NEET-PG 2017 - Dermatology PYQs Practice Questions

Q: A 38-year-old man presents with the manifestation shown in the image. He has a number of family members suffering from the same condition, though the severity is different in different members. Which of the following statements is false regarding this condition?

Basal cell carcinoma. ***Basal cell carcinoma*** - Basal cell carcinoma is a type of skin cancer that is **not typically a primary manifestation** of Neurofibromatosis Type 1 (NF1). - While individuals with NF1 may have an increased risk of certain cancers, basal cell carcinoma is **not one of the characteristic features** of the condition. - **This statement is FALSE**, making it the correct answer to this question. *Autosomal dominant condition* - Neurofibromatosis Type 1 (NF1) is inherited in an **autosomal dominant pattern**, meaning only one copy of the mutated gene is needed to cause the disorder. - The patient's history of **multiple family members** suffering from the same condition with varying severity is consistent with autosomal dominant inheritance. - **This statement is TRUE.** *Chromosomal abnormality seen in chromosome 17* - Neurofibromatosis Type 1 is caused by a mutation in the **NF1 gene**, located on **chromosome 17 (17q11.2)**. - This gene encodes for **neurofibromin**, a tumor suppressor protein, and its dysfunction leads to the characteristic features of NF1. - **This statement is TRUE.** *Café-au-lait spots and neurofibromas are characteristic features* - The image displays characteristic features of NF1, including **café-au-lait spots** (large, hyperpigmented macules) and **neurofibromas** (benign tumors of nerve sheath cells). - These are classic diagnostic findings in Neurofibromatosis Type 1, along with axillary/inguinal freckling and Lisch nodules. - **This statement is TRUE.** [Practice more Dermatology PYQs on OnCourse]

Q: A 45-year-old Ulcerative colitis patient presents with multiple painful lesions on both legs. What is the diagnosis?

Pyoderma gangrenosum. ***Pyoderma gangrenosum*** - This patient has **ulcerative colitis**, which is strongly associated with **pyoderma gangrenosum**, a neutrophilic dermatosis. - The image shows characteristic **painful, rapidly expanding ulcers** with violaceous, undermined borders, typical of pyoderma gangrenosum. *Febrile neutropenic dermatosis* - This condition (also known as **Sweet syndrome**) occurs in patients with **neutropenia** and **fever**, presenting with painful erythematous plaques or nodules. - While systemic illness like ulcerative colitis can predispose to skin conditions, the specific presentation and lack of mentioned neutropenia make this less likely. *Necrotizing fasciitis* - **Necrotizing fasciitis** is a rapidly progressive, life-threatening infection of the deep fascia and subcutaneous tissue, typically presenting with severe pain, erythema, swelling, and crepitus. - The lesions in the image appear to be chronic ulcers with specific borders rather than acute, rapidly spreading infection of necrotizing fasciitis. *Granulomatosis with polyangiitis* - Also known as **Granulomatosis with polyangiitis (GPA)**, formerly **Wegener's granulomatosis**, this is an autoimmune vasculitis primarily affecting the respiratory tract and kidneys, and can cause skin lesions such as palpable purpura, nodules, or ulcers. - While skin lesions can occur, the characteristic features of **pyoderma gangrenosum** and its strong association with inflammatory bowel disease make it a more probable diagnosis in this context. [Practice more Dermatology PYQs on OnCourse]

Q: Which of the following vesico-bullous disorders will exhibit the direct immunofluorescence shown below? (Recent NEET Pattern 2016-17)

Pemphigus vulgaris. ***Pemphigus vulgaris*** - The direct immunofluorescence image shows a characteristic **"chicken wire"** or **intercellular** staining pattern in the epidermis. - This pattern indicates the presence of autoantibodies (typically **IgG**) targeting **desmoglein 1 and 3** in the desmosomes, leading to intraepidermal blistering, which is a hallmark of pemphigus vulgaris. *Bullous pemphigoid* - Direct immunofluorescence in bullous pemphigoid typically shows a **linear deposition of IgG and C3 along the dermal-epidermal junction** (basement membrane zone). - This pattern is distinctly different from the intercellular epidermal staining seen in the image. *Cicatricial pemphigoid* - This condition also presents with **linear deposition of immunoreactants along the basement membrane zone**, similar to bullous pemphigoid, but with a different antigen target. - The image does not show a linear basement membrane pattern, ruling out cicatricial pemphigoid. *Chronic bullous dermatosis of childhood* - Also known as **linear IgA bullous dermatosis**, it is characterized by a **linear deposition of IgA along the basement membrane zone**. - The image clearly displays an intercellular staining pattern within the epidermis, not a linear pattern at the dermal-epidermal junction. [Practice more Dermatology PYQs on OnCourse]

Q: The clinical sign shown in the image is:

