1. Langerhans cells are important antigen presenting cells of the skin. The density of these cells in human skin decreases with all of the following EXCEPT: 

A. Increasing age.

B. Chronic actinic damage.

C. Location on the palms and soles.

D. Location on anogenital skin.

E. Location on the face 2. All the following are true about granulomas EXCEPT: 

A. They are chronic proliferative lesions containing mononuclear cells (lymphocytes, monocytes, macrophages) as well as epithelioid and/or multinucleated giant cells.

B. Foreign body granulomas usually show many epithelioid cells.

C. Zirconium, beryllium, and tattoos can produce allergic granulomas.

D. Allergic granulomas are characterized by the presence of epithelioid and multinucleated giant cells. 3. All of the following characteristics are true of keratinocytes EXCEPT: 

A. Basal keratinocytes are 10–14 nm in diameter.

B. All keratinocytes contain keratin in their cytoplasm.

C. The granular layer contains numerous basophilic granules of keratohyalin.

D. The spinous layer has numerous hemidesmosomal connection plaque.

E. Terminally differentiated keratinocytes are nonviable

4. Which statement about vacuolar degeneration of the basal layer of the epidermis is FALSE? 

A. It occurs in lupus erythematosus, lichen sclerosus and poikiloderma atrophicans vasculare.

B. It is a distinctive feature in lichen planus and acute dermatitis.

C. It may lead to pigment incontinence.

D. It may lead to formation of bullae5. All are true regarding integrins EXCEPT: 

A. Integrins are cell surface glycoproteins that form receptors.

B. They mediate interactions between cells and extracellular matrix protein.

C. They function in intercellular adhesion.

D. They consist of three subunits: alpha, beta, and gamma.

E. They are important in wound healing and immune defense mechanisms.

6. Which of the following are FALSE about nails? 

A. The nail bed is primarily responsible for the production of the nail plate.

B. Keratinization in the matrix occurs without a granular layer.

C. Absence of subcutaneous tissue, allowing close association with the vasculature, is a

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unique feature of the dermal component of the nail structure.

D. The rate of growth of the thumbnail is around 0.1 mm/day. 7. Eccrine glands are present in the following sites EXCEPT: 

A. The labia minora.

B. The palms and soles.

C. The inner aspect of the prepuce.

D. The axillae.8. Langerhans cells: 

A. Constitute 2 to 4% of the total epidermal cell population.

B. Express immune response-associated antigens 1A and HLA DR.

C. Express S100 protein.

D. Possess actin-like filaments.

E. All the above are true. 9. Estrogens have the following effects on skin: 

A. They maintain dermal collagen.

B. They increase the synthesis of ground substance.

C. In the long term, if given in pharmacologic doses, they can inhibit sebaceous gland secretion.

D. Estradiol binds to cytosolic receptors in human skin.

E. All of the above.10. For the following pairs of collagen and their locations, which is INCORRECT? 

A. Type 1 collagen—reticular dermis.

B. Type 3 collagen—subepidermal regions.

C. Type 4 collagen—basement membrane zone and perivascular regions.

D. Type 2 collagen—cartilage.

E. Type 7 collagen—anchoring filaments11. Specific androgen targets in the skin are all of the following EXCEPT: 

A. Sebaceous glands.

B. Some hair follicles.

C. Apocrine sweat glands.

D. Eccrine sweat glands12. Each of the following statements is true EXCEPT: 

A. Mitosis are found in the normal human epidermis, mostly in the basal layer.

B. The average normal germinative cell has a DNA synthesis time of 16 hours.

C. In normal skin, the average time required for transit of a cell from the basal cell layer to surface of the granular cell layer is between 26 and 42 days.

D. The passage of horny cells through the normal stratum corneum requires approximate 35 days.

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E. The germinative cell population in normal human epidermis is principally in the basal layer.

13. Hair change from vellus to terminal hair starts in the axillae in both men and women. 

True

False 14. All of the following are true about parakeratosis EXCEPT: 

A. It refers to retention of nuclei by keratinocytes in the horny layer.

B. It is usually associated with an increased granular cell layer.

C. It is usually focal in psoriasis.

D. It is a physiologic phenomenon in the oral mucosa15. In normal wound healing, which cell type dominates the initial part of the first stage of wound repair? 

A. Macrophages.

B. Neutrophils.

C. Fibroblasts.

D. Platelets.

E. Leukocytes16. Contrasting dark and clear eccrine cells, which of the following is TRUE: 

A. Clear cells are broader near the lumen.

B. Dark cells secrete glycogen.

C. Clear cells contain PAS-positive sialomucin.

D. None of the above are true. 17. Sebaceous glands produce the following lipids EXCEPT: 

A. Triglycerides.

B. Phospholipids.

C. Esterified cholesterol.

D. Free cholesterol.

E. Waxes18. All of the following can be considered primary lesions of the skin EXCEPT: 

A. Nodule.

B. Macule.

C. Pustule.

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D. Excoriation.

