NEET-PG 2017 Practice Questions

Q: Which of the following vesico-bullous disorders will exhibit the direct immunofluorescence shown below? (Recent NEET Pattern 2016-17)

Pemphigus vulgaris. ***Pemphigus vulgaris*** - The direct immunofluorescence image shows a characteristic **"chicken wire"** or **intercellular** staining pattern in the epidermis. - This pattern indicates the presence of autoantibodies (typically **IgG**) targeting **desmoglein 1 and 3** in the desmosomes, leading to intraepidermal blistering, which is a hallmark of pemphigus vulgaris. *Bullous pemphigoid* - Direct immunofluorescence in bullous pemphigoid typically shows a **linear deposition of IgG and C3 along the dermal-epidermal junction** (basement membrane zone). - This pattern is distinctly different from the intercellular epidermal staining seen in the image. *Cicatricial pemphigoid* - This condition also presents with **linear deposition of immunoreactants along the basement membrane zone**, similar to bullous pemphigoid, but with a different antigen target. - The image does not show a linear basement membrane pattern, ruling out cicatricial pemphigoid. *Chronic bullous dermatosis of childhood* - Also known as **linear IgA bullous dermatosis**, it is characterized by a **linear deposition of IgA along the basement membrane zone**. - The image clearly displays an intercellular staining pattern within the epidermis, not a linear pattern at the dermal-epidermal junction.

Q: The clinical sign shown in the image is:

Dennie-Morgan fold. ***Dennie-Morgan fold (infraorbital fold)*** - The image clearly shows a prominent **infraorbital fold** or crease below the lower eyelid. - This crease is known as **Dennie-Morgan fold** (also called Dennie-Morgan lines) and is a common finding in individuals with atopic dermatitis or chronic allergic conditions. - It represents an accentuated line or fold in the skin of the lower eyelid and is considered a minor diagnostic criterion for atopic dermatitis. *Allergic salute* - An **allergic salute** refers to the characteristic gesture where a child repeatedly pushes the tip of the nose upward with the palm of the hand to relieve nasal itching and obstruction. - This action often leads to a transverse crease across the bridge of the nose, but it is not depicted in the image. *Allergic line* - The term **allergic line** (or allergic crease) is synonymous with the transverse nasal crease resulting from the allergic salute. - While it's a sign associated with chronic allergic rhinitis, it does not describe the infraorbital fold seen in the image. *Allergic shiners* - **Allergic shiners** are dark, discolored areas under the eyes, resembling bruises, caused by venous congestion secondary to chronic allergic rhinitis or nasal obstruction. - While allergic shiners may coexist with Dennie-Morgan folds, the prominent feature indicated in the image is the infraorbital fold itself, not periorbital darkening.

Q: The following lesion appears on the leg of a patient of ulcerative colitis. All are useful in management except:

Sulfapyridine. ***Sulfapyridine*** - The image shows **pyoderma gangrenosum**, a painful ulcerative skin condition often associated with inflammatory bowel disease like ulcerative colitis. Among the given options, **sulfapyridine** has the **least established role** in pyoderma gangrenosum management. - **Sulfapyridine** is an inactive component of **sulfasalazine** and primarily acts as an **antibacterial agent**. While sulfasalazine has been reported in some PG cases, sulfapyridine alone is not a recognized treatment for the inflammatory, non-infectious nature of pyoderma gangrenosum. - Unlike the other options which have well-established roles, sulfapyridine lacks strong evidence for efficacy in PG. *Steroids* - **Corticosteroids** (oral or topical) are the **first-line treatment** for pyoderma gangrenosum due to their potent anti-inflammatory and immunosuppressive effects. - They help to reduce the inflammation and promote healing of the painful ulcers. *Procto-colectomy* - In cases of severe, refractory pyoderma gangrenosum associated with ulcerative colitis, **colectomy** can be a **definitive treatment** as it removes the underlying inflammatory trigger. - This surgical intervention is considered when medical therapies are unsuccessful or when the colonic disease itself necessitates surgery. *Infliximab* - **Infliximab**, a **TNF-alpha inhibitor**, is a biologic agent effective in treating both ulcerative colitis and pyoderma gangrenosum. - It is used in cases that are refractory to steroids or when patients cannot tolerate steroid therapy.

