Nail Psoriasis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Nail Psoriasis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Nail Psoriasis Indian Medical PG Question 1: What is the primary condition for which calcitriol is used as a treatment?
- A. Pemphigus
- B. Secondary hyperparathyroidism (Correct Answer)
- C. Lichen planus
- D. Leprosy
Nail Psoriasis Explanation: Secondary hyperparathyroidism
- Calcitriol is the active form of vitamin D (1,25-dihydroxyvitamin D₃), and it is crucial for regulating calcium and phosphate levels in the body [1].
- In secondary hyperparathyroidism, often seen in chronic kidney disease (CKD), the kidneys cannot convert vitamin D to its active form, leading to hypocalcemia and increased PTH secretion [1], [2].
- Calcitriol supplementation helps to increase calcium absorption from the gut and suppress the release of parathyroid hormone (PTH), thereby treating the underlying cause of secondary hyperparathyroidism [1], [2].
- This is the primary therapeutic indication for calcitriol in clinical practice.
Lichen planus
- This is a chronic inflammatory condition affecting the skin, hair, nails, and mucous membranes
- Typically treated with corticosteroids or other immunosuppressants
- Calcitriol has no primary role in the treatment of lichen planus; its therapeutic applications are predominantly related to calcium and bone metabolism
Pemphigus
- Pemphigus is a group of rare autoimmune blistering diseases that affect the skin and mucous membranes
- Primary treatment involves immunosuppressants like corticosteroids, often in high doses
- Calcitriol is not indicated for the treatment of pemphigus, as its mechanism of action is unrelated to the autoimmune processes characteristic of this disease
Leprosy
- Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae
- Treated with multi-drug therapy (MDT), which includes antibiotics like rifampicin, dapsone, and clofazimine
- Calcitriol is not an antibiotic and therefore has no role in treating the bacterial infection responsible for leprosy
Nail Psoriasis Indian Medical PG Question 2: All are nail changes seen in cases of psoriasis except:
- A. Subungual hyperkeratosis
- B. Oil drop sign
- C. Mees lines (Correct Answer)
- D. Pitting
Nail Psoriasis Explanation: ***Mees lines***
- **Mees lines** (or Aldrich-Mees lines) are **transverse white bands** that appear in the nail plate.
- They are typically associated with **heavy metal poisoning** (e.g., arsenic), chemotherapy, or systemic illnesses, not psoriasis.
*Subungual hyperkeratosis*
- This is a common finding in **psoriasis**, characterized by the **thickening of the nail bed** due to excessive keratin production.
- It leads to lifting of the nail plate from the nail bed.
*Oil drop sign*
- The **oil drop sign** (or salmon patch) is a classic psoriatic nail change, presenting as a **translucent, yellowish-red discoloration** under the nail plate.
- It is due to psoriasis of the nail bed.
*Pitting*
- **Nail pitting** refers to the presence of **small depressions or pits** on the nail surface.
- It results from defective keratinization of the nail matrix and is a characteristic sign of nail psoriasis.
Nail Psoriasis Indian Medical PG Question 3: Treatment of choice for Pustular psoriasis is:
- A. Methotrexate (Correct Answer)
- B. Psoralen - UV therapy
- C. Systemic steroid
- D. Estrogen
Nail Psoriasis Explanation: ***Methotrexate***
- **Methotrexate** is a systemic immunosuppressant often considered the first-line treatment for severe forms of **pustular psoriasis** due to its efficacy in reducing inflammation and hyperproliferation of skin cells.
- It works by inhibiting **dihydrofolate reductase**, thereby interfering with DNA synthesis and cell division, which is crucial in rapidly dividing cells like those found in psoriasis.
*Psoralen - UV therapy*
- **Psoralen and ultraviolet A (PUVA)** therapy can be used for chronic plaque psoriasis, but it is generally **contraindicated or used with extreme caution** in pustular psoriasis due to the risk of exacerbating the disease or causing irritation.
- **UV light therapy** can sometimes trigger or worsen pustular flares, especially in acute generalized pustular psoriasis.
*Systemic steroid*
- While systemic steroids can provide temporary relief by addressing inflammation, their use in pustular psoriasis is generally **not recommended for long-term management** due to the high risk of severe rebound flares upon withdrawal.
- Withdrawal of **systemic corticosteroids** can precipitate or worsen generalized pustular psoriasis, making them a less desirable long-term treatment option.
*Estrogen*
- **Estrogen** has no direct role in the treatment of psoriasis. Psoriasis is an inflammatory skin condition, and its pathophysiology is not directly influenced by estrogen levels.
- Hormonal therapies are not indicated for the management of psoriasis, including its pustular forms.
