Ministry of Health of Ukraine

KharkivNationalMedicalUniversity
Department of Dermatology, Venereology and
AIDS
II Medical Faculty

GUIDE
For independent work for ILE “KROK-2”

In course “Dermatology, Venereology”

for fourth-year students of VI medical faculty

Approved
at a meeting of the
Department of Dermatology,
Venereology and AIDS
On August“29”, 2017.
Protocol No. 13
Head of the Department
Prof. A. M. Dashchuk

Kharkiv 2017
Guide for independent work for ILE “KROK-2” in course
“Dermatology, venereology and AIDS” for fourth-year students of
the VI medical faculty.
The guide for independent work for ILE “KROK-2” consists of three
parts:
1. Examples of solving situational problems.
2. Clinical tasks (2016).
3.Clinical tasks(2007-2016)
4.Clinical tasks (2017)
Examples of solving situational problems.
Task 1.
A 20-year old male patient complains of a genital rash¸ which
appeared 6 weeks ago after a sexual contact with an unfamiliar
woman. Objective data: on the glans penis there is a bright red round
ulcer, 1 cm in diameter with smooth edges and a shiny surface. The
skin around the ulcer is not inflamed, a dense elastic consistency
forms the base of the ulcer. Regional lymph nodes are enlarged,
painless, not soldered to the surrounding skin. What kind of disease is
this?
A. Syphilis, primary period
B. Herpes simplex progenitalis
C. Chancriformpyoderma
D. Scabies ecthyma
E. Trichomonas ulcer

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Keywords: "sexual contact with a unfamiliar woman"; "ulcer" on the
penis; enlarged lymph nodes.
By the information about sexual contact we can assume a sexually
transmitted disease. Sexually transmitted diseases for which there are
ulcers on the genitals can be: syphilis, trichomoniasis, herpes simplex
progenitalis; of non-venereal diseases with very similar clinical
picture there may be chancriformpyoderma. To select the correct
diagnosis you need to find information about the incubation period
(often a time from sexual contact until ulcer). Incubation period of
syphilis is on average 3-4 weeks, incubation period of trichomoniasis
- 10 days on average (may be shorter) and incubation period of
herpes simplex - 5-7 days on average.
Next, look for information about characteristics of ulcer: the number
of ulcers, the size, the shape (round, polycyclic); dense elastic
consistency on palpation or not; is there an inflammation around the
ulcer or not; is the ulcer covered with bloom or it has a shiny surface;
painful or painless.
Is there discharge from the urethra? What came the first: the
discharge from the urethra or an ulcer?
Information about regional lymph nodes - the size, the color of the
skin over them, are they soldered to the surrounding skin or not, are
they mobile or not, painful or painless.
Syphilis ulcer is usually single, round- or oval- shaped, 1-2 cm in
diameter, with smooth borders, the bottom of the ulcer is on the same
level with the surrounding skin, the ulcer surface is smooth, bright
pink or red (the color of "raw meat"). On the surface of the ulcer
there is a clear discharge, giving it a kind of lacquer shine. In case of
irritation of the ulcer, serous discharge becomes abundant, it contains
a large number of Treponemaspallidum, which is used to diagnose
syphilis (dark field microscopy, PCR). Syphilis ulcer is painless and
dense elastic consistency on palpation, that is the reason to call it
primary syphiloma or hard chancre. Regional lymph nodes are
usually enlarged, of densely-elastic consistency, not soldered to the
surrounding skin, painless, the skin over them is not inflamed.

