NEET-PG 2013 Practice Questions

Q: A 15cm hyperpigmented macule on an adolescent male undergoes changes such as coarseness, growth of hair & acne. Diagnosis is?

Becker nevus. ***Becker nevus*** - A Becker nevus is a **hyperpigmented patch** that typically appears during adolescence in males, often on the shoulder or upper trunk. - It characteristically becomes **hairy (hypertrichosis)**, more coarse, and can develop acne within the lesion, particularly during puberty due to androgen sensitivity. *Melanocytic nevus* - While melanocytic nevi are hyperpigmented, they generally do not show the characteristic changes of **coarseness, significant hair growth, or acne** within the lesion during adolescence. - They are typically stable in size and texture after initial development, with changes raising concern for **melanoma**. *Sebaceous nevus* - A sebaceous nevus is a **congenital lesion** often appearing as a yellowish-orange, waxy, or bumpy patch, usually on the scalp or face. - It does not typically present as a large, flat hyperpigmented macule that develops hair and acne in adolescence; instead, it may become verrucous or develop tumors in adulthood. *Sebaceous adenoma* - A sebaceous adenoma is a **benign tumor** of the sebaceous glands, usually appearing as a small, solitary, flesh-colored to yellowish papule or nodule, especially on the face. - It is not typically seen as a large, hyperpigmented macule that grows hair and acne over a broad area, as described in the question.

Q: What is the treatment for granuloma inguinale?

Azithromycin. ***Azithromycin*** - **Azithromycin** is the recommended first-line treatment for **granuloma inguinale** (donovanosis) caused by *Klebsiella granulomatis*. - Current recommended regimens: **Azithromycin 1g orally once weekly** OR **500mg daily for at least 3 weeks** (until all lesions have completely healed). - Preferred due to excellent tissue penetration, good efficacy, and convenient dosing that improves patient compliance. *Tetracycline* - **Tetracycline** (500mg four times daily) was historically used but has been largely replaced by **doxycycline** (100mg twice daily) as the preferred tetracycline-class antibiotic. - While effective against *Klebsiella granulomatis*, it requires frequent dosing leading to poor adherence. - **Doxycycline** (not listed here) is actually considered a co-first-line option alongside azithromycin in current CDC guidelines. *Clarithromycin* - **Clarithromycin** is a macrolide antibiotic but is not a recommended first-line agent for granuloma inguinale. - Limited clinical data supports its use for this condition, and it is not included in standard treatment guidelines. - Azithromycin from the same macrolide class is preferred due to better-established efficacy. *Streptomycin* - **Streptomycin** is an aminoglycoside antibiotic primarily used for mycobacterial infections (e.g., tuberculosis, plague). - Not indicated for granuloma inguinale as *Klebsiella granulomatis* responds well to macrolides (azithromycin) and tetracyclines (doxycycline). - Requires parenteral administration and has significant toxicity concerns (ototoxicity, nephrotoxicity).

Q: What percentage of skin involvement is characteristic of erythroderma?

More than 90%. ***More than 90%*** - Erythroderma, also known as **exfoliative dermatitis**, is defined by diffuse redness and scaling involving **more than 90% of the body surface area**. - This extensive involvement leads to significant physiological disturbances due to impaired skin barrier function. *Less than 30%* - Skin involvement less than 30% does not meet the criteria for erythroderma and would be considered more localized dermatological conditions. - This percentage of involvement would typically indicate a benign rash or localized eczema, not a widespread inflammatory process. *30% to 60%* - While significant, 30% to 60% skin involvement is still insufficient to classify a condition as erythroderma. - This range might be seen in severe but still localized forms of conditions like psoriasis or eczema. *60% to 70%* - 60% to 70% involvement is extensive but falls short of the critical threshold for erythroderma. - Although indicating widespread disease, it does not constitute the near-total body erythema and scaling characteristic of erythroderma.

Q: Pathergy test is used for which condition?

Behçet's syndrome. ***Behçet's syndrome*** - The **pathergy test** is a diagnostic test where a sterile needle is used to prick the skin, and a positive result (erythematous papule or pustule) indicates a hyperreactivity of the skin, common in **Behçet's syndrome**. - This syndrome is a **vasculitis** characterized by recurrent oral and genital ulcers, ocular inflammation, and skin lesions, where pathergy is a characteristic feature. *Lichen planus* - This is an **inflammatory dermatosis** affecting the skin, hair, nails, and mucous membranes, characterized by "6 P's": **Pruritic, Purple, Polygonal, Planar, Papules, and Plaques**. - The pathergy test is **not used** in the diagnosis of lichen planus. *Atopic dermatitis* - Also known as **eczema**, it is a chronic, relapsing inflammatory skin condition characterized by dry, itchy skin and often associated with a personal or family history of allergies, asthma, or allergic rhinitis. - Diagnosis is primarily clinical, focusing on characteristic skin lesions and symptoms, and the **pathergy test is not applicable**. *Reiter's syndrome* - Now known as **reactive arthritis**, this condition is an autoimmune disorder that develops in response to an infection elsewhere in the body, typically genitourinary or gastrointestinal. - It classically presents with **arthritis, urethritis, and conjunctivitis** (Can't see, can't pee, can't climb a tree), and the **pathergy test is not used** for its diagnosis.

