The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
a) Tzanck smear
b) Fungal culture
c) Histologic examination of the nail plate
d) X-ray
e) Nail matrix biopsy
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
b) Mastocytosis (diarrhea uncommon)
c) Pheochromocytoma
d) Verner-Morrison syndrome ( VIPoma)
Answers on page 2
{{pagebreak}}
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
d) X-ray
This patient presents with what is most probably a subungual exostosis which is most frequently found in the great toe, are present for a long period of time, and are frequently painful. Tzanck smear and fungal culture will not help in evaluating the etiology of this patient’s problem. A nail matrix biopsy is not diagnostic of a subungual exostosis. Histologic examination of the nail plate will likewise not provide any relevant information. Since this is really a bony lesion and not a lesion of the nail unit itself, the only significant test that should be performed is an x-ray, which will delineate the bony lesion. Hallux is the most common location.
References
Starmes A, Crosby K, Rowe DJ, Bordeaux JS. Subungual exostosis: a simple surgical technique. Dermatol Surg. 2012;38(2):258-260.
Unlu S, Demirkale I, Kalkan T, Tunc B, Bozkurt M. Large subungual exostosis of the great toe: a case report. J Am Podiatr Med Assoc. 2010;100(4):296-298.
Scher RK, Daniel CR III. Nails: Diagnosis, Therapy, Surgery. 3rd ed. Philadelphia, PA: Saunders; 2005.
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
Flushing is found in 95% and chronic watery diarrhea in 85% of patients with carcinoid syndrome. In contrast, chronic diarrhea is an uncommon finding in patients with mastocytosis. Also, flushing and diarrhea can occur with pheochromocytoma and medullary carcinoma of the thyroid; however, these features are not prominent. In pheochromocytoma, a flushed face is usually seen after a paroxysm of hypertension, tachycardia, and chest pain. Pallor is more typical during the attack. The diarrhea is sufficiently severe in Verner-Morrison syndrome to warrant the synonym “pancreatic cholera.” Vasoactive intestinal polypeptide is overproduced in these patients and is the most likely agent causing the watery diarrhea, hypokalemia, and acidosis.
Because this patient has only intermittent diarrhea and his weight has remained stable, Verner-Morrison syndrome would be an unlikely diagnosis. Carcinoid syndrome has important characteristics that correlate with the site of tumor origin. Foregut carcinoid tumors produce histamine, which may explain the association of peptic ulcer disease with foregut, rather than midgut, carcinoid tumors. Also, the flushing reaction with foregut tumors is a brighter salmon-pink to red1 and is more persistent, intense, and with a geographic pattern. In contrast to the “maiden flush” of the foregut tumors, the midgut tumors are associated with a cyanotic flush. Hindgut tumors do not lead to flushing. Rosacea is also in differential diagnosis.
References
Khoo J, Bee YM, Giraud S, Chen RY, Rajasoorya C, The BT. Novel association of thymic carcinoid with a germline mutation in a kindred with multiple endocrine neoplasia 1 (MEN1). Exp Clin Endocrinol Diabetes. 2012;120(5):257-260.
Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy : diagnosis and management. Am J Clin Dermatol. 2006;7(2):71-84.
Bell HK, Poston GJ, Vora J, Wilson NJ. Cutaneous manifestations of the malignant carcinoid syndrome. Br J Dermatol. 2005;152(1):71-75.
Dr McMichael is professor and chair in the department of dermatology at Wake Forest Baptist Health in Winston-Salem, NC.
The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
a) Tzanck smear
b) Fungal culture
c) Histologic examination of the nail plate
d) X-ray
e) Nail matrix biopsy
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
b) Mastocytosis (diarrhea uncommon)
c) Pheochromocytoma
d) Verner-Morrison syndrome ( VIPoma)
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
d) X-ray
This patient presents with what is most probably a subungual exostosis which is most frequently found in the great toe, are present for a long period of time, and are frequently painful. Tzanck smear and fungal culture will not help in evaluating the etiology of this patient’s problem. A nail matrix biopsy is not diagnostic of a subungual exostosis. Histologic examination of the nail plate will likewise not provide any relevant information. Since this is really a bony lesion and not a lesion of the nail unit itself, the only significant test that should be performed is an x-ray, which will delineate the bony lesion. Hallux is the most common location.
References
Starmes A, Crosby K, Rowe DJ, Bordeaux JS. Subungual exostosis: a simple surgical technique. Dermatol Surg. 2012;38(2):258-260.
