Internal-Medicine

42 2: Skin
32. A 32-year-old woman comes to the emergency
department because of a generalized erythematous
skin rash. She was recently started on
trimethoprim-sulfamethoxazole (Septra) for a
urinary tract infection. Examination shows the
diffuse rash involving her whole body including
the palms and soles. Except for generalized lymphadenopathy,
the rest of the examination is
normal. Which of the following is the most
appropriate interpretation of the generalized
lymphadenopathy finding?
(A)
(B)
(C)
(D)
(E)
a viral infection
pyoderma
lymphoma
leukemia
nothing specific
33. A 62-year-old man develops scaling and nonscaling
patches, and plaques over his chest and
back. They are itchy, but not painful. The rest of
the examination is normal, except for lymphadenopathy.
Examinations of the blood film
and skin biopsy histology, both, reveal unusually
large monocytoid cells. Which of the following is
the most likely diagnosis? (See Fig. 2–9.)
34. Which of the following statements about the
prognosis of cutaneous T-cell lymphoma is
true?
(A) rapidly downhill
(B) determined by the type of medical care
(C) rarely fatal
(D) remissions and exacerbations, but with
eventual progression to a fatal outcome
(E) eventual complete recovery, regardless
of treatment
35. Which of the following treatments is used for
most patients with cutaneous T-cell lymphoma?
(A) antibiotics
(B) antiviral medication
(C) aggressive systemic chemotherapy to
ensure cure
(D) symptomatic treatment
(E) early use of high-dose systemic steroids
36. A 72-year-old man is newly diagnosed with
bullous pemphigoid. Which of the following is
the most appropriate next step in the management?
(A)
(B)
(C)
(D)
(E)
leukemia
visceral B-cell lymphoma
primary cutaneous T-cell lymphoma
viral infection (usually Epstein-Barr)
paraneoplastic syndrome secondary to
lung cancer
(A)
(B)
(C)
(D)
(E)
plasmapheresis
low-dose prednisone (10–20 mg/day)
high-dose prednisone (50–100 mg/day)
azathioprine 150 mg/day
dapsone (100–150 mg/day)
37. Which of the following features indicates a
more negative prognosis for patients with
malignant melanoma?
(A)
(B)
(C)
(D)
(E)
female sex
location on the leg
dark pigmentation of the lesion
nodularity of the lesion
level A invasion
Figure 2–9.
38. A 34-year-old man presents with a chronic and
progressive skin rash. He has a history of
poorly controlled Crohn’s disease and has lost
20 lb in the past 6 months. On examination,
there are dry, scaly patches and plaques, which
are sharply marginated and bright red around
his mouth, and anogenital regions. There is