Blistering Diseases

Blistering Diseases Indian Medical PG Question 1: The web-based IT system for case-based surveillance under National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) is

• A. NIKSHAY (Correct Answer)
• B. E-TB Tracker
• C. SURAKSHA
• D. SAFETY-NET

Blistering Diseases Explanation: ***NIKSHAY*** - **NIKSHAY** is the official web-based IT system used by the National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) in India for **case-based surveillance** and monitoring of TB cases. - Launched in 2012, it facilitates **real-time data entry**, tracking of patient outcomes, drug logistics management, and program monitoring, significantly improving the efficiency of TB control efforts. - It enables **notification of all TB cases**, both from public and private sectors, ensuring comprehensive surveillance. *E-TB Tracker* - **E-TB Tracker** is not the designated IT system for TB surveillance under NTEP in India. - This term may refer to other electronic tracking systems used in different contexts, but NIKSHAY remains the official platform for India's TB programme. *SURAKSHA* - **SURAKSHA** means safety or protection in Hindi and is not associated with any specific web-based IT system for TB surveillance under NTEP. - This is not a recognized TB surveillance platform in the Indian context. *SAFETY-NET* - **SAFETY-NET** is a generic term referring to social protection programs or health support systems. - There is no specific NTEP initiative for TB surveillance identified by this name.

Blistering Diseases Indian Medical PG Question 2: A 60-year-old female presents with eczematous itching lesions. Biopsy revealed a subepidermal cleft with Direct Immunofluorescence showing Linear C3 & IgG deposition along the basement membrane zone. What is the likely diagnosis?

• A. Pemphigus foliaceus
• B. Pemphigus Vulgaris
• C. Dermatitis herpetiformis
• D. Bullous Pemphigoid (Correct Answer)

Blistering Diseases Explanation: ***Bullous Pemphigoid*** - The presence of **eczematous itching lesions**, a **subepidermal cleft**, and **linear C3 and IgG deposition along the basement membrane zone** on direct immunofluorescence (DIF) are classic diagnostic features of Bullous Pemphigoid. - This autoimmune blistering disease typically affects older individuals and is characterized by antibodies targeting components of the **hemidesmosomes**, specifically BP180 and BP230. *Pemphigus foliaceus* - This condition involves **intraepidermal blistering**, specifically within the granular layer, rather than a subepidermal cleft. - DIF in Pemphigus foliaceus shows **intercellular IgG deposition** in the epidermis, not linear deposition along the basement membrane zone. *Pemphigus Vulgaris* - Pemphigus Vulgaris is characterized by **intraepidermal blistering** above the basal cell layer (**suprabasal clefting**), leading to fragile bullae that rupture easily. - DIF typically reveals **intercellular IgG and C3 deposition** in a "chicken wire" pattern throughout the epidermis, which differs from the linear pattern seen in this case. *Dermatitis herpetiformis* - While Dermatitis herpetiformis is also an autoimmune blistering disease with itching lesions, its characteristic DIF finding is **granular IgA deposition** in the dermal papillae, not linear C3 and IgG at the basement membrane zone. - Histopathology in Dermatitis herpetiformis shows **subepidermal vesicles** with neutrophil infiltration in the dermal papillae, but the direct immunofluorescence pattern is distinct.

Blistering Diseases Indian Medical PG Question 3: Which of the following is NOT a characteristic of pemphigus vulgaris?

• A. Oral erosions
• B. Tzanck smear showing acantholytic cells
• C. Positive Nikolsky’s sign
• D. Subepidermal bulla (Correct Answer)

Blistering Diseases Explanation: ***Subepidermal bulla*** - Pemphigus vulgaris is characterized by **intraepidermal bullae** resulting from acantholysis (loss of cohesion between keratinocytes), not subepidermal bullae. - **Subepidermal bullae** are characteristic of conditions like **bullous pemphigoid**, where the split occurs below the epidermis. *Positive Nikolsky’s sign* - The **Nikolsky's sign** is positive in pemphigus vulgaris, indicating the fragility of the skin where gentle lateral pressure causes epidermal shearing. - This sign is a direct result of the **intraepidermal blistering** due to weakened cell-to-cell adhesion. *Oral erosions* - **Oral erosions** are a very common and often the initial manifestation of pemphigus vulgaris, frequently preceding skin lesions. - These painful erosions are persistent and heal slowly, sometimes making eating difficult. *Tzanck smear showing acantholytic cells* - A **Tzanck smear** from a fresh blister in pemphigus vulgaris typically reveals **acantholytic cells**, which are detached, rounded keratinocytes with basophilic cytoplasm. - The presence of acantholytic cells confirms the **loss of intercellular adhesion** within the epidermis, a hallmark of pemphigus.

