Psoriasis Practice Questions

Q: Which of the following features is characteristic of psoriasis?

Micro-Munro's abscess. ***Micro-Munro's abscess*** - These are small collections of **neutrophils in the stratum corneum** and represent a **specific histological hallmark of psoriasis**. - Also known as **Munro microabscesses**, they are formed due to neutrophil migration into the upper epidermis in response to inflammatory signals. - This is a **characteristic and diagnostic feature** that helps differentiate psoriasis from other papulosquamous disorders. *Hyperkeratosis* - While hyperkeratosis (thickening of stratum corneum) is present in psoriasis and causes the silvery scales, it is **not specific** to psoriasis. - Hyperkeratosis occurs in many dermatological conditions including **eczema, lichen planus, ichthyosis**, and other keratinization disorders. - It is a general finding rather than a characteristic diagnostic feature. *Grenz zone* - The **Grenz zone** is a clear, narrow band of unaffected dermis between the epidermis and underlying dermal infiltrate. - This feature is characteristic of conditions like **granulomatous diseases** and **mycosis fungoides**, not psoriasis. - In psoriasis, the dermal infiltrate typically extends to the dermoepidermal junction without a clear zone. *Pautrier's microabscess* - These are **intraepidermal collections of atypical lymphocytes** and are a diagnostic feature of early-stage **mycosis fungoides** (cutaneous T-cell lymphoma). - They are not seen in psoriasis; psoriasis involves **neutrophils** (Munro microabscesses), not lymphocytic collections.

Q: Auspitz's sign is characteristically seen in

Plaque Psoriasis. ***Plaque Psoriasis*** - **Auspitz's sign** is the appearance of pinpoint bleeding after the removal of scales from a psoriatic plaque, a classic finding in **plaque psoriasis**. - This phenomenon is due to the thinning of the epidermis over elongated and dilated dermal papillae, making the superficial capillaries prone to rupture. *Pustular Psoriasis* - This form of psoriasis is characterized by the presence of sterile **pustules** on erythematous skin, either localized or generalized. - While it is a type of psoriasis, Auspitz's sign is not its characteristic feature; rather, the presence of pustules defines this variant. *Inverse Psoriasis* - Inverse psoriasis typically affects **skin folds** (e.g., axillae, groin, inframammary regions) and presents as smooth, erythematous patches without the characteristic scaling seen in plaque psoriasis. - Due to the absence of thick scales, Auspitz's sign is generally not observed in inverse psoriasis. *Lichen Planus (flat-topped, purple papules)* - Lichen planus is an inflammatory condition characterized by **pruritic, polygonal, planar, purple papules** and plaques, often with **Wickham's striae**. - It does not involve the epidermal scaling and capillary changes that lead to Auspitz's sign.

Q: Which type of psoriasis is commonly seen in children and may follow a streptococcal sore throat?

Guttate psoriasis. ***Guttate psoriasis*** - This form of psoriasis is characterized by **small, drop-like lesions** that often appear suddenly over the trunk and extremities. - It is frequently precipitated by an **upper respiratory infection**, most commonly a **streptococcal sore throat**, particularly in children and young adults. *Pustular psoriasis* - This is a rare, severe form characterized by widespread **sterile pustules** on red, inflamed skin. - It is not typically associated with streptococcal infections or common in children as an initial presentation. *Stable plaque psoriasis* - This is the most common form, presenting with **well-demarcated, erythematous plaques** covered with silvery scales. - It usually has a **chronic course** and is not typically triggered by acute infections like strep throat. *Arthropathic psoriasis* - This is a form of **psoriatic arthritis** where psoriasis is accompanied by inflammation of the joints. - While it can occur in children, its hallmark is joint involvement, and it is not primarily associated with preceding streptococcal infections.

Q: Which of the following conditions is characterized by specific nail changes such as pitting, onycholysis, and oil spots?

Psoriasis. ***Psoriasis*** - **Psoriasis** characteristically causes several specific nail changes, including **pitting**, **onycholysis** (separation of the nail plate from the nail bed), and **oil spots** (yellow-brown discoloration resembling an oil drop under the nail). - These nail manifestations are often indicative of underlying psoriatic disease, even in the absence of extensive skin lesions. *Lichen planus* - **Lichen planus** can affect the nails, causing longitudinal ridging, thinning, and sometimes pterygium formation, but typically not pitting, onycholysis, or oil spots. - In severe cases, it can lead to permanent nail loss or scarring. *Darier disease* - **Darier disease** (keratosis follicularis) is characterized by specific nail findings such as longitudinal red and white streaks, V-shaped notching at the distal nail edge, and subungual hyperkeratosis. - It does not present with the classic triad of pitting, onycholysis, and oil spots. *Onychomycosis* - **Onychomycosis** is a fungal infection of the nail that typically causes thickening, discoloration (yellow, brown, white), and crumbling of the nail plate. - While it can cause onycholysis, it does not typically produce pitting or oil spots, which are more specific to psoriasis.

Q: Acrodermatitis continua of Hallopeau is due to which of the following?

