USMLE Forum - Largest USMLE Community

You have been managing a patient with a severe
case of tinea pedis with oral therapy. Two weeks into the
treatment course, the patient develops thickened and
opacified nails on the right hand. The left hand fingernails
are affected to a lesser degree. The nails have become
discolored and have significant debris under the nail. Nail
scrapings from the fingernails are most likely to grow
which organism?A. Candida spp.
B. Malassezia spp.
C. Rhizopogon spp.
D. Trichophyton spp.
. A patient presents to you for evaluation of this lesion,
which has been on his skin for 6 months. The lesion
began as a red papule with a thick adherent scale (see
Color Atlas, Figure XII-18). Since that time, it has progressed
to the current pictured lesion with raised borders
and scars. There has been no improvement with use of
topical glucocorticoids, which the patient borrowed from
a friend. What is the best course of action for this patient
at this time?
A. Aminoquinoline antimalarials
B. Azathioprine
C. Systemic glucocorticoids
D. Vitamin E ointment
E. Wide surgical excision with regional lymph node
dissection

1.D
2.C or B

D
C

2 E

D & B ?

D & E

D. Trichophyton spp.

A. Aminoquinoline antimalarials

do u have the explanations to these qs ? or if anyone else can explain?

Thanks

The answer is A. (Chap. 55) The patient has discoid lupus erythematosus (DLE) or
chronic cutaneous lupus erythematosus. It is characterized by discrete lesions most often
on the face, scalp, or ears. The lesions are usually erythematous papules or plaques with a
thick scale that occludes hair follicles. The lesions persist for years and grow slowly. Less
than 10% of patients with DLE meet criteria for systemic lupus erythematosus (SLE), although
skin lesions are common in patients with SLE. Chronically, the lesions evolve to
look similar to the one pictured. Treatment consists of topical or intralesional glucocorticoids.
If that is ineffective, systemic therapy with an aminoquinoline antimalarial may be
indicated. Systemic glucocorticoids or immunosuppressives are not indicated for localized
disease. Although malignant melanoma may take on myriad appearances, the location,
progress, and description of this lesion is more suggestive of discoid lupus,
therefore, surgical excision and lymph node dissection are not indicated at this time. Vitamin
E ointment has no proven role in the treatment of DLE.