ETAS_MCQ_14 plants and creatures of dermatologic significance

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ETAS_MCQ_14 plants and creatures of dermatologic significance

  1. 1. Plants and Creatures of Dermatologic Significance1) Name this creature:A. Demodex folliculorumB. Ornithonyssus sylviarumC. Pediculus capitisD. Pediculus humanusCorrect ChoiceE. Pthirus pubisThis is the body louse, or Pediculus humanus var. corporis. The pubic louse (pthirus pubis) isshorter, and squatter. The head louse (pediculus capitis) has a narrow body2) When doing patch testing for compositae sensitivity, which of the following substances is used?A. Tuliposide AB. RhusC. Sesquiterpene lactone mix Correct ChoiceD. ColophonyE. PentadecacatecholsColophony cross reacts with turpentine resin, hairpiece adhesive, mascara, dental cement andothers. Pentadecacatechols are in the rhus family and are found in poision ivy, oak and sumac inaddition to cross reacting with mango and cashew. Tuliposide A is found in Peruvian lily(alstomeria), and tulip3) A previously healthy 25-year-old man presents to the ER 8 hours after experiencing anextremely painful spider bite. The bite site is erythematous and indurated, without necrosis oreschar. The patient is vomitting and experiencing chills, violent cramps, and abdominal pain andrigidity. The surgical consultant suspects an acute abdomen. You correctly propose that:A. The patient has a likely Lycosidae bite and needs supportive careB. The patient has a likely Loxosceles bite and should go to the OR for excision and debridementC. The patient needs anti-venom after a likely Phidippus formosus biteD. The patient has likely experienced a hobo spider biteE. The patient needs anti-venom after a likely Lactrodectus biteCorrect ChoiceThe patient has signs and symptoms a black widow spider bite, caused by Lactrodectus. Anti-venommay be helpful up to 90 hours after the bite4) Match the photo to the plant identified:A. Poison oakB. Poison sumac Correct ChoiceC. Mango leavesD. GingkoE. Poison ivyPoison sumac leaves grow in groupings of 7-13 with a single leaf at the tip. 1
  2. 2. 5) All of the following are food mites except:A. DermatophagoidesCorrect ChoiceB. AcarusC. GlyciphagusD. All of the listed answers are food mitesE. TyrophagusAcarus (grain mite), Tyrophagus (grocery mite), and Glyciphagus (cheese mite) are all food mitesthat ingest foodstuffs. They can produce papular urticaria or vesicopapular eruptions.Dermatophagoides is the dust mite, and causes environmental allergic reactions.6) Which of the following statements regarding Megalopyge opercularis is correct?A. Are also called "bed bugs" by lay peopleB. These creatures can be vectors of many diseases from typhus to plagueC. These creatures, found in Hawaii, are nocturnal carnivores that produce painful wounds bydischarging venomD. Contact with this creature often causes immediate pain, urticaria, and erythematous papules orpurpura in a tram-track patternCorrect ChoiceE. Bites are usually asymptomatic, initially, but then form linear purpuric maculesMegalopyge opercularis (puss caterpillar) is one of the most widespread causes of caterpillardermatitis. Contact with this creature often causes immediate pain, urticaria, and erythematouspapules or purpura in a tram-track pattern. Bites of Cimicidae (bedbugs) are usually asymptomatic,initially, but then form linear purpuric macules. Fleas can be vectors of many diseases from typhusto plague. Chilopoda (centipedes) are nocturnal carnivores that produce painful wounds bydischarging venom. Scolopendra is a species of centipede found in Hawaii7) The venom from which of the following creatures contains phospholipase A?A. CimicidaeB. Ctenocephalides canisC. TheraphosidaeD. HoneybeeCorrect ChoiceE. Solenopsis invictaHoneybees (Hymenoptera) leave a barbed ovipositor and paired venom sacs impaled into theirvictim. The honeybee dies after stinging, but other hymenoptera do not. The venom from thehoneybee contains phospholipase A. Theraphosidae (tarantulas) are of dermatologic importance dueto the presence of urticating hairs. Cimicidae (bedbugs) cause initially asymptomatic bites that thenform linear, purpuric, pruritic macules and erythematous papules. Ctenocephalides canis is a fleathat causes frequent infestations on dogs. Solenopsis invicta is the imported fire ant, and attacks ingroups. Solenopsis inject a venom that contains a hemolytic factor, solenopsin D8) Unilateral swelling of the eyelid at the site of the bite of the assassin bug is called what?A. Rothschilds sign 2
  3. 3. B. Romanas signCorrect ChoiceC. Russells signD. Raynauds signE. Unilateral Chagas diseaseRothschilds sign is alopecia of the lateral 1/3 of the eyebrows secondary to hypothyroidism.Russells sign is the development of callouses on the dorsal dominant hand. Raynauds sign is thedevelopment of acrocyanosis9) A butcher’s nodule is caused by which of the following?A. HPV 2, 7 Correct ChoiceB. HPV 16, 18C. HPV 1D. HPV 24E. HPV 13, 32HPV 24 causes common warts. HPV 16 and 18 are found in genital warts; 1 is for plantar warts andtypes 13 and 32 are seen in Heck’s Disease (focal epithelial hyperplasia10) Immunologic contact urticaria is frequently caused by:A. None of these answers are correctB. Plants of the Urticaceae familyC. Hevea brasiliensisCorrect ChoiceD. All of these answers are correctE. Plants of the Euphorbiacea familyContact urticaria occurs after direct contact, and can be immunologic (IgE) or non-immunologic(toxin-mediated). Type I hypersensitivity, or IgE mediated reactions, require previous sensitization.Frequent causes of immunologic eruptions include latex proteins (Hevea brasiliensis). Plants such asstinging nettles (Urticaceae family) and spurge nettle (Euphorbiaceas) cause nonimmunologicurticaria, which occurs without previous sensitization in any host.11) Phytophotodermatitis is caused by which of the following wavelengths of light?A. 290-320 nmB. 320-400 nm Correct ChoiceC. 100-200 nmD. 200-290 nmE. 311 nmUVA rays are responsible for the phototoxic reaction which occurs with phytophotodermatitis12) Identify this caterpillar:A. Greenback caterpillarB. Hag moth caterpillar 3
