ETAS_MCQ_14 plants and creatures of dermatologic significance

Plants and Creatures of Dermatologic Significance1) Name this creature:

A. Demodex folliculorum

B. Ornithonyssus sylviarum

C. Pediculus capitis

D. Pediculus humanusCorrect Choice

E. Pthirus pubis

This is the body louse, or Pediculus humanus var. corporis. The pubic louse (pthirus pubis) is shorter, and squatter. The head louse (pediculus capitis) has a narrow body

2) When doing patch testing for compositae sensitivity, which of the following substances is used?

A. Tuliposide A

B. Rhus

C. Sesquiterpene lactone mix Correct Choice

D. Colophony

E. Pentadecacatechols

Colophony cross reacts with turpentine resin, hairpiece adhesive, mascara, dental cement and others. Pentadecacatechols are in the rhus family and are found in poision ivy, oak and sumac in addition to cross reacting with mango and cashew. Tuliposide A is found in Peruvian lily (alstomeria), and tulip

3) A previously healthy 25-year-old man presents to the ER 8 hours after experiencing an extremely painful spider bite. The bite site is erythematous and indurated, without necrosis or eschar. The patient is vomitting and experiencing chills, violent cramps, and abdominal pain and rigidity. The surgical consultant suspects an acute abdomen. You correctly propose that:

A. The patient has a likely Lycosidae bite and needs supportive care

B. The patient has a likely Loxosceles bite and should go to the OR for excision and debridement

C. The patient needs anti-venom after a likely Phidippus formosus bite

D. The patient has likely experienced a hobo spider bite

E. The patient needs anti-venom after a likely Lactrodectus biteCorrect Choice

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The patient has signs and symptoms a black widow spider bite, caused by Lactrodectus. Anti-venom may be helpful up to 90 hours after the bite

4) Match the photo to the plant identified:

A. Poison oak

B. Poison sumac Correct Choice

C. Mango leaves

D. Gingko

E. Poison ivy

Poison sumac leaves grow in groupings of 7-13 with a single leaf at the tip.

5) All of the following are food mites except:

A. DermatophagoidesCorrect Choice

B. Acarus

C. Glyciphagus

D. All of the listed answers are food mites

E. Tyrophagus

Acarus (grain mite), Tyrophagus (grocery mite), and Glyciphagus (cheese mite) are all food mites that ingest foodstuffs. They can produce papular urticaria or vesicopapular eruptions. Dermatophagoides is the dust mite, and causes environmental allergic reactions.

6) Which of the following statements regarding Megalopyge opercularis is correct?

A. Are also called "bed bugs" by lay people

B. These creatures can be vectors of many diseases from typhus to plague

C. These creatures, found in Hawaii, are nocturnal carnivores that produce painful wounds by discharging venom

D. Contact with this creature often causes immediate pain, urticaria, and erythematous papules or purpura in a tram-track patternCorrect Choice

E. Bites are usually asymptomatic, initially, but then form linear purpuric macules

Megalopyge opercularis (puss caterpillar) is one of the most widespread causes of caterpillar dermatitis. Contact with this creature often causes immediate pain, urticaria, and erythematous papules or purpura in a tram-track pattern. Bites of Cimicidae (bedbugs) are usually asymptomatic, initially, but then form linear purpuric macules. Fleas can be vectors of many diseases from typhus

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to plague. Chilopoda (centipedes) are nocturnal carnivores that produce painful wounds by discharging venom. Scolopendra is a species of centipede found in Hawaii

7) The venom from which of the following creatures contains phospholipase A?

A. Cimicidae

B. Ctenocephalides canis

C. Theraphosidae

D. HoneybeeCorrect Choice

E. Solenopsis invicta

Honeybees (Hymenoptera) leave a barbed ovipositor and paired venom sacs impaled into their victim. The honeybee dies after stinging, but other hymenoptera do not. The venom from the honeybee contains phospholipase A. Theraphosidae (tarantulas) are of dermatologic importance due to the presence of urticating hairs. Cimicidae (bedbugs) cause initially asymptomatic bites that then form linear, purpuric, pruritic macules and erythematous papules. Ctenocephalides canis is a flea that causes frequent infestations on dogs. Solenopsis invicta is the imported fire ant, and attacks in groups. Solenopsis inject a venom that contains a hemolytic factor, solenopsin D

8) Unilateral swelling of the eyelid at the site of the bite of the assassin bug is called what?

A. Rothschild's sign

B. Romana's signCorrect Choice

C. Russell's sign

D. Raynaud's sign

E. Unilateral Chagas' disease

Rothschild's sign is alopecia of the lateral 1/3 of the eyebrows secondary to hypothyroidism. Russell's sign is the development of callouses on the dorsal dominant hand. Raynaud's sign is the development of acrocyanosis

9) A butcher’s nodule is caused by which of the following?

A. HPV 2, 7 Correct Choice

B. HPV 16, 18

C. HPV 1

D. HPV 24

E. HPV 13, 32

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HPV 24 causes common warts. HPV 16 and 18 are found in genital warts; 1 is for plantar warts and types 13 and 32 are seen in Heck’s Disease (focal epithelial hyperplasia

10) Immunologic contact urticaria is frequently caused by:

A. None of these answers are correct

B. Plants of the Urticaceae family

C. Hevea brasiliensisCorrect Choice

D. All of these answers are correct

E. Plants of the Euphorbiacea family

Contact urticaria occurs after direct contact, and can be immunologic (IgE) or non-immunologic (toxin-mediated). Type I hypersensitivity, or IgE mediated reactions, require previous sensitization. Frequent causes of immunologic eruptions include latex proteins (Hevea brasiliensis). Plants such as stinging nettles (Urticaceae family) and spurge nettle (Euphorbiaceas) cause nonimmunologic urticaria, which occurs without previous sensitization in any host.

11) Phytophotodermatitis is caused by which of the following wavelengths of light?

A. 290-320 nm

B. 320-400 nm Correct Choice

C. 100-200 nm

D. 200-290 nm

E. 311 nm

UVA rays are responsible for the phototoxic reaction which occurs with phytophotodermatitis

12) Identify this caterpillar:

A. Greenback caterpillar

B. Hag moth caterpillar

C. Io caterpillar

D. Puss caterpillar

E. Saddleback caterpillarCorrect Choice

This is the saddleback caterpillar, as it appears that the caterpillar is wearing a saddle

13) Which of the following is false regarding this image?

