FMGE 2023 — Dermatology
9 Previous Year Questions with Answers & Explanations
A 45-year-old man with multiple sexual partners presents with a palmoplantar rash as seen below. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?
A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?
A patient presents with a violaceous rash on the upper back and shoulders (img-16.jpeg) and Gottron's papules on hands (img-17.jpeg). What is the likely diagnosis?
An 18-year-old female patient comes with the following findings. Which of the following is pathognomonic of the primary stage of this disease?
A 26-year-old male presented with erythematous plaques covered with silvery scales over the extensor surfaces of both arms. Punctate pitting was noted on examining the nails. What is the most likely diagnosis?
A patient presented with itchy lesions, as shown below. What is the diagnosis?
A patient presents with erythematous streaks extending peripherally from a site of infection on the skin. Involvement of which of the following structures leads to this clinical presentation?
A patient presented with multiple painful blisters on an erythematous base along a dermatome on the trunk as shown in the image. What is the diagnosis?
A 45-year-old truck driver with a history of multiple sex partners presented to the dermatological department, as shown below. What is the likely diagnosis?
FMGE 2023 - Dermatology FMGE Practice Questions and MCQs
Question 1: A 45-year-old man with multiple sexual partners presents with a palmoplantar rash as seen below. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?
- A. Psoriasis
- B. Secondary syphilis (Correct Answer)
- C. Meningococcemia
- D. Stevens-Johnson syndrome
Explanation: ***Secondary syphilis*** - The classic rash of secondary syphilis is a diffuse, maculopapular eruption that characteristically involves the **palms and soles**, as seen in the image. A history of multiple sexual partners is a major risk factor. - **Epitrochlear lymphadenopathy** is a highly suggestive, though not pathognomonic, sign of secondary syphilis. Other systemic symptoms may include fever, malaise, and **condylomata lata**. *Psoriasis* - While psoriasis can affect the palms and soles (**palmoplantar psoriasis**), it typically presents as well-demarcated, erythematous plaques with a silvery scale, which differs from the rash shown. - Psoriasis is an autoimmune condition and is not associated with **epitrochlear lymphadenopathy** or risk factors like multiple sexual partners. *Meningococcemia* - This is an acute, life-threatening infection that presents with a **petechial or purpuric rash** that can become necrotic, not a papular rash on the palms and soles. - Patients with **meningococcemia** are typically systemically unwell with high fever, hypotension, and signs of meningitis, which are absent in this presentation. *Steven Johnson syndrome* - SJS is a severe mucocutaneous reaction characterized by **targetoid lesions**, bullae, and epidermal detachment, which are not features of the rash shown. - A key feature of SJS is severe involvement of at least two **mucous membranes** (e.g., oral, ocular, genital), which is not mentioned in this case.
Question 2: A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?
- A. Portwine stain
- B. Naevus simplex
- C. Capillary hemangioma (Correct Answer)
- D. Cavernous hemangioma
Explanation: ***Capillary hemangioma*** - Also known as a **strawberry hemangioma**, this is the most common benign vascular tumor of infancy, appearing as a bright red, raised, soft plaque or nodule with sharply defined borders. - These lesions are characterized by an initial rapid **proliferative phase** typically occurring in the first year of life, followed by a slow, eventual **spontaneous involution**. *Portwine stain* - This is a vascular **capillary malformation**, characterized by a flat (**macular**) pink, red, or purple patch that is present at birth. - Unlike hemangiomas, portwine stains **do not involute** spontaneously and persist throughout life; they may thicken and darken over time. *Cavernous hemangioma* - This term is often used for hemangiomas that are **deeper** (involving the reticular dermis and subcutaneous tissue), resulting in a blue, soft, or ill-defined mass. - While they also undergo spontaneous involution, they lack the characteristic superficial, bright red, **raised** appearance seen in typical capillary (strawberry) hemangiomas. *Naevus simplex* - Also known as a **salmon patch** or **stork bite**, this is a common, faint, macular pink-to-red vascular mark typically found on the nape of the neck, eyelids, or glabella. - These lesions are transient and usually **fade completely** before 18 months of age, unlike capillary hemangiomas which are raised and generally take longer to involute.
Question 3: A patient presents with a violaceous rash on the upper back and shoulders (img-16.jpeg) and Gottron's papules on hands (img-17.jpeg). What is the likely diagnosis?