  4. 4. C. Io caterpillarD. Puss caterpillarE. Saddleback caterpillarCorrect ChoiceThis is the saddleback caterpillar, as it appears that the caterpillar is wearing a saddle13) Which of the following is false regarding this image?A. This is a glossina flyB. This transmits trypanosomesC. A large abscess may occur following a biteCorrect ChoiceD. This transmits sleeping sicknessE. This is the tsetse flyCutaneous reactions tend to be minimal from the bite of the tsetse, or glossina, fly which transmitstrypanosomes and sleeping sickness14) Flying squirrels can carry many infections, including which of the following?A. all of these infections are correctCorrect ChoiceB. Toxoplasma gondiiC. Staphlyococcus spD. none of these infections are correctE. Epidemic typhusFlying squirrels can carry many infections, including Toxoplasma gondii, Staphylococcus sp., andRickettsia prowazekii (via the body lous, causing epidemic typhus15) A patient who experiences an allergic contact dermatitis in reaction to an extract from the Pinuspalustris tree may also be sensitized to:A. None of these answers are correctB. VarnishC. MascaraD. RosinE. All of these answers are correctCorrect ChoiceColophony, derived from the Pinus palustris tree, may cross react with rosin, medications, mascara,adhesives, bandages, varnish, wax, paper products, and dental cement16) A butcher presents with numerous verrucous papules of the hands and fingers. Based on heroccupation, you consider a diagnosis of infection with which HPV types?A. HPV 2 and 7Correct ChoiceB. HPV 1 and 2C. HPV 6 and 8D. HPV 16 and 18 4
  5. 5. E. HPV is not associated with this conditionMeat, fish, and poultry handlers often suffer from hand and finger verrucae, usually caused byhuman papilloma virus types 2 and 7.17) This snake, the coral snake, is a member of what family?A. ElapidaeCorrect ChoiceB. LepidopteraC. TheraphosidaeD. CrotalidaeE. ApiaceaeThe Crotalidae family includes rattlesnakes and copperheads. Lepidoptera are caterpillars.Theraphosidae is the scientific name for tarantulas. Apiaceae (Umbelliferae) is a plant family whichincludes parsley, celery and fennel. Elapidae is the correct family of snakes, including coral snakes18) Which of the following plants contains thiocyanates that can cause an irritant dermatitis?A. RadishB. All of these answers are correctCorrect ChoiceC. Plants of the Brassicaceae familyD. MustardE. GarlicThiocyanates are found in garlic (Alliaceae family), mustard, and radish (Brassicaceae family19) This tick transmits:A. BabesiosisB. ErlichiosisC. Rocky mountain spotted feverCorrect ChoiceD. Relapsing feverE. LymeThis is Dermacentor variabilis which transmits Rocky Mountain Spotted Fever as well as Tularemia20) Which family of plants is most commonly implicated in phytophotodermatitis caused byfurocoumarins?A. MoraceaeB. PapilonaceaeC. ApiaceaeCorrect ChoiceD. CompositaeE. RutaceaeThe Apiaceae (formerly umbelliferae) family is the most common cause of phytophotodermatitis.The members of this family include cow parsley, celery, wild parsnip, false bishops weed, gianthogweed, angelica, meadow grass, fennel, wild carrot, caraway, and coriander 5
  6. 6. 21) The reaction caused by this plant is mediated by:A. IgEB. EosinophilsC. Langerhans cellsCorrect ChoiceD. Mast cellsE. HistamineThis is ragweed, which causes allergic contact dermatitis. Mast cells, IgE and histamine arecharacteristic of contact urticaria. Allergic contact dermatitis is caused by langerhans cellspresenting antigen to CD4+ lymphocytes leading to a cell-mediated delayed hypersentitivityreaction22) Which of the following mites is a cause of "walking dandruff" in dogs and cats?A. All of these answers are correctB. None of these answers are correctC. Allodermanyssus sanguineusD. AcarusE. CheyletiellaCorrect ChoiceCheyletiella mites are harbored by dogs and cats and cause walking dandruff. The pet isasymptomatic, but people handling the pet may experience pruritus when mites feed on skin.Diagnosis is by microscopic examination of cellophane tape applied to the pets skin. Acarus is thegrain mite, and causes bakers itch. Allodermanyssus sanguineus is the house mouse mite, and thevector of rickettsial pox23) Which of the following statements regarding Theraphosidae is correct?A. All of these statements are correctCorrect ChoiceB. These creatures possess urticating hairs that are of dermatologic significanceC. These creatures can cause visual loss by causing a chronic granulomatous reaction (ophthalmianodosa)D. None of these statements are correctE. Bites do not generally produce any systemic toxicityTheraphosidae (tarantulas) are large, brown to black, hairy spiders frequently found in thesouthwest. They are of dermatologic importance due to urticating hairs. Tarantula bites generally donot produce any systemic toxicity. The spider releases hairs in the direction of the perceivedattacker; hairs can penetrate the skin as deeply as the reticular dermis. If they injure the cornea,they can cause a chronic granulomatous reaction (ophthalmia nodosa) and loss of vision24) A veterinarian presents with an edematous pustule on the right arm, with nodules along thelymphatic drainage route. You consider a diagnosis of glanders. What treatment do yourecommend?A. Surgical excision followed by antibiotic treatment with streptomycin combined withtetracyclineCorrect Choice 6
  7. 7. B. Reassurance. No treatment is necessary, as infection is self-limited and should resolve within 6weeksC. Surgical excision followed by antibiotic treatment with rifampin and ethambutolD. Surgical excisionE. Antibiotic treatment with streptomycin combined with tetracyclineFarcy, or glanders, is caused by infection with the gram-negative rod Pseudomonas mallei. It mostfrequently infects horses, donkeys, and mules; humans can occasionally also be infected. Anedematous nodule, pustule, or vesicle develops at the inoculation site. Nodules are often presentalong the lymphatic drainage route and are called "farcy buds." Importantly, nasal ulceration andseptum perforation can be caused by glanders. A chronic form leads to deep, painful abscesses.Treatment is with surgical excision of the lesion followed by streptomycin combined withtetracycline.25) Ananas comosus causes an irritant dermatitis attributed to which irritant?A. Phorbol estersB. ThiocyanatesC. CapsaicinD. RanunculinE. BromelinCorrect ChoiceAnanas comosus is the pineapple. Pineapples contain the irritants bromelin (a proteolytic enzyme)and calcium oxalate (which causes fissures that grant bromelin access to dermal vessels). Capsaicinis found in chili peppers. Phorbol esters are found in spurges, crotons, poinsettas, and machineeltrees. Thiocyanates are found in garlic, mustard, and radishes. Ranunculin is found in buttercups26) This is a:A. Moth caterpillarB. Woolybear caterpillarCorrect ChoiceC. Brownbear caterpillarD. Puss caterpillarE. Furrybear caterpillarThis is a woolybear caterpillar27) Onions and chives:A. Are members of the family AnacardiaceaB. Contain diallyl disulfideCorrect ChoiceC. Cross-react with artichoke in sensitized patientsD. Contain pentadecylcatecholE. Are members of the same family as GingkoOnions, garlic, and chive are members of the family Alliaceae and contain diallyl disulfide (alsoallylpropyl disulfide, allicin28) Poison sumac is: 7