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Herpes simplex progenitalis. After a short incubation period (4-5
days on average), small grouped of vesicles with the clear serous
fluid on the hyperemic edematous skin are observed. After 3-4 days
the vesicles open with the formation of small erosions. Erosions have
polycyclic borders, the bottom of the erosions is clean. The skin
around the erosions is edematous and hyperemic. There is no dense
elastic consistency on palpation. The patient complains of a burning
sensation and itching. Epithelization of herpetic erosions passes in 1-
2 weeks, but there can be relapses. There is no regional
lymphadenitis. The diagnosis is confirmed with PCR (HSV DNA
was detected), ELISA (detected antibodies to HSV - IgM, IgG).
Trichomonas ulcers on the penis occur in people suffering from
trichomoniasis (urethritis caused by Trichomonasvaginalis). In this
disease, the discharge from urethra first appear and then erosions and
ulcers appear. Trichomonas ulcers are characterized by acute
inflammation process. The ulcer have irregular, often polycyclic
outlines, sometimes coalescing into large pockets. There is no dense
elastic consistency on palpation. The bottom of the ulcer is bright red
color with abundant discharge, which on microscopically
examination reveal Trich. vaginalis. The skin around the ulcer or
erosion is edematous and hyperemic, painless on palpation.
Discharge from urethra is mucopurulent, foaming, with an unpleasant
odor. Regional lymph nodes are not enlarged. The diagnosis is based
on the microscopically analysis, PCR, bacterial inoculation.
Scabies ecthyma. The clinical manifestation of scabies (localization
on the glans penis) is similar to the clinical manifestation of syphilis
(hard chancre). Clinical characteristics of scabies ecthyma: the
absence of a dense infiltrate in the base of ecthyma, purulent
discharge, the presence of itching and the rash. It easily dries to form
a crust. The diagnosis is based on the microscopically analysis
(finding the mites, their eggs or feces by scraping the burrows). There
is no regional lymphadenitis.
Chancriformpyoderma - a rare disease, the clinical manifestation is
very similar to the primary syphiloma. It is localized mostly on the
genitals and face (red border of the lips, eyelids). Clinical
4
manifestations: round or oval ulcer or erosion with regular shape,
smooth edges, shiny bottom and serous discharge. At the base of
erosion or ulcer there is an induration that goes beyond the edge of
the ulcer. Regional lymph nodes are enlarged, dense but remain
mobile and painless which resembles hard chancre. The diagnosis is
based on the microscopically analysis (can be finding staphylococci
and streptococci).
Thus, as a result of the differential diagnosis herpes simplex
progenitalis, trichomonas ulcers, scabies ecthyma,
chancriformpyoderma can be excluded. You can think of syphilis,
primary period. Clinical manifestations of primary syphilis are the
following: the occurrence of ulcer after 6 weeks of sexual contact
with unfamiliar woman (incubation period of syphilis is 4 weeks on
average), the ulcer is regular shaped, painless, with no signs of
inflammation around, with lacquered shiny bottom, there is dense
infiltrate on the palpation. Regional lymph nodes are enlarged,
painless and not soldered to the skin.
To confirm the diagnosis, we need to:
• explore serous discharge from ulcer on Treponemapallidum (dark-
field microscopy), PCR will detect the DNA of Treponemapallidum,
the ELISA method will detect the antigen of Treponemapallidum;
• investigate the blood TPHA, FTA, ELISA (detection of antibodies
to Treponemapallidum);
• examine the alleged source of infection (if possible).
If we find Treponemapallidum in the discharge from the ulcers, we
make a diagnosis –syphilis, primary period.
Persons, who have had sexual contact and household contact with a
patient, who suffers from this disease must undergo preventive
treatment.

Task 2.
A 20 years-old female patient came to the dermatologist with
complaints on the rash accompanied by slight itching. The disease
appeared 3 weeks ago after a strong emotional stress. Not treated.

5
Objectively data: the pathological process is symmetrical, localized
on the scalp, skin extensor surfaces of the upper and lower
extremities, abdomen, waist. Primary element – the papule.
Characteristic: inflammatory, red colored, teardrop-shaped papule,
round shape with peeling in the central part, and form the silver-white
scales, easily torn away when scraping. On the periphery of papules -
pink rim not covered by scales. Isomorphic reaction and psoriatic
triad positive. Doctor made a diagnosis - psoriasis, disseminated
form.
What stage of psoriasis?
A Stage of primary manifestations
B. Stage of remission
C. Stationary stage
D. Regressing stage
E. Progressive stage

In solving this problem we should first recall all stages of psoriasis:

progressive, stationary, regressive, and remission.
Thus, the stage of primary manifestations does not exist.
In stage of remission there is no clinical manifestation. In some cases,
the locations of the former localization lesions hyper- or
hypopigmentation may persist for a while.
In the stationary stage papules are large (up to nail), merge into
plaques, often infiltrated, red- colored, completely covered with
silvery-white scales. New lesions have not been noted for a month or
more. Usually, there is no itching. Isomorphic response (Koebner
phenomenon) is usually not called.
In the regressing stage plaque flatten (usually in the center),
sometimes forming a ring-shaped elements. Peeling on the surface is
significantly reduced, at the periphery of some elements a narrow
whitish pseudoatroficVoronov’s rim can be seen. There are no new
rashes and itching. Koebner phenomenon and psoriatic triad are
usually not called.
The progressive stage is characterized by the recent (1-2 weeks) acute
onset, frequent communication with stressful situations. The process
6
is symmetrical. Favorite localization is: scalp, extensor surfaces of
the extremities, thorax. Elements of rash are usually smaller than 3-5
mm in diameter, pink-red colored. Silvery white peeling is present
only at the center of the element and on the periphery there is a pink
rim. When scraping with a glass 3 psoriatic phenomenon are
identified: "stearin spot", "terminal film" and "blood dew." Frequent
complaints of itching.Koebner phenomenon is positive.
As can be seen from the above the described clinical picture clearly
fits in the progressive stage of psoriasis (the correct answer).

CLINICAL TASKS ( 2015 )

1.10 days after birth an infant developed a sudden fever up to 38,
1oC. Objectively: the skin of navel, abdomen and chest is
erythematous; there are multiple pea-sized blisters with no infiltration
at the base; single bright red moist erosions with epidermal fragments
on the periphery.What is your provisionaldiagnosis?
A. Epidemic pemphigus of newborn
B. Syphilitic pemphigus
C. Streptococcal impetigo
D. Vulgar impetigo
E. Atopic dermatitis

2 .A 19-year-old patient complains of severe pain in axillary crease.