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A. This is a glossina fly

B. This transmits trypanosomes

C. A large abscess may occur following a biteCorrect Choice

D. This transmits sleeping sickness

E. This is the tsetse fly

Cutaneous reactions tend to be minimal from the bite of the tsetse, or glossina, fly which transmits trypanosomes and sleeping sickness

14) Flying squirrels can carry many infections, including which of the following?

A. all of these infections are correctCorrect Choice

B. Toxoplasma gondii

C. Staphlyococcus sp

D. none of these infections are correct

E. Epidemic typhus

Flying squirrels can carry many infections, including Toxoplasma gondii, Staphylococcus sp., and Rickettsia prowazekii (via the body lous, causing epidemic typhus

15) A patient who experiences an allergic contact dermatitis in reaction to an extract from the Pinus palustris tree may also be sensitized to:


B. Varnish

C. Mascara

D. Rosin

E. All of these answers are correctCorrect Choice

Colophony, derived from the Pinus palustris tree, may cross react with rosin, medications, mascara, adhesives, bandages, varnish, wax, paper products, and dental cement

16) A butcher presents with numerous verrucous papules of the hands and fingers. Based on her occupation, you consider a diagnosis of infection with which HPV types?

A. HPV 2 and 7Correct Choice

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B. HPV 1 and 2

C. HPV 6 and 8

D. HPV 16 and 18

E. HPV is not associated with this condition

Meat, fish, and poultry handlers often suffer from hand and finger verrucae, usually caused by human papilloma virus types 2 and 7.

17) This snake, the coral snake, is a member of what family?

A. ElapidaeCorrect Choice

B. Lepidoptera

C. Theraphosidae

D. Crotalidae

E. Apiaceae

The Crotalidae family includes rattlesnakes and copperheads. Lepidoptera are caterpillars. Theraphosidae is the scientific name for tarantulas. Apiaceae (Umbelliferae) is a plant family which includes parsley, celery and fennel. Elapidae is the correct family of snakes, including coral snakes

18) Which of the following plants contains thiocyanates that can cause an irritant dermatitis?

A. Radish

B. All of these answers are correctCorrect Choice

C. Plants of the Brassicaceae family

D. Mustard

E. Garlic

Thiocyanates are found in garlic (Alliaceae family), mustard, and radish (Brassicaceae family

19) This tick transmits:

A. Babesiosis

B. Erlichiosis

C. Rocky mountain spotted feverCorrect Choice

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D. Relapsing fever

E. Lyme

This is Dermacentor variabilis which transmits Rocky Mountain Spotted Fever as well as Tularemia

20) Which family of plants is most commonly implicated in phytophotodermatitis caused by furocoumarins?

A. Moraceae

B. Papilonaceae

C. ApiaceaeCorrect Choice

D. Compositae

E. Rutaceae

The Apiaceae (formerly umbelliferae) family is the most common cause of phytophotodermatitis. The members of this family include cow parsley, celery, wild parsnip, false bishop's weed, giant hogweed, angelica, meadow grass, fennel, wild carrot, caraway, and coriander

21) The reaction caused by this plant is mediated by:

A. IgE

B. Eosinophils

C. Langerhans cellsCorrect Choice

D. Mast cells

E. Histamine

This is ragweed, which causes allergic contact dermatitis. Mast cells, IgE and histamine are characteristic of contact urticaria. Allergic contact dermatitis is caused by langerhans cells presenting antigen to CD4+ lymphocytes leading to a cell-mediated delayed hypersentitivity reaction

22) Which of the following mites is a cause of "walking dandruff" in dogs and cats?

A. All of these answers are correct

B. None of these answers are correct

C. Allodermanyssus sanguineus

D. Acarus

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E. CheyletiellaCorrect Choice

Cheyletiella mites are harbored by dogs and cats and cause walking dandruff. The pet is asymptomatic, but people handling the pet may experience pruritus when mites feed on skin. Diagnosis is by microscopic examination of cellophane tape applied to the pet's skin. Acarus is the grain mite, and causes baker's itch. Allodermanyssus sanguineus is the house mouse mite, and the vector of rickettsial pox

23) Which of the following statements regarding Theraphosidae is correct?

A. All of these statements are correctCorrect Choice

B. These creatures possess urticating hairs that are of dermatologic significance

C. These creatures can cause visual loss by causing a chronic granulomatous reaction (ophthalmia nodosa)

D. None of these statements are correct

E. Bites do not generally produce any systemic toxicity

Theraphosidae (tarantulas) are large, brown to black, hairy spiders frequently found in the southwest. They are of dermatologic importance due to urticating hairs. Tarantula bites generally do not produce any systemic toxicity. The spider releases hairs in the direction of the perceived attacker; hairs can penetrate the skin as deeply as the reticular dermis. If they injure the cornea, they can cause a chronic granulomatous reaction (ophthalmia nodosa) and loss of vision

24) A veterinarian presents with an edematous pustule on the right arm, with nodules along the lymphatic drainage route. You consider a diagnosis of glanders. What treatment do you recommend?

A. Surgical excision followed by antibiotic treatment with streptomycin combined with tetracyclineCorrect Choice

B. Reassurance. No treatment is necessary, as infection is self-limited and should resolve within 6 weeks

C. Surgical excision followed by antibiotic treatment with rifampin and ethambutol

D. Surgical excision

E. Antibiotic treatment with streptomycin combined with tetracycline

Farcy, or glanders, is caused by infection with the gram-negative rod Pseudomonas mallei. It most frequently infects horses, donkeys, and mules; humans can occasionally also be infected. An edematous nodule, pustule, or vesicle develops at the inoculation site. Nodules are often present along the lymphatic drainage route and are called "farcy buds." Importantly, nasal ulceration and septum perforation can be caused by glanders. A chronic form leads to deep, painful abscesses. Treatment is with surgical excision of the lesion followed by streptomycin combined with tetracycline.

25) Ananas comosus causes an irritant dermatitis attributed to which irritant?

