Basic Dermatology — MCQs

Basic Dermatology Indian Medical PG Practice Questions and MCQs

Question 251: Identify the lesion: (Recent NEET Pattern 2016-17)

A. Lichen nitidus (Correct Answer)
B. Lichen planus
C. Atopic dermatitis
D. Pompholyx

Explanation: ***Lichen nitidus*** - The image displays multiple **tiny, flesh-colored, shiny papules**, which are characteristic of lichen nitidus, often appearing in clusters. - These lesions are typically asymptomatic or mildly pruritic, and commonly found on the trunk, upper extremities, and genitalia. *Lichen planus* - Characterized by **purplish, polygonal, planar, pruritic papules and plaques** (the "6 P's"), often with fine white lines (Wickham's striae). - The lesions in the image do not exhibit the typical purplish hue, distinct polygonal shape, or surface striae of lichen planus. *Atopic dermatitis* - Presents with **erythematous, intensely itchy plaques** that are often excoriated, lichenified, or crusted. - While it can involve various body sites, the discrete, shiny, flesh-colored papules seen here are not typical for atopic dermatitis. *Pompholyx* - Also known as dyshidrotic eczema, this condition is characterized by **small, deep-seated, clear vesicles and bullae** on the palms, soles, and sides of the fingers and toes. - The image does not show vesicular or bullous lesions, nor are the papules consistent with the presentation of pompholyx.

Question 252: A 65-year-old patient presents with development of multiple papules and nodules around the right knee for last one year. Which of the following hyper-lipoproteinemia is associated with this condition?

A. Type I Hyper-lipoproteinemia
B. Type II Hyper-lipoproteinemia
C. Type III Hyper-lipoproteinemia (Correct Answer)
D. Type IV Hyper-lipoproteinemia

Explanation: ***Type III Hyperlipoproteinemia*** - The clinical presentation shows **tuberous or tuberoeruptive xanthomas**, which are firm papules and nodules developing slowly over months on extensor surfaces like knees and elbows - These are highly characteristic of **Type III hyperlipoproteinemia (familial dysbetalipoproteinemia)**, caused by accumulation of **chylomicron and VLDL remnants** - Type III involves a defect in **apolipoprotein E (apoE)**, leading to impaired clearance of remnant lipoproteins - **Pathognomonic feature**: Xanthoma striatum palmare (yellow-orange palmar creases) *Type I Hyperlipoproteinemia* - Characterized by severe elevation of **chylomicrons** and triglycerides due to **lipoprotein lipase deficiency** or apoC-II deficiency - Presents with **eruptive xanthomas** (small, sudden-onset yellow papules with red base) and **lipemia retinalis** - Eruptive xanthomas appear rapidly (days-weeks), unlike the slow development described in this case - Major complication: Recurrent acute pancreatitis *Type II Hyperlipoproteinemia* - Familial hypercholesterolemia with elevated **LDL cholesterol** - Manifests as **tendon xanthomas** (Achilles tendon, extensor tendons of hands), **xanthelasmas**, and corneal arcus - Does not typically cause nodular lesions around the knees *Type IV Hyperlipoproteinemia* - Characterized by elevated **VLDL** and triglycerides, often associated with metabolic syndrome - Rarely presents with xanthomas; when present, they are eruptive rather than tuberous - Main clinical concerns are cardiovascular disease and pancreatitis risk

Question 253: The following lesion is seen in all of the following conditions except: (Recent NEET Pattern 2016-17)

A. Carcinoid syndrome
B. Hartnup disease
C. Alcoholism
D. Porphyria (Correct Answer)

Explanation: ***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.

Question 254: A 55-year-old patient presented with following lesions on his buttock. He consulted a general physician who diagnosed it as an allergy, but lesions are persisting. His blood sample was drawn and shows a creamy top layer. What is the diagnosis?

A. Tuberous xanthoma
B. Tendinous xanthoma
C. Eruptive xanthoma (Correct Answer)
D. Xanthelasma palpebrarum

Explanation: ***Eruptive xanthoma*** - The image shows numerous 2-4 mm, yellowish-orange papules on the buttocks, characteristic of **eruptive xanthomas**, which are often found on extensor surfaces and buttocks. - The **creamy top layer** in the blood sample indicates severe **hypertriglyceridemia**, the underlying metabolic cause of eruptive xanthomas. *Tuberous xanthoma* - These are typically larger, painless, firm nodules found over extensor surfaces like elbows and knees, not small papules particularly on the buttocks. - While also associated with hyperlipidemia, they are usually seen with **elevated LDL cholesterol** rather than severe hypertriglyceridemia leading to a creamy serum layer. *Tendinous xanthoma* - These present as subcutaneous nodules that develop in tendons, most commonly the Achilles tendon and extensor tendons of the hands and feet. - They are primarily linked to **familial hypercholesterolemia** (elevated LDL) and would not manifest as small papules on the buttocks. *Xanthelasma palpebrarum* - These are soft, yellowish plaques that appear on or around the eyelids, and are distinct from the widespread papular lesions seen on the buttocks. - While sometimes associated with hyperlipidemia, they are confined to the periorbital area and do not present as generalized eruptive lesions.