Condition onset was a week ago after her swimming in cold river and
epilation. The next day painful "boil"appeared that was becoming
larger every day and became a plum-sized tumor. Upon examination
nodular conical growths joined together are detected, the skin
covering them is bluishred in colour. Some nodules have fistulous
openings producing thick purulent mass. Body temperature is 38,5ºС,
general malaise. The most likely diagnosis is:
A. Hydradenitis
B. Carbuncle
C. Cutaneous tuberculosis
D. Necrotizing ulcerative trichophytosis
E. Pyodermachancriformis
7
3.A young woman suffering from seborrheaoleosa has numerous
light-brown and white spots on the skin of her torso and shoulders.
The spots have clear margins,branny desquamation, no itching. What
provisional diagnosis can be made?
A. Pityriasisversicolor
B. Torso dermatophytosis
C. Seborrheic dermatitis
D. Pityriasisrosea
E. Vitiligo

4.A child was taken to a hospital with focal changes in the skin folds.
The child was anxious during examination, examination revealed dry
skin with solitary papulous elements and ill-defined lichenification
zones. Skin eruption was accompanied by strong itch. The child
usually feels better in summer, his condition is getting worse in
winter. The child has been on bottle feeding since he was 2 months
old. He has a history of exudative diathesis. His grandmother on his
mother’s side has bronchial asthma. What is the most likely
diagnosis?
A. Atopic dermatitis
B. Contact dermatitis
C. Seborrheal eczema
D. Strophulus
E. Urticaria

5 .A 45-year-old patient (14-year-long work record as a house

painter) upon the contact with synthetic paint develops skin
reddening, edema, severe itching and oozing lesions on her face.
Symptoms disappear after the contact with this chemical substance
stops but even the smell of paint alone is enough to make them
reappear each time. Each recurrence is characterised by increased
severityof symptoms.What provisional diagnosis can be made?
A. Professional eczema
B. Simple contact dermatitis
C. Allergic contact dermatitis
8
D. Urticaria
E. Toxicodermia

CLINICAL TASKS (2007-2016)

DERMATOLOGY
1. A 30 y.o. patient has got multiple body skin rash consisting of
small paired elements that are scattered on the skin diorderly and
mostly focally, they are accompanied by itch. The rash appeared a
few days after attending sport centre and sauna. What is the most
probable diagnosis?
A. Scab
B. Eczema
C. Contact dermatitis
D. Allergic dermatitis
E. Neurodermitis

2. A 5-grade pupil complains about extensive skin rash accompanied

by intensive itch, especially at night. Objectively: there are small red
papules set mostly in pairs in the region of interdigital folds on both
hands, on the flexor surface of radicarpal articulations, abdomen and
buttock skin as well as internal surface of thighs. In the centre of
some papules vesicles or serohaemorrhagic crusts can be seen. There
are multiple excoriations. What is the most likely diagnosis?
A. Scabies
B. Dermatitis
C. Ringworm of body
D. Toxicoderma
E. Eczema

3. A female patient consulted a dermatologist about the rash on the

trunk and extremities. Objectively: interdigital folds, flexor surfaces
of wrists and navel region are affected with pairs of nodulocystic
eruptions and crusts. The rash isaccompanied by skin itch that is

9
getting stronger at night. What external treatmentshould be
administered?
A. 20% benzyl benzoate emulsion
B. 5%sulfuric ointment
C. 2% sulfuric paste
D. 5%naphthalan ointment
E. 5% tetracycline ointment

4. The patient complains of a painful swelling in the chin region,

malaise, headache. Examination reveals an acutely inflamed cone-
shaped dense node. The skin over it is tense, red. In the center of the
node there is an ulcer with overhanging edges and a necrotic core of a
dirty green colour. Submandibular lymph nodes on the right are
enlarged and painful. What is the most likely diagnosis?
A. Furuncle
B. Tuberculosis
C. Carbuncle
D. Tertiary syphilis (gummatous form)
E. Parasitic sycosis

5. A 23 year old patient fell ill 3 weeks ago when she noticed a very
painful induration in her axillary crease. 4-5 days later it burst and
discharged a lot of pus. After that some new infiltrations appeared
around the affected area. The patient has never suffered from skin
diseases before. What is the most probable diagnosis?
A. Hydradenitis
B. Furuncle
C. Mycosis
D. Herpes zoster
E. Streptococcal impetigo

6. A 25-year-old patient works as a tractor driver. Four days ago, he

got pain in the leftaxillary region, general weakness, fever up to
38oC. He hadn’t sought medical helf until a painful solid lump
appeared in this region. Objectively: in the left axilla there is a very
10
painful cone-shaped mass sized 3x2,5 cm, with a destruction in the
center of the pointed vertex. The surrounding skin is hyperemic, there
are purulent discharges. What is the most likely diagnosis?
A. Hydradenitis
B. Carbuncle
C. Furuncle
D. Lymphadenitis
E. Abscess