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A. Phorbol esters

B. Thiocyanates

C. Capsaicin

D. Ranunculin

E. BromelinCorrect Choice

Ananas comosus is the pineapple. Pineapples contain the irritants bromelin (a proteolytic enzyme) and calcium oxalate (which causes fissures that grant bromelin access to dermal vessels). Capsaicin is found in chili peppers. Phorbol esters are found in spurges, crotons, poinsettas, and machineel trees. Thiocyanates are found in garlic, mustard, and radishes. Ranunculin is found in buttercups

26) This is a:

A. Moth caterpillar

B. Woolybear caterpillarCorrect Choice

C. Brownbear caterpillar

D. Puss caterpillar

E. Furrybear caterpillar

This is a woolybear caterpillar

27) Onions and chives:

A. Are members of the family Anacardiacea

B. Contain diallyl disulfideCorrect Choice

C. Cross-react with artichoke in sensitized patients

D. Contain pentadecylcatechol

E. Are members of the same family as Gingko

Onions, garlic, and chive are members of the family Alliaceae and contain diallyl disulfide (also allylpropyl disulfide, allicin

28) Poison sumac is:

A. A source of colophony

B. The common name for Myroxylon balsamum

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C. A source of tuliposide A

D. The common name for Pinus palustris

E. A member of the Toxicodendron genusCorrect Choice

Poison ivy, oak, and sumac are members of the Anacardiacea family, Toxicodendron genus. Alstromeria (Peruvian lily) is the source of tuliposide A. Myroxylon balsamum is the source of Balsam of Peru. The Pinus palustris tree is the source of colophony

29) Cantharadin is derived from:

A. Ranunculaceae

B. Compositae

C. Lytta vesicatoriaCorrect Choice

D. Pentadecacatechol

E. Solanaceae

Ranunculaceae (buttercup) causes irritant dermatitis. Pentadecacatechol is the rhus antigen found in poison ivy, oak and sumac. Solanaceae (chili pepper) contains capsaicin. Pyrethrin is derived from compositae (chrysanthemum flower). Lytta vesicatoria (spanish fly) is a blister beetle from which cantharadin is made

30) Which of these mites is the most likely cause of a pruritic papulovesicular eruption in a baker?

A. Dermanyssus

B. Dermatophagoides

C. none of the above

D. Cheyletiella

E. AcarusCorrect Choice

Acarus (grain mite) causes so-called "baker's itch." Dermatophagoides (dust mite) causes allergic reactions, Dermanyssus (fowl mite) causes equine encephalitis, and Cheyletiella causes walking dandruff in dogs and cats

31) Lipase is a notable active component of the venom of which of the following spiders?

A. Loxosceles

B. Hidippus

C. ChiracanthiumCorrect Choice

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D. Lactrodectus

E. Lycosidae

The venom of Chiracanthium (sac spiders) contains lipase. The venom of Lycosidae (wolf spiders) is notable for histamine; Lactrodectus (black widow spiders) for alpha lactrotoxin; Hidippus (jumping spiders) for hyaluronidase; and Loxosceles (brown recluse spiders) for sphingomyelinase-D.

32) The reaction in this picture is most likely a result of:

A. UV exposure Correct Choice

B. Child abuse

C. Irritant response from garlic

D. Toxicodendron bullous reaction

E. Nickel

This is an example of phytophotodermatitis. This is a reaction between furocoumarins followed by exposure to UVA

33) Furocoumarins, such as 5-methoxypsoralen or 8-methoxypsoralen:

A. Cause a type IV delayed hypersensitivity reaction after exposure to all wavelengths of UV light

B. Cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light in the 320-400nm rangeCorrect Choice

C. Cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light in the 280-320nm range

D. Cause a photoallergic reaction after contact with the skin, followed by exposure to ultraviolet light in the 320-400nm range

E. Cause a photoallergic reaction after contact with the skin, followed by exposure to ultraviolet light in the 280-320nm range

Unlike photoallergic reactions, which involve the immune system (type IV or delayed hypersensitivity), phytophotodermatitis is non-immunologic. Photoallergic reactions are more frequently caused by other, non-plant sources. Furocoumarins, such as 5-methoxypsoralen or 8-methoxypsoralen, cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light in the UVA range (320 to 400nm).

34) A 47 year old park ranger developed a diffuse, erythematous, eczematous eruption after fighting a forest fire. What is the most likely allergen causing this airborn contact dermatitis?

A. Alphamethylene

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B. Pyrethrins

C. D-usnic acidCorrect Choice

D. Psoralen

E. Diallyl disulfide

Lichen causes airborne allergic contact dermatitis in lumberjacks, forest workers, and people exposed to firewood, funeral wreaths, and masculine fragrances. The primary allergen is d-usnic acid

35) Which disease is transmitted by this insect?

A. Chagas diseaseCorrect Choice

B. Onchocerciasis

C. African sleeping sickness

D. Visceral leishmaniasis

E. Dracunculiasis

This a picture of the reduviid bug, also called the kissing bug or assassin bug. It is the vector for American Trypanosomiasis (Chagas disease), which is caused by Trypanosoma cruzii. The reduviid bug prefers to bite at mucocutaneous junctions

36) Which of the following plants are members of the Solanaceae family?

A. Prickly pear

B. Radish

C. Garlic

D. Crotons

E. Chili pepperCorrect Choice

Chili peppers belong to the Solanaceae family. Prickly pears (Opuntia vulgaris), crotons (Euphorbiaceae family), garlic (Alliaceae family), and radishes (Brassicaceae family) are not members of this family

37) Leishmania donovani is transmitted by:

A. Glossina

B. Callitroga americana

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C. Attagenus megatoma

D. PhlebotomusCorrect Choice

E. Anopheles

Leishmania donovani is transmitted by Phlebotomid sandflies. Callitroga americana is the most important cause of cutaneous myiasis in the United States. Glossina, the tsetse fly, transmits sleeping sickness. Attagenus megatoma is a carpet beetle, the larvae of which can cause an allergic contact dermatitis. Anopheles mosquitoes transmit malaria.

38) Sharp hairs on plants of the Urticaceae family contain which of the following toxins that are released into the skin causing rapid edema, pruritus, and burning?

A. Serotonin

B. Histamine and acetylcholine

C. Acetylcholine

D. All of these answers are correctCorrect Choice

E. Histamine

Sharp hairs on plants such as stinging nettles (Urticaceae family) contain toxins (histamine, serotonin, and acetylcholine) which are released into the skin causing rapid edema, pruritus, and burning

39) Which of the following may NOT occur after contact with the organism in the photo?