  8. 8. A. A source of colophonyB. The common name for Myroxylon balsamumC. A source of tuliposide AD. The common name for Pinus palustrisE. A member of the Toxicodendron genusCorrect ChoicePoison ivy, oak, and sumac are members of the Anacardiacea family, Toxicodendron genus.Alstromeria (Peruvian lily) is the source of tuliposide A. Myroxylon balsamum is the source ofBalsam of Peru. The Pinus palustris tree is the source of colophony29) Cantharadin is derived from:A. RanunculaceaeB. CompositaeC. Lytta vesicatoriaCorrect ChoiceD. PentadecacatecholE. SolanaceaeRanunculaceae (buttercup) causes irritant dermatitis. Pentadecacatechol is the rhus antigen foundin poison ivy, oak and sumac. Solanaceae (chili pepper) contains capsaicin. Pyrethrin is derivedfrom compositae (chrysanthemum flower). Lytta vesicatoria (spanish fly) is a blister beetle fromwhich cantharadin is made30) Which of these mites is the most likely cause of a pruritic papulovesicular eruption in a baker?A. DermanyssusB. DermatophagoidesC. none of the aboveD. CheyletiellaE. AcarusCorrect ChoiceAcarus (grain mite) causes so-called "bakers itch." Dermatophagoides (dust mite) causes allergicreactions, Dermanyssus (fowl mite) causes equine encephalitis, and Cheyletiella causes walkingdandruff in dogs and cats31) Lipase is a notable active component of the venom of which of the following spiders?A. LoxoscelesB. HidippusC. ChiracanthiumCorrect ChoiceD. LactrodectusE. LycosidaeThe venom of Chiracanthium (sac spiders) contains lipase. The venom of Lycosidae (wolf spiders) isnotable for histamine; Lactrodectus (black widow spiders) for alpha lactrotoxin; Hidippus (jumpingspiders) for hyaluronidase; and Loxosceles (brown recluse spiders) for sphingomyelinase-D.32) The reaction in this picture is most likely a result of: 8
  9. 9. A. UV exposure Correct ChoiceB. Child abuseC. Irritant response from garlicD. Toxicodendron bullous reactionE. NickelThis is an example of phytophotodermatitis. This is a reaction between furocoumarins followed byexposure to UVA33) Furocoumarins, such as 5-methoxypsoralen or 8-methoxypsoralen:A. Cause a type IV delayed hypersensitivity reaction after exposure to all wavelengths of UV lightB. Cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light inthe 320-400nm rangeCorrect ChoiceC. Cause a phototoxic reaction after contact with the skin, followed by exposure to ultraviolet light inthe 280-320nm rangeD. Cause a photoallergic reaction after contact with the skin, followed by exposure to ultraviolet lightin the 320-400nm rangeE. Cause a photoallergic reaction after contact with the skin, followed by exposure to ultraviolet lightin the 280-320nm rangeUnlike photoallergic reactions, which involve the immune system (type IV or delayedhypersensitivity), phytophotodermatitis is non-immunologic. Photoallergic reactions are morefrequently caused by other, non-plant sources. Furocoumarins, such as 5-methoxypsoralen or 8-methoxypsoralen, cause a phototoxic reaction after contact with the skin, followed by exposure toultraviolet light in the UVA range (320 to 400nm).34) A 47 year old park ranger developed a diffuse, erythematous, eczematous eruption afterfighting a forest fire. What is the most likely allergen causing this airborn contact dermatitis?A. AlphamethyleneB. PyrethrinsC. D-usnic acidCorrect ChoiceD. PsoralenE. Diallyl disulfideLichen causes airborne allergic contact dermatitis in lumberjacks, forest workers, and peopleexposed to firewood, funeral wreaths, and masculine fragrances. The primary allergen is d-usnicacid35) Which disease is transmitted by this insect?A. Chagas diseaseCorrect ChoiceB. OnchocerciasisC. African sleeping sicknessD. Visceral leishmaniasisE. Dracunculiasis 9
  10. 10. This a picture of the reduviid bug, also called the kissing bug or assassin bug. It is the vector forAmerican Trypanosomiasis (Chagas disease), which is caused by Trypanosoma cruzii. The reduviidbug prefers to bite at mucocutaneous junctions36) Which of the following plants are members of the Solanaceae family?A. Prickly pearB. RadishC. GarlicD. CrotonsE. Chili pepperCorrect ChoiceChili peppers belong to the Solanaceae family. Prickly pears (Opuntia vulgaris), crotons(Euphorbiaceae family), garlic (Alliaceae family), and radishes (Brassicaceae family) are notmembers of this family37) Leishmania donovani is transmitted by:A. GlossinaB. Callitroga americanaC. Attagenus megatomaD. PhlebotomusCorrect ChoiceE. AnophelesLeishmania donovani is transmitted by Phlebotomid sandflies. Callitroga americana is the mostimportant cause of cutaneous myiasis in the United States. Glossina, the tsetse fly, transmitssleeping sickness. Attagenus megatoma is a carpet beetle, the larvae of which can cause an allergiccontact dermatitis. Anopheles mosquitoes transmit malaria.38) Sharp hairs on plants of the Urticaceae family contain which of the following toxins that arereleased into the skin causing rapid edema, pruritus, and burning?A. SerotoninB. Histamine and acetylcholineC. AcetylcholineD. All of these answers are correctCorrect ChoiceE. HistamineSharp hairs on plants such as stinging nettles (Urticaceae family) contain toxins (histamine,serotonin, and acetylcholine) which are released into the skin causing rapid edema, pruritus, andburning39) Which of the following may NOT occur after contact with the organism in the photo?A. Loss of visionB. Purpura in a tram-track patternC. UrticariaD. Pruritus 10
