Dermatology
9 questionsWhat is the treatment of choice for lichen planus?
The Grattage test is used to diagnose which of the following conditions?
Most common metal in contact allergic dermatitis is?
A 25-year-old patient presents with chronic itchy, erythematous skin lesions on the flexural areas that have been recurring since childhood. The patient has a family history of asthma. Which of the following is the most important diagnostic criterion for the most likely diagnosis?
Which of the following conditions does NOT cause nail pitting?
Which of the following causes non-cicatricial alopecia?
Brown macular pigmentation in malar area in a pregnant female is due to ?
Lines of Blaschko are related to?
Characteristic of chronic eczema?
NEET-PG 2013 - Dermatology NEET-PG Practice Questions and MCQs
Question 1301: What is the treatment of choice for lichen planus?
- A. Topical corticosteroids (Correct Answer)
- B. Systemic corticosteroids
- C. Antihistamines
- D. Acitretin
Explanation: ***Topical corticosteroids*** - **Topical corticosteroids** are the first-line treatment for localized lichen planus due to their potent **anti-inflammatory** and **immunosuppressive** effects. - They effectively reduce **itching**, **inflammation**, and the characteristic **violaceous papules** of lichen planus. *Systemic corticosteroids* - **Systemic corticosteroids** are typically reserved for widespread, severe, or refractory cases of lichen planus, not as initial treatment. - Their use is limited by potential **systemic side effects**, such as **osteoporosis**, **hypertension**, and **diabetes**. *Antihistamines* - **Antihistamines** primarily target **itching** (pruritus) associated with lichen planus but do not address the underlying **inflammatory process** or resolve the skin lesions themselves. - They may be used as an adjunct for symptomatic relief, especially for nocturnal pruritus. *Acitretin* - **Acitretin** is a **retinoid** used for severe or refractory cases of lichen planus (including erosive, oral, and hypertrophic variants), but not as first-line treatment for localized cutaneous disease. - It carries significant **teratogenic risks** and other side effects, making it unsuitable as initial therapy when topical corticosteroids are effective.
Question 1302: The Grattage test is used to diagnose which of the following conditions?
- A. Tinea capitis
- B. Lichen planus
- C. Pemphigus vulgaris
- D. Psoriasis (Correct Answer)
Explanation: ***Psoriasis*** - The **Grattage test** (candle grease sign) involves **scraping the psoriatic lesion** to reveal characteristic features - First reveals **fine, silvery-white scales** resembling candle wax - Further scraping exposes **pinpoint bleeding points** (**Auspitz sign**) due to exposure of dilated capillaries in dermal papillae - This combination is **pathognomonic for psoriasis** and helps differentiate it from other scaly dermatoses *Tinea capitis* - A **fungal infection of the scalp** caused by dermatophytes - Diagnosed by **KOH mount** (showing fungal hyphae), **fungal culture**, and sometimes **Wood's lamp examination** - The Grattage test is not used for diagnosing fungal infections *Lichen planus* - Characterized by **purplish, polygonal, flat-topped, pruritic papules and plaques** - Surface shows **Wickham's striae** (fine white lines) - Diagnosis is **clinical**, supported by **skin biopsy** showing band-like lymphocytic infiltrate and sawtooth rete ridges - The Grattage test is not applicable *Pemphigus vulgaris* - A severe **autoimmune blistering disorder** with **suprabasal acantholysis** - Presents with **flaccid bullae** that rupture easily, leaving erosions - Diagnosed by **skin biopsy**, **direct immunofluorescence** (intercellular IgG and C3 deposits), and **Nikolsky's sign** (positive) - The Grattage test is not used for bullous disorders
Question 1303: Most common metal in contact allergic dermatitis is?
- A. Gold
- B. Silver
- C. Aluminum
- D. Nickel (Correct Answer)
Explanation: ***Nickel*** - **Nickel** is the most frequent cause of **metal-induced contact allergic dermatitis**, affecting a significant portion of the population. - It is commonly found in jewelry, belt buckles, buttons, and other everyday metallic objects. *Gold* - **Gold allergy** can occur but is much less common than nickel allergy. - Reactions typically arise from jewelry and may involve **allergic contact dermatitis**. *Silver* - **Silver allergy** is quite rare and often due to impurities or alloys rather than pure silver itself. - Pure silver is generally considered **hypoallergenic**. *Aluminum* - **Aluminum** is generally not a common cause of **allergic contact dermatitis**. - While it can be an irritant in some products (e.g., antiperspirants), true allergic reactions are infrequent.
Question 1304: A 25-year-old patient presents with chronic itchy, erythematous skin lesions on the flexural areas that have been recurring since childhood. The patient has a family history of asthma. Which of the following is the most important diagnostic criterion for the most likely diagnosis?