Unlu S, Demirkale I, Kalkan T, Tunc B, Bozkurt M. Large subungual exostosis of the great toe: a case report. J Am Podiatr Med Assoc. 2010;100(4):296-298.
Scher RK, Daniel CR III. Nails: Diagnosis, Therapy, Surgery. 3rd ed. Philadelphia, PA: Saunders; 2005.
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
Flushing is found in 95% and chronic watery diarrhea in 85% of patients with carcinoid syndrome. In contrast, chronic diarrhea is an uncommon finding in patients with mastocytosis. Also, flushing and diarrhea can occur with pheochromocytoma and medullary carcinoma of the thyroid; however, these features are not prominent. In pheochromocytoma, a flushed face is usually seen after a paroxysm of hypertension, tachycardia, and chest pain. Pallor is more typical during the attack. The diarrhea is sufficiently severe in Verner-Morrison syndrome to warrant the synonym “pancreatic cholera.” Vasoactive intestinal polypeptide is overproduced in these patients and is the most likely agent causing the watery diarrhea, hypokalemia, and acidosis.
Because this patient has only intermittent diarrhea and his weight has remained stable, Verner-Morrison syndrome would be an unlikely diagnosis. Carcinoid syndrome has important characteristics that correlate with the site of tumor origin. Foregut carcinoid tumors produce histamine, which may explain the association of peptic ulcer disease with foregut, rather than midgut, carcinoid tumors. Also, the flushing reaction with foregut tumors is a brighter salmon-pink to red1 and is more persistent, intense, and with a geographic pattern. In contrast to the “maiden flush” of the foregut tumors, the midgut tumors are associated with a cyanotic flush. Hindgut tumors do not lead to flushing. Rosacea is also in differential diagnosis.
References
Khoo J, Bee YM, Giraud S, Chen RY, Rajasoorya C, The BT. Novel association of thymic carcinoid with a germline mutation in a kindred with multiple endocrine neoplasia 1 (MEN1). Exp Clin Endocrinol Diabetes. 2012;120(5):257-260.
Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy : diagnosis and management. Am J Clin Dermatol. 2006;7(2):71-84.
Bell HK, Poston GJ, Vora J, Wilson NJ. Cutaneous manifestations of the malignant carcinoid syndrome. Br J Dermatol. 2005;152(1):71-75.
Dr McMichael is professor and chair in the department of dermatology at Wake Forest Baptist Health in Winston-Salem, NC.
The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
a) Tzanck smear
b) Fungal culture
c) Histologic examination of the nail plate
d) X-ray
e) Nail matrix biopsy
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
b) Mastocytosis (diarrhea uncommon)
c) Pheochromocytoma
d) Verner-Morrison syndrome ( VIPoma)
,
The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
a) Tzanck smear
b) Fungal culture
c) Histologic examination of the nail plate
d) X-ray
e) Nail matrix biopsy
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
b) Mastocytosis (diarrhea uncommon)
c) Pheochromocytoma
d) Verner-Morrison syndrome ( VIPoma)
Answers on page 2
{{pagebreak}}
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
d) X-ray
This patient presents with what is most probably a subungual exostosis which is most frequently found in the great toe, are present for a long period of time, and are frequently painful. Tzanck smear and fungal culture will not help in evaluating the etiology of this patient’s problem. A nail matrix biopsy is not diagnostic of a subungual exostosis. Histologic examination of the nail plate will likewise not provide any relevant information. Since this is really a bony lesion and not a lesion of the nail unit itself, the only significant test that should be performed is an x-ray, which will delineate the bony lesion. Hallux is the most common location.
References
Starmes A, Crosby K, Rowe DJ, Bordeaux JS. Subungual exostosis: a simple surgical technique. Dermatol Surg. 2012;38(2):258-260.
Unlu S, Demirkale I, Kalkan T, Tunc B, Bozkurt M. Large subungual exostosis of the great toe: a case report. J Am Podiatr Med Assoc. 2010;100(4):296-298.
Scher RK, Daniel CR III. Nails: Diagnosis, Therapy, Surgery. 3rd ed. Philadelphia, PA: Saunders; 2005.