  11. 11. E. Tram-track calcification on skull x-ray Correct ChoiceThe most common response is erythema, pruritus and urticaria. Purpura and hemorrhage in a tram-track or ladder pattern may be seen as well. Ophthalmia nodosa may occur if hairs injure thecornea. Tram-track calcification on skull films is seen in Sturge-Weber syndrome40) A patient comes to you with complaints of numerous erythematous pruritic papules under herbathing suit after swimming in the ocean. What is the most likely diagnosis?A. Seabather’s eruption Correct ChoiceB. Swimmer’s itchC. Nematocyst stingsD. Hydrozoa contactE. Hot tub folliculitisSea bather’s eruption is seen after ocean exposure and can be intensely pruritic. It is due to jellyfishlarvae (Linuche unguiculata) and can be prevented by rinsing off soon after coming out of thewater. Swimmer’s itch is a cercarial dermatitis caused by avian schistosomes which occurs afterfreshwater exposure. It is usually seen on exposed areas. Portuguese man of war (hydrozoa) stingscan lead to hemorrhagic lesions with vesiculations41) Which of the following plant families commonly causes phytophotodermatitis?A. RubiaceaeB. RanunculaceaeC. Apiaceae Correct ChoiceD. CompositaeE. UrticaceaeThe Apiaceae family (formerly Umbelliferae) includes parsley, celery, parsnip, hogweed, and fennel,all potential causes of phytophotodermatitis42) When bitten with the spider in the photograph, the active agent in the venom is:A. Sphingomyelinase-DB. Alpha lactrotoxin Correct ChoiceC. LipaseD. HyaluronidaseE. HistamineThis is a black widow spider which can be identifiec by its shiny black bodywith characteristic white hourglass marking on the abdomen43) The vector for Babesia microti is also a vector for:A. Rickettsia rickettsiiB. None of these answers are correctC. Francisella tularensis 11
  12. 12. D. Borrelia burgdorferiCorrect ChoiceE. All of these answers are correctThe vector for Babesia microti, the pathogenic organism of babesiosis, is Ixodes dammini, which isalso a vector for Borrelia burgdorferi, the pathogenic organism of Lyme borreliosis. Francisellatularensis (the pathogenic organism of tularemia) is transmitted by Dermacentor andersoni andDermacentor variabilis. Rickettsia rickettsii (the pathogenic organism of Rocky Mountain SpottedFever) is transmitted by Dermacentor andersoni, Dermacentor variabilis, and Amblyommaamericanum44) Allergic contact dermatitis is a:A. Type III hypersensitivityB. Type II hypersensitivityC. Type I hypersensitivityD. Undetermined hypersensitivityE. Type IV hypersensitivity Correct ChoiceNEEDS EXPLANATIONS45) Match the photo to the plant identified:A. Mango leavesB. Poison ivyC. GingkoD. Poison oak Correct ChoiceE. Poison sumacPoison oak is identified by leaf shape - irregular lobing and varied leaf size46) The insect pictured is:A. A vector of relapsing feverB. The cause of maculae ceruleaC. A vector of Lyme borreliosisCorrect ChoiceD. OrnithonyssusE. A vector of babesiosisThe insect pictured is a female Amblyomma americanum tick. This tick can serve as a vector forLyme borreliosis and Rocky Mountain Spotted Fever. Relapsing fever is transmitted by Ornithodorosmoubata. Babesiosis is trasnmitted by Ixodes dammini. Maculae cerulea are seen in severe cases ofcrab lice. Ornithonyssus is the fowl mite47) Which of the following is the most common cause of dermatitis in florists?A. Sesquiterpene lactonesB. Calcium oxalate Correct ChoiceC. Primin 12
  13. 13. D. Tuliposide AE. Mechanical dermatitisCalcium oxalate is present in the bulbs and stems of Narcissus (daffodil48) Snake bite antivenin is derived from:A. Pooled IVIgB. Horse antibodyCorrect ChoiceC. Human antibodyD. Mouse antibodyE. Antigen extracted directly from the attacking snakeFollowing envenomation, antivenins are derived from horses49) All of the following plants commonly cause a phytophotodermatitis except:A. CeleryB. Ficus caricaC. Hawaiian lei flowersD. Myroxylon balsamumCorrect ChoiceE. All of these plants commonly cause a phytophotodermatitisMyroxylon balsamum is the source of Balsam of Peru, a common sensitizer of allergic contactdermatitis. Hawaiian lei flowers, Ficus carica (fig tree), and celery all are known to commonly causephytophotodermatitis50) On slide preparation, many organisms were noted on this patient, as well as occasional bluemacules on the buttocks. He most likely has:A. Chigoe fleasB. Pediculus capitis infestationC. Pthirus pubis infestationCorrect ChoiceD. Sarcoptes scabiei infestationE. Pediculus humanus infestationIt is often very easy to find crab lice on physical exam in contrast with scabies. Head liceinfestations are usually limited to the scalp. Body lice are not often found on the patient, morecommonly in clothing seams. Maculae caerulea can be seen in widespread involvement as in thiscase51) Which of the following plants are members of the family Rutaceae?A. Burning bushB. RueC. All of these answers are correctCorrect ChoiceD. None of these answers are correct 13
  14. 14. E. Bergamot orangeThe family Rutaceae includes lime, rue, burning bush, bergamot orange, and Hawaiian lei flowers.Plants from this family commonly cause phytophotodermatitis52) The toxin holothurin, released by which of the following marine creatures, can causeconjunctivitis in exposed swimmers?A. Sea cucumberCorrect ChoiceB. None of these answers are correctC. Chironex fleckeriD. Edwardsiella lineateE. Linuche unguiculataSea cucumbers are cucumber-shaped bottom-dwellers that can cause conjunctivitis due to releaseof a toxin called holothurin to which nearby swimmers can be exposed. The larva of Linucheunguiculata (thimble jelly fish) and Edwardsiella lineate (sea anemone) are causes of seabatherseruption (or sea lice). Chironex fleckeri is the box jellyfish; its stings are extremely toxic and maylead to shock and death, especially in small adults and children53) Cantharidin creates a vesicle by which of the following mechanisms?A. Subcorneal layer separationB. Instability of the hemidesmosomeC. Antibodies to desmosomal proteinsD. Local recruitment of neutrophilsE. Disruption of keratinocyte-keratinocyte adhesion Correct ChoiceDesmosomal adhesions are interrupted by proteases with eventual tonofilament detachment54) Patients with an allergy to the compositae family may have an allergic reaction to which of thefollowing drugs?A. Pyruvic acidB. Pyrethrins Correct ChoiceC. PsoralensD. Propylene glycolE. PseudoephedrinePyrethrins are derived from chrysanthemum flowers. Patients with allergy to these flowers orragweed may experience allergic symptoms after using pyrethrins55) This patient complains of intense itching at this site. KOH examination is negative. She deniesany recent travel, however does take her 2 year old to the local playground where there is asandbox. Which of the following is appropriate?A. Give her clobetasol ointmentB. Slowly extract the organismC. Inform the patient she is contagious and should isolate herself from her children 14
