Drugs for Psoriasis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Drugs for Psoriasis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Drugs for 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
Drugs for 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
Drugs for Psoriasis Indian Medical PG Question 2: What is the best range of UV light used for treatment of skin diseases?
- A. 100 – 200 nm
- B. > 700 nm
- C. 400 – 700 nm
- D. 200 – 400 nm (Correct Answer)
Drugs for Psoriasis Explanation: ***200 – 400 nm***
- This range encompasses **UVA (320-400 nm)** and **UVB (290-320 nm)**, which are the most commonly used portions of the **UV spectrum** for treating various skin conditions like psoriasis and eczema.
- Specifically, **narrowband UVB (311-313 nm)** is highly effective due to its therapeutic benefits with reduced side effects compared to broadband UVB or UVA.
*100 – 200 nm*
- This range falls into the **vacuum UV (VUV)** spectrum, which is largely absorbed by air and is not practical for dermatological phototherapy due to its limited penetration and potential for significant cellular damage.
- It is known for its germicidal properties but is not used for treating skin diseases in living tissue due to its **high energy** and **low penetration** depth.
*> 700 nm*
- Wavelengths above 700 nm fall into the **infrared (IR) spectrum** or visible light, which primarily produces heat and has different therapeutic applications.
- While IR light can be used for therapies like **pain relief** and **wound healing**, it does not have the immunomodulatory effects on skin cells needed for conditions traditionally treated by UV.
*400 – 700 nm*
- This range represents the **visible light spectrum**, which is used in some dermatological treatments like **photodynamic therapy (PDT)** or for certain **pigmentary disorders**.
- However, visible light does not possess the same **immunomodulatory** and **antiproliferative effects** on keratinocytes and T-cells that make UV light effective for conditions like psoriasis.
Drugs for Psoriasis Indian Medical PG Question 3: All trans retinoic acid is used topically for -
- A. Lupus vulgaris
- B. Alopecia areata
- C. Acne vulgaris (Correct Answer)
- D. Androgenic alopecia
Drugs for Psoriasis Explanation: ***Acne vulgaris***
- **All-trans retinoic acid (tretinoin)** is a topical retinoid that is highly effective in treating **acne vulgaris** by normalizing follicular keratinization, reducing sebum production, and possessing anti-inflammatory properties.
- It helps in preventing the formation of new **comedones** and promoting the clearance of existing lesions.
*Lupus vulgaris*
- **Lupus vulgaris** is a cutaneous form of **tuberculosis**, typically treated with multidrug antitubercular therapy.
- Retinoic acid is **not a primary treatment** for this condition.
*Alopecia areata*
- **Alopecia areata** is an autoimmune hair loss condition, often treated with **topical or intralesional corticosteroids**, or immunomodulators.
- Topical retinoic acid is **not indicated** for its treatment.
*Androgenic alopecia*
- **Androgenic alopecia (male or female pattern baldness)** is primarily treated with **topical minoxidil** or **oral finasteride**.
- While retinoids can stimulate hair growth, they are **not a first-line treatment** for androgenic alopecia and are sometimes used as an adjuvant to minoxidil.
Drugs for Psoriasis Indian Medical PG Question 4: PUVA therapy is used in all except:
- A. Psoriasis
- B. Vitiligo
- C. Mycosis fungoides
- D. Melasma (Correct Answer)
Drugs for Psoriasis Explanation: ***Melasma***
- **PUVA (Psoralen plus UVA) therapy** is contraindicated in melasma due to its potential to worsen hyperpigmentation and cause paradoxical darkening.
- Melasma is best managed with topical agents like **hydroquinone**, **tretinoin**, and chemical peels, along with strict **sun protection**.
*Psoriasis*
- **PUVA therapy** is a well-established and effective treatment for moderate to severe psoriasis, especially for patients with widespread plaques.
- It works by inhibiting DNA synthesis and cell proliferation in rapidly dividing keratinocytes, leading to a reduction in psoriatic lesions.
*Vitiligo*
- **PUVA therapy** is a common treatment for vitiligo, stimulating melanocyte activity and promoting repigmentation in affected areas.
- Psoralen sensitizes melanocytes to UVA light, which then encourages melanin production.
