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NBME 21 Answers

nbme21/Block 1/Question#26

A 62-year-old man who is a farmer comes to the ...

Actinic keratosis

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submitted by niboonsh(81),

i think of this as ole farmer joe on his actinic farm picking karats (carrots) (actinic keratosis)

The whole "picks at the lesion...causes some bleeding", made me think Psoriasis. Should have gone with Actinic Keratosis based on the patient history (lots of sun exposure).

Actinic Keratosis

Premalignant lesions caused by sun exposure. Small, rough, erythematous or brownish papules or plaques. Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia.

thisisfine   Same - the bleeding thing pushed me over to psoriasis as well. Oops. +1  
temmy  the distribution of the other lesions, forearm, face, ear, scalp..is not characteristic for psoriasis. +1  
hyperfukus  the scalp and ear are actually very common for psoriasis IRL the key is more of the fact that its in areas with UV exposure...actually UV Therapy is found to be helpful in treating some pts w/Psoriasis. Lastly the appearance and lots of things bleed if they were trying to go for auspitz sign it would have tiny dots of bright red blood with slightly touching it +1  
hyperfukus  oh last thing psoriasis itches! they said no itching +  

i fell for bleeding from lesion at chose psoriasis but psoriasis pts experience itching. Also, the distribution is not characteristic.