A. Loss of vision

B. Purpura in a tram-track pattern

C. Urticaria

D. Pruritus

E. Tram-track calcification on skull x-ray Correct Choice

The most common response is erythema, pruritus and urticaria. Purpura and hemorrhage in a tram-track or ladder pattern may be seen as well. Ophthalmia nodosa may occur if hairs injure the cornea. Tram-track calcification on skull films is seen in Sturge-Weber syndrome

40) A patient comes to you with complaints of numerous erythematous pruritic papules under her bathing suit after swimming in the ocean. What is the most likely diagnosis?

A. Seabather’s eruption Correct Choice

B. Swimmer’s itch

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C. Nematocyst stings

D. Hydrozoa contact

E. Hot tub folliculitis

Sea bather’s eruption is seen after ocean exposure and can be intensely pruritic. It is due to jellyfish larvae (Linuche unguiculata) and can be prevented by rinsing off soon after coming out of the water. Swimmer’s itch is a cercarial dermatitis caused by avian schistosomes which occurs after freshwater exposure. It is usually seen on exposed areas. Portuguese man of war (hydrozoa) stings can lead to hemorrhagic lesions with vesiculations

41) Which of the following plant families commonly causes phytophotodermatitis?

A. Rubiaceae

B. Ranunculaceae

C. Apiaceae Correct Choice

D. Compositae

E. Urticaceae

The Apiaceae family (formerly Umbelliferae) includes parsley, celery, parsnip, hogweed, and fennel, all potential causes of phytophotodermatitis

42) When bitten with the spider in the photograph, the active agent in the venom is:

A. Sphingomyelinase-D

B. Alpha lactrotoxin Correct Choice

C. Lipase

D. Hyaluronidase

E. Histamine

This is a black widow spider which can be identifiec by its shiny black body with characteristic white hourglass marking on the abdomen

43) The vector for Babesia microti is also a vector for:

A. Rickettsia rickettsii


C. Francisella tularensis

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D. Borrelia burgdorferiCorrect Choice

E. All of these answers are correct

The vector for Babesia microti, the pathogenic organism of babesiosis, is Ixodes dammini, which is also a vector for Borrelia burgdorferi, the pathogenic organism of Lyme borreliosis. Francisella tularensis (the pathogenic organism of tularemia) is transmitted by Dermacentor andersoni and Dermacentor variabilis. Rickettsia rickettsii (the pathogenic organism of Rocky Mountain Spotted Fever) is transmitted by Dermacentor andersoni, Dermacentor variabilis, and Amblyomma americanum

44) Allergic contact dermatitis is a:

A. Type III hypersensitivity

B. Type II hypersensitivity

C. Type I hypersensitivity

D. Undetermined hypersensitivity

E. Type IV hypersensitivity Correct Choice

NEEDS EXPLANATIONS


A. Mango leaves

B. Poison ivy

C. Gingko

D. Poison oak Correct Choice

E. Poison sumac

Poison oak is identified by leaf shape - irregular lobing and varied leaf size

46) The insect pictured is:

A. A vector of relapsing fever

B. The cause of maculae cerulea

C. A vector of Lyme borreliosisCorrect Choice

D. Ornithonyssus

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E. A vector of babesiosis

The insect pictured is a female Amblyomma americanum tick. This tick can serve as a vector for Lyme borreliosis and Rocky Mountain Spotted Fever. Relapsing fever is transmitted by Ornithodoros moubata. Babesiosis is trasnmitted by Ixodes dammini. Maculae cerulea are seen in severe cases of crab lice. Ornithonyssus is the fowl mite

47) Which of the following is the most common cause of dermatitis in florists?

A. Sesquiterpene lactones

B. Calcium oxalate Correct Choice

C. Primin

D. Tuliposide A

E. Mechanical dermatitis

Calcium oxalate is present in the bulbs and stems of Narcissus (daffodil

48) Snake bite antivenin is derived from:

A. Pooled IVIg

B. Horse antibodyCorrect Choice

C. Human antibody

D. Mouse antibody

E. Antigen extracted directly from the attacking snake

Following envenomation, antivenins are derived from horses

49) All of the following plants commonly cause a phytophotodermatitis except:

A. Celery

B. Ficus carica

C. Hawaiian lei flowers

D. Myroxylon balsamumCorrect Choice

E. All of these plants commonly cause a phytophotodermatitis

Myroxylon balsamum is the source of Balsam of Peru, a common sensitizer of allergic contact dermatitis. Hawaiian lei flowers, Ficus carica (fig tree), and celery all are known to commonly cause phytophotodermatitis

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50) On slide preparation, many organisms were noted on this patient, as well as occasional blue macules on the buttocks. He most likely has:

A. Chigoe fleas

B. Pediculus capitis infestation

C. Pthirus pubis infestationCorrect Choice

D. Sarcoptes scabiei infestation

E. Pediculus humanus infestation

It is often very easy to find crab lice on physical exam in contrast with scabies. Head lice infestations are usually limited to the scalp. Body lice are not often found on the patient, more commonly in clothing seams. Maculae caerulea can be seen in widespread involvement as in this case

51) Which of the following plants are members of the family Rutaceae?

A. Burning bush

B. Rue

C. All of these answers are correctCorrect Choice

D. None of these answers are correct

E. Bergamot orange

The family Rutaceae includes lime, rue, burning bush, bergamot orange, and Hawaiian lei flowers. Plants from this family commonly cause phytophotodermatitis

52) The toxin holothurin, released by which of the following marine creatures, can cause conjunctivitis in exposed swimmers?

A. Sea cucumberCorrect Choice


C. Chironex fleckeri

D. Edwardsiella lineate

E. Linuche unguiculata

Sea cucumbers are cucumber-shaped bottom-dwellers that can cause conjunctivitis due to release of a toxin called holothurin to which nearby swimmers can be exposed. The larva of Linuche unguiculata (thimble jelly fish) and Edwardsiella lineate (sea anemone) are causes of seabather's eruption (or sea lice). Chironex fleckeri is the box jellyfish; its stings are extremely toxic and may lead to shock and death, especially in small adults and children

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53) Cantharidin creates a vesicle by which of the following mechanisms?

A. Subcorneal layer separation

B. Instability of the hemidesmosome

C. Antibodies to desmosomal proteins

D. Local recruitment of neutrophils

E. Disruption of keratinocyte-keratinocyte adhesion Correct Choice

Desmosomal adhesions are interrupted by proteases with eventual tonofilament detachment

54) Patients with an allergy to the compositae family may have an allergic reaction to which of the following drugs?

