NMS Q&A Family Medicine

Dermatology 307(A) Squamous cell carcinoma(B) Malignant melanoma(C) Basal cell carcinoma(D) Seborrheic keratosis(E) Actinic keratosis11 A 28-year-old white male former college basketballplayer complains of intermittent arthralgias over thepast 3 months, which involve the left ring finger proximalinterphalangeal joint (PIP) and right index andmiddle finger distal interphalangeal (DIP) joints. Headmits to morning stiffness. On examination, you notedysplasia of the right index nail with some pitting. Theremainder of the integument is within normal limits.Which of the following is the most likely diagnosis?(A) Rheumatoid arthritis(B) Psoriatic arthritis(C) Osteoarthritis(D) Gouty arthritis(E) Traumatic arthritis12 A 35-year-old man comes to you with the complaintof a rash virtually covering the anterior chest andabdomen to well below the beltline and the upper halfof his posterior trunk. The patient has taken neitherprescription nor over-the-counter medications. Sinceonset, the course has been steady, without waxing orwaning in intensity. The lesions are papulosquamousand ovoid with their long axes oriented more or lesshorizontally, tilting downward and laterally. He hashad the rash for about 1 week and remembers a periodof mild malaise and slight nausea 3 weeks ago. Oncloser examination, you find neither vesiculation norbulla formation. The patient says he has not changedsoaps and wears cotton T-shirts that are tucked outsideof his underwear that is made of a synthetic fiber.You look for a larger patch that may have precededthe rash and find none. The patient is monogamousand shows neither oral nor palmar lesions. Which ofthe following is the most likely diagnosis?(A) Pityriasis rosea(B) Secondary syphilis(C) Contact dermatitis(D) Nummular eczema (neuro eczema)(E) Food allergy13 A blond mother of a red-headed daughter seeksinformation to fortify her in counseling her teenageddaughter not to pursue suntans during the summermonths. Which of the following is the least protectiveof skin against skin cancer and aging?(A) Avoidance of sun exposure between the hoursof 10 AM and 2 PM(B) Daily low-grade exposure to sunlight (e.g.,experienced by people in outdoor occupations)(C) Use of sunscreens that block ultraviolet B(UVB)(D) Use of sunscreens that block UVB andultraviolet A (UVA)(E) Sunlight exposure to normally unexposed areasof the body only during special occasions suchas trips to the beaches and winter vacations intropical or semitropical latitudes14 A 45-year-old black woman complains to you ofhyperpigmented spotty areas on her lower legs, especiallyprominent just above the medial malleoli. Shereminds you that, last month, you treated her successfullyfor itching patches in those areas that hadbeen present for several weeks. She is concerned fromthe cosmetic point of view and worries as to thecause. You notice no fasciculations. Which of the followingis the diagnosis of the condition?(A) Hyperpigmentation caused by Addison disease(B) Melanoma(C) Acanthosis nigricans(D) Hyperpigmentation secondary to inflammation(E) Pigmented seborrheic keratosis15 Your patient, a 45-year-old white woman, complainsto you of having irregular menses, being overweight,and having hair on her upper lip. On examination, inaddition to the foregoing, you notice a pigmentedvelvety thickening of the skin in 3- to 4-cm patcheson her dorsal neck surface and deep in the axillae.Her palms and sublingual areas are unremarkable.Which of the following is the likely diagnosis?(A) Addison disease(B) Seborrheic keratoses(C) Nummular eczema(D) Epidermoid cysts(E) Acanthosis nigricans16 Regarding the patient in Question 12, to which ofthe following endocrine conditions should you bealert?(A) Polycystic ovary syndrome (PCOS)(B) Autoimmune thyroiditis(C) Addison disease(D) Graves disease(E) Pregnancy17 A 35-year-old woman complains that, for about ayear, she has had a mysterious rash involving her facethat is nonpruritic. She stopped using topical facialmake-up preparations 6 months ago. In the past2 months, she has noticed muscle weakness of theneck, trunk, and limbs. You see on inspection that hereyes manifest a purple discoloration and discernible