Neonatal Dermatology — MCQs

10 questions

Dermatitis may be a clinical manifestation of deficiency states of all of the following nutrients except -

A child with fever presents with multiple tender erythematous skin lesions, and on microscopic examination, the skin lesions are found to have neutrophilic infiltration in the dermis. What is the diagnosis?

A child has a rash. His family history is positive for asthma. What could be the most probable diagnosis?

The following findings on Tzanck smear can be seen in:

A child presents with grouped vesicles on an erythematous base on the buttocks. What is the most likely diagnosis?

What is the correct term for candidiasis of the penis?

Which of the following is not a feature of dermatomyositis?

Potato nose is seen in ?

Q10

Which of the following is the MOST characteristic feature of skin tags (acrochordons)?

Neonatal Dermatology Indian Medical PG Practice Questions and MCQs

Question 1: Dermatitis may be a clinical manifestation of deficiency states of all of the following nutrients except -

A. Biotin
B. Niacin
C. Pyridoxine
D. Thiamine (Correct Answer)

Explanation: ***Thiamine*** - A deficiency in **thiamine (vitamin B1)** primarily affects the nervous and cardiovascular systems, leading to conditions like **beriberi**, characterized by neuropathy, heart failure, and Wernicke-Korsakoff syndrome. - Dermatitis is **not a typical or direct clinical manifestation** of thiamine deficiency. *Biotin* - **Biotin (vitamin B7)** deficiency can cause **dermatitis**, often described as a scaly, erythematous rash around the eyes, nose, and mouth. - Hair loss (**alopecia**) and **neurological symptoms** are also associated with biotin deficiency. *Niacin* - **Niacin (vitamin B3)** deficiency leads to **pellagra**, classically presenting with the "3 Ds": **dermatitis**, **diarrhea**, and **dementia**. - The dermatitis in pellagra is typically symmetrical and photosensitive, affecting sun-exposed areas. *Pyridoxine* - **Pyridoxine (vitamin B6)** deficiency can result in **seborrheic dermatitis-like rash**, especially around the eyes, nose, and mouth. - Other symptoms include **glossitis**, **cheilosis**, and **neurological disturbances** like peripheral neuropathy.

Question 2: A child with fever presents with multiple tender erythematous skin lesions, and on microscopic examination, the skin lesions are found to have neutrophilic infiltration in the dermis. What is the diagnosis?

A. Sweet syndrome (Correct Answer)
B. Behcet's syndrome
C. Pyoderma gangrenosum
D. Leukemia cutis

Explanation: ***Sweet syndrome*** - **Sweet syndrome**, also known as acute febrile neutrophilic dermatosis, presents with **fever**, **tender erythematous plaques**, and a characteristic histology of **dense neutrophilic infiltrate in the dermis** without vasculitis. - It is often triggered by **infection**, malignancy, or drugs and is more common in women, though it can occur in children. *Behçet's syndrome* - **Behçet's syndrome** is a multisystem vasculitis characterized by **recurrent oral and genital ulcers**, uveitis, and skin lesions such as erythema nodosum or papulopustular lesions, but not typically the specific neutrophilic dermatosis seen here. - The hallmark is **recurrent aphthous ulceration**, which is not mentioned in the patient's presentation. *Pyoderma gangrenosum* - **Pyoderma gangrenosum** presents as rapidly enlarging, **painful necrotic ulcers** with undermined purplish borders, often associated with inflammatory bowel disease or hematological disorders. - While it also involves neutrophilic infiltration, the clinical presentation of **tender erythematous plaques without ulceration** is not typical. *Leukemia cutis* - **Leukemia cutis** refers to infiltration of the skin by leukemic cells, which can present as papules, nodules, or plaques with **neutrophilic (myeloid) infiltration** on histology. - However, it typically occurs in patients with **known or occult hematologic malignancy**, and the lesions are usually **non-tender** and may have a violaceous hue, unlike the tender erythematous plaques of Sweet syndrome. - Sweet syndrome itself can be **paraneoplastic** and associated with myeloid malignancies, making the distinction important.

Question 3: A child has a rash. His family history is positive for asthma. What could be the most probable diagnosis?

A. Seborrheic dermatitis
B. Atopic dermatitis (Correct Answer)
C. Allergic contact dermatitis
D. Erysipelas

Explanation: ***Atopic dermatitis*** - The presence of a rash in a child with a family history of **asthma** strongly suggests atopic dermatitis, as it is part of the **atopic triad** (eczema, asthma, allergic rhinitis). - Atopic dermatitis often presents with **erythematous, pruritic patches** and plaques, commonly affecting flexural areas like the antecubital and popliteal fossae, as well as the face and neck in younger children. *Seborrheic dermatitis* - This condition typically presents with **greasy, yellowish scales** on an erythematous base, often affecting areas rich in sebaceous glands such as the scalp, face (nasolabial folds), and chest. - While it can occur in infants, it does not have the strong association with a family history of asthma seen in atopic dermatitis. *Allergic contact dermatitis* - This rash results from an **exposure to an allergen**, leading to a localized, erythematous, and pruritic eruption, often with vesicles or bullae, at the site of contact. - The history does not provide information about a specific allergen exposure, and while it could produce a similar-looking rash, the family history of asthma points more strongly to atopic diathesis. *Erysipelas* - Erysipelas is a superficial skin infection, usually caused by *Streptococcus pyogenes*, presenting as a **well-demarcated, intensely erythematous, warm, and painful rash** with a raised border. - This is an **acute bacterial infection** and would typically be accompanied by systemic symptoms like fever and chills, which are not mentioned in the child's presentation.