- A. Systemic lupus erythematosus
- B. Dermatomyositis (Correct Answer)
- C. Systemic sclerosis
- D. Cushing syndrome
Explanation: ***Dermatomyositis*** - The presence of a **heliotrope rash** (violaceous eruption on the upper eyelids) and **Gottron's papules** (violaceous papules over the knuckles) are pathognomonic for this inflammatory myopathy. - Other characteristic skin findings include the **shawl sign** (a photosensitive rash on the upper back, shoulders, and posterior neck, as seen in the image), the **V-sign**, and associated proximal muscle weakness. *Systemic lupus erythematosus* - SLE is classically associated with a **malar rash** (butterfly rash) over the bridge of the nose and cheeks, which spares the nasolabial folds. - While photosensitivity is a common feature, the specific findings of a heliotrope rash and Gottron's papules are not typical for SLE. *Systemic sclerosis* - This condition is characterized by progressive **skin thickening** and fibrosis, particularly **sclerodactyly** (tightening of the skin on the fingers). - Key differentiating features include **Raynaud phenomenon** and internal organ involvement, which are absent in this presentation. *Cushing syndrome* - This endocrine disorder is caused by excess **cortisol** and presents with distinct features like a **moon face**, **buffalo hump**, and purple **striae**. - It does not cause the inflammatory, photosensitive rashes that are characteristic of dermatomyositis.
Question 4: An 18-year-old female patient comes with the following findings. Which of the following is pathognomonic of the primary stage of this disease?
- A. Pustule
- B. Abscess
- C. Comedone (Correct Answer)
- D. Papule
Explanation: ***Comedone*** - The **comedo** is the primary, pathognomonic lesion of **acne vulgaris**. It is a non-inflammatory lesion formed by a blocked **pilosebaceous unit** with sebum and keratinocytes. - Comedones can be open (**blackheads**) or closed (**whiteheads**) and are the precursor to all inflammatory acne lesions like papules and pustules. *Papule* - A **papule** is a small, solid, raised inflammatory lesion that develops when a comedo ruptures, leading to an inflammatory response. - It represents a progression from the non-inflammatory primary stage to **inflammatory acne** and is therefore not the initial lesion. *Pustule* - A **pustule** is a superficial inflammatory lesion containing visible purulent material (pus), which typically evolves from a papule. - The presence of pus signifies a more advanced inflammatory process involving **Propionibacterium acnes** and neutrophils, not the primary stage. *Abscess* - An **abscess** is a deep, painful, pus-filled lesion that is characteristic of severe **nodulocystic acne**, a more advanced form of the disease. - This represents a severe inflammatory response and is not the primary lesion, which is much smaller and non-inflammatory.
Question 5: A 26-year-old male presented with erythematous plaques covered with silvery scales over the extensor surfaces of both arms. Punctate pitting was noted on examining the nails. What is the most likely diagnosis?
- A. Eczema
- B. Pityriasis rosea
- C. Lichen planus
- D. Psoriasis (Correct Answer)
Explanation: ***Psoriasis*** - The clinical presentation of **well-demarcated, erythematous plaques** covered with **silvery scales** on **extensor surfaces** is the hallmark of plaque psoriasis. - **Nail pitting**, as shown in the image, along with other nail changes like **onycholysis** (separation of the nail from the nail bed) and the **oil drop sign**, are highly characteristic findings in psoriasis. *Lichen planus* - Lichen planus is characterized by the "6 P's": **Pruritic, Purple, Polygonal, Planar Papules, and Plaques**, which differ significantly from the silvery-scaled lesions of psoriasis. - It commonly appears on **flexor surfaces**, such as the wrists, and is often associated with **Wickham's striae** (fine white lines on the lesions or oral mucosa). *Eczema* - Eczema (atopic dermatitis) typically presents with **poorly-demarcated, erythematous patches** with intense **pruritus**, leading to **lichenification** and **excoriations**, rather than well-defined plaques with silvery scales. - In adults, eczema classically involves the **flexor surfaces**, such as the antecubital and popliteal fossae, contrasting with the extensor distribution seen in this case. *Pityriasis rosea* - Pityriasis rosea typically begins with a solitary, larger lesion known as a **herald patch**, which is absent in this presentation. - This is followed by a generalized eruption of smaller, oval, pink papules with fine scale in a **"Christmas tree" distribution** on the trunk, which is inconsistent with the described findings.
Question 6: A patient presented with itchy lesions, as shown below. What is the diagnosis?
- A. Scabies
- B. Lichen planus (Correct Answer)
- C. Psoriasis
- D. Warts
Explanation: ***Lichen planus*** - The image displays classic features of lichen planus, which are often described by the **'5 P's'**: **P**ruritic (itchy), **P**olygonal, **P**lanar (flat-topped), **P**urple **P**apules and plaques. - A characteristic sign, though not always clearly visible, is the presence of fine white lines on the surface of the lesions, known as **Wickham's striae**. It is also associated with **Hepatitis C** infection. *Scabies* - Scabies presents with intensely pruritic small papules, vesicles, and pathognomonic **burrows**, which are not seen in the image. The lesions shown are large plaques, not typical for a mite infestation. - The distribution of scabies is characteristic, favoring **finger web spaces**, wrists, axillae, and the genital area, whereas the lesions shown are on a broader surface. *Psoriasis* - Psoriasis typically appears as well-demarcated, erythematous plaques covered with a thick, **silvery-white scale**. The lesions in the image are violaceous and lack the prominent silvery scale. - A key clinical sign in psoriasis is the **Auspitz sign**, where pinpoint bleeding occurs after the scale is removed. Lesions are commonly found on **extensor surfaces** like the elbows and knees. *Warts* - Warts (verruca vulgaris) are caused by the **Human Papillomavirus (HPV)** and present as hyperkeratotic, exophytic papules with a rough, papillomatous surface, unlike the flat-topped lesions in the image. - On close inspection, warts often show thrombosed capillaries appearing as **black dots** (pepper pot sign), which are absent in these lesions.