A. Pyruvic acid

B. Pyrethrins Correct Choice

C. Psoralens

D. Propylene glycol

E. Pseudoephedrine

Pyrethrins are derived from chrysanthemum flowers. Patients with allergy to these flowers or ragweed may experience allergic symptoms after using pyrethrins

55) This patient complains of intense itching at this site. KOH examination is negative. She denies any recent travel, however does take her 2 year old to the local playground where there is a sandbox. Which of the following is appropriate?

A. Give her clobetasol ointment

B. Slowly extract the organism

C. Inform the patient she is contagious and should isolate herself from her children

D. Treat with po ivermectin Correct Choice

E. Obviously this is dermatophyte despite a negative KOH. Treat with topical antifungals

This is hookworm, or cutaneous larva migrans; systemic ivermectin or topical thiobendazole would be appropriate treatments. The causative organism is the larvae of Ancylostoma braziliensis or A. canium

56) This creature can do the following EXCEPT:

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A. Cause a painful sting

B. Transmit Yersinia pestisCorrect Choice

C. Cause anaphylaxis

D. Be used as a natural control for the tick population

E. Build large characteristic mounds

This is a fire ant. In some parts of the world, they are used as a natural tick control as they are scavengers and consumers of tick eggs. They can cause anaphylaxis in an allergic person. They do not transmit disease. The mounds are characteristic in appearance

57) Babesia microti:

A. Is transmitted by Ixodes dammini

B. All of these answers are correctCorrect Choice

C. None of these answers are correct

D. Is an intracellular parasite

E. Is pathogenic in an infection that is endemic on Martha's Vineyard

Babesiosis is caused by an intracellular RBC parasite, Babesia microti. It is transmitted by the larvae of Ixodes dammini. This disease is endemic in eastern Long Island, Martha's Vineyard, and Nantucket, and carries an increased risk in those with T-cell depression or after splenectomy. The condition is associated with fever, drenching sweats, myalgias, and hemolytic anemia

58) Which chemical is present in large quantities of this insect's venom?

A. Lipase

B. Hyaluronidase

C. Sphingomyelinase D

D. Alpha lactrotoxin

E. HistamineCorrect Choice

The spider shown is the Wolf spider (Lycosidae). This Australian spider's bites contains large amounts of histamine. Bites are painful with edema, erythema and subsequent lymphangitis

59) Which of the following is false?

A. Divers are at risk of contacting these creatures

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B. Only pigmented varieties pose any riskCorrect Choice

C. These spines may contain toxins

D. This is a sea urchin

E. Granulomas can form around the spines if not removed

This is a sea cucumber. A small fraction of spines contain toxins which affect humans. Divers may step on these creatures which is quite painful. Spines should be removed to avoid foreign body reactions

60) Which of the following mites is also known as the chigger and often causes intense pruritus on the ankles, legs, or belt line?

A. Glyciphagus

B. Allodermanyssus sanguineus

C. Trombicula alfreddugesi Correct Choice

D. Demodex

E. Ornithonyssus

Trombicula alfreddugesi (chigger mite, harvest mites) frequently causes intense pruritus on the ankles, legs, or belt line. Contact occurs during summer and fall. In sensitized individuals, papular urticaria, vesiculation, or a granulomatous reaction with fever and lymphadenopathy may occur. Allodermanyssus sanguineus (house mouse mite) is the vector of rickettsial pox. Demodex folliculorum is a mite that can live within the sebaceous glands of hair follicles and may be important in some subsets of patients with acne rosacea, as well as patients with HIV infection and folliculitis. Glyciphagus (cheese mite) is the cause of grocer's itch. Ornithonyssus (fowl mite) can carry Western equine encephalitis

61) Contact urticaria is a:

A. Type II hypersensitivity

B. Type I hypersensitivity Correct Choice

C. Type III hypersensitivity

D. Undetermined hypersensitivity

E. Type IV hypersensitivity

NEEDS EXPLANATIONS

62) Which of these spiders is bright green with red spots, with black spines on its legs?

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A. Phidippus formosus

B. Loxosceles reclusa

C. Latrodectus mactans

D. Peucetia viridansCorrect Choice

E. Centruroides sculpturatus

Peucetia viridans (green lynx spider) is common in the southern United States. It is bright green with red spots; the legs have black spines. The bite is painful, with tenderness and pruritus. Phidippus formosus (jumping spider) is an aggressive spider with dark body hairs and various white patterns. They are the most common biting spiders in the United States. Loxosceles reclusa (brown recluse) is a tan spider with a violin-shaped marking on the abdomen. The bite may be painless, however the patient may develop erythema, a vesicle, and eventual necrosis. Latrodectus mactans (black widow) is a large, black, shiny spider with an hourglass shaped white marking on the abdomen. Bites are acutely painful, and may swell but do not cause necrosis; the venom contains neurotoxins. Centruroides sculpturatus is a primary scorpion species in the U.S

63) Mechanical irritant dermatitis can be caused by:

A. GlochidsCorrect Choice

B. Bromelin

C. Stinging nettles

D. Capsacin


Mechanical irritant dermatitis can be caused by the direct effects of thorns and barbs. Small glochids (barbed hairs or brisles) or large thorns (on cacti for example) can become imbedded into the skin causing injury and resultant dermatitis. Secondary infection can be caused by microorganism inoculation

64) Which of the statements regarding Tegenaria agrestis is correct?

