Photodynamic Therapy — MCQs
Replacing alanine by which amino acid, will increase UV absorbance of protein at 280 nm wavelength?
In which of the following conditions is phototherapy, specifically ultraviolet light therapy, useful for treatment?
Which of the following events does NOT occur in rods in response to light
Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
Podophyllin was historically used as treatment of choice in
A patient presents with a skin rash that is exaggerated on sun exposure. What is the repair mechanism involved in this condition?
Dermatological manifestation of which of the following diseases?
An 8-year-old girl has extreme photosensitivity since birth. She has recently been diagnosed with skin cancer. What is the diagnosis?
A 6-year-old child born to consanguinity has pallor and intolerance to sunlight. His urine was exposed to Wood's light. Probable diagnosis is:
Which of the following is NOT a complication of PUVA therapy?
Photodynamic Therapy Indian Medical PG Practice Questions and MCQs
Question 1: Replacing alanine by which amino acid, will increase UV absorbance of protein at 280 nm wavelength?
- A. Glycine
- B. Tryptophan (Correct Answer)
- C. Arginine
- D. Lysine
Explanation: ***Tryptophan*** - **Tryptophan** contains an **indole ring**, which is a **chromophore** that strongly absorbs UV light at 280 nm. - Increased tryptophan content in a protein directly correlates with a higher **UV absorbance** at this wavelength. *Glycine* - **Glycine** is the simplest amino acid, with only a **hydrogen atom** as its side chain. - It does not contain any aromatic rings or other groups that absorb UV light at 280 nm, so replacing alanine with glycine would not increase UV absorbance. *Arginine* - **Arginine** is a basic amino acid with a **guanidinium group** in its side chain. - While it has a slightly complex side chain, it does not possess any **aromatic rings** that absorb significantly at 280 nm. *Lysine* - **Lysine** is another basic amino acid with a long **aliphatic chain** and an **amino group** at the end. - Similar to arginine, lysine lacks the necessary **aromatic chromophores** to contribute to UV absorbance at 280 nm.
Question 2: In which of the following conditions is phototherapy, specifically ultraviolet light therapy, useful for treatment?
- A. Psoriasis (Correct Answer)
- B. Tinea corporis
- C. Pemphigus
- D. PMLE
Explanation: ***Psoriasis*** - **Phototherapy** (narrowband UVB, broadband UVB, or PUVA) is a **well-established first-line treatment** for **moderate-to-severe psoriasis**. - It works by **suppressing overactive immune cells** in the skin, reducing inflammation and decreasing keratinocyte proliferation. - **Direct therapeutic effect** on active psoriatic lesions makes this the primary indication for phototherapy in dermatology. *Tinea corporis* - **Tinea corporis** is a **superficial fungal infection** (dermatophytosis) of the skin. - Requires **antifungal medications** (topical azoles or oral terbinafine/griseofulvin) for treatment. - **Phototherapy has no antifungal activity** and is not used for this condition. *Pemphigus* - **Pemphigus** is an **autoimmune blistering disease** with intraepidermal acantholysis. - Treatment requires **systemic immunosuppression** (corticosteroids, rituximab, azathioprine). - **Phototherapy is not indicated** and could potentially worsen the condition. *PMLE* - **Polymorphous light eruption (PMLE)** is a common **photosensitivity disorder**. - While **prophylactic photohardening** (gradual controlled UV exposure) can be used to build tolerance **before sun exposure season**, this is a **preventative desensitization strategy**, not treatment of active disease. - Unlike psoriasis, phototherapy does **not treat active PMLE lesions** and can trigger flares if not done properly. - The primary approach for active PMLE is **sun avoidance, sun protection, and topical corticosteroids**.
Question 3: Which of the following events does NOT occur in rods in response to light
- A. Opening of Na+ channels (Correct Answer)
- B. Activation of transducin
- C. Structural changes in rhodopsin
- D. Decreased intracellular cGMP
Explanation: ***Opening of Na+ channels*** - In response to light, **rods hyperpolarize** due to the **closure of Na+ channels**, which reduces the influx of positive ions. - The opening of Na+ channels would lead to depolarization, which is the opposite of what occurs during light detection in rods. *Activation of transducin* - Light causes **conformational changes in rhodopsin**, which in turn activates the G-protein **transducin**. - Activated transducin then goes on to activate **phosphodiesterase (PDE)** as part of the phototransduction cascade. *Structural changes in rhodopsin* - When light strikes the rhodopsin molecule, the **11-cis-retinal chromophore** isomerizes to **all-trans-retinal**. - This **conformational change** in rhodopsin is the initial step that triggers the entire phototransduction pathway. *Decreased intracellular cGMP* - Activated **phosphodiesterase (PDE)**, stimulated by transducin, hydrolyzes **cGMP to GMP**. - The reduction in **cGMP levels** leads to the closure of cGMP-gated Na+ channels, causing hyperpolarization.
