Tinea Versicolor — MCQs
A child of 7-8 years of age presents with scalp swelling and alopecia. What is the most appropriate diagnostic investigation?
A child comes with a circular 3cm x 3cm scaly patchy hair loss with itching in the lesions. The investigation of choice is
All the following drugs are effective in the treatment of Pityriasis Versicolor except:
Large unilateral hypopigmented lesions on the right trunk and arm in a female are best explained by which of the following?
Wood lamp is used to diagnose –
Tinea "incognito" is due to inappropriate use of systemic and topical:
A patient presents with annular, scaly plaques with perifollicular extension on the trunk. What is the most likely diagnosis?
A 7-year-old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hairs and lymph nodes enlarged in occipital region. Which one of the following would be most helpful for diagnostic evaluation?
A 24 year old man had multiple, small hypopigmented macules on the upper chest and back for the last three months. The macules were circular, arranged around follicles and many had coalesced to form large sheets. The surface of the macules showed fine scaling. He had similar lesions one year ago which subsided with treatment. The most appropriate investigation to confirm the diagnosis is -
A 10-year-old boy presented with painful boggy swelling of scalp, multiple sinuses, with purulent discharge, easily pluckable hair and lymph nodes enlarged in occipital region. Which will be most helpful for diagnostic evaluation?
Tinea Versicolor Indian Medical PG Practice Questions and MCQs
Question 1: A child of 7-8 years of age presents with scalp swelling and alopecia. What is the most appropriate diagnostic investigation?
- A. KOH staining of the scrapings (Correct Answer)
- B. Blood culture
- C. PAS staining
- D. Gram staining
Explanation: ***KOH staining of the scrapings*** - This presentation is highly suggestive of **tinea capitis**, a fungal infection of the scalp. **Potassium hydroxide (KOH) staining** of hair and scalp scrapings is the primary diagnostic method to identify fungal elements (hyphae and spores). - KOH dissolves keratinous material, making it easier to visualize the **fungal hyphae or spores** under a microscope. *Blood culture* - **Blood culture** is used to diagnose **systemic infections**, particularly bacterial or fungal infections that have entered the bloodstream. - It is **not indicated** for the initial diagnosis of localized skin and hair infections like tinea capitis. *PAS staining* - **Periodic acid–Schiff (PAS) staining** is primarily used for **histopathological examination** of tissue biopsies to detect fungi or other carbohydrates. - While it can identify fungi in tissue sections, it is **not the first-line diagnostic investigation** for tinea capitis, which typically uses direct microscopic examination of scrapings. *Gram staining* - **Gram staining** is a differential staining technique used to classify **bacteria** based on their cell wall properties (Gram-positive or Gram-negative). - It is **not effective** for identifying fungal organisms, which have different cell wall compositions.
Question 2: A child comes with a circular 3cm x 3cm scaly patchy hair loss with itching in the lesions. The investigation of choice is
- A. Tzanck smear
- B. Gram stain
- C. KOH mount (Correct Answer)
- D. Split skin smear
Explanation: ***Correct: KOH mount (Potassium Hydroxide mount)*** - A **KOH mount** is the investigation of choice for suspected **dermatophyte infections** (tinea capitis), which commonly present as circular, scaly patches of hair loss with itching in children. - It involves dissolving keratinous material to visualize **fungal hyphae** and spores directly under a microscope. - This is a quick, cost-effective, and highly specific first-line diagnostic test. *Incorrect: Tzanck smear* - A **Tzanck smear** is primarily used to diagnose **viral infections** like herpes simplex or varicella-zoster by identifying multinucleated giant cells. - It is not effective for detecting fungal elements responsible for scaly hair loss. *Incorrect: Gram stain* - A **Gram stain** is a technique used to classify **bacteria** based on their cell wall properties. - It would not reveal fungal hyphae or spores relevant to the described condition. *Incorrect: Split skin smear* - A **split skin smear** (or slit-skin smear) is typically used in the diagnosis of **leprosy** to identify acid-fast bacilli. - This technique involves scraping the dermis and is not suitable for diagnosing superficial fungal infections.