A. This creature is the leading cause of necrotic arachnidism in several states of the Pacific NorthwestCorrect Choice


C. Contact with this creature results in erythematous papules, hemorrhage, or purpura in a classic "tram-track" pattern

D. Stings from this scorpion can produce cardiovascular complications

E. This ant injects a venom that contains a hemolytic factor, solenopsin D

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Tegenaria agrestis (the Hobo spider) is the leading cause of necrotic arachnidism in several states of the Pacific Northwest. These spiders are large, with a herringbone-striped pattern on the abdomen. Contact with caterpillars (Lepidoptera) may produce lesions in a classic "tram-track" pattern. Solenopsis (fire ants) ants inject a venom that contains a hemolytic factor, solenopsin D, that causes a release of histamine and other vasoactive amines from mast cells

65) Insects from the species pictured:

A. Trasmit yellow fever

B. Transmit malaria and yellow fever

C. Transmit dengue fever

D. Trasmit yellow fever and dengue feverCorrect Choice

E. Transmit malaria

The insect pictured is an Aedes mosquito. Aedes transmits yellow fever and dengue fever. Anopheles mosquitoes transmit malaria

66) A 52 year-old gardener presents with innumerable linear hyperpigmented streaks across the chest and arms. He states that several weeks previously he had a painful, erythematous, blistering eruption at the same site. The most likely botanical cause for this eruption is:

A. Plants of the Alliaceae family

B. Lime

C. HogweedCorrect Choice

D. Peruvian lily

E. Ragweed

The gardener has so-called "strimmer dermatitis." The use of a weed-whacker may result in a spray of weeds (such as cow parsley, wild chervil, and hogweed) leading to this phytophotodermatitis on exposed areas such as the chest and arms

67) Identify this plant:

A. Alstromeria

B. Toxicodentron

C. Myroxylon balsamum

D. PrimroseCorrect Choice

E. Ragweed

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This is primrose (primulaceae) a cause of allergic contact dermatitis

68) Necrosis may be seen in which of the following:

A. Allergic contact dermatitis

B. Irritant contact dermatitis Correct Choice

C. Dermatographism

D. Contact urticaria

E. Acute urticaria

Necrosis may be seen in severe irritant reactions. The other reactions do not involve necrosis

69) Which creature is a human flea that can also be seen on dogs?

A. Liponyssoides sanuineus

B. Pulex irritansCorrect Choice

C. Lytta vesicatoria

D. Ctenocephalides canis

E. Pediculus humanus

Pulex irritans is the human flea; it can also be seen on dogs. More frequent infestations on domestic animals are by Ctenocephalides felis and canis (on cats and dogs respectively). Lytta vesicatoria is a blister beetle from which cantharadin is derived. Pediculus humanus var. corporis is the human body louse.

70) Which of the following is a complication of Thermage treatment?

A. Hyperpigmentation

B. LipoatrophyCorrect Choice

C. Keloid formation

D. Granuloma formation

E. Herpes simplex infection

Thermage (ThermaCool) is a nonablative radiofrequency-based system which uses volumetric heating to induce tightening of the skin and dermal remodeling. Lipoatrophy is a late-occurring potential complication of this technology

71) Which of the following is not a hallmark of allergic contact dermatitis?

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A. Eosinophils

B. Neutrophils Correct Choice

C. Langerhans cells

D. CD4+ Lymphocytes

E. Vesicles

Langerhans cells present the antigens to CD4+ lymphocytes in the dermis and after traveling through lymphatics to regional lymph nodes. Eosinophils may also be present. Neutrophils are not characteristic of this reaction

72) The female Sarcoptes scabiei var. hominis mite can lay up to 100 eggs. It has an ovoid, flat body and how many short legs?

A. 10

B. 6


D. 12

E. 8Correct Choice

The female Sarcoptes scabiei var. hominis mite has an ovoid, flat body and 8 short legs

73) Which snake is part of the Crotalidae family?

A. Garden snake

B. Coral snake

C. RattlesnakeCorrect Choice

D. Cobra

E. Water snake

The Crotalidae family includes rattlesnakes and copperheads. The coral snake is part of the elapidae family

74) A 22 year-old man presents with an irregular laceration on the dorsal metacarpals following a fist fight in which he struck someone in the mouth. The tissue surrounding the wound is erythematous, edematous, indurated, warm, and tender. There is some purulence of the wound. You consider infection with:

A. Erysipelothrix rhusiopathiae

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B. Eikenella corrodensCorrect Choice

C. Pasteurella multocida

D. Pasteurella canis

E. Capnocytophaga

Human bites may result in infection with Eikenella corrodens, a gram-negative bacillus that is part of the normal flora of the human mouth. This infection can follow fist fights with blows to the mouth

75) Which of the following infections is commonly known to occur from contact with infected sheep?

A. Oculoglandular syndrome of Parinaud

B. Infectious pustular dermatitis

C. Cutaneous anthrax

D. Infectious pustular dermatitis and cutaneous anthraxCorrect Choice

E. Erysipeloid

Infectious pustular dermatitis is another name for orf, or ecthyma contagiosum. It is transmitted to humans by a parapoxvirus in sheep, goats, and reindeer. Cutaneous anthrax is also called "woolsorter's disease" and is caused by Bacillus anthracis, a gram-positive rod transmitted from contact with carcasses of infected sheep, cows, goats, and horses. The oculoglandular syndrome of Parinaud is the combination of granulomatous conjunctivitis and preauricular lymphadenopathy seen in cat-scratch disease

76) A goat farmer presents with fever and flu-like symptoms, as well as violaceous papulonodules on the trunk and lower extremities. You consider Malta fever in your differential diagnosis. Which of the following statements regarding this diagnosis is correct?

A. Skin lesions are infrequently seen



D. Treatment is with rifampin

E. Treatment is with doxycycline

Malta fever is another name for Brucellosis. This infection is caused by ingesting raw goat milk and unpasteurized goat cheese infected with Brucellae (gram-negative rods). It is infrequent in the US, occurring mainly in veterinarians and farmers. Acute brucellosis has very non-specific features and presents as a flu-like illness. Skin lesions are infrequent (20% of cases) but are usually violaceous papulonodules on the trunk and lower extremities. Treatment is with doxycycline or rifampin

77) Which disease is transmitted by this insect?

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A. Visceral leishmaniasis

B. African sleeping sickness

C. OnchocerciasisCorrect Choice

D. Chagas disease

E. Dracunculiasis

The insect depicted is the black fly, Simulium species. The black fly is the vector for onchocerciasis, which is caused by onchocerca volvulus. Clinical manifestation of this disease include atrophy, depigmentation and thickening of the skin. In addition, the infection may cause "river blindess" and onchocercomas, which are nodules containing microfilariae

78) This organism is:

A. Chigoe flea

B. Pthirus pubis Correct Choice

C. Pediculus capitis

D. Pulex irritans

E. Pediculus humanus

This is a crab louse. It is shorter and wider than the head and body louse. Note the crab-like claws

79) A 54 year-old man with psoriatic arthritis on methotrexate and infliximab calls you after he is bitten deeply on the ankle by his daughter's 2 year-old Chihuahua. He is concerned that his immunocompromised status puts him at risk for infection and potential complications from this bite. You correctly tell him:

A. Capnocytophaga from dog bites can cause sepsis in immunocompromised victimsCorrect Choice

B. As long as the dog has been vaccinated, he need not worry about serious infections

C. Eikenella corrodens is the most common cause of infection following dog bites

D. Pasteurella multocida infection is frequent after dog bites but not cat bites

E. Rickettsial pox can be seen after dog bites

Local infection and cellulitis is a concern following domesticated animal bites; vaccination may prevent against rabies, but not other infections. Cat bites most frequently result in Pasteurella multocida infections, while dog bites result in Pasteurella canis. However, most bites are polymicrobial with mixed aerobes and anaerobes. Infrequently systemic infections may result in brain or lung abscess, endocarditis, or sepsis. Sepsis is more frequent in immunocompromised victims and may be due to Capnocytophaga or Pasteurella

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80) What is the initial treatment of choice for this dermatitis?

