INI-CET 2026 - Dermatology PYQs Practice Questions

Q: A patient presents with focal hair loss accompanied by pruritus and scalp scaling. Which of the following treatments is most suitable?

Oral antifungals. ***Oral antifungals*** - The clinical presentation of focal hair loss, pruritus, and scaling is highly characteristic of **tinea capitis**, a dermatophyte infection of the scalp. - **Griseofulvin** or **terbinafine** are the gold-standard systemic treatments required to penetrate the hair shaft and successfully eradicate the fungal infection. *Methotrexate* - This is an **immunosuppressive agent** typically reserved for severe inflammatory conditions like psoriasis or rheumatoid arthritis. - It has no role in treating common fungal scalp infections and could potentially worsen the condition by causing immunosuppression. *Topical corticosteroids* - While these may alleviate itching and inflammation, they do not treat the underlying fungal pathogen in **tinea capitis**. - Using steroids alone can lead to **tinea incognito**, where the infection continues to spread and proliferate while the classic appearance is masked by the steroid effect. *Oral antibiotics* - Antibiotics are indicated for **bacterial infections**, such as impetigo or secondary folliculitis, not fungal etiologies. - They are ineffective against dermatophytes and contribute to unnecessary antibiotic resistance. [Practice more Dermatology PYQs on OnCourse]

Q: A patient is found to have a dark black lesion on the plantar surface of the foot. What is the most appropriate initial investigation?

Skin biopsy. ***Skin biopsy*** - A suspicious **pigmented lesion**, specifically one that is darkly pigmented on the acral surface (plantar surface of the foot), raises immediate concern for **acral lentiginous melanoma**. - An **excision biopsy** with an appropriate margin is the definitive diagnostic procedure to obtain a **histopathological diagnosis** and determine the **Breslow thickness**. *KOH mount* - This is utilized to identify **fungal infections** (dermatophytes) through the visualization of **hyphae** or yeast. - It is unsuitable for this case because a dark black lesion is suggestive of a **melanocytic neoplasm** rather than a fungal infection. *Gram stain* - This diagnostic tool is used for the rapid identification of **bacterial pathogens** in samples like pus, sputum, or blood. - It has no utility in the diagnosis of skin malignancies, as it provides no information regarding **cellular atypia** or **melanocytic lineage**. *Tzanck smear* - This test is employed to diagnose **herpesvirus infections** (like HSV or VZV) by looking for **multinucleated giant cells**. - It is not indicated for screening or diagnosing **dermal malignancies** such as melanoma. [Practice more Dermatology PYQs on OnCourse]

Q: During tattooing, in which layer of the skin is the pigment/ink primarily deposited?

Dermis. ***Dermis*** - The **dermis** is the stable layer of the skin that lies beneath the epidermis, containing an extracellular matrix of **collagen and elastin** that anchors the ink particles. - Because the dermis does not undergo the continuous **desquamation** (shedding) process like the epidermis, tattoo ink remains permanently trapped within **dermal fibroblasts** and **macrophages**. *Epidermis* - The epidermis, specifically the **stratum corneum**, constantly sheds cells; ink placed here would be lost within a few weeks as the skin regenerates. - Tattoo needles are specifically designed to penetrate through the epidermis to reach the underlying **dermal layer**. *Subcutaneous tissue* - While some ink may inadvertently reach the **subcutaneous tissue (hypodermis)**, deposition here results in a [Practice more Dermatology PYQs on OnCourse]

Q: Match each clinical sign in Column A with its corresponding dermatological condition in Column B: Column A (Clinical Sign) Column B (Condition) Positive Nikolsky sign Pemphigus vulgaris Pseudo-Nikolsky sign Stevens-Johnson syndrome False Nikolsky sign Bullous pemphigoid Cerebriform tongue Pemphigus vegetans Which of the following is the correct match?

A-1, B-3, C-2, D-4. ***A-1, B-3, C-2, D-4*** - A **Positive Nikolsky sign** involves the separation of the epidermis from the dermis with lateral pressure, which is classically seen in **Pemphigus vulgaris** due to autoantibodies against **desmogleins**. - The other matches are: Pseudo-Nikolsky sign (also known as Asboe-Hansen sign) for **Stevens-Johnson syndrome** (or toxic epidermal necrolysis), False Nikolsky sign for **Bullous pemphigoid** (subepidermal split leads to less fragility), and **Cerebriform tongue** for **Pemphigus vegetans**. *A-2, B-1, C-3, D-4* - The **Nikolsky sign** would be incorrectly matched with **Stevens-Johnson syndrome** as the primary index condition. - This sequence fails to correctly identify the **Pseudo-Nikolsky sign** and the specific clinical correlation for **Bullous pemphigoid**. *A-1, B-2, C-3, D-4* - While A-1 is correct, this match incorrectly pairs **Pseudo-Nikolsky sign** with **Pemphigus vulgaris**. - It also misidentifies the clinical association for **Bullous pemphigoid** regarding the Nikolsky sign status. *A-4, B-2, C-1, D-3* - This option incorrectly lists the **cerebriform tongue** as a sign of **Pemphigus vulgaris** rather than **Pemphigus vegetans**. - It completely swaps the associations for the **Nikolsky sign** variants, leading to incorrect dermatological diagnoses. [Practice more Dermatology PYQs on OnCourse]