  15. 15. D. Treat with po ivermectin Correct ChoiceE. Obviously this is dermatophyte despite a negative KOH. Treat with topical antifungalsThis is hookworm, or cutaneous larva migrans; systemic ivermectin or topical thiobendazole wouldbe appropriate treatments. The causative organism is the larvae of Ancylostoma braziliensis or A.canium56) This creature can do the following EXCEPT:A. Cause a painful stingB. Transmit Yersinia pestisCorrect ChoiceC. Cause anaphylaxisD. Be used as a natural control for the tick populationE. Build large characteristic moundsThis is a fire ant. In some parts of the world, they are used as a natural tick control as they arescavengers and consumers of tick eggs. They can cause anaphylaxis in an allergic person. They donot transmit disease. The mounds are characteristic in appearance57) Babesia microti:A. Is transmitted by Ixodes damminiB. All of these answers are correctCorrect ChoiceC. None of these answers are correctD. Is an intracellular parasiteE. Is pathogenic in an infection that is endemic on Marthas VineyardBabesiosis is caused by an intracellular RBC parasite, Babesia microti. It is transmitted by the larvaeof Ixodes dammini. This disease is endemic in eastern Long Island, Marthas Vineyard, andNantucket, and carries an increased risk in those with T-cell depression or after splenectomy. Thecondition is associated with fever, drenching sweats, myalgias, and hemolytic anemia58) Which chemical is present in large quantities of this insects venom?A. LipaseB. HyaluronidaseC. Sphingomyelinase DD. Alpha lactrotoxinE. HistamineCorrect ChoiceThe spider shown is the Wolf spider (Lycosidae). This Australian spiders bites contains largeamounts of histamine. Bites are painful with edema, erythema and subsequent lymphangitis59) Which of the following is false?A. Divers are at risk of contacting these creaturesB. Only pigmented varieties pose any riskCorrect ChoiceC. These spines may contain toxins 15
  16. 16. D. This is a sea urchinE. Granulomas can form around the spines if not removedThis is a sea cucumber. A small fraction of spines contain toxins which affect humans. Divers maystep on these creatures which is quite painful. Spines should be removed to avoid foreign bodyreactions60) Which of the following mites is also known as the chigger and often causes intense pruritus onthe ankles, legs, or belt line?A. GlyciphagusB. Allodermanyssus sanguineusC. Trombicula alfreddugesi Correct ChoiceD. DemodexE. OrnithonyssusTrombicula alfreddugesi (chigger mite, harvest mites) frequently causes intense pruritus on theankles, legs, or belt line. Contact occurs during summer and fall. In sensitized individuals, papularurticaria, vesiculation, or a granulomatous reaction with fever and lymphadenopathy may occur.Allodermanyssus sanguineus (house mouse mite) is the vector of rickettsial pox. Demodexfolliculorum is a mite that can live within the sebaceous glands of hair follicles and may beimportant in some subsets of patients with acne rosacea, as well as patients with HIV infection andfolliculitis. Glyciphagus (cheese mite) is the cause of grocers itch. Ornithonyssus (fowl mite) cancarry Western equine encephalitis61) Contact urticaria is a:A. Type II hypersensitivityB. Type I hypersensitivity Correct ChoiceC. Type III hypersensitivityD. Undetermined hypersensitivityE. Type IV hypersensitivityNEEDS EXPLANATIONS62) Which of these spiders is bright green with red spots, with black spines on its legs?A. Phidippus formosusB. Loxosceles reclusaC. Latrodectus mactansD. Peucetia viridansCorrect ChoiceE. Centruroides sculpturatusPeucetia viridans (green lynx spider) is common in the southern United States. It is bright greenwith red spots; the legs have black spines. The bite is painful, with tenderness and pruritus.Phidippus formosus (jumping spider) is an aggressive spider with dark body hairs and various whitepatterns. They are the most common biting spiders in the United States. Loxosceles reclusa (brownrecluse) is a tan spider with a violin-shaped marking on the abdomen. The bite may be painless,however the patient may develop erythema, a vesicle, and eventual necrosis. Latrodectus mactans(black widow) is a large, black, shiny spider with an hourglass shaped white marking on the 16
  17. 17. abdomen. Bites are acutely painful, and may swell but do not cause necrosis; the venom containsneurotoxins. Centruroides sculpturatus is a primary scorpion species in the U.S63) Mechanical irritant dermatitis can be caused by:A. GlochidsCorrect ChoiceB. BromelinC. Stinging nettlesD. CapsacinE. All of these answers are correctMechanical irritant dermatitis can be caused by the direct effects of thorns and barbs. Small glochids(barbed hairs or brisles) or large thorns (on cacti for example) can become imbedded into the skincausing injury and resultant dermatitis. Secondary infection can be caused by microorganisminoculation64) Which of the statements regarding Tegenaria agrestis is correct?A. This creature is the leading cause of necrotic arachnidism in several states of the PacificNorthwestCorrect ChoiceB. None of these answers are correctC. Contact with this creature results in erythematous papules, hemorrhage, or purpura in a classic"tram-track" patternD. Stings from this scorpion can produce cardiovascular complicationsE. This ant injects a venom that contains a hemolytic factor, solenopsin DTegenaria agrestis (the Hobo spider) is the leading cause of necrotic arachnidism in several states ofthe Pacific Northwest. These spiders are large, with a herringbone-striped pattern on the abdomen.Contact with caterpillars (Lepidoptera) may produce lesions in a classic "tram-track" pattern.Solenopsis (fire ants) ants inject a venom that contains a hemolytic factor, solenopsin D, thatcauses a release of histamine and other vasoactive amines from mast cells65) Insects from the species pictured:A. Trasmit yellow feverB. Transmit malaria and yellow feverC. Transmit dengue feverD. Trasmit yellow fever and dengue feverCorrect ChoiceE. Transmit malariaThe insect pictured is an Aedes mosquito. Aedes transmits yellow fever and dengue fever.Anopheles mosquitoes transmit malaria66) A 52 year-old gardener presents with innumerable linear hyperpigmented streaks across thechest and arms. He states that several weeks previously he had a painful, erythematous, blisteringeruption at the same site. The most likely botanical cause for this eruption is:A. Plants of the Alliaceae familyB. Lime 17
