Trial test · Dermatologist MCQs (Prometric)

Question 1 of 10

Histology from an established scarring alopecia shows permanent destruction of the epithelial compartment near the arrector pili insertion. Loss of which cell population best explains irreversible failure of follicular regeneration?

Hair follicle bulge stem cells

Sebaceous gland basal progenitors

Dermal papilla mesenchymal cells

Hair matrix transient amplifying cells

Question 2 of 10

Two hematoxylin-and-eosin sections obtained at different levels through the same hair-follicle region.

A small facial biopsy shows basaloid epithelial islands on one histologic level, initially raising concern for basal cell carcinoma. The displayed paired sections are adjacent levels from the same specimen. Which interpretive step best avoids a false-positive diagnosis?

Order direct immunofluorescence testing

Apply fungal special stains

Measure Breslow tumor thickness

Review deeper serial sections

Question 3 of 10

After ultraviolet exposure, melanosomes transferred from melanocytes are reorganized within neighboring keratinocytes. Which intracellular arrangement most directly protects keratinocyte genomic DNA from ultraviolet injury?

Supranuclear melanin caps in keratinocytes

Keratinized pigment within corneocytes

Increased melanocyte numbers in epidermis

Dermal melanophages surrounding capillaries

Question 4 of 10

Both great toenails show yellow-brown discoloration, distal nail dystrophy, thickening, and subungual keratinous change.

A 62-year-old is considering a twelve-week course of oral terbinafine for slowly progressive bilateral great-toe nail abnormalities. He has no known psoriasis or recent nail trauma. The nails are shown. What should be done before systemic antifungal treatment is prescribed?

Begin oral itraconazole before mycologic confirmation

Obtain mycologic confirmation before oral treatment

Begin oral fluconazole before mycologic confirmation

Begin oral terbinafine before mycologic confirmation

Question 5 of 10

A 78-year-old has three weeks of severe pruritus followed by widespread tense blisters with minimal mucosal involvement. Representative lesional histology is shown. The patient can reliably apply treatment with caregiver assistance. Which initial therapy is preferred?

Oral dapsone anti-inflammatory therapy

Superpotent topical corticosteroid therapy

Oral doxycycline anti-inflammatory therapy

Oral prednisone systemic therapy

Question 6 of 10

Clinical photograph showing a linear depression over a superficial forearm vein, the characteristic groove sign of eosinophilic fasciitis. Sitecore +1

A 48-year-old develops symmetric painful forearm and leg induration after unusually strenuous exercise. Eosinophilia is present, Raynaud phenomenon is absent, and the hands are spared. The forearm finding is shown. Which biopsy technique best confirms the diagnosis?

Perilesional punch biopsy for immunofluorescence

Superficial shave biopsy of epidermis

Four-millimeter punch biopsy of dermis

Full-thickness incisional biopsy including fascia

Question 7 of 10

A 6-year-old has recurrent non-scarring blisters at friction sites since infancy. Genetic testing identifies a pathogenic KRT14 variant. Which structural defect most directly explains the skin fragility?

Basement-membrane anchoring-fibril failure

Suprabasal desmosomal cadherin failure

Basal keratin intermediate-filament fragility

Cornified-envelope protein cross-linking failure

Question 8 of 10

A 41-year-old has spontaneous wheals almost daily for nine months. Individual lesions disappear within 12 hours without bruising. Symptoms remain severe despite regular second-generation H1 antihistamine at four times the standard dose. Which treatment should be added next?

Add omalizumab therapy

Add cyclosporine therapy

Add prednisone maintenance

Add montelukast monotherapy

Question 9 of 10

Clinical photograph documenting palmoplantar pustulosis with a pustular lesion on palmar skin. Вікімедія Коммонс +1

A 52-year-old smoker has recurrent sterile pustules confined to the palms and soles. Bacterial and fungal cultures are negative, and the current palm is shown. Disease is limited and has not yet received prescription treatment. Which initial therapy is most appropriate?

Biologic systemic therapy

Ultrapotent topical corticosteroid ointment

Oral acitretin systemic therapy

Methotrexate systemic therapy

Question 10 of 10

A 39-year-old has a persistent photosensitive facial plaque for 10 months. Anti-Ro/SSA is negative, and there are no systemic symptoms. The current lesion is shown. Which diagnosis is most likely?

Discoid lupus erythematosus

Subacute cutaneous lupus

Facial plaque psoriasis

Lupus erythematosus tumidus