FMGE 2025 — Dermatology

Q: A person with the H/o long-term sexual relationship presented with painful ulcers on his genitals with tender lymphadenopathy. What is the diagnosis?

Chancroid. ***Chancroid*** - Caused by the bacterium **_Haemophilus ducreyi_**, it classically presents with one or more deep, painful genital ulcers that have ragged, undermined borders and a purulent base. - It is characteristically associated with tender, suppurative inguinal lymphadenopathy, often unilateral, which is consistent with the patient's presentation. *Gonorrhoea* - Caused by **_Neisseria gonorrhoeae_**, it typically presents as **purulent urethritis** or cervicitis with discharge and dysuria. - While it can cause systemic infection, painful genital ulcers are not a characteristic feature of a primary gonococcal infection. *Chlamydia* - Caused by **_Chlamydia trachomatis_** (serovars D-K), it is a leading cause of nongonococcal urethritis and is frequently asymptomatic, especially in women. - This infection does not typically cause painful genital ulcers; its presentation is more commonly urethritis, cervicitis, or pelvic inflammatory disease. *LGV* - Lymphogranuloma venereum (LGV) is caused by invasive serovars (L1, L2, L3) of **_Chlamydia trachomatis_**. - It typically begins with a small, transient, **painless** papule or ulcer, followed by the development of painful inguinal lymphadenopathy (buboes), which differentiates it from the painful ulcers of chancroid. [Practice more Dermatology PYQs on OnCourse]

Q: An elderly female undergoing chemotherapy for breast cancer is experiencing significant hair loss. What is the most likely cause of her condition?

Anagen Effluvium. ***Anagen Effluvium***- This condition is the abrupt cessation of cell division in the rapidly proliferating hair matrix, directly caused by cytotoxic agents (chemotherapy) used to treat **breast cancer**.- It results in the hair shaft narrowing and fracturing, leading to massive, acute hair shedding (often non-scarring) that occurs within days to weeks of starting the **chemotherapy treatment**.*Telogen Effluvium*- This type of hair loss involves premature shifting of hairs from the growth (anagen) to the resting (telogen) phase due to a major stressor (e.g., severe illness, childbirth).- The shedding typically appears **2 to 4 months after** the initial precipitating event, which is too delayed for the immediate hair loss associated with most chemotherapy regimens.*Trichotillomania*- This is a psychological disorder characterized by recurrent, irresistible urges to **pull out one's hair**, leading to hair loss.- The resulting alopecia is typically patchy, irregular, and features hairs of different lengths due to continuous pulling, contrasting sharply with the diffuse loss from chemotherapy.*Alopecia Areata*- This is an **autoimmune** disorder where T-lymphocytes attack the anagen hair follicles, resulting in distinct, usually circular or oval, non-scarring patches of hair loss.- It classically presents with "exclamation mark" hairs (hairs that are narrower near the scalp) and is not directly induced by cytotoxic chemotherapy. [Practice more Dermatology PYQs on OnCourse]

Q: A neonate presents with a growing skin lesion, as shown in the image provided. The mother reports that the lesion has been increasing in size daily. What is the appropriate management?

Observation. ***Observation*** - The image displays a classic **infantile hemangioma** (strawberry nevus), a benign vascular tumor that typically appears shortly after birth. These lesions characteristically undergo a rapid proliferation phase in the first few months, followed by spontaneous involution over several years. - For uncomplicated hemangiomas that do not obstruct vital functions (like vision or breathing), ulcerate, or cause significant disfigurement, **observation** is the standard management, as most resolve on their own. *Excision and Laser Therapy* - Surgical excision or laser therapy are typically reserved for complicated hemangiomas, such as those that are ulcerated, bleeding, or causing functional impairment. - These invasive procedures carry risks of scarring and are generally avoided for simple lesions that are expected to regress spontaneously. *Immediate Biopsy due to Malignancy Risk* - The clinical presentation is highly characteristic of a benign **infantile hemangioma**, making the risk of malignancy extremely low and a biopsy unnecessary in most cases. - A biopsy is only considered if the lesion has atypical features or if the diagnosis is uncertain, to rule out rare malignant vascular tumors. *Cryotherapy* - Cryotherapy is not a standard treatment for infantile hemangiomas as it may not penetrate deep enough to be effective and carries a high risk of causing scarring, hypopigmentation, and pain. - This modality is more appropriate for smaller, more superficial lesions like warts or actinic keratoses, not for vascular tumors. [Practice more Dermatology PYQs on OnCourse]

Q: A child presents with a vesiculobullous, pustular rash around the mouth and on the extremities, along with alopecia and diarrhea. What is the most likely nutritional deficiency?

