Autoimmune Thyroid Disease and the Skin — MCQs
Which of the following statements about factitious thyrotoxicosis is true?
A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:
Which condition is most commonly associated with non-pitting edema?
Which one of the following statements about Graves' disease is FALSE?
Acute febrile neutrophilic dermatosis is seen in-
A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?
Most common indication of liver transplantation in children is:
A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin like hands, arms, chest, etc. she also complaints of arthralgia and breathlessness. Which among the following antibodies will be useful in diagnosing this condition?
Lady presents with joint pain in both knees and low-grade fever, which occurs intermittently. On examination, she has a rash on sun-exposed areas. What is the clinical diagnosis?
Which drug is least likely to cause exanthematous skin eruptions?
Autoimmune Thyroid Disease and the Skin Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements about factitious thyrotoxicosis is true?
- A. TSH levels are typically elevated.
- B. It can be seen in healthcare professionals.
- C. It presents with features typical of thyrotoxicosis.
- D. Radionuclide uptake is low. (Correct Answer)
Explanation: ***Radionuclide uptake is low.*** - In **factitious thyrotoxicosis**, the exogenous thyroid hormone suppresses the thyroid gland, leading to very low or absent **radionuclide uptake** on a scan [1]. - This differentiates it from other causes of thyrotoxicosis, like **Graves' disease** or **toxic multinodular goiter**, which show high uptake [1]. *It can be seen in healthcare professionals.* - While factitious thyrotoxicosis can occur in anyone, it is not uniquely or predominantly seen in **healthcare professionals**. - The behavior is linked to **deception** regarding illness or medication use, not profession. *TSH levels are typically elevated.* - In factitious thyrotoxicosis, the **exogenous thyroid hormone** suppresses endogenous thyroid stimulating hormone (TSH) production [1]. - Therefore, **TSH levels are typically suppressed or undetectable**, indicating the thyroid gland is not being stimulated to produce excess hormones. *It presents with features typical of thyrotoxicosis.* - While patients with factitious thyrotoxicosis may have symptoms of **thyrotoxicosis** due to excess thyroid hormone, the term refers to the *cause* being external (self-administered hormone) [1]. - The disease refers to the *self-administration* of thyroid hormones, which then leads to the symptoms [1].
Question 2: A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:
- A. Tinea capitis
- B. Cradle cap
- C. Alopecia areata (Correct Answer)
- D. Telogen effluvium
Explanation: ***Alopecia areata*** - This condition is characterized by **localized, well-demarcated patches of complete hair loss** on the scalp. - The underlying skin typically appears **normal, smooth, and healthy**, without inflammation or scaling. *Tinea capitis* - This fungal infection usually presents with **scaly patches**, inflammation, pustules, or "black dots" where hairs have broken off. - The scalp appearance is typically **abnormal** due to scaling and inflammation, unlike the normal scalp seen here. *Cradle cap* - Also known as **seborrheic dermatitis in infants**, it presents as greasy, yellowish, scaly patches on the scalp. - It does not cause **complete hair loss** in localized patches, but rather diffuse scaling and sometimes mild thinning. *Telogen effluvium* - This condition involves **diffuse hair shedding** (increased number of hairs falling out), often triggered by stress, illness, or medications. - It does not present as **localized patches of complete hair loss**, and the hair thinning is generally widespread.
Question 3: Which condition is most commonly associated with non-pitting edema?
- A. Congestive heart failure (CHF)
- B. Myxedema (Hypothyroidism) (Correct Answer)
- C. Liver cirrhosis
- D. Nephrotic syndrome
Explanation: ***Myxedema (Hypothyroidism)*** - Non-pitting edema in myxedema is caused by the accumulation of **hyaluronic acid** and other glycosaminoglycans in the interstitial tissue [2]. - This accumulation creates a **gel-like matrix** that does not pit when pressed, distinguishing it from other forms of edema. *Congestive heart failure (CHF)* - CHF typically causes **pitting edema** due to increased hydrostatic pressure, leading to fluid extravasation into the interstitial space. - The excess fluid is primarily water and electrolytes, allowing for displacement upon pressure. *Liver cirrhosis* - Liver cirrhosis leads to **pitting edema**, often in the lower extremities and abdomen (**ascites**), due to decreased albumin synthesis and portal hypertension. - The reduced oncotic pressure and increased hydrostatic pressure result in fluid leakage that is easily compressible [1]. *Nephrotic syndrome* - Nephrotic syndrome is characterized by **pitting edema**, which is widespread (**anasarca**) and primarily caused by severe **hypoalbuminemia** [1]. - The significant loss of protein in the urine reduces plasma oncotic pressure, leading to fluid accumulation that readily pits with pressure.
Question 4: Which one of the following statements about Graves' disease is FALSE?