Nail Psoriasis Indian Medical PG Question 4: All are true about psoriasis except –
- A. Auspitz sign positive
- B. Parakeratosis & acanthosis
- C. Joint involvement in 5–10% (Correct Answer)
- D. Pitting of nails
- E. Koebner phenomenon
Nail Psoriasis Explanation: ***Joint involvement in 5–10%***
- While **psoriasis** is a skin condition, it can involve the joints in about **30% of patients**, leading to **psoriatic arthritis**.
- Therefore, stating that joint involvement occurs in only **5-10%** is incorrect, as the percentage is significantly higher.
- This is the **FALSE statement** in this EXCEPT question.
*Auspitz sign positive*
- The **Auspitz sign** (pinpoint bleeding when scales are removed) is a classic feature of psoriasis.
- It occurs due to the proximity of dilated capillaries to the thinned suprapapillary epidermis.
- This is a **TRUE statement**.
*Parakeratosis & acanthosis*
- **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological features of psoriasis.
- These features reflect the **rapid cell turnover** and **thickening of the epidermis** characteristic of psoriatic plaques.
- This is a **TRUE statement**.
*Pitting of nails*
- **Nail pitting** is a common manifestation of psoriasis, affecting up to **50% of patients** with chronic plaque psoriasis and **80% of patients with psoriatic arthritis**.
- Other nail changes include **onycholysis**, **subungual hyperkeratosis**, and discoloration.
- This is a **TRUE statement**.
*Koebner phenomenon*
- **Koebner phenomenon** (isomorphic response) is the development of psoriatic lesions at sites of trauma or injury.
- This is seen in approximately **25% of patients** with psoriasis and is a well-recognized clinical feature.
- This is a **TRUE statement**.
Nail Psoriasis Indian Medical PG Question 5: Which of the following nail findings is seen in the condition shown below?
- A. Pterygium
- B. Pigmentation
- C. Pitting (Correct Answer)
- D. Ridges
Nail Psoriasis Explanation: ***Pitting***
- The image displays multiple small, **punctate depressions** on the nail plate, which are characteristic features of nail pitting.
- Nail pitting is a common finding in conditions affecting the **nail matrix**, such as psoriasis.
*Pterygium*
- **Pterygium** refers to the forward growth of the proximal nail fold onto the nail plate, or the lateral nail folds onto the nail plate, often leading to nail loss.
- This is not observed in the image, which primarily shows depressions rather than overgrowth of skin onto the nail.
*Pigmentation*
- **Nail pigmentation** involves discoloration of the nail plate, appearing as streaks, spots, or diffuse changes in color (e.g., brown, black, blue).
- The nail in the image does not show abnormal discoloration but rather surface irregularities.
*Ridges*
- **Ridges** in nails (longitudinal or transverse) are linear elevations or grooves on the nail surface.
- While some linear texture is present, the predominant feature in the image is distinct, small, and scattered depressions, which are consistent with pitting rather than continuous ridges.
Nail Psoriasis Indian Medical PG Question 6: A 54-year-old man presents with well-demarcated scaly plaques on the extensor surfaces of elbows and knees. The scales are silvery-white in appearance. What is the most likely diagnosis?
- A. Eczema
- B. Psoriasis (Correct Answer)
- C. Lichen planus
- D. Pityriasis rosea
Nail Psoriasis Explanation: ***Psoriasis***
- **Psoriasis** classically presents with **scaly plaques** that often appear on the **extensor surfaces** like elbows and knees.
- The scales are typically **silvery-white** and can be associated with itching or discomfort.
*Eczema*
- **Eczema** (atopic dermatitis) typically presents with **pruritic (itchy)**, **erythematous (red)**, and sometimes **weeping lesions**, often in flexural areas like the antecubital and popliteal fossae.
- While it can be scaly, the scales are usually finer and less prominent than those seen in psoriasis, and it often presents on **flexor surfaces**.
*Lichen planus*
- **Lichen planus** is characterized by **pruritic, purple, polygonal, planar papules and plaques** (the "6 Ps"), often found on flexural surfaces, wrists, and ankles.
- It does not typically present with the thick, silvery scales on extensor surfaces seen in this case.
*Pityriasis rosea*
- **Pityriasis rosea** typically begins with a **herald patch**, followed by an eruption of smaller, oval, scaly patches that follow the skin Langer's lines, often described as a "Christmas tree" pattern on the trunk.
- It is usually self-limiting and rarely involves the thick, scaly plaques on extensor surfaces seen in psoriasis.
Nail Psoriasis Indian Medical PG Question 7: All are true about psoriasis except:
- A. Parakeratosis & acanthosis
- B. Pitting of nails
- C. Very pruritic (Correct Answer)
- D. Joint involvement in 5–30%
Nail Psoriasis Explanation: ***Very pruritic***
- While psoriasis can be itchy, it is generally not characterized as "very pruritic" compared to other dermatological conditions like **eczema** or **scabies**.
