Biological Agents in Dermatology — MCQs
Secukinumab is used in:
Tildrakizumab was approved in March 2018 for what indication?
Ranibizumab is a monoclonal antibody against?
A 45 year old female presents with the complaint of pain in the metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints of both right and left hands. Serology showed positive anti-CCP antibodies. She was placed on infliximab for control. Which of the following need to tested before starting treatment?
Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
Which interleukin is specifically secreted by Th17 cells?
Which monoclonal antibody is used in the treatment of Bronchial Asthma?
Drug of choice in scabies in pregnant woman is -
N95 mask is used for:
23 years old woman complains of recurrent acne over her face. History revealed that she had taken topical antibiotics for her acne without any significant improvement. Which one of the following tetracyclines is most preferred for her acne?
Biological Agents in Dermatology Indian Medical PG Practice Questions and MCQs
Question 1: 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.
Question 2: 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 3: Ranibizumab is a monoclonal antibody against?
- A. VEGF (Correct Answer)
- B. Interleukin-6
- C. Cluster of Differentiation 20
- D. Epidermal Growth Factor Receptor
Explanation: ***VEGF*** - **Ranibizumab** is a **monoclonal antibody** specifically designed to inhibit **vascular endothelial growth factor A (VEGF-A)**. - By binding to VEGF-A, ranibizumab prevents its interaction with receptors on endothelial cells, thereby inhibiting **angiogenesis** and reducing vascular permeability, which is crucial in treating conditions like **wet age-related macular degeneration (AMD)** and **diabetic macular edema**. *Interleukin-6* - **Interleukin-6 (IL-6)** is a **pro-inflammatory cytokine** involved in various autoimmune and inflammatory diseases. - Monoclonal antibodies targeting IL-6, such as **tocilizumab**, are used in conditions like **rheumatoid arthritis** and **cytokine release syndrome**, not for ocular neovascularization. *Cluster of Differentiation 20* - **Cluster of Differentiation 20 (CD20)** is a protein found on the surface of **B lymphocytes**. - Monoclonal antibodies against CD20, like **rituximab**, are used in the treatment of **B-cell lymphomas**, **leukemia**, and certain **autoimmune diseases**, not for conditions requiring anti-VEGF therapy. *Epidermal Growth Factor Receptor* - The **epidermal growth factor receptor (EGFR)** is a **tyrosine kinase receptor** involved in cell growth and proliferation. - Monoclonal antibodies targeting EGFR, such as **cetuximab** and **panitumumab**, are used in the treatment of various **cancers**, particularly **colorectal cancer** and **head and neck cancer**.
Question 4: A 45 year old female presents with the complaint of pain in the metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints of both right and left hands. Serology showed positive anti-CCP antibodies. She was placed on infliximab for control. Which of the following need to tested before starting treatment?
- A. G6PD
- B. PPD skin test (Correct Answer)
- C. Uric acid
- D. Complete blood count
Explanation: ***PPD skin test*** - **Infliximab** is a **TNF-alpha inhibitor**, which can **reactivate latent tuberculosis** (TB) by suppressing the immune response critical for containing the infection. [1] - A **PPD skin test** (or interferon-gamma release assay like Quantiferon) is essential to screen for latent TB before initiating treatment with biologics like infliximab to prevent severe active infection. [1] *G6PD* - **Glucose-6-phosphate dehydrogenase (G6PD) deficiency** is primarily relevant when prescribing drugs that can cause **hemolysis**, such as certain antimalarials or sulfonamides. - It does not have a direct interaction or contraindication with infliximab, and screening is not standard practice before starting TNF-alpha inhibitors. *Uric acid* - **Uric acid levels** are primarily monitored in conditions like **gout** or when using medications that affect uric acid metabolism. - They are not a standard pre-treatment screening test for patients starting infliximab for rheumatoid arthritis. *Complete blood count* - A **complete blood count (CBC)** is generally part of routine workup for many conditions and can help assess baseline blood cell counts before starting any significant medication. [1] - While useful for monitoring during treatment, it is not the critical specific test required to prevent a severe infectious complication, like a PPD test, before starting infliximab. [1]
Question 5: 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 6: Which interleukin is specifically secreted by Th17 cells?
- A. IFN Gamma
- B. IL6
- C. IL-17 (Correct Answer)
- D. IL-22
Explanation: ***IL22*** - Th17 cells predominantly secrete **IL-17** and also produce **IL-22**, which is significant in mucosal immunity and inflammation [1]. - **IL-22** plays a crucial role in the response to infections and in the pathogenesis of inflammatory diseases. *IL16* - IL-16 is primarily associated with **chemoattractant and regulatory functions** for lymphocytes and not directly secreted by Th17 cells. - It is involved in **eosinophil and T cell activation**, which is not characteristic of the Th17 response. *IFN Gamma* - IFN-gamma is mainly produced by **Th1 cells** and is critical for **cell-mediated immunity**, which is distinct from the function of Th17 cells. - It plays a role in activating **macrophages**, unlike Th17 cells which focus on **neutrophil recruitment** and inflammation. *IL6* - While IL-6 is a pro-inflammatory cytokine that can be involved in various immune responses, it is not primarily secreted by Th17 cells. - It is produced by a variety of cell types including fibroblasts and macrophages, acting as a mediator in the **acute phase response**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 158-160.