*Mycosis fungoides*
- In its early stages, **mycosis fungoides**, a cutaneous T-cell lymphoma, can be effectively treated with **PUVA therapy**.
- PUVA induces apoptosis of malignant T-cells in the skin, leading to remission of skin lesions.
Drugs for Psoriasis Indian Medical PG Question 5: Auspitz's sign is characteristically seen in
- A. Plaque Psoriasis (Correct Answer)
- B. Inverse Psoriasis
- C. Pustular Psoriasis
- D. Lichen Planus (flat-topped, purple papules)
Drugs for Psoriasis Explanation: ***Plaque Psoriasis***
- **Auspitz's sign** is the appearance of pinpoint bleeding after the removal of scales from a psoriatic plaque, a classic finding in **plaque psoriasis**.
- This phenomenon is due to the thinning of the epidermis over elongated and dilated dermal papillae, making the superficial capillaries prone to rupture.
*Pustular Psoriasis*
- This form of psoriasis is characterized by the presence of sterile **pustules** on erythematous skin, either localized or generalized.
- While it is a type of psoriasis, Auspitz's sign is not its characteristic feature; rather, the presence of pustules defines this variant.
*Inverse Psoriasis*
- Inverse psoriasis typically affects **skin folds** (e.g., axillae, groin, inframammary regions) and presents as smooth, erythematous patches without the characteristic scaling seen in plaque psoriasis.
- Due to the absence of thick scales, Auspitz's sign is generally not observed in inverse psoriasis.
*Lichen Planus (flat-topped, purple papules)*
- Lichen planus is an inflammatory condition characterized by **pruritic, polygonal, planar, purple papules** and plaques, often with **Wickham's striae**.
- It does not involve the epidermal scaling and capillary changes that lead to Auspitz's sign.
Drugs for Psoriasis Indian Medical PG Question 6: Treatment of choice for Pustular psoriasis is:
- A. Methotrexate (Correct Answer)
- B. Psoralen - UV therapy
- C. Systemic steroid
- D. Estrogen
Drugs for 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.
Drugs for Psoriasis Indian Medical PG Question 7: All of the following are true about "Imiquimod" except:
- A. Antitumor activity
- B. Indirect antiviral activity
- C. Direct antiviral activity (Correct Answer)
- D. It releases cytokines
Drugs for Psoriasis Explanation: ***Direct antiviral activity***
- Imiquimod is a **Toll-like receptor 7 (TLR7) agonist** that primarily works by **stimulating the immune system** to produce cytokines, which then fight viral infections and cancerous cells.
- It does not directly inhibit viral replication or destroy viral particles; its action is entirely **immune-mediated**.
*Antitumor activity*
- Imiquimod stimulates the local immune response, leading to the production of interferons and other cytokines that can inhibit the growth of **tumor cells**, such as in basal cell carcinoma.
- This activity is **indirect**, as it relies on the host immune system rather than direct cytotoxic effects on cancer cells.
*Indirect antiviral activity*
- As a TLR7 agonist, imiquimod prompts immune cells to release significant amounts of **cytokines** like interferon-alpha, which have potent antiviral effects.
- This **enhances the body's natural defense mechanisms** against viral infections, such as those causing genital warts.
*It releases cytokines*
- Imiquimod's mechanism of action involves binding to **Toll-like receptor 7 (TLR7)** on immune cells like macrophages and dendritic cells.
- This binding triggers a signaling cascade that results in the robust production and release of various **pro-inflammatory and anti-viral cytokines**, including interferons and TNF-alpha.
Drugs for Psoriasis Indian Medical PG Question 8: Which of the following is used in the treatment of Multiple Sclerosis:
- A. Interferon Alpha
- B. Infliximab
- C. Interferon gamma
- D. Interferon Beta (Correct Answer)
Drugs for Psoriasis Explanation: ***Interferon Beta***
- **Interferon beta** is a disease-modifying therapy commonly used for **relapsing-remitting multiple sclerosis (RRMS)** to reduce the frequency and severity of relapses.
- It works by modulating the immune system, decreasing inflammation and preventing demyelination in the central nervous system.
*Interferon Alpha*
- **Interferon alpha** is primarily used in the treatment of certain **cancers** (e.g., leukemia, melanoma) and **viral infections** (e.g., chronic hepatitis B and C).
