WorksheetsCardiovascular Disease Risk and Severe Psoriasis
Total questions: 30
Worksheet time: 42mins
You are discussing the cardiovascular disease risk of a patient with severe psoriasis with her primary care provider. You are asked how the risk of cardiovascular disease associated with severe psoriasis compares to that associated with other risk factors. You explain that the risk of cardiovascular disease that is associated with severe psoriasis is similar to that conferred by which of the following:
Diabetes
Dyslipidemia
Hypertension
Inflammatory bowel disease
Smoking
What percentage of patients with psoriasis are at risk of developing psoriatic arthritis (PsA)?
10%
20%
30%
50%
What is the most common genetic susceptibility associated with psoriasis?
HLA-B27
HLA-DR4
HLA-A1
HLA-Cw6
What type of arthritis is most commonly associated with patients diagnosed with psoriatic arthritis (PsA)?
Reactive arthritis
Erosive arthritis
Inflammatory arthritis
Degenerative arthritis
What is the maximum recommended body surface area percentage for the application of Tazarotene in the treatment of psoriasis?
5–10%
10–20%
20–30%
30–40%
A pregnant woman nearing delivery has been treated with a TNF-alpha inhibitor. What is the recommended course of action regarding the vaccination of her newborn, particularly concerning live vaccines?
The newborn can receive live vaccines immediately after birth without any precautions.
The newborn should not receive live vaccines for at least 18 months after birth due to potential immunosuppression.
The newborn should not receive live vaccines for at least 12 months after birth to avoid risks associated with maternal immunosuppression.
The newborn should follow the standard vaccination schedule without any modifications, as TNF-alpha inhibitors do not affect vaccine safety.
A 56-year-old man comes in for a pruritic skin eruption. A biopsy is performed and shown below. Based on this diagnosis, targeting which cytokine(s) would offer a reasonable treatment strategy for this patient?
IL-31
IL-23 and/or IL-27
IL-23
IL-4 and/or IL-13
IL-4
Which of the following is most likely associated with this mucosal finding?
vitamin deficiency
Oral candidiasis
psoriasis
ulcerative colitis
smoking
A 25-year-old male presents to the dermatology clinic with a sudden onset of multiple small, red, scaly lesions on his trunk and extremities. He reports that these lesions appeared after a recent URTI. The patient has no significant past medical history and is otherwise healthy. As part of the evaluation, the physician considers potential autoimmune associations related to his skin condition. Which of the following antibodies is most commonly associated with this type of skin condition?
Anti-nuclear antibodies (ANA)
Anti-DNase antibodies
Anti-citrullinated protein
antibodies (ACPA)
Anti-double-stranded DNA
antibodies
Anti-Smith antibodies
In the management of psoriasis, phototherapy has been shown to have various effects on cytokine levels.
Which of the following statements best describes the relationship between phototherapy and cytokine
levels in psoriasis patients ?
Phototherapy increases IL-23 levels in psoriasis patients, while reducing levels of other
pro-inflammatory cytokines.
Phototherapy has no effect on IL-23 levels but decreases levels of TNF-alpha and IL-17.
Phototherapy reduces IL-23 levels in psoriasis patients.
Phototherapy selectively targets IL-23 without affecting other cytokines such as IL-17 and TNF-alpha.
Phototherapy increases the expression of IL-23 receptors while also reducing levels of IL-1 and IL-6 in psoriasis patients.
A 45-year-old male presents to the dermatology clinic with large, erythematous plaques on his trunk and extremities. The lesions have been present for several months and are asymptomatic. Upon examination, the plaques are well-defined, scaly, and slightly raised. The patient has no significant past medical history and denies any family history of skin cancer. A skin biopsy reveals a dense infiltrate of lymphocytes in the upper dermis, with some areas showing epidermal atrophy and a mild lichenoid tissue reaction. There is no evidence of atypical lymphoid cells at this time. Based on the clinical and histopathological findings, what is the probability of this condition transforming into malignancy?
