Dermatopathology Practice Questions

Q: "Church spire effect" is shown by which of the following conditions?

Verruca vulgaris. The **"Church spire effect"** is a classic histopathological descriptor for **Verruca vulgaris** (the common wart), caused by Human Papillomavirus (HPV) [1]. **1. Why Verruca vulgaris is correct:** In Verruca vulgaris, the epidermis undergoes significant reactive changes. The "church spire" appearance refers to **pointed projections of hyperkeratosis** (thickening of the stratum corneum) and **parakeratosis** (retention of nuclei in the stratum corneum) that sit atop a papillomatous (undulating) epidermis [1]. These sharp, peaked elevations resemble the spires of a church. **2. Why the other options are incorrect:** * **Pemphigus vulgaris:** Characterized by **suprabasal acantholysis** (loss of cell-to-cell adhesion) leading to a "tombstone appearance" of the basal layer and intraepidermal blisters. * **Pemphigus vegetans:** A variant of pemphigus characterized by exuberant granulation tissue and **pseudoepitheliomatous hyperplasia**, but it lacks the peaked, spire-like keratinization. * **Verrucous papillary outgrowth:** This is a general morphological description rather than a specific pathological sign like the "church spire" effect. **3. High-Yield Clinical Pearls for NEET-PG:** * **Koilocytes:** The hallmark of HPV infection; these are squamous cells with shrunken, "raisin-like" nuclei surrounded by a clear halo [1]. * **Other features of Verruca:** Hypergranulosis (thickened granular layer) and inward-bending rete ridges (often called "kissing" rete ridges) [1]. * **Acanthosis:** Diffuse epidermal hyperplasia is always present in verrucous lesions [1]. * **Differential Diagnosis:** Seborrheic keratosis also shows papillomatosis but is distinguished by "horn cysts" and a "stuck-on" clinical appearance. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1177-1178.

Q: Abrus precatorius (abrin) poisoning is characterized by which of the following findings?

Abrus precatorius poisoning. **Explanation:** **Abrus precatorius (Abrin) poisoning** is a high-yield topic in forensic pathology and toxicology. The seeds of *Abrus precatorius* (Rosary pea/Ratti) contain **abrin**, a potent Type II Ribosome-Inactivating Protein (RIP). Its mechanism of action is identical to ricin: it inhibits protein synthesis by removing an adenine residue from the 28S ribosomal RNA, leading to cell death. 1. **Why Option A is correct:** The question asks to identify the condition characterized by its own name (a common pattern in recall-based questions). Clinically, abrin poisoning via "suicidal needles" (sui) causes intense local inflammation, **hemorrhagic edema**, and necrosis at the injection site. Systemically, it leads to multi-organ failure and fatal gastroenteritis if ingested. 2. **Why other options are incorrect:** * **Pemphigus:** An autoimmune blistering disease characterized by acantholysis (loss of intercellular connections) due to antibodies against desmogleins [1]. * **Aphthous ulcer:** Common, painful oral ulcers (canker sores) associated with T-cell mediated immune responses, not toxins. * **Erythema multiforme:** A hypersensitivity reaction (often triggered by HSV or drugs) characterized by "target" or "iris" lesions and subepidermal bullae. **High-Yield Clinical Pearls for NEET-PG:** * **The "Sui" (Needles):** Traditionally used for cattle poisoning; seeds are decorticated, made into a paste, and shaped into needles. * **Fatal Dose:** 1–2 seeds (ingested) or 0.1–1.0 mg of abrin (injected). * **Post-mortem finding:** Presence of a "sui" or fragments of the seed at the site of injection/inflammation. * **Treatment:** Primarily supportive; there is no specific antidote for abrin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 645-646.

Q: Melanin pigmentation in pregnancy is known as?