Zinc Deficiency. ***Zinc Deficiency*** - This clinical presentation represents a classic case of **acrodermatitis enteropathica**, a condition caused by zinc deficiency, characterized by a vesiculobullous, pustular, and eczematous rash in a **periorificial** (around the mouth) and **acral** distribution. - Other key features of zinc deficiency include **alopecia** (hair loss), chronic **diarrhea**, **impaired growth**, and **immunodeficiency**, leading to recurrent infections. *Vitamin C Deficiency* - Known as **scurvy**, this deficiency leads to impaired collagen synthesis, resulting in manifestations like **petechiae**, **ecchymoses**, perifollicular hemorrhage, **bleeding gums**, and **corkscrew hairs**. - In infants, it can present with **subperiosteal hemorrhages**, causing severe pain and reluctance to move (**pseudoparalysis**), but not the periorificial rash seen here. *Vitamin D Deficiency* - This deficiency primarily affects bone mineralization, leading to **rickets** in children and **osteomalacia** in adults. Clinical signs include **bowed legs** (genu varum), **rachitic rosary** (beading of the ribs), and **craniotabes** (soft skull). - Cutaneous manifestations are not a feature of vitamin D deficiency; its role is primarily in **calcium homeostasis** and bone health. *Copper Deficiency* - Copper deficiency primarily manifests with hematological abnormalities like **microcytic anemia** (refractory to iron treatment) and neurological symptoms such as **myelopathy** and peripheral neuropathy. - Cutaneous signs are rare but can include **hypopigmentation** of the skin and kinky, brittle hair (**pili torti**), which are features of the genetic disorder **Menkes disease**. [Practice more Dermatology PYQs on OnCourse]

Q: What is the most appropriate treatment for severe acne?

Isotretinoin. ***Isotretinoin***- This is the most effective and definitive treatment for **severe nodular or cystic acne** that has failed to respond to conventional treatments like topical agents and oral antibiotics. - It is a systemic retinoid that targets all four major pathogenic factors of acne: reducing **sebum production**, normalizing follicular keratinization, inhibiting *Cutibacterium acnes*, and providing anti-inflammatory effects.*Topical Tretinoin*- Topical retinoids are the first-line agents, primarily effective for **mild to moderate comedonal acne**. - They lack the necessary systemic penetration and potency to resolve deep-seated inflammation and nodules characteristic of **severe acne**.*Steroids*- Systemic steroids are generally reserved for highly specific, severe, and acute inflammatory complications of acne, such as **acne fulminans**, or used short-term to manage Isotretinoin-induced flares. - They are not the standard long-term treatment for severe acne due to significant systemic side effects and the fact that they do not address the underlying pathology of **sebum hypersecretion**.*Antibiotics*- Oral antibiotics (e.g., **doxycycline, minocycline**) are indicated for **moderate inflammatory acne**, often combined with topical retinoids. - They are typically insufficient as monotherapy for severe, scarring, nodulocystic acne, and overuse contributes significantly to **antibiotic resistance**. [Practice more Dermatology PYQs on OnCourse]

12 Previous Year Questions with Answers & Explanations

Questions

A person with the H/o long-term sexual relationship presented with painful ulcers on his genitals with tender lymphadenopathy. What is the diagnosis?

An elderly female undergoing chemotherapy for breast cancer is experiencing significant hair loss. What is the most likely cause of her condition?

A neonate presents with a growing skin lesion, as shown in the image provided. The mother reports that the lesion has been increasing in size daily. What is the appropriate management?

A child presents with a vesiculobullous, pustular rash around the mouth and on the extremities, along with alopecia and diarrhea. What is the most likely nutritional deficiency?

What is the most appropriate treatment for severe acne?