Dennie-Morgan fold. ***Dennie-Morgan fold (infraorbital fold)*** - The image clearly shows a prominent **infraorbital fold** or crease below the lower eyelid. - This crease is known as **Dennie-Morgan fold** (also called Dennie-Morgan lines) and is a common finding in individuals with atopic dermatitis or chronic allergic conditions. - It represents an accentuated line or fold in the skin of the lower eyelid and is considered a minor diagnostic criterion for atopic dermatitis. *Allergic salute* - An **allergic salute** refers to the characteristic gesture where a child repeatedly pushes the tip of the nose upward with the palm of the hand to relieve nasal itching and obstruction. - This action often leads to a transverse crease across the bridge of the nose, but it is not depicted in the image. *Allergic line* - The term **allergic line** (or allergic crease) is synonymous with the transverse nasal crease resulting from the allergic salute. - While it's a sign associated with chronic allergic rhinitis, it does not describe the infraorbital fold seen in the image. *Allergic shiners* - **Allergic shiners** are dark, discolored areas under the eyes, resembling bruises, caused by venous congestion secondary to chronic allergic rhinitis or nasal obstruction. - While allergic shiners may coexist with Dennie-Morgan folds, the prominent feature indicated in the image is the infraorbital fold itself, not periorbital darkening. [Practice more Dermatology PYQs on OnCourse]

Q: The following lesion appears on the leg of a patient of ulcerative colitis. All are useful in management except:

Sulfapyridine. ***Sulfapyridine*** - The image shows **pyoderma gangrenosum**, a painful ulcerative skin condition often associated with inflammatory bowel disease like ulcerative colitis. Among the given options, **sulfapyridine** has the **least established role** in pyoderma gangrenosum management. - **Sulfapyridine** is an inactive component of **sulfasalazine** and primarily acts as an **antibacterial agent**. While sulfasalazine has been reported in some PG cases, sulfapyridine alone is not a recognized treatment for the inflammatory, non-infectious nature of pyoderma gangrenosum. - Unlike the other options which have well-established roles, sulfapyridine lacks strong evidence for efficacy in PG. *Steroids* - **Corticosteroids** (oral or topical) are the **first-line treatment** for pyoderma gangrenosum due to their potent anti-inflammatory and immunosuppressive effects. - They help to reduce the inflammation and promote healing of the painful ulcers. *Procto-colectomy* - In cases of severe, refractory pyoderma gangrenosum associated with ulcerative colitis, **colectomy** can be a **definitive treatment** as it removes the underlying inflammatory trigger. - This surgical intervention is considered when medical therapies are unsuccessful or when the colonic disease itself necessitates surgery. *Infliximab* - **Infliximab**, a **TNF-alpha inhibitor**, is a biologic agent effective in treating both ulcerative colitis and pyoderma gangrenosum. - It is used in cases that are refractory to steroids or when patients cannot tolerate steroid therapy. [Practice more Dermatology PYQs on OnCourse]

Question 1

A 38-year-old man presents with the manifestation shown in the image. He has a number of family members suffering from the same condition, though the severity is different in different members. Which of the following statements is false regarding this condition?

Accepted Answer

Basal cell carcinoma

Answer

Autosomal dominant condition

Answer

Chromosomal abnormality seen in chromosome 17

Answer

Café-au-lait spots and neurofibromas are characteristic features

Question 2

A 45-year-old Ulcerative colitis patient presents with multiple painful lesions on both legs. What is the diagnosis?

Accepted Answer

Pyoderma gangrenosum

Answer

Febrile neutropenic dermatosis

Answer

Necrotizing fasciitis

Answer

Granulomatosis with polyangiitis

Question 3

Which of the following vesico-bullous disorders will exhibit the direct immunofluorescence shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Pemphigus vulgaris

Answer

Bullous pemphigoid

Answer

Cicatricial pemphigoid

Answer

Chronic bullous dermatosis of childhood

Question 4

The clinical sign shown in the image is:

Accepted Answer

Dennie-Morgan fold

Answer

Allergic salute

Answer

Allergic line

Answer

Allergic shiners

Question 5

The following lesion appears on the leg of a patient of ulcerative colitis. All are useful in management except:

Accepted Answer

Sulfapyridine

Answer

Steroids

Answer

Procto-colectomy

Answer

Infliximab

Question 6

All are true about this lesion seen in a child with epilepsy except:

Accepted Answer

Minor criteria for diagnosis

Answer

Collagenoma

Answer

Peau d'orange appearance

Answer

Predominantly seen over trunk

Question 7

An 8-year-old boy who was diagnosed with hypertrophic cardiomyopathy has reddish papules all over the body developing after birth. He also complains of severe pain in hands and feet. Which of the following is correct?

Accepted Answer

Angiokeratoma, Fabry's disease

Answer

Actinic keratosis, Xeroderma pigmentosa

Answer

Pseudoxanthomas, pseudoxanthoma elasticum

Answer

Angiofibroma, tuberous sclerosis

Question 8

All are true about the condition shown in the figure except: (Recent NEET Pattern 2016-17)

Accepted Answer

Interconnecting sinus tracts

Answer

Patulous pilo-sebaceous orifices

Answer

Foul smelling cheesy material

Answer

Can lead to difficulty in breathing

Question 9

The following lesion is seen in all of the following conditions except: (Recent NEET Pattern 2016-17)

Accepted Answer

Porphyria

Answer

Carcinoid syndrome

Answer

Hartnup disease

Answer

Alcoholism

Question 10

All are correct about the condition shown in the image except: (Recent NEET Pattern 2016-17)

Accepted Answer

Necrotising Fasciitis

Answer

Epidermolysin mediated

Answer

Staphylococcal scalded skin syndrome

Answer

Caused by gram positive cocci in clusters

NEET-PG 2017 — Dermatology