Dermabrasion and Microdermabrasion — MCQs
Which of the following are treatment options for acne vulgaris?
A 27-year-old sexually active male develops a vesiculobullous lesion on the glans shortly after taking a tablet of paracetamol for fever. The lesion healed with hyperpigmentation. What is the most likely diagnosis?
A patient consults a dermatologist about a skin lesion on her neck. Examination reveals a 1-cm diameter, red, scaly plaque with a rough texture and irregular margins. Biopsy demonstrates epidermal cells with large, pleomorphic, hyperchromatic nuclei. What is the most likely diagnosis?
Which anatomical structure is most commonly the target of incisions during major gynecological surgical procedures?
Microabrasion using modified Croll technique utilizes:
A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?
Potato nose is seen in ?
Identify the lesion: (Recent NEET Pattern 2016-17)
Unna boot is used for the treatment of which condition?
Dermabrasion and Microdermabrasion Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following are treatment options for acne vulgaris?
- A. Isotretinoin
- B. All of the options (Correct Answer)
- C. Topical erythromycin
- D. Oral Minocycline
Explanation: ***All of the options*** - All listed options (Isotretinoin, Topical erythromycin, and Oral Minocycline) are well-established and commonly used **treatment options for acne vulgaris**, depending on the severity and type of acne. - The choice of treatment often follows a stepped approach, starting with topical agents for mild to moderate acne and progressing to oral medications like antibiotics or isotretinoin for more severe or resistant cases. *Isotretinoin* - **Isotretinoin** is a powerful oral retinoid primarily used for **severe, recalcitrant nodular acne** that has not responded to other treatments. - It works by reducing sebum production, follicular hyperkeratinization, inflammation, and the growth of *P. acnes*. *Topical erythromycin* - **Topical erythromycin** is an **antibiotic** used to treat mild to moderate inflammatory acne by reducing the growth of *Cutibacterium acnes* (formerly *Propionibacterium acnes*) and decreasing inflammation. - It is often combined with other topical agents like benzoyl peroxide to minimize the development of **antibiotic resistance**. *Oral Minocycline* - **Oral minocycline** is a **tetracycline antibiotic** used for moderate to severe inflammatory acne. - It reduces bacterial populations on the skin and exhibits **anti-inflammatory properties**, making it effective for widespread or deeper lesions.
Question 2: A 27-year-old sexually active male develops a vesiculobullous lesion on the glans shortly after taking a tablet of paracetamol for fever. The lesion healed with hyperpigmentation. What is the most likely diagnosis?
- A. Behcet's syndrome
- B. Herpes genitalis
- C. Fixed drug eruption (Correct Answer)
- D. Pemphigus vulgaris
Explanation: ***Fixed drug eruption*** - A **fixed drug eruption** is highly suggested by the development of a solitary **vesiculobullous lesion** on the glans shortly after taking **paracetamol**, which then heals with **hyperpigmentation**. The recurrence at the same site upon re-exposure to the drug is a hallmark. - The rapid appearance following drug intake and the consistent site of eruption with residual pigmentation are classic features. *Behcet's syndrome* - Behcet's syndrome is a **multisystemic inflammatory disorder** characterized by recurrent **oral** and **genital ulcers**, skin lesions, and ocular inflammation. - While it involves genital ulcers, its recurrent nature, systemic symptoms (like uveitis or neurological manifestations), and lack of a clear drug trigger differentiate it from this presentation. *Herpes genitalis* - Herpes genitalis presents with clusters of small, painful, itching **vesicles** often on an erythematous base, but it is caused by the **herpes simplex virus (HSV)** and is sexually transmitted, not drug-induced. - Lesions from herpes typically recur due to viral reactivation, but not in response to a specific medication, and typically resolve without significant hyperpigmentation unless secondary infection occurs. *Pemphigus vulgaris* - Pemphigus vulgaris is a rare, severe **autoimmune blistering disease** affecting the skin and mucous membranes, characterized by **flaccid bullae** that rupture easily, leading to erosions. - This condition presents with widespread blistering, not a solitary, drug-induced lesion, and typically does not heal with localized hyperpigmentation in this manner.