7. A 19-year-old patient complains of severe pain in axillary crease.

Condition onset was a week ago after her swimming in cold river and
epilation. The next day painful "boil "appeared that was becoming
larger every day and became a plum-sized tumor. Upon examination
nodular conical growths joined together are detected, the skin
covering them is bluish red in colour. Some nodules have fistulous
openings producing thick purulent mass. Body temperature is 38,
5Oc, general malaise. The most likely diagnosis is:
A. Hydradenitis
B. Carbuncle
C. Cutaneous tuberculosis
D. Necrotizing ulcerative trichophytosis
E. Pyoderma chancriformis

8. On the 6th day of life a child got multiple vesicles filled with
seropurulent fluid in the region of occiput, neck and buttocks.
General condition of the child is normal. What disease should be
suspected?
A. Vesiculopustulosis
B. Impetigo neonatorum
C. Miliaria
D. Impetigo
E. Epidermolysisbullosa

9. A 22-day-old infant had developed red subcutaneous nodules from

1,0 to 1,5cm large on the scalp. Later the nodules suppurated, body
11
temperature rose up to 37, 7oC, there appeared symptoms of
intoxication, the regional lymph nodes grew bigger. Blood test
results: anemia, leukocytosis, neutrophilia, accelerated ESR. What is
the most likely diagnosis?
A. Pseudofurunculosis
B. Pemphigus
C. Vesiculopustulosis
D. Scalp phlegmon
E. -

10. A mother of a newborn child suffers from chronic pyelonephritis.

She had acute respiratory viral disease before the labor. Delivery in
time, with prolonged period without waters. A child had
erythematous eruption on the 2 day,then there were seropurulent
vesicles for about 1cm large. Nikolsky’s symptom is positive.
Erosions have occured after vesicle rupture. The child is flabby. The
temperature is subfebrile. What is themost probable diagnosis?
A. Newborn pemphigus
B. Vesiculopustulosis
C. Pseudofurunculosis
D. Sepsis
E. Ritter’s dermatitis

11. Mother of a newborn child suffers from chronic pyelonephritis.

She survivedacute respiratory viral infection directly before labor.
Delivery was at term, the period before discharge of waters
wasprolonged. On the 2-nd day the child got erythematous rash, later
on – vesicles about 1 cm large with seropurulent content. Nikolsky’s
symptom is positive. Dissection of vesicles results in erosions.The
child is inert, body temperature is subfebrile. What is the most
probable diagnosis?
A. Impetigo neonatorum
B. Vesicular pustulosis
C. Pseudofurunculosis
D. Sepsis
12
E. Ritter’s dermatitis

12. 10 days after birth a newborn developed a sudden fever up to 38,

1oC.Objectively: the skin in the region of navel, abdomen and chest
is erythematous; there are multiple pea sized blisters with no
infiltration at the base; single bright red moist erosions with
epidermal fragments on the periphery. What is your provisional
diagnosis?
A. Epidemic pemphigus of newborn
B. Syphilitic pemphigus
C. Streptococcal impetigo
D. Vulgar impetigo
E. Atopic dermatitis

13. A full-term infant is 3 days old. On the different parts of skin

there are erythemas, erosive spots, cracks, areas of epidermis peeling.
The infant has scalded skin syndrome. Nikolsky’s symptom is
positive. General condition of the infant is grave. Anxiety,
hyperesthesia, febrile temperature are evident. What is the most
probable diagnosis?
A. Exfoliative dermatitis
B. Phlegmon of newborn
C. Finger’s pseudofurunculosis
D. Impetigo neonatorum
E. Mycotic erythema

14. A young woman with seborrhea adipose has numerous non-itchy

light brownand white spots with clear outlines and defurfuration on
the torso and shoulder skin. What is the provisional diagnosis?
A. Pityriasisversicolor (scaly skin disease)
B. Tineacorporis
C. Seborrheic dermatitis
D. Pityriasisrosea
E. Vitiligo

13
15. A young woman suffering from seborrhea oleosa has numerous
light-brown and white spots on the skin of her torso and shoulders.
The spots have clear margins, branny desquamation, no itching. What
provisional diagnosis can be made?
A. Pityriasis versicolor
B. Torso dermatophytosis
C. Seborrheic dermatitis
D. Pityriasisrosea
E. Vitiligo

16. A patient is being prepared for the operation on account of varix

dilatation of lower extremities veins. Examination of the patient’s
soles revealed flour-like desquamation along the skin folds. All the
toenails are greyish-yellow, thickened and partially decayed. What
dermatosis should be suspected?
A. Rubromycosis
B. Pityriasisversicolor
C. Candidosis
D. Microsporia
E. Microbial eczema

17.A child is 2 m.o. Inguinofemoral folds contain acutely inflamed

foci with distinctborders in form of spots that are slightly above the
surrounding areas due to skinedema. The rash has appeared during
the week. Vesiculation and wetting are absent.What is the most
probable diagnosis?
A. Napkin-area dermatitis
B. Infantile eczema
C. Dermatomycosis
D. Psoriasis
E. Complicated course of scabies

