FMGE 2023 - Dermatology PYQs Practice Questions

Q: A 45-year-old man with multiple sexual partners presents with a palmoplantar rash as seen below. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?

Secondary syphilis. ***Secondary syphilis*** - The classic rash of secondary syphilis is a diffuse, maculopapular eruption that characteristically involves the **palms and soles**, as seen in the image. A history of multiple sexual partners is a major risk factor. - **Epitrochlear lymphadenopathy** is a highly suggestive, though not pathognomonic, sign of secondary syphilis. Other systemic symptoms may include fever, malaise, and **condylomata lata**. *Psoriasis* - While psoriasis can affect the palms and soles (**palmoplantar psoriasis**), it typically presents as well-demarcated, erythematous plaques with a silvery scale, which differs from the rash shown. - Psoriasis is an autoimmune condition and is not associated with **epitrochlear lymphadenopathy** or risk factors like multiple sexual partners. *Meningococcemia* - This is an acute, life-threatening infection that presents with a **petechial or purpuric rash** that can become necrotic, not a papular rash on the palms and soles. - Patients with **meningococcemia** are typically systemically unwell with high fever, hypotension, and signs of meningitis, which are absent in this presentation. *Steven Johnson syndrome* - SJS is a severe mucocutaneous reaction characterized by **targetoid lesions**, bullae, and epidermal detachment, which are not features of the rash shown. - A key feature of SJS is severe involvement of at least two **mucous membranes** (e.g., oral, ocular, genital), which is not mentioned in this case. [Practice more Dermatology PYQs on OnCourse]

Q: A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?

Capillary hemangioma. ***Capillary hemangioma*** - Also known as a **strawberry hemangioma**, this is the most common benign vascular tumor of infancy, appearing as a bright red, raised, soft plaque or nodule with sharply defined borders. - These lesions are characterized by an initial rapid **proliferative phase** typically occurring in the first year of life, followed by a slow, eventual **spontaneous involution**. *Portwine stain* - This is a vascular **capillary malformation**, characterized by a flat (**macular**) pink, red, or purple patch that is present at birth. - Unlike hemangiomas, portwine stains **do not involute** spontaneously and persist throughout life; they may thicken and darken over time. *Cavernous hemangioma* - This term is often used for hemangiomas that are **deeper** (involving the reticular dermis and subcutaneous tissue), resulting in a blue, soft, or ill-defined mass. - While they also undergo spontaneous involution, they lack the characteristic superficial, bright red, **raised** appearance seen in typical capillary (strawberry) hemangiomas. *Naevus simplex* - Also known as a **salmon patch** or **stork bite**, this is a common, faint, macular pink-to-red vascular mark typically found on the nape of the neck, eyelids, or glabella. - These lesions are transient and usually **fade completely** before 18 months of age, unlike capillary hemangiomas which are raised and generally take longer to involute. [Practice more Dermatology PYQs on OnCourse]

Q: A patient presents with a violaceous rash on the upper back and shoulders (img-16.jpeg) and Gottron's papules on hands (img-17.jpeg). What is the likely diagnosis?

Dermatomyositis. ***Dermatomyositis*** - The presence of a **heliotrope rash** (violaceous eruption on the upper eyelids) and **Gottron's papules** (violaceous papules over the knuckles) are pathognomonic for this inflammatory myopathy. - Other characteristic skin findings include the **shawl sign** (a photosensitive rash on the upper back, shoulders, and posterior neck, as seen in the image), the **V-sign**, and associated proximal muscle weakness. *Systemic lupus erythematosus* - SLE is classically associated with a **malar rash** (butterfly rash) over the bridge of the nose and cheeks, which spares the nasolabial folds. - While photosensitivity is a common feature, the specific findings of a heliotrope rash and Gottron's papules are not typical for SLE. *Systemic sclerosis* - This condition is characterized by progressive **skin thickening** and fibrosis, particularly **sclerodactyly** (tightening of the skin on the fingers). - Key differentiating features include **Raynaud phenomenon** and internal organ involvement, which are absent in this presentation. *Cushing syndrome* - This endocrine disorder is caused by excess **cortisol** and presents with distinct features like a **moon face**, **buffalo hump**, and purple **striae**. - It does not cause the inflammatory, photosensitive rashes that are characteristic of dermatomyositis. [Practice more Dermatology PYQs on OnCourse]

Q: An 18-year-old female patient comes with the following findings. Which of the following is pathognomonic of the primary stage of this disease?