Question 3: A patient consults a dermatologist about a skin lesion on her neck. Examination reveals a 1-cm diameter, red, scaly plaque with a rough texture and irregular margins. Biopsy demonstrates epidermal cells with large, pleomorphic, hyperchromatic nuclei. What is the most likely diagnosis?
- A. Dermal nevus
- B. Actinic keratosis (Correct Answer)
- C. Junctional nevus
- D. Compound nevus
Explanation: ***Actinic keratosis*** - This diagnosis aligns with the description of a **red, scaly plaque** with a **rough texture** and **irregular margins**, which are classic clinical features of actinic keratosis. - The biopsy findings of epidermal and dermal cells with **large, pleomorphic, hyperchromatic nuclei** are consistent with **atypical keratinocytes**, a hallmark of actinic keratosis, indicating **premalignant change**. *Dermal nevus* - A dermal nevus is a **benign melanocytic lesion** that typically presents as a smooth, flesh-colored to light brown papule or nodule, not a scaly or rough plaque. - Histologically, it would show nests of nevus cells primarily in the **dermis** without the significant cellular atypia described. *Junctional nevus* - A junctional nevus is a **benign melanocytic lesion** characterized by nests of nevus cells located at the **dermoepidermal junction**. - Clinically, it appears as a flat or slightly raised, well-demarcated macule or papule, usually uniform in color, lacking the scaly, rough, and irregular features of the presented lesion. *Compound nevus* - A compound nevus is a **benign melanocytic lesion** with nevus cell nests present at both the **dermoepidermal junction** and within the dermis. - It typically presents as a raised, pigmented papule or nodule with a smooth or slightly warty surface, not a scaly plaque with irregular margins.
Question 4: Which anatomical structure is most commonly the target of incisions during major gynecological surgical procedures?
- A. Ovary
- B. Cervix
- C. Fallopian tube
- D. Uterus (Correct Answer)
Explanation: ***Uterus*** - The **uterus** is the primary anatomical target for many major gynecological procedures, such as **hysterectomy** (removal of the uterus) and **myomectomy** (removal of fibroids from the uterus). - These are among the most commonly performed major gynecological surgeries, making the uterus the most frequent target for incisions in gynecological practice. - In obstetric procedures, the uterus is also incised during **cesarean sections**, highlighting its central role in both obstetric and gynecologic surgery. *Ovary* - While ovaries are involved in gynecological surgery (e.g., **oophorectomy**, cystectomy), they are not as frequently the *primary* target for incisions as the uterus in the context of major procedures. - Ovarian surgeries are often performed for **cysts**, **tumors**, or in conjunction with hysterectomy, but are less common than uterine procedures. - Many ovarian procedures can be managed laparoscopically without major incisions. *Cervix* - The **cervix** is incised in procedures like **trachelectomy** for cervical cancer or during specific cervical cerclage procedures, but these are less frequent compared to surgeries involving the uterine body itself. - Many cervical procedures are considered minor (e.g., LEEP, cone biopsy) or are part of a larger uterine surgery. *Fallopian tube* - The **fallopian tubes** are primarily targeted for procedures like **salpingectomy** (removal of the tube, often for ectopic pregnancy or sterilization) or salpingostomy. - While significant, these procedures are generally less common than those involving the uterus and overall less frequently associated with major incisions compared to uterine procedures.
Question 5: Microabrasion using modified Croll technique utilizes:
- A. 5% HF
- B. 37% Phosphoric Acid
- C. 10% HCl
- D. 18% Citric acid (Correct Answer)
Explanation: ***18% Citric acid*** - The modified Croll technique for **microabrasion** specifically utilizes an 18% solution of **citric acid**. - This technique is effective for removing superficial enamel discolorations and opacities by gently abrading the affected surface. *5% HF* - **Hydrofluoric acid (HF)** is a highly corrosive acid primarily used by **dental technicians** for etching ceramic restorations, not for in-office microabrasion on natural teeth. - Due to its extreme toxicity and potential for severe tissue damage, HF is generally not used intraorally for enamel procedures. *37% Phosphoric Acid* - **37% phosphoric acid** is routinely used in dentistry as an **etchant** to prepare enamel and dentin surfaces for bonding procedures, creating a microporous surface for resin penetration. - Its mechanism is to demineralize the tooth surface to enhance adhesion, not to mechanically abrade or remove superficial stains in the same manner as microabrasion. *10% HCl* - While hydrochloric acid (HCl) was historically used in earlier microabrasion techniques, the **modified Croll technique** specifically moved to **citric acid** due to its gentler nature and reduced potential for adverse effects on tooth structure compared to stronger acids. - Stronger concentrations of HCl can be more aggressive and carry a higher risk of excessive enamel removal or chemical burns if not carefully controlled.
Question 6: A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
- A. 3rd degree burn (Correct Answer)
- B. 2nd degree superficial
- C. 2nd degree deep
- D. 1st degree
Explanation: ***3rd degree burn*** - **Third-degree burns** involve the entire thickness of the skin (dermis and epidermis) and often extend into the **subcutaneous tissue**, muscle, or bone. - These burns typically appear dry, leathery, and often lack pain sensation due to nerve destruction. *2nd degree superficial* - **Superficial second-degree burns** involve the epidermis and the superficial part of the dermis, often presenting with **blisters** and painful, red, moist skin. - They do not extend to the subcutaneous tissue, which is a key feature of the burn described. *2nd degree deep* - **Deep second-degree burns** involve the epidermis and deeper layers of the dermis, but not the entire dermis or subcutaneous tissue. - While they can be less painful and appear dry, the involvement of **subcutaneous tissue** pushes the classification to third-degree. *1st degree* - **First-degree burns** only affect the epidermis, causing redness and pain but **no blistering** or damage to deeper layers. - These are typically sunburns or minor scalds and do not involve the dermis or subcutaneous tissue.
Question 7: For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?
- A. Mohs surgery (Correct Answer)
- B. Superficial laser surgery
- C. Curettage and electrodesiccation
- D. Wide local excision
Explanation: ***Mohs surgery*** - **Mohs micrographic surgery** is the most popular and highly effective procedure specifically designed for **basal cell carcinoma (BCC)**, especially on the face and other cosmetically sensitive areas. - It involves the **progressive removal** of thin layers of skin, which are immediately examined under a microscope, allowing for complete tumor removal while preserving maximum healthy tissue. - Mohs surgery has the **highest cure rate** (95-99%) for BCC and is particularly preferred for high-risk locations, recurrent tumors, and poorly defined borders. *Superficial laser surgery* - While lasers can sometimes be used for very superficial skin lesions, **superficial laser surgery** is generally not the primary treatment for established **BCC** due to the risk of incomplete removal and recurrence. - It lacks the **histological margin control** provided by Mohs surgery, which is crucial for ensuring complete eradication of BCC. *Curettage and electrodesiccation* - **Curettage and electrodesiccation** is an alternative surgical treatment for small, low-risk BCCs in non-critical areas. - However, it has **lower cure rates** (85-95%) compared to Mohs surgery and does not provide histological margin assessment. - It is less preferred for facial BCCs where cosmetic outcome and complete removal are critical. *Wide local excision* - **Wide local excision** is a standard surgical approach that removes the tumor with predetermined margins (typically 4-5 mm for BCC). - While effective, it requires **larger tissue removal** compared to Mohs surgery and lacks the real-time microscopic margin control. - Mohs surgery remains more popular due to its tissue-sparing nature and higher cure rates, especially in cosmetically sensitive areas.
Question 8: Potato nose is seen in ?