A 60-year-old person presented with an ulcer on the medial canthus. The ulcer has rolled-out, beaded margins. Histopathology shows nesting cells with peripheral palisading patterns. What is the most likely diagnosis?

A Tzanck smear prepared from a vesicle shows multinucleated giant cells. What is the diagnosis?

A female presents with multiple small, pink, umbilicated papules on the face. What is the most likely diagnosis?

Identify the given condition and its treatment.

Q10

Which of the following best describes the characteristic lesion of Kaposi sarcoma?

FMGE 2025 - Dermatology FMGE Practice Questions and MCQs

Question 1: A person with the H/o long-term sexual relationship presented with painful ulcers on his genitals with tender lymphadenopathy. What is the diagnosis?

A. LGV
B. Chlamydia
C. Gonorrhoea
D. Chancroid (Correct Answer)

Explanation: ***Chancroid*** - Caused by the bacterium **_Haemophilus ducreyi_**, it classically presents with one or more deep, painful genital ulcers that have ragged, undermined borders and a purulent base. - It is characteristically associated with tender, suppurative inguinal lymphadenopathy, often unilateral, which is consistent with the patient's presentation. *Gonorrhoea* - Caused by **_Neisseria gonorrhoeae_**, it typically presents as **purulent urethritis** or cervicitis with discharge and dysuria. - While it can cause systemic infection, painful genital ulcers are not a characteristic feature of a primary gonococcal infection. *Chlamydia* - Caused by **_Chlamydia trachomatis_** (serovars D-K), it is a leading cause of nongonococcal urethritis and is frequently asymptomatic, especially in women. - This infection does not typically cause painful genital ulcers; its presentation is more commonly urethritis, cervicitis, or pelvic inflammatory disease. *LGV* - Lymphogranuloma venereum (LGV) is caused by invasive serovars (L1, L2, L3) of **_Chlamydia trachomatis_**. - It typically begins with a small, transient, **painless** papule or ulcer, followed by the development of painful inguinal lymphadenopathy (buboes), which differentiates it from the painful ulcers of chancroid.

Question 2: An elderly female undergoing chemotherapy for breast cancer is experiencing significant hair loss. What is the most likely cause of her condition?

A. Alopecia Areata
B. Trichotillomania
C. Anagen Effluvium (Correct Answer)
D. Telogen Effluvium

Explanation: ***Anagen Effluvium***- This condition is the abrupt cessation of cell division in the rapidly proliferating hair matrix, directly caused by cytotoxic agents (chemotherapy) used to treat **breast cancer**.- It results in the hair shaft narrowing and fracturing, leading to massive, acute hair shedding (often non-scarring) that occurs within days to weeks of starting the **chemotherapy treatment**.*Telogen Effluvium*- This type of hair loss involves premature shifting of hairs from the growth (anagen) to the resting (telogen) phase due to a major stressor (e.g., severe illness, childbirth).- The shedding typically appears **2 to 4 months after** the initial precipitating event, which is too delayed for the immediate hair loss associated with most chemotherapy regimens.*Trichotillomania*- This is a psychological disorder characterized by recurrent, irresistible urges to **pull out one's hair**, leading to hair loss.- The resulting alopecia is typically patchy, irregular, and features hairs of different lengths due to continuous pulling, contrasting sharply with the diffuse loss from chemotherapy.*Alopecia Areata*- This is an **autoimmune** disorder where T-lymphocytes attack the anagen hair follicles, resulting in distinct, usually circular or oval, non-scarring patches of hair loss.- It classically presents with "exclamation mark" hairs (hairs that are narrower near the scalp) and is not directly induced by cytotoxic chemotherapy.

Question 3: A neonate presents with a growing skin lesion, as shown in the image provided. The mother reports that the lesion has been increasing in size daily. What is the appropriate management?

