INI-CET 2025 — Dermatology
5 Previous Year Questions with Answers & Explanations
Which of the following are recognized side effects of topical corticosteroid use? a. Hypertrichosis b. Acneiform eruptions c. Skin atrophy d. Blue pigmentation of the skin
A male presents with lesions as shown in the image and a history of unprotected sexual intercourse a few months ago. What is the most appropriate investigation to confirm the diagnosis?
A patient presents with painful ulcer in the mouth and a past history of recurrent vesicular lesions in the genitalia. Bedside test findings are shown. What is the most appropriate drug for management?
A patient with asymptomatic annular skin lesion as shown presents to OPD. Which investigation should be done?
In an infant with scabies, what is the preferred treatment?
INI-CET 2025 - Dermatology INI-CET Practice Questions and MCQs
Question 1: Which of the following are recognized side effects of topical corticosteroid use? a. Hypertrichosis b. Acneiform eruptions c. Skin atrophy d. Blue pigmentation of the skin
- A. a, b, d
- B. a, c, d
- C. b, c, d
- D. a, b, c (Correct Answer)
Explanation: ***a, b, c*** - This option correctly includes three well-established local adverse effects of topical corticosteroids: **Hypertrichosis** (increased hair growth), **Acneiform eruptions** (steroid acne), and crucial connective tissue damage leading to **Skin atrophy**. - Other recognized local side effects include telangiectasias, striae, hypopigmentation, purpura, and delayed wound healing. *a, b, d* - This option incorrectly includes 'd. Blue pigmentation of the skin'; topical steroids primarily cause **hypopigmentation** due to melanocyte suppression, not true blue discoloration. - Blue pigmentation (e.g., slate-grey or blue-black) is typically associated with drugs like **Minocycline** or conditions like **Ochronosis** (Alkaptonuria). *a, c, d* - This option incorrectly lists 'd. Blue pigmentation of the skin' (as explained above) and simultaneously omits 'b. **Acneiform eruptions**', which is a very common side effect, especially with high-potency steroids applied to the face. - **Steroid acne** results from follicular occlusion and changes in the sebaceous unit, presenting as monomorphic papules and pustules. *b, c, d* - This option incorrectly includes 'd. Blue pigmentation of the skin' while omitting 'a. **Hypertrichosis**', an effect common due to the stimulation of hair follicles by circulating corticosteroid metabolites. - The development of **hypertrichosis** is concentration-dependent and especially noticeable in women using potent topical steroids on the face.
Question 2: A male presents with lesions as shown in the image and a history of unprotected sexual intercourse a few months ago. What is the most appropriate investigation to confirm the diagnosis?
- A. Serology (Correct Answer)
- B. Tzanck smear
- C. KOH
- D. Biopsy
Explanation: ***Serology*** - The clinical presentation (diffuse body rash, often involving the palms and soles, following recent unprotected sexual exposure) is highly suggestive of **Secondary Syphilis**. - **Serological tests** (Non-treponemal tests like RPR/VDRL and specific Treponemal tests like TPPA/FTA-ABS) are the definitive and most appropriate confirmatory investigation for syphilis. *Tzanck smear* - This test is used primarily for the rapid diagnosis of vesicular lesions caused by herpes viruses, such as **Herpes Simplex Virus (HSV)** or **Varicella-Zoster Virus (VZV)**. - It is not indicated for the diagnosis of the typical maculopapular rash seen in secondary syphilis. *KOH* - **Potassium hydroxide (KOH) preparation** is a direct microscopy test specifically used to identify structures like hyphae and spores in the diagnosis of **superficial fungal infections**. - The patient's presentation with a rash secondary to sexually transmitted infection is not typically investigated using KOH. *Biopsy* - While a skin biopsy might confirm the diagnosis histologically (showing characteristic perivascular infiltrate), it is **invasive** and generally reserved for cases where serology is equivocal or the presentation is atypical. - **Serology** provides a systemic assessment and is the standard initial confirmatory test for syphilis.
Question 3: A patient presents with painful ulcer in the mouth and a past history of recurrent vesicular lesions in the genitalia. Bedside test findings are shown. What is the most appropriate drug for management?