Question 4: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
- A. Cyclophosphamide
- B. Methotrexate
- C. Cisplatin (Correct Answer)
- D. Dacarbazine
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.
Question 5: Podophyllin was historically used as treatment of choice in
- A. Plain warts
- B. Condyloma acuminata (Correct Answer)
- C. Condyloma lata
- D. Plantar warts
Explanation: ***Condyloma acuminata*** - **Podophyllin** is a **cytotoxic agent** that inhibits cell division and was historically a common topical treatment for **genital warts (condyloma acuminata)**. - Its mechanism of action targets the rapidly dividing cells of the HPV-induced warts, leading to necrosis and shedding. *Plain warts* - Plain warts (verruca vulgaris) are typically self-limiting and are often treated with **salicylic acid**, cryotherapy, or electrocautery. - While podophyllin can be effective against certain kinds of warts, it was not the primary or historical treatment of choice for common plain warts. *Condyloma lata* - **Condyloma lata** are moist, flat, broad lesions associated with **secondary syphilis** and are highly infectious. - Treatment involves **penicillin** to cure the underlying syphilis infection, not topical podophyllin. *Plantar warts* - **Plantar warts** occur on the soles of the feet and are often covered by a callus, making them difficult to treat with superficial methods. - Treatment typically involves **salicylic acid**, cryotherapy, **surgical excision**, or laser therapy due to their tough nature, rather than podophyllin.
Question 6: A patient presents with a skin rash that is exaggerated on sun exposure. What is the repair mechanism involved in this condition?
- A. Nucleotide excision repair (Correct Answer)
- B. Base excision repair
- C. Mismatch repair
- D. Double stranded DNA break repair
Explanation: ***Nucleotide excision repair*** - This mechanism is responsible for repairing **bulky lesions** in DNA, such as **pyrimidine dimers** caused by **UV radiation** from sun exposure. - Patients with defects in nucleotide excision repair (e.g., **xeroderma pigmentosum**) are highly sensitive to sunlight and develop skin rashes, pigment changes, and skin cancers. *Base excision repair* - This pathway primarily corrects **small damaged bases** that do not cause significant distortion of the DNA helix, such as deaminated, oxidized, or alkylated bases. - It does not primarily address the bulky lesions induced by UV light that cause exaggerated sun sensitivity. *Mismatch repair* - This system corrects errors, like **mismatched base pairs**, that are incorporated during DNA replication. - It is not directly involved in repairing DNA damage caused by environmental factors like UV radiation. *Double stranded DNA break repair* - This mechanism repairs **double-strand breaks** in DNA, which are highly deleterious lesions caused by ionizing radiation or oxidative stress. - While critical for genome stability, it is not the primary repair pathway for UV-induced DNA lesions or the direct cause of sun sensitivity.
Question 7: Dermatological manifestation of which of the following diseases?
- A. Photo dermatitis
- B. Pellagra (Correct Answer)
- C. Acrodermatitis enteropathica
- D. Vitamin B deficiency
Explanation: ***Pellagra*** - The image shows a classic "butterfly" rash on the face, specifically a photosensitive dermatitis, which is a hallmark of **pellagra**. - Pellagra is caused by a deficiency of **niacin (vitamin B3)**, characterized by the "3 D's": **dermatitis**, **diarrhea**, and **dementia**. *Photo dermatitis* - While pellagra often presents with photosensitive dermatitis, "photo dermatitis" is a general term for **skin inflammation caused by light exposure** and not a specific disease itself. - It could be caused by various factors, including medication, immune reactions, or other underlying conditions, but the pattern seen here is highly suggestive of pellagra. *Acrodermatitis enteropathica* - This condition is a **hereditary zinc deficiency** that typically presents with a periorificial and acral dermatitis. - The skin lesions are typically **vesicular-pustular or eczematous** and do not usually have the distinct butterfly pattern of photosensitive dermatitis seen in the image. *Vitamin B deficiency* - While pellagra is a vitamin B **(niacin, B3)** deficiency, this option is too broad. - Other vitamin B deficiencies, such as **riboflavin (B2)** or **pyridoxine (B6)** deficiency, have different dermatological manifestations like angular cheilitis, glossitis, or seborrheic dermatitis, but not the characteristic facial rash seen here.
Question 8: An 8-year-old girl has extreme photosensitivity since birth. She has recently been diagnosed with skin cancer. What is the diagnosis?
