Basic Dermatology Practice Questions

Q: The appearance described as an inverted champagne bottle is associated with which condition?

Lipodermatosclerosis. ***Lipodermatosclerosis*** - This condition presents with a characteristic "inverted champagne bottle" appearance, where the **ankle area is narrow** and the **calf area above it is wider** due to fibrotic changes and fat atrophy. - It's a severe manifestation of **chronic venous insufficiency**, characterized by **skin hardening**, pigmentation, and inflammation, often preceding venous ulceration. *Varicose veins (enlarged, twisted veins)* - While associated with **venous insufficiency**, varicose veins themselves are **dilated, tortuous superficial veins**, and do not typically cause the generalized lower leg shape change described. - They may cause swelling and discomfort but do not directly lead to the **fibrotic narrowing** seen in an "inverted champagne bottle" leg. *Deep vein thrombosis (DVT) (acute venous obstruction)* - DVT is an **acute condition** involving a **blood clot in a deep vein**, leading to sudden onset pain, swelling, and redness. - It does not cause the **chronic skin changes** and **fibrotic reshaping** of the calf and ankle that characterize lipodermatosclerosis. *Venous ulceration (open sores due to venous insufficiency)* - Venous ulcers are **open sores** that occur in severe chronic venous insufficiency, often found above the medial malleolus. - While they are a complication of the underlying venous disease that can also cause lipodermatosclerosis, the ulceration itself is a **skin lesion**, not the **overall inverted champagne bottle shape** of the leg.

Q: Phrynoderma is primarily associated with a deficiency of which of the following?

Vitamin A. ***Vitamin A*** - **Phrynoderma** (toad skin) has been **classically attributed to vitamin A deficiency** in traditional medical literature and was the accepted answer in historical examinations. - It presents as **follicular hyperkeratosis** with dry, scaly, rough skin having prominent hair follicles with a sandpaper-like texture. - However, **modern evidence** suggests phrynoderma is a **multifactorial condition** often involving **multiple nutritional deficiencies**, with vitamin A being one important contributor among others. *Essential fatty acid* - Deficiency of **essential fatty acids** (linoleic and alpha-linolenic acid) causes **skin dryness, flakiness, and follicular hyperkeratosis**. - **Recent studies** indicate EFA deficiency may play a **significant role** in phrynoderma, particularly in developing countries where multiple nutritional deficiencies coexist. - The clinical presentation can closely mimic vitamin A deficiency-related skin changes. *Vitamin D* - Deficiency of **vitamin D** primarily causes **rickets** in children and **osteomalacia** in adults with bone pain, muscle weakness, and skeletal deformities. - While vitamin D has roles in skin health, its deficiency does not directly cause the follicular hyperkeratosis characteristic of phrynoderma. *Niacin* - **Niacin (vitamin B3)** deficiency causes **pellagra** with the classic \"3 Ds\": **dermatitis, diarrhea, and dementia**. - Pellagra dermatitis is typically **symmetrical in sun-exposed areas** with redness, scaling, and hyperpigmentation—distinctly different from the follicular pattern of phrynoderma.

Q: Loss of intercellular cohesion between keratinocytes is referred to as?

Acantholysis. ***Acantholysis*** - This term specifically refers to the **loss of cohesion between keratinocytes** in the epidermis due to the breakdown of desmosomal attachments. - It is a hallmark feature of several **blistering skin diseases**, such as pemphigus. *Acanthosis* - This refers to the **thickening of the stratum spinosum** (prickle cell layer) of the epidermis, often due to an increase in the number of keratinocytes. - It is seen in conditions like **psoriasis** and seborrheic keratosis, but does not involve a loss of intercellular cohesion. *Keratinolysis* - This term describes the **breakdown or dissolution of keratin**, which is the primary structural protein of the epidermis. - While keratinocytes produce keratin, keratinolysis itself is not the specific term for loss of cohesion between these cells. *Spongiosis* - This is defined as **intercellular edema** (fluid accumulation) within the epidermis, especially prominent in the stratum spinosum. - It leads to the widening of intercellular spaces and stretching of desmosomes, but the cells generally remain attached, unlike in acantholysis.

Q: A child with fever who has multiple erythematous skin lesions and, on microscopic examination, shows neutrophilic and histiocytic infiltration in the dermis is diagnosed with what?

Sweet syndrome. ***Sweet syndrome*** - Sweet syndrome (acute febrile neutrophilic dermatosis) is characterized by **fever** and the sudden onset of **erythematous plaques or nodules**. - **Histopathology** reveals diffuse **neutrophilic and histiocytic infiltration** in the dermis without vasculitis, which matches the description. *Behçet's syndrome* - Behçet's syndrome is characterized by recurrent **oral and genital ulcers**, **uveitis**, and skin lesions, but typically does not show widespread erythematous lesions with neutrophilic infiltration as the primary skin manifestation. - The histopathology may show leukocytoclastic vasculitis or neutrophilic infiltration in some cases, but the classic clinical triad distinguishes it from Sweet syndrome. *Pyoderma gangrenosum* - Pyoderma gangrenosum presents as rapidly enlarging, **painful necrotic ulcers** with undermined borders, which differs from the "multiple erythematous skin lesions" described. - While it involves neutrophilic infiltration, the clinical presentation of an ulcer is distinct from the more diffuse erythematous lesions of Sweet syndrome. *Kawasaki disease* - Kawasaki disease is a childhood vasculitis presenting with **fever** and **polymorphous rash**, along with conjunctivitis, oral changes, and extremity changes. - Histopathology shows **vasculitis** with perivascular infiltration, not the diffuse dermal neutrophilic infiltration without vasculitis seen in Sweet syndrome. - The clinical criteria (conjunctivitis, strawberry tongue, cervical lymphadenopathy) help distinguish it.

Q: Target or iris lesions are seen in:

Erythema multiforme. ***Erythema multiforme*** - Erythema multiforme is characterized by **target lesions** (also known as iris lesions), which are concentric rings of color resembling a bull's-eye. - These lesions typically have a **dusky center**, a paler edematous ring, and an outer erythematous halo. *Urticaria (hives)* - Urticaria presents with **pruritic, transient wheals** (hives) that are typically erythematous and edematous, but they do not form target or iris patterns. - The lesions in urticaria are often **blanchable** and migrate rapidly. *Scabies (itch mite infestation)* - Scabies manifests as **intensely pruritic papules, vesicles, and burrows**, often found in web spaces of fingers, wrists, and genitalia. - It does not produce target lesions; burrows are a **pathognomonic sign**. *Lichen planus (inflammatory skin condition)* - Lichen planus characteristically presents with **pruritic, polygonal, purple, planar papules and plaques** (the 6 P's). - It may also show **Wickham's striae** (fine white lines on the surface), but it does not form target-like lesions.

Q: Which of the following statements about erythema multiforme is false?

Lesions are usually asymmetrical.. ***Lesions are usually asymmetrical.*** - Erythema multiforme characteristically presents with **bilateral and symmetrical lesions**, not asymmetrical ones. - The classic **targetoid lesions** (distinctive bullseye shape) typically appear symmetrically on the extremities and trunk. - This statement is FALSE and is therefore the correct answer to this question. *Due to Herpes simplex* - **Herpes simplex virus (HSV) infection** is the most common infectious cause of erythema multiforme, particularly the recurrent form. - The rash typically appears 1-3 weeks after an HSV outbreak. - This statement is TRUE. *Due to sulphonamide* - **Sulfonamide drugs** are well-known to trigger drug-induced erythema multiforme, as well as more severe forms like Stevens-Johnson syndrome (SJS). - This highlights its association with medications as triggers. - This statement is TRUE. *Mucous membrane involvement occurs in EM major* - **Mucous membrane involvement** is a defining feature of **erythema multiforme major**, affecting the oral cavity, eyes, and genitals. - **EM minor** typically presents with only cutaneous lesions without significant mucosal involvement. - This statement is TRUE.

Q: All of the following regarding lichen planus are true except which of the following?

Does not involve mucous membrane. ***Does not involve mucous membrane*** - **Lichen planus** frequently involves mucous membranes, particularly the **oral mucosa**, where it can present as white reticular striae (Wickham's striae) or erosive lesions. - Mucous membrane involvement is a key diagnostic feature and can be painful, affecting eating and drinking. *Associated with Hepatitis 'C'* - There is a well-established association between **lichen planus** and **Hepatitis C virus** (HCV) infection, particularly in cases of oral lichen planus. - HCV infection can trigger or exacerbate immune-mediated conditions like lichen planus. *Topical steroids are the mainstay of therapy* - **Topical corticosteroids** are indeed the **first-line treatment** for many forms of lichen planus, especially localized cutaneous or oral lesions, to reduce inflammation and symptoms. - For more severe or widespread cases, systemic corticosteroids or other immunomodulators may be used. *Spontaneous remission occurs after 6 months to 2 years* - **Lichen planus** often undergoes **spontaneous remission**, typically within **6 months to 2 years** for cutaneous forms. - However, oral lichen planus tends to be more chronic and persistent.

Q: Which "P" describes the characteristic shape of lichen planus lesions?

Polygonal. ***Polygonal*** - Lichen planus lesions are classically described as having a **polygonal (angular) shape**, one of the "6 Ps" of lichen planus. - The papules have **distinct, angular borders** that create a geometric, many-sided appearance. - This is a key morphological feature used to identify lichen planus clinically. *Polyhedral* - **Polyhedral** refers to a three-dimensional solid figure with many faces (like a crystal or polyhedron). - This term does not describe the two-dimensional shape of skin lesions. - Not part of the classic "6 Ps" mnemonic. *Plane* - While lichen planus lesions are **planar (flat-topped)**, which IS one of the "6 Ps," this describes the **surface topography**, not the **shape** of the lesions. - "Plane/planar" refers to the flat surface when viewed from the side, whereas "polygonal" describes the angular outline when viewed from above. *Pruritus* - **Pruritic (itchy)** is indeed one of the "6 Ps" of lichen planus and a very common clinical feature. - However, pruritus describes a **symptom**, not the **shape** of the lesions. - The question specifically asks about shape characteristics.

Q: Which of the following statements about Pityriasis rosea is true?

It is a self-limiting condition.. ***It is a self-limiting condition.*** - **Pityriasis rosea** is characterized by a distinctive rash that typically resolves on its own within **6-8 weeks** without specific treatment. - Most patients experience complete resolution, and **recurrences are uncommon**. - Often preceded by a **herald patch** followed by smaller oval lesions in a **"Christmas tree" distribution** on the trunk. *It can lead to life-threatening infections.* - While the exact etiology is unknown, **Pityriasis rosea** is generally considered **benign** and does not typically lead to systemic complications or life-threatening infections. - The rash itself is a localized skin condition that does not compromise the immune system or predispose to severe secondary infections. *It is caused by dermatophytes.* - **Dermatophytes** are fungi that cause superficial fungal infections such as ringworm (**tinea** infections). - **Pityriasis rosea** is thought to be triggered by certain **viral infections**, particularly **human herpesvirus 6 (HHV-6)** and **HHV-7**, not fungal organisms. - This helps differentiate it from fungal conditions like tinea corporis. *It is a chronic relapsing condition.* - **Pityriasis rosea** is generally an **acute, self-limiting eruption** that resolves spontaneously, making it distinct from chronic, relapsing conditions such as **psoriasis** or **eczema**. - A single episode usually confers long-lasting immunity, and **recurrences are rare** (occurring in <2% of cases).

Question 1

The appearance described as an inverted champagne bottle is associated with which condition?

Accepted Answer

Lipodermatosclerosis

Answer

Varicose veins

Answer

Deep vein thrombosis

Answer

Venous ulceration

Question 2

Phrynoderma is primarily associated with a deficiency of which of the following?

Accepted Answer

Vitamin A

Answer

Essential fatty acid

Answer

Vitamin D

Answer

Niacin

Question 3

Loss of intercellular cohesion between keratinocytes is referred to as?

Accepted Answer

Acantholysis

Answer

Acanthosis

Answer

Keratinolysis

Answer

Spongiosis

Question 4

A child with fever who has multiple erythematous skin lesions and, on microscopic examination, shows neutrophilic and histiocytic infiltration in the dermis is diagnosed with what?

Accepted Answer

Sweet syndrome

Answer

Pyoderma gangrenosum

Answer

Kawasaki disease

Answer

Behçet's syndrome

Question 5

Target or iris lesions are seen in:

Accepted Answer

Erythema multiforme

Answer

Urticaria

Answer

Scabies

Answer

Lichen planus

Question 6

Which of the following statements about erythema multiforme is false?

Accepted Answer

Lesions are usually asymmetrical.

Answer

Due to sulphonamide

Answer

Due to Herpes simplex

Answer

Mucous membrane involvement occurs in EM major

Question 7

Dyskeratosis refers to which of the following?

Accepted Answer

Abnormal, premature keratinization within cells below the stratum granulosum.

Answer

Discontinuity of the skin showing incomplete loss of epidermis.

Answer

Keratinization with retained nuclei in the stratum corneum.

Answer

Thickening of stratum corneum, often associated with a qualitative abnormality of keratin.

Question 8

All of the following regarding lichen planus are true except which of the following?

Accepted Answer

Does not involve mucous membrane

Answer

Associated with Hepatitis 'C'

Answer

Topical steroids are the mainstay of therapy

Answer

Spontaneous remission occurs after 6 months to 2 years

Question 9

Which "P" describes the characteristic shape of lichen planus lesions?

Accepted Answer

Polygonal

Answer

Polyhedral

Answer

Plane

Answer

Pruritus

Question 10

Which of the following statements about Pityriasis rosea is true?

Accepted Answer

It is a self-limiting condition.

Answer

It can lead to life-threatening infections.

Answer

It is caused by dermatophytes.

Answer

It is a chronic relapsing condition.

Basic Dermatology — MCQs

Basic Dermatology — MCQs

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