- A. Common in male (Correct Answer)
- B. Referred to as toxic diffuse goiter
- C. Results in hyperthyroidism
- D. Autoimmune disorder
Explanation: ***Common in male*** - Graves' disease is significantly **more common in females** than males, with a female-to-male ratio of approximately 7:1 [1]. It is a female predominant disease [2]. - The peak incidence is between the ages of 20 and 50 years, and it is the most common cause of **hyperthyroidism** in women [1], [2]. *Results in hyperthyroidism* - Graves' disease is characterized by the production of **autoantibodies** against the TSH receptor, leading to excessive stimulation of the thyroid gland [1]. - This overstimulation results in **increased synthesis and release of thyroid hormones**, causing a state of hyperthyroidism [2]. *Autoimmune disorder* - Graves' disease is a classic example of an **organ-specific autoimmune disease** [2]. - The immune system mistakenly produces antibodies that mimic the action of TSH, leading to thyroid overactivity [1]. *Referred to as toxic diffuse goiter* - The term "toxic" refers to the **hyperthyroid state** (thyrotoxicosis), and "diffuse goiter" describes the generally uniform enlargement of the entire thyroid gland [1]. - This terminology accurately reflects the typical presentation of Graves' disease, which involves an overactive, diffusely enlarged thyroid gland [2].
Question 5: Acute febrile neutrophilic dermatosis is seen in-
- A. Behcet's syndrome
- B. Sweet syndrome (Correct Answer)
- C. Haberman syndrome
- D. Kasabach-Merritt syndrome
Explanation: ***Sweet syndrome*** - Sweet syndrome is also known as **Acute febrile neutrophilic dermatosis**. - It presents with **fever**, painful erythematous plaques, and a prominent **neutrophilic infiltrate** in the dermis. *Behcet's syndrome* - Behcet's syndrome is characterized by **recurrent oral and genital ulcers**, uveitis, and skin lesions like **erythema nodosum** or **pathergy**. - It is a systemic vasculitis, not typically presenting as acute febrile neutrophilic dermatosis. *Haberman syndrome* - Haberman syndrome is better known as **Pityriasis lichenoides et varioliformis acuta (PLEVA)**. - It is a rare skin condition characterized by an acute eruption of **papules** and **erosions** that can resemble **chickenpox**. *Kasabach-Merritt syndrome* - This syndrome is a rare disorder involving **vascular tumors** (e.g., hemangiomas) that lead to profound **thrombocytopenia** and **consumptive coagulopathy**. - It does not present with acute febrile neutrophilic dermatosis.
Question 6: A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?
- A. Butterfly rash sparing the nasolabial folds (Correct Answer)
- B. Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy
- C. Port-wine stain with CNS malformations
- D. Silvery scales or plaques
Explanation: ***Butterfly rash sparing the nasolabial folds*** - The patient's presentation with oral ulcers, sensitivity to light (photosensitivity), and a rash over the malar area **sparing the nasolabial folds** is highly characteristic of **Systemic Lupus Erythematosus (SLE)**, a condition where a butterfly rash is a hallmark. - This specific distribution of the malar rash is a key diagnostic feature differentiating it from other facial rashes. *Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy* - A **heliotrope rash** on the upper eyelids is characteristic of **dermatomyositis**, which also presents with muscle weakness, not typically oral ulcers or a malar rash. - **Bilateral hilar lymphadenopathy** is a classic finding in **sarcoidosis**, a granulomatous disease, not directly related to the patient's symptoms. *Port-wine stain, CNS malformations: seen in Sturge-Weber syndrome* - A **port-wine stain** (nevus flammeus) is a congenital capillary malformation, often on the face, and is a principal feature of **Sturge-Weber syndrome**, which involves CNS malformations and seizures. - This condition has no association with oral ulcers, photosensitivity, or the described malar rash. *Silvery scales or plaques: seen in psoriasis* - **Silvery scales or plaques** are the characteristic dermatological lesions of **psoriasis**, a chronic inflammatory skin condition. - Psoriasis typically presents with well-demarcated erythematous plaques and is not associated with oral ulcers, photosensitivity, or a lupus-specific malar rash.
Question 7: Most common indication of liver transplantation in children is:
- A. Biliary atresia (Correct Answer)
- B. Wilson's disease
- C. Hemochromatosis
- D. Primary biliary cirrhosis
Explanation: ***Biliary atresia*** - **Biliary atresia** is the leading cause of chronic liver disease and liver transplant in children, accounting for approximately **50% of all pediatric liver transplants**. - It involves progressive **fibrosis and obliteration of the bile ducts**, leading to cholestasis, cirrhosis, and liver failure in infancy. *Wilson's disease* - While Wilson's disease can lead to liver failure requiring transplant, it is a **less common indication** than biliary atresia in children. - It is a genetic disorder of **copper metabolism**, leading to copper accumulation in various organs. *Hemochromatosis* - **Hemochromatosis** is a disorder of **iron overload** that can cause liver damage and cirrhosis. - However, it is a **rare indication for liver transplant in childhood** compared to biliary atresia. *Primary biliary cirrhosis* - **Primary biliary cirrhosis (PBC)** is an autoimmune disease primarily affecting **small bile ducts** in the liver. - PBC predominantly affects **adults, especially women**, and is a very rare cause of liver failure in children.