A. Warm compresses

B. Topical steroid

C. Topical antibiotics

D. 5% acetic acidCorrect Choice

E. Observation

The linear appearance of the dermatitis is typical of jellyfish stings. To prevent further nematocyte activation, 5% acetic acids should be applied for 15-30 minutes. Papain found in meat tenderizers or 70% isopropyl alcohol may also be applied. Warm compresses are contraindicated as they may increase systemic absorption of the venom

81) Pineapples contain which of the following proteolytic enzymes?


B. BromelinCorrect Choice

C. Phorbol esters

D. Ranunculin


Bromelin is a proteolytic enzyme found in pineapples. It is granted access to dermal vessels by calcium oxalate-induced fissures. Phorbol esters are found in plants of the Euphorbiaceae family. Ranunculin is an irritant found in buttercups (Ranunculaceae family

82) Which of the following infections is caused by a gram-positive rod?

A. Brucellosis

B. Erysipeloid of RosenbachCorrect Choice

C. Cat-scratch disease

D. Milker's nodule

E. Glanders

Erysipeloid of Rosenbach is an infection with Erysipelothrix insidiosa or Erysipelothrix rhusiopathiae, gram-positive rods. Brucellosis is caused by infection with Brucellae (gram-negative rod). Cat-scratch disease is caused by infection with Bartonella henselae, a gram-negative rod. Glanders is caused by infection with Pseudomonas mallei, a gram-negative rod. Milker's nodule is caused by the paravaccinia viurs, a parapoxvirus related to the orf virus

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83) Which of the following vectors transmits Borrelia duttonii?

A. Rhipicephalus sanguineus

B. Amblyomma americanum

C. Ornithodoros moubataCorrect Choice

D. Ixodes pacificus

E. none of the above

Borrelia duttonii is a pathogenic organism of relapsing fever. It is transmitted by Ornithodoros moubata. Ixodes pacificus is one of the vectors of Lyme Borreliosis. Rhipicephalus sanguineus is a vector of Ehrlichiosis. Amblyomma americanum is a vector of Lyme Borreliosis and Rocky Mountain Spotted Fever

84) Ehrlichiosis is classified in two primary forms. These are:

A. Intracellular and extracellular

B. Primary and secondary


D. Endemic and epidemic

E. Monocytic and granulocyticCorrect Choice

Ehrlichiosis comes in two forms: monocytic, which invades mononuclear WBCs, and granulocytic, in which peripheral PMNs show intracytoplasmic inclusions. Patients present with fever, chills, headache, and myalgias, along with leukopenia, anemia, and thrombocytopenia

85) Capsaicin causes which of the following?

A. Blocking the influx of sodium ions into the cell

B. Decreased firing of nerve fibers transmitting pain

C. Increased substance P release Correct Choice

D. Creating a barrier between nerves and their stimuli

E. Decreased substance P release

Repeated substance P release leads to eventual depletion of this agent which causes pain transmission

86) Which of the following infections is caused by a gram-negative rod?

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A. Bacillary angiomatosis

B. Malta fever


D. Farcy

E. All of these answers are correctCorrect Choice

Malta fever is another name for Brucellosis, an infection caused by Brucellae (gram-negative rod). Farcy is another name for Glanders, an infection with the gram-negative rod Pseudomonas mallei. Bacillary angiomatosis is caused by infection with Bartonella henselae, a gram-negative rod

87) Sesquiterpene lactones are found in which of the following plants?

A. Alstromeria

B. Pinus palustris

C. Gingko

D. ArtichokeCorrect Choice

E. Chive

Sesquiterpene lactones are sensitizers found in plants of the Asteraceae (Compositae) family. Members include ragweed, pyrethrum, chrysanthemum, weeds, feverfew, and artichoke. The sensitzer found in alstromeria (Peruvian lily) is tuliposide A (a glycoside). The Pinus palustris tree is the source of colophony. Chives contain diallyl disulfide. Gingko fruit pulp is a sensitizer


A. Compositae

B. Alstromeria Correct Choice

C. Primulaceae

D. Anacardiacea

E. Alliaceae

Alstromeria is pictured

89) Which of the following contains active furocoumarins?

A. Fig Correct Choice

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B. Lichens

C. Mango

D. Chrysanthemum

E. Primrose

The fig tree may cause a phytophotodermatitis

90) The necrosis and hemolysis that can result from a brown recluse spider bite may be attributed to which of the following toxins?

A. Lipase

B. Sphingomyelinase-DCorrect Choice

C. Alpha lactrotoxin

D. Hyaluronidase

E. Histamine

The brown recluse spider (Loxosceles reclusa) is a tan spider with a violin-shaped marking on the abdomen. Its bite may be painless, however the patient may develop erythema, a vesicle, and eventual necrosis. This may result in the "red, white, and blue sign." Systemic reactions (viscerocutaneous loxoscelism) may occur. The venom contains several toxins, however sphingomyelinase D seems to be causative of the necrosis and hemolysis

91) This patient acquired an infection with a microorganism that may have been inoculated into the skin from contact with:

A. Grasses

B. Rose thorns


D. Sphagnum moss

E. None of these answers are correct

This patient has sporotrichosis, which is caused by Sporothrix schenckii. Sporothrix schenckii can be inoculated into the skin by grasses, sphagnum moss, and rose thorns

92) If suspicious for scabies infestation, which of the following areas is least likely to be involved?

A. External genitalia

B. Umbilicus

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C. Fingerwebs

D. Nipples

E. Occipital scalpCorrect Choice

Erythematous papules and burrows are commonly seen in webspaces, nipples, external genitalia, umbilicus and axilla in sarcoptes scabiei infestation

93) Which of the following statements regarding orf is correct?

