NEET-PG 2015 - Dermatology Practice Questions

Q: Acanthosis nigricans is characterized by all of the following except?

Histologically there is hypermelanosis. ***Histologically there is hypermelanosis*** - This statement is **FALSE** and is the correct answer to this "EXCEPT" question - The characteristic dark appearance of acanthosis nigricans is **NOT due to increased melanin** (hypermelanosis) - Histologically, the key features are **hyperkeratosis, papillomatosis, and mild acanthosis** - There is typically **minimal or no increase in melanocytes or melanin pigment** - The hyperpigmentation seen clinically is an optical effect from the thickened, hyperkeratotic epidermis *May be a sign of internal malignancy* - This statement is **true**; acanthosis nigricans can be a paraneoplastic syndrome associated with internal malignancies - **Malignant acanthosis nigricans** is particularly associated with **gastrointestinal adenocarcinomas** (especially gastric) - This form typically has sudden onset, rapid progression, and more widespread involvement *Common in obese people* - This statement is **true**; acanthosis nigricans is frequently associated with **insulin resistance** - Commonly seen in individuals with **obesity, type 2 diabetes, and metabolic syndrome** - This benign form typically affects flexural areas (neck, axillae, groin) *Associated with thick skin with hyperpigmentation* - This statement is **true**; these are the hallmark clinical features of acanthosis nigricans - Presents as **velvety thickening** and **dark brown to black hyperpigmentation** - Typically affects intertriginous areas and skin folds

Q: All of the following are premalignant conditions except which of the following?

Pyoderma Gangrenosum. ***Pyoderma Gangrenosum*** - This is a **neutrophilic dermatosis** characterized by rapidly enlarging, painful ulcers with undermined, violaceous borders. It is an inflammatory condition, not premalignant. - While often associated with systemic diseases such as **inflammatory bowel disease** or **rheumatoid arthritis**, it does not inherently carry an increased risk of developing into skin cancer. *Bowen's Disease* - This is a form of **squamous cell carcinoma in situ**, meaning the cancerous cells are confined to the epidermis and have not yet invaded the dermis. - It is considered a **premalignant lesion** because it has the potential to progress to invasive squamous cell carcinoma if left untreated. *Actinic Keratosis* - These are **rough, scaly patches** on the skin caused by years of sun exposure, predominantly in fair-skinned individuals. - Actinic keratoses are considered **premalignant lesions** with a risk of transforming into invasive squamous cell carcinoma. *Xeroderma Pigmentosum* - This is a rare, **autosomal recessive genetic disorder** characterized by a defect in DNA repair mechanisms, specifically nucleotide excision repair. - Individuals with xeroderma pigmentosum have an extremely high risk of developing various **skin cancers** (basal cell carcinoma, squamous cell carcinoma, melanoma) at an early age due to their inability to repair UV-induced DNA damage.

Q: Which of the following organisms has a role to play in Seborrheic dermatitis?

Pityrosporum ovale. ***Pityrosporum ovale*** - **Pityrosporum ovale**, now known as **Malassezia furfur**, is a lipophilic yeast that colonizes the skin and plays a significant role in the pathogenesis of **seborrheic dermatitis**. - Its presence is commonly associated with the inflammatory response seen in seborrheic dermatitis, though the exact mechanism is not fully understood. *Candida albicans* - **Candida albicans** is a common cause of **mucocutaneous candidiasis** and **intertrigo**, but it is not directly implicated in the etiology of seborrheic dermatitis. - While it can cause skin infections, its typical presentation involves erythematous, macerated rashes with satellite lesions in skin folds. *Propionibacterium* - **Propionibacterium acnes**, now known as **Cutibacterium acnes**, is primarily associated with the pathogenesis of **acne vulgaris**. - It plays a role in the inflammation and comedone formation characteristic of acne, not the scaling and erythema of seborrheic dermatitis. *None of the above* - This option is incorrect because **Pityrosporum ovale (Malassezia furfur)** is a well-recognized organism involved in seborrheic dermatitis. - The other organisms listed are associated with different dermatological conditions.

Q: Which of the following is characterized by a solitary painless ulcer on genitalia?