18. A triad of symptoms (“stearingspot”,“terminal film”, “blood

dew”) have been revealed on examination of a patient. What disease
should you think about?
14
A. Psoriasis
B. Lichen ruberplanus
C. Vasculitis
D. Seborrhea
E. Ritter’s disease

19. A 45-year-old patient complains of some painless nodular

elements tending to peripheral growth and fusion. He has a 2-year
history of this disease. Aggravation takes place mainly in spring. In
anamnesis: the patient’s father had similar skin lesions. Objectively:
pathological elements looke like guttate and nummular nodules,
plaques covered with white scales. What is your provisional
diagnosis?
A. Psoriasis
B. Lichen ruberplanus
C. Neurodermitis
D. Pityriasisrosea
E. Seborrheic eczema

20. A 38-year-old female suddenly developed acute inflammatory

rash in form of roseolas, papules, vesicles that are scattered on the
skin of trunk in irregular and predominantly focal manner. The rash
appeared a few hours after visiting a restaurant. The patient
complains of itching skin/ What is the most likely diagnosis?
A. Toxicodermatosis
B. Atopic dermatitis
C. Contact dermatitis
D. Eczema
E. –

21. A 32 y.o. woman has got the Laiel’s syndrome after taking the
biceptol. What immunotrope medicines are to be prescribed in this
situation?
A. Steroid immunosupressants
B. Non-specific immune modulators
15
C. Specific immune modulators
D. Interferons
E. Non-steroid immunosupressants

22. A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body
temperature raised up to 39 − 400_. She complains of general
indisposition, dizziness, sudden rash in form of red spots and
blisters.Objectively: skin lesions resemble of second-degree burns,
here and there with erosive surface or epidermis peeling. Nikolsky’s
symptom is positive. What is the most probable diagnosis?
A. Acute epidermal necrolisis
B. Pemphigus vulgaris
C. Polymorphous exudative erythema
D. Bullous dermatitis
E. Duhring’s disease

23. A 35 year old woman consulted a doctor about affection of arm

skin and lower third of forearm in form of a large edema, hyperemia,
vesiculation and maceration. The disease developed after using a
laundry detergent "Lotos". The patient has been using it for a month.
She hasn’t suffered from dermatological diseases before. What is the
most probable diagnosis?
A. Allergic dermatitis
B. Dermatitis simplex
C. Toxicoallergic dermatitis
D. Microbial eczema
E. Localized neurodermatitis

24. A 22-year-old girl has been complaining of having itching rash on

her face for 2 days. She associates this disease with application of
cosmetic face cream. Objectively: apparent reddening and edema of
skin in the region of cheeks, chin and forehead; fine papulovesicular
rash. What is the most likely diagnosis?
A. Allergic dermatitis
B. Dermatitis simplex
16
C. Eczema
D. Erysipelas
E. Neurodermatitis

25. A child was taken to a hospital with focal changes in the skin
folds. The child was anxious during examination, examination
revealed dry skin with solitary papulous elements and ill-defined
lichenification zones. Skin eruption was accompanied by strong itch.
The child usually feels better in summer, his condition is getting
worse in winter. The child has been artificially fed since he was 2
months old. He has a history of exudative diathesis. Grandmother by
his mother’s side has bronchial asthma. What is the most likely
diagnosis?
A. Atopic dermatitis
B. Contact dermatitis
C. Seborrheal eczema
D. Strophulus
E. Urticaria

26. An 8-year-old boy has a 2-year history of blotchy itchy rash

appearingafter eating citrus fruit. The first eruption occurred at the
age of 6 months after theintroduction of juices to the baby’s diet.
Father has a history of bronchial asthma,mother - that of allergic
rhinitis. What is the most likely diagnosis?
A. Atopic dermatitis
B. Psoriasis
C. PityriasisRosea
D. Urticaria
E. Quincke’s edema

27. A 35 y.o. patient experienced a strong nervous stress that resulted

in formationof reddened and edematic areas on the back surface of
her hands with further formation of small inflammated
nodules,vesicles and then erosions accompanied by profuse discharge
of serous liquid. The process is also accompanied by intense itching.
17
What is the most probable diagnosis?
A. Common eczema
B. Allergic dermatitis
C. Microbial eczema
D. Common contact dermatitis
E. Toxicodermia

28. A 45-year-old female patient has worked as a painter for 14 years.

Contacts with synthetic paint result in face skin redness, swelling,
intense itching, oozing lesions. The symptoms disappear after the
exposure to chemical agents, but recur even at the smell of paint. The
symptom intensity progresses with relapses. Make a provisional
diagnosis:
A. Occupational eczema
B. Simple contact dermatitis
C. Contact-type allergy
D. Urticaria
E. Toxicoderma

29.After a serious nervous stress a 35- year-old patient has developed

on the dorsal surface of hands redness and swelling that were later
replaced by small inflammatory nodules, vesicles and following
erosion with a significant serous discharge. The process is
accompanied by severe itching. What is the most likely diagnosis?
A. True eczema
B. Allergic dermatitis
C. Microbal eczema
D. Simple contact dermatitis
E. Toxicoderma