A. Orf is also known as "pseudocowpox."

B. Lesions last indefinitely without treatment

C. The papillomatous stage of lesion progression preceeds the regenerative stage

D. The virus is very sturdy and survives many months in cold weatherCorrect Choice

E. The papular stage of lesion progression follows the target stage

Orf, also known as ecthyma contagiosum or infectious pustular dermatitis, is transmitted to humans by a parapoxvirus in sheep, goats, and reindeer. This is a self-limited condition with an excellent prognosis lasting approximately 6 weeks. Lesion morphology changes through a series of stages: papular (red, elevated) -> target (nodule with red center, white middle ring, red periphery) --> acute (red, weeping) --> regenerative (thin, dry crust overlying lesion) --> papillomatous --> regressive. The virus is very sturdy and survives many months in cold weather. Milker's nodule, caused by the paravaccinia virus (a parapoxvirus, related to the orf virus), infects cows and can be transmitted to dairy workers, and is also known as pseudocowpox

94) The majority of phytophotodermatitis is caused by plants from which family?

A. ApiaceaeCorrect Choice

B. Compositae

C. Liliaceae

D. Alliaceae

E. None of these answers are correct

The Apiaceae family (formerly Umbelliferae) includes parsley, celery, parsnip, hogweed, and fennel, and causes the majority of phytophotodermatitis

95) Thorns and barbs on blackberry bushes have been known to cause secondary infection through inoculation of:


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B. Mycobacterium ulcerans

C. Sporothrix schenckii

D. All of these answers are correct

E. Mycobacterium kansaiiCorrect Choice

Thorns and barbs on blackberry bushes have been known to cause secondary infection through inoculation of Mycobacterium kansaii. Sporothrix schenckii can be innoculated by grasses, sphagnum moss, and rose thorns. Mycobacterium ulcerans has been innoculated by spiky tropical vegetation


A. Toxicodendron

B. Compositae Correct Choice

C. Primulaceae

D. Alstromeria

E. Alliaceae

This is ragweed, a member of the compositae (or asteraceae) family

97) Plants from the family Moraceae include which of the following?

A. All of these answers are correct

B. Fennel


D. Burning bush

E. Ficus caricaCorrect Choice

Ficus carica (fig tree) is a member of the family Moraceae and a cause of phytophotodermatitis. Burning bush is a member of the family Rutaceae. Fennel is a member of the family Apiaceae

98) Identify this tick:

A. Dermacentor andersoni

B. Rhipicephalus sanguineus

C. Dermacentor variabilis

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D. Amblyomma americanumCorrect Choice

E. Ixodes dammini

This is Amblyomma americanum which transmits Lyme as well as RMSF

99) Which of the following is a common cause of seabather's eruption?

A. Linuche unguiculata

B. Thimble jelly fish


D. Edwardsiella lineate

E. Sea anemone

Seabather's eruption (or sea lice) can be sporadic or part of an outbreak. Clinically, it appears as dermatitis beneath areas covered by swim suits. The geographic distribution is most frequent from the Caribbean to Bermuda, however there have been three outbreaks at Long Island, NY beaches. A variety of cnidarian larvae can cause this eruption, including thimble jelly fish (Linuche unguiculata) and sea anemone (Edwardsiella lineate). Quick removal of bathing suits and rinsing can help with prevention. Symptom relief is the mainstay of therapy

100) Phytophotodermatitis caused by skin exposure to limes is caused by:

A. D-limonene

B. Furocoumarin Correct Choice

C. Tuliposide A

D. Sesquiterpene lactone

E. Ascorbic acid

Phytophotodermatatitis (phototoxic eruptions from plants) are relatively commonly seen in florists, nursery personnel, gardeners, and farm workers. Plants that cause this eruption may produce photoxins such as furocoumarins Fig, fennel, lime, lemon, parsley, celery, dill, and hogweed are all causes of phytophotodermatitis

101) “Strimmer” dermatitis is caused by which of the following?

A. M. marinum

B. Lime

C. Pseudomonas

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D. Cryptococcus

E. Chervil Correct Choice

Strimmer dermatitis is a phytophotodermatitis caused by spray of plant matter when using a weed-whacker or similar trimming tool

102) Identify this insect:

A. Water flea

B. Tsetse fly

C. Mango fly

D. Reduviid bugCorrect Choice

E. Phlebotomous sandfly

This a picture of the reduviid bug, also called the kissing bug or assassin bug. It is the vector for American Trypanosomiasis (Chagas disease), which is caused by Trypanosoma cruzii. The reduviid bug prefers to bite at mucocutaneous junctions

103) Solenopsin D is a:

A. Phospholipase

B. Piperdine derivative

C. Hemolytic factor

D. Hemolytic factor, piperdine derivative, histamine-releaserCorrect Choice

E. Histamine-releaser

Solenopsin D is a venom which is a hemolytic factor, a piperidine derative and leads to histamine release. The venom from honeybeeds contains phospholipase A

104) The majority of naturally-occurring cases of anthrax:

A. Are extra-cutaneous

B. Are acquired through ingestion of spores

C. Are pulmonary

D. Are cutaneousCorrect Choice

E. Are oropharyngeal

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The majority (95%) of naturally-occurring cases of anthrax are of the cutaneous form, acquired from direct contact with the carcasses of dead sheep, cows, goats, and horses. Naturally-occurring pulmonary, gastrointestinal (acquired by ingestion of spores) and oropharyngeal infection with anthrax is less common

105) Ticks of the species shown:

A. Can transit tularemia but not Rocky Mountain Spotted Fever

B. Can transmit Rocky Mountain Spotted Fever and tularemiaCorrect Choice

C. Can transmit Lyme borreliosis but not Rocky Mountain Spotted Fever or tularemia

D. Can transmit Rocky Mountain Spotted Fever and Lyme borreliosis

E. Can transmit Lyme borreliosis and tularemia

The tick pictured is a male Dermacentor variabilis tick. Dermacentor variabilis can transmit Rocky Mountain Spotted Fever and tularemia. Lyme borreliosis is transmitted by Ixodes dammini, Ixodes pacificus, and Amblyomma americanum.

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Health & Medicine

ETAS_MCQ_14 plants and creatures of dermatologic significance