NEET-PG 2024 - Dermatology PYQs Practice Questions

Q: A patient who has always neglected his nutrition presented with follicular hyperkeratosis on the extensor aspect of the forearm. What is the diagnosis?

Phrynoderma. ***Phrynoderma*** - **Phrynoderma**, also known as **toad skin**, is characterized by **follicular hyperkeratosis**, particularly on the **extensor surfaces** of limbs like the forearm. - This condition is closely linked to **nutritional deficiencies**, often involving **vitamin A**, **essential fatty acids**, or sometimes **B vitamins**. *Eruptive xanthoma* - **Eruptive xanthomas** are small, yellow-red papules that often appear suddenly, typically on the **buttocks**, **extensor surfaces of the limbs**, and **trunk**. - They are a cutaneous manifestation of **severe hypertriglyceridemia** and not primarily related to general nutritional neglect or follicular hyperkeratosis. *Darier's disease* - **Darier's disease** is a **rare, inherited genetic disorder** characterized by greasy, crusted papules primarily in **seborrheic areas** such as the scalp, forehead, chest, and groin. - It results from a mutation in the **ATP2A2 gene**, affecting calcium signaling in keratinocytes, and is not a nutritional deficiency condition. *Folliculitis* - **Folliculitis** is the inflammation of one or more **hair follicles**, often caused by **bacterial** (e.g., *Staphylococcus aureus*) or **fungal infections**. - It presents as small, red, sometimes pus-filled bumps around hair follicles, distinct from the dry, rough texture of follicular hyperkeratosis seen in phrynoderma. [Practice more Dermatology PYQs on OnCourse]

Q: A patient presents with painful vesicles as shown in the image. What is the diagnosis?

Herpes. ***Herpes*** - The image shows a cluster of **small, painful vesicles on an erythematous base**, which is highly characteristic of a herpes simplex virus (HSV) infection. - These lesions typically evolve into ulcers, crust over, and heal, and are often recurrent. *Chancroid* - Chancroid presents as **painful, soft chancres** (ulcers) with irregular, undermined borders and a gray or yellow base, often accompanied by **buboes** (enlarged, tender lymph nodes). - It does not typically manifest as clusters of small vesicles. *Syphilis* - Primary syphilis presents as a **painless chancre**—a single, firm, ulcerated lesion with a clean base and raised borders. - Secondary syphilis can cause a variety of skin manifestations, but not painful vesicles. *Candidiasis* - Cutaneous candidiasis usually appears as a **red, moist rash with satellite lesions** (smaller papules or pustules spreading from the main rash), often in skin folds. - While it can be inflammatory and itchy, it does not typically form discreet painful vesicles as seen in the image. [Practice more Dermatology PYQs on OnCourse]

Q: A 25-year-old male presents with a burning sensation during urination and purulent discharge from the penis, which started 5 days ago. He reports unprotected sexual intercourse with a new partner two weeks ago. Examination reveals an erythematous urethral meatus with noticeable purulent discharge. A Gram stain of the discharge reveals intracellular gramnegative diplococci. The patient is otherwise healthy with no known drug allergies. What is the most appropriate treatment for this patient?

Cefixime 400 mg orally once. ***Cefixime 400 mg orally once*** - This patient presents with symptoms and a Gram stain consistent with **gonococcal urethritis** (**intracellular gram-negative diplococci**) [1]. - Oral cefixime is an alternative first-line option for **uncomplicated gonococcal infections** when intramuscular ceftriaxone is not feasible or available [1]. *Metronidazole 500 mg orally twice daily for 7 days* - **Metronidazole** is primarily used to treat **anaerobic bacterial infections** and **parasitic infections** (e.g., trichomoniasis, bacterial vaginosis). - It is not effective against **Neisseria gonorrhoeae**, the causative agent of this patient's condition. *Doxycycline 100 mg orally twice daily for 7 days* - **Doxycycline** is the treatment of choice for **Chlamydia trachomatis infections** and is often co-administered empirically with gonorrhea treatment due to high rates of co-infection [1]. - While it addresses potential chlamydial co-infection, it is not the primary treatment for **gonococcal urethritis** itself. *Ceftriaxone 500 mg intramuscularly* - **Ceftriaxone 500 mg IM (or 1 gram in some guidelines)** is the **preferred first-line treatment for uncomplicated gonococcal infections** due to its high efficacy and single-dose administration [1]. - While an excellent choice, the question asks for the *most appropriate* given the options, and oral cefixime is an acceptable alternative, especially in scenarios where IM injections are impractical. [Practice more Dermatology PYQs on OnCourse]

Q: Identify the diagnosis based on the dermatology immunofluorescence (IF) image provided.

