INI-CET 2025 - Dermatology PYQs Practice Questions

Q: Which of the following are recognized side effects of topical corticosteroid use? a. Hypertrichosis b. Acneiform eruptions c. Skin atrophy d. Blue pigmentation of the skin

a, b, c. ***a, b, c*** - This option correctly includes three well-established local adverse effects of topical corticosteroids: **Hypertrichosis** (increased hair growth), **Acneiform eruptions** (steroid acne), and crucial connective tissue damage leading to **Skin atrophy**. - Other recognized local side effects include telangiectasias, striae, hypopigmentation, purpura, and delayed wound healing. *a, b, d* - This option incorrectly includes 'd. Blue pigmentation of the skin'; topical steroids primarily cause **hypopigmentation** due to melanocyte suppression, not true blue discoloration. - Blue pigmentation (e.g., slate-grey or blue-black) is typically associated with drugs like **Minocycline** or conditions like **Ochronosis** (Alkaptonuria). *a, c, d* - This option incorrectly lists 'd. Blue pigmentation of the skin' (as explained above) and simultaneously omits 'b. **Acneiform eruptions**', which is a very common side effect, especially with high-potency steroids applied to the face. - **Steroid acne** results from follicular occlusion and changes in the sebaceous unit, presenting as monomorphic papules and pustules. *b, c, d* - This option incorrectly includes 'd. Blue pigmentation of the skin' while omitting 'a. **Hypertrichosis**', an effect common due to the stimulation of hair follicles by circulating corticosteroid metabolites. - The development of **hypertrichosis** is concentration-dependent and especially noticeable in women using potent topical steroids on the face. [Practice more Dermatology PYQs on OnCourse]

Q: A male presents with lesions as shown in the image and a history of unprotected sexual intercourse a few months ago. What is the most appropriate investigation to confirm the diagnosis?

Serology. ***Serology*** - The clinical presentation (diffuse body rash, often involving the palms and soles, following recent unprotected sexual exposure) is highly suggestive of **Secondary Syphilis**. - **Serological tests** (Non-treponemal tests like RPR/VDRL and specific Treponemal tests like TPPA/FTA-ABS) are the definitive and most appropriate confirmatory investigation for syphilis. *Tzanck smear* - This test is used primarily for the rapid diagnosis of vesicular lesions caused by herpes viruses, such as **Herpes Simplex Virus (HSV)** or **Varicella-Zoster Virus (VZV)**. - It is not indicated for the diagnosis of the typical maculopapular rash seen in secondary syphilis. *KOH* - **Potassium hydroxide (KOH) preparation** is a direct microscopy test specifically used to identify structures like hyphae and spores in the diagnosis of **superficial fungal infections**. - The patient's presentation with a rash secondary to sexually transmitted infection is not typically investigated using KOH. *Biopsy* - While a skin biopsy might confirm the diagnosis histologically (showing characteristic perivascular infiltrate), it is **invasive** and generally reserved for cases where serology is equivocal or the presentation is atypical. - **Serology** provides a systemic assessment and is the standard initial confirmatory test for syphilis. [Practice more Dermatology PYQs on OnCourse]

Q: A patient presents with painful ulcer in the mouth and a past history of recurrent vesicular lesions in the genitalia. Bedside test findings are shown. What is the most appropriate drug for management?

Acyclovir. ***Correct: Acyclovir*** - The clinical history of recurrent painful oral and genital vesicular lesions, combined with the **Tzanck smear** finding of **multinucleated giant cells** (as shown in the image), is classic for **Herpes Simplex Virus (HSV)** infection. - **Acyclovir** is a guanosine analog antiviral drug that inhibits viral DNA polymerase, making it the first-line treatment for HSV and Varicella-Zoster Virus (VZV) infections. *Incorrect: Penicillin* - **Penicillin** is an antibiotic used to treat bacterial infections, most notably **syphilis**, which is caused by the spirochete *Treponema pallidum*. - Syphilis typically presents with a single, **painless chancre**, not recurrent painful vesicles, and penicillin has no efficacy against viral pathogens like HSV. *Incorrect: Ceftriaxone* - **Ceftriaxone** is a third-generation cephalosporin antibiotic, primarily used for bacterial infections such as **gonorrhea** and meningitis. - It is ineffective for treating viral infections, and the clinical presentation does not align with the purulent discharge characteristic of gonorrhea. *Incorrect: Azithromycin* - **Azithromycin** is a macrolide antibiotic effective against bacteria that can cause genital ulcers, such as **Haemophilus ducreyi** (causing **Chancroid**) and *Chlamydia trachomatis*. - While Chancroid causes painful ulcers, it does not typically present with a vesicular stage or the recurrent pattern seen in this case, nor would it show multinucleated giant cells on a smear. [Practice more Dermatology PYQs on OnCourse]

Q: A patient with asymptomatic annular skin lesion as shown presents to OPD. Which investigation should be done?

KOH mount. ***KOH mount*** - The image displays a classic **annular (ring-shaped) lesion** with a raised, erythematous, and scaly border with central clearing, which is pathognomonic for **Tinea corporis** (ringworm). - A **KOH mount** is the gold standard, rapid, and cost-effective diagnostic test for dermatophytosis, allowing visualization of **septate hyphae** from skin scrapings. ***HIV testing*** - While widespread or severe fungal infections can be associated with **immunocompromised states** like HIV, it is not the initial diagnostic step for a localized lesion. - This test would be considered only if the infection is unusually persistent, recurrent, or if there are other systemic signs suggesting immunosuppression. ***Biopsy*** - A **skin biopsy** is an invasive procedure and is not the first-line investigation for a typical presentation of tinea corporis. - It is reserved for atypical cases or when the diagnosis is uncertain after non-invasive tests, to rule out other annular dermatoses like **granuloma annulare** or **psoriasis**. ***Chest X-ray*** - A **Chest X-ray** is indicated for evaluating cardiopulmonary conditions and has no diagnostic value for a cutaneous fungal infection. - This investigation is entirely unrelated to the patient's presenting skin lesion. [Practice more Dermatology PYQs on OnCourse]

Question 1

Which of the following are recognized side effects of topical corticosteroid use?
a. Hypertrichosis
b. Acneiform eruptions
c. Skin atrophy
d. Blue pigmentation of the skin

Accepted Answer

a, b, c

Answer

a, b, d

Answer

a, c, d

Answer

b, c, d

Question 2

A male presents with lesions as shown in the image and a history of unprotected sexual intercourse a few months ago. What is the most appropriate investigation to confirm the diagnosis?

Accepted Answer

Serology

Answer

Tzanck smear

Answer

KOH

Answer

Biopsy

Question 3

A patient presents with painful ulcer in the mouth and a past history of recurrent vesicular lesions in the genitalia. Bedside test findings are shown. What is the most appropriate drug for management?

Accepted Answer

Acyclovir

Answer

Ceftriaxone

Answer

Azithromycin

Answer

Penicillin

Question 4

A patient with asymptomatic annular skin lesion as shown presents to OPD. Which investigation should be done?

Accepted Answer

KOH mount

Answer

Biopsy

Answer

Chest X-ray

Answer

HIV testing

Question 5

In an infant with scabies, what is the preferred treatment?

Accepted Answer

1, 3, 4 (Permethrin, Benzyl benzoate, Crotamiton)

Answer

1, 2, 4 (Permethrin, Ivermectin, Crotamiton)

Answer

1, 2, 3 (Permethrin, Ivermectin, Benzyl benzoate)

Answer

2, 4 (Ivermectin, Crotamiton)

INI-CET 2025 — Dermatology