Comedone. ***Comedone*** - The **comedo** is the primary, pathognomonic lesion of **acne vulgaris**. It is a non-inflammatory lesion formed by a blocked **pilosebaceous unit** with sebum and keratinocytes. - Comedones can be open (**blackheads**) or closed (**whiteheads**) and are the precursor to all inflammatory acne lesions like papules and pustules. *Papule* - A **papule** is a small, solid, raised inflammatory lesion that develops when a comedo ruptures, leading to an inflammatory response. - It represents a progression from the non-inflammatory primary stage to **inflammatory acne** and is therefore not the initial lesion. *Pustule* - A **pustule** is a superficial inflammatory lesion containing visible purulent material (pus), which typically evolves from a papule. - The presence of pus signifies a more advanced inflammatory process involving **Propionibacterium acnes** and neutrophils, not the primary stage. *Abscess* - An **abscess** is a deep, painful, pus-filled lesion that is characteristic of severe **nodulocystic acne**, a more advanced form of the disease. - This represents a severe inflammatory response and is not the primary lesion, which is much smaller and non-inflammatory. [Practice more Dermatology PYQs on OnCourse]

Q: A 26-year-old male presented with erythematous plaques covered with silvery scales over the extensor surfaces of both arms. Punctate pitting was noted on examining the nails. What is the most likely diagnosis?

Psoriasis. ***Psoriasis*** - The clinical presentation of **well-demarcated, erythematous plaques** covered with **silvery scales** on **extensor surfaces** is the hallmark of plaque psoriasis. - **Nail pitting**, as shown in the image, along with other nail changes like **onycholysis** (separation of the nail from the nail bed) and the **oil drop sign**, are highly characteristic findings in psoriasis. *Lichen planus* - Lichen planus is characterized by the "6 P's": **Pruritic, Purple, Polygonal, Planar Papules, and Plaques**, which differ significantly from the silvery-scaled lesions of psoriasis. - It commonly appears on **flexor surfaces**, such as the wrists, and is often associated with **Wickham's striae** (fine white lines on the lesions or oral mucosa). *Eczema* - Eczema (atopic dermatitis) typically presents with **poorly-demarcated, erythematous patches** with intense **pruritus**, leading to **lichenification** and **excoriations**, rather than well-defined plaques with silvery scales. - In adults, eczema classically involves the **flexor surfaces**, such as the antecubital and popliteal fossae, contrasting with the extensor distribution seen in this case. *Pityriasis rosea* - Pityriasis rosea typically begins with a solitary, larger lesion known as a **herald patch**, which is absent in this presentation. - This is followed by a generalized eruption of smaller, oval, pink papules with fine scale in a **"Christmas tree" distribution** on the trunk, which is inconsistent with the described findings. [Practice more Dermatology PYQs on OnCourse]

Question 1

A 45-year-old man with multiple sexual partners presents with a palmoplantar rash as seen below. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?

Accepted Answer

Secondary syphilis

Answer

Psoriasis

Answer

Meningococcemia

Answer

Stevens-Johnson syndrome

Question 2

A 6-month-old baby presents with a bright red, raised, soft nodule measuring 2 cm in diameter on the forehead. The lesion has well-defined borders, appeared 2 weeks after birth as a small red spot, and has been growing rapidly over the past few months. The surface has a characteristic strawberry-like appearance with a lobulated texture. What is the most likely diagnosis?

Accepted Answer

Capillary hemangioma

Answer

Portwine stain

Answer

Naevus simplex

Answer

Cavernous hemangioma

Question 3

A patient presents with a violaceous rash on the upper back and shoulders (img-16.jpeg) and Gottron's papules on hands (img-17.jpeg). What is the likely diagnosis?

Accepted Answer

Dermatomyositis

Answer

Systemic lupus erythematosus

Answer

Systemic sclerosis

Answer

Cushing syndrome

Question 4

An 18-year-old female patient comes with the following findings. Which of the following is pathognomonic of the primary stage of this disease?

Accepted Answer

Comedone

Answer

Pustule

Answer

Abscess

Answer

Papule

Question 5

A 26-year-old male presented with erythematous plaques covered with silvery scales over the extensor surfaces of both arms. Punctate pitting was noted on examining the nails. What is the most likely diagnosis?

Accepted Answer

Psoriasis

Answer

Eczema

Answer

Pityