Psoriasis — MCQs
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All are true about psoriasis except:
Which statement about systemic steroids in psoriasis is correct:
Which of the following is true about Pityriasis rubra pilaris?
Nail changes are found in about ______ cases of psoriasis:
Bleeding spots seen on removal of scales in psoriasis is called:
Psoriasis typically seen after β-hemolytic streptococcal infection is
All of the following are used in systemic therapy of psoriasis except
In which of the following, Koebner phenomenon is NOT seen -
Antibiotics are indicated in which type of psoriasis?
Treatment of choice for Pustular psoriasis is:
Psoriasis Indian Medical PG Practice Questions and MCQs
Question 91: All are true about psoriasis except:
- A. Parakeratosis & acanthosis
- B. Pitting of nails
- C. Very pruritic (Correct Answer)
- D. Joint involvement in 5–30%
Explanation: ***Very pruritic*** - While psoriasis can be itchy, it is generally not characterized as "very pruritic" compared to other dermatological conditions like **eczema** or **scabies**. - **Pruritus** in psoriasis tends to be mild to moderate, and it is not a defining characteristic that differentiates it from other skin disorders. *Parakeratosis & acanthosis* - **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological hallmarks of psoriasis. - These features reflect the rapid epidermal turnover characteristic of the condition. *Pitting of nails* - **Nail pitting**, onycholysis, and subungual hyperkeratosis are common and characteristic manifestations of psoriasis, affecting up to 50% of patients. - These nail changes are highly indicative of **psoriatic involvement**. *Joint involvement in 5–10%* - **Psoriatic arthritis**, involving inflammation of the joints, affects approximately 5-30% of individuals with psoriasis. - This statistic makes joint involvement a significant comorbidity of psoriasis.
Question 92: Which statement about systemic steroids in psoriasis is correct:
- A. No definitive indication exists (Correct Answer)
- B. Only as bridge therapy in rare cases
- C. Emergency situations under specialist supervision only
- D. Systemic steroids are contraindicated in all forms of psoriasis
Explanation: ***No definitive indication exists*** - Systemic steroids have **no established therapeutic role** in psoriasis management and are **strongly avoided** in clinical practice. - They can cause severe **rebound flares** upon withdrawal and may precipitate life-threatening **pustular psoriasis** or **erythrodermic psoriasis**. - While not absolutely contraindicated in every conceivable scenario, they provide **no long-term benefit** and actively worsen disease control by masking symptoms and creating dependency. - This statement most accurately reflects the medical consensus: systemic steroids lack definitive indications and should be avoided. *Systemic steroids are contraindicated in all forms of psoriasis* - While systemic steroids are strongly discouraged, the absolute term "contraindicated in **all forms**" is **too extreme**. - There may be rare emergency situations where short-term use under specialist care is considered when safer alternatives are unavailable. - The statement overstates the position; "no definitive indication" is more medically accurate. *Only as bridge therapy in rare cases* - Bridge therapy with systemic steroids is **not recommended** in psoriasis due to high risk of disease exacerbation. - Unlike other inflammatory conditions, psoriasis responds poorly to steroid withdrawal, making bridge therapy particularly dangerous. *Emergency situations under specialist supervision only* - This suggests systemic steroids have a defined role in emergencies, which is **misleading**. - Even in urgent situations, alternative treatments like **cyclosporine**, **methotrexate**, or **biologics** are strongly preferred. - The rare exceptions don't constitute a "definitive indication."
Question 93: Which of the following is true about Pityriasis rubra pilaris?
- A. Oral cyclosporine is the drug of choice
- B. Isolated patches of normal skin are found (Correct Answer)
- C. Common in females
- D. Occurs mainly in adults
Explanation: ***Isolated patches of normal skin are found*** - This characteristic, known as **"islands of sparing"** or **"skip areas"**, is a hallmark clinical feature of Pityriasis rubra pilaris (PRP), where small patches of unaffected skin are seen within widespread erythematous and scaling plaques. - These spared areas help differentiate PRP from other generalized erythematous skin conditions. *Oral cyclosporine is the drug of choice* - While systemic retinoids (e.g., **acitretin**) are often considered first-line systemic therapy for Pityriasis rubra pilaris, cyclosporine is a second-line option for severe, refractory cases. - **Corticosteroids** and **methotrexate** are also used, but there is no single drug of choice; treatment is often individualized based on disease severity. *Common in females* - Pityriasis rubra pilaris does not show a significant gender predilection and affects **males and females equally**. - Its incidence is generally rare, making gender-specific prevalence less notable than in some other dermatological conditions. *Occurs mainly in adults* - Pityriasis rubra pilaris has a **bimodal age distribution**, with peaks in incidence during **childhood** (juvenile form, often localized) and in **adulthood** (classical adult form, more generalized). - Therefore, stating it occurs *mainly* in adults is inaccurate as a significant proportion of cases occur in children.
