Autoimmune Thyroid Disease and the Skin — MCQs
Which of the following statements about Grave's disease is false?
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?
A 30 years old female presents with a diffuse thyroid swelling. On investigation, TSH levels were elevated. Post-operative histopathological examination revealed chronic inflammation with characteristic cellular changes. Which of the following is the most likely diagnosis?
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?
Autoimmune Thyroid Disease and the Skin Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements about Grave's disease is false?
- A. Autoimmune disorder
- B. Common in male (Correct Answer)
- C. Referred as toxic diffuse goiter
- D. Results in hyperthyroidism
Explanation: ***Common in male*** - Grave's disease has a **strong female preponderance**, with women being 5 to 10 times more likely to be affected than men [1]. - While it can occur in males, it is **not commonly seen** in this demographic compared to females [2]. *Autoimmune disorder* - Grave's disease is an **autoimmune disorder** where the body produces antibodies (primarily **TSH receptor antibodies**) that stimulate the thyroid gland [1], [2]. - These antibodies mimic the action of TSH, leading to **overproduction of thyroid hormones** [1]. *Results in hyperthyroidism* - The constant stimulation of the thyroid gland by **TSH receptor antibodies** leads to excessive synthesis and release of thyroid hormones [2]. - This overactivity of the thyroid gland is the primary cause of the **hyperthyroid state** characteristic of Grave's disease [2]. *Referred as toxic diffuse goiter* - The term **"toxic diffuse goiter"** accurately describes Grave's disease, as the entire thyroid gland is typically enlarged (**goiter**) and overactive (**toxic**) [1]. - The enlargement is usually **diffuse** rather than nodular, differentiating it from other causes of hyperthyroidism like toxic multinodular goiter.
Question 2: 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 3: 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 4: 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 5: 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 6: A 30 years old female presents with a diffuse thyroid swelling. On investigation, TSH levels were elevated. Post-operative histopathological examination revealed chronic inflammation with characteristic cellular changes. Which of the following is the most likely diagnosis?
- A. Grave's disease
- B. Medullary thyroid carcinoma
- C. Follicular carcinoma
- D. Hashimoto's thyroiditis (Correct Answer)
Explanation: ***Hashimoto's thyroiditis*** - **Elevated TSH** with diffuse thyroid swelling suggests **hypothyroidism**, and **chronic inflammation** with characteristic cellular changes (lymphocytic infiltration, Hurthle cells) on histopathology are hallmarks of **Hashimoto's thyroiditis** [1], [2]. - This condition is an **autoimmune disorder** leading to gradual destruction of thyroid tissue [1], [2]. *Grave's disease* - Grave's disease is an autoimmune condition causing **hyperthyroidism**, which would typically manifest as **low TSH levels** [1]. - Histopathology would show features consistent with **thyroid hyperactivity**, not chronic inflammation and destruction. *Medullary thyroid carcinoma* - This is a **neuroendocrine tumor** derived from parafollicular C cells, which produce calcitonin, not thyroid hormones. - It would not typically present with elevated TSH or diffuse chronic inflammation, and biopsy would show **malignant cells** with amyloid deposits. *Follicular carcinoma* - Follicular carcinoma is a **malignant thyroid tumor** characterized by invasion through the capsule or vascular invasion. - While it can present as a thyroid nodule or swelling, it is a malignancy and not primarily a chronic inflammatory condition with elevated TSH typical of hypothyroidism. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1088-1091. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 427-428.
Question 7: 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 8: 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 9: 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 10: 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.
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