E. Wheal19. Each of the following is true about apocrine glands EXCEPT: 

A. They usually open directly into the surface of the skin.

B. Their secretion is odorless.

C. Their secretion is pulsatile.

D. Their secretion is controlled by adrenergic nervesFor each cell type, choose whether it is found in the epidermis, dermis, both, or neither. 30. Melanocyte 

 31. Langerhans cell 

 32. Mast cell 

 33. Macrophage 

 34. Merkel cell 

 35. All of the following are true of apocrine glands EXCEPT that they: 

A. Originate from the hair germ.

B. Contain PAS-negative diastase-resistant granules.

C. Possess eosinophilic cytoplasm.

D. Have a larger lumen than that of eccrine glands.

E. Secrete sialomucin.36. Which of the following is (are) true of epidermal growth factor (EGF)? 

A. EGF is a polypeptide that stimulates epidermal cell proliferation in some animals.

B. Receptors for EGF are mainly found in the basal cell layer.

C. Receptors for EGF may also occur in mitotically inactive cells such as those of sweat ducts.

D. In mice, production of EGF may be affected by estrogen and testosterone.

E. All of the above are true. 37. Which one of the following statements is TRUE about colloid bodies? 

A. They are seen only in the epidermis.

B. They are round, basophilic, homogeneous bodies.

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C. They should not be confused with Civatte bodies, which are primarily found in poikiloderma of Civatte.

D. They commonly occur in lupus erythematosus and lichen planus. 

38. The mechanical properties of the skin depend primarily on the: 

A. Epidermis.

B. Dermis.

C. Subcutaneous tissue.

D. Stratum corneumRegarding melanocytes, mark the following as TRUE or FALSE: 39. The highest concentration of melanocytes is found on the trunk. 

True

False 40. The lowest concentration of melanocytes is found on the face and the male genitalia. 

True

False 41. Black skin contains larger and more dendritic melanocytes than white skin. 

True

False 42. In black skin, there is increased density and numbers of melanocytes for any given area compared with white skin. 

True

False 43. The main determinant of skin color is the quantity and quality of pigment, not the melanocyte density. 

True

False 44. Single exposure to ultraviolet light in white skin results in increased numbers of dopa-positive melanocytes. 

True

False 45. Repeated exposure to ultraviolet light causes an increase in the concentration of dopa-positive melanocytes. 

True

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False 46. A single exposure to ultraviolet light in vivo causes increased size and functional activity of melanocytes.  

True

False 47. Multiple exposures of white skin to ultraviolet light cause an increase in the size and functional activity of melanocytes. 

True

False48. Which of the following giant cell types is matched with the correct histologic description? 

A. Langhans giant cell/horseshoe nuclei pattern.

B. Foreign body giant/random nuclei.

C. Touton/wreathed nuclei along a foamy rim.

D. Osteoclastic/giant cells with eosinophilic cytoplasm.

E. All of the above49. Which is FALSE regarding black skin? 

A. Melanosomes can be found throughout the epidermis.

B. Melanosomes can be found in the stratum corneum.

C. Melanosomes and keratinocytes are aggregated within membrane-bound melanosome.

D. Melanosomes are larger in size in black skin than in white skin.50. All of the following are TRUE regarding Langerhans cells EXCEPT: 

A. They present antigen to B lymphocytes.

B. They play an important role in contact sensitization.

C. They are important in skin graft rejection.

D. They increase in number in skin after UV radiation.51. Each of the following statements is true EXCEPT: 

A. The epithelial keratins can be divided into basic and acidic groups.

B. Simple epithelia are characterized by the keratins 6 and 16.

C. The major keratins in the basal layer are keratins 5 and 14.

D. Hyperproliferative conditions induce expression of keratins 6 and 1652. Melanocytes constitute approximately 25% of the epidermal cell population. 

True

False53. All of these cells are involved in the immune response in the skin EXCEPT: 

A. Langerhans cells.

B. Keratinocytes.

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C. Indeterminate dendritic cells.

D. Melanocytes.

54. The paucity of stratum corneum lipids in patients with atopic dermatitis makes them: 

A. Less readily sensitized to all cutaneous antigens.

B. Less readily sensitized to water-soluble antigens, but more readily sensitized to lipid-soluble antigens.

C. Less readily sensitized to lipid-soluble antigens, but more readily sensitized to water-soluble antigens.

D. More readily sensitized to all cutaneous antigens.

55. Regarding the lamina lucida and anchoring fibrils, decide which of the following is FALSE: 

A. The distal part of anchoring fibrils inserts into the lamina lucida.

B. Anchoring fibrils contain type 7 collagen.

C. In junctional epidermolysis bullosa, blisters arise within the lamina lucida.

D. Anchoring fibril antigens I and 2 are deficient or totally absent in patients with recessively inherited dystrophic epidermolysis bullosa.

56. Chronic wounds may not follow the normal late stages of the wound-healing process. Recent work suggests that which cells become unresponsive to the otherwise proliferative cytokines TGF-B and PDGF? 