Q: All are true about this lesion seen in a child with epilepsy except:

Minor criteria for diagnosis. ***Minor criteria for diagnosis*** - The presented lesion is a **Shagreen patch**, which is considered a **major diagnostic criterion** for **Tuberous Sclerosis Complex (TSC)**, not a minor one. - A definitive diagnosis of TSC requires two major criteria or one major and two minor criteria. *Collagenoma* - A Shagreen patch is a type of dermal **collagenoma**, characterized by an overgrowth of connective tissue, primarily collagen. - These lesions often feel like **roughened or leathery plaques** on the skin. *Peau d'orange appearance* - The Shagreen patch is often described as having a **'peau d'orange'** or orange peel-like texture due to its irregular surface. - This characteristic texture helps in its clinical identification. *Predominantly seen over trunk* - Shagreen patches are typically located on the **trunk**, especially in the lumbosacral region, as seen in the image. - They are one of the distinctive cutaneous manifestations of TSC.

Q: An 8-year-old boy who was diagnosed with hypertrophic cardiomyopathy has reddish papules all over the body developing after birth. He also complains of severe pain in hands and feet. Which of the following is correct?

Angiokeratoma, Fabry's disease. ***Angiokeratoma, Fabry's disease*** - The constellation of **hypertrophic cardiomyopathy**, **reddish papules (angiokeratomas)**, and **severe pain in hands and feet (acroparesthesias)** are classic symptoms of **Fabry's disease**. - Fabry's disease is an **X-linked lysosomal storage disorder** caused by a deficiency of **alpha-galactosidase A**, leading to the accumulation of globotriaosylceramide (Gb3). *Actinic keratosis, Xeroderma pigmentosa* - **Actinic keratosis** are precancerous skin lesions caused by sun exposure, typically appearing in older adults, not as widespread papules from birth in a child. - **Xeroderma pigmentosum** is characterized by extreme sensitivity to UV light, leading to a high incidence of skin cancers, freckle-like pigmentation, and ocular abnormalities, but not typically hypertrophic cardiomyopathy or these specific papules. *Pseudoxanthomas, pseudoxanthoma elasticum* - **Pseudoxanthoma elasticum** causes small, yellowish papules, mainly on flexible skin areas, along with angioid streaks in the retina and cardiovascular issues due to calcification of elastic fibers. - While it can involve the heart, it doesn't typically present with the widespread reddish papules (angiokeratomas) or the severe acroparesthesias described. *Angiofibroma, tuberous sclerosis* - **Angiofibromas** are facial papules associated with **tuberous sclerosis**, which is also characterized by brain tubers, renal angiomyolipomas, and hypomelanotic macules. - While tuberous sclerosis can cause cardiac rhabdomyomas (tumors), it is not typically associated with widespread angiokeratomas or acroparesthesias as seen in this case.

Q: All are true about the condition shown in the figure except: (Recent NEET Pattern 2016-17)

Interconnecting sinus tracts. ***Interconnecting sinus tracts*** - This is a characteristic feature of **Acne Conglobata**, NOT rhinophyma. Acne conglobata is a severe form of nodulocystic acne characterized by multiple interconnected comedones, abscesses, cysts, and draining sinus tracts, typically affecting the trunk, face, and neck. - **Rhinophyma** is a severe manifestation of rosacea involving progressive hypertrophy of sebaceous glands and connective tissue of the nose, producing a bulbous, enlarged appearance. It does **not** feature interconnecting sinus tracts. - This is the FALSE statement about rhinophyma, making it the correct answer for this "except" question. *Patulous pilo-sebaceous orifices* - This is a **hallmark feature of rhinophyma**. The sebaceous gland hyperplasia leads to markedly **dilated follicular openings** (patulous orifices) on the nasal surface. - These prominent, enlarged pores are a key diagnostic sign and contribute to the characteristic cobblestone appearance of the affected nose. *Foul smelling cheesy material* - The hypertrophied sebaceous glands in **rhinophyma** produce excessive sebum which accumulates in the dilated follicular openings. - This material consists of **keratin plugs, sebum, and bacterial debris**, often presenting as a foul-smelling, cheesy substance that can be expressed from the enlarged pores. *Can lead to difficulty in breathing* - **TRUE for severe rhinophyma**. Progressive nasal tissue hypertrophy can cause **external nasal valve obstruction** and narrowing of the nasal airways, leading to breathing difficulties. - Severe cases may require **surgical intervention** (e.g., laser therapy, surgical excision) not only for cosmetic reasons but also to relieve nasal obstruction and improve airflow. - This is a recognized complication documented in dermatology and otolaryngology literature.