Melasma. **Explanation:** **Melasma** (also known as chloasma or the "mask of pregnancy") is a common acquired hypermelanosis characterized by symmetric, brown-to-grayish patches on sun-exposed areas, most frequently the face. In the context of pregnancy, it is driven by elevated levels of estrogen, progesterone, and melanocyte-stimulating hormone (MSH), which stimulate melanocytes to increase melanin production. **Analysis of Options:** * **Melasma (Correct):** This is the classic dermatological manifestation of hormonal changes during pregnancy. It typically affects the cheeks, forehead, and upper lip. * **Melanoma:** This is a malignant neoplasm of melanocytes. While pregnancy can sometimes affect the prognosis or detection of melanoma, it is not a term for physiological pigmentation [1]. * **Epulis:** Specifically "Epulis Gravidarum" (Pyogenic Granuloma), this refers to a vascular, tumor-like gingival growth occurring in pregnant women, not a pigmentary disorder. * **Melanosis:** This is a general term for abnormal melanin deposition (e.g., Smoker’s melanosis or Melanosis coli) but is not the specific clinical term used for pregnancy-induced facial hyperpigmentation. **High-Yield NEET-PG Pearls:** * **Histopathology:** Melasma shows increased melanin in the basal and suprabasal layers of the epidermis and/or dermal melanophages. * **Wood’s Lamp Examination:** Used to classify melasma into Epidermal (enhances under light), Dermal (does not enhance), or Mixed types. * **Treatment:** Often resolves postpartum. First-line medical therapy is **Kligman’s Formula** (Hydroquinone + Tretinoin + Fluocinolone acetonide). * **Other Pregnancy Pigmentary Changes:** Darkening of the linea alba (becoming **linea nigra**), secondary areola, and darkening of pre-existing nevi [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1146-1148.

Question 1

"Church spire effect" is shown by which of the following conditions?

Accepted Answer

Verruca vulgaris

Answer

Pemphigus vulgaris

Answer

Pemphigus vegetans

Answer

Verrucous papillary outgrowth

Question 2

What is the characteristic feature of Paget's cells?

Accepted Answer

Abundant clear cytoplasm

Answer

Eosinophilic cytoplasm

Answer

Glycogen mass

Answer

Multinucleated giant cell

Question 3

Examination of a skin lesion demonstrates very abnormal squamous cells with a high nuclear/cytoplasmic ratio and clumped chromatin. These cells form nests within the epidermis that extend to the superficial surface of the epithelium. In some places, nests of these cells have central areas of abnormal keratin formation. The basement membrane is intact and no nests of cells are seen in the dermis. Which of the following terms best describes this lesion?

Accepted Answer

Carcinoma in situ

Answer

Dysplasia

Answer

Invasive carcinoma

Answer

Metaplasia

Question 4

Abrus precatorius (abrin) poisoning is characterized by which of the following findings?

Accepted Answer

Abrus precatorius poisoning

Answer

Pemphigus

Answer

Aphthous ulcer

Answer

Erythema multiforme

Question 5

What is Mycosis fungoides?

Accepted Answer

Cutaneous T cell lymphoma

Answer

Fungal infection

Answer

Bacterial infection

Answer

Cutaneous B cell lymphoma

Question 6

Which marker is used for malignant melanoma?

Accepted Answer

S 100

Answer

Cytokeratin

Answer

MBN-45

Answer

Alpha FP

Question 7

Which of the following is a feature of acanthosis nigricans?

Accepted Answer

Insulin resistance, obesity, cutaneous hyperpigmentation

Answer

Insulinoma, obesity & cutaneous hypopigmentation

Answer

Thickening of spinous layer, insulin resistance, obesity

Answer

Thickening of spinous layer, insulin resistance, lean

Question 8

Which of the following conditions is associated with Psoriasis?

Accepted Answer

Geographic tongue

Answer

Benign median rhomboid glossitis

Answer

Lupus erythematosus

Answer

Lupus vulgaris

Question 9

Melanin pigmentation in pregnancy is known as?

Accepted Answer

Melasma

Answer

Melanoma

Answer

Epulis

Answer

Melanosis

Question 10

What is the characteristic pathological feature of pyogenic granuloma?

Accepted Answer

Granulation tissue

Answer

Epithelioid cells

Answer

Cavernous hemangioma

Answer

Giant cells

Dermatopathology — MCQs

Dermatopathology — MCQs

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