5% in 5 years and 2-5% in 6-10 years
20% in 5 years and 10-36% in 6-10 years
50% in 5 years and 30-40% in 6-10 years
10% in 5 years and 1-3% in 6-10 years
A 38-year-old female presents to the dermatology clinic with a history of persistent, erythematous plaques and scaling over her arms, legs, trunk and scalp. She reports that these lesions have been present for several months and are accompanied by mild itching. Upon further questioning, she mentions that her 40-year-old brother has same skin lesions. Their mother also had a history of similar skin issues.
IL36RN
CARD14
TNFAIP3
FLG
A 22-year-old male presents to the dermatology clinic with a 3-week history of an itchy rash that began on his trunk and has since spread to his extremities. He reports that the rash started as small red spots that have evolved into vesicular lesions, some of which have crusted over. He denies any significant medical history but mentions that he experienced mild fever and malaise about a week before the rash appeared. On examination, the patient has multiple erythematous papules and vesicles, some with a necrotic center, distributed across his torso and arms. The lesions are predominantly located on the trunk and proximal extremities. A clinical photo is attached for reference.A skin biopsy is performed, revealing a superficial perivascular infiltrate with necrosis of the epidermis. What is the possible underlying infectious cause associated with this patient's condition?
HHV-8
Parvovirus B19
HSV
Coxsackievirus
A 28-year-old female presents to her primary care physician with a 2-week history of a rash on her trunk. She reports that the rash started as a single, large, oval shaped pink patch on her chest, which was followed by the development of smaller, similar lesions on her abdomen and back. The patient describes mild itching associated with the rash but denies any pain or discomfort. She also mentions having experienced flu-like symptoms, including fever, fatigue, and body aches about a week before the rash appeared. The patient has no significant past medical history and is not taking any medications. What is the possible underlying infectious cause associated with this patient's condition?
VZV
H1N1 Influenza Virus
Herpes Simplex Virus
Cytomegalovirus (CMV)
A 26-year-old man who is HIV positive is noted to have developed seborrhoeic dermatitis. Which of the following two complications are most associated with this condition?
Alopecia and otitis externa
Blepharitis and otitis externa
Photosensitivity and alopecia
Photosensitivity and blepharitis
Blepharitis and alopecia
A 36-year-old woman is reviewed. She presented 4 weeks ago with itchy dry skin on her arms and was diagnosed as having atopic eczema. She was prescribed hydrocortisone 1% cream with an emollient. Unfortunately there has been no improvement in her symptoms. What is the next step in management, alongside continued regular use of an emollient?
Betamethasone valerate 0.1%
Clobetasone butyrate 0.05%
Clobetasol propionate 0.05%
Topical tetracycline
Regular wet wraps
What is the treatment goal for Atopic Dermatitis (AD) in relation to the Pruritus Numeric Rating Scale (NRS)?
0
<3
<4
<6
Which of the following is a side effect of Upadacitinib?
Dry mouth
Headache
blurred vision
weight loss
A 22-year-old male presents to the dermatology clinic with a persistent, itchy rash on his lower legs. He reports that the rash started about six months ago and has not improved despite using over-the-counter hydrocortisone cream and other topical moisturizers. The patient has a history of eczema as a child with flare and remission history. He also complain of hair fall with positive family history. He denies any recent changes in his skincare routine or exposure to new products. What is the most likely diagnosis?
Hyper IgE syndrome
Wiscott-Aldrich Syndrome
Sulzberger Garbe syndrome
Netherton syndrome
At what age is Eucrisa (crisaborole) FDA approved for use in patients with mild to moderate atopic dermatitis?
1 year and older
2 years and older
3 months and older
6 months and older
A 5-year-old child presents to the clinic with a history of itchy, red patches on their skin, particularly in the creases of their elbows and knees. The pediatrician consider the common bacterial colonization associated with this condition. What is the percentage of Staphylococcus aureus colonization commonly found in these patients?
30%
10%
50%
90%
A 60-year-old male patient with a history of lung cancer, currently in remission, presents to the clinic with moderate to severe psoriasis. He is concerned about managing his skin condition while ensuring that his treatment does not interfere with his cancer status. The patient is particularly interested in biologic therapies but wants to avoid any medications that may compromise his immune system or increase the risk of cancer recurrence. Which of the following biologic treatments is considered the safest and most appropriate for managing psoriasis in a patient with a history of lung cancer?