Q: The following lesion is seen in all of the following conditions except: (Recent NEET Pattern 2016-17)

Porphyria. ***Correct: Porphyria*** - **Porphyria** causes **photosensitive skin lesions** but does NOT cause pellagra or the **Casal's necklace** pattern shown in the image. - Porphyria results from defects in **heme synthesis**, leading to vesicles, bullae, and hyperpigmentation, particularly on sun-exposed areas. - The image depicts **Pellagra**, characterized by **photosensitive dermatosis** in a **Casal's necklace** distribution, caused by **niacin (vitamin B3) deficiency**. *Incorrect: Carcinoid syndrome* - **Carcinoid syndrome** can cause **pellagra** due to **tryptophan diversion** for excessive serotonin synthesis. - This leads to **niacin deficiency** and can present with the characteristic skin lesions shown in the image. - Classic features include flushing, diarrhea, and cardiac involvement. *Incorrect: Hartnup disease* - **Hartnup disease** is an **autosomal recessive disorder** with impaired absorption of neutral amino acids, including **tryptophan**. - Reduced tryptophan absorption leads to **secondary niacin deficiency**, causing pellagra-like symptoms. - Patients present with photosensitive dermatitis, cerebellar ataxia, and psychiatric manifestations. *Incorrect: Alcoholism* - **Chronic alcoholism** is a common cause of **pellagra** due to poor dietary intake, malabsorption, and impaired nutrient metabolism. - Alcoholics are at high risk for **niacin deficiency**, presenting with the **3 Ds**: dermatitis, diarrhea, and dementia. - The photosensitive rash in a Casal's necklace distribution is characteristic.

Q: All are correct about the condition shown in the image except: (Recent NEET Pattern 2016-17)

Necrotising Fasciitis. ***Necrotising Fasciitis*** - The image shows widespread superficial blistering and peeling of the skin, resembling a burn, which is characteristic of **Staphylococcal Scalded Skin Syndrome (SSSS)**, not necrotizing fasciitis. - **Necrotizing fasciitis** is a deeper, rapidly spreading infection of the subcutaneous tissue and fascia, characterized by severe pain, dusky skin, bullae, and crepitus, which is not depicted here. *Epidermolysin mediated* - **Staphylococcal Scalded Skin Syndrome (SSSS)** is indeed caused by **exotoxins (epidermolysins A and B)** produced by *Staphylococcus aureus* strains, which target desmoglein 1, leading to widespread epidermal detachment. - These epidermolysins act as **superantigens**, causing a systemic toxic effect without direct bacterial invasion of the skin at affected sites. *Staphyloccocal scalded skin syndrome* - The image is pathognomonic for **Staphylococcal Scalded Skin Syndrome (SSSS)**, characterized by generalized erythema, flaccid blisters, and epidermal exfoliation, particularly in infants and young children. - The peeling skin suggests a **positive Nikolsky sign**, where slight rubbing of the skin causes the epidermis to separate from the dermis, a hallmark of SSSS. *Caused by gram positive cocci in clusters* - **Staphylococcal Scalded Skin Syndrome (SSSS)** is caused by specific strains of **Gram-positive cocci in clusters**, namely *Staphylococcus aureus*, which produce exfoliative toxins. - These bacteria are commonly found on the skin and mucous membranes and are responsible for a variety of skin and soft tissue infections.

Q: A 25-year-old construction worker presents with following skin lesions. All are true about the image shown except: (Recent NEET Pattern 2016-17)

Oral terbinafine is drug of choice. ***Correct Answer: Oral terbinafine is drug of choice*** - **Oral terbinafine is NOT the drug of choice** for tinea versicolor, making this the correct answer to the "EXCEPT" question - **Malassezia species lack the enzyme** (squalene epoxidase) necessary to convert terbinafine into its active form - Terbinafine is primarily used for **dermatophyte infections** (tinea corporis, cruris, pedis), not Malassezia infections - **Drug of choice for tinea versicolor**: Topical azoles (ketoconazole shampoo, selenium sulfide) or oral azoles (fluconazole, itraconazole) for extensive disease *Incorrect: Wood's lamp will produce yellow fluorescence* - This statement is TRUE, so it is not the exception - Wood's lamp examination reveals characteristic **yellow-gold to coppery-orange fluorescence** in tinea versicolor - The fluorescence is due to production of **porphyrins (malassezin)** by the *Malassezia* organism *Incorrect: KOH mount shows spaghetti and meat ball appearance* - This statement is TRUE, so it is not the exception - **KOH mount** of skin scrapings shows short, stubby **hyphae** (spaghetti) and round **spores** (meatballs) - This is the **pathognomonic microscopic finding** for *Malassezia furfur* *Incorrect: Caused by Malassezia furfur* - This statement is TRUE, so it is not the exception - The image shows **hypopigmented and hyperpigmented patches** on the trunk, characteristic of tinea versicolor - Caused by dimorphic yeast ***Malassezia furfur*** (also *M. globosa*, *Pityrosporum ovale*) - Normal skin commensal that becomes pathogenic in hot, humid conditions

Q: A 2-year-old mentally retarded child with the marked skin lesion presents with left side flank pain. CT scan of abdomen shows -50 to -60 HU densities of the lesions in kidney and liver. The most probable diagnosis is?