  18. 18. C. HogweedCorrect ChoiceD. Peruvian lilyE. RagweedThe gardener has so-called "strimmer dermatitis." The use of a weed-whacker may result in a sprayof weeds (such as cow parsley, wild chervil, and hogweed) leading to this phytophotodermatitis onexposed areas such as the chest and arms67) Identify this plant:A. AlstromeriaB. ToxicodentronC. Myroxylon balsamumD. PrimroseCorrect ChoiceE. RagweedThis is primrose (primulaceae) a cause of allergic contact dermatitis68) Necrosis may be seen in which of the following:A. Allergic contact dermatitisB. Irritant contact dermatitis Correct ChoiceC. DermatographismD. Contact urticariaE. Acute urticariaNecrosis may be seen in severe irritant reactions. The other reactions do not involve necrosis69) Which creature is a human flea that can also be seen on dogs?A. Liponyssoides sanuineusB. Pulex irritansCorrect ChoiceC. Lytta vesicatoriaD. Ctenocephalides canisE. Pediculus humanusPulex irritans is the human flea; it can also be seen on dogs. More frequent infestations on domesticanimals are by Ctenocephalides felis and canis (on cats and dogs respectively). Lytta vesicatoria is ablister beetle from which cantharadin is derived. Pediculus humanus var. corporis is the human bodylouse.70) Which of the following is a complication of Thermage treatment?A. HyperpigmentationB. LipoatrophyCorrect ChoiceC. Keloid formationD. Granuloma formation 18
  19. 19. E. Herpes simplex infectionThermage (ThermaCool) is a nonablative radiofrequency-based system which uses volumetricheating to induce tightening of the skin and dermal remodeling. Lipoatrophy is a late-occurringpotential complication of this technology71) Which of the following is not a hallmark of allergic contact dermatitis?A. EosinophilsB. Neutrophils Correct ChoiceC. Langerhans cellsD. CD4+ LymphocytesE. VesiclesLangerhans cells present the antigens to CD4+ lymphocytes in the dermis and after travelingthrough lymphatics to regional lymph nodes. Eosinophils may also be present. Neutrophils are notcharacteristic of this reaction72) The female Sarcoptes scabiei var. hominis mite can lay up to 100 eggs. It has an ovoid, flatbody and how many short legs?A. 10B. 6C. None of these answers are correctD. 12E. 8Correct ChoiceThe female Sarcoptes scabiei var. hominis mite has an ovoid, flat body and 8 short legs73) Which snake is part of the Crotalidae family?A. Garden snakeB. Coral snakeC. RattlesnakeCorrect ChoiceD. CobraE. Water snakeThe Crotalidae family includes rattlesnakes and copperheads. The coral snake is part of the elapidaefamily74) A 22 year-old man presents with an irregular laceration on the dorsal metacarpals following afist fight in which he struck someone in the mouth. The tissue surrounding the wound iserythematous, edematous, indurated, warm, and tender. There is some purulence of the wound.You consider infection with:A. Erysipelothrix rhusiopathiaeB. Eikenella corrodensCorrect ChoiceC. Pasteurella multocida 19
  20. 20. D. Pasteurella canisE. CapnocytophagaHuman bites may result in infection with Eikenella corrodens, a gram-negative bacillus that is partof the normal flora of the human mouth. This infection can follow fist fights with blows to the mouth75) Which of the following infections is commonly known to occur from contact with infected sheep?A. Oculoglandular syndrome of ParinaudB. Infectious pustular dermatitisC. Cutaneous anthraxD. Infectious pustular dermatitis and cutaneous anthraxCorrect ChoiceE. ErysipeloidInfectious pustular dermatitis is another name for orf, or ecthyma contagiosum. It is transmitted tohumans by a parapoxvirus in sheep, goats, and reindeer. Cutaneous anthrax is also called"woolsorters disease" and is caused by Bacillus anthracis, a gram-positive rod transmitted fromcontact with carcasses of infected sheep, cows, goats, and horses. The oculoglandular syndrome ofParinaud is the combination of granulomatous conjunctivitis and preauricular lymphadenopathy seenin cat-scratch disease76) A goat farmer presents with fever and flu-like symptoms, as well as violaceous papulonoduleson the trunk and lower extremities. You consider Malta fever in your differential diagnosis. Which ofthe following statements regarding this diagnosis is correct?A. Skin lesions are infrequently seenB. None of these answers are correctC. All of these answers are correctCorrect ChoiceD. Treatment is with rifampinE. Treatment is with doxycyclineMalta fever is another name for Brucellosis. This infection is caused by ingesting raw goat milk andunpasteurized goat cheese infected with Brucellae (gram-negative rods). It is infrequent in the US,occurring mainly in veterinarians and farmers. Acute brucellosis has very non-specific features andpresents as a flu-like illness. Skin lesions are infrequent (20% of cases) but are usually violaceouspapulonodules on the trunk and lower extremities. Treatment is with doxycycline or rifampin77) Which disease is transmitted by this insect?A. Visceral leishmaniasisB. African sleeping sicknessC. OnchocerciasisCorrect ChoiceD. Chagas diseaseE. DracunculiasisThe insect depicted is the black fly, Simulium species. The black fly is the vector for onchocerciasis,which is caused by onchocerca volvulus. Clinical manifestation of this disease include atrophy,depigmentation and thickening of the skin. In addition, the infection may cause "river blindess" andonchocercomas, which are nodules containing microfilariae78) This organism is: 20