Ixekizumab
Infliximab
Ustekinumab
Apremilast
A 46-year-old male with chronic plaque psoriasis was treated with adalimumab for 16 weeks with <25% improvement in PASI. What is the most appropriate next step?
Continue adalimumab for 4 more weeks
Switch to infliximab
Switch to ustekinumab
Add methotrexate to adalimumab
Increase adalimumab dose
Which of the following is a documented benefit of combining acitretin with NB–UVB therapy?
Reduces teratogenicity of acitretin
Reduces erythema and burns from NB–UVB
Accelerates clearance and reduces cumulative UV dose
Prevents post-treatment relapse completely
Allows weekly instead of daily
Sarah is a 32-year-old woman who has been struggling with moderate to severe psoriasis for several years. After trying topical treatments and phototherapy without significant improvement, her dermatologist has suggested starting a TNF antagonist therapy, which is known for its effectiveness in treating psoriasis. However, during her consultation, Sarah mentions that her Grandmother was diagnosed with multiple sclerosis (MS) many years ago. Given this information, what should the dermatologist recommend to Sarah?
Proceed with TNF antagonist therapy as it is one of the most effective treatments for psoriasis.
Recommend against TNF antagonist therapy due to her family history of multiple sclerosis and suggest alternative treatments.
Inform Sarah that there is a low risk linking TNF antagonist therapy to increased risk of MS and proceed with treatment.
Refer Sarah to a neurologist for further evaluation before making any treatment recommendations.
Which of the following statements is true regarding the use of acitretin in men?
Men receiving acitretin are advised to stop all forms of contraception during their wives'
pregnancies.
It is recommended that men using acitretin avoid all forms of sexual activity during treatment.
Men receiving acitretin should use barrier methods of contraception post conception to limit exposure to semen during pregnancy.
Acitretin use in men has no impact on reproductive health and does not require any precautions.
A 42-year-old medically free patient with stable, moderate-tosevere psoriasis is scheduled for an elective laparoscopic repair of inguinal hernia with mesh reinforcement. Their only regular medication is Ixekizumab, which they last injected 7 days ago. According to current perioperative guidelines for biologics, what is the most appropriate management of the Ixekizumab therapy?
Stop Ixekizumab 2 weeks prior to surgery.
Stop Ixekizumab 4 weeks (one full cycle) prior to surgery.
Continue Ixekizumab on the regular schedule; no need to stop.
Postpone the surgery until the patient has been off Ixekizumab for
at least 3 weeks.
A 58-year-old patient with moderate-to-severe psoriasis and a history of successfully treated Hepatitis C virus (HCV) infection still on treatment, now has very low viral load. The patient also has a history of inflammatory arthritis. The dermatology team is considering initiating a biologic agent. Considering the patient's history which class of biologic agents has emerging data suggesting a potentially favorable safety profile in the context of this patient's hepatitis history, while also being effective ?
IL-23 Inhibitors (e.g.,
guselkumab, risankizumab)
IL-17 Inhibitors (e.g.,
secukinumab, ixekizumab)
TNF-α Inhibitors (e.g.,
adalimumab, infliximab)
IL-12/23 Inhibitors (e.g.,
ustekinumab)
All of the following Systemic Therapy are FDA approved and indicated for Atopic Dermatitis Except ?
Tralokinumab
Abrocitinib
Upadacitinib
Baricitinib
Dupilumab
A 45-year-old patient with severe atopic dermatitis, weighing 85 kg, has been on tralokinumab 300 mg every 2 weeks for 5 months. At the follow-up appointment, their Investigator's Global Assessment (IGA) score is 1 (almost clear), indicating an excellent response to therapy. Which of the following is TRUE regarding the subsequent management of this patient's tralokinumab therapy?
The dose should be changed to
600 mg every 3 weeks.
Therapy should be discontinued and only re-initiated upon the recurrence of significant flares.
The dosing frequency can be reduced to 300 mg every 4 weeks for maintenance.
A switch to a different biologic class is recommended to prevent the development of anti drug antibodies.
