Test your dermatology knowledge with JAMA Network clinical challenges

Online CME isn’t just convenient; it can be hugely additive to a physician’s knowledge of their specialty.

JN Learning™, the CME arm of the JAMA Network™, enables users to browse the JAMA Network catalogue of over 5,000 online resources by any medical topic. A filter then lets users locate more than 1,700 relevant online CME opportunities. 

The AMA has added lessons for many of the most common specialty health topics. The dermatology category helps learners correctly diagnose and treat unusual presentations of skin cancer, atopic dermatitis, psoriasis, skin lymphomas, cutaneous drug reactions and more. The 10-lesson online series covers the following topics.

1. "Fever, Rash and Dizziness in a 32-Year-Old." 

   1. A 32-year-old transgender woman presented in July to an emergency department in Ann Arbor, Michigan, with fever, rash and dizziness. Two weeks prior to presentation, she developed fatigue, myalgias and fever of 38.9 °C (102 °F), which all resolved in seven days. One week after symptom onset, she developed a nonpruritic, painless rash with multiple, well-defined annular lesions. On the day of presentation, she developed dizziness with exertion, and her digital watch reported a heart rate in the low 50s. What is your diagnosis?

2. "Unmasking a Masquerade of Ocular Dysgenesis." 

   1. A 66-year-old man presented with progressive visual decline in his only-seeing left eye over three years, with a best-corrected visual acuity of 20/200. Slitlamp examination revealed nebulomacular corneal opacities, iris atrophy and corectopia. Gonioscopy showed broad peripheral anterior synechiae with multiple, elevated, well-circumscribed, pearly-white nodules on the iris surface. Posterior embryotoxon was absent. Intraocular pressure was 30 mm Hg, and the optic disc had a cup-disc ratio of 0.7, though the neuroretinal rim appeared relatively preserved. A clinically relevant nuclear cataract was present. What would you do next?

3. "A Woman With Rheumatoid Arthritis and Vesicular Rash." 

   1. A 57-year-old woman with rheumatoid arthritis (RA) presented to rheumatology clinic with a new rash. Nine months previously, her immunosuppressive medication was changed from the anti-tumor necrosis factor inhibitor (TNFi) etanercept to the TNFi adalimumab to treat an exacerbation of RA. She took hydroxychloroquine, a vitamin D supplement and ibuprofen and acetaminophen as needed. Two weeks prior to presentation, she developed painful and intermittently pruritic vesicles on her neck, mouth, ears, chest and hands. Ten days prior, she was prescribed cephalexin at an urgent care clinic but discontinued the antibiotic after two days due to worsening of the rash. What is your diagnosis?

4. "A Two-Month-Old Boy With Pink Papules and Plaques." 

   1. A 2-month-old boy, born at 39 weeks and one day of gestation via normal spontaneous vaginal delivery with normal newborn screening results presented with a 10-day history of rash. On presentation, his temperature was 37.0 °C (98.6 °F); blood pressure, 113/74 mm Hg; and heart rate, 132 beats per minute. Skin examination showed multiple annular, pink papules and plaques with hyperpigmentation and desquamation on the scalp, palms and soles. Physical examination showed hepatosplenomegaly. What would you do next?

5. "A Patient With Prior Skin Cancers and New Diagnosis of Bell Palsy." 

   1. A 78-year-old man with a history of nonmelanoma skin cancers, including a left temporal skin cutaneous squamous cell carcinoma treated with cryosurgery, presented to primary care with left-sided upper and lower facial weakness diagnosed as Bell palsy. Eighteen months prior, he first became symptomatic with left external auditory canal dysesthesia. He was initially prescribed a neomycin sulfate, polymyxin b sulfate and hydrocortisone solution that did not improve his left ear aches. Thereafter, the patient gradually developed a patch of numbness on the skin overlying the left tragus. One month prior to his initial visit, this sensory deficit had spread to the entire left half of his face and motor weaknesses emerged, including diplopia and a left facial droop. What is your diagnosis?

6. "Forearm Pain and Stiffness in a 34-Year-Old Woman." 

   1. A 34-year-old woman presented with one year of progressive skin tightening over her right elbow and forearm, bilateral forearm and anterior tibia pain, and difficulty extending her fingers and elbows. She had no history of autoimmune disease, diabetes, Raynaud phenomenon or trauma, but her symptoms worsened after playing tennis. Six months prior, she received prednisone (40 mg daily for three days), which mildly improved her forearm and anterior tibia pain and decreased her skin tightening for several days. What is your diagnosis?

7. "Foot Lesions and Perianal Lump in an Adult Woman." 

   1. A 50-year-old woman presented to the dermatology department with a 10-year history of recurrent plaque outbreaks between her toes. She had a history of Bowen disease in the anus that had been treated with excision and skin grafting. Physical examination revealed multiple dark brown, flat, hyperproliferative lesions with ulcerations and erosions located between the toes and on the vulva. Additionally, a 5 -by-4 by-1-cm ulcerated perianal tumor with easy bleeding was noted. Coagulation, thyroid, liver and kidney test results were within the normal ranges. Tests for syphilis, HIV and autoantibodies were negative. What would you do next?

8. "Autoamputation in Mismatch Repair-Deficient Colon Cancer." 

   1. A woman in her 50s with a history of hemochromatosis, psoriasis and type 2 diabetes presented with a three-month history of abdominal pain, weight loss and a large palpable fixed abdominal mass. Computed tomographic imaging of the thorax, abdomen and pelvis identified a transverse colon mass involving the abdominal wall, stomach and mesenteric vessels with no evidence of distant metastatic disease. A partially obstructing tumor was identified at colonoscopy. What is your diagnosis?

9. "A 40-Year-Old With Nasal Ulceration and Septal Perforation." 

   1. A 40-year-old male patient presented to a primary care clinic with a two-month history of a pruritic, nontender irritation at the nasal sills bilaterally after minor trauma that involved scratching his nose after getting fiberglass particles in his nostrils while installing lights in his attic. He was a tobacco smoker but was otherwise healthy, with no known allergies. The primary care physician and consulting dermatologist initially diagnosed cellulitis and allergic rhinitis, and the patient was administered a five-day course of an antibiotic ointment and, as needed, oral antihistamines. What is your diagnosis?

10. "External Auditory Canal Stenosis in a Child." 

    1. An 11-year-old boy with a history of cleft palate repair, placement of multiple sets of pressure-equalizing tubes, and suspected ectodermal dysplasia (not confirmed with genetic testing) was referred from a general ear, nose and throat physician. The patient had presented with a chief concern of a one-year history of hearing loss. He had no otorrhea or otalgia during this time. Otoscopic examination of the ear showed bilateral dead-end ear canals with smooth hypervascular fibrosis extending medially from the bony cartilaginous junction. There were no granulation tissue, pit or tract. What would you do next?

AMA members can explore a range of peer-reviewed research and clinical information published by the JAMA Network, which brings JAMA® together with JAMA Network Open and 11 specialty journals, including JAMA Dermatology. Published continuously since 1883, JAMA is one of the most widely circulated, peer-reviewed, general medical journals in the world. If you are a member or interested in becoming one, learn how to access these educational materials and innovative tools. 

Browse the full JN Learning collection of over 200 dermatology CME activities. Take the activities on JN Learning to receive more than 200 CME credits.

The AMA Ed Hub™ is an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards. 

Learn more about AMA CME accreditation.