Psoriasis — MCQs
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Which HLA allele is most strongly associated with psoriasis?
Which of the following features is characteristic of psoriasis?
Auspitz's sign is characteristically seen in
Which type of psoriasis is commonly seen in children and may follow a streptococcal sore throat?
Which of the following conditions is characterized by specific nail changes such as pitting, onycholysis, and oil spots?
What is Woronoff's ring?
Acrodermatitis continua of Hallopeau is due to which of the following?
Tildrakizumab was approved in March 2018 for what indication?
Secukinumab is used in:
Psoriasis Indian Medical PG Practice Questions and MCQs
Question 131: Which HLA allele is most strongly associated with psoriasis?
- A. HLA B27
- B. HLA DR4
- C. HLA CW6 (Correct Answer)
- D. HLA B8
Explanation: ***HLA CW6*** - **HLA-Cw6** is the most strongly associated **HLA allele** with **psoriasis**, particularly with Type I (early-onset) psoriasis. - Its presence is linked to a more severe and widespread form of the disease. *HLA B27* - **HLA-B27** is strongly associated with **spondyloarthropathies** like **ankylosing spondylitis** and **reactive arthritis**, not directly with psoriasis itself, although it can be present in psoriatic arthritis. - Its primary role is in conditions affecting the **axial skeleton** and **entheses**. *HLA DR4* - **HLA-DR4** is a significant genetic marker for **rheumatoid arthritis** and **Type 1 diabetes**. - It is not directly associated with the pathogenesis of psoriasis. *HLA B8* - **HLA-B8** is associated with various autoimmune diseases such as **celiac disease**, **myasthenia gravis**, and **lupus erythematosus**. - It does not have a direct or strong association with psoriasis.
Question 132: Which of the following features is characteristic of psoriasis?
- A. Grenz zone
- B. Micro-Munro's abscess (Correct Answer)
- C. Hyperkeratosis
- D. Pautrier's microabscess
Explanation: ***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.
Question 133: Auspitz's sign is characteristically seen in
- A. Plaque Psoriasis (Correct Answer)
- B. Inverse Psoriasis
- C. Pustular Psoriasis
- D. Lichen Planus (flat-topped, purple papules)
Explanation: ***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.
Question 134: Which type of psoriasis is commonly seen in children and may follow a streptococcal sore throat?
- A. Pustular psoriasis
- B. Stable plaque psoriasis
- C. Arthropathic psoriasis
- D. Guttate psoriasis (Correct Answer)
Explanation: ***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.
Question 135: Which of the following conditions is characterized by specific nail changes such as pitting, onycholysis, and oil spots?
- A. Lichen planus
- B. Psoriasis (Correct Answer)
- C. Darier disease
- D. Onychomycosis
Explanation: ***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.
Question 136: What is Woronoff's ring?
- A. A ring of lesions seen in flexural areas when hands are rested on the trunk.
- B. An annular hypopigmented ring surrounding lesions of psoriasis. (Correct Answer)
- C. Ring-shaped pruritic lesions on the dorsum of the foot.
- D. An annular erythematous rash around the eyes in allergic dermatitis.
Explanation: **An annular hypopigmented ring surrounding lesions of psoriasis.** - Woronoff's ring is a **clinical finding** characterized by a pale, **hypopigmented halo** or ring that appears around resolving psoriatic plaques. - It is thought to reflect a local release of **prostaglandins** or other modulators that inhibit melanocyte activity or cause vasoconstriction. *A ring of lesions seen in flexural areas when hands are rested on the trunk.* - This description does not correspond to Woronoff's ring and is inconsistent with its typical presentation as a **halo around psoriatic lesions**. - No specific dermatological condition is commonly defined by "a ring of lesions seen in flexural areas when hands are rested on the trunk." *Ring-shaped pruritic lesions on the dorsum of the foot.* - This describes a symptom of various dermatophyte infections (like **tinea pedis**) or other inflammatory conditions, which is distinct from Woronoff's ring. - Woronoff's ring is specifically associated with **psoriasis resolution**, not primary pruritic foot lesions. *An annular erythematous rash around the eyes in allergic dermatitis.* - This description is typical of an **allergic contact dermatitis** or periorbital dermatitis, characterized by **erythema** and **pruritus** in a ring distribution around the eyes. - Woronoff's ring is neither erythematous nor associated with allergic reactions, but rather with the **resolution phase of psoriasis**.
Question 137: Acrodermatitis continua of Hallopeau is due to which of the following?
- A. Zinc toxicity
- B. Zinc deficiency
- C. Collodion baby
- D. Pustular psoriasis (Correct Answer)
Explanation: ***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.
Question 138: Tildrakizumab was approved in March 2018 for what indication?
- A. Psoriasis (Correct Answer)
- B. HIV
- C. Hepatitis C
- D. Rheumatoid arthritis
Explanation: ***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**.
Question 139: Secukinumab is used in:
- A. Psoriasis (Correct Answer)
- B. Colorectal carcinoma
- C. Breast cancer
- D. Rheumatoid arthritis
Explanation: ***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.
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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