  21. 21. A. Chigoe fleaB. Pthirus pubis Correct ChoiceC. Pediculus capitisD. Pulex irritansE. Pediculus humanusThis is a crab louse. It is shorter and wider than the head and body louse. Note the crab-like claws79) A 54 year-old man with psoriatic arthritis on methotrexate and infliximab calls you after he isbitten deeply on the ankle by his daughters 2 year-old Chihuahua. He is concerned that hisimmunocompromised status puts him at risk for infection and potential complications from this bite.You correctly tell him:A. Capnocytophaga from dog bites can cause sepsis in immunocompromised victimsCorrect ChoiceB. As long as the dog has been vaccinated, he need not worry about serious infectionsC. Eikenella corrodens is the most common cause of infection following dog bitesD. Pasteurella multocida infection is frequent after dog bites but not cat bitesE. Rickettsial pox can be seen after dog bitesLocal infection and cellulitis is a concern following domesticated animal bites; vaccination mayprevent against rabies, but not other infections. Cat bites most frequently result in Pasteurellamultocida infections, while dog bites result in Pasteurella canis. However, most bites arepolymicrobial with mixed aerobes and anaerobes. Infrequently systemic infections may result inbrain or lung abscess, endocarditis, or sepsis. Sepsis is more frequent in immunocompromisedvictims and may be due to Capnocytophaga or Pasteurella80) What is the initial treatment of choice for this dermatitis?A. Warm compressesB. Topical steroidC. Topical antibioticsD. 5% acetic acidCorrect ChoiceE. ObservationThe linear appearance of the dermatitis is typical of jellyfish stings. To prevent further nematocyteactivation, 5% acetic acids should be applied for 15-30 minutes. Papain found in meat tenderizersor 70% isopropyl alcohol may also be applied. Warm compresses are contraindicated as they mayincrease systemic absorption of the venom81) Pineapples contain which of the following proteolytic enzymes?A. None of these answers are correctB. BromelinCorrect ChoiceC. Phorbol estersD. RanunculinE. All of these answers are correct 21
  22. 22. Bromelin is a proteolytic enzyme found in pineapples. It is granted access to dermal vessels bycalcium oxalate-induced fissures. Phorbol esters are found in plants of the Euphorbiaceae family.Ranunculin is an irritant found in buttercups (Ranunculaceae family82) Which of the following infections is caused by a gram-positive rod?A. BrucellosisB. Erysipeloid of RosenbachCorrect ChoiceC. Cat-scratch diseaseD. Milkers noduleE. GlandersErysipeloid of Rosenbach is an infection with Erysipelothrix insidiosa or Erysipelothrix rhusiopathiae,gram-positive rods. Brucellosis is caused by infection with Brucellae (gram-negative rod). Cat-scratch disease is caused by infection with Bartonella henselae, a gram-negative rod. Glanders iscaused by infection with Pseudomonas mallei, a gram-negative rod. Milkers nodule is caused by theparavaccinia viurs, a parapoxvirus related to the orf virus83) Which of the following vectors transmits Borrelia duttonii?A. Rhipicephalus sanguineusB. Amblyomma americanumC. Ornithodoros moubataCorrect ChoiceD. Ixodes pacificusE. none of the aboveBorrelia duttonii is a pathogenic organism of relapsing fever. It is transmitted by Ornithodorosmoubata. Ixodes pacificus is one of the vectors of Lyme Borreliosis. Rhipicephalus sanguineus is avector of Ehrlichiosis. Amblyomma americanum is a vector of Lyme Borreliosis and Rocky MountainSpotted Fever84) Ehrlichiosis is classified in two primary forms. These are:A. Intracellular and extracellularB. Primary and secondaryC. None of these answers are correctD. Endemic and epidemicE. Monocytic and granulocyticCorrect ChoiceEhrlichiosis comes in two forms: monocytic, which invades mononuclear WBCs, and granulocytic, inwhich peripheral PMNs show intracytoplasmic inclusions. Patients present with fever, chills,headache, and myalgias, along with leukopenia, anemia, and thrombocytopenia85) Capsaicin causes which of the following?A. Blocking the influx of sodium ions into the cellB. Decreased firing of nerve fibers transmitting painC. Increased substance P release Correct Choice 22
  23. 23. D. Creating a barrier between nerves and their stimuliE. Decreased substance P releaseRepeated substance P release leads to eventual depletion of this agent which causes paintransmission86) Which of the following infections is caused by a gram-negative rod?A. Bacillary angiomatosisB. Malta feverC. None of these answers are correctD. FarcyE. All of these answers are correctCorrect ChoiceMalta fever is another name for Brucellosis, an infection caused by Brucellae (gram-negative rod).Farcy is another name for Glanders, an infection with the gram-negative rod Pseudomonas mallei.Bacillary angiomatosis is caused by infection with Bartonella henselae, a gram-negative rod87) Sesquiterpene lactones are found in which of the following plants?A. AlstromeriaB. Pinus palustrisC. GingkoD. ArtichokeCorrect ChoiceE. ChiveSesquiterpene lactones are sensitizers found in plants of the Asteraceae (Compositae) family.Members include ragweed, pyrethrum, chrysanthemum, weeds, feverfew, and artichoke. Thesensitzer found in alstromeria (Peruvian lily) is tuliposide A (a glycoside). The Pinus palustris tree isthe source of colophony. Chives contain diallyl disulfide. Gingko fruit pulp is a sensitizer88) Match the photo to the plant identified:A. CompositaeB. Alstromeria Correct ChoiceC. PrimulaceaeD. AnacardiaceaE. AlliaceaeAlstromeria is pictured89) Which of the following contains active furocoumarins?A. Fig Correct ChoiceB. LichensC. MangoD. Chrysanthemum 23
  24. 24. E. PrimroseThe fig tree may cause a phytophotodermatitis90) The necrosis and hemolysis that can result from a brown recluse spider bite may be attributedto which of the following toxins?A. LipaseB. Sphingomyelinase-DCorrect ChoiceC. Alpha lactrotoxinD. HyaluronidaseE. HistamineThe brown recluse spider (Loxosceles reclusa) is a tan spider with a violin-shaped marking on theabdomen. Its bite may be painless, however the patient may develop erythema, a vesicle, andeventual necrosis. This may result in the "red, white, and blue sign." Systemic reactions(viscerocutaneous loxoscelism) may occur. The venom contains several toxins, howeversphingomyelinase D seems to be causative of the necrosis and hemolysis91) This patient acquired an infection with a microorganism that may have been inoculated into theskin from contact with:A. GrassesB. Rose thornsC. All of these answers are correctCorrect ChoiceD. Sphagnum mossE. None of these answers are correctThis patient has sporotrichosis, which is caused by Sporothrix schenckii. Sporothrix schenckii can beinoculated into the skin by grasses, sphagnum moss, and rose thorns92) If suspicious for scabies infestation, which of the following areas is least likely to be involved?A. External genitaliaB. UmbilicusC. FingerwebsD. NipplesE. Occipital scalpCorrect ChoiceErythematous papules and burrows are commonly seen in webspaces, nipples, external genitalia,umbilicus and axilla in sarcoptes scabiei infestation93) Which of the following statements regarding orf is correct?A. Orf is also known as "pseudocowpox."B. Lesions last indefinitely without treatmentC. The papillomatous stage of lesion progression preceeds the regenerative stageD. The virus is very sturdy and survives many months in cold weatherCorrect Choice 24
