Saudi Board Dermatology Final Written Exam (SCFHS) Feed

Question

A 45-year-old patient presents with painful oral mucosal erosions followed by the development of flaccid cutaneous bullae on the trunk. Direct immunofluorescence of a perilesional skin biopsy reveals intercellular IgG and C3 deposition throughout the epidermis. Which of the following is the primary autoantigen target in the mucosal-dominant form of this disease?

General Dermatology

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Which of the following direct immunofluorescence (DIF) findings is most characteristic of Bullous Pemphigoid?

General Dermatology

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A 32-year-old patient with severe plaque psoriasis is being considered for biologic therapy. The patient's dermatologist discusses a class of biologics that selectively binds to the p19 subunit of interleukin-23 (IL-23). Which of the following cytokines is shared with IL-12 and thus NOT targeted by a selective p19 inhibitor?

General Dermatology

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A 54-year-old patient presents with clinically amyopathic dermatomyositis. She has mild heliotrope erythema and Gottron's papules but no objective muscle weakness. Which of the following myositis-specific autoantibodies is most strongly associated with rapidly progressive interstitial lung disease (RP-ILD) in dermatomyositis patients?

General Dermatology

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A 48-year-old female presents with an annular, erythematous, scaling eruption in a photo-distributed pattern on her upper back and chest. A biopsy confirms subacute cutaneous lupus erythematosus (SCLE). She was recently started on a new medication for hypertension. Which of the following autoantibodies is present in over 80% of SCLE cases, and which drug is a classic trigger for drug-induced SCLE?

General Dermatology

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A 35-year-old man presents with a rapidly progressive, painful ulcer on his lower leg with a violaceous, undermined border. He notes that the ulcer began as a small pustule at the site of a minor scratch. Which of the following systemic diseases is most commonly associated with this cutaneous condition, and what is the term for the development of lesions at sites of trauma?

General Dermatology

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A 50-year-old male presents with sudden onset of high fever, leukocytosis, and painful, juicy, erythematous plaques on his head, neck, and upper extremities. Skin biopsy shows a dense dermal neutrophilic infiltrate with marked papillary dermal edema but no evidence of leukocytoclastic vasculitis. Which of the following malignancies is most frequently associated with the drug-induced or malignancy-associated forms of this disease?

General Dermatology

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A 40-year-old patient presents with pruritic, purple, polygonal, planar papules on the flexor wrists. White reticulated lines (Wickham's striae) are visible on the surface of the papules and oral mucosa. A biopsy shows a band-like lymphocytic infiltrate at the dermo-epidermal junction and saw-tooth epidermal hyperplasia. Which chronic viral infection has a well-documented epidemiological association with this disease?

General Dermatology

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A 24-year-old female presents with painful, erythematous, warm nodules on her bilateral shins. She reports a history of recent sore throat. A biopsy of a nodule shows septal panniculitis with a mixed inflammatory infiltrate and Miescher's radial granulomas, but without any vasculitis. What is the most likely diagnosis?

General Dermatology

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A 55-year-old male with a history of alcohol abuse presents with skin fragility, vesicles, and bullae on the dorsum of his hands, along with facial hypertrichosis and hyperpigmentation. Analysis of his urine reveals elevated levels of uroporphyrins. Which of the following enzymes is deficient in this disease, and which viral infection is most commonly co-associated?

General Dermatology

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A 58-year-old male presents with generalized erythroderma. Examination reveals thick, orange-red scaly plaques with distinct 'islands of sparing' on the trunk, waxy palmoplantar keratoderma, and follicular keratotic papules on the dorsal proximal phalanges. Which of the following is the most likely diagnosis?

General Dermatology

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A 28-year-old female presents with multiple asymptomatic, skin-colored to erythematous annular plaques on her lateral fingers and the dorsum of her hands. A biopsy shows necrobiotic granulomas, characterized by altered dermal collagen surrounded by palisading histiocytes, increased dermal mucin, and a sparse perivascular lymphocytic infiltrate. What is the most likely diagnosis?

General Dermatology

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A 30-year-old patient presents with intensely pruritic, grouped vesicles on the elbows, knees, and buttocks. Direct immunofluorescence of perilesional skin reveals granular IgA deposition clustered in the dermal papillae. Which of the following autoantigens is targeted by IgA antibodies in this disease, and what is the primary systemic association?

General Dermatology

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A 25-year-old male presents with sudden onset of patchy hair loss on his scalp. Examination reveals smooth, round patches of hair loss with 'exclamation point' hairs at the margins. A scalp biopsy shows a peribulbar lymphocytic infiltrate described as a 'swarm of bees'. Which of the following pathogenetic mechanisms is primary in this condition?

General Dermatology

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A 34-year-old female presents with persistent facial erythema, papules, and pustules on her nose and cheeks. She notes that hot drinks, spicy food, and sun exposure worsen her symptoms. Which of the following pathophysiological mechanisms is most implicated in this disease?