- A. Personal or family history of atopy
- B. Elevated serum IgE levels
- C. Early age of onset (before 2 years)
- D. Chronic pruritic eczema with typical morphology and distribution (Correct Answer)
Explanation: ***Chronic pruritic eczema with typical morphology and distribution*** - The patient presents with **chronic**, **itchy**, **erythematous lesions** on the **flexural areas** (e.g., antecubital and popliteal fossae), characteristic of **atopic dermatitis** (eczema). - The **recurrence since childhood** and the typical distribution represent the **major diagnostic criteria** based on clinical morphology and distribution. - **Clinical presentation with typical morphology** is the **primary diagnostic criterion** according to Hanifin and Rajka criteria. *Elevated serum IgE levels* - While **elevated serum IgE** is often associated with atopic dermatitis, it is a **minor criterion** and a **laboratory finding**, not a primary diagnostic feature. - It reflects an **atopic predisposition**, but **clinical morphology and distribution** remain the most important diagnostic factors. *Personal or family history of atopy* - A **family history of asthma** (an atopic condition) is a **minor criterion** that supports the diagnosis of atopic dermatitis. - However, this is a **predisposing/supporting factor**, not as important as the characteristic clinical morphology and distribution. *Early age of onset (before 2 years)* - While atopic dermatitis often begins in **infancy or early childhood**, this is a **minor criterion** in the diagnostic framework. - The question states symptoms **recurring since childhood** but onset timing is less diagnostically important than the characteristic **clinical presentation** with typical morphology and distribution.
Question 1305: Which of the following conditions does NOT cause nail pitting?
- A. Lichen planus
- B. Fungal infection
- C. Pityriasis Rosea (Correct Answer)
- D. Psoriasis
Explanation: ***Pityriasis Rosea*** - This condition primarily affects the **skin**, causing a distinctive rash of oval, pinkish-red patches, often preceded by a **herald patch**. - It characteristically spares the **nails**, meaning nail pitting is not a feature of pityriasis rosea. - Nail changes are not associated with this self-limiting dermatosis. *Lichen planus* - **Nail lichen planus** can cause various nail changes, including **pitting**, longitudinal ridging, pterygium formation, and thinning of the nail plate. - It is an inflammatory condition affecting the skin, hair, nails, and mucous membranes. - Nail involvement occurs in approximately 10% of patients with cutaneous lichen planus. *Psoriasis* - **Nail psoriasis** is common, affecting up to 50% of patients with psoriasis, and **pitting is the most characteristic nail finding**. - Pitting appears as small punctate depressions on the nail surface due to defects in the proximal nail matrix. - Other nail changes include onycholysis (oil drop sign), subungual hyperkeratosis, and salmon patches. *Fungal infection* - **Onychomycosis** (fungal nail infection) typically causes **thickening, discoloration, onycholysis, and crumbling** of the nail. - **True nail pitting is NOT a characteristic feature** of fungal infections, as pitting results from defects in the proximal nail matrix, not fungal invasion. - Fungal infections affect the nail plate and bed differently, causing destruction rather than the punctate depressions seen in pitting.
Question 1306: Which of the following causes non-cicatricial alopecia?
- A. Tinea capitis
- B. SLE
- C. Alopecia areata
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Tinea capitis**, **SLE** (Systemic Lupus Erythematosus), and **Alopecia areata** all can cause **non-cicatricial alopecia**. - **Non-cicatricial alopecia** refers to hair loss where the hair follicle is not permanently destroyed, and hair regrowth is possible, leaving no scarring. *Tinea capitis* - This is a **fungal infection** of the scalp that causes hair shafts to break, leading to patches of hair loss. - While it can lead to inflammation, it typically does not cause permanent destruction of the hair follicle unless severe and untreated, thus being predominantly **non-cicatricial**. *SLE* - Hair loss in **SLE** can occur due to various mechanisms, including diffuse thinning, patchy alopecia, or the characteristic "**lupus hair**" (fragile hairs around the hairline). - This type of hair loss is usually **non-scarring** and reversible, although discoid lupus erythematosus often causes scarring alopecia. *Alopecia areata* - This is an **autoimmune condition** characterized by patchy, sudden hair loss on the scalp or other body parts. - The hair follicles are attacked by the immune system but are not destroyed, making the condition largely **non-cicatricial** and potentially reversible.
Question 1307: Brown macular pigmentation in malar area in a pregnant female is due to ?