- A. Xeroderma Pigmentosum (Correct Answer)
- B. Bloom syndrome
- C. Griscelli syndrome
- D. Chediak Higashi syndrome
Explanation: ***Xeroderma Pigmentosum*** - This condition is characterized by an extreme sensitivity to **ultraviolet (UV) light** from birth due to defects in **DNA repair mechanisms**, leading to severe sunburns, pigmentary changes (freckles, hypopigmented macules), and a high risk of developing **skin cancers** at a young age. - The history of extreme photosensitivity since birth and the diagnosis of skin cancer in an 8-year-old girl is highly indicative of Xeroderma Pigmentosum. *Bloom syndrome* - Bloom syndrome is an inherited disorder characterized by **stunted growth**, a **photosensitive facial rash (telangiectatic erythema)**, and a predisposition to **various cancers**, including leukemia and lymphomas. - While photosensitivity and cancer risk are present, the extreme skin damage and early onset of specific skin cancers (as opposed to leukemias/lymphomas often seen in Bloom) make Xeroderma Pigmentosum a more fitting diagnosis. *Griscelli syndrome* - Griscelli syndrome is a rare autosomal recessive disorder characterized by **partial albinism**, immunodeficiency, and neurological impairment. - While it involves pigmentary abnormalities, it does not typically present with the extreme photosensitivity or the very early skin cancer development described in the patient. *Chediak Higashi syndrome* - Chediak-Higashi syndrome is an autosomal recessive disorder characterized by **partial albinism**, recurrent pyogenic infections, and neurological abnormalities, due to defective lysosomal trafficking. - This syndrome is not primarily associated with extreme photosensitivity leading to early skin cancers but rather with immunodeficiency and neurological issues.
Question 9: A 6-year-old child born to consanguinity has pallor and intolerance to sunlight. His urine was exposed to Wood's light. Probable diagnosis is:
- A. SLE
- B. Xeroderma pigmentosum
- C. Gunther disease (Correct Answer)
- D. Bloom syndrome
Explanation: ***Gunther disease*** - The combination of **pallor**, **intolerance to sunlight** (photosensitivity), **consanguinity**, and particularly the **red fluorescence of urine under Wood's light** (due to increased uroporphyrins and coproporphyrins) is highly characteristic of **congenital erythropoietic porphyria (CEP)**, also known as Gunther disease. - This is an **autosomal recessive** disorder of heme synthesis, leading to accumulation of porphyrin precursors. Affected individuals often have **erythrodontia** (reddish-brown discoloration of teeth), severe **anemia**, and **hemolysis**, alongside marked photosensitivity. *SLE* - **Systemic lupus erythematosus (SLE)** can cause **photosensitivity** and **pallor (due to anemia)**, but it is an autoimmune disease, not an inborn error of metabolism. - It does not typically present with red fluorescent urine under Wood's light, which is a specific finding for porphyrias. *Xeroderma pigmentosum* - This is a rare **autosomal recessive** genetic disorder characterized by extreme **photosensitivity** and a high risk of skin cancers due to a defect in DNA repair mechanisms. - While it causes severe photosensitivity, it does not involve abnormalities in porphyrin metabolism or lead to red fluorescent urine. *Bloom syndrome* - **Bloom syndrome** is a rare **autosomal recessive** genetic disorder characterized by **photosensitivity**, **short stature**, a **distinctive facial appearance**, and an increased risk of cancer. - It does not involve porphyrin metabolism or result in red fluorescent urine under Wood's light.
Question 10: Which of the following is NOT a complication of PUVA therapy?
- A. Premature aging of the skin
- B. Cataracts
- C. Skin cancers
- D. Exfoliative dermatitis (Correct Answer)
Explanation: **Explanation:** PUVA (Psoralen + Ultraviolet A) therapy involves the administration of a photosensitizer (8-methoxypsoralen) followed by exposure to UVA radiation. While it is an effective treatment for conditions like psoriasis and vitiligo, it carries specific long-term and short-term risks. **Why Exfoliative Dermatitis is the correct answer:** Exfoliative dermatitis (Erythroderma) is **not** a direct complication of PUVA. In fact, PUVA is often used as a *treatment* modality for certain types of exfoliative dermatitis, such as those caused by Mycosis Fungoides or Psoriasis. While PUVA can cause a "PUVA itch" or a phototoxic burn (erythema), it does not typically trigger generalized exfoliation. **Analysis of Incorrect Options:** * **Premature aging of the skin (Dermatoheliosis):** Chronic UVA exposure leads to the degradation of collagen and elastin fibers, resulting in wrinkles, lentigines, and telangiectasia. * **Cataracts:** Psoralens distribute to the lens of the eye. If the eyes are not protected with UVA-blocking sunglasses for 24 hours post-ingestion, UVA exposure can lead to lens opacification. * **Skin cancers:** PUVA is mutagenic. Long-term therapy significantly increases the risk of Non-Melanoma Skin Cancers (NMSC), particularly **Squamous Cell Carcinoma (SCC)**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common acute side effect:** Erythema (phototoxicity) and pruritus. * **Most common long-term risk:** Squamous Cell Carcinoma (SCC) is more common than Basal Cell Carcinoma (BCC) in PUVA patients (reversing the usual ratio). * **PUVA Lentigines:** Distinctive, irregular pigmented macules that appear after chronic therapy. * **Contraindications:** Pregnancy, lactation, history of skin cancer (Xeroderma Pigmentosum), and severe hepatic/renal failure.
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