Question 7: A patient presents with erythematous streaks extending peripherally from a site of infection on the skin. Involvement of which of the following structures leads to this clinical presentation?
- A. Superficial lymphatics (Correct Answer)
- B. Skin
- C. Superficial veins
- D. Deep lymphatics
Explanation: ***Superficial lymphatics*** (Assuming the image shows signs of **lymphangitis** or **cellulitis**, characterized by **red streaks** spreading from an infected site.)- The classic presentation of **acute lymphangitis** involves **erythematous streaks** extending peripherally from a site of infection (often a wound or cellulitis), which are typically visible superficial structures.- This pattern suggests inflammation and infection tracking along the **superficial lymphatic vessels** which drain the peripheral skin and subcutaneous tissues.*Deep lymphatics*- Involvement of the **deep lymphatics** (e.g., those alongside major blood vessels) typically leads to **lymphedema** (swelling) of the entire limb, rather than the visible **red streaking** seen in acute superficial lymphangitis.- They are located deeper and their inflammation is less likely to produce the superficial, linear rash visible on the skin.*Superficial veins*- Inflammation and thrombosis of superficial veins (**superficial thrombophlebitis**) typically presents as a localized, **palpable, tender cord** rather than multiple linear streaks that spread over distance, which are characteristic of lymphatic tracing.- This condition would primarily involve blood flow obstruction, not the characteristic infection tracking seen in lymphangitis.*Skin*- Although the signs are *visible* on the skin, the primary pathological process causing the streaks is the infection spreading *within* the **lymphatic vessels** beneath the skin surface, not solely a primary skin disease (like **erysipelas** or **cellulitis** alone).- Cellulitis is often the source, but the visible tracking (streaks) follows the path of the **superficial lymphatics**.
Question 8: A patient presented with multiple painful blisters on an erythematous base along a dermatome on the trunk as shown in the image. What is the diagnosis?
- A. Herpes simplex
- B. Herpes zoster (Correct Answer)
- C. Molluscum contagiosum
- D. Chicken pox
Explanation: ***Herpes zoster*** - This diagnosis is indicated by the classic presentation of a **painful, unilateral vesicular eruption** on an erythematous base, which is confined to a single **dermatome**. - It is caused by the **reactivation** of the latent **varicella-zoster virus (VZV)** from the dorsal root ganglia, which previously caused chickenpox. *Herpes simplex* - Herpes simplex virus (HSV) typically causes vesicular lesions grouped around the **orolabial** (HSV-1) or **genital** (HSV-2) regions, not in a dermatomal pattern on the trunk. - While it can cause a widespread eruption (eczema herpeticum), it does not characteristically follow a single nerve distribution like herpes zoster. *Molluscum contagiosum* - This condition presents as discrete, flesh-colored, **dome-shaped papules** with central **umbilication**, not as painful vesicles on an erythematous base. - It is caused by a **poxvirus**, and the lesions are typically scattered and not confined to a dermatome. *Chicken pox* - Chickenpox (primary VZV infection) presents as a **generalized, diffuse vesicular rash** that affects the entire body, rather than being limited to a single dermatome. - The rash appears in successive crops, resulting in lesions at **various stages of development** (papules, vesicles, and crusted lesions) simultaneously.
Question 9: A 45-year-old truck driver with a history of multiple sex partners presented to the dermatological department, as shown below. What is the likely diagnosis?
- A. Secondary syphilis (Correct Answer)
- B. Lichen planus
- C. Scabies
- D. Psoriasis
Explanation: ***Secondary syphilis*** - The image shows a classic **maculopapular rash** involving the **palms**, a hallmark feature of secondary syphilis, which is caused by the spirochete **Treponema pallidum**. - The patient's history of **multiple sex partners** is a significant risk factor, and other associated findings can include generalized lymphadenopathy, fever, and **condylomata lata**. *Lichen planus* - Characterized by the "6 P's": **pruritic, polygonal, planar, purple papules and plaques**, often with fine white lines on the surface known as **Wickham's striae**. - The lesions in the image lack these classic features and are not typically pruritic, distinguishing it from the presented case. *Scabies* - This is an intensely **pruritic** infestation caused by the mite **Sarcoptes scabiei**, which creates linear **burrows**, especially in the **interdigital web spaces**, wrists, and axillae. - The rash in secondary syphilis is classically non-pruritic, and the morphology is maculopapular rather than burrow-like. *Psoriasis* - Typically presents as **well-demarcated erythematous plaques** with a **silvery scale** on extensor surfaces like the elbows and knees. - While palmoplantar psoriasis occurs, it usually manifests as hyperkeratotic plaques or pustules, not the diffuse maculopapular rash seen here.