Pustular psoriasis. ***Pustular psoriasis*** - **Acrodermatitis continua of Hallopeau** is considered a severe, chronic, and localized variant of **pustular psoriasis** that primarily affects the distal extremities, particularly the nail beds and fingertips. - It involves recurrent outbreaks of **sterile pustules** that can lead to onychodystrophy, anonychia, and bone resorption. *Zinc toxicity* - **Zinc toxicity** can cause symptoms such as nausea, vomiting, abdominal pain, and copper deficiency, but it is not linked to acrodermatitis continua of Hallopeau. - Dermatological manifestations of zinc toxicity are generally not pustular or associated with nail and digit changes seen in this condition. *Zinc deficiency* - **Zinc deficiency** can lead to acrodermatitis enteropathica, a condition characterized by periorificial and acral dermatitis, alopecia, and diarrhea. - While it involves skin involvement in similar areas, the primary lesions are **eczematous and psoriasiform**, not typically sterile pustules as seen in acrodermatitis continua. *Collodion baby* - **Collodion baby** refers to a newborn covered by a taut, shiny membrane that resembles plastic wrap, typically associated with congenital ichthyoses. - It is a specific neonatal presentation of a skin barrier defect and is not related to acrodermatitis continua of Hallopeau or pustular skin conditions.

Q: Tildrakizumab was approved in March 2018 for what indication?

Psoriasis. ***Psoriasis*** - **Tildrakizumab** (Ilumya) is an **IL-23 inhibitor** specifically approved for the treatment of **moderate to severe plaque psoriasis** in adults. - It targets the **p19 subunit of IL-23**, which plays a key role in the inflammatory cascade of psoriasis. *HIV* - HIV treatment involves **antiretroviral therapy (ART)**, which targets various stages of the viral life cycle. - Tildrakizumab has no known efficacy against **HIV infection**. *Rheumatoid arthritis* - Management of **rheumatoid arthritis** typically involves **DMARDs (disease-modifying antirheumatic drugs)**, biologics like **TNF inhibitors**, or **IL-6 inhibitors**. - While IL-23 is involved in inflammation, tildrakizumab is not indicated for **rheumatoid arthritis**. *Hepatitis C* - **Hepatitis C** is treated with direct-acting antiviral (DAA) medications that target viral enzymes. - Tildrakizumab is an immunomodulator and has no role in the treatment of **Hepatitis C**.

Q: Secukinumab is used in:

Psoriasis. ***Psoriasis*** - **Secukinumab** is a monoclonal antibody that targets **interleukin-17A (IL-17A)**, a cytokine crucial in the pathogenesis of psoriasis. - It is approved for the treatment of **moderate to severe plaque psoriasis**, psoriatic arthritis, and ankylosing spondylitis. *Colorectal carcinoma* - **Secukinumab** is not used in the treatment of colorectal carcinoma; different classes of drugs like **chemotherapy**, **targeted therapies**, and **immunotherapy** (e.g., PD-1 inhibitors for MSI-high status) are employed. - Colorectal cancer treatment focuses on blocking pathways specific to cancer cell growth and survival, not IL-17A. *Breast cancer* - **Secukinumab** has no role in the treatment of breast cancer, which is managed with therapies such as **hormonal therapy**, **chemotherapy**, **HER2-targeted therapy**, and PARP inhibitors. - Breast cancer involves distinct molecular pathways and immune responses unrelated to IL-17A. *Rheumatoid arthritis* - While **rheumatoid arthritis** is an inflammatory condition, **secukinumab** is not a primary or approved treatment for it; other biologics like **TNF inhibitors**, **IL-6 inhibitors**, or **JAK inhibitors** are commonly used. - The inflammatory cascade in rheumatoid arthritis involves different key cytokines and cellular processes compared to those targeted by secukinumab.

Question 1

Which of the following features is characteristic of psoriasis?

Accepted Answer

Micro-Munro's abscess

Answer

Grenz zone

Answer

Hyperkeratosis

Answer

Pautrier's microabscess

Question 2

Auspitz's sign is characteristically seen in

Accepted Answer

Plaque Psoriasis

Answer

Inverse Psoriasis

Answer

Pustular Psoriasis

Answer

Lichen Planus (flat-topped, purple papules)

Question 3

Which type of psoriasis is commonly seen in children and may follow a streptococcal sore throat?

Accepted Answer

Guttate psoriasis

Answer

Pustular psoriasis

Answer

Stable plaque psoriasis

Answer

Arthropathic psoriasis

Question 4

Which of the following conditions is characterized by specific nail changes such as pitting, onycholysis, and oil spots?

Accepted Answer

Psoriasis

Answer

Lichen planus

Answer

Darier disease

Answer

Onychomycosis

Question 5

What is Woronoff's ring?

Accepted Answer

An annular hypopigmented ring surrounding lesions of psoriasis.

Answer

A ring of lesions seen in flexural areas when hands are rested on the trunk.

Answer

Ring-shaped pruritic lesions on the dorsum of the foot.

Answer

An annular erythematous rash around the eyes in allergic dermatitis.

Question 6

Acrodermatitis continua of Hallopeau is due to which of the following?

Accepted Answer

Pustular psoriasis

Answer

Zinc toxicity

Answer

Zinc deficiency

Answer

Collodion baby

Question 7

Tildrakizumab was approved in March 2018 for what indication?

Accepted Answer

Psoriasis

Answer

HIV

Answer

Hepatitis C

Answer

Rheumatoid arthritis

Question 8

Secukinumab is used in:

Accepted Answer

Psoriasis

Answer

Colorectal carcinoma

Answer

Breast cancer

Answer

Rheumatoid arthritis

Psoriasis — MCQs

Psoriasis — MCQs

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