Question 8: A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin like hands, arms, chest, etc. she also complaints of arthralgia and breathlessness. Which among the following antibodies will be useful in diagnosing this condition?
- A. Anti-centromere antibodies
- B. Anti-RNP antibodies
- C. Anti-dsDNA antibodies (Correct Answer)
- D. Anti-Scl 70 antibodies
Explanation: Anti-dsDNA antibodies - The clinical presentation with erythematous lesions in sun-exposed areas (consistent with photosensitivity [1] or malar rash), arthralgia, and breathlessness (suggesting serositis [4] or pulmonary involvement) is highly suggestive of Systemic Lupus Erythematosus (SLE) [3]. - Anti-dsDNA antibodies are highly specific for SLE and are included in the diagnostic criteria [4]. Their levels often correlate with disease activity, especially in lupus nephritis. *Anti-centromere antibodies* - These antibodies are typically associated with CREST syndrome (a limited form of systemic sclerosis), characterized by Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasias. - This clinical picture does not align with the patient's symptoms, which point more towards an inflammatory multi-systemic disease. *Anti-RNP antibodies* - Anti-ribonucleoprotein (RNP) antibodies are characteristic of Mixed Connective Tissue Disease (MCTD) [2], which features overlapping symptoms of SLE, systemic sclerosis, and polymyositis [3]. - While some features like arthralgia might overlap, the classic erythematous lesions and breathlessness are more directly linked to SLE in this presentation, and anti-dsDNA is more specific for distinguishing SLE. *Anti-Scl 70 antibodies* - Also known as anti-topoisomerase I antibodies, these are highly specific for diffuse cutaneous systemic sclerosis. - This condition is characterized by widespread skin thickening, interstitial lung disease, and other visceral organ involvement, which is not fully supported by the patient's primary symptoms of prominent erythematous rashes and isolated arthralgia.
Question 9: Lady presents with joint pain in both knees and low-grade fever, which occurs intermittently. On examination, she has a rash on sun-exposed areas. What is the clinical diagnosis?
- A. Systemic lupus erythematosus (SLE) (Correct Answer)
- B. Rheumatoid arthritis (RA)
- C. Photodermatitis
- D. Porphyria cutanea tarda
Explanation: ***Systemic lupus erythematosus (SLE)*** - The combination of **polyarthralgia (joint pain)**, **low-grade fever**, and a **photosensitive rash** is highly characteristic of SLE. [1] - SLE is a **multisystem autoimmune disease** that can affect joints, skin, and cause constitutional symptoms like fever. [1] *Rheumatoid arthritis (RA)* - While RA causes **joint pain**, it typically presents with **symmetrical polyarthritis** primarily affecting small joints, and a photosensitive rash is not a common feature. [2] - **Fever** can be present in severe RA, but the triad of symptoms in this case points away from RA as the primary diagnosis. *Photodermatitis* - **Photodermatitis** is a skin inflammation caused by sunlight exposure, resulting in a rash. - This diagnosis does not account for the **joint pain** or **low-grade fever**, which are systemic manifestations. *Porphyria cutanea tarda* - This condition primarily affects the skin, causing **photosensitivity**, blistering lesions, and increased fragility, especially on sun-exposed areas. - It does **not typically present with joint pain or fever**, differentiating it from the presented symptoms.
Question 10: Which drug is least likely to cause exanthematous skin eruptions?
- A. Phenytoin
- B. Ampicillin
- C. Phenylbutazone
- D. Hydrocortisone (Correct Answer)
Explanation: ***Hydrocortisone*** - **Corticosteroids** like hydrocortisone are **anti-inflammatory** and immunosuppressive agents. - They are commonly used to **treat allergic reactions** and skin eruptions, making them highly unlikely to cause exanthematous eruptions themselves. *Phenytoin* - **Anticonvulsant** medications like phenytoin are frequently associated with various **drug-induced skin reactions**, including exanthematous eruptions. - It is a common cause of **drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome**, which manifests with a widespread rash. *Ampicillin* - **Antibiotics**, particularly **aminopenicillins** like ampicillin, are well-known triggers for **maculopapular rashes** and other exanthematous eruptions. - The incidence of ampicillin-induced rash is notably higher, especially in patients with **viral infections** like infectious mononucleosis. *Phenylbutazone* - This **non-steroidal anti-inflammatory drug (NSAID)** has a documented history of causing severe cutaneous adverse reactions, including **exanthematous eruptions**. - Due to its potential for serious side effects, such as **aplastic anemia** and severe skin reactions, its use is now highly restricted.
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