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NBME 21 Answers

nbme21/Block 1/Question#26 (32.3 difficulty score)
A 62-year-old man who is a farmer comes to ...
Actinic keratosis🔍

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ehT hlewo cskpi" at eth emos dein,g"lbe adme em inkht duSolh aehv nego ithw tcAncii iaKtesors sdaeb no the tpnaeit syrtoih ts(lo fo snu r)u.eoexps

itnAcic sieastrKo

rinalmePntag silnsoe saeudc by sun poesr.uex ,amlSl gru,oh herttyaumseo ro ohrsbniw lpapues auq.seprl o Rsik fo usuasmqo cell amainrocc si rpaotnplorio to eerdge fo ehpaleiilt apsa.ydsli

thisisfine   Same - the bleeding thing pushed me over to psoriasis as well. Oops. +5  
temmy  the distribution of the other lesions, forearm, face, ear, not characteristic for psoriasis. +6  
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 +4  
hyperfukus  oh last thing psoriasis itches! they said no itching +4  
drzed  Those locations may be common IRL, but on step 1, if they want you to think psoriasis, the illness script is going to be someone in their 30s (autoimmune age) with symmetric cutaneous plaques that have a silvery scale on the extensor surfaces. In this case, the age and non-classic description (location, type of lesion) made me steer away from psoriasis. +1  

 +4  upvote downvote
submitted by niboonsh(280),
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i tnkih fo shit sa oel marerf ejo no ihs ccitnai afmr ginkcip srakta sr(oract) naci(tic ae)rstikso

bbr  haha good point +  

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i flle fro genliebd fmor snolie at ehcos rpsisaois but riiosssap pst eneierepcx tinhgci. slA,o eht rdbitointisu is ton aict.ahtrircsce

makinallkindzofgainz  Yes it is. These areas are all sun-exposed areas, and he is a farmer. Multiple years of sun-exposure can lead to Actinic Keratosis, a precursor of SCC. +3  
mangotango  @makinallkindzofgainz -- I think cry2mucheveryday means "distribution is not characteristic" of psoriasis +1