- It does not have a recognized role in the standard treatment protocols for multiple sclerosis.
*Infliximab*
- **Infliximab** is a **monoclonal antibody** that targets **tumor necrosis factor-alpha (TNF-α)** and is used in the treatment of inflammatory conditions like rheumatoid arthritis, Crohn's disease, and ulcerative colitis.
- While TNF-α plays a role in inflammation, **anti-TNF therapy** has been shown to potentially worsen MS and is generally contraindicated.
*Interferon gamma*
- **Interferon gamma** is a pro-inflammatory cytokine that can exacerbate MS symptoms and **increase disease activity**.
- It is **not used** in the treatment of multiple sclerosis and in fact, some studies suggest it may be detrimental.
Drugs for Psoriasis Indian Medical PG Question 9: Which of the following steroids possesses maximum glucocorticoid activity?
- A. Prednisolone
- B. Aldosterone
- C. Dexamethasone (Correct Answer)
- D. Cortisol
Drugs for Psoriasis Explanation: ***Dexamethasone***
- **Dexamethasone** is a synthetic glucocorticoid with high potency, making it one of the steroids with the **maximum glucocorticoid activity** [1], [2].
- It exhibits a much longer duration of action and significantly greater anti-inflammatory effects compared to natural glucocorticoids like cortisol [2].
*Prednisolone*
- **Prednisolone** is a synthetic glucocorticoid that has approximately four times the anti-inflammatory potency of cortisol [1].
- While potent, it does not reach the glucocorticoid activity levels of dexamethasone.
*Cortisol*
- **Cortisol** is the body's primary natural glucocorticoid, involved in stress response and metabolism [2].
- Its glucocorticoid activity serves as a baseline for comparing the potencies of other synthetic corticosteroids [2].
*Aldosterone*
- **Aldosterone** is primarily a mineralocorticoid, not a glucocorticoid, with its main role being the regulation of electrolyte and water balance [2].
- It possesses minimal to no glucocorticoid activity.
Drugs for Psoriasis Indian Medical PG Question 10: The Drug of choice for a pregnant woman in 2nd trimester with pustular psoriasis is:
- A. Prednisolone (Correct Answer)
- B. Acitretin
- C. Methotrexate
- D. Dapsone
Drugs for Psoriasis Explanation: ***Prednisolone***
- **Systemic corticosteroids** such as prednisolone are considered **safe and effective** for treating severe pustular psoriasis during pregnancy and represent the **best option among the choices provided**.
- Pustular psoriasis is a severe systemic condition that can be associated with fever, malaise, and potential complications, necessitating **systemic therapy** rather than topical treatment alone.
- While **cyclosporine** is often considered the preferred first-line agent for severe pustular psoriasis in pregnancy in current practice, it is not listed among the options here, making prednisolone the most appropriate choice.
- Prednisolone **crosses the placenta minimally** (converted to less active prednisolone by placental 11β-HSD2 enzyme) and has a well-established safety profile in pregnancy.
*Acitretin*
- **Acitretin** is a systemic **retinoid** that is **highly teratogenic** and can cause severe birth defects including craniofacial, cardiac, thymic, and CNS abnormalities.
- It is **absolutely contraindicated in pregnancy** (FDA Category X) and must be avoided for at least 2-3 years before conception due to its long half-life and storage in adipose tissue.
*Methotrexate*
- **Methotrexate** is an **antimetabolite** and **folate antagonist** that is a potent teratogen, particularly during the first trimester.
- It can cause **aminopterin syndrome** (neural tube defects, craniofacial abnormalities, limb defects) and is **absolutely contraindicated in pregnancy** (FDA Category X).
- Women on methotrexate must use effective contraception and discontinue the drug at least 3 months before attempting conception.
*Dapsone*
- **Dapsone** has anti-inflammatory properties and is used in some dermatological conditions, but it is **not indicated for pustular psoriasis**.
- Risks in pregnancy include **hemolytic anemia** (particularly in G6PD-deficient individuals), methemoglobinemia in the newborn, and potential neonatal hyperbilirubinemia.
- It is **not a first-line or appropriate treatment** for pustular psoriasis in pregnancy.
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