30. A welder at work got the first-degree burns of the middle third of
his rightshin. 5 days later the skin around them burn became edematic
and itchy. Objectively:on a background of a well-defined erythema
there is polymorphic rash in form of papules, vesicles, pustules,
erosions with serous discharge. What is the most likely diagnosis?
18
A. Microbial eczema
B. True eczema
C. Toxicoderma
D. Occupational eczema
E. Streptococcal impetigo

31. A 72 year old male patient complains about itch in his left shin,
especially around a trophic ulcer. Skin is reddened and edematic,
there are some oozing lesions, single yellowish crusts. The focus of
affection is well-defined. What is the most probable diagnosis?
A. Microbial eczema
B. Allergic dermatitis
C. Seborrheic eczema
D. Cutaneous tuberculosis
E. Streptococcal impetigo

32. A 26-year-old male patient complains of a rash on the upper lip

skin, which arose on a background of influenza with high-grade fever
and is accompanied by pain and burning. The rash has been present
for 3 days. Objectively: the skin of the upper lip is edematic and
erythematous, grouped vesicles are filled with serous fluid and have a
rough surface. What is the most likely diagnosis?
A. Herpetic vesicular dermatitis
B. Eczema
C. Contact dermatitis
D. Dermatitis herpetiformis
E. Erythema multiforme

33. A 27-year-old sexually active female complains of numerous

vesicles on the rightsex lip, itch and burning. Eruptions regularly turn
up before menstruation and disappear 8-10 days later. What is the
most likely diagnosis?
A. Herpes simplex virus
B. Bartholinitis
C. Primary syphilis
19
D. Cytomegalovirus infection
E. Genital condylomata

34. A patient complained about general weakness, fever, painful rash

on his trunk skin . He has been suffering from this for 3 days.
Objectively: lateral surface of trunk on the left is hyperemic and
edematic, there are some groups of vesicles with serous and
haemorrhagic contents. What is the most probable diagnosis?
A. Herpes zoster
B. Contact dermatitis simplex
C. Contact allergic dermatitis
D. Microbial eczema
E. HerpetiformisDuhring’sdermatosis

35. A 67-year-old male patient complains of rash, severe pain in the

subscapular regionon the right. Objectively: skin in the right
subscapular region is covered with linearly arranged pink-red
edematous lesions that are somewhat infiltrated, and have clear
boundaries. On the lesion surface there are vesicles with transparent
exudate. What is the most likely diagnosis?
A. Herpes zoster
B. Duhring dermatitis
C. Erysipelas
D. Atopic dermatitis
E. Impetigo

36. 2 days ago a patient presented with acute pain in the left half of
chest, general weakness, fever and headache. Objectively: between
the 4 and 5 rib on the left the skin is erythematous, there are multiple
groups of vesicles 2-4 mm in diameter filled with transparent liquid.
What disease are these symptoms typical for?
A. Herpes zoster
B. Pemphigus
C. Herpes simplex
D. Streptococcal impetigo
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E. HerpetiformDuhring’sdermatosis

37. A 26 year old manual worker complained of 3 weeks history of

fevers and fatigue, weight loss with no other symptoms. Physical
findings: Temperature 37, 6oC, Ps- 88 bpm, blood pressure
115/70mmHg, superficial lymph nodes (occipital, submental,
cervical, axillary) are enlarged, neither tender nor painful. Rubella-
like rash on the trunkand extremities.Herpes simplex lesions on the
lips.Candidosis of oral cavity. What infectious disease would you
suspect?
A. HIV infection
B. Influenza
C. Rubella
D. Infectious mononucleosis
E. Tuberculosis

38. A19-year-old patient complains of severe pain in axillary crease.

Condition onset was a week ago after her swimming in a cold river
and epilation. The next day painful ”boil”
appeared that was becoming larger every day and became a plum-
sized tumor. Upon examination nodular conical growths joined
together are detected, the skin covering them is bluish-red in color.
Some nodules have fistulous openings producing thick purulent mass.
Body temperature is 38, 5oC, general malaise. The most likely
diagnosis is:

A. Hydradenitis
B. Carbuncle
C. Cutaneous tuberculosis
D. Necrotizing ulcerative trichophytosis
E. Pyoderma chancriformis

VENEROLOGY

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39. A 36-year-old patient complains of skin rash that appeared a
week ago and doesn’t cause any subjective problems .Objectively:
palm and sole skin is covered with multiple lenticular disseminated
papules not raised above the skin level. The papules are reddish,
dense on palpation and covered with keratinous squamas. What is the
provisional diagnosis?
A. Secondary syphilis
B. Verrucosis
C. Palmoplanar psoriasis
D. Palmoplanarrubrophytosis
E. Palm and sole callosity

