Minnesota Dermatological Society
MAINTENANCE OF CERTIFICATION
PRACTICE QUESTIONS
Paraneoplastic Signs & Cutaneous Metastases
1.
A 12-year-old boy presents to your clinic with dark macules on his lips. In the
past year he has been hospitalized on several occasions for severe abdominal pain and
vomiting. Which of the following is this patient at increased risk of developing?
a. Hepatocellular carcinoma
b. Malignant melanoma
c. Squamous cell carcinoma
d. Colorectal carcinoma
e. Esophageal carcinoma
2.
In the patient from Question 1 which enzyme is most likely to be defective?
a. Serine threonine kinase
b. Neutrophil elastase
c. Phosphlipase
d. Fibroblast growth factor
e. Protein kinase C
3.
A 62-year-old male presents to your clinic with this lesion in his umbilicus. It has
been present for only a few months and is asymptomatic. Which of the following is the
most likely diagnosis?
a. Breast cancer
b. Colon cancer
c. Lung cancer
d. Gastric cancer
e. Leukemia
4.
A 64-year-old male returns to clinic for his annual skin check. He notes that these
lesions have developed rapidly and are very itchy. He also notes an unexplained 20
pound weight loss and poor appetite. Which of the following is the most likely
diagnosis?
a. Bazex syndrome
b. Necrolytic migratory erythema
c. Sign of Leser-Trelat
d. Erythema gyratum repens
e. Muir-Torre syndrome
Minnesota Dermatological Society / M.O.C. Questions / page 2 of 7
5.
Which of the following internal malignancies is the patient from Question 4 most
likely to have?
a. Nasopharyngeal carcinoma
b. Squamous cell carcinoma
c. Acute myelogenous leukemia
e. Gastrointestinal adenocarcinoma
e. Breast carcinoma
6.
A 60-year-old asian male is referred by his primary care physician for evaluation
of these rapidly-changing patches. Patient is a heavy smoker. Which of the following is
the most likely diagnosis?
a. Psoriasis
b. Erythema gyratum repens
c. Eczema
d.Contact dermatitis
e. Tinea corporis
7.
Which of the following internal malignancies is the patient from Question 6 most
likely to have?
a. Esophagal cancer
b. Breast cancer
c. Lung cancer
d. Multiple myeloma
e. Gastric cancer
8.
A 42-year-old male returns to clinic for a follow-up exam for his psoriasis. The
patient has been using Class I topical steroids on the lesions and has seen no
improvement. Which of the following is the most likely diagnosis?
a. Erythema Gyratum Repens
b. Bazex syndrome
c. Paraneoplastic pemphigus
d. Dishydrotic eczema
e. Tinea manuum
9.
Which of the following cancers is the patient from Question 8 most likely to have?
a. Laryngeal carcinoma
b. Intraductal breast cancer
c. Large cell lung cancer
d. Small cell lung cancer
e. Malignant melanoma
Minnesota Dermatological Society / M.O.C. Questions / page 3 of 7
10.
A 68-year-old female noticed this increased hair growth and an unexplained 30pound weight loss over the past year. Which of the following cancers is the patient at
increased risk for developing?
a. Pancreatic cancer
b. Breast cancer
c. Gastric cancer
d. Brain tumor
e. Colon cancer
11.
Which of the following is the most common site of cutaneous metastases?
a. Scalp
b. Face
c. Upper extemities
d. Trunk
e. Lower extremities
12.
A 63-year-old female with a one-year history of poorly-controlled diabetes
mellitus presents with these ulcerations on her lips, shins and groin. Which of the
following tests would be the most reasonable next step?
a. Complete blood count
b. Fungal culture
c. Patch test
d. Computed tomography of abdomen
e. Chest X-ray
13.
In the scenario from Question 12 what would be the most likely diagnosis?
a. Erythema gyratum repens
b. Necrolytic migratory erythema
c. Paraneoplastic pemphigus
d. Cutaneous candidiasis
e. Contact dermatitis
14. In the patient from Question 12 which symptom would you not expect?
a. Hairloss
b. Pruritis
c. Anemia
d. Thromboembolism
e. Weight loss
Minnesota Dermatological Society / M.O.C. Questions / page 4 of 7
15.
A 79-year-old female complains of painful oral sores and blistering patches on
her trunk. She has had both symptoms for two months. Which of the following is the
most likely diagnosis?
a. Paraneoplastic pemphigus
b. Necrolytic migratory erythema
c. Erythema multiforme
d. Contact dermatitis
e. Disseminated herpes simplex
16.
Which of the following substrates used for indirect immunofluorescence would
confirm the diagnosis of the patient from Question 15?
a. monkey skin
b. rat bladder
c. pig skin
d. monkey intestine
17.
Which of the following is the most likely diagnosis from Question 15?
a. Colon cancer
b. Non-Hodgkin’s lymphoma
c. Lung cancer
d. Castleman’s disease
e. Leukemia
18.
The patient from Question 15 is at increased risk for which of the following?:
a. Cardiac arrest
b. Sepsis
c. Respiratory failure
d. Gangrene
19.
A 56-year-old female with nipple discharge presents for evaluation of this
unilateral patch that is mildly pruritic. Which of following is the mostly likely diagnosis?
a. Pityriais rotunda
b. Contact dermatitis
c. Intertrigo
d. Carcinoma erysipeloides
e. Sweet’s syndrome
20.
Which of the following internal cancers is the mostly likely diagnosis for the
patient from Question 19?
Minnesota Dermatological Society / M.O.C. Questions / page 5 of 7
a. Breast cancer
b. Colon cancer
c. Lung cancer
d. Kidney cancer
e. Gastric cancer
21.
A 52-year-old male is referred to you by his primary physician for evaluation of
ongoing pruritus. Patient says he itches all day long, and it is even worse at night. Your
clinical examination, however, discovers no primary lesions. Which of the following is
the most likely diagnosis?
a. Colon cancer
b. Leukemia
c. Lymphoma
d. Prostate cancer
e. Lung cancer
22.
A 46-year-old male is referred by his primary physician for removal of this rapidlygrowing lesion. It has been present for a few weeks and does not bleed with trauma.
Which of the following is the most likely diagnosis?
a. Renal cell carcinoma
b. B-cell lymphoma
c. Basal cell carcinoma
d. T-cell lymphoma
23.
A 70-year-old male with blisters and scarring on his conjunctiva is diagnosed with
cicatricial pemphigoid. Which of the following autoantibodies, if detected, would indicate
the patient is at increased risk of having an internal malignancy?
a. Desmoplakin
b. Anti-epilagrin
c. Desmoglein
d. c-ANCA
e. p-ANCA
24.
An 82-year-old male presents with three asymptomatic, rapidly-growing nodules
on the scalp. Biopsy of the lesions indicates they are metastases of internal cancer.
Which of the following is the most likely diagnosis?
a. Lung cancer
b. Gastric cancer
c. Colon cancer
d. Prostate cancer
Minnesota Dermatological Society / M.O.C. Questions / page 6 of 7
25.
A 55-year-old male presents with thickening on his palms and soles. On review
of systems the patient acknowledges dysphagia and weight loss. The patient is
diagnosed with Howell-Evans syndrome. Which of the following patterns best describes
how this syndrome is inherited?
a. Autosomal dominant
b. Autosomal recessive
c. Sporadic
d. Imprinted
e. Unknown
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Minnesota Dermatological Society / M.O.C. Questions / page 7 of 7
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