Question 255: The following skin condition is associated with:

A. Diabetes (Correct Answer)
B. Hyperthyroidism
C. Hypothyroidism
D. Sarcoidosis

Explanation: ***Diabetes*** - The image displays characteristics of **necrobiosis lipoidica**, a skin condition strongly associated with **diabetes mellitus**. - Necrobiosis lipoidica typically presents as **shiny, atrophic plaques with distinct red or violaceous borders and a yellow-brown center**, often on the shins, as seen in the image. *Hyperthyroidism* - This condition is associated with **pretibial myxedema**, which presents as non-pitting edema and thickened, discolored skin, distinct from the atrophic plaques shown. - Other dermatological manifestations include **onycholysis** (Plummer's nails), fine hair, and generalized hyperpigmentation, none of which are consistent with the image. *Hypothyroidism* - Hypothyroidism is associated with **generalized myxedema**, which results in dry, coarse, cold skin, and facial puffiness. - It does not typically cause the **atrophic, yellow-brown plaques** characteristic of the presented skin lesion. *Sarcoidosis* - Sarcoidosis can cause various skin lesions, including **erythema nodosum**, lupus pernio, and subcutaneous nodules. - These lesions have distinct appearances that do not match the **necrobiosis lipoidica** depicted in the image.

Question 256: Identify the condition which is present since birth: (AIIMS May 2017)

A. Epidermal verrucous nevus
B. Melano-acanthoma
C. Malignant melanoma
D. Congenital nevus (Correct Answer)

Explanation: **Correct: *Congenital nevus*** - A congenital nevus is a **melanocytic nevus** that is present at **birth** or appears shortly thereafter, characterized by a proliferation of **melanocytes** in the skin - These nevi can vary in size and appearance, often appearing as darkly pigmented, sometimes hairy patches - By definition, this is the condition present since birth as asked in the question *Incorrect: Epidermal verrucous nevus* - An **epidermal verrucous nevus** is a common **hamartoma of the epidermis** that can be present at birth or develop in early childhood, characterized by **verrucous** (wart-like) or ridge-like papules and plaques - While it can be congenital, its distinctive **verrucous texture** (wart-like appearance) differentiates it from the smooth, pigmented melanocytic lesion - Not the best answer as the question specifically asks for a condition present since birth, and congenital nevus is more definitively congenital *Incorrect: Melano-acanthoma* - **Melano-acanthoma** is a rare, benign, typically **pigmented lesion** that usually arises in older adults, often on the **trunk or face** - Its late-onset presentation (typically in adulthood) makes it unlikely to be present since birth - This is an acquired condition, not congenital *Incorrect: Malignant melanoma* - **Malignant melanoma** is a serious form of **skin cancer** that typically develops from pre-existing moles or new lesions, most commonly in adulthood - While congenital nevi can rarely undergo malignant transformation into melanoma, melanoma itself is generally not present at birth - Characterized by rapid changes in size, shape, or color (ABCDE criteria), which distinguishes it from stable congenital lesions

Question 257: Which of the following layers contains Odland bodies?

A. A
B. B (Correct Answer)
C. C
D. D

Explanation: ***B*** - The layer indicated by **B** is the **stratum granulosum**, which is characterized by the presence of **keratohyalin granules** and **Odland bodies** (lamellar bodies). - **Odland bodies** are crucial for forming the **epidermal water barrier** as they release lipids and enzymes into the intercellular space. *A* - The layer indicated by **A** is the **stratum corneum**, which consists of dead, flattened keratinocytes. - This layer is primarily involved in protection and does not contain Odland bodies, which are found in deeper layers. *C* - The layer indicated by **C** is the **stratum spinosum**, characterized by many **desmosomes** giving a "spiny" appearance. - While cells in this layer are metabolically active and produce keratin, Odland bodies primarily form and are extruded in the stratum granulosum. *D* - The layer indicated by **D** is the **stratum basale** (or stratum germinativum), the deepest layer of the epidermis. - This layer contains **stem cells** that are constantly dividing to replenish the epidermal layers and is also where melanocytes are located; it does not contain Odland bodies.