Question 94: Nail changes are found in about ______ cases of psoriasis:
- A. Two thirds
- B. One third
- C. One half (Correct Answer)
- D. All cases
Explanation: ***One half*** - Approximately **50% of patients with psoriasis** will experience nail changes, which can be a key diagnostic feature. - Nail involvement is even higher, around **80-90%**, in patients with **psoriatic arthritis**. *Two thirds* - While a significant proportion, **two-thirds (roughly 66%)** is a slight overestimate of the general prevalence of nail changes in psoriasis. - This figure might be seen in specific populations or more severe cases, but not overall. *One third* - **One-third (roughly 33%)** is an underestimation of the frequency of nail changes in psoriasis. - Nail involvement is a very common manifestation of the disease. *All cases* - It is incorrect to state that **all cases of psoriasis** have nail changes. - While common, nail involvement is not universal and can range from mild to severe, or be entirely absent.
Question 95: Bleeding spots seen on removal of scales in psoriasis is called:
- A. Auspitz sign (Correct Answer)
- B. Punctate hemorrhage
- C. Darier sign
- D. Nikolsky's sign
Explanation: ***Auspitz sign*** - This sign is characterized by the appearance of **pinpoint bleeding** after the removal of psoriatic scales due to the thinning of the epidermis covering the **dilated capillaries** in the dermal papillae. - It's a classic clinical finding in **psoriasis**, indicating active disease. *Punctuate hemorrhage* - This term is a generalized description for **small, pinpoint bleeding** spots. - While the Auspitz sign involves punctate hemorrhages, it's a more specific term for this phenomenon in the context of **psoriasis** and scale removal. *Darier sign* - This sign involves the formation of a **urticarial wheal** or a visible edema response when a skin lesion is rubbed. - It is classically associated with **urticaria pigmentosa** (cutaneous mastocytosis) and not psoriasis. *Nikolsky's sign* - This sign describes the **detachment of the epidermis** from the underlying dermis with slight lateral pressure on seemingly normal skin, leading to blister formation. - It is characteristic of conditions like **pemphigus vulgaris** and **toxic epidermal necrolysis**, not psoriasis.
Question 96: Psoriasis typically seen after β-hemolytic streptococcal infection is
- A. Psoriasis vulgaris
- B. Guttate psoriasis (Correct Answer)
- C. Erythrodermic psoriasis
- D. Pustular psoriasis
Explanation: ***Guttate psoriasis*** - This form of psoriasis is classically triggered by an antecedent **streptococcal pharyngitis** (often β-hemolytic streptococcal infection), presenting as small, **tear-drop shaped lesions** scattered over the trunk and proximal extremities. - The onset is typically **acute**, occurring a few weeks after the infection. *Psoriasis vulgaris* - This is the **most common form** of psoriasis, characterized by well-demarcated, erythematous plaques with silvery scales. - While infections can exacerbate psoriasis vulgaris, it is **not typically triggered de novo** by streptococcal infections in the same way guttate psoriasis is. *Erythrodermic psoriasis* - This is a **severe and rare form** of psoriasis where nearly the entire skin surface becomes red and scaly, often accompanied by systemic symptoms like fever and malaise. - It represents a generalized inflammatory response and is usually a **flare of existing psoriasis** rather than an initial presentation following bacterial infection. *Pustular psoriasis* - This presentation involves widespread or localized pustules, often on a red, tender skin base, and can be associated with systemic symptoms. - While infections can be a trigger, **streptococcal infections** are not the classic trigger for pustular psoriasis outbreaks as they are for guttate psoriasis.
Question 97: All of the following are used in systemic therapy of psoriasis except
- A. Methotrexate
- B. Cyclosporine
- C. Oral glucocorticoids (Correct Answer)
- D. Acitretin
Explanation: ***Oral glucocorticoids*** - **Oral glucocorticoids** are generally avoided in psoriasis because they can precipitate severe **rebound flares** upon discontinuation or during dose tapering. - While they can temporarily suppress inflammation, the risk of worsening psoriasis and other systemic side effects makes them unsuitable for long-term systemic therapy. *Methotrexate* - **Methotrexate** is a commonly used systemic agent for psoriasis due to its **immunosuppressive** and **anti-proliferative effects**, targeting rapidly dividing cells. - It works by inhibiting dihydrofolate reductase and is typically given once weekly for chronic plaque psoriasis. *Cyclosporine* - **Cyclosporine** is an effective systemic immunosuppressant used for severe, resistant psoriasis, particularly when rapid control is needed. - It primarily acts by inhibiting **T-cell activation** and proliferation, thereby reducing the inflammatory response in psoriasis. *Acitretin* - **Acitretin** is an oral retinoid derivative of vitamin A, used in severe forms of psoriasis, especially **pustular** and **erythrodermic** types. - It works by modulating **keratinocyte differentiation** and proliferation, helping to normalize skin cell growth.