Question 7: Which monoclonal antibody is used in the treatment of Bronchial Asthma?
- A. Omalizumab (Correct Answer)
- B. Rituximab
- C. Daclizumab
- D. Trastuzumab
Explanation: ***Omalizumab*** - **Omalizumab** is a **monoclonal antibody** specifically designed to target and bind to **immunoglobulin E (IgE)**. - By reducing free IgE levels, it prevents the cascade of allergic reactions, making it effective for **severe allergic asthma** that is difficult to control with conventional treatments. *Rituximab* - **Rituximab** targets the **CD20 protein** found on the surface of B cells, leading to their depletion. - It is primarily used in the treatment of **non-Hodgkin's lymphoma**, **chronic lymphocytic leukemia**, and certain autoimmune diseases like **rheumatoid arthritis**, but not asthma. *Daclizumab* - **Daclizumab** is a monoclonal antibody that targets the **CD25 (alpha chain of the IL-2 receptor)** on activated T-cells. - It was primarily used to prevent **organ transplant rejection** and for the treatment of **relapsing-remitting multiple sclerosis**, but it is no longer widely used due to safety concerns. *Trastuzumab* - **Trastuzumab** is a monoclonal antibody that targets the **HER2 protein** (Human Epidermal growth factor Receptor 2). - It is a cornerstone therapy for **HER2-positive breast cancer** and **gastric cancer**, playing no role in the management of asthma.
Question 8: Drug of choice in scabies in pregnant woman is -
- A. Gamma Benzene Hexachloride
- B. Ivermectin
- C. Benzyl benzoate
- D. Permethrin (Correct Answer)
Explanation: ***Permethrin*** - **Permethrin cream** (5%) is considered the **drug of choice** for scabies in pregnant women due to its high efficacy and excellent safety profile. - It has **minimal systemic absorption**, reducing potential risks to the developing fetus. *Gamma Benzene Hexachloride* - **Gamma Benzene Hexachloride (lindane)** is **not recommended** in pregnancy due to potential **neurotoxicity** and higher systemic absorption. - It can cause **seizures** and other central nervous system effects, especially in infants and young children. *Ivermectin* - **Ivermectin** is an oral medication that has **limited safety data** in pregnancy and is generally avoided unless topical treatments fail. - It is classified as **Pregnancy Category C** by the FDA, meaning animal studies have shown adverse effects on the fetus, but there are no adequate and well-controlled studies in humans. *Benzyl benzoate* - **Benzyl benzoate** is an older scabicide that can be **irritating to the skin** and is generally considered a second-line option. - While it has been used in pregnancy, **permethrin** is preferred due to its superior safety and lower irritation profile.
Question 9: N95 mask is used for:
- A. respiratory droplets
- B. Dust
- C. aerosol (Correct Answer)
- D. in general
Explanation: ***aerosol*** - **N95 masks** are specifically designed to filter out at least 95% of **airborne particles** (aerosols) 0.3 microns or larger. - This level of filtration is crucial for protecting against diseases transmitted via **aerosolized droplets**, such as tuberculosis or COVID-19. *respiratory droplets* - While an N95 mask can filter respiratory droplets, it is primarily designed for smaller **aerosol particles** that can remain suspended in the air. - **Surgical masks** are generally adequate for blocking larger respiratory droplets, preventing splash and splatter. *Dust* - While an N95 mask can filter dust, it is an **overkill** for most common dust exposures. - A simple **dust mask** or even a surgical mask can provide adequate protection against larger dust particles. *in general* - This option is too broad; N95 masks are specifically used when there's a risk of exposure to **aerosolized infectious agents** or **fine particulate matter**. - Their use is typically reserved for settings where **aerosol-generating procedures** are performed or when caring for patients with **airborne diseases**.
Question 10: 23 years old woman complains of recurrent acne over her face. History revealed that she had taken topical antibiotics for her acne without any significant improvement. Which one of the following tetracyclines is most preferred for her acne?
- A. Doxycycline (Correct Answer)
- B. Oxytetracycline
- C. Minocycline
- D. Demeclocycline
Explanation: ***Doxycycline*** - **Doxycycline** is a commonly preferred tetracycline for acne due to its **anti-inflammatory properties** and efficacy against *P. acnes* at sub-antimicrobial doses. - Its **longer half-life** allows for once-daily dosing, improving patient adherence compared to other tetracyclines. *Oxytetracycline* - While effective against *P. acnes*, **oxytetracycline** generally requires higher doses and more frequent administration, which can lead to poorer patient compliance. - It often causes **gastric irritation**, making it less favorable for long-term acne management. *Minocycline* - **Minocycline** is also effective for acne but is associated with a higher risk of **side effects** like dizziness, headache, and hyperpigmentation (e.g., skin, teeth). - Its potential for **drug-induced lupus-like syndrome** and **hepatotoxicity** makes it less preferred compared to doxycycline, especially for prolonged use. *Demeclocycline* - **Demeclocycline** is primarily used as an **ADH antagonist** for treating syndrome of inappropriate antidiuretic hormone (SIADH) and is not a first-line treatment for acne. - It has a higher incidence of **photosensitivity** and overall greater renal toxicity compared to other tetracyclines, making it unsuitable for acne.
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