INI-CET 2015 - Dermatology PYQs Practice Questions

Q: A 9-year-old girl presents with pigmentation over forehead and redness over upper eyelids. On physical examination following clinical sign was elicited. What is the next best step for diagnosis?

CK level. ***CK level*** - The combination of **Gottron's papules** (pigmentation over joints), **Heliotrope rash** (redness over upper eyelids), and difficulty standing up as depicted (suggesting **proximal muscle weakness**) are classic signs of **dermatomyositis**, especially in a child. - **Creatine Kinase (CK)** is a key enzyme released by damaged muscle fibers, making its measurement the most appropriate initial diagnostic step to assess for muscle inflammation and damage in dermatomyositis. *Rheumatoid factor* - **Rheumatoid factor (RF)** is primarily associated with **rheumatoid arthritis**, which typically affects joints and not primarily the skin or proximal muscles in the manner described. - While some autoimmune conditions can overlap, RF is not a primary diagnostic marker for dermatomyositis. *Electromyography* - **Electromyography (EMG)** measures muscle electrical activity and can indeed show abnormalities in dermatomyositis (e.g., fibrillation potentials, positive sharp waves, and polyphasic motor unit potentials). - However, it is typically a **secondary diagnostic step** performed after initial biochemical tests like CK levels indicate muscle involvement. *Nerve conduction studies* - **Nerve conduction studies (NCS)** assess the function of peripheral nerves and are primarily used to diagnose **neuropathies**. - Dermatomyositis is a **myopathy** (muscle disease) not a neuropathy, so NCS would likely be normal or show non-specific findings, making it less relevant for initial diagnosis. [Practice more Dermatology PYQs on OnCourse]

Q: The image shows presence of:

Nevus of Ota. - ***Nevus of Ota*** - The image exhibits a characteristic **blue-grey or brownish discoloration** on the face, specifically around the eye (periorbital region) and extending to the temple and cheek. - The presence of **scleral pigmentation** (blue discoloration of the sclera) is a classic finding associated with Nevus of Ota, due to dermal melanocytosis affecting both skin and ocular structures. - *Nevus spilus* - This condition presents as a **light brown patch** with speckles of darker macules or papules within it, resembling "spots on a spot." - It does not typically involve the deep blue-grey coloration or ocular pigmentation seen in the image. - *Giant melanocytic nevus of face* - While also a melanocytic nevus, a giant congenital melanocytic nevus is typically much larger, often covering extensive body areas, and has a more **uniform dark brown to black coloration** with a rugose or hairy surface, differing from the blue-grey hue and distribution shown. - Though it can occur on the face, the overall appearance, particularly the distinct blue-grey color and scleral involvement, is not typical for a giant melanocytic nevus. - *Port wine stain* - A port wine stain is a type of **capillary malformation** characterized by a flat, pink to red vascular lesion that darkens with age to a deep purple. - It blanches under pressure and is due to dilated capillaries, not melanin deposition, and does not cause the blue-grey pigmentation or scleral involvement seen here. [Practice more Dermatology PYQs on OnCourse]

Q: An elderly patient presents with itchy tense blisters on normal looking skin as well as on urticarial plaques as shown below. The most probable diagnosis is: (AIIMS Nov 2015)

Bullous pemphigoid. ***Bullous pemphigoid*** - This condition typically presents in **elderly patients** with **itchy, tense blisters** on either normal or erythematous/urticarial skin, which aligns with the clinical description and image. - The blisters in bullous pemphigoid are characterized by **subepidermal blistering**, meaning the epidermis separates from the dermis, resulting in tense, fluid-filled lesions. *Pemphigus vulgaris* - Characterized by **flaccid blisters** that rupture easily, leading to erosions, unlike the tense blisters seen in the image. - Pemphigus vulgaris frequently involves **mucous membranes** and is caused by autoantibodies against desmoglein 1 and 3, leading to intraepidermal blistering (acantholysis). *Linear IgA disease* - This autoimmune blistering condition typically presents with **annular or rosette-shaped lesions** with small peripheral blisters, often referred to as a "string of pearls" appearance, which is not evident in the image. - On **direct immunofluorescence**, it shows a linear deposition of IgA at the dermoepidermal junction. *Dermatitis herpetiformis* - Often presents with **intensely pruritic papules and vesicles** typically found on extensor surfaces (elbows, knees, buttocks), and the lesions are often excoriated due to scratching. - Strongly associated with **celiac disease** and characterized by granular IgA deposits in the dermal papillae on direct immunofluorescence, distinguishing it from the tense blisters seen. [Practice more Dermatology PYQs on OnCourse]

Question 1

A 9-year-old girl presents with pigmentation over forehead and redness over upper eyelids. On physical examination following clinical sign was elicited. What is the next best step for diagnosis?

Accepted Answer

CK level

Answer

Rheumatoid factor

Answer

Electromyography

Answer

Nerve conduction studies

Question 2

The image shows presence of:

Accepted Answer

Nevus of Ota

Answer

Nevus spilus

Answer

Giant melanocytic nevus of face

Answer

Port wine stain

Question 3

An elderly patient presents with itchy tense blisters on normal looking skin as well as on urticarial plaques as shown below. The most probable diagnosis is: (AIIMS Nov 2015)

Accepted Answer

Bullous pemphigoid

Answer

Pemphigus vulgaris

Answer

Linear IgA disease

Answer

Dermatitis herpetiformis

INI-CET 2015 — Dermatology