Q: Which of the following drugs is effective in the treatment of pityriasis versicolor?

Ketoconazole. ***Ketoconazole*** - **Ketoconazole** is an **azoles antifungal agent** effective against the *Malassezia* species, the causative agent of **pityriasis versicolor**. - It works by inhibiting the synthesis of **ergosterol**, a crucial component of the fungal cell membrane, leading to its disruption and fungal cell death. *Metronidazole* - **Metronidazole** is an **antibiotic** and **amoebicide** primarily used to treat bacterial and parasitic infections. - It has **no antifungal activity** and is thus ineffective against *Malassezia* or other fungal infections. *Griseofulvin* - **Griseofulvin** is an **oral antifungal drug** primarily used for **dermatophyte infections** of the skin, hair, and nails (e.g., tinea capitis, onychomycosis). - It is **ineffective against yeasts and molds**, including *Malassezia*, making it unsuitable for pityriasis versicolor. *Chloroquine* - **Chloroquine** is an **antimalarial drug** also used in the treatment of some autoimmune conditions like lupus erythematosus. - It possesses **no antifungal properties** and is not used to treat fungal infections of any kind.

Q: Skin scraping and KOH mounting is primarily used to diagnose which of the following conditions?

Dermatophyte infection. ***Dermatophyte infection*** - Skin scraping followed by **KOH mounting** is the **primary and gold standard** diagnostic method for dermatophyte infections - **Potassium hydroxide (KOH)** dissolves keratin, making **fungal hyphae and arthroconidia** clearly visible under microscopy - This is the **most common indication** for KOH preparation in dermatology practice - Demonstrates **septate hyphae** characteristic of dermatophytes *Candidiasis* - KOH mounting can also identify *Candida* species by revealing **pseudohyphae and budding yeast cells** - While KOH can diagnose candidiasis, dermatophyte infections remain the **primary and most frequent indication** for this test in skin lesions - Candida more commonly affects mucosal surfaces where other diagnostic methods may be preferred *Bacterial infection* - Bacterial infections are diagnosed using **Gram stain, culture, and sensitivity** testing - KOH mounting is specifically for **fungal elements** and does not visualize bacteria effectively - Bacterial skin infections require different diagnostic approaches *Herpes Simplex Virus (HSV)* - HSV infections are diagnosed using **Tzanck smear** (showing multinucleated giant cells), **viral culture, or PCR** - KOH mounting is exclusively for fungal identification and **cannot detect viruses** - Viral cytopathic effects are not visible with KOH preparation

Q: Which type of leprosy does not involve nerve damage?

Indeterminate leprosy. ***Indeterminate leprosy*** - This is the earliest form of leprosy and often presents with only a **single skin lesion** and no demonstrable nerve damage. - Due to the minimal immune response, it can be difficult to classify and may progress to other forms if left untreated. *Tuberculoid leprosy* - Characterized by a **strong cell-mediated immune response** to *Mycobacterium leprae*, leading to significant nerve involvement [1]. - Patients typically present with well-demarcated, **hypopigmented patches** with definite **sensory loss** due to nerve damage [1]. *Borderline tuberculoid leprosy* - This form sits between tuberculoid and borderline lepromatous leprosy, showing features of both, including **nerve involvement** [2]. - It presents with a few to several skin lesions that are usually smaller and less clearly defined than tuberculoid lesions, often with **palpable nerves** and mild sensory loss [2]. *Lepromatous leprosy* - Characterized by a **weak or absent cell-mediated immune response**, leading to widespread bacterial proliferation and extensive nerve damage, often symmetrical [1]. - Patients show numerous, poorly defined skin lesions, nodules, and severe nerve involvement, which can result in significant **deformities** [2].

Q: In which condition is an ulceronecrotic nodule typically observed?

Lucio's leprosy. ***Lucio's leprosy*** - This is a rare, diffuse variant of **lepromatous leprosy** characterized by widespread, diffuse infiltration of the skin without distinct nodules. - The distinctive feature is the occurrence of **necrotizing vasculitis**, leading to painful, irregular ulcers and scars, known as **Lucio phenomenon** or erythema necroticans. *Lepromatous leprosy* - Characterized by **multiple, symmetrical nodules**, plaques, and diffuse infiltration, but typically without the profound ulceronecrotic changes seen in Lucio's leprosy. - The immune response is weak, leading to high bacterial load and widespread involvement, but usually not spontaneous ulceration. *Indeterminate leprosy* - This is an **early, undifferentiated form** of leprosy, characterized by a single or a few hypopigmented or erythematous macules. - Distinct nodules or ulceronecrotic lesions are not a feature of indeterminate leprosy, as the disease has not yet progressed to develop specific clinical manifestations. *Histoid leprosy* - A rare variant of lepromatous leprosy that presents with **cutaneous nodules** and papules that often resemble dermatofibromas or xanthomas. - These nodules are firm, smooth, and have a unique histological appearance, but they do not typically undergo spontaneous ulceronecrotic changes like those in Lucio's leprosy.

