internal malignancy presents with several nodules over the scalp. The lesion is EMA positive. The best diagnosis is:

  1. Metastatic kidney carcinoma
  2. Angiosarcoma
  3. Atypical fibroxanthoma
  4. Kaposi’s sarcoma
  5. Spindle cell hemangioma

 

26. 61 year-old female presents with a painful nodule on her right toe. The best diagnosis is:
A. Eccrine spiradenoma
B. Angiolipoma
C. Spindle cell hemangioma
D. Glomus tumor
E. Merkel cell carcinoma

 

27. 45 year-old male presents with slightly elevated hemorrhagic lesions affecting both lower extremities. The best diagnosis is:

  1. Cryoglobulinemia (Type I)
  2. Leukocytoclastic vasculitis (LCV)
  3. Arthropod bite reaction
  4. Cellulitis
  5. Atypical mycobacterial infection

 

28. An HIV+ female presents with several deep purple colored tumors affecting the lower extremities one of them is biopsied. What immunostain is expected to be positive?

  1. Cytokeratin AE1/AE3
  2. S100
  3. HHV-6
  4. HHV-8
  5. EBV latent membrane antigen

 

29. 82 year-old male present with a tumor on the left cheek. It is CK20 (perinuclear dot positivity), synaptophysin, and neurofilament positive. What stain would you use for prognostic purposes?

  1. P53
  2. P63
  3. Ki-67
  4. BRAF
  5. EGFR

 

30. A homosexual, HIV positive 45 year-old male presents with a generalized skin eruption. What immunostain would you use to confirm the diagnosis?

  1. PAS
  2. GMS
  3. FITE
  4. Treponema pallidum immunohistochemistry
  5. Bartonella henselae immunohistochemistry

 

31. 5 year-old girl presents with a very dark pigmented lesion with sharp borders affecting the left thigh. The best diagnosis is:

  1. Melanoma
  2. Pigmented spindle cell nevus of Reed
  3. Blue nevus
  4. Deep penetrating nevus
  5. Common blue nevus

 

32. 48 year-old lady presents with neck nodules. Upon questioning she admits to receive cosmetic procedures in La Paz, Bolivia. The best diagnosis is:

  1. Atypical mycobacterial infection
  2. Adult xanthogranuloma
  3. Necrobiotic xanthogranuloma
  4. Silicon granuloma
  5. Malakoplakia

 

33. 6 month-girl presents with dusky wheals. Special stains of choice:

  1. von Kossa
  2. Van Gieson elastic
  3. Mast cell tryptase
  4. Fite
  5. CD45

 

34. 12 year-old girl presents with a forearm papule. The best diagnosis is:

  1. Pilomatricoma
  2. Inverted follicular keratosis
  3. Basal cell carcinoma in a patient with basal cell nevus syndrome
  4. Pilomatrix carcinoma
  5. Panfolliculoma

 

35. 66 year-old male patient presents with a nodule on his shoulder. The best diagnosis is:
A.   Poroma

  1. Seborrheic keratosis
  2. Inverted follicular keratosis
  3. Verruca vulgaris
  4. Clear cell acanthoma

 

36.  This CD34 negative lesion evolved rapidly (within 4 weeks) on the shoulder of a 34 year-old female patient. The best diagnosis is:

  1. Dermatofibroma
  2. Dermatofibrosarcoma protuberans
  3. Leiomyosarcoma
  4. Nodular fasciitis
  5. Ossifying fibrobyxoid tumor

 

37. 40 year-old male presents with a growing nodule on his scalp. The best diagnosis is:
A. Pilomatricoma
B. Epidermal inclusion cyst
C. Pilar cyst
D. Proliferating trichilemmal cyst
E. Bronchogenic cyst

38.  43 year-old African American female presents with a balding spot on her central scalp the best diagnosis is:

  1. Alopecia areata
  2. Female pattern alopecia
  3. Telogen effluvium
  4. Trichotillomania
  5. Central centrifugal cicatricial alopecia (CCCA)

 

39. 68 year-old male patient presents with a 10x10 cm rectangular, indurated lesion over his chest. He admits recent heart problems. The best diagnosis is:

  1. Graft-versus-host disease
  2. Discoid lupus erythematosus
  3. Radiation dermatitis
  4. Scar
  5. Lichenoid drug eruption

40.  45 year-old homosexual male presents with verrucous perianal lesions. In situ hybridization for high risk HPV is positive. The best diagnosis is:

  1. Condyloma acuminatum

B.   Bowenoid papulosis
C.   Verruca vulgaris

  1. Seborrheic keratosis
  2. Extramammary Paget’s disease

 

41. This lesion is from a 38 year-old female. Which HPV subtypes would be identified most likely:

  1. HPV 16, 18
  2. HPV 33, 35
  3. HPV 5, 8
  4. HPV 2,7
  5. HPV 1

42. 3 year-old girl presents with several of these lesions in the groin area. The best diagnosis is:

  1. Verruca vulgaris
  2. Molluscum contagiosum
  3. Herpes infection
  4. Darrier’s disease
  5. Condyloma acuminatum

 

43. 30 year-old female presents with several plaques on her lower and upper extremities. The best diagnosis is:

  1. Necorbiosis lipoidica
  2. Necrobiotic xanthogranuloma
  3. Rheumatoid arthritis associated neutrophilic dermatosis
  4. Morphea
  5. Granuloma annulare

 

44. A 57 year-old female with long history of diabetes presents with plaques involving the lower extremities. The best diagnosis is:

  1. Morphea
  2. Scleroderma
  3. Lichen sclerosus et atrophicus (LS&A)
  4. Necrobiosis Lipoidica
  5. Granuloma annulare

 

45. This nodule was excised from a 53 year-old female, who had a CT scan and showed bilateral hilar adenopathy. Her cultures and special stains for microorganisms were negative. What is the best answer?