Question 258: The following appearance on Wood's lamp is seen in?

A. Erythrasma (Correct Answer)
B. Erythroderma
C. Ecthyma
D. Erysipelas

Explanation: ***Erythrasma*** - Erythrasma, caused by *Corynebacterium minutissimum*, is characterized by a **coral-red fluorescence** under Wood's lamp due to the production of **porphyrins**. - The image clearly shows this characteristic coral-red and purplish fluorescence, which is pathognomonic for erythrasma. *Erythroderma* - Erythroderma is a serious inflammatory skin condition affecting more than 90% of the body surface with **generalized redness and scaling**. - It does not exhibit any specific fluorescence under Wood's lamp; the diagnosis is purely clinical. *Ecthyma* - Ecthyma is a **deep skin infection** resembling impetigo but extending into the dermis, forming **ulcers** with a crusted surface. - It does not produce a characteristic fluorescence under Wood's lamp; diagnosis is based on clinical appearance of ulcerative lesions. *Erysipelas* - Erysipelas is a **superficial cellulitis** primarily involving the upper dermis and superficial lymphatics, typically presenting as a rapidly spreading, erythematous, raised, and warm plaque with a distinctive border. - While it is a bacterial skin infection, it does not show any specific fluorescence under Wood's lamp.

Question 259: A 25-year-old man with a history of road traffic injury presents to your clinic 4 months after the episode. His clinical presentation is shown in the image. What is the most likely diagnosis?

A. Keloid
B. Hypertrophic scar
C. Normal scar (Correct Answer)
D. Wound contraction

Explanation: ***Normal scar*** - A **normal scar** appears as a flat, pale line, typically within the bounds of the original wound, as seen in the image after 4 months. - Histologically, a mature normal scar is characterized by **dense collagen bundles** arranged in parallel fashion, replacing the original dermis. *Keloid* - **Keloids** are characterized by **scar tissue growing beyond the boundaries of the original wound**, often appearing raised, firm, and reddish-purple. This is not seen in the image. - Histologically, keloids show irregularly arranged, **thick, hyalinized collagen bundles**, often with nodular formations and increased vascularity. *Hypertrophic scar* - A **hypertrophic scar** is elevated and red but remains **within the confines of the original wound**. Unlike keloids, they can often regress spontaneously. The image does not show an elevated or reddish scar. - Histologically, hypertrophic scars also feature **thick collagen bundles** but these are typically arranged **parallel to the epidermis** and are more organized than in keloids. *Wound contraction* - **Wound contraction** is a normal process during healing where the wound edges pull together, reducing the wound size. This is a process, not a final scar appearance. - While contraction occurs in all phases of wound healing, severe or excessive contraction can lead to **contractures**, which limit joint movement and are usually seen in extensive burns or chronic wounds.

Question 260: Identify the lesion seen on the tongue in the given image.

A. Geographic tongue (Correct Answer)
B. Black hairy tongue
C. Acrodermatitis enteropathica
D. Stevens-Johnson syndrome

Explanation: ***Geographic tongue*** - The image distinctly shows **irregular, red patches** on the dorsal surface of the tongue, surrounded by a **white or yellowish border**. - These patches represent areas of **atrophy of the filiform papillae**, which migrate and resolve spontaneously, giving the tongue a "map-like" appearance. *Black hairy tongue* - Characterized by the **elongation and hypertrophy of the filiform papillae**, leading to a hair-like appearance, often **dark-stained** due to trapped debris or chromogenic bacteria. - The image does not show elongated or discolored papillae; instead, there are smooth, reddened areas. *Stevens-Johnson syndrome* - A **severe mucocutaneous reaction**, often triggered by medications, presenting with extensive **vesicles, bullae, and erosions** on mucous membranes and skin. - The image shows localized tongue findings typical of inflammation, not widespread skin sloughing or blistering. *Acrodermatitis enteropathica* - A rare genetic disorder causing **zinc deficiency**, leading to a classic triad of **dermatitis**, **diarrhea**, and **alopecia**. - Oral findings can include stomatitis and glossitis, but the characteristic rash is typically periorificial and acral, and the image does not show general signs of zinc deficiency.

Practice by Chapter

Structure and Function of Skin

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Cutaneous Histopathology

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Dermatological Examination

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Skin Lesions: Morphology and Description

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Principles of Diagnosis in Dermatology

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Dermatological Procedures

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Wound Healing

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Cutaneous Immunology

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Genetics in Dermatology

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Cutaneous Manifestations of Systemic Diseases

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Geriatric Dermatology

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Pediatric Dermatology Basics

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