Fungal Skin Infections Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Fungal Skin Infections. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Fungal Skin Infections Indian Medical PG Question 1: A 10-year-old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hair, and lymph nodes enlarged in occipital region, which of the following would be most helpful for diagnostic evaluation?
- A. Bacterial culture
- B. Biopsy and giemsa staining
- C. Patch test, gram staining and Tzank smear
- D. KOH mount (Correct Answer)
Fungal Skin Infections Explanation: ***KOH mount***
- The symptoms of **painful boggy scalp swelling**, **purulent discharge**, **easily pluckable hair**, and **occipital lymphadenopathy** in a child are highly suggestive of **Tinea capitis**, specifically **Kerion**.
- A **KOH mount** is the most direct and rapid method to identify fungal elements (hyphae and spores) in hair shafts and scales, confirming the diagnosis of a dermatophyte infection.
*Bacterial culture*
- While there is **purulent discharge**, the primary presentation with **boggy swelling** and **hair loss** is more indicative of a fungal etiology.
- A bacterial culture would only be useful to rule out secondary bacterial infection, but not as the initial diagnostic step for the described primary fungal condition.
*Biopsy and Giemsa staining*
- A **biopsy** is an invasive procedure and generally not the first-line diagnostic test for uncomplicated **Tinea capitis/Kerion**, where a non-invasive KOH mount is sufficient.
- **Giemsa staining** is primarily used for identifying certain bacteria, parasites, or cellular morphology, but it is not the standard or most efficient method for diagnosing fungal infections of the hair.
*Patch test, Gram staining and Tzank smear*
- A **patch test** is used to diagnose **allergic contact dermatitis** and is irrelevant to the presented symptoms.
- **Gram staining** is for bacterial identification, and a **Tzank smear** is used for viral infections like herpes, neither of which are indicated by the clinical picture of a fungal scalp infection.
Fungal Skin Infections Indian Medical PG Question 2: Which of the following is NOT a fungal infection?
- A. Black Piedra
- B. White Piedra
- C. Tinea nigra Palmaris
- D. Mycoses fungoides (Correct Answer)
Fungal Skin Infections Explanation: ***Mycoses fungoides***
- This is a type of **cutaneous T-cell lymphoma**, which is a **malignancy of lymphocytes**, not a fungal infection [1].
- It presents with skin lesions that can mimic various dermatological conditions but is characterized by abnormal T-cells infiltrating the skin [1], [2].
*Black Piedra*
- This is a superficial fungal infection of the **hair shaft** caused by **Piedraia hortae**, forming hard, black nodules.
- It is an example of a **dermatomycosis**.
*White Piedra*
- This is a fungal infection of the **hair shaft** caused by **Trichosporon species**, leading to soft, white to light brown nodules.
- Like black piedra, it is also a **dermatomycosis**.
*Tinea nigra Palmaris*
- This is a superficial fungal infection of the **stratum corneum** of the skin, primarily on the palms and soles, caused by **Hortaea werneckii**.
- It presents as irregular, darkly pigmented (brown to black) macules and is a true **mycosis**.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 613-614.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 564-565.
Fungal Skin Infections Indian Medical PG Question 3: Identify the condition causing this infection on the upper arm
- A. Tinea capitis (scalp ringworm)
- B. Tinea cruris (jock itch)
- C. Tinea manus (hand ringworm)
- D. Tinea corporis (body ringworm) (Correct Answer)
Fungal Skin Infections Explanation: ***Tinea corporis (body ringworm)***
- This lesion, depicted on the upper arm, is characteristic of **tinea corporis** due to its **annular, erythematous, and scaly border with central clearing**.
- The term "corporis" refers to the **body surface**, excluding the scalp, hands, feet, groin, and nails.
*Tinea capitis (scalp ringworm)*
- Tinea capitis specifically affects the **scalp** and can present with scaling, hair loss, and inflammation.
- The image clearly shows a lesion on the **upper arm**, not the scalp.
*Tinea cruris (jock itch)*
- Tinea cruris is a fungal infection found in the **groin area**, often extending to the inner thighs and buttocks.
- The location of the lesion in the image, on the **upper arm**, rules out tinea cruris.
*Tinea manus (hand ringworm)*
- Tinea manus affects the **hands**, typically causing dryness, scaling, and sometimes blister formation on the palms or between the fingers.
- The lesion in the image is located on the **upper arm**, not the hand.
Fungal Skin Infections Indian Medical PG Question 4: Assertion: Vitamin D analogues are effective in psoriasis. Reason: They reduce keratinocyte proliferation
- A. Both A & R true, R explains A (Correct Answer)
- B. A false R true
- C. Both A & R true, R doesn't explain A
- D. A true R false
Fungal Skin Infections Explanation: ***Both A & R true, R explains A***
- **Vitamin D analogues** (e.g., calcipotriol) are a cornerstone treatment for psoriasis because they effectively modulate **keratinocyte proliferation** and differentiation.
- Psoriasis is characterized by the **rapid overgrowth of keratinocytes**, and the antiproliferative effects of vitamin D analogues directly address this pathological hallmark.
*A false R true*
- This option is incorrect because both the assertion (Vitamin D analogues are effective in psoriasis) and the reason (They reduce keratinocyte proliferation) are individually true.
- The effectiveness of vitamin D analogues in treating psoriasis is well-established in dermatological practice.
*Both A & R true, R doesn't explain A*
- This option is incorrect because the reduction of keratinocyte proliferation is precisely *how* vitamin D analogues exert their therapeutic effect in psoriasis.
- The mechanism of action described in the reason directly explains the efficacy mentioned in the assertion.
*A true R false*
- This option is incorrect because the reason ("They reduce keratinocyte proliferation") is a fundamental and well-understood mechanism by which vitamin D analogues work in psoriasis.
- Vitamin D analogues bind to vitamin D receptors in keratinocytes, influencing gene expression to inhibit their excessive growth.
Fungal Skin Infections Indian Medical PG Question 5: Which of the following is used in the treatment of Pityriasis versicolor?
- A. Itraconazole (Correct Answer)
- B. Griseofulvin
- C. Terbinafine
- D. All of the options
Fungal Skin Infections Explanation: ***Itraconazole***
- **Itraconazole** is an effective oral antifungal agent commonly used to treat Pityriasis versicolor, particularly in widespread or recurrent cases.
- It works by inhibiting fungal cytochrome P450-dependent 14α-lanosterol demethylase, thereby disrupting ergosterol synthesis and fungal cell membrane integrity.
- Standard regimen: 200 mg once daily for 5-7 days or 200 mg twice daily for 1 day.
*Griseofulvin*
- **Griseofulvin** is an oral antifungal primarily used for dermatophyte infections (e.g., tinea capitis, tinea corporis), not Pityriasis versicolor, which is caused by *Malassezia* species (a yeast).
- It acts by disrupting fungal mitosis and is concentrated in keratinocytes, but has **no activity against yeasts** like *Malassezia*.
*Terbinafine*
- **Terbinafine** is an allylamin antifungal that primarily targets dermatophytes by inhibiting squalene epoxidase, an enzyme involved in ergosterol synthesis.
- While it has **limited activity** against *Malassezia* species, it is not considered a first-line or preferred systemic treatment for Pityriasis versicolor.
- Azoles (itraconazole, fluconazole) are far more effective for this condition.
*All of the options*
- This option is incorrect because **griseofulvin** has no antifungal activity against *Malassezia* species and **terbinafine** is not a preferred treatment.
- Only **itraconazole** among the listed options is an appropriate and effective systemic treatment for Pityriasis versicolor.
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