Question 3: All the following drugs are effective in the treatment of Pityriasis Versicolor except:
- A. Griseofulvin (Correct Answer)
- B. Clotrimazole
- C. Selenium Sulphide
- D. Ketoconazole
Explanation: ***Griseofulvin*** - **Griseofulvin** is an oral antifungal agent primarily effective against **dermatophytes** (tinea infections) by interfering with microtubule assembly and fungal cell division. - It is **ineffective against *Malassezia furfur***, the yeast responsible for Pityriasis Versicolor, as this organism is not a dermatophyte. *Clotrimazole* - **Clotrimazole** is a topical azole antifungal that inhibits **lanosterol 14-alpha-demethylase**, a crucial enzyme in fungal ergosterol synthesis, making it effective against *Malassezia furfur*. - It works by disrupting the **fungal cell membrane**, leading to its fungistatic and fungicidal properties. *Selenium Sulphide* - **Selenium Sulphide** is a topical antifungal agent that acts as a **cytostatic agent**, reducing the growth rate of epidermal cells and inhibiting the growth of *Malassezia furfur*. - It is commonly used in **shampoos and lotions** for treating Pityriasis Versicolor, often applied as a lather and left on the skin. *Ketoconazole* - **Ketoconazole** is another azole antifungal, available in both topical and oral forms, effective against *Malassezia furfur* by inhibiting **ergosterol synthesis**. - Its broad-spectrum antifungal activity makes it a common and effective treatment for **Pityriasis Versicolor**.
Question 4: Large unilateral hypopigmented lesions on the right trunk and arm in a female are best explained by which of the following?
- A. Autoimmune theory
- B. Neurogenic theory (Correct Answer)
- C. Genetic predisposition
- D. Lerner's self-destruct theory
Explanation: ***Neurogenic theory*** - This theory posits that **neural mechanisms** play a role in the development of some hypopigmented disorders. The **unilateral distribution** along a dermatome or nerve pathway strongly supports a neurogenic origin. - The **large, unilateral hypopigmented lesions on the right trunk and arm** are characteristic of conditions like **segmental vitiligo** or **hypopigmentation following nerve injury**, where neural factors are implicated in melanocyte dysfunction. *Autoimmune theory* - The autoimmune theory explains **generalized vitiligo**, where the body's immune system attacks melanocytes, leading to widespread depigmentation. - It does not account for the **segmental, unilateral distribution** observed in this case, which is typically not seen in autoimmune conditions. *Genetic predisposition* - While genetics can increase susceptibility to certain pigmentary disorders, it does not explain the **unilateral, segmental pattern** of hypopigmentation. - Genetic factors usually lead to more generalized or bilateral presentations rather than a localized, nerve-distribution pattern. *Lerner's self-destruct theory* - **Lerner's self-destruct theory** suggests that melanocytes may destroy themselves from within due to metabolic defects or oxidative stress. - This theory also fails to explain the **unilateral, dermatomal distribution** of the lesions, as self-destruction would likely occur more randomly or symmetrically.
Question 5: Wood lamp is used to diagnose –
- A. Erysipelas
- B. Pityriasis rosea
- C. Psoriasis
- D. Tinea versicolor (Correct Answer)
Explanation: ***Tinea versicolor*** - A Wood lamp is used to diagnose **tinea versicolor** by revealing a characteristic **yellow-green fluorescence** of the affected areas due to the production of **porphyrins** by the causative yeast, *Malassezia*. - This specific fluorescence helps differentiate **tinea versicolor** from other skin conditions that may have a similar appearance. *Erysipelas* - **Erysipelas** is a superficial bacterial skin infection, typically diagnosed based on its **clinical presentation** of a rapidly spreading, fiery red, tender, and sharply demarcated rash. - A Wood lamp is **not used** in the diagnosis of erysipelas, as it does not cause any specific fluorescence under UV light. *Pityriasis rosea* - **Pityriasis rosea** is a self-limiting inflammatory skin rash, usually diagnosed clinically by its distinctive morphology, including a **herald patch** followed by smaller, oval, fawn-colored lesions in a "Christmas tree" pattern. - A Wood lamp examination would **not show any specific fluorescence** indicative of pityriasis rosea. *Psoriasis* - **Psoriasis** is a chronic autoimmune skin condition characterized by well-demarcated, erythematous plaques covered with silvery scales, typically diagnosed through **clinical examination** and sometimes a skin biopsy. - A Wood lamp is **not a diagnostic tool** for psoriasis, as psoriatic lesions do not fluoresce in a characteristic manner under UV light.