General Dermatology

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Which of the following represents the correct sequence of the four primary pathogenetic factors in the development of Acne Vulgaris?

General Dermatology

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A 45-year-old female presents with indurated, violaceous, plaque-like lesions on her nose, cheeks, and earlobes (Lupus pernio). A biopsy shows non-caseating epithelioid granulomas ('naked granulomas'). Which of the following organ involvements is most strongly correlated with the presence of Lupus pernio?

General Dermatology

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A 22-year-old female presents with depigmented patches on her hands and around her mouth. A diagnosis of Vitiligo is made. Which of the following immunopathogenetic mechanisms is primarily responsible for the destruction of melanocytes in this disease?

General Dermatology

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A 19-year-old male develops targetoid lesions on his palms and soles, and oral mucosal erosions, one week after an episode of herpes simplex virus (HSV) labialis. What is the most likely diagnosis, and how is it distinguished from Stevens-Johnson syndrome (SJS)?

General Dermatology

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A 45-year-old female with diffuse systemic sclerosis presents with a sudden onset of severe headache, visual disturbances, a blood pressure of 210/120 mmHg, and acute renal failure. Which of the following autoantibodies is most strongly associated with this complication (Scleroderma Renal Crisis), and which common medication class is a known risk factor that should be avoided in these patients?

General Dermatology

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A 10-month-old infant presents with pruritic, erythematous, eczematous plaques on the cheeks and extensor surfaces of the limbs. Which of the following gene mutations is most strongly linked to the barrier dysfunction seen in this disease, and what is the primary immunological pathway involved in its acute phase?

Pediatric Dermatology

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A 3-week-old infant presents with thick, greasy, yellowish scales on the scalp ('cradle cap') and erythematous patches in the diaper area and axillae. The infant is otherwise healthy and not distressed. What is the most likely diagnosis, and what is the typical clinical course of this condition?

Pediatric Dermatology

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A 6-month-old infant presents with a refractory 'seborrheic dermatitis-like' eruption on the scalp and diaper area, interspersed with petechiae and purpuric macules. Skin biopsy reveals an infiltrate of large mononuclear cells with reniform (kidney-shaped) nuclei. On electron microscopy, Birbeck granules are seen. Which of the following pairs of immunohistochemical markers is positive in the cells of this disease?

Pediatric Dermatology

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A 4-month-old infant presents with multiple orange-brown macules and papules on the trunk. Stroking a lesion results in localized urtication and erythema. What is the name of this clinical sign, and which gene mutation is most commonly identified in this disease?

Pediatric Dermatology

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A newborn infant presents with annular, erythematous, scaling plaques on the face and scalp, particularly in a periorbital 'raccoon-eye' distribution. The mother has a history of Sjögren's syndrome. What is the most likely diagnosis, and what is the most serious potential systemic complication that must be screened for immediately?

Pediatric Dermatology

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A 2-month-old female infant presents with a rapidly growing, bright red, lobulated plaque on her right cheek. Biopsy of this lesion would show cells that stain positive for which of the following immunohistochemical markers, and what is the first-line systemic therapy if this lesion threatens vision?

Pediatric Dermatology

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A child presents with a large port-wine stain (nevus flammeus) covering the left forehead and upper eyelid. What syndrome is this child at risk for, and which somatic mutation in the GNAQ gene is associated with this vascular malformation?

Pediatric Dermatology

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A 6-year-old child presents with fine, whitish, adherent scales on the extensor surfaces of his limbs, sparing the flexures. He also has hyperlinear palms and soles and keratosis pilaris. The father has a similar history. What is the most likely diagnosis, and what gene mutation is responsible?

Pediatric Dermatology

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A 10-year-old boy presents with large, dark-brown, adherent scales on his neck, trunk, and extremities, giving him a 'dirty' appearance. The palms and soles are spared. His mother recalls that his birth was complicated by a failure of labor progression, requiring a Cesarean section. What enzyme deficiency is responsible for this condition, and what extracutaneous finding is commonly associated?

Pediatric Dermatology

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A newborn infant is noted to have blister formation at sites of friction and trauma. Histopathology of a fresh blister demonstrates intraepidermal cleavage at the basal layer of the epidermis. Which of the following gene mutations is most characteristic of this form of Epidermolysis Bullosa (EB)?

Pediatric Dermatology

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A patient with Junctional Epidermolysis Bullosa (JEB) has blistering that occurs within the lamina lucida of the basement membrane zone. Which of the following proteins is the primary component of the anchoring filaments located in the lamina lucida?

Pediatric Dermatology

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A 12-year-old child with severe generalized dystrophic epidermolysis bullosa (RDEB-HS) presents with extensive scarring, mucosal strictures, and fusion of the fingers ('mitten deformity' or pseudosyndactyly). Which of the following represents the genetic defect in this disease, and what is the most common cause of death in these patients in early adulthood?

Pediatric Dermatology

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A 5-year-old child presents with eight café-au-lait macules (>5 mm in diameter), axillary freckling (Crowe sign), and multiple small hyperpigmented iris hamartomas. What is the diagnosis, and what is the function of the protein encoded by the gene mutated in this condition?

