Therapeutic Considerations in Pediatric Dermatology — MCQs
Molluscum contagiosum is caused by a:
Which of the following is a contraindication to topical steroids?
All the following drugs are effective in the treatment of Pityriasis Versicolor except:
Eleven-month-old child presents with an erythematous lesion that has been decreasing in size. What is the most likely diagnosis?
Which of the following statements about molluscum contagiosum is FALSE?
Topical steroids are most effective in:
The following patient presented to the OPD with history of hair loss. There was no erythema, scarring or scratching. Diagnosis is:
Which of the following is not a part of P. versicolor treatment -
A child presents with a history of hypopigmented macules on the back, infantile spasms, and delayed milestones. What is the most likely diagnosis?
A 14-year-old boy presents with seizures and skin macules. What is the probable diagnosis?
Therapeutic Considerations in Pediatric Dermatology Indian Medical PG Practice Questions and MCQs
Question 1: Molluscum contagiosum is caused by a:
- A. Flavi virus
- B. Adenovirus
- C. Rubivirus
- D. Pox virus (Correct Answer)
Explanation: ***Pox virus*** - **Molluscum contagiosum** is a common **cutaneous viral infection** caused by the **Molluscum Contagiosum Virus (MCV)**. - MCV belongs to the **Poxviridae family**, which are known for causing characteristic skin lesions. *Flavi virus* - **Flaviviruses** are a genus of RNA viruses, which cause diseases like **Dengue fever**, **Yellow fever**, and **Zika virus infection**. - They typically cause **systemic illnesses** with fever and rash, rather than localized skin lesions like molluscum contagiosum. *Adenovirus* - **Adenoviruses** are DNA viruses primarily associated with **respiratory infections** (e.g., common cold, bronchitis) and **conjunctivitis**. - They are not known to cause the characteristic **umbilicated papules** seen in molluscum contagiosum. *Rubivirus* - **Rubivirus** is a genus that includes the **Rubella virus**, which causes **German measles** (Rubella). - Rubella is characterized by a **maculopapular rash** and **lymphadenopathy**, which is distinct from the **umbilicated papules** seen in molluscum contagiosum.
Question 2: Which of the following is a contraindication to topical steroids?
- A. Dendritic ulcer (Correct Answer)
- B. Herpetic stromal keratitis without epithelial defect
- C. Elevated intraocular pressure
- D. Non-infectious anterior uveitis
Explanation: ***Dendritic ulcer*** - A **dendritic ulcer** is characteristic of **herpes simplex keratitis**, which is an active viral infection of the cornea. - **Topical steroids** are contraindicated because they can suppress the immune response, leading to viral replication, corneal melt, and potentially severe vision loss or perforation. *Herpetic stromal keratitis without epithelial defect* - In cases of **stromal keratitis**, where the infection is deeper and an intact epithelium is present, topical steroids may be used cautiously in conjunction with antiviral agents to reduce inflammation and scarring. - The primary concern with steroids in herpes simplex keratitis is activating viral replication in the presence of an **epithelial defect**, which is not present here. *Elevated intraocular pressure* - **Elevated intraocular pressure** is a known side effect of topical steroid use, especially with prolonged administration, but it is not an absolute contraindication in itself. - It necessitates careful monitoring and may require concurrent glaucoma treatment, but the primary condition needing steroids may still warrant their use. *Non-infectious anterior uveitis* - **Topical corticosteroids** are the **mainstay of treatment** for non-infectious anterior uveitis to reduce inflammation and prevent complications such as synechiae and vision loss. - The benefits of controlling inflammation in uveitis generally outweigh the risks associated with judicious steroid use.
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: Eleven-month-old child presents with an erythematous lesion that has been decreasing in size. What is the most likely diagnosis?
- A. Strawberry hemangioma (Infantile hemangioma) (Correct Answer)
- B. Melanocytic nevus
- C. Port wine stain (Nevus flammeus)
- D. Cavernous hemangioma
Explanation: ***Strawberry hemangioma (Infantile hemangioma)*** - **Infantile hemangiomas** (also known as strawberry hemangiomas) are common benign vascular tumors of infancy that typically **proliferate rapidly** in the first few months of life and then undergo **spontaneous involution** (decreasing in size) over several years. - The child's age (11 months) and the description of an **erythematous lesion decreasing in size** are highly consistent with the natural history of an infantile hemangioma in its involution phase. - Most infantile hemangiomas begin involution after 12 months and continue to regress over 5-7 years. *Melanocytic nevus* - A **melanocytic nevus** (mole) is a benign proliferation of **melanocytes** and typically presents as a brown or black lesion. - These lesions tend to be stable in size or grow slowly and **do not spontaneously decrease in size**. *Port wine stain (Nevus flammeus)* - A **port wine stain** is a capillary malformation that appears as a **flat, pink, red, or purple patch** from birth. - Unlike hemangiomas, port wine stains are **permanent vascular malformations** and do not involute; in fact, they may darken and thicken over time. *Cavernous hemangioma* - **Cavernous hemangiomas** represent deeper infantile hemangiomas with **subcutaneous involvement**, appearing as deeper, bluish, or skin-colored masses. - While they also undergo involution like superficial strawberry hemangiomas, they present differently as **deeper lesions** rather than the bright erythematous superficial appearance described in this case. - The primarily **erythematous** presentation in this case is more characteristic of a superficial (strawberry) hemangioma.
