Psoriasis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Psoriasis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Psoriasis Indian Medical PG Question 1: What is the primary condition for which calcitriol is used as a treatment?
- A. Pemphigus
- B. Secondary hyperparathyroidism (Correct Answer)
- C. Lichen planus
- D. Leprosy
Psoriasis Explanation: Secondary hyperparathyroidism
- Calcitriol is the active form of vitamin D (1,25-dihydroxyvitamin D₃), and it is crucial for regulating calcium and phosphate levels in the body [1].
- In secondary hyperparathyroidism, often seen in chronic kidney disease (CKD), the kidneys cannot convert vitamin D to its active form, leading to hypocalcemia and increased PTH secretion [1], [2].
- Calcitriol supplementation helps to increase calcium absorption from the gut and suppress the release of parathyroid hormone (PTH), thereby treating the underlying cause of secondary hyperparathyroidism [1], [2].
- This is the primary therapeutic indication for calcitriol in clinical practice.
Lichen planus
- This is a chronic inflammatory condition affecting the skin, hair, nails, and mucous membranes
- Typically treated with corticosteroids or other immunosuppressants
- Calcitriol has no primary role in the treatment of lichen planus; its therapeutic applications are predominantly related to calcium and bone metabolism
Pemphigus
- Pemphigus is a group of rare autoimmune blistering diseases that affect the skin and mucous membranes
- Primary treatment involves immunosuppressants like corticosteroids, often in high doses
- Calcitriol is not indicated for the treatment of pemphigus, as its mechanism of action is unrelated to the autoimmune processes characteristic of this disease
Leprosy
- Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae
- Treated with multi-drug therapy (MDT), which includes antibiotics like rifampicin, dapsone, and clofazimine
- Calcitriol is not an antibiotic and therefore has no role in treating the bacterial infection responsible for leprosy
Psoriasis Indian Medical PG Question 2: Skin biopsy shows psoriasiform hyperplasia with neutrophilic microabscesses in stratum corneum. Most likely diagnosis?
- A. Psoriasis (Correct Answer)
- B. Seborrheic dermatitis
- C. Pityriasis rosea
- D. Lichen planus
Psoriasis Explanation: ***Psoriasis***
- **Psoriasiform hyperplasia**, characterized by regular epidermal acanthosis and elongated rete ridges, is a classic histological feature of psoriasis.
- The presence of **neutrophilic microabscesses (Munro microabscesses)** in the stratum corneum is a pathognomonic finding for psoriasis.
*Seborrheic dermatitis*
- Histologically, seborrheic dermatitis typically shows **irregular acanthosis** with parakeratosis and a **perivascular lymphocytic infiltrate**, but not regular psoriasiform hyperplasia or Munro microabscesses.
- There may be *spongiosis* and neutrophils in the stratum corneum, but not the distinct microabscesses seen in psoriasis.
*Pityriasis rosea*
- Pityriasis rosea histology often reveals **focal parakeratosis**, **spongiosis**, and a **perivascular lymphocytic infiltrate** with extravasated red blood cells.
- It does not demonstrate the characteristic regular psoriasiform hyperplasia or neutrophilic microabscesses of psoriasis.
*Lichen planus*
- Lichen planus is characterized by a **"sawtooth" rete ridge pattern**, a **band-like lymphocytic infiltrate** at the dermo-epidermal junction, and **colloid bodies (Civatte bodies)**.
- It does not exhibit psoriasiform hyperplasia or neutrophilic microabscesses in the stratum corneum.
Psoriasis Indian Medical PG Question 3: In psoriasis, the following are seen except:
- A. Skin involvement
- B. CNS involvement (Correct Answer)
- C. Nail changes
- D. Arthritis
Psoriasis Explanation: ***CNS involvement***
- Psoriasis is primarily a **skin disorder** with systemic manifestations but typically does **not directly involve the central nervous system**.
- While patients with psoriasis may experience symptoms like depression or anxiety, these are generally considered **comorbid conditions** rather than direct manifestations of psoriatic pathology in the CNS.
