FMGE 2026 - Dermatology PYQs Practice Questions

Q: A 48-year-old woman with a 10-year history of rheumatoid arthritis (anti-CCP positive) presents with a rapidly progressive, extremely painful ulcer over the anterior aspect of the shin. The lesion began as a pustule and progressed to a deep ulcer with anecrotic black eschar and violaceous undermined margins. There is no history of trauma or diabetes. What is the most likely diagnosis?

Pyoderma gangrenosum. ***Pyoderma gangrenosum*** - The presence of a rapidly progressive, painful ulcer with **violaceous, undermined, and irregular margins** is the classic presentation of this condition. - It is strongly associated with underlying systemic inflammatory disorders, particularly **rheumatoid arthritis** and **inflammatory bowel disease**. *Cutaneous TB* - This usually presents as a slow-growing plaque or nodule, often manifesting as **lupus vulgaris** or **scrofuloderma**, rather than a rapid, necrotizing ulcer. - Diagnosis typically requires biopsy showing **caseating granulomas** and demonstration of mycobacteria, which is inconsistent with this acute clinical picture. *Ecthmya gangrenosum* - Primarily caused by **Pseudomonas aeruginosa** sepsis, typically affecting immunocompromised patients, and lacks the strong association with RA. - The lesions usually start as erythematous macules that evolve into bullae and then ulcers with a **central black eschar**, but are typically linked to systemic bacterial infection rather than chronic autoimmune disease. *Necrotising fasciitis* - A life-threatening surgical emergency characterized by **crepitus**, rapid spread along fascial planes, and systemic signs of **sepsis**. - It does not typically present as a localized, chronic-associated ulcer with distinctively **undermined borders** in an ambulatory patient. [Practice more Dermatology PYQs on OnCourse]

Q: Identify the type of skin graft?

Split thickness skin graft. ***Split thickness skin graft*** - This graft includes the **epidermis** and a **variable thickness of the dermis**, which allows the donor site to heal by re-epithelialization from the remaining adnexal structures. - It is the **most versatile** option for covering large surface area wounds as it provides a reliable take, though it has a higher tendency for secondary contraction and pigment dyschromia compared to full-thickness grafts. *Full-Thickness Skin Graft* - This graft contains the **entire epidermis** and **entire dermis**, which provides better durability, color match, and minimal wound contraction post-healing. - Due to the complete removal of the dermis, the donor site cannot heal spontaneously and requires **primary closure** or another skin graft. *Composite Graft* - This type of graft involves two or more tissue types (e.g., skin and cartilage) harvested as a single unit, often used for **nasal or ear reconstruction**. - It lacks an intrinsic blood supply and depends entirely on receiving revascularization from the host bed, limiting its size to usually **less than 1 cm** to ensure survival. *Biomesh* - This is a **biological scaffold** or extracellular matrix (ECM) derived from human or animal tissue rather than a traditional skin graft. - It is primarily used for **tissue regeneration** and hernia repair rather than surface coverage of skin defects. [Practice more Dermatology PYQs on OnCourse]

Q: A patient with a long history of betel nut chewing presents with a progressively enlarging mass protruding through the mouth. What is the IOC of likely diagnosis?

Edge biopsy. ***Edge biopsy (Incisional biopsy)*** - An **incisional biopsy** performed at the edge of the lesion is the **gold standard** (standard of care) for diagnosing oral malignancies, as it allows for the evaluation of both the **tumor tissue** and the **adjacent normal tissue** to assess the depth of invasion. - By sampling the **interface** of the lesion's border, the pathologist can confirm the diagnosis, determine the **histological grade**, and evaluate the **tumor margins** effectively. *Brush biopsy* - This technique, often referred to as **oral brush cytology** or **exfoliative cytology**, is primarily a **screening tool** rather than a diagnostic one. - It has a high rate of **false negatives** because it only collects superficial cells and cannot evaluate the **depth of invasion** or architectural patterns required for a definitive **malignancy** diagnosis. *Punch biopsy* - While useful for some superficial skin conditions, it is generally considered insufficient for deep, complex **oral masses** compared to an **incisional edge biopsy**. - There is a significant risk of **under-sampling** or missing the most representative area of the tumor, potentially leading to inaccurate staging or **misdiagnosis** of the malignancy. [Practice more Dermatology PYQs on OnCourse]

Q: A 28-year-old man diagnosed with borderline tuberculoid (BT) leprosy was started on WHO -MDT. After 2 months of regular treatment, he now presents with sudden onset of tender, erythematous, oedematous lesions over the nose and forehead associated with mild fever. There is no new sensory loss or nerve tenderness. What is the most appropriate next step in management?

Continue MDT and start oral prednisolone. ***Continue MDT and start oral prednisolone*** - This patient is presenting with a **Type 1 Reaction (Reversal Reaction)**, which is an immunological response commonly seen in **borderline leprosy** (like BT) due to an increase in cell-mediated immunity against mycobacterial antigens. - **Systemic corticosteroids (prednisolone)** are the treatment of choice to reduce inflammation and prevent permanent **nerve damage**, while **MDT should be continued** as it helps clear the antigenic load. *Stop MDT and start oral prednisolone* - Stopping MDT is contraindicated because there is no evidence that the leprosy bacilli themselves are causing the increased inflammation; the reaction is host-driven. - Discontinuing the anti-leprosy medication could potentially lead to bacterial resurgence and treatment failure. *Stop MDT and start thalidomide.* - **Thalidomide** is the specific treatment for **Type 2 Reactions (Erythema Nodosum Leprosum)**, which typically occur in lepromatous (BL/LL) leprosy and present with crops of painful nodules. - This patient has BT leprosy, which is strongly associated with **Type 1 reactions**, not Type 2, making thalidomide inappropriate. *Continue MDT alone without steroids* - This approach is dangerous because untreated Type 1 reactions can rapidly lead to **irreversible nerve damage** and deformity. - Anti-inflammatory therapy with **corticosteroids** is mandatory to control the acute immune response and preserve nerve function. [Practice more Dermatology PYQs on OnCourse]

Q: A patient from TN, presents with a long -standing painless swelling of the foot with multiple discharging sinuses, as shown in the image. HYPHAE in biopsy. What is the most appropriate treatment?