Question 4: The following findings on Tzanck smear can be seen in:

A. Herpes simplex
B. Herpes zoster
C. Paraneoplastic pemphigus
D. All of the above (Correct Answer)

Explanation: ***All of the above*** - The image displays multiple **acantholytic cells** (keratinocytes that have lost intercellular connections) with prominent nuclei, which are characteristic findings in several dermatological conditions. - A **Tzanck smear** is a rapid cytological test performed by scraping the base of a fresh blister, staining with Giemsa or Wright stain, and examining under microscopy. **Why all three conditions show similar findings:** *Herpes simplex* - Tzanck smear shows **multinucleated giant cells** with molding of nuclei and **balloon degeneration** of keratinocytes - Acantholytic cells are present due to viral cytopathic effect causing cell separation - These findings are **identical** to those seen in Herpes zoster *Herpes zoster* - Cannot be distinguished from Herpes simplex on Tzanck smear morphology alone - Shows the same **multinucleated giant cells** and **acantholytic keratinocytes** - Viral culture, PCR, or direct fluorescent antibody (DFA) testing needed for definitive differentiation *Paraneoplastic pemphigus* - Shows **acantholytic cells** (rounded keratinocytes with hyperchromatic nuclei) due to autoantibody-mediated destruction of intercellular adhesion - Unlike herpes infections, typically shows acantholytic cells **without** multinucleated giant cells - Definitive diagnosis requires direct immunofluorescence (DIF) on skin biopsy showing intercellular and basement membrane zone IgG/C3 deposition **Note**: While Tzanck smear can show acantholytic cells in all three conditions, the **pattern differs** - herpes shows multinucleated giant cells prominently, while pemphigus shows isolated acantholytic cells. Clinical correlation and confirmatory tests are essential for accurate diagnosis.

Question 5: A child presents with grouped vesicles on an erythematous base on the buttocks. What is the most likely diagnosis?

A. Bullous impetigo
B. Dermatitis herpetiformis
C. Pemphigus
D. Herpes simplex (Correct Answer)

Explanation: ***Herpes simplex*** - Herpes simplex virus (HSV) classically presents with **grouped vesicles on an erythematous base**, which perfectly matches this clinical presentation. - In **children**, HSV commonly affects the **buttocks** through autoinoculation or direct contact, especially in the diaper area. - The lesions are typically **painful and pruritic**, and may be preceded by tingling or burning sensation. - Diagnosis is confirmed by **Tzanck smear** (multinucleated giant cells), **PCR**, or **viral culture**. - Treatment includes **acyclovir** or other antivirals, especially for severe or recurrent cases. *Dermatitis herpetiformis* - While DH does present with intensely pruritic, grouped vesicles on an erythematous base, it is **extremely rare in children** and typically presents in **adults (3rd-4th decade)**. - Classic sites include **extensor surfaces** (elbows, knees), scalp, and buttocks, but the pediatric presentation makes this diagnosis unlikely. - It is strongly associated with **celiac disease** and responds to **gluten-free diet** and **dapsone**. *Bullous impetigo* - Bullous impetigo presents with **flaccid bullae** that rupture to form **honey-colored crusts**, not grouped vesicles. - It is a **bacterial infection** caused by *Staphylococcus aureus* producing exfoliative toxin. - Common in **young children**, particularly in warm, humid conditions. *Pemphigus* - Pemphigus is **extremely rare in children** and causes **fragile bullae** that easily rupture, leading to erosions. - Typically affects **mucous membranes first** (oral cavity), then skin. - It is an **autoimmune blistering disease** with antibodies against desmoglein, causing intraepidermal acantholysis.

Question 6: What is the correct term for candidiasis of the penis?

A. Oral thrush
B. No candidiasis present
C. Candidal balanitis (Correct Answer)
D. Leukoplakia

Explanation: ***Balanitis*** - **Candidiasis of the penis** is specifically referred to as Candidal balanitis, an inflammatory condition affecting the **glans penis**. - This term accurately describes the location and cause of the infection. *Oral thrush* - **Oral thrush** is candidiasis of the mouth, characterized by **white patches** on the tongue and oral mucosa. - This term refers to a different anatomical location and is not applicable to penile infection. *No candidiasis present* - This option is incorrect because candidiasis can indeed affect the penis, leading to a recognized clinical condition. - Symptoms like **redness, itching, and discharge** would indicate the presence of candidiasis. *Leukoplakia* - **Leukoplakia** is a condition characterized by **white patches** that develop on the mucous membranes of the mouth, tongue, or sometimes the genitals. - It is a **precancerous lesion** that is not caused by Candida infection, distinguishing it from balanitis.