Pediatric Dermatology

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A 7-year-old child presents with seizures, developmental delay, and facial angiofibromas. Cutaneous exam also reveals three hypopigmented macules (ash-leaf spots), a connective tissue nevus on the lower back (shagreen patch), and periungual fibromas (Koenen tumors). Which of the following protein complexes is abnormally activated in this syndrome?

Pediatric Dermatology

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A newborn female presents with linear streaks of inflammatory vesicles and bullae along the lines of Blaschko. Within a few weeks, these lesions become verrucous, followed by hyperpigmentation in whorls and streaks, and finally thin, hypopigmented atrophic bands. What is the mode of inheritance, and which gene mutation is responsible?

Pediatric Dermatology

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A 1-year-old child presents with a solitary, asymptomatic, firm, orange-yellow nodule on his scalp. A biopsy shows a well-demarcated dermal infiltrate of histiocytes, lymphocytes, eosinophils, and multinucleated giant cells with a ring of nuclei and peripheral lipid vacuolization (Touton giant cells). What is the diagnosis?

Pediatric Dermatology

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A healthy newborn is noted to have small, sterile pustules on a hyperpigmented macular base, present at birth. The pustules rupture easily, leaving a collodion-like rim of scale around a hyperpigmented macule. Tzanck smear of a pustule reveals numerous neutrophils. What is the most likely diagnosis?

Pediatric Dermatology

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A 2-day-old term infant develops multiple erythematous macules and papules with a central yellowish-white pustule ('flea-bite' appearance) on the trunk and limbs, sparing the palms and soles. A smear of the pustule contents shows a predominance of eosinophils. What is the most likely diagnosis, and what is the management?

Pediatric Dermatology

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A 3-month-old infant is brought to the clinic due to an itchy eruption. Physical examination reveals erythematous papules, pustules, and nodules concentrated on the palms, soles, scalp, and face. The mother notes that she and the father also have itchy bumps, particularly on their hands and web spaces. What is the diagnosis and recommended first-line treatment for the infant?

Pediatric Dermatology

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A 3-year-old child presents with a fever of 39.5°C for 6 days. She also has bilateral non-purulent conjunctivitis, erythema of the oral mucosa with a 'strawberry tongue', edema and erythema of the hands and feet, a polymorphous trunk rash, and a single unilateral cervical lymph node measuring 1.8 cm. Which of the following is the most critical cardiovascular complication of this disease, and what is the standard treatment to prevent it?

Pediatric Dermatology

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A scalp biopsy of a patient with thick, scaling plaques shows regular elongation of the rete ridges ('test-tube' appearance), thinning of the suprapapillary plates, absent granular layer, and confluent parakeratosis. Micropustules containing neutrophils are noted in the stratum corneum. What is the pathognomonic term for these intracorneal neutrophilic aggregates?

Dermatopathology

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A skin biopsy from a patient's purple wrist papule shows vacuolar degeneration of the basal layer, a band-like lymphocytic infiltrate hugging the dermo-epidermal junction, saw-tooth epidermal hyperplasia, and numerous eosinophilic Civatte bodies in the lower epidermis. What tissue reaction pattern does this represent?

Dermatopathology

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A biopsy of a skin lesion reveals multiple well-formed granulomas composed of epithelioid histiocytes and multinucleated giant cells. The granulomas are surrounded by a very sparse rim of lymphocytes, and no necrobiosis or caseation necrosis is identified. Asteroid bodies are noted inside some giant cells. Which of the following terms best describes these granulomas?

Dermatopathology

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A patient with palpable purpura on the lower extremities undergoes a skin biopsy. Histopathologic examination shows fibrinoid necrosis of small dermal vessel walls, a perivascular neutrophilic infiltrate, nuclear dust (karyorrhexis), and extravasated erythrocytes. What is the most likely histopathologic diagnosis?

Dermatopathology

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Which of the following histopathologic features distinguishes Pemphigus Vulgaris from Bullous Pemphigoid?

Dermatopathology

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A biopsy from a patient with chronic intertriginous erosions shows extensive, diffuse acantholysis throughout the epidermis, giving the appearance of a 'dilapidated brick wall'. In contrast, a biopsy from another patient shows focal suprabasal acantholysis along with dyskeratotic cells: round cells with a basophilic nucleus and perinuclear halo ('corps ronds') and flattened hyperchromatic cells in the stratum corneum ('grains'). What are the diagnoses for these two patients, respectively?

Dermatopathology

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A vulvar biopsy from a postmenopausal female shows hyperkeratosis, epidermal atrophy with loss of rete ridges, vacuolar degeneration of the basal layer, and a prominent band of homogeneous, pale, edematous-looking collagen (sclerosis) in the upper dermis. A band-like lymphocytic infiltrate is present immediately beneath this sclerotic zone. What is the diagnosis?

Dermatopathology

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