Long -term antifungal therapy with surgical debridement. ***Long-term antifungal therapy with surgical debridement*** - This patient presents with features of **eumycetoma** (a fungal form of mycetoma), characterized by painless swelling, sinus tracts, and the presence of **hyphae** on biopsy. - Because fungal infections in mycetoma can be deep-seated and difficult to clear, the standard of care involves a combined approach of **prolonged antifungal therapy** (such as itraconazole or voriconazole) alongside **surgical debridement** of necrotic tissue. *Immediate amputation* - Amputation is reserved for cases with severe, extensive tissue destruction, secondary infection, or loss of function, rather than an initial management step. - Most cases of mycetoma can be managed conservatively with medical and surgical interventions before considering aggressive measures like amputation. *Short-term antifungal therapy alone* - **Eumycetoma** is a chronic, slow-growing infection that requires very long courses of antifungal therapy, often lasting for months or even years. - Short-term treatment is ineffective and will result in high **relapse rates** given the deep, granulomatous nature of the fungal infection. *Surgical debridement only* - Surgical debridement alone is insufficient as the fungal elements often infiltrate deep into the subcutaneous tissue and bone, leading to high rates of **local recurrence**. - Medical therapy is essential to treat the residual fungus that surgery alone cannot clear, necessitating the **combined therapeutic approach**. [Practice more Dermatology PYQs on OnCourse]

Question 1

A 48-year-old woman with a 10-year history of rheumatoid arthritis (anti-CCP positive) presents with a rapidly progressive, extremely painful ulcer over the anterior aspect of the shin. The lesion began as a pustule and progressed to a deep ulcer with anecrotic black eschar and violaceous undermined margins. There is no history of trauma or diabetes. What is the most likely diagnosis?

Accepted Answer

Pyoderma gangrenosum

Answer

Cutaneous TB

Answer

Ecthmya gangrenosum

Answer

Necrotising fasciitis

Question 2

Identify the type of skin graft?

Accepted Answer

Split thickness skin graft

Answer

Full-Thickness Skin Graft

Answer

Composite Graft

Answer

Biomesh

Question 3

A patient with a long history of betel nut chewing presents with a progressively enlarging mass protruding through the mouth. What is the IOC of likely diagnosis?

Accepted Answer

Edge biopsy

Answer

Brush biopsy

Answer

Punch biopsy

Question 4

A 28-year-old man diagnosed with borderline tuberculoid (BT) leprosy was started on WHO -MDT. After 2 months of regular treatment, he now presents with sudden onset of tender, erythematous, oedematous lesions over the nose and forehead associated with mild fever. There is no new sensory loss or nerve tenderness. What is the most appropriate next step in management?

Accepted Answer

Continue MDT and start oral prednisolone

Answer

Stop MDT and start oral prednisolone

Answer

Stop MDT and start thalidomide.

Answer

Continue MDT alone without steroids

Question 5

A patient from TN, presents with a long -standing painless swelling of the foot with multiple discharging sinuses, as shown in the image. HYPHAE in biopsy. What is the most appropriate treatment?

Accepted Answer

Long -term antifungal therapy with surgical debridement

Answer

Immediate amputation

Answer

Short-term antifungal therapy alone

Answer

Surgical debridement only

Question 6

A patient with bronchial asthma on long -term inhaled corticosteroid therapy presents with whitish plaques over the palate and tonsillar region. What is the most likely diagnosis?

Accepted Answer

Oral candidiasis

Answer

Oral lichen planus

Answer

Aphthous ulcer

Answer

Leukoplakia

Question 7

A patient presents with multiple painful genital ulcers associated with tender cervical/inguinal lymphadenopathy. The ulcers are soft and irregular as shown in the image. What is the most likely causative organism?

Accepted Answer

Haemophilus ducreyi

Answer

Chlamydia trachomatis

Answer

Klebsiella granulomatis

Answer

Treponema pallidum

Question 8

A young woman presents with vesiculobullous lesions involving the upper lips and target lesions on extremities. What is the most likely diagnosis?

Accepted Answer

Erythema multiforme

Answer

Dermatitis herpetiformis

Answer

Bullous pemphigoid

Answer

Pemphigus vulgaris

Question 9

A truck driver presents with a single painless genital ulcer that appeared 3 weeks after an unprotected sexual encounter. There is associated non-tender inguinal lymphadenopathy. What is the most likely diagnosis?

Accepted Answer

Primary syphilis

Answer

Chancroid

Answer

Genital herpes

Answer

Lymphogranuloma venereum

Question 10

A child presents with severe itching involving the extensor surface, especially at night . There is a positive family history of asthma in father. On examination, the child has dry, itchy skin with eczematous lesions. What is the most likely diagnosis?

Accepted Answer

Atopic dermatitis

Answer

Scabies

Answer

Cradle cap (Seborrheic dermatitis)

Answer

Contact dermatitis

FMGE 2026 — Dermatology