- A. Chloasma (Correct Answer)
- B. Urticaric pigmentosa
- C. Acanthosis nigricans
- D. Acne rosacea
Explanation: ***Chloasma*** - **Chloasma**, also known as the **mask of pregnancy**, is characterized by **dark, irregular patches** of hyperpigmentation on the face, commonly in the malar areas. - It is caused by an increase in **estrogen and progesterone levels** during pregnancy, which stimulate melanin production. *Acanthosis nigricans* - This condition presents as **dark, velvety patches of skin**, typically in the body folds and creases, such as the neck, armpits, and groin. - It is often associated with **insulin resistance**, obesity, or underlying malignancies, not specifically pregnancy-induced facial pigmentation. *Urticaric pigmentosa* - This is a form of **mastocytosis** characterized by reddish-brown spots or patches that can **urticate (itch and swell)** when rubbed, a sign known as **Darier's sign**. - It results from an accumulation of **mast cells** in the skin and is not related to hormonal changes in pregnancy. *Acne rosacea* - **Acne rosacea** is a chronic inflammatory skin condition primarily affecting the face, causing **redness, flushing, visible blood vessels**, and sometimes bumps or pimples. - It is unrelated to hyperpigmentation and does not typically result in brown macular pigmentation.
Question 1308: Lines of Blaschko are related to?
- A. Keratinocytes (Correct Answer)
- B. Blood vessels
- C. Nerves
- D. Bones
Explanation: ***Keratinocytes*** - **Lines of Blaschko** represent the migratory pathways of embryonic cells, primarily **keratinocytes**, in the skin. - These lines are not visible under normal conditions but become apparent in various **genetic skin disorders** where abnormal cells follow these specific patterns. *Blood vessels* - While blood vessels are extensively present in the skin, they do not follow the specific **migratory patterns** described by the Lines of Blaschko. - Their arrangement is more related to **vascular networks** and anatomical supply rather than embryonic cell migration. *Nerves* - **Nerves** in the skin have specific distributions, often following dermatomal patterns, which are distinct from the **Lines of Blaschko**. - Nerve distribution is related to their segmental origin from the **spinal cord**, not the migratory paths of epidermal cells. *Bones* - **Bones** are part of the skeletal system and are not found in the skin, making them unrelated to the **Lines of Blaschko**. - These lines describe epidermal cell migration, which is a feature of the **integumentary system**.
Question 1309: Characteristic of chronic eczema?
- A. Erythema
- B. Induration
- C. Lichenification (Correct Answer)
- D. Edema
Explanation: ***Lichenification*** - **Lichenification** is a hallmark of chronic eczema, characterized by thickening of the epidermis with exaggerated skin markings due to persistent rubbing or scratching. - This response reflects the long-term inflammatory and reparative processes in chronically affected skin. *Erythema* - **Erythema**, or redness, is a common finding in both acute and chronic inflammatory skin conditions, including acute eczema, but is not specifically characteristic of chronicity. - While present, it does not distinguish chronic from acute phases as definitively as other features. *Induration* - **Induration** refers to hardening or firmness of the skin, often due to inflammation or infection, and while it can be present in chronic eczema, it's a more general sign and not as specific as lichenification. - It might also suggest other conditions like cellulitis or deep tissue involvement. *Edema* - **Edema**, or swelling, is more prominent in the acute phase of eczema due to vasodilation and increased vascular permeability leading to fluid extravasation. - While some edema can persist, it's a less defining feature of chronic eczema compared to the epidermal changes observed in lichenification.
Pathology
1 questionsWhich layer of the epidermis is primarily involved in spongiosis?
NEET-PG 2013 - Pathology NEET-PG Practice Questions and MCQs
Question 1301: Which layer of the epidermis is primarily involved in spongiosis?
- A. Stratum basale
- B. Stratum corneum
- C. Stratum granulosum
- D. Stratum spinosum (Correct Answer)
Explanation: ***Stratum spinosum*** - **Spongiosis** is characterized by **intercellular edema** (fluid accumulation between cells) within the epidermis [1], primarily affecting the **stratum spinosum** [2]. - The cells of the stratum spinosum, known as **keratinocytes**, become separated by this edema, giving the tissue a "spongy" appearance on histology due to the preservation of **desmosomal attachments**. *Stratum basale* - The **stratum basale** is the deepest layer of the epidermis, responsible for **cell proliferation** and attachment to the basement membrane. - While edema can affect all epidermal layers in severe cases, spongiosis specifically refers to the intercellular edema most prominent in the stratum spinosum [2]. *Stratum corneum* - The **stratum corneum** is the outermost layer of the epidermis, composed of dead, flattened **keratinocytes** that provide a protective barrier. - Edema in this layer is less common and would not be described as spongiosis, which implies living cells with preserved intercellular junctions. *Stratum granulosum* - The **stratum granulosum** lies above the stratum spinosum and is characterized by cells containing **keratohyalin granules**. - While it can be affected by intercellular edema, the most pronounced and characteristic spongiosis occurs in the stratum spinosum where cells are still actively synthesizing keratin and have strong desmosomal connections [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, p. 636. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, p. 1166.