Question 98: In which of the following, Koebner phenomenon is NOT seen -
- A. psoriasis
- B. Lichen simplex chronicus (Correct Answer)
- C. Lichen planus
- D. Lichen nitidus
Explanation: ***Lichen simplex chronicus*** - The **Koebner phenomenon**, which involves the appearance of skin lesions at sites of trauma, is not typically observed in **lichen simplex chronicus**. - This condition is characterized by **chronic scratching and rubbing**, leading to thickened, leathery skin, but the lesions themselves do not spread to new trauma sites in the classic Koebner fashion. *Psoriasis* - The **Koebner phenomenon** (also known as the isomorphic response) is highly characteristic of psoriasis, where new psoriatic lesions develop in areas of skin trauma. - This response is a key diagnostic feature and helps differentiate psoriasis from other skin conditions. *Lichen planus* - The **Koebner phenomenon** is a well-recognized feature of lichen planus, where the skin lesions can appear along lines of trauma, such as scratches or surgical scars. - This isomorphic response can be helpful in the diagnosis and understanding of the disease pathogenesis. *Lichen nitidus* - **Lichen nitidus** is another dermatological condition in which the **Koebner phenomenon** is observed. - New papules can erupt at sites of minor trauma, indicating an isomorphic response similar to that seen in psoriasis and lichen planus.
Question 99: Antibiotics are indicated in which type of psoriasis?
- A. Chronic plaque psoriasis
- B. Erythrodermic psoriasis
- C. Guttate (Correct Answer)
- D. Pustular
Explanation: ***Guttate*** - **Guttate psoriasis** is frequently triggered by a preceding **streptococcal infection**, such as streptococcal pharyngitis (strep throat). - Treatment with **antibiotics** (e.g., penicillin) is indicated to eradicate the streptococcal infection, which can help in resolving the psoriatic lesions and preventing future flares. *Chronic plaque psoriasis* - This is the most common form of psoriasis, characterized by **well-demarcated, erythematous plaques with silvery scales**. - Its etiology is primarily **autoimmune**, and while infections can sometimes exacerbate it, antibiotics are not a standard part of its treatment. *Erythrodermic psoriasis* - This is a severe, generalized form of psoriasis affecting nearly the **entire skin surface**, leading to significant inflammation and desquamation. - While patients with erythrodermic psoriasis are at higher risk for **secondary infections** due to skin barrier disruption, antibiotics are only indicated for treating these secondary bacterial infections, not for the psoriasis itself. *Pustular* - **Pustular psoriasis** is characterized by the presence of sterile pustules on an erythematous base. - Though severe, it is primarily an **inflammatory condition**, and antibiotics are not used in its primary management unless a secondary bacterial infection is suspected and confirmed.
Question 100: Treatment of choice for Pustular psoriasis is:
- A. Methotrexate (Correct Answer)
- B. Psoralen - UV therapy
- C. Systemic steroid
- D. Estrogen
Explanation: ***Methotrexate*** - **Methotrexate** is a systemic immunosuppressant often considered the first-line treatment for severe forms of **pustular psoriasis** due to its efficacy in reducing inflammation and hyperproliferation of skin cells. - It works by inhibiting **dihydrofolate reductase**, thereby interfering with DNA synthesis and cell division, which is crucial in rapidly dividing cells like those found in psoriasis. *Psoralen - UV therapy* - **Psoralen and ultraviolet A (PUVA)** therapy can be used for chronic plaque psoriasis, but it is generally **contraindicated or used with extreme caution** in pustular psoriasis due to the risk of exacerbating the disease or causing irritation. - **UV light therapy** can sometimes trigger or worsen pustular flares, especially in acute generalized pustular psoriasis. *Systemic steroid* - While systemic steroids can provide temporary relief by addressing inflammation, their use in pustular psoriasis is generally **not recommended for long-term management** due to the high risk of severe rebound flares upon withdrawal. - Withdrawal of **systemic corticosteroids** can precipitate or worsen generalized pustular psoriasis, making them a less desirable long-term treatment option. *Estrogen* - **Estrogen** has no direct role in the treatment of psoriasis. Psoriasis is an inflammatory skin condition, and its pathophysiology is not directly influenced by estrogen levels. - Hormonal therapies are not indicated for the management of psoriasis, including its pustular forms.
Practice by Chapter
Pathophysiology of Psoriasis
Practice Questions
Psoriasis Vulgaris
Practice Questions
Guttate Psoriasis
Practice Questions
Erythrodermic Psoriasis
Practice Questions
Pustular Psoriasis
Practice Questions
Palmoplantar Psoriasis
Practice Questions
Nail Psoriasis
Practice Questions
Scalp Psoriasis
Practice Questions
Psoriatic Arthritis
Practice Questions
Topical Therapy for Psoriasis
Practice Questions
Systemic Therapy for Psoriasis
Practice Questions
Phototherapy and Biologics for Psoriasis
Practice Questions
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