- A. Ceftriaxone
- B. Azithromycin
- C. Penicillin
- D. Acyclovir (Correct Answer)
Explanation: ***Correct: Acyclovir*** - The clinical history of recurrent painful oral and genital vesicular lesions, combined with the **Tzanck smear** finding of **multinucleated giant cells** (as shown in the image), is classic for **Herpes Simplex Virus (HSV)** infection. - **Acyclovir** is a guanosine analog antiviral drug that inhibits viral DNA polymerase, making it the first-line treatment for HSV and Varicella-Zoster Virus (VZV) infections. *Incorrect: Penicillin* - **Penicillin** is an antibiotic used to treat bacterial infections, most notably **syphilis**, which is caused by the spirochete *Treponema pallidum*. - Syphilis typically presents with a single, **painless chancre**, not recurrent painful vesicles, and penicillin has no efficacy against viral pathogens like HSV. *Incorrect: Ceftriaxone* - **Ceftriaxone** is a third-generation cephalosporin antibiotic, primarily used for bacterial infections such as **gonorrhea** and meningitis. - It is ineffective for treating viral infections, and the clinical presentation does not align with the purulent discharge characteristic of gonorrhea. *Incorrect: Azithromycin* - **Azithromycin** is a macrolide antibiotic effective against bacteria that can cause genital ulcers, such as **Haemophilus ducreyi** (causing **Chancroid**) and *Chlamydia trachomatis*. - While Chancroid causes painful ulcers, it does not typically present with a vesicular stage or the recurrent pattern seen in this case, nor would it show multinucleated giant cells on a smear.
Question 4: A patient with asymptomatic annular skin lesion as shown presents to OPD. Which investigation should be done?
- A. Biopsy
- B. Chest X-ray
- C. HIV testing
- D. KOH mount (Correct Answer)
Explanation: ***KOH mount*** - The image displays a classic **annular (ring-shaped) lesion** with a raised, erythematous, and scaly border with central clearing, which is pathognomonic for **Tinea corporis** (ringworm). - A **KOH mount** is the gold standard, rapid, and cost-effective diagnostic test for dermatophytosis, allowing visualization of **septate hyphae** from skin scrapings. ***HIV testing*** - While widespread or severe fungal infections can be associated with **immunocompromised states** like HIV, it is not the initial diagnostic step for a localized lesion. - This test would be considered only if the infection is unusually persistent, recurrent, or if there are other systemic signs suggesting immunosuppression. ***Biopsy*** - A **skin biopsy** is an invasive procedure and is not the first-line investigation for a typical presentation of tinea corporis. - It is reserved for atypical cases or when the diagnosis is uncertain after non-invasive tests, to rule out other annular dermatoses like **granuloma annulare** or **psoriasis**. ***Chest X-ray*** - A **Chest X-ray** is indicated for evaluating cardiopulmonary conditions and has no diagnostic value for a cutaneous fungal infection. - This investigation is entirely unrelated to the patient's presenting skin lesion.
Question 5: In an infant with scabies, what is the preferred treatment?
- A. 1, 3, 4 (Permethrin, Benzyl benzoate, Crotamiton) (Correct Answer)
- B. 1, 2, 4 (Permethrin, Ivermectin, Crotamiton)
- C. 1, 2, 3 (Permethrin, Ivermectin, Benzyl benzoate)
- D. 2, 4 (Ivermectin, Crotamiton)
Explanation: ***Correct: 1, 3, 4 (Permethrin, Benzyl benzoate, Crotamiton)*** - **Permethrin 5% cream** is the **first-line treatment** for scabies in infants and children over 2 months of age due to its high efficacy (>90%) and excellent safety profile - **Benzyl benzoate (10-25% emulsion)** is a safe and effective alternative topical agent, particularly useful in resource-limited settings or when permethrin is unavailable - **Crotamiton 10% cream** is another alternative topical treatment option, though it has lower efficacy compared to permethrin - All three agents are **safe for topical use in infants** and represent appropriate treatment choices *Incorrect: 2, 4 (Ivermectin, Crotamiton)* - This option excludes **permethrin**, the first-line and most effective treatment for infant scabies - **Ivermectin is contraindicated in infants** as it is generally reserved for children over 5 years old or weighing more than 15 kg - Relying on ivermectin and crotamiton alone is not standard practice for routine infant scabies *Incorrect: 1, 2, 3 (Permethrin, Ivermectin, Benzyl benzoate)* - While this includes the first-line agent **permethrin** and the alternative **benzyl benzoate**, it incorrectly includes **ivermectin** - **Ivermectin is not recommended for routine use in infants** due to safety concerns in children under 15 kg or under 5 years of age - Ivermectin is reserved for special circumstances such as crusted scabies, treatment failures, or institutional outbreaks in older children *Incorrect: 1, 2, 4 (Permethrin, Ivermectin, Crotamiton)* - Although this includes the first-line treatment **permethrin** and alternative **crotamiton**, it inappropriately includes **ivermectin** - **Ivermectin is not standard therapy for infant scabies** and should not be routinely used in this age group - The combination with ivermectin makes this a non-preferred choice for general infant scabies management