  25. 25. E. The papular stage of lesion progression follows the target stageOrf, also known as ecthyma contagiosum or infectious pustular dermatitis, is transmitted to humansby a parapoxvirus in sheep, goats, and reindeer. This is a self-limited condition with an excellentprognosis lasting approximately 6 weeks. Lesion morphology changes through a series of stages:papular (red, elevated) -> target (nodule with red center, white middle ring, red periphery) -->acute (red, weeping) --> regenerative (thin, dry crust overlying lesion) --> papillomatous -->regressive. The virus is very sturdy and survives many months in cold weather. Milkers nodule,caused by the paravaccinia virus (a parapoxvirus, related to the orf virus), infects cows and can betransmitted to dairy workers, and is also known as pseudocowpox94) The majority of phytophotodermatitis is caused by plants from which family?A. ApiaceaeCorrect ChoiceB. CompositaeC. LiliaceaeD. AlliaceaeE. None of these answers are correctThe Apiaceae family (formerly Umbelliferae) includes parsley, celery, parsnip, hogweed, and fennel,and causes the majority of phytophotodermatitis95) Thorns and barbs on blackberry bushes have been known to cause secondary infection throughinoculation of:A. None of these answers are correctB. Mycobacterium ulceransC. Sporothrix schenckiiD. All of these answers are correctE. Mycobacterium kansaiiCorrect ChoiceThorns and barbs on blackberry bushes have been known to cause secondary infection throughinoculation of Mycobacterium kansaii. Sporothrix schenckii can be innoculated by grasses,sphagnum moss, and rose thorns. Mycobacterium ulcerans has been innoculated by spiky tropicalvegetation96) Match the photo to the plant identified:A. ToxicodendronB. Compositae Correct ChoiceC. PrimulaceaeD. AlstromeriaE. AlliaceaeThis is ragweed, a member of the compositae (or asteraceae) family97) Plants from the family Moraceae include which of the following?A. All of these answers are correctB. Fennel 25
  26. 26. C. None of these answers are correctD. Burning bushE. Ficus caricaCorrect ChoiceFicus carica (fig tree) is a member of the family Moraceae and a cause of phytophotodermatitis.Burning bush is a member of the family Rutaceae. Fennel is a member of the family Apiaceae98) Identify this tick:A. Dermacentor andersoniB. Rhipicephalus sanguineusC. Dermacentor variabilisD. Amblyomma americanumCorrect ChoiceE. Ixodes damminiThis is Amblyomma americanum which transmits Lyme as well as RMSF99) Which of the following is a common cause of seabathers eruption?A. Linuche unguiculataB. Thimble jelly fishC. All of these answers are correctCorrect ChoiceD. Edwardsiella lineateE. Sea anemoneSeabathers eruption (or sea lice) can be sporadic or part of an outbreak. Clinically, it appears asdermatitis beneath areas covered by swim suits. The geographic distribution is most frequent fromthe Caribbean to Bermuda, however there have been three outbreaks at Long Island, NY beaches. Avariety of cnidarian larvae can cause this eruption, including thimble jelly fish (Linuche unguiculata)and sea anemone (Edwardsiella lineate). Quick removal of bathing suits and rinsing can help withprevention. Symptom relief is the mainstay of therapy100) Phytophotodermatitis caused by skin exposure to limes is caused by:A. D-limoneneB. Furocoumarin Correct ChoiceC. Tuliposide AD. Sesquiterpene lactoneE. Ascorbic acidPhytophotodermatatitis (phototoxic eruptions from plants) are relatively commonly seen in florists,nursery personnel, gardeners, and farm workers. Plants that cause this eruption may producephotoxins such as furocoumarins Fig, fennel, lime, lemon, parsley, celery, dill, and hogweed are allcauses of phytophotodermatitis101) “Strimmer” dermatitis is caused by which of the following?A. M. marinum 26
  27. 27. B. LimeC. PseudomonasD. CryptococcusE. Chervil Correct ChoiceStrimmer dermatitis is a phytophotodermatitis caused by spray of plant matter when using a weed-whacker or similar trimming tool102) Identify this insect:A. Water fleaB. Tsetse flyC. Mango flyD. Reduviid bugCorrect ChoiceE. Phlebotomous sandflyThis a picture of the reduviid bug, also called the kissing bug or assassin bug. It is the vector forAmerican Trypanosomiasis (Chagas disease), which is caused by Trypanosoma cruzii. The reduviidbug prefers to bite at mucocutaneous junctions103) Solenopsin D is a:A. PhospholipaseB. Piperdine derivativeC. Hemolytic factorD. Hemolytic factor, piperdine derivative, histamine-releaserCorrect ChoiceE. Histamine-releaserSolenopsin D is a venom which is a hemolytic factor, a piperidine derative and leads to histaminerelease. The venom from honeybeeds contains phospholipase A104) The majority of naturally-occurring cases of anthrax:A. Are extra-cutaneousB. Are acquired through ingestion of sporesC. Are pulmonaryD. Are cutaneousCorrect ChoiceE. Are oropharyngealThe majority (95%) of naturally-occurring cases of anthrax are of the cutaneous form, acquiredfrom direct contact with the carcasses of dead sheep, cows, goats, and horses. Naturally-occurringpulmonary, gastrointestinal (acquired by ingestion of spores) and oropharyngeal infection withanthrax is less common105) Ticks of the species shown:A. Can transit tularemia but not Rocky Mountain Spotted FeverB. Can transmit Rocky Mountain Spotted Fever and tularemiaCorrect Choice 27
  28. 28. C. Can transmit Lyme borreliosis but not Rocky Mountain Spotted Fever or tularemiaD. Can transmit Rocky Mountain Spotted Fever and Lyme borreliosisE. Can transmit Lyme borreliosis and tularemiaThe tick pictured is a male Dermacentor variabilis tick. Dermacentor variabilis can transmit RockyMountain Spotted Fever and tularemia. Lyme borreliosis is transmitted by Ixodes dammini, Ixodespacificus, and Amblyomma americanum. 28

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