  1. Caseating granulomas are typical
  2. The etiological agent of this condition is well known
  3. Asteroid and Schaumann bodies are diagnostic of this condition
  4. Angiotensin-converting enzyme levels are used in diagnosis and monitoring of this condition.
  5. All patients need to be treated

 

46. This biopsy is from a child living in a farm in Texas. The best histological diagnosis is:

  1. Wells syndrome
  2. Sweet’s syndrome
  3. Tumid lupus
  4. Henoch-Schonlein purpura
  5. Cryoglobulinemia type 1

 

47. 70 year-old male complains about skin nodules affecting several body parts. What is the best diagnosis?

  1. Xanthogranuloma
  2. Necrobiotic xanthogranuloma
  3. Kenalog injection
  4. Gout
  5. Deep granuloma annulare

 

48. 10 year-old boy presents with flaccid, honey colored bullae affecting the perioral area, cheek and the focally the forehead. The best diagnosis is:

  1. Herpes infection
  2. Tinea infection
  3. Impetigo
  4. Subcorneal pustular dermatoses of Sneddon-Wilkinson
  5. Pemphigus vulgaris

 

49. This lesion has arisen on a 28 year female on her abdomen with no significant medical history. The best diagnosis is.

  1. Tumid lupus erythematosus
  2. Lichen sclerosus et atrophicus (LS&A) with features of morphea
  3. Fluoroscopy associated dermatitis
  4. Granuloma annulare
  5. Insect/arachnid bite reaction

 

50. 79 year old male presents with this lesion on his left forearm. You see smaller nodules around the main lesion and palpate lymph node enlargement affecting his left axilla. What immunostain can you order to check if the patient is eligible for treating his metastatic disease?

  1. Melan-A
  2. Ki-67
  3. Mitf-1
  4. BRAF
  5. HMB-45

 

51. 50 year-old patient missionary from a recent trip to South America presents with an ulcerated ear papule. The best diagnosis is:

  1. Impetigo
  2. Larva migrans
  3. Leishmaniasis
  4. Cryptoscoccosis
  5. Coccidioidomycosis

 

52. This lesion shows association with one of the following genetic syndrome. (Select only one answer)

  1. Gardner syndrome

B.  Cowden syndrome
C.  Birt-Hogg-Dube syndrome
D.  Brooke-Spriegler syndrome
E.   Tuberous sclerosis

 

53. 43 year-old male presents with generalized papular lesions in a recurring-remitting fashion. The best diagnosis is:

  1. Insect bite reaction
  2. Lymphomatoid papulosis (LyP)
  3. Follicular B-cell lymphoma
  4. Chronic lymphocytic lymphoma/leukemia
  5. Diffuse large B-cell lymphoma of leg type

 

54. 67 year-old male patient with the history of acute myologenous leukemia presents with several nodular, erythematous lesions affecting the forearms. The best diagnosis is:

  1. Arthropod bite reaction
  2. Well’s syndrome
  3. Sweet’s syndrome
  4. Erythema elevatum diutinum
  5. Polymorphous light eruption

 

55. Verrucous lesion from the shoulder of a 43 year-old male. The best diagnosis is:

  1. Verruca plana
  2. Seborrheic keratosis
  3. Acantholytic acanthoma
  4. Epidermolytic hyperkeratosis
  5. Clear cell acanthoma

 

56. 38 year-old male patient presented with flaccid bullous lesions affecting the chest, extremities and the oral mucosa. Direct immunofluorescence with IgG shows intercellular “fishnet” deposition. The best diagnosis is:

  1. Hailey-Hailey disease
  2. Grover’s disease
  3. Darier’s disease
  4. Pemhigus vulgaris
  5. Bullous pemphigoid

 

57. The best diagnosis is:

  1. Common blue nevus
  2. Combined nevus
  3. Proliferating nodule in a congenital nevus
  4. Balloon cell nevus
  5. Cellular blue nevus

 

58. Cells containing organisms of this condition are called:
A.   Lymphocytes
B.   Virchow’s cells
C.   Kutzner’s bodies
D.   Langerhans cells
E.   Pustulo ovoid body of Milia

 

59. The best diagnosis is:

  1. Soft tissue chondroma
  2. Chondrosarcoma
  3. Myoepithelioma
  4. Mixed tumor
  5. Oncocytic carcinoma

 

60. This biopsy is from a 5 month-old girl. The gene involved in this condition is:

  1. NEMO IKBKG gene
  2. BRAF
  3. STS gene Xp22.3
  4. SPINK5 gene
  5. SLURP1 gene