Question 6: Tinea "incognito" is due to inappropriate use of systemic and topical:
- A. Steroids (Correct Answer)
- B. Antibiotics
- C. Antivirals
- D. Antifungals
Explanation: ***Steroids*** - The use of **topical or systemic steroids** can mask the typical presentation of tinea infections, leading to a modified appearance known as tinea "incognito." - Steroids reduce inflammation and symptoms like itching and redness, but they do not eliminate the fungal infection, often allowing it to spread or become more extensive. *Antibiotics* - Antibiotics are used to treat **bacterial infections** and have no direct effect on fungal organisms that cause tinea. - While inappropriate use of antibiotics can lead to other issues, it does not cause the characteristic presentation of tinea incognito. *Antivirals* - Antivirals are specifically used for **viral infections** and are ineffective against fungal pathogens. - Their use would not lead to the altered clinical presentation of a tinea infection. *Antifungals* - Antifungals are the direct treatment for tinea infections; however, their **inappropriate or insufficient use** might lead to treatment failure or resistance, but not the "incognito" appearance. - Tinea incognito specifically arises when inflammatory agents like steroids suppress visible signs without eradicating the fungus.
Question 7: A patient presents with annular, scaly plaques with perifollicular extension on the trunk. What is the most likely diagnosis?
- A. Psoriasis
- B. Lichen planus
- C. Tinea (Correct Answer)
- D. Pityriasis versicolor
Explanation: ***Tinea*** - **Tinea corporis** classically presents with **annular, scaly plaques with central clearing** and an active, raised border. - On hairy areas or with follicular involvement, dermatophyte infections show **perifollicular extension** as the fungus invades hair follicles. - The **annular morphology with scale** is pathognomonic for dermatophyte infection, confirmed by **KOH preparation** showing septate hyphae. - Common sites include trunk, limbs, and any body area with hair follicles. *Psoriasis* - Presents with **well-demarcated, erythematous plaques** with **silvery-white scales**, typically on extensor surfaces (elbows, knees, scalp). - **Follicular psoriasis** is rare and shows **pinpoint follicular papules**, not annular plaques with perifollicular extension. - Auspitz sign (pinpoint bleeding on scale removal) helps differentiate from tinea. *Lichen planus* - Characterized by **pruritic, polygonal, purple, planar papules** (the "6 Ps"). - **Lichen planopilaris** (follicular variant) causes **scarring alopecia** with follicular hyperkeratosis, not annular scaly plaques. - Wickham striae may be visible on mucosal surfaces. *Pityriasis versicolor* - Caused by **Malassezia species**, presents as **hypo- or hyperpigmented macules** with fine scale on trunk and upper arms. - **Follicular variant** (pityriasis folliculorum) shows discrete follicular papules, NOT annular plaques. - "Spaghetti and meatballs" appearance on KOH prep (short hyphae and spores) differentiates from dermatophytes.
Question 8: A 7-year-old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hairs and lymph nodes enlarged in occipital region. Which one of the following would be most helpful for diagnostic evaluation?