A. Observation (Correct Answer)
B. Immediate Biopsy due to Malignancy Risk
C. Cryotherapy
D. Excision and Laser Therapy

Explanation: ***Observation*** - The image displays a classic **infantile hemangioma** (strawberry nevus), a benign vascular tumor that typically appears shortly after birth. These lesions characteristically undergo a rapid proliferation phase in the first few months, followed by spontaneous involution over several years. - For uncomplicated hemangiomas that do not obstruct vital functions (like vision or breathing), ulcerate, or cause significant disfigurement, **observation** is the standard management, as most resolve on their own. *Excision and Laser Therapy* - Surgical excision or laser therapy are typically reserved for complicated hemangiomas, such as those that are ulcerated, bleeding, or causing functional impairment. - These invasive procedures carry risks of scarring and are generally avoided for simple lesions that are expected to regress spontaneously. *Immediate Biopsy due to Malignancy Risk* - The clinical presentation is highly characteristic of a benign **infantile hemangioma**, making the risk of malignancy extremely low and a biopsy unnecessary in most cases. - A biopsy is only considered if the lesion has atypical features or if the diagnosis is uncertain, to rule out rare malignant vascular tumors. *Cryotherapy* - Cryotherapy is not a standard treatment for infantile hemangiomas as it may not penetrate deep enough to be effective and carries a high risk of causing scarring, hypopigmentation, and pain. - This modality is more appropriate for smaller, more superficial lesions like warts or actinic keratoses, not for vascular tumors.

Question 4: A child presents with a vesiculobullous, pustular rash around the mouth and on the extremities, along with alopecia and diarrhea. What is the most likely nutritional deficiency?

A. Vitamin C Deficiency
B. Zinc Deficiency (Correct Answer)
C. Vitamin D Deficiency
D. Copper Deficiency

Explanation: ***Zinc Deficiency*** - This clinical presentation represents a classic case of **acrodermatitis enteropathica**, a condition caused by zinc deficiency, characterized by a vesiculobullous, pustular, and eczematous rash in a **periorificial** (around the mouth) and **acral** distribution. - Other key features of zinc deficiency include **alopecia** (hair loss), chronic **diarrhea**, **impaired growth**, and **immunodeficiency**, leading to recurrent infections. *Vitamin C Deficiency* - Known as **scurvy**, this deficiency leads to impaired collagen synthesis, resulting in manifestations like **petechiae**, **ecchymoses**, perifollicular hemorrhage, **bleeding gums**, and **corkscrew hairs**. - In infants, it can present with **subperiosteal hemorrhages**, causing severe pain and reluctance to move (**pseudoparalysis**), but not the periorificial rash seen here. *Vitamin D Deficiency* - This deficiency primarily affects bone mineralization, leading to **rickets** in children and **osteomalacia** in adults. Clinical signs include **bowed legs** (genu varum), **rachitic rosary** (beading of the ribs), and **craniotabes** (soft skull). - Cutaneous manifestations are not a feature of vitamin D deficiency; its role is primarily in **calcium homeostasis** and bone health. *Copper Deficiency* - Copper deficiency primarily manifests with hematological abnormalities like **microcytic anemia** (refractory to iron treatment) and neurological symptoms such as **myelopathy** and peripheral neuropathy. - Cutaneous signs are rare but can include **hypopigmentation** of the skin and kinky, brittle hair (**pili torti**), which are features of the genetic disorder **Menkes disease**.

Question 5: What is the most appropriate treatment for severe acne?

A. Topical Tretinoin
B. Antibiotics
C. Steroids
D. Isotretinoin (Correct Answer)

Explanation: ***Isotretinoin***- This is the most effective and definitive treatment for **severe nodular or cystic acne** that has failed to respond to conventional treatments like topical agents and oral antibiotics. - It is a systemic retinoid that targets all four major pathogenic factors of acne: reducing **sebum production**, normalizing follicular keratinization, inhibiting *Cutibacterium acnes*, and providing anti-inflammatory effects.*Topical Tretinoin*- Topical retinoids are the first-line agents, primarily effective for **mild to moderate comedonal acne**. - They lack the necessary systemic penetration and potency to resolve deep-seated inflammation and nodules characteristic of **severe acne**.*Steroids*- Systemic steroids are generally reserved for highly specific, severe, and acute inflammatory complications of acne, such as **acne fulminans**, or used short-term to manage Isotretinoin-induced flares. - They are not the standard long-term treatment for severe acne due to significant systemic side effects and the fact that they do not address the underlying pathology of **sebum hypersecretion**.*Antibiotics*- Oral antibiotics (e.g., **doxycycline, minocycline**) are indicated for **moderate inflammatory acne**, often combined with topical retinoids. - They are typically insufficient as monotherapy for severe, scarring, nodulocystic acne, and overuse contributes significantly to **antibiotic resistance**.