- A. Acne vulgaris
- B. Rhinosporoidosis
- C. Acne rosacea (Correct Answer)
- D. Lupus vulgaris
Explanation: ***Acne rosacea*** - **Potato nose**, also known as **rhinophyma**, is a severe manifestation of **acne rosacea**, characterized by thickened, red, and bumpy skin on the nose. - This condition results from **hyperplasia of sebaceous glands** and connective tissue in the nose, leading to its characteristic bulbous appearance. *Acne vulgaris* - This common skin condition is characterized by **comedones**, **papules**, **pustules**, and sometimes cysts, primarily on the face, chest, and back. - It does **not typically cause rhinophyma** or significant thickening of nasal skin. *Rhinosporoidosis* - This is a **chronic granulomatous fungal infection** affecting mucous membranes, particularly the nose. - While it can cause nasal polyps and masses, it does **not result in the sebaceous gland hyperplasia** and thickened skin characteristic of rhinophyma. *Lupus vulgaris* - Lupus vulgaris is a chronic and progressive form of **cutaneous tuberculosis**, often affecting the face. - It presents with **reddish-brown plaques** and nodules that can ulcerate and scar but does **not lead to the specific nasal hypertrophy** seen in rhinophyma.
Question 9: Identify the lesion: (Recent NEET Pattern 2016-17)
- A. Erythema multiforme (Correct Answer)
- B. Gianotti-Crosti syndrome
- C. Pityriasis rosea
- D. Acne rosacea
Explanation: ***Erythema multiforme*** - The image displays characteristic **targetoid lesions** with multiple concentric rings of color (erythema, edema, pallor), typical of **erythema multiforme**. - These lesions often appear suddenly, symmetrically, and commonly on the extremities, often triggered by infections (e.g., **herpes simplex virus**) or medications. *Gianotti-Crosti syndrome* - Characterized by **monomorphic, flesh-colored to erythematous papules** and papulovesicles, often on the cheeks, buttocks, and extensor surfaces of the limbs. - This condition is typically observed in **children** after viral infections and does not usually present with target lesions. *Pityriasis rosea* - Starts with a single **"herald patch,"** followed by smaller, oval, pinkish-red patches with fine scales, often arranged in a **"Christmas tree pattern"** on the trunk. - The morphology of the lesions in the image, specifically the targetoid appearance, is not consistent with pityriasis rosea. *Acne rosacea* - Marked by **facial erythema**, papules, pustules, and telangiectasias, primarily affecting the central face. - It does not present with the widespread, distinct target lesions seen in the image.
Question 10: Unna boot is used for the treatment of which condition?
- A. Diabetic foot ulcer
- B. Varicose ulcers (Correct Answer)
- C. Ankle instability
- D. Calcaneum fracture
Explanation: **Explanation:** The **Unna boot** is a specialized compression dressing used primarily for the management of **venous stasis ulcers (varicose ulcers)**. It consists of a zinc oxide-impregnated bandage, often containing calamine and glycerin, which is wrapped around the lower leg from the base of the toes to just below the knee. **Why it is the correct answer:** The mechanism of action is based on **compression therapy**. As the bandage dries, it becomes semi-rigid. When the patient walks, the calf muscles contract against this rigid barrier, significantly enhancing the **musculovenous pump** efficiency. This reduces venous hypertension, decreases edema, and promotes the healing of chronic venous ulcers. **Analysis of Incorrect Options:** * **Diabetic foot ulcer:** These are primarily neuropathic or ischemic. Treatment focuses on offloading pressure (e.g., total contact casts) and revascularization, rather than the semi-rigid compression provided by an Unna boot. * **Ankle instability:** This requires mechanical stabilization via braces, taping, or surgical intervention to protect ligaments, not a medicated compression wrap. * **Calcaneum fracture:** Fractures require rigid immobilization (plaster casts) or surgical fixation. An Unna boot does not provide sufficient structural support for bone healing. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Zinc oxide (promotes healing), Calamine (soothes skin), and Glycerin. * **Contraindication:** It should **not** be used in patients with severe Peripheral Arterial Disease (ABI < 0.5) as compression can worsen ischemia. * **Application:** It is typically changed once a week. * **Gold Standard:** While Unna boots are classic, multilayer compression wraps are now often considered the gold standard for venous ulcers.
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