A. Macrophages.

B. Basal cells.

C. Fibroblasts.

D. Leukocytes.

E. Platelets.57. Which of the following is FALSE about vitamin D synthesis in the skin? 

A. Vitamin D3 synthesis occurs mainly in stratum basale and stratum spinosum.

B. It is synthesized from 7-dehydrocholesterol through the intermediate pre-vitamin D3.

C. A plateau of vitamin D3 is reached when around 15% of 7-dehydrocholesterol has been converted.

D. Vitamin D3 is synthesized in the skin mainly as a result of exposure to UVA.58. The normal pH of the stratum corneum is approximately: 

A. 4.0

B. 4.5

C. 5.0

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D. 5.5

E. 6.559. Ground substance contains all of the following EXCEPT: 

A. Glycosaminoglycans.

B. Proteoglycans.

C. Hyaluronic acid.

D. Collagen.

For each statement, choose whether it describes testosterone, 5α-dihydrotestosterone, both, or neither.60. Can bind to receptors in the skin 

 61. Needed for development of pubic and axillary hair 

 62. Needed for development of facial and body hair 

 63. Which of the following statements regarding Odland bodies in the skin is FALSE? 

A. They are also called membrane-coating granules or lamellar bodies.

B. They are present only in the granular cell layer.

C. They discharge their contents into the intercellular spaces to form intercellular cement.

D. They contain lipids, proteins, and enzymes.64. All of the following are true about Odland bodies EXCEPT: 

A. They are discharged from the spinous cells into the intercellular space.

B. They help establish a barrier to water loss.

C. They mediate stratum corneum adhesion.

D. They measure 300 to 500 nm in diameter.65. Regarding the basement membrane zone, decide which of the following is FALSE: 

A. The lamina lucida separates the trilaminar plasma membrane from the lamina densa.

B. The upper lamina lucida contains the sub-basal cell dense plate.

C. Anchoring fibrils extend from the hemidesmosome of the basal cell plasma membrane to the lamina lucida.

D. The lamina lucida is 30 to 60 nm wide.

E. Type 4 collagen is are found within the lamina den66. Meissner corpuscles mediate the sense of heat and their concentration is highest on the ventral aspect of hands and feet. 

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True

False

67. All are true of Meissner's corpuscles EXCEPT that they: 

A. Are located in the deep dermis.

B. Mediate the sense of touch.

C. Occur on acral surfaces.

D. Are found in more numbers on the hands than on the feet.

E. Average 200 microns in size. 

68. The main barriers to passage of water and electrolytes in the skin are the: 

A. Epidermis.

B. Stratum corneum.

C. Dermis.

D: All of the above.

E. A and B.69. All are true regarding stage I melanosomes EXCEPT: 

A. They are round.

B. They typically measure 0.3 microns in diameter.

C. They possess intense tyrosinase activity.

D. They contain melanin.70. Normally functioning skin contributes what percentage to total body cholesterol synthesis? 

A. <1%

B. 5%

C. 10%

D. 20%

E. 40%71. Heat can be lost through the skin surface by:  

A. Radiation.

B. Convection.

C. Conduction.

D. Evaporation.

E. All of the above72. Melanocytes can be identified with the following stains EXCEPT: 

A. Bloch dopa reaction.

B. Silver stains.

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C. Fontana Masson stain.

D. Congo red73. Keratin in the skin is expressed qualitatively and quantitatively differently as cells move from the stratum basale to the stratum granulosum. Which sequence of keratin expression is most correct? 

A. k5, 14; k1, 10; k2e, 10

B. k5, 14; k4, 13; k1, 10

C. k5, 14; k4, 13; k8, 18

D. k1, 10; k5, 14; k2e, 10

E. k1, 10; k4, 13; k2e, 10

74. The most immediate and important reaction to environmental cooling of the skin is: 

A. Piloerection.

B. Metabolic heat production.

C. Cutaneous vasoconstriction.

D. Cutaneous vasodilation.

E. Increase in the subcutaneous fat layer.75. Langerhans cells may be identified with the following histologic stains EXCEPT: 

A. Adenosine triphosphatase (ATP).

B. Aminopeptidase.

C. OKT 6.

D. Argentaffin.

E. Gold chloride 76. Choose the TRUE response regarding tyrosinase: 

A. It catalyzes the conversion of tyrosine to dihydroxyphenylalanine.

B. It catalyzes the oxidation of dopa to dopaquinone.

C. It converts tyrosine to melanin.

D. It requires dopa as a cofactor in its action.

E. All the above are true77. Which of the following is FALSE regarding hair biology? 

A. The hair matrix gives rise to hair and the inner root sheath.

B. The outer root sheath represents a downward extension of the epidermis.

C. The keratin of cortex represents hard keratin.

D. The inner root sheath contains melanin.

E. The three layers of the inner root sheath keratinize by means of trichohyaline granules.78. Each of the following is true about hair EXCEPT: 

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A. Anagen lasts around 3 years; telogen, 3 months; and catagen, 3 weeks.

B. On the scalp, the average daily growth is approximately 0.4 mm.

C. A loss of around 100 scalp hairs daily is considered normal.

D. Isthmus refers to the upper portion of the hair follicle extending from the entrance of the sebaceous duct to the surface of the skin 

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