Syphilis. ***Syphilis*** - Primary syphilis typically presents as a **painless chancre** (ulcer) at the site of infection, usually the **genitalia**. - The painless nature is a key differentiating feature as it often goes unnoticed, allowing the disease to progress. *Genital herpes* - Characterized by multiple, small, often painful vesicles or ulcers that may coalesce [1]. - Lesions are typically tender or painful, unlike the **painless chancre** of syphilis [1]. *Traumatic injury* - While a traumatic injury can cause a solitary ulcer, it is usually painful and often associated with a clear history of trauma. - The ulcer's morphology and healing process may differ from a classic syphilitic chancre. *Chancroid* - Caused by *Haemophilus ducreyi*, chancroid presents as one or more painful, tender ulcers with ragged, undermined borders. - This is a significant differentiator from the **painless ulcer** seen in primary syphilis.

Q: What condition is suggested by eyelid papules and a hoarse cry in a child?

Lipoid proteinosis. ***Lipoid proteinosis*** - This condition is characterized by **hoarseness from infancy** due to deposition in the vocal cords and characteristic **beaded papules on the eyelids** (moniliform blepharosis). - Also known as **Urbach-Wiethe disease**, it is a rare autosomal recessive disorder resulting from mutations in the **ECM1 gene**, leading to abnormal deposition of hyaline material in various tissues. *Croup* - Croup typically presents with a **barking cough** and **stridor**, often following a viral upper respiratory infection. - It does not cause eyelid papules or chronic hoarseness from infancy, but rather acute respiratory distress. *Acrodermatitis enteropathica* - This is a rare autosomal recessive disorder of **zinc malabsorption**, leading to a classic triad of **dermatitis**, **diarrhea**, and **alopecia**. - It does not involve eyelid papules or hoarseness as primary features. *Congenital syphilis* - Congenital syphilis can cause a wide range of manifestations, including skin rashes, bone abnormalities, and rhinitis ("snuffles"), but eyelid papules and chronic hoarseness are not typical presenting features. - Diagnosis is usually confirmed by serological tests for syphilis.

Q: Pruritus is a feature of which of the following conditions?

Bullous pemphigoid. ***Bullous pemphigoid*** - **Pruritus**, often severe, is a common and early symptom of bullous pemphigoid, often preceding the appearance of skin lesions. - The disease involves autoantibodies against **hemidesmosomal proteins** (BPAG1, BPAG2), leading to subepidermal blister formation. *Pemphigus foliaceous* - This condition is characterized by **superficial blistering** and erosions, but **pruritus is typically mild or absent**. - Blisters form in the **granular layer of the epidermis** due to autoantibodies against desmoglein 1. *Pemphigus vulgaris* - Patients with pemphigus vulgaris present with **flaccid blisters and erosions**, mainly affecting the skin and mucous membranes, but **pruritus is not a prominent feature**. - The disease involves intraepidermal blistering caused by autoantibodies targeting **desmoglein 3 (and sometimes desmoglein 1)**. *None of the options* - This option is incorrect, as **pruritus is a characteristic symptom of bullous pemphigoid**.

Q: All of the following are part of the treatment of scabies except?

Long term oral steroids. ***Long term oral steroids*** - **Long-term oral steroids** are generally avoided in scabies treatment as they can **suppress the immune system**, potentially worsening the infestation. - While steroids might offer temporary relief from itching, they do not address the underlying parasitic cause and can lead to various **side effects** with prolonged use. *Topical Permethrin* - **Topical permethrin** 5% cream is a **first-line treatment** for scabies, highly effective against the *Sarcoptes scabiei* mite. - It is typically applied to the entire body from the neck down, left on for 8-14 hours, and then washed off. *Oral ivermectin* - **Oral ivermectin** is an alternative treatment, particularly useful for **crusted scabies**, widespread infestations, or in cases where topical treatments are difficult to administer. - It acts by disrupting the nervous system of the mites, leading to their death. *Oral antihistamines* - **Oral antihistamines** are used to manage the **intense pruritus** (itching) associated with scabies. - They do not kill the mites but provide symptomatic relief, improving patient comfort.