Question 6: A 60-year-old person presented with an ulcer on the medial canthus. The ulcer has rolled-out, beaded margins. Histopathology shows nesting cells with peripheral palisading patterns. What is the most likely diagnosis?

A. Nevus
B. Melanoma
C. Squamous Cell Carcinoma (SCC)
D. Basal Cell Carcinoma (BCC) (Correct Answer)

Explanation: ***Basal Cell Carcinoma (BCC)***- The clinical presentation of a slow-growing ulcer with **rolled-out, beaded margins** on a sun-exposed area like the medial canthus is classic for the nodular variant of BCC.- Histopathology showing nests of **basaloid cells** originating from the epidermis, with characteristic **peripheral palisading** of nuclei, is the pathognomonic microscopic description for BCC.*Squamous Cell Carcinoma (SCC)*- SCC often presents as a **firm, hyperkeratotic nodule** or plaque that frequently ulcerates, but it typically lacks the pearly, beaded margins characteristic of BCC.- Histologically, SCC consists of **squamous differentiation**, demonstrating **keratin pearls** and intercellular bridges, not peripheral palisading.*Nevus*- A nevus (mole) is a benign proliferation of **melanocytes**; it is usually a pigmented macule or papule and does not typically present as a destructive ulcer with rolled borders.- Histopathology shows uniform nests of nevus cells, confined to the junction or dermis, lacking the malignant architecture and the **basaloid cells** seen here.*Melanoma*- Melanoma often presents as an **asymmetrical, irregularly bordered**, and variably pigmented lesion (ABCDE criteria), which differs from the non-pigmented ulcer described.- Histopathology would reveal atypical **melanocytes** with characteristic nuclear features and dermal invasion, not the nested, palisading basaloid cells of BCC.

Question 7: A Tzanck smear prepared from a vesicle shows multinucleated giant cells. What is the diagnosis?

A. HSV (Correct Answer)
B. EBV
C. HIV
D. HPV

Explanation: ***HSV*** - The Tzanck smear is a rapid cytological test used to detect the viral cytopathic effects seen in vesicles caused by the *Herpesviridae* family, including **Herpes Simplex Virus (HSV)** and **Varicella-Zoster Virus (VZV)**. - The finding of **multinucleated giant cells** (also called **Tzanck cells**) formed by the fusion of infected keratinocytes is highly characteristic of herpetic infections. - **Important note**: The Tzanck smear **cannot distinguish between HSV and VZV** as both produce identical cytopathic effects. However, among the given options, **only HSV** is from the Herpesviridae family that causes vesicular lesions with this classic finding. - Clinical context (location, distribution, patient age) and confirmatory tests like **PCR** or **viral culture** are needed to differentiate HSV from VZV definitively. *HIV* - **HIV** (Human Immunodeficiency Virus) is diagnosed through blood tests, such as fourth-generation antigen/antibody screens or **PCR** for viral load. - The Tzanck smear is a test for vesicular dermatoses and **does not** play a role in the diagnosis of HIV infection. - HIV does not cause vesicles with multinucleated giant cells. *HPV* - **HPV** (Human Papillomavirus) causes warts and condylomas, which are diagnosed histologically showing characteristic **koilocytes** (squamous cells with perinuclear halos). - HPV lesions are **papular or verrucous**, not vesicular, and therefore would not yield multinucleated giant cells on Tzanck smear. - HPV does not belong to the Herpesviridae family. *EBV* - **EBV** (Epstein-Barr Virus) primarily causes Infectious Mononucleosis and is diagnosed using serological tests, such as the **Monospot test** (detecting heterophile antibodies) or EBV-specific antibodies. - EBV is **not associated with vesicular eruptions** and does not produce Tzanck-positive lesions. - EBV belongs to the Herpesviridae family but manifests systemically rather than with characteristic skin vesicles.

Question 8: A female presents with multiple small, pink, umbilicated papules on the face. What is the most likely diagnosis?