Q: An infant presents with pruritic lesions distributed over the hands, feet, and periumbilical region. Which of the following diagnoses best fits this clinical picture?

Scabies. ***Scabies*** - The distribution pattern involving the **hands, feet, and periumbilical region** is a hallmark sign of **scabies** infestation in infants, where the mite (*Sarcoptes scabiei*) prefers skin with a thin stratum corneum. - Intense **pruritus** that is often worse at night is the classic symptom resulting from a **delayed type IV hypersensitivity reaction** to the mites, their feces, and eggs. *Atopic dermatitis* - Classically presents as **erythematous, scaly patches** on the **extensor surfaces** of infants (often affecting cheeks or scalp), rather than the specific web space or periumbilical distribution seen in scabies. - While it is highly pruritic, it is typically a chronic, relapsing condition associated with a **personal or family history of atopy** (e.g., asthma, allergic rhinitis). *Bullous impetigo* - Presents as **flaccid, fluid-filled bullae** that rupture to leave a thin, varnish-like crust, typically caused by **Staphylococcus aureus**. - It is generally not associated with the intense, generalized pruritus seen in infestation diseases and usually lacks the specific distribution pattern described. *Eczema* - This is an umbrella term often used interchangeably with atopic dermatitis, characterized by **inflammation, scaling, and dryness**. - It does not involve **burrows or papules** in the webs of fingers or wrists, which are characteristic physical exam findings of scabies infestation. [Practice more Dermatology PYQs on OnCourse]

Question 1

A patient presents with focal hair loss accompanied by pruritus and scalp scaling. Which of the
following treatments is most suitable?

Accepted Answer

Oral antifungals

Answer

Methotrexate

Answer

Topical corticosteroids

Answer

Oral antibiotics

Question 2

A patient is found to have a dark black lesion on the plantar surface of the foot. What is the most
appropriate initial investigation?

Accepted Answer

Skin biopsy

Answer

KOH mount

Answer

Gram stain

Answer

Tzanck smear

Question 3

During tattooing, in which layer of the skin is the pigment/ink primarily deposited?

Accepted Answer

Dermis

Answer

Epidermis

Answer

Subcutaneous tissue

Answer

Muscle and vascular tissue

Question 4

Match each clinical sign in Column A with its corresponding dermatological condition in Column
B:

Column A (Clinical Sign) Column B (Condition)

Positive Nikolsky sign Pemphigus vulgaris

Pseudo-Nikolsky sign Stevens-Johnson syndrome

False Nikolsky sign Bullous pemphigoid

Cerebriform tongue Pemphigus vegetans

Which of the following is the correct match?

Accepted Answer

A-1, B-3, C-2, D-4

Answer

A-2, B-1, C-3, D-4

Answer

A-1, B-2, C-3, D-4

Answer

A-4, B-2, C-1, D-3

Question 5

An infant presents with pruritic lesions distributed over the hands, feet, and periumbilical region.
Which of the following diagnoses best fits this clinical picture?

Accepted Answer

Scabies

Answer

Atopic dermatitis

Answer

Bullous impetigo

Answer

Eczema

Question 6

A female presents with greenish frothy discharge; whiff test and Amsel’s criteria are negative.
What microscopy feature is expected?

Accepted Answer

Motile flagellates

Answer

Pseudohyphae

Answer

Clue cells

Answer

Gram-negative diplococci

Question 7

A male patient reports painful vesicular eruptions on the penis. Based on this presentation,
which of the following is the most likely causative agent?

Accepted Answer

Herpes simplex virus

Answer

Haemophilus ducreyi

Answer

Human papillomavirus

Answer

Treponema pallidum

Question 8

A newborn presents with a skin lesion as shown. The infant
is feeding normally, has no fever, hypotension, or shock signs.
Which diagnosis is most likely?

Accepted Answer

Neonatal pemphigus due to transplacental antibody transfer

Answer

Staphylococcal scalded skin syndrome

Answer

Bullous pemphigoid

Answer

Epidermolysis bullosa

INI-CET 2026 — Dermatology