Q: A girl about to marry has comedonal acne. Drug to treat such a case is:

Retinoids. ***Retinoids*** - **Topical retinoids** (e.g., tretinoin, adapalene) are the gold standard for comedonal acne as they normalize **follicular keratinization** and prevent microcomedone formation. - Being **Category C in pregnancy**, topical retinoids require **contraception counseling** for women of childbearing age but are still first-line treatment with proper precautions. *Benzoyl peroxide* - **Benzoyl peroxide** has mild comedolytic properties but is primarily effective for **inflammatory acne** due to its antimicrobial action against *Cutibacterium acnes*. - Less effective than retinoids for purely **comedonal acne** as it doesn't address the core pathology of abnormal keratinization. *Estrogen* - **Hormonal therapy** with estrogen-containing contraceptives reduces sebum production by suppressing androgens but takes **3-6 months** to show effects. - More suitable for **hormonal acne** with inflammatory lesions rather than purely comedonal acne, and not first-line for this presentation. *Topical antibiotic* - **Topical antibiotics** (clindamycin, erythromycin) target bacterial overgrowth and inflammation but have limited efficacy in **non-inflammatory comedonal acne**. - Risk of **bacterial resistance** when used alone, and they don't address the underlying hyperkeratinization that causes comedone formation.

Q: Maculae cerulea is seen in ?

Pediculosis pubis. ***Pediculosis pubis*** - **Maculae ceruleae** (blue spots) are **pathognomonic** for pubic louse (*Pthirus pubis*) infestation. - These characteristic **bluish-gray macules** are typically found on the trunk, thighs, and lower abdomen. - They result from the **anticoagulant in louse saliva** converting hemoglobin to biliverdin at feeding sites, causing localized hemorrhage and pigment deposition. - This is a **classic diagnostic feature** of pediculosis pubis. *Pediculosis hominis corporis* - Body louse infestation causes **pruritus** and **excoriations**, typically along clothing lines (waistband, collar). - **Maculae ceruleae** are not a feature of body louse infestation. *Pediculosis capitis* - Head lice infestation presents with **scalp pruritus**, **nits on hair shafts**, and excoriations. - **Maculae ceruleae** do not occur with head lice. *Scabies* - Caused by *Sarcoptes scabiei* mite burrowing in the stratum corneum. - Presents with **burrows**, **papules**, **vesicles**, and intense **nocturnal pruritus**. - **Maculae ceruleae** are NOT associated with scabies infestation.

Question 1

Acanthosis nigricans is characterized by all of the following except?

Accepted Answer

Histologically there is hypermelanosis

Answer

Associated with thick skin with hyperpigmentation

Answer

May be a sign of internal malignancy

Answer

Common in obese people

Question 2

All of the following are premalignant conditions except which of the following?

Accepted Answer

Pyoderma Gangrenosum

Answer

Bowen's Disease

Answer

Xeroderma Pigmentosum

Answer

Actinic Keratosis

Question 3

Which of the following organisms has a role to play in Seborrheic dermatitis?

Accepted Answer

Pityrosporum ovale

Answer

Propionibacterium

Answer

Candida albicans

Answer

None of the above

Question 4

Which of the following is characterized by a solitary painless ulcer on genitalia?

Accepted Answer

Syphilis

Answer

Genital herpes

Answer

Traumatic injury

Answer

Chancroid

Question 5

What condition is suggested by eyelid papules and a hoarse cry in a child?

Accepted Answer

Lipoid proteinosis

Answer

Croup

Answer

Acrodermatitis enteropathica

Answer

Congenital syphilis

Question 6

Pruritus is a feature of which of the following conditions?

Accepted Answer

Bullous pemphigoid

Answer

Pemphigus foliaceous

Answer

Pemphigus vulgaris

Answer

None of the options

Question 7

All of the following are part of the treatment of scabies except?

Accepted Answer

Long term oral steroids

Answer

Topical Permethrin

Answer

Oral antihistamines

Answer

Oral ivermectin

Question 8

A girl about to marry has comedonal acne. Drug to treat such a case is:

Accepted Answer

Retinoids

Answer

Topical antibiotic

Answer

Estrogen

Answer

Benzoyl peroxide

Question 9

Maculae cerulea is seen in ?

Accepted Answer

Pediculosis pubis

Answer

Pediculosis hominis corporis

Answer

Scabies

Answer

Pediculosis capitis

NEET-PG 2015 — Dermatology