Blistering Diseases Indian Medical PG Question 4: Match List-I with List-II and select the correct answer using the code given below the Lists:

• A. A→1 B→2 C→4 D→3
• B. A→3 B→2 C→4 D→1
• C. A→3 B→4 C→2 D→1 (Correct Answer)
• D. A→1 B→4 C→2 D→3

Blistering Diseases Explanation: ***Correct Answer: A→3, B→4, C→2, D→1*** **Understanding Health Education Methods:** **A. Symposium → 3. Series of speeches** - A symposium is a formal meeting where multiple experts deliver **sequential speeches** on different aspects of a selected subject - Each speaker presents their perspective, typically without much interaction between speakers during the presentation **B. Panel Discussion → 4. Discussion among the speakers** - A panel involves **interactive discussion among panelists** (experts) on a particular topic - Characterized by dialogue and exchange of views between speakers, often followed by audience questions **C. Workshop → 2. Arriving at a plan of action** - A workshop is a **participatory, problem-solving session** designed to achieve practical outcomes - Participants actively engage in exercises and activities to develop concrete action plans or solutions **D. Role-play → 1. Dramatizing a situation** - Role-play involves **acting out scenarios** to experience different perspectives - Participants assume roles and dramatize situations to understand behaviors, emotions, and decision-making processes *Key Differentiation:* - Symposium = One-way presentations (speakers → audience) - Panel = Two-way discussion (speakers ↔ speakers) - Workshop = Participatory action planning - Role-play = Experiential learning through dramatization

Blistering Diseases Indian Medical PG Question 5: A 40-year-old male developed persistent oral ulcers, followed by multiple flaccid bullae on the trunk and extremities. Direct immunofluorescence examination of a skin biopsy showed intercellular IgG deposits in the epidermis. What is the most probable diagnosis?

• A. Pemphigus vulgaris (Correct Answer)
• B. Bullous Pemphigoid
• C. Bullous Lupus erythematosus
• D. Epidermolysis bullosa acquisita

Blistering Diseases Explanation: ***Pemphigus vulgaris*** - The presence of **persistent oral ulcers** followed by **flaccid bullae** on the trunk and extremities are classic clinical features. - **Direct immunofluorescence (DIF)** showing **intercellular IgG deposits** in the epidermis confirms the diagnosis, indicating antibodies against **desmogleins** within the desmosomes. *Bullous Pemphigoid* - Characterized by **tense bullae**, unlike the flaccid bullae seen in this case, and typically affects older individuals. - DIF would show **linear IgG and C3 deposits along the dermal-epidermal junction**, not intercellular epidermal deposits. *Bullous Lupus erythematosus* - This condition is rare and presents with **tense bullae** and other systemic manifestations of lupus erythematosus. - DIF usually shows granular or linear deposits of **IgG, IgA, or C3 at the dermal-epidermal junction**, sometimes in a "lupus band" pattern, but not intercellular epidermal IgG. *Epidermolysis bullosa acquisita* - Presents with skin fragility and **blisters in response to trauma**, particularly on acral surfaces, with features resembling **dystrophic epidermolysis bullosa**. - DIF reveals **linear IgG or IgA deposits along the dermal-epidermal junction** targeting type VII collagen, distinguishing it from pemphigus vulgaris.

Blistering Diseases Flashcard 1 of 5

Question: Blistering skin lesions are characteristic of _____

Answer: Porphyria cutanea tarda::Porphyria

Blistering Diseases Flashcard 2 of 5

Question: _____ microabscesses are seen in Pemphigus vegetans

Answer: Eosinophilic

Blistering Diseases Flashcard 3 of 5

Question: Bullous Pemphigoid is characterized by _____ non-acantholytic blisters.

Answer: subepidermal

Blistering Diseases Flashcard 4 of 5

Question: Pemphigus foliaceus presents with _____ involvement

Answer: skin (only skin/both skin and mucosal)

Blistering Diseases Flashcard 5 of 5

Question: Lesions of pemphigus vulgaris heal with_____ scarring

Answer: out