- A. Bacterial culture
- B. Biopsy
- C. KOH mount (Correct Answer)
- D. Patch test
Explanation: ***KOH mount*** - The symptoms described (painful boggy swelling of the scalp, multiple sinuses with purulent discharge, easily pluckable hairs, and occipital lymph nodes) are highly characteristic of **kerion celsi**, a severe inflammatory form of **tinea capitis**. - A **KOH mount** is the most direct and rapid method to confirm a fungal infection by visualizing fungal elements (hyphae and spores) from removed hairs or scalp scrapings. - It is the **first-line diagnostic test** for tinea capitis, providing results within minutes and having high specificity when positive. *Bacterial culture* - While there is purulent discharge, the primary pathology in kerion is fungal, not bacterial. Bacterial culture would likely show **secondary infection** rather than the underlying cause. - Antibiotics alone would not resolve the fungal infection, making a bacterial culture less helpful for the primary diagnosis. *Biopsy* - A biopsy would be more invasive and reveal an inflammatory reaction, but it is **not the first-line diagnostic test** for suspected tinea capitis. - While it can demonstrate fungal elements, a **KOH mount** is much quicker, less invasive, and equally effective for initial diagnosis. *Patch test* - A patch test is used to identify **allergic contact dermatitis** by applying specific allergens to the skin. - It is completely irrelevant for diagnosing a fungal infection like kerion celsi, which is an infection, not an allergic reaction.
Question 9: A 24 year old man had multiple, small hypopigmented macules on the upper chest and back for the last three months. The macules were circular, arranged around follicles and many had coalesced to form large sheets. The surface of the macules showed fine scaling. He had similar lesions one year ago which subsided with treatment. The most appropriate investigation to confirm the diagnosis is -
- A. Potassium hydroxide preparation of scales (Correct Answer)
- B. Slit skin smear from discrete macules
- C. Skin biopsy of coalesced macules
- D. Tzanck test
Explanation: ***Potassium hydroxide preparation of scales*** - The description of **hypopigmented macules** with **fine scaling** on the upper chest and back, which coalesced and recurred, is highly suggestive of **Pityriasis versicolor** (also known as Tinea versicolor). - A **potassium hydroxide (KOH) preparation** of the scales directly visualizes the fungal elements (**hyphae and spores**, often described as "spaghetti and meatballs" appearance), confirming the diagnosis. *Slit skin smear from discrete macules* - A **slit skin smear** is primarily used for diagnosing mycobacterial infections, particularly **leprosy**, to detect acid-fast bacilli. - This procedure is not appropriate for diagnosing superficial fungal infections like Pityriasis versicolor. *Skin biopsy of coalesced macules* - While a **skin biopsy** can show fungal elements in the stratum corneum, it is an invasive and generally unnecessary procedure for diagnosing Pityriasis versicolor. - **KOH preparation** is a faster, simpler, and less invasive method that provides a definitive diagnosis. *Tzanck test* - The **Tzanck test** is used to identify multinucleated giant cells characteristic of viral infections, such as **herpes simplex virus** or **varicella-zoster virus**. - It involves scraping the base of a vesicle or bulla, which is not consistent with the described presentation of scaling macules.
Question 10: A 10-year-old boy presented with painful boggy swelling of scalp, multiple sinuses, with purulent discharge, easily pluckable hair and lymph nodes enlarged in occipital region. Which will be most helpful for diagnostic evaluation?
- A. Tests for allergic, bacterial, and viral causes
- B. KOH mount (Correct Answer)
- C. Microbiological culture
- D. Histopathological examination
Explanation: ***KOH mount*** - The clinical presentation of a **painful boggy scalp swelling**, **purulent discharge**, **easily pluckable hair**, and **occipital lymphadenopathy** is highly suggestive of **kerion**, a severe inflammatory form of **tinea capitis**. - A **KOH mount** is the most rapid and cost-effective diagnostic test for confirming a fungal infection by directly visualizing fungal elements (hyphae, spores) in hair shafts and scales. *Tests for allergic, bacterial, and viral causes* - While other infections might cause scalp swelling, the specific features of **easily pluckable hair** and a **boggy swelling with purulent discharge** point away from common bacterial or viral infections. - Allergic reactions typically present with itching and erythema, not necessarily with purulent discharge or hair loss. *Microbiological culture* - **Fungal culture** is indeed important for species identification and guiding treatment; however, it takes several days to yield results. - A **KOH mount** provides immediate confirmation of fungal infection, which is crucial for initiating timely treatment in a condition like kerion. *Histopathological examination* - A **biopsy with histopathological examination** can confirm fungal infection and assess the extent of inflammation. - However, it is an invasive procedure and not the first-line diagnostic test for suspected tinea capitis with kerion, especially given the ease and speed of a KOH mount.
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