Q: All are seen in Behçet's syndrome except:

Pyoderma gangrenosum. ***Pyoderma gangrenosum*** - While Behçet's syndrome can involve skin lesions, **pyoderma gangrenosum** is not typically part of its diagnostic criteria or common manifestations. - Pyoderma gangrenosum is a distinct neutrophilic dermatosis characterized by rapidly enlarging, painful ulcers. *Erythema nodosum* - **Erythema nodosum** is a common dermatological manifestation in Behçet's syndrome, characterized by tender subcutaneous nodules, usually on the shins. - These lesions reflect the systemic inflammatory nature of the disease in various organs. *Genital ulcers* - **Genital ulcers** are one of the major diagnostic criteria for Behçet's syndrome, often painful and recurrent. - They tend to be deep and can form scars, appearing on the scrotum, penis, labia, or perianal area. *Oral ulcers* - **Recurrent oral aphthous ulcers** are the most common and often the initial symptom of Behçet's syndrome. - These ulcers are typically painful, varying in size, and can occur on any mucosal surface in the mouth.

Q: Match stick test is positive in ?

Leprosy. ***Leprosy*** - The **matchstick test** is a simple neurological examination used to detect **nerve damage** in leprosy, specifically **sensory loss** [1]. - A positive test indicates the patient cannot perceive the touch or pain from a matchstick, commonly due to damage to superficial nerves caused by *Mycobacterium leprae* [1]. *Rhinophyma* - This condition is characterized by **sebaceous gland hypertrophy** and **fibrosis** of the nose, often associated with rosacea. - It does not involve nerve damage or sensory loss that would be assessed by a matchstick test. *Rhinoscleroma* - Rhinoscleroma is a **chronic granulomatous bacterial infection** of the upper respiratory tract. - While it causes significant tissue destruction and structural changes, it is not primarily associated with the sensory neuropathies that the matchstick test evaluates. *P. vesticolor* - *Pityriasis versicolor* is a **superficial fungal infection** of the skin, causing discolored patches. - This condition is a dermatological issue and does not involve nerve damage or sensory deficits, making the matchstick test irrelevant.

Question 1

A 15cm hyperpigmented macule on an adolescent male undergoes changes such as coarseness, growth of hair & acne. Diagnosis is?

Accepted Answer

Becker nevus

Answer

Melanocytic nevus

Answer

Sebaceous nevus

Answer

Sebaceous adenoma

Question 2

What is the treatment for granuloma inguinale?

Accepted Answer

Azithromycin

Answer

Tetracycline

Answer

Clarithromycin

Answer

Streptomycin

Question 3

What percentage of skin involvement is characteristic of erythroderma?

Accepted Answer

More than 90%

Answer

Less than 30%

Answer

30% to 60%

Answer

60% to 70%

Question 4

Pathergy test is used for which condition?

Accepted Answer

Behçet's syndrome

Answer

Lichen planus

Answer

Atopic dermatitis

Answer

Reiter's syndrome

Question 5

Which of the following drugs is effective in the treatment of pityriasis versicolor?

Accepted Answer

Ketoconazole

Answer

Metronidazole

Answer

Griseofulvin

Answer

Chloroquine

Question 6

Skin scraping and KOH mounting is primarily used to diagnose which of the following conditions?

Accepted Answer

Dermatophyte infection

Answer

Bacterial infection

Answer

Candidiasis

Answer

Herpes Simplex Virus (HSV)

Question 7

Which type of leprosy does not involve nerve damage?

Accepted Answer

Indeterminate leprosy

Answer

Borderline tuberculoid leprosy

Answer

Tuberculoid leprosy

Answer

Lepromatous leprosy

Question 8

In which condition is an ulceronecrotic nodule typically observed?

Accepted Answer

Lucio's leprosy

Answer

Lepromatous leprosy

Answer

Indeterminate leprosy

Answer

Histoid leprosy

Question 9

All are seen in Behçet's syndrome except:

Accepted Answer

Pyoderma gangrenosum

Answer

Erythema nodosum

Answer

Genital ulcers

Answer

Oral ulcers

Question 10

Match stick test is positive in ?

Accepted Answer

Leprosy

Answer

Rhinophyma

Answer

P. versicolor

Answer

Rhinoscleroma

NEET-PG 2013

Dermatology

Internal Medicine