A. Acne vulgaris
B. Molluscum contagiosum (Correct Answer)
C. HPV
D. Herpes simplex

Explanation: ***Molluscum contagiosum*** - This condition, caused by a **poxvirus**, classically presents as multiple, discrete, small (2-5 mm), dome-shaped, pink or skin-colored papules with central **umbilication**. - It is a common, benign skin infection that spreads through direct contact or fomites and is frequently seen in children, sexually active adults, and immunocompromised individuals. *Herpes simplex* - Herpes simplex virus infection typically manifests as clusters of painful **vesicles** (small blisters) on an erythematous base, which later ulcerate and crust over. - The primary lesions are not solid papules and lack the characteristic central umbilication seen in molluscum. *HPV* - Human Papillomavirus (HPV) causes warts (verrucae), which are typically rough, hyperkeratotic papules (**verruca vulgaris**) or flat-topped papules (**verruca plana**). - Warts do not characteristically present with the smooth surface and central depression seen in molluscum contagiosum. *Acne vulgaris* - Acne is a disorder of the pilosebaceous unit, presenting with a variety of lesions including **comedones** (blackheads and whiteheads), inflammatory papules, and pustules. - Acne lesions are not umbilicated and are often associated with follicular inflammation and sebum production.

Question 9: Identify the given condition and its treatment.

A. Erythema multiforme with steroids
B. Impetigo bullosa with antibiotics
C. Epidermolysis bullosa with bandaging
D. Staphylococcal scalded skin syndrome with Inj cephalexin (Correct Answer)

Explanation: ***Staphylococcal scalded skin syndrome with Inj cephalexin*** - This is a serious skin infection caused by **exfoliative toxins** produced by *Staphylococcus aureus*, leading to widespread erythema and desquamation. The image may represent the initial focus of infection. - Treatment involves systemic **anti-staphylococcal antibiotics**, such as cephalexin or nafcillin, to eliminate the toxin-producing bacteria, along with supportive care for the skin. *Epidermolysis bullosa with bandaging* - This is a group of inherited **genetic disorders** causing extreme skin fragility and blistering in response to minimal trauma, not an infection. - The clinical presentation involves **mechanically-induced bullae** and erosions, rather than the infectious pustules seen here. *Impetigo bullosa with antibiotics* - Bullous impetigo is a **localized skin infection** with flaccid bullae caused by *S. aureus* exotoxins, confined to the area of infection. - Staphylococcal scalded skin syndrome is a **systemic illness** where toxins circulate, causing widespread skin sloughing far from the initial infection site, and often presents with fever and irritability. *Erythema multiforme with steroids* - This is an immune-mediated **hypersensitivity reaction**, most commonly triggered by infections like **Herpes simplex virus** or medications. - The characteristic skin lesions are **targetoid papules** and plaques, which are morphologically distinct from the pustules shown in the image.

Question 10: Which of the following best describes the characteristic lesion of Kaposi sarcoma?

A. Small, red erosions
B. A raised, purple-red lesion (Correct Answer)
C. A white, striated lesion that cannot be scraped off
D. A yellow lesion containing pus

Explanation: ***A raised, purple-red lesion*** - Kaposi sarcoma is a vascular tumor caused by **Human Herpesvirus-8 (HHV-8)**, presenting as violaceous (purple-red) macules, papules, or nodules on the skin and mucosa. - These lesions are common in immunocompromised individuals, particularly those with **HIV/AIDS**, and are characterized by the proliferation of endothelial cells. *A yellow lesion containing pus* - This description is characteristic of a **pustule** or an **abscess**, which are typically signs of a bacterial infection, such as those caused by **Staphylococcus aureus**. - Kaposi sarcoma is a neoplastic lesion, not an acute purulent infection, and does not contain pus. *A white, striated lesion that cannot be scraped off* - This is the classic presentation of **oral hairy leukoplakia**, a benign mucosal lesion caused by the **Epstein-Barr virus (EBV)**, also seen in immunocompromised patients. - It differs from Kaposi sarcoma in its color (white vs. purple-red), location (typically lateral tongue), and causative virus. *Small, red erosions* - This description is more consistent with conditions like **herpes simplex virus (HSV)** infection, where vesicles rupture to form erosions, or with erosive inflammatory dermatoses. - Kaposi sarcoma typically manifests as proliferative papules or nodules, not as primary erosions.