Dermatitis herpetiformis. ***Dermatitis herpetiformis*** - The immunofluorescence image shows **granular IgA deposits** at the **dermal papillae region**, which is characteristic of dermatitis herpetiformis. - This condition is strongly associated with **celiac disease** and presents with intensely pruritic papules and vesicles. *Pemphigus vulgaris* - Immunofluorescence in pemphigus vulgaris typically shows a **fishnet pattern** of IgG deposits throughout the **epidermis**, reflecting antibodies against desmoglein 3 and 1. - This pattern is an intercellular deposition, not granular at the dermal papillae. *Pemphigus foliaceus* - Similar to pemphigus vulgaris, pemphigus foliaceus also exhibits **intercellular IgG deposits** in the epidermis, but it is usually more superficial, targeting desmoglein 1. - The image does not show this intercellular epidermal staining. *Bullous pemphigoid* - Bullous pemphigoid is characterized by **linear IgG and C3 deposits along the dermal-epidermal junction** (basement membrane zone). - The image distinctly shows granular IgA, not linear IgG/C3, and specifically in the dermal papillae. [Practice more Dermatology PYQs on OnCourse]

Q: A patient presents with loss of sensation along the ulnar nerve path. The histology is shown in the image, and a Lepromin test was performed. What is the expected outcome?

Tuberculoid leprosy with lepromin positive. ***Tuberculoid leprosy with lepromin positive*** - The image shows **epithelioid cell granulomas** with sparse lymphocytes, characteristic of a **strong cell-mediated immune response** seen in tuberculoid leprosy. - Patients with tuberculoid leprosy typically have a **positive lepromin skin test**, indicating a robust CMI response capable of containing the infection. *Borderline leprosy with lepromin positive* - Borderline leprosy exhibits a wider spectrum of histological features, often with a mix of tuberculoid and lepromatous characteristics, and is typically **lepromin variable or weakly positive**. - The significant presence of well-formed granulomas in the image points more strongly towards the tuberculoid pole rather than borderline forms. *Lepromatous leprosy with lepromin positive* - Lepromatous leprosy is characterized by a **weak or absent cell-mediated immune response**, leading to diffuse infiltration of **foamy macrophages (Virchow cells)** packed with abundant *M. leprae*, and the **absence of well-formed granulomas**. - Patients with lepromatous leprosy are typically **lepromin negative** due to their anergic immune state. *Scrofuloderma* - **Scrofuloderma** is a form of **cutaneous tuberculosis** resulting from direct extension of underlying tuberculous lymphadenitis or osteomyelitis to the skin. - While it involves granulomatous inflammation, the clinical context of ulnar nerve involvement and the specific histological appearance of well-formed epithelioid granulomas with sparse bacilli are more indicative of tuberculoid leprosy. [Practice more Dermatology PYQs on OnCourse]

Question 1

A patient who has always neglected his nutrition presented with follicular hyperkeratosis on the extensor aspect of the forearm. What is the diagnosis?

Accepted Answer

Phrynoderma

Answer

Eruptive xanthoma

Answer

Darier's disease

Answer

Folliculitis

Question 2

A patient presents with painful vesicles as shown in the image. What is the diagnosis?

Accepted Answer

Herpes

Answer

Chancroid

Answer

Syphilis

Answer

Candidiasis

Question 3

A 25-year-old male presents with a burning sensation during urination and purulent discharge from the penis, which started 5 days ago. He reports unprotected sexual intercourse with a new partner two weeks ago. Examination reveals an erythematous urethral meatus with noticeable purulent discharge. A Gram stain of the discharge reveals intracellular gramnegative diplococci. The patient is otherwise healthy with no known drug allergies. What is the most appropriate treatment for this patient?

Accepted Answer

Cefixime 400 mg orally once

Answer

Metronidazole 500 mg orally twice daily for 7 days

Answer

Doxycycline 100 mg orally twice daily for 7 days

Answer

Ceftriaxone 500 mg intramuscularly

Question 4

Identify the diagnosis based on the dermatology immunofluorescence (IF) image provided.

Accepted Answer

Dermatitis herpetiformis

Answer

Pemphigus vulgaris

Answer

Pemphigus foliaceus

Answer

Bullous pemphigoid

Question 5

A patient presents with loss of sensation along the ulnar nerve path. The histology is shown in the image, and a Lepromin test was performed. What is the expected outcome?

Accepted Answer

Tuberculoid leprosy with lepromin positive

Answer

Borderline leprosy with lepromin positive

Answer

Lepromatous leprosy with lepromin positive

Answer

Scrofuloderma

Question 6

A patient's skin biopsy shows a box-shaped or square-shaped pattern of inflammatory infiltrate, as shown in the image. What is the most likely diagnosis?

Accepted Answer

Lichen planus

Answer

Lichen amyloidosis

Answer

Morphea

Answer

Lichen nitidus

Question 7

A patient presents with orange-hued skin lesions and hyperkeratotic palms and soles. A biopsy shows alternating parakeratosis and orthokeratosis. What is the most likely diagnosis?

Accepted Answer

Pityriasis rubra pilaris

Answer

Follicular psoriasis

Answer

Keratosis follicularis

Answer

Ichthyosis vulgaris

Question 8

A patient presents with annular, scaly plaques with perifollicular extension on the trunk. What is the most likely diagnosis?

Accepted Answer

Tinea

Answer

Psoriasis

Answer

Lichen planus

Answer

Pityriasis versicolor

Question 9

An adolescent male presents with severe acne lesions and sinus tracts. Which is the most effective drug for this condition?

Accepted Answer

Isotretinoin

Answer

Minocycline

Answer

Doxycycline

Answer

Topical dapsone

Question 10

A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?

Accepted Answer

Offloading and comprehensive wound care

Answer

Restart MDT

Answer

Amputation

Answer

Intense debridement and intravenous antibiotics

NEET-PG 2024 — Dermatology