Tuberous sclerosis. ***Tuberous sclerosis*** - The combination of **mental retardation**, **skin lesions** (ash-leaf spots are shown in the image), and **renal/hepatic lesions** with characteristic negative HU densities (-50 to -60 HU, consistent with fat in angiomyolipomas) is highly suggestive of Tuberous Sclerosis Complex. - Tuberous sclerosis involves benign tumors (hamartomas) in multiple organs, including the **brain**, **skin**, **kidneys** (angiomyolipomas), and **liver** (hepatic angiomyolipomas), which explains the diverse clinical presentation. *Familial Angiolipomatosis* - While it involves **angiomyolipomas**, it typically does not present with the widespread neurological abnormalities like **mental retardation** or characteristic skin lesions seen in Tuberous Sclerosis. - This condition is often limited to the presence of multiple bilateral renal angiomyolipomas. *ADPKD* - **Autosomal dominant polycystic kidney disease (ADPKD)** primarily involves numerous **renal cysts** with positive or near-zero Hounsfield units (HU), and sometimes hepatic cysts, but does not present with **mental retardation** or **fat-containing lesions** (negative HU) in the kidneys or liver. - The cystic lesions in ADPKD typically have HU values similar to water (0-20 HU). *V.H.L* - **Von Hippel-Lindau disease (VHL)** is characterized by **hemangioblastomas** of the CNS and retina, **renal cell carcinoma**, **pheochromocytomas**, and **pancreatic cysts/tumors**. - VHL does not typically cause the **skin lesions** (ash-leaf spots) or **mental retardation** as described, nor are the kidney lesions characterized by negative HU on CT.

Question 1

Which of the following vesico-bullous disorders will exhibit the direct immunofluorescence shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Pemphigus vulgaris

Answer

Bullous pemphigoid

Answer

Cicatricial pemphigoid

Answer

Chronic bullous dermatosis of childhood

Question 2

The clinical sign shown in the image is:

Accepted Answer

Dennie-Morgan fold

Answer

Allergic salute

Answer

Allergic line

Answer

Allergic shiners

Question 3

The following lesion appears on the leg of a patient of ulcerative colitis. All are useful in management except:

Accepted Answer

Sulfapyridine

Answer

Steroids

Answer

Procto-colectomy

Answer

Infliximab

Question 4

All are true about this lesion seen in a child with epilepsy except:

Accepted Answer

Minor criteria for diagnosis

Answer

Collagenoma

Answer

Peau d'orange appearance

Answer

Predominantly seen over trunk

Question 5

An 8-year-old boy who was diagnosed with hypertrophic cardiomyopathy has reddish papules all over the body developing after birth. He also complains of severe pain in hands and feet. Which of the following is correct?

Accepted Answer

Angiokeratoma, Fabry's disease

Answer

Actinic keratosis, Xeroderma pigmentosa

Answer

Pseudoxanthomas, pseudoxanthoma elasticum

Answer

Angiofibroma, tuberous sclerosis

Question 6

All are true about the condition shown in the figure except: (Recent NEET Pattern 2016-17)

Accepted Answer

Interconnecting sinus tracts

Answer

Patulous pilo-sebaceous orifices

Answer

Foul smelling cheesy material

Answer

Can lead to difficulty in breathing

Question 7

The following lesion is seen in all of the following conditions except: (Recent NEET Pattern 2016-17)

Accepted Answer

Porphyria

Answer

Carcinoid syndrome

Answer

Hartnup disease

Answer

Alcoholism

Question 8

All are correct about the condition shown in the image except: (Recent NEET Pattern 2016-17)

Accepted Answer

Necrotising Fasciitis

Answer

Epidermolysin mediated

Answer

Staphylococcal scalded skin syndrome

Answer

Caused by gram positive cocci in clusters

Question 9

A 25-year-old construction worker presents with following skin lesions. All are true about the image shown except: (Recent NEET Pattern 2016-17)

Accepted Answer

Oral terbinafine is drug of choice

Answer

Wood's lamp will produce yellow fluorescence

Answer

KOH mount shows spaghetti and meat ball appearance

Answer

Caused by Malassezia furfur

Question 10

A 2-year-old mentally retarded child with the marked skin lesion presents with left side flank pain. CT scan of abdomen shows -50 to -60 HU densities of the lesions in kidney and liver. The most probable diagnosis is?

Accepted Answer

Tuberous sclerosis

Answer

Familial Angiolipomatosis

Answer

ADPKD

Answer

V.H.L

NEET-PG 2017

Dermatology

General Medicine