Question 5: Which of the following statements about molluscum contagiosum is FALSE?
- A. Lesions contain characteristic inclusion bodies
- B. Autoinoculation can spread the infection to new sites
- C. It is caused by a poxvirus
- D. Laboratory confirmation is required for diagnosis (Correct Answer)
Explanation: ***Laboratory confirmation is required for diagnosis*** - The diagnosis of **molluscum contagiosum** is primarily **clinical**, based on the characteristic appearance of the lesions (small, flesh-colored, dome-shaped papules with central umbilication). - While histology can confirm the diagnosis by revealing **molluscum bodies**, it is **not routinely required** for typical cases. *Lesions contain characteristic inclusion bodies* - This statement is **true**. Histological examination of molluscum contagiosum lesions reveals large, eosinophilic cytoplasmic inclusions, known as **molluscum bodies** or **Henderson-Paterson bodies**, within infected epidermal cells. - These inclusion bodies contain viral particles and are a **hallmark of the infection**. *Autoinoculation can spread the infection to new sites* - This statement is **true**. Molluscum contagiosum is highly contagious, and scratching or touching existing lesions can lead to the spread of the virus to previously unaffected skin areas on the same individual. - This process of **autoinoculation** explains why lesions often appear in clusters or linear arrays (Koebner phenomenon). *It is caused by a poxvirus* - This statement is **true**. Molluscum contagiosum is caused by the **molluscum contagiosum virus (MCV)**, which belongs to the **Poxviridae family**. - Poxviruses are known for their relatively large size and the ability to replicate entirely in the cytoplasm of host cells.
Question 6: Topical steroids are most effective in:
- A. Bullous lesions due to HSV
- B. Herpes Zoster
- C. Dermal atrophy
- D. Eczematous dermatitis (Correct Answer)
Explanation: ***Eczematous dermatitis*** - Topical steroids are the **first-line treatment** for eczematous dermatitis due to their potent **anti-inflammatory** and **immunosuppressive** properties. - They effectively reduce **itching**, **redness**, and **inflammation** associated with eczema. *Bullous lesions due to HSV* - **Topical steroids are contraindicated** in herpes simplex virus (HSV) infections as they can exacerbate viral replication and worsen the lesions, potentially leading to widespread infection. - **Antiviral medications** like acyclovir are the appropriate treatment for HSV infections. *Herpes Zoster* - Similar to HSV, herpes zoster is a **viral infection** (reactivation of varicella-zoster virus), and topical steroids can worsen the condition by suppressing the immune response. - **Antiviral drugs** (e.g., valacyclovir, famciclovir) are the primary treatment for herpes zoster. *Dermal atrophy* - Dermal atrophy is a **side effect** of prolonged or potent topical steroid use, not a condition treated by them. - It involves **thinning of the skin**, **telangiectasias**, and **striae**, indicating skin damage from steroid exposure.
Question 7: The following patient presented to the OPD with history of hair loss. There was no erythema, scarring or scratching. Diagnosis is:
- A. Trichotillomania
- B. Alopecia areata (Correct Answer)
- C. Telogen effluvium
- D. Tinea infection
Explanation: ***Alopecia areata*** - The image shows **well-demarcated patches of hair loss** with no signs of inflammation or scarring, which is characteristic of alopecia areata. - This condition is an **autoimmune disorder** where the immune system attacks hair follicles, leading to patchy hair loss. - Classic presentation includes **smooth, round patches** with no erythema or scarring. *Trichotillomania* - This condition involves **compulsive hair pulling**, which typically results in **irregularly shaped patches of hair loss** with hairs of varying lengths. - Hair loss in trichotillomania often shows **broken hair shafts** and may be associated with signs of trauma or follicular damage. - The absence of scratching/pulling behavior and the well-defined patches make this less likely. *Telogen effluvium* - Telogen effluvium presents as **diffuse hair shedding** (increased shedding of resting phase hairs) rather than the distinct, localized patches seen in the image. - It usually follows a **stressful event** (e.g., illness, surgery, childbirth) and there's no visible inflammation or scarring. - Would not present as well-demarcated patches. *Tinea infection* - Tinea capitis (ringworm of the scalp) would typically present with **erythema, scaling, inflammation**, and sometimes pustules or kerion formation within the patches of hair loss. - The patches of hair loss in tinea infections often show **broken hairs** or "black dots" where hairs have broken off at the scalp surface. - The **absence of erythema** in this case rules out tinea infection.