40. A 32 y.o. man is divorced, has an irregular sexual life. He

complains of falling out of hair in the region of eyelashes, eyebrows,
scalp. Objectively: diffuse alopecia is observed, eyebrow margin is
absent, eyelashes are stair-like (Pinkus’ sign). What examination
should be carried out first of all?
A. Wasserman test, IFT
B. T.pallidum Immobilization Test (TPI)
C. Detection of the nasal mucous membrane for Micobacterium
Leprae Hansen
D. Consultation of neuropathist
E. CBC

41. A patient consulted a venereologist about painful urination,

reddening of the external opening of urethra, profuse purulent
discharges from the urethra. He considers himself to be ill for 3 days.
He also associates the disease with a casual sexual contact that took
place for about a week ago. If provisional diagnosis "acute
gonorrheal urethritis" will be confirmed, then bacteriological study of
urethral discharges will reveal:
A. Gram-negative diplococci
B. Gram-positive diplococci
C. Spirochaete
D. Proteus vulgaris
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E. Mycoplasma

42. An 18 year old woman consulted a gynecologist about the pain in

the lower part of abdomen, fever up to 37, 5oC, considerable
mucopurulent discharges from the genital tracts, painful urination.
Vaginal and speculum examination results: the urethra is infiltrated,
cervix of the uterus is hyperemic, erosive. The uterus is painful,
ovaries are painful, thickened; fornixes are free. Bacterioscopy test
revealed diplococcus. What diagnosis is the most probable?
A. Recent acute ascending gonorrhea
B. Trichomoniasis
C. Candydomycosis
D. Chronic gonorrhea
E. Chlamydiosis
43. A 25-year-old patient complains of burning and pain during
urination, purulent discharges from the urethra that turned up 2 days
ago. Objectively: the urethral labia are edematic, hyperemic, there are
profuse purulent discharges from the urethra. Provisional diagnosis:
recent acute gonorrheal urethritis. What supplemental data of clinical
examinations will alow to specify the diagnosis?
A. Microscopy of the urethral discharges
B. Serological blood analysis
C. Common urine analysis
D. Coccal cells detection during discharge
microscopy
E. Yeast cells detection during discharge
microscopy

44. On the fifth day after a casual sexual contact a 25-year-old female
patientconsulted a doctor about purulent discharges from the genital
tracts and itch. Vaginal examination showed that vaginal part of
uterine cervix was hyperemic and edematic. There was an erosive
area around the external orifice of uterus. There were mucopurulent
profuse discharges from the cervical canal, uterine body and
appendages exhibited no changes. Bacterioscopic examination
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revealed bean-shaped diplococci that became red after Gram’s
staining. What is the most likely diagnosis?
A. Acute gonorrheal endocervicitis
B. Trichomonalcolpitis
C. Candidalvulvovaginitis
D. Clamydialendocervicitis
E. Bacterial vaginitis

45. A 28-year-old patient has been admitted to the gynecological

department three days after a casual coitus. She complains about pain
in her lower abdomen and during urination, profuse purulent
discharges from the vagina, body temperature rise up to 37, 8oC. The
patient was diagnosed with acute bilateral adnexitis. Supplemental
examination revealed: the 4th degree of purity of the vaginal
secretion, leukocytes within the whole visual field, diplococcal
bacteria located both intra- and extracellularly.What is the etiology of
acute adnexitis in this patient?
A. Gonorrheal
B. Colibacterial
C. Chlamydial
D. Trichomonadal
E. Staphylococcal
46. A 35-year-old patient has been admitted to a hospital for pain in
the leftsternoclavicular and knee joints, lumbar area. The disease has
an acute characterand is accompanied by fever up to 38oC.
Objectively: the left sternoclavicular andknee joints are swollen and
painful. In blood: WBCs - 9, 5 · 109/l, ESR - 40 mm/h,CRP -
1,5millimole/l, fibrinogen - 4,8 g/l, uric acid - 0,28 millimole/l.
Examinationof the urethra scrapings reveals chlamydia. What is the
most likely diagnosis?
A. Reiter’s syndrome
B. Rheumatic arthritis
C. Gout
D. Bechterew’s disease
E. Rheumatoid arthritis
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47. A 27-year-old sexually active woman complains of numerous
vesicles on the right sexual lip, itch and burning. Eruptions regularly
appear before menstruation and disappear 8-10 days later. What is the
most likely diagnosis?

A. Herpes simplex virus

B. Bartholinitis
C. Primary syphilis
D. Cytomegalovirus infection
E. Genital condylomata

48. An 18-year-old woman complains of pains in her lower abdomen,

purulent discharge from the vagina, temperature rise up to 37, 8oC.
Anamnesis states that she had random sexual contact the day before
the signs appeared. She was diagnosed with acute bilateral adnexitis.
On additional examination: leukocytes in the all field of
vision,bacteria, diplococci with intracellular and extracellular
position. What agent is most likely in the given case?