*Skin involvement*
- **Plaque psoriasis**, the most common form, is characterized by well-demarcated, erythematous plaques with silvery scales.
- Psoriasis directly affects the skin, leading to rapid **keratinocyte proliferation** and inflammation.
*Nail changes*
- **Onycholysis (separation of the nail from the nail bed)**, **pitting**, and **oil spots** (yellow-brown discolorations under the nail) are common in psoriasis.
- These nail changes can occur with or without concurrent skin involvement.
*Arthritis*
- **Psoriatic arthritis (PsA)** is a chronic inflammatory arthritis associated with psoriasis, affecting up to 30% of patients.
- It can involve peripheral joints, the **axial skeleton**, and entheses, often presenting with symptoms like stiffness and pain.
Psoriasis Indian Medical PG Question 4: All are true about psoriasis except –
- A. Auspitz sign positive
- B. Parakeratosis & acanthosis
- C. Joint involvement in 5–10% (Correct Answer)
- D. Pitting of nails
- E. Koebner phenomenon
Psoriasis Explanation: ***Joint involvement in 5–10%***
- While **psoriasis** is a skin condition, it can involve the joints in about **30% of patients**, leading to **psoriatic arthritis**.
- Therefore, stating that joint involvement occurs in only **5-10%** is incorrect, as the percentage is significantly higher.
- This is the **FALSE statement** in this EXCEPT question.
*Auspitz sign positive*
- The **Auspitz sign** (pinpoint bleeding when scales are removed) is a classic feature of psoriasis.
- It occurs due to the proximity of dilated capillaries to the thinned suprapapillary epidermis.
- This is a **TRUE statement**.
*Parakeratosis & acanthosis*
- **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological features of psoriasis.
- These features reflect the **rapid cell turnover** and **thickening of the epidermis** characteristic of psoriatic plaques.
- This is a **TRUE statement**.
*Pitting of nails*
- **Nail pitting** is a common manifestation of psoriasis, affecting up to **50% of patients** with chronic plaque psoriasis and **80% of patients with psoriatic arthritis**.
- Other nail changes include **onycholysis**, **subungual hyperkeratosis**, and discoloration.
- This is a **TRUE statement**.
*Koebner phenomenon*
- **Koebner phenomenon** (isomorphic response) is the development of psoriatic lesions at sites of trauma or injury.
- This is seen in approximately **25% of patients** with psoriasis and is a well-recognized clinical feature.
- This is a **TRUE statement**.
Psoriasis Indian Medical PG Question 5: Treatment of choice for Pustular psoriasis is:
- A. Methotrexate (Correct Answer)
- B. Psoralen - UV therapy
- C. Systemic steroid
- D. Estrogen
Psoriasis Explanation: ***Methotrexate***
- **Methotrexate** is a systemic immunosuppressant often considered the first-line treatment for severe forms of **pustular psoriasis** due to its efficacy in reducing inflammation and hyperproliferation of skin cells.
- It works by inhibiting **dihydrofolate reductase**, thereby interfering with DNA synthesis and cell division, which is crucial in rapidly dividing cells like those found in psoriasis.
*Psoralen - UV therapy*
- **Psoralen and ultraviolet A (PUVA)** therapy can be used for chronic plaque psoriasis, but it is generally **contraindicated or used with extreme caution** in pustular psoriasis due to the risk of exacerbating the disease or causing irritation.
- **UV light therapy** can sometimes trigger or worsen pustular flares, especially in acute generalized pustular psoriasis.
*Systemic steroid*
- While systemic steroids can provide temporary relief by addressing inflammation, their use in pustular psoriasis is generally **not recommended for long-term management** due to the high risk of severe rebound flares upon withdrawal.
- Withdrawal of **systemic corticosteroids** can precipitate or worsen generalized pustular psoriasis, making them a less desirable long-term treatment option.
*Estrogen*
- **Estrogen** has no direct role in the treatment of psoriasis. Psoriasis is an inflammatory skin condition, and its pathophysiology is not directly influenced by estrogen levels.
- Hormonal therapies are not indicated for the management of psoriasis, including its pustular forms.
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