Question 8: 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 9: A child presents with a history of hypopigmented macules on the back, infantile spasms, and delayed milestones. What is the most likely diagnosis?
- A. Neurofibromatosis
- B. Sturge-Weber syndrome
- C. Tuberous sclerosis (Correct Answer)
- D. Nevus anemicus
Explanation: ### Explanation **Correct Answer: C. Tuberous Sclerosis (TSC)** The clinical triad of **hypopigmented macules (Ash-leaf spots)**, **infantile spasms** (West Syndrome), and **delayed milestones** is classic for Tuberous Sclerosis Complex. * **Pathophysiology:** TSC is an autosomal dominant neurocutaneous syndrome caused by mutations in the *TSC1* (Hamartin) or *TSC2* (Tuberin) genes, leading to the overactivation of the mTOR pathway and the formation of hamartomas in multiple organs. * **Dermatological markers:** Ash-leaf spots are often the earliest sign. Other features include Adenoma sebaceum (angiofibromas), Shagreen patches (connective tissue nevi), and periungual fibromas (Koenen tumors). * **Neurological markers:** Cortical tubers and subependymal nodules lead to seizures (infantile spasms) and intellectual disability. **Why Incorrect Options are Wrong:** * **A. Neurofibromatosis:** Characterized by *hyperpigmented* Café-au-lait macules, Lisch nodules, and neurofibromas, rather than hypopigmentation and infantile spasms. * **B. Sturge-Weber Syndrome:** Presents with a Port-wine stain (Nevus Flammeus) in the V1/V2 distribution of the trigeminal nerve, glaucoma, and leptomeningeal angiomas. * **C. Nevus Anemicus:** A localized vascular anomaly presenting as a pale patch due to catecholamine sensitivity. It does not cause systemic neurological symptoms or developmental delay. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign:** Ash-leaf spots (best seen under **Wood’s lamp**). * **Most common heart lesion:** Rhabdomyoma (often regresses spontaneously). * **Most common kidney lesion:** Angiomyolipoma. * **Drug of choice for Infantile Spasms in TSC:** Vigabatrin. * **Pathognomonic sign:** Koenen tumors (Periungual fibromas).
Question 10: A 14-year-old boy presents with seizures and skin macules. What is the probable diagnosis?
- A. Sturge-Weber syndrome
- B. Turcot syndrome
- C. Tuberous sclerosis (Correct Answer)
- D. Von Hippel-Lindau disease
Explanation: ### Explanation **Correct Answer: C. Tuberous Sclerosis (TSC)** The combination of **seizures** and **skin macules** (specifically hypopigmented "Ash-leaf" spots) is a classic presentation of Tuberous Sclerosis Complex, a neurocutaneous syndrome inherited in an autosomal dominant fashion (TSC1/TSC2 gene mutations). * **Why it is correct:** In pediatric dermatology, the earliest sign of TSC is often the **Ash-leaf macule** (hypopigmented macules visible under Wood’s lamp). The involvement of the Central Nervous System leads to cortical tubers and subependymal nodules, which manifest clinically as **seizures** and intellectual disability (the "Vogt’s Triad": Seizures, Mental Retardation, and Adenoma Sebaceum). **Analysis of Incorrect Options:** * **A. Sturge-Weber Syndrome:** Characterized by a **Port-wine stain** (Nevus Flammeus) usually in the V1/V2 distribution of the trigeminal nerve. While it causes seizures, the skin lesion is a vascular malformation, not a macule. * **B. Turcot Syndrome:** A variant of Familial Adenomatous Polyposis (FAP) associated with CNS tumors (medulloblastoma/glioma) and colonic polyps. It does not typically present with characteristic skin macules. * **C. Von Hippel-Lindau (VHL) Disease:** Characterized by hemangioblastomas (retina/cerebellum) and renal cell carcinoma. It lacks the specific cutaneous macules associated with seizures in childhood. **High-Yield Clinical Pearls for NEET-PG:** 1. **Skin Findings in TSC:** Ash-leaf spots (earliest), Adenoma Sebaceum (angiofibromas), Shagreen patches (connective tissue nevi), and Periungual fibromas (Koenen tumors). 2. **Diagnostic Triad (Vogt’s):** Epilepsy, Low IQ, and Adenoma Sebaceum (only present in ~30% of cases). 3. **Other Associations:** Cardiac rhabdomyomas (often regress), Renal Angiomyolipomas (AML), and Lymphangioleiomyomatosis (LAM) in the lungs. 4. **Wood’s Lamp:** Essential for identifying Ash-leaf spots in fair-skinned children.
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