- **Pruritus** in psoriasis tends to be mild to moderate, and it is not a defining characteristic that differentiates it from other skin disorders.
*Parakeratosis & acanthosis*
- **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological hallmarks of psoriasis.
- These features reflect the rapid epidermal turnover characteristic of the condition.
*Pitting of nails*
- **Nail pitting**, onycholysis, and subungual hyperkeratosis are common and characteristic manifestations of psoriasis, affecting up to 50% of patients.
- These nail changes are highly indicative of **psoriatic involvement**.
*Joint involvement in 5–10%*
- **Psoriatic arthritis**, involving inflammation of the joints, affects approximately 5-30% of individuals with psoriasis.
- This statistic makes joint involvement a significant comorbidity of psoriasis.
Nail Psoriasis Indian Medical PG Question 8: A 25-year-old patient presents with well-demarcated plaques with silvery scales on the elbows and knees. What is the most likely diagnosis?
- A. Lichen planus
- B. Pityriasis rosea
- C. Psoriasis (Correct Answer)
- D. Eczema
Nail Psoriasis Explanation: ***Psoriasis***
- **Psoriasis** is characterized by well-demarcated erythematous plaques with characteristic silvery scales, commonly found on extensor surfaces like the **elbows and knees**.
- This chronic inflammatory skin condition results from an accelerated epidermal turnover rate.
*Lichen planus*
- **Lichen planus** typically presents with pruritic, polygonal, purple, planar papules and plaques, often with **Wickham's striae**, which are absent here.
- It commonly affects the wrists, ankles, and oral mucosa, not primarily the elbows and knees with silvery scales.
*Pityriasis rosea*
- **Pityriasis rosea** usually starts with a single **"herald patch"** followed by smaller, oval, salmon-colored patches in a "Christmas tree" distribution on the trunk.
- It does not present with thick silvery scales on the elbows and knees.
*Eczema*
- **Eczema** (atopic dermatitis) typically presents with intensely itchy, erythematous, oozing, and crusted lesions in acute flares, or dry, thickened, and lichenified skin in chronic cases.
- While it can affect the extremities, the presence of distinct **silvery scales** is more characteristic of psoriasis.
Nail Psoriasis Indian Medical PG Question 9: A 54-year-old man presents with scaly plaques on extensor surfaces. What is the most likely diagnosis?
- A. Lichen planus
- B. Eczema
- C. Pityriasis rosea
- D. Psoriasis (Correct Answer)
Nail Psoriasis Explanation: ***Psoriasis***
- **Psoriasis** is characterized by the presence of **scaly plaques** on extensor surfaces.
- The scales are typically silvery and can be associated with *pruritus* (itching).
*Lichen planus*
- **Lichen planus** presents as **pruritic, purple, polygonal papules and plaques** (the "6 P's")
- It usually affects the flexor surfaces and mucous membranes, not primarily extensor surfaces with scaly plaques.
*Eczema*
- **Eczema** (dermatitis) often manifests as **erythematous, intensely itchy patches** and plaques, which can be dry or oozing.
- While it can occur on extensor surfaces, the classic description of "scaly plaques" on extensor surfaces points more strongly to psoriasis.
*Pityriasis rosea*
- **Pityriasis rosea** typically begins with a single **"herald patch"** followed by smaller, oval, salmon-colored patches in a **"Christmas tree" pattern** on the trunk.
- It does not primarily present as thick scaly plaques on extensor surfaces.
Nail Psoriasis Indian Medical PG Question 10: A 25-year-old presents with silvery scales on elbows and knees. Likely diagnosis?
- A. Psoriasis (Correct Answer)
- B. Atopic dermatitis
- C. Pityriasis rosea
- D. Lichen planus
Nail Psoriasis Explanation: ***Psoriasis***
- **Silvery scales** on **extensor surfaces** like elbows and knees are classic presentations of plaque psoriasis.
- This chronic inflammatory skin condition is characterized by **accelerated epidermal turnover**.
*Atopic dermatitis*
- Typically presents as **eczematous lesions** characterized by **red, itchy, and often oozing or crusted patches**, mainly on flexural surfaces in adults.
- It is strongly associated with a history of **allergies, asthma, or hay fever**.
*Pityriasis rosea*
- Usually starts with a **herald patch** followed by smaller, oval, pinkish-orange macules and patches with fine scales in a **Christmas tree pattern** on the trunk.
- It is distinguished from psoriasis by its distribution and appearance of scales.
*Lichen planus*
- Characterized by **pruritic, purple, polygonal, planar papules and plaques** (the "6 P's") often with fine, white lacy streaks called **Wickham's striae**, typically affecting flexor surfaces, wrists, and oral mucosa.
- It does not present with silvery scales on extensor surfaces.
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