A. Gonococcus
B. Colibacillus
C. Chlamydia
D. Trichomonad
E. Staphylococcus

49. A 6-year-old girl visited a general practitioner with her mother.

The child complains of burning pain and itching in her external
genitalia. The girl was taking antibiotics the day before due to her
suffering from acute bronchitis. On examination: external genitalia
are swollen, hyperemic, there is white deposit accumulated in the
folds. The most likely diagnosis is:

A. Candidalvulvovaginitis

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B. Trichomoniasis
C. Nonspecific vulvitis
D. Helminthic invasion
E. Herpes vulvitis

CLINICAL TASKS (2017)

1. A 28-year-old man complains of skin rash and itching on the both

of his hands. The condition persists for 1,5 years. The exacerbation of
his condition he ascribes to the occupational contact with
formaldehyde resins. Objectively: lesion foci are symmetrically
localized on both hands. Against the background of erythema with
blurred margins there are papulae, vesicles, erosions, crusts, and
scales. What is the most likely pathology?
A. Occupational eczema
B. Idiopathic eczema
C. Allergic dermatitis
D. Simple contact dermati

2. A 14-year-old patient complains of alopecia foci on his scalp. The

patient has been presenting with this condition for 2 weeks.
Objectively: on the scalp there are several small oval foci with
blurred margins. The skin in the foci is pink-red, the hairs are broken
off at 4-5 mm length or at skin level. Under Wood’s lamp there are
no foci of green luminescence detected. What disease is it?
A. Trichophytosis capitis
B. Syphilitic alopecia
C. Alopecia areata
D. Scleroderma
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E. Psoriasis

3. A young woman suffering from seborrhea oleosa has numerous

light-brown and white spots on the skin of her torso and shoulders.
The spots have clear margins, branny desquamation, no itching. What
provisional diagnosis can be made?

A. Pityriasis versicolor
B. Torso dermatophytosis
C. Seborrheic dermatitis
D. Pityriasis rosea
E. Vitiligo

4. 10 days after birth a newborn developed sudden fever up to

38,1oC. Objectively: the skin in the region of navel, abdomen and
chest is erythematous; there are multiple peasized blisters with no
infiltration at the base; isolated bright red moist erosions with
epidermal fragments are observed on the periphery. What is the
provisional diagnosis?
A. Epidemic pemphigus of newborn
B. Syphilitic pemphigus
C. Streptococcal impetigo
D. Vulgar impetigo
E. Atopic dermatitis

5. An 18-year-old patient complains of skin rash. The patient has

been suffering from this condition for 5 years. The first instance of
this disease occurred after a car accident. Objectively: the patient
presents with papular rash covered in silvery scales, ”thimble”
symptom (small pits on the nails), affected joints. What is the most
likely diagnosis?
A. Psoriasis
B. Panaritium
C. Onychomycosis

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D. Lupus erythematosus
E. Rheumatism

6. A man came to an urologist with complains of painful urination,

discharge from urethra. The patient has been suffering from this
condition for a week. Objectively: hyperemic urinary meatus, edema,
purulent discharge. Microscopy of smears detected gram-negative
bacteria. Specify the diagnosis:
A. Acute gonorrheal urethritis
B. Trichomonas urethritis
C. Candidal urethritis
D. Chlamydial urethritis
E. Chronic gonorrhea

7. An 18-year-old woman complains of pain in her lower abdomen,

profuse purulent discharge from the vagina, temperature rise up to
37,8oC. Anamnesis states that she had a random sexual contact the
day before the signs appeared. She was diagnosed with acute bilateral
adnexitis. On additional examination: leukocytes are present
throughout all vision field, bacteria, diplococci with intracellular and
extracellular position. What is the most likely agent in the given
case?
A. Neisseria gonorrhoeae
B. Escherichia coli
C. Chlamydia trachomatis
D. Trichomona vaginalis
E. Staphylococcus aureus

8 A patient complains of painless ”sores” on his penis and inguinal

lymph nodes enlargement. Synthomycin emulsion that the patient
have been applying to the ”sores” was ineffective. Objectively: on the
inner leaf of the foreskin there are three closely situated rounded
erosions, 0,5 cm in diameter, with dense infiltration that can be
palpated at their bases. Make the preliminary diagnosis:
A. Primary syphilis
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B. Herpes simplex (Herpes pro genitalis)
C. Candidiasis of the inner leaf of the foreskin
D. Shingles
E. Erythema multiforme

9. A 6-year-old girl visited a general practitioner with her mother.

The child complains of burning pain and itching in her external
genitalia. The girl was taking antibiotics the day before due to her
suffering from acute bronchitis. On examination: external genitalia
are swollen, hyperemic, there is white deposit accumulated in the
folds. The most likely diagnosis is:

A. Candidalvulvovaginitis
B. Trichomoniasis
C. Nonspecific vulvitis
D. Helminthic invasion
E. Herpes vulvitis

The guide was written by: prof. Dashchuk A. M., assoc. prof.
Pustovaya N. A., Dobrzhanskaya E. I., ass. Pochernina V.V.

Approved at the meeting of the Department of Dermatology,

Venereology and AIDS on August “29” 2017. Protocol No. 13.

Head of the Department Prof. Dashchuk A.M.

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