Question 7: Which of the following is not a feature of dermatomyositis?

A. Salmon Patch (Correct Answer)
B. Periungual telangiectasias
C. Gottron's patch
D. Mechanic's hands

Explanation: ***Salmon Patch*** - A **salmon patch** (also known as a nevus simplex or stork bite) is a common, benign vascular birthmark that presents as a flat, red or pink patch. - It is **not associated with dermatomyositis** and has no pathogenic link to the condition. *Gottron's patch* - **Gottron's patches** are a classic cutaneous manifestation of dermatomyositis, characterized by erythematous, violaceous, or dusky red papules or plaques over the **extensor surfaces of the metacarpophalangeal and interphalangeal joints**. - Their presence is highly suggestive of dermatomyositis, often preceding or co-occurring with muscle weakness. *Periungual telangiectasias* - **Periungual telangiectasias** are dilated capillaries around the nail folds and are a common skin manifestation of dermatomyositis. - They represent small vessel vasculopathy, a histological feature, and suggest microvascular damage often seen in systemic connective tissue diseases like dermatomyositis. *Mechanic's hands* - **Mechanic's hands** are a cutaneous feature seen in dermatomyositis (and other inflammatory myopathies like antisynthetase syndrome). - They are characterized by **hyperkeratosis**, fissuring, and scaling of the skin, particularly on the lateral and palmar aspects of the fingers, resembling the hands of a manual laborer.

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: Match the following scale types with their lesions. | Scales | Lesions | | :-- | :-- | | 1. Collarette scales | a. Pityriasis versicolour | | 2. Silvery scales | b. Pityriasis rosea | | 3. Mica-like scales | c. Psoriasis | | 4. Branny scales | d. Pityriasis lichenoides |

A. 1-d, 2-c, 3-a, 4-b
B. 1-c, 2-b, 3-d, 4-a
C. 1-a, 2-b, 3-d, 4-c
D. 1-b, 2-c, 3-d, 4-a (Correct Answer)

Explanation: ***1-b, 2-c, 3-d, 4-a*** - **Collarette scales** are pathognomonic of **Pityriasis rosea**, appearing as fine, trailing scales around the periphery of oval lesions in a "Christmas tree" distribution. - **Silvery scales** are the classic hallmark of **Psoriasis**, presenting as thick, adherent, silvery-white scales overlying well-demarcated erythematous plaques. - **Mica-like scales** are characteristic of **Pityriasis lichenoides**, appearing as thick, shiny, adherent scales that can be peeled off like mica sheets. - **Branny scales** are typical of **Pityriasis versicolor**, presenting as fine, powdery scales caused by **Malassezia** yeast overgrowth. *1-d, 2-c, 3-a, 4-b* - Incorrectly matches **collarette scales with Pityriasis lichenoides**, which typically presents with mica-like scales, not collarette scales. - Misassociates **mica-like scales with Pityriasis versicolor**, which characteristically has branny (fine, powdery) scales. *1-c, 2-b, 3-d, 4-a* - Wrongly pairs **collarette scales with Psoriasis**, which is known for thick silvery scales, not peripheral collarette scales. - Incorrectly matches **silvery scales with Pityriasis rosea**, which has collarette scales at lesion periphery, not silvery scales. *1-a, 2-b, 3-d, 4-c* - Falsely associates **collarette scales with Pityriasis versicolor**, which has branny scales from yeast infection, not collarette scales. - Mismatches **branny scales with Psoriasis**, which has characteristic thick silvery scales, not fine powdery scales.

Question 10: Which of the following is the MOST characteristic feature of skin tags (acrochordons)?

A. They commonly occur on the neck and axilla.
B. They have malignant potential.
C. They are associated with seborrhoeic keratosis.
D. They are typically pedunculated. (Correct Answer)

Explanation: ***They are typically pedunculated.*** - **Skin tags (acrochordons)** are benign soft tissue tumors characterized by their **pedunculated morphology** - they are attached to the skin by a narrow stalk or pedicle. - This **pedunculated appearance** is the **most characteristic** and **defining feature** that distinguishes them from other benign skin lesions. - They are typically **soft, flesh-colored or hyperpigmented**, and range from 1-5 mm in size. *They commonly occur on the neck and axilla.* - While **skin tags** frequently occur in areas of friction such as the neck, axilla, eyelids, groin, and inframammary folds, this **location is not specific**. - Many other skin conditions also favor these sites, so location alone is not a characteristic diagnostic feature. *They are associated with seborrhoeic keratosis.* - There is **no established clinical association** between skin tags and seborrheic keratoses. - Both are common **benign skin growths** in adults but represent different pathological entities with different clinical appearances. *They have malignant potential.* - This is **incorrect**. Skin tags are **benign fibrous polyps** with **no malignant potential**. - They do not require removal unless symptomatic or for cosmetic reasons.

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