Dyshidrotic Eczema — MCQs
Which of the following conditions is primarily treated by sympathectomy?
A 70-year-old man comes to the emergency department because of a skin rash and severe itching. He appears ill; there is a generalized skin rash that is scaly, erythematous, and thickened. His palms, soles, and scalp are also involved. Which of the following is the most likely diagnosis?
Pompholyx affects:
A patient who experiences recurrent urticaria during exercise and heat exposure, including sunlight, most likely has:
In the acute management of ecchymosis and hematoma, which thermal modality is most appropriate?
A child presents with a rash in the neck folds as shown in the image. The area appears erythematous with satellite lesions and maceration. What is the most likely diagnosis?
Which of the following is not a part of P. versicolor treatment -
Most common precipitant of contact dermatitis is?
A 22-year-old female presents with dry papules in the seborrheic areas, especially in the summer. Her father also has a history of similar lesions. What is the most probable diagnosis?
The UK refinement of Hannifin and Rajka criteria is used in the diagnosis of which condition?
Dyshidrotic Eczema Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following conditions is primarily treated by sympathectomy?
- A. Buerger's disease
- B. Acrocyanosis
- C. Hyperhidrosis (Correct Answer)
- D. Raynaud's disease
Explanation: ***Hyperhidrosis*** - **Sympathectomy** (especially thoracic sympathectomy) is a definitive treatment for severe, localized **hyperhidrosis** (excessive sweating) that has not responded to conservative therapies. - The procedure aims to interrupt the sympathetic nerves responsible for stimulating sweat glands, commonly in the palms, soles, or axillae. *Buerger's disease* - While **sympathectomy** was historically used, its efficacy in **Buerger's disease** (thromboangiitis obliterans) is questionable and largely replaced by smoking cessation and other treatments for limb salvage. - The primary issue is **inflammation** and **thrombosis** of small and medium-sized arteries and veins, not primarily sympathetic overactivity. *Acrocyanosis* - **Acrocyanosis** is a benign condition characterized by persistent, painless, blue discoloration of the extremities due to vasospasm of small skin arteries and arterioles. - Treatment is generally reassurance and avoidance of cold, and **sympathectomy** is rarely, if ever, indicated or effective due to the non-progressive and cosmetic nature of the condition. *Raynaud's disease* - **Raynaud's disease** is a vasospastic disorder, but **sympathectomy** is usually reserved for severe cases with impending tissue loss or critical ischemia that fail medical management. - Medical management with calcium channel blockers is the primary treatment, as the condition involves episodic vasospasm of digital arteries.
Question 2: A 70-year-old man comes to the emergency department because of a skin rash and severe itching. He appears ill; there is a generalized skin rash that is scaly, erythematous, and thickened. His palms, soles, and scalp are also involved. Which of the following is the most likely diagnosis?
- A. erythroderma (exfoliative dermatitis) (Correct Answer)
- B. pemphigus vulgaris
- C. dermatitis herpetiformis
- D. rosacea
Explanation: ***erythroderma (exfoliative dermatitis)*** - Erythroderma is characterized by a **generalized erythematous (red), scaly, and thickened skin rash** covering more than 90% of the body surface, accompanied by **severe itching**. - This condition is often associated with a **systemic illness**, and the patient's description of "appears ill" further supports this diagnosis. *pemphigus vulgaris* - Pemphigus vulgaris typically presents with **flaccid blisters** and erosions, particularly affecting mucous membranes, which are not described here. - While it can be widespread, the primary lesion is a **blister** rather than diffuse erythema and scaling. *dermatitis herpetiformis* - Dermatitis herpetiformis is characterized by intensely **pruritic (itchy) papules and vesicles** typically found on the extensor surfaces (e.g., elbows, knees, buttocks). - It is strongly associated with **celiac disease** and does not present as a generalized scaly, erythematous thickening. *rosacea* - Rosacea primarily affects the **face**, causing **erythema**, flushing, papules, and pustules, often sparing the palms, soles, and scalp. - It is not characterized by generalized scaling, thickening, or severe itching over the entire body.
Question 3: Pompholyx affects:
- A. Groin
- B. Scalp
- C. Trunk
- D. Palms and soles (Correct Answer)
Explanation: ***Palms and soles*** - **Pompholyx**, also known as **dyshidrotic eczema**, is characterized by recurrent outbreaks of **vesicles and bullae** predominantly on the palms and soles. - These lesions are typically very **itchy** and can cause significant discomfort. *Groin* - Conditions like **tinea cruris** (jock itch) or **intertrigo** commonly affect the groin, presenting with erythema and scaling rather than vesicles. - While eczema can occur in the groin, classical pompholyx has a predilection for the acral regions. *Scalp* - The scalp is more commonly affected by conditions such as **seborrheic dermatitis** or **psoriasis**, which manifest as scaling, redness, and flaking. - Vesicular eruptions are rare on the scalp unless due to specific conditions like herpes zoster. *Trunk* - The trunk is a common site for various dermatoses, including **atopic dermatitis**, **psoriasis**, or **pityriasis rosea**, but these typically present with different morphologic features (e.g., plaques, patches). - Pompholyx is specific to palms and soles and does not usually involve the trunk.
Question 4: A patient who experiences recurrent urticaria during exercise and heat exposure, including sunlight, most likely has:
- A. Chronic Spontaneous Urticaria
- B. Universal Dermographism
- C. Cholinergic Urticaria (Correct Answer)
- D. Photodermatitis
Explanation: ***Cholinergic Urticaria*** - Cholinergic urticaria is characterized by the appearance of small, itchy wheals in response to stimuli that raise the **body temperature**, such as **exercise**, **heat**, or **emotional stress**. - The symptoms resolve when the body cools down, aligning with the patient's presentation of recurrent urticaria during exercise and heat exposure. *Chronic Spontaneous Urticaria* - This condition involves daily or almost daily urticaria for **six weeks or more** without an identifiable external cause. - While it is chronic, the specific triggers of exercise and heat exposure point more directly to a physical urticaria like cholinergic urticaria. *Universal Dermographism* - **Dermographism** (or dermatographia) is a type of physical urticaria where hives appear after **firm stroking or scratching** of the skin. - Universal dermographism would imply this reaction over a large body surface area, but it is not typically triggered by systemic heat or exercise. *Photodermatitis* - **Photodermatitis** is a general term for skin inflammation caused by **exposure to light**, especially sunlight, often due to an abnormal reaction to UV radiation. - While sunlight is a trigger for this patient's symptoms, the additional triggers of exercise and general heat exposure make cholinergic urticaria a more encompassing diagnosis than photodermatitis alone.
Question 5: In the acute management of ecchymosis and hematoma, which thermal modality is most appropriate?
- A. Continuous ice pack
- B. Pressure and pack
- C. Intermittent hot pack
- D. Intermittent ice pack (Correct Answer)
Explanation: ***Intermittent ice pack*** - An **intermittent ice pack** is the cornerstone of acute thermal management for ecchymosis and hematoma, reducing **swelling** and **inflammation**. - Cold application causes **vasoconstriction**, minimizing further bleeding into tissues and providing **analgesia** by numbing the affected area. - Intermittent application (15-20 minutes on, 20-30 minutes off) prevents tissue damage while maximizing therapeutic benefit. - Part of the **RICE protocol** (Rest, Ice, Compression, Elevation) for acute soft tissue injuries. *Continuous ice pack* - **Continuous ice pack** application can cause **tissue damage**, including frostbite, nerve injury, and skin necrosis. - Prolonged vasoconstriction impairs tissue perfusion and delays healing by limiting oxygen and nutrient delivery. - Should be avoided in favor of intermittent application. *Pressure and pack* - While **compression/pressure** is indeed an important component of acute hematoma management, this option refers to the mechanical intervention rather than the thermal modality asked in the question. - Pressure dressings are used **in conjunction with** ice application, not as an alternative thermal treatment. - The question specifically asks about thermal modality, making ice the correct answer. *Intermittent hot pack* - **Heat application** in the acute phase causes **vasodilation**, which would increase blood flow and exacerbate bleeding. - This would worsen swelling and hematoma formation in the initial 24-48 hours post-injury. - Heat therapy is reserved for the later stages (after 48-72 hours) to promote healing and reduce chronic inflammation.
Question 6: A child presents with a rash in the neck folds as shown in the image. The area appears erythematous with satellite lesions and maceration. What is the most likely diagnosis?
- A. Intertrigo (Correct Answer)
- B. Heat rash
- C. Eczema
- D. Impetigo
Explanation: ***Intertrigo*** - The image shows a reddened, inflamed rash in skin folds (neck creases), which is characteristic of **intertrigo**. This condition results from skin-on-skin friction, moisture, and warmth. - The rash appears to have satellite lesions and a somewhat macerated appearance, which would be consistent with secondary fungal (e.g., Candida) or bacterial infection, common complications of intertrigo. *Heat rash* - **Heat rash (miliaria)** typically presents as small, itchy red bumps or clear blisters, often found in areas prone to sweating. - While it can occur in skin folds, the diffuse, raw-looking erythema and presence of potential satellite lesions shown in the image are less typical for simple heat rash. *Eczema* - **Eczema (atopic dermatitis)** is characterized by dry, itchy, inflamed skin, often with scaling, crusting, or lichenification during chronic stages. - While eczema can affect skin folds, the appearance in the image (intense redness, maceration, potential satellite lesions) is more suggestive of an irritant or infectious process like intertrigo rather than typical eczema. *Impetigo* - **Impetigo** is a bacterial skin infection characterized by honey-colored crusts, vesicles, or bullae, typically appearing anywhere on the body, especially around the nose and mouth. - The rash in the image lacks the characteristic honey-colored crusts or vesiculobullous lesions associated with impetigo.
Question 7: Which of the following is not a part of P. versicolor treatment -
- A. Selenium sulfide
- B. Clotrimazole
- C. Ketoconazole
- D. Griseofulvin (Correct Answer)
Explanation: **Griseofulvin (Correct - NOT used for P. versicolor)** - **Griseofulvin** interferes with fungal cell division and is primarily used for dermatophyte infections of the skin, hair, and nails, not superficial yeast infections like *P. versicolor*. - It is systemically absorbed and incorporated into **keratin precursor cells**, offering protection against dermatophytes in newly formed tissue. - *Malassezia* species (causing P. versicolor) are **yeasts**, not dermatophytes, making griseofulvin ineffective. *Selenium sulfide (Incorrect - IS used)* - **Selenium sulfide** is an effective topical antifungal agent commonly used in shampoos and lotions to treat *P. versicolor* by inhibiting the growth of *Malassezia* species. - It works by reducing **sebum production** and having a direct fungistatic effect on the yeast. *Clotrimazole (Incorrect - IS used)* - **Clotrimazole** is a broad-spectrum azole antifungal that is very effective as a topical treatment for *P. versicolor* by inhibiting ergosterol synthesis in the fungal cell membrane. - It works well for localized patches of the infection. *Ketoconazole (Incorrect - IS used)* - **Ketoconazole**, another azole antifungal, is highly effective for *P. versicolor* and can be used topically (shampoos, creams) or orally in more extensive or recalcitrant cases. - It disrupts the fungal cell membrane by inhibiting the synthesis of **ergosterol**.
Question 8: Most common precipitant of contact dermatitis is?
- A. Gold
- B. Silver
- C. Iron
- D. Nickel (Correct Answer)
Explanation: ***Nickel*** - **Nickel** is the most frequent cause of **allergic contact dermatitis**, commonly found in jewelry, belt buckles, and zippers. - Exposure leads to a **Type IV hypersensitivity reaction**, characterized by erythema, itching, and vesiculation. *Gold* - While gold can cause contact dermatitis, it is **far less common** than nickel allergy. - Reactions to gold are often seen with prolonged skin contact, such as with jewelry. *Silver* - **Silver** is a **rare cause** of allergic contact dermatitis. - Allergic reactions to silver are typically observed in individuals with extensive exposure, such as jewelers. *Iron* - **Iron** is **not a common precipitant** of contact dermatitis. - Allergic reactions to iron are exceedingly rare, as iron is an essential element found naturally in the body.
Question 9: A 22-year-old female presents with dry papules in the seborrheic areas, especially in the summer. Her father also has a history of similar lesions. What is the most probable diagnosis?
- A. Pemphigus foliaceus
- B. Keratosis pilaris
- C. Darier's disease (Correct Answer)
- D. Seborrheic dermatitis
Explanation: ### Explanation **Correct Answer: C. Darier’s Disease** **Why it is correct:** Darier’s disease (Keratosis Follicularis) is an autosomal dominant genodermatosis caused by a mutation in the **ATP2A2 gene**, which encodes the **SERCA2 calcium pump**. This defect leads to a loss of cell-to-cell adhesion (acantholysis) and abnormal keratinization. * **Clinical Presentation:** It typically manifests as greasy, crusted, "dirty-looking" **malodorous papules** in a **seborrheic distribution** (chest, back, forehead, and scalp). * **Exacerbating Factors:** A classic hallmark is **photo-exacerbation**; lesions characteristically flare up during the **summer** due to heat, humidity, and UV exposure. The positive family history in this case further supports an inherited condition. **Why the other options are incorrect:** * **A. Pemphigus foliaceus:** While it involves acantholysis and affects seborrheic areas, it presents with superficial blisters and erosions rather than persistent keratotic papules, and it lacks a strong genetic/hereditary pattern. * **B. Keratosis pilaris:** Presents as "goose-flesh" papules on the extensor surfaces of arms and thighs. It is not typically found in seborrheic areas and does not flare specifically with summer heat. * **D. Seborrheic dermatitis:** Though it occurs in the same distribution, it presents as erythematous plaques with greasy yellow scales (dandruff-like) rather than discrete keratotic papules, and it usually improves or remains stable in summer rather than worsening. **High-Yield Clinical Pearls for NEET-PG:** * **Nail Findings:** Pathognomonic **"V-shaped" nicking** at the distal margin and longitudinal red/white bands. * **Mucosal Findings:** "Cobblestone" appearance of the oral mucosa. * **Histopathology:** Look for **"Corps ronds"** (in the stratum spinosum) and **"Grains"** (in the stratum corneum). * **Hand Findings:** Palmar pits and punctate keratosis.
Question 10: The UK refinement of Hannifin and Rajka criteria is used in the diagnosis of which condition?
- A. Atopic dermatitis (Correct Answer)
- B. Nummular Eczema
- C. Eczema Herpeticum
- D. Contact dermatitis
Explanation: **Explanation:** The **UK Refinement of the Hanifin and Rajka Criteria** is the most widely used clinical tool for diagnosing **Atopic Dermatitis (AD)** in epidemiological studies and clinical practice. While the original Hanifin and Rajka criteria (1980) are considered the gold standard, they were deemed too cumbersome for routine use. The UK Working Party simplified these into a more practical set of criteria. To meet the UK diagnostic criteria, a patient must have an **itchy skin condition (pruritus)** plus three or more of the following: 1. History of involvement of the skin creases (flexural dermatitis). 2. Personal history of asthma or hay fever (or history of atopic disease in a first-degree relative if the child is under 4). 3. History of a general dry skin in the last year. 4. Visible flexural eczema. 5. Onset under the age of 2 years. **Analysis of Incorrect Options:** * **B. Nummular Eczema:** Characterized by coin-shaped, well-demarcated plaques; diagnosis is purely clinical and does not use these specific criteria. * **C. Eczema Herpeticum:** A viral complication (HSV-1) of AD; diagnosis is clinical or via Tzanck smear/PCR. * **D. Contact Dermatitis:** Diagnosed via history and **Patch Testing**, not the UK refinement criteria. **High-Yield Clinical Pearls for NEET-PG:** * **Hanifin & Rajka Criteria:** Consists of 4 Major and 23 Minor criteria (3 of each required for diagnosis). * **Atopic March:** The typical progression from Atopic Dermatitis → Food Allergy → Asthma → Allergic Rhinitis. * **Dennier-Morgan Fold:** An extra fold of skin under the lower eyelid, a minor criterion for AD. * **Filaggrin (FLG) Mutation:** The most common genetic association with Atopic Dermatitis.
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