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
Flushing is found in 95% and chronic watery diarrhea in 85% of patients with carcinoid syndrome. In contrast, chronic diarrhea is an uncommon finding in patients with mastocytosis. Also, flushing and diarrhea can occur with pheochromocytoma and medullary carcinoma of the thyroid; however, these features are not prominent. In pheochromocytoma, a flushed face is usually seen after a paroxysm of hypertension, tachycardia, and chest pain. Pallor is more typical during the attack. The diarrhea is sufficiently severe in Verner-Morrison syndrome to warrant the synonym “pancreatic cholera.” Vasoactive intestinal polypeptide is overproduced in these patients and is the most likely agent causing the watery diarrhea, hypokalemia, and acidosis.
Because this patient has only intermittent diarrhea and his weight has remained stable, Verner-Morrison syndrome would be an unlikely diagnosis. Carcinoid syndrome has important characteristics that correlate with the site of tumor origin. Foregut carcinoid tumors produce histamine, which may explain the association of peptic ulcer disease with foregut, rather than midgut, carcinoid tumors. Also, the flushing reaction with foregut tumors is a brighter salmon-pink to red1 and is more persistent, intense, and with a geographic pattern. In contrast to the “maiden flush” of the foregut tumors, the midgut tumors are associated with a cyanotic flush. Hindgut tumors do not lead to flushing. Rosacea is also in differential diagnosis.
References
Khoo J, Bee YM, Giraud S, Chen RY, Rajasoorya C, The BT. Novel association of thymic carcinoid with a germline mutation in a kindred with multiple endocrine neoplasia 1 (MEN1). Exp Clin Endocrinol Diabetes. 2012;120(5):257-260.
Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy : diagnosis and management. Am J Clin Dermatol. 2006;7(2):71-84.
Bell HK, Poston GJ, Vora J, Wilson NJ. Cutaneous manifestations of the malignant carcinoid syndrome. Br J Dermatol. 2005;152(1):71-75.
Dr McMichael is professor and chair in the department of dermatology at Wake Forest Baptist Health in Winston-Salem, NC.
The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
a) Tzanck smear
b) Fungal culture
c) Histologic examination of the nail plate
d) X-ray
e) Nail matrix biopsy
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
b) Mastocytosis (diarrhea uncommon)
c) Pheochromocytoma
d) Verner-Morrison syndrome ( VIPoma)
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
d) X-ray
This patient presents with what is most probably a subungual exostosis which is most frequently found in the great toe, are present for a long period of time, and are frequently painful. Tzanck smear and fungal culture will not help in evaluating the etiology of this patient’s problem. A nail matrix biopsy is not diagnostic of a subungual exostosis. Histologic examination of the nail plate will likewise not provide any relevant information. Since this is really a bony lesion and not a lesion of the nail unit itself, the only significant test that should be performed is an x-ray, which will delineate the bony lesion. Hallux is the most common location.
References
Starmes A, Crosby K, Rowe DJ, Bordeaux JS. Subungual exostosis: a simple surgical technique. Dermatol Surg. 2012;38(2):258-260.
Unlu S, Demirkale I, Kalkan T, Tunc B, Bozkurt M. Large subungual exostosis of the great toe: a case report. J Am Podiatr Med Assoc. 2010;100(4):296-298.
Scher RK, Daniel CR III. Nails: Diagnosis, Therapy, Surgery. 3rd ed. Philadelphia, PA: Saunders; 2005.
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
Flushing is found in 95% and chronic watery diarrhea in 85% of patients with carcinoid syndrome. In contrast, chronic diarrhea is an uncommon finding in patients with mastocytosis. Also, flushing and diarrhea can occur with pheochromocytoma and medullary carcinoma of the thyroid; however, these features are not prominent. In pheochromocytoma, a flushed face is usually seen after a paroxysm of hypertension, tachycardia, and chest pain. Pallor is more typical during the attack. The diarrhea is sufficiently severe in Verner-Morrison syndrome to warrant the synonym “pancreatic cholera.” Vasoactive intestinal polypeptide is overproduced in these patients and is the most likely agent causing the watery diarrhea, hypokalemia, and acidosis.
Because this patient has only intermittent diarrhea and his weight has remained stable, Verner-Morrison syndrome would be an unlikely diagnosis. Carcinoid syndrome has important characteristics that correlate with the site of tumor origin. Foregut carcinoid tumors produce histamine, which may explain the association of peptic ulcer disease with foregut, rather than midgut, carcinoid tumors. Also, the flushing reaction with foregut tumors is a brighter salmon-pink to red1 and is more persistent, intense, and with a geographic pattern. In contrast to the “maiden flush” of the foregut tumors, the midgut tumors are associated with a cyanotic flush. Hindgut tumors do not lead to flushing. Rosacea is also in differential diagnosis.
References
Khoo J, Bee YM, Giraud S, Chen RY, Rajasoorya C, The BT. Novel association of thymic carcinoid with a germline mutation in a kindred with multiple endocrine neoplasia 1 (MEN1). Exp Clin Endocrinol Diabetes. 2012;120(5):257-260.
Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy : diagnosis and management. Am J Clin Dermatol. 2006;7(2):71-84.
Bell HK, Poston GJ, Vora J, Wilson NJ. Cutaneous manifestations of the malignant carcinoid syndrome. Br J Dermatol. 2005;152(1):71-75.
Dr McMichael is professor and chair in the department of dermatology at Wake Forest Baptist Health in Winston-Salem, NC.
1. This 37-year-old man presented with a painful lesion of the right hallux which has been present for approximately 1 year. Which one of the tests listed below will confirm the diagnosis?
d) X-ray
This patient presents with what is most probably a subungual exostosis which is most frequently found in the great toe, are present for a long period of time, and are frequently painful. Tzanck smear and fungal culture will not help in evaluating the etiology of this patient’s problem. A nail matrix biopsy is not diagnostic of a subungual exostosis. Histologic examination of the nail plate will likewise not provide any relevant information. Since this is really a bony lesion and not a lesion of the nail unit itself, the only significant test that should be performed is an x-ray, which will delineate the bony lesion. Hallux is the most common location.
References
Starmes A, Crosby K, Rowe DJ, Bordeaux JS. Subungual exostosis: a simple surgical technique. Dermatol Surg. 2012;38(2):258-260.
Unlu S, Demirkale I, Kalkan T, Tunc B, Bozkurt M. Large subungual exostosis of the great toe: a case report. J Am Podiatr Med Assoc. 2010;100(4):296-298.
Scher RK, Daniel CR III. Nails: Diagnosis, Therapy, Surgery. 3rd ed. Philadelphia, PA: Saunders; 2005.
2. This 56-year-old man has had a 2-year history of excessive flushing reactions that are provoked by drinking hot beverages, physical exertion, and possibly, by emotional upsets. He has a 3-year history of intermittent diarrhea, although his weight has been stable. The most likely diagnosis is:
a) Carcinoid syndrome
Flushing is found in 95% and chronic watery diarrhea in 85% of patients with carcinoid syndrome. In contrast, chronic diarrhea is an uncommon finding in patients with mastocytosis. Also, flushing and diarrhea can occur with pheochromocytoma and medullary carcinoma of the thyroid; however, these features are not prominent. In pheochromocytoma, a flushed face is usually seen after a paroxysm of hypertension, tachycardia, and chest pain. Pallor is more typical during the attack. The diarrhea is sufficiently severe in Verner-Morrison syndrome to warrant the synonym “pancreatic cholera.” Vasoactive intestinal polypeptide is overproduced in these patients and is the most likely agent causing the watery diarrhea, hypokalemia, and acidosis.
Because this patient has only intermittent diarrhea and his weight has remained stable, Verner-Morrison syndrome would be an unlikely diagnosis. Carcinoid syndrome has important characteristics that correlate with the site of tumor origin. Foregut carcinoid tumors produce histamine, which may explain the association of peptic ulcer disease with foregut, rather than midgut, carcinoid tumors. Also, the flushing reaction with foregut tumors is a brighter salmon-pink to red1 and is more persistent, intense, and with a geographic pattern. In contrast to the “maiden flush” of the foregut tumors, the midgut tumors are associated with a cyanotic flush. Hindgut tumors do not lead to flushing. Rosacea is also in differential diagnosis.
References
Khoo J, Bee YM, Giraud S, Chen RY, Rajasoorya C, The BT. Novel association of thymic carcinoid with a germline mutation in a kindred with multiple endocrine neoplasia 1 (MEN1). Exp Clin Endocrinol Diabetes. 2012;120(5):257-260.
Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy : diagnosis and management. Am J Clin Dermatol. 2006;7(2):71-84.
Bell HK, Poston GJ, Vora J, Wilson NJ. Cutaneous manifestations of the malignant carcinoid syndrome. Br J Dermatol. 2005;152(1):71-75.
Dr McMichael is professor and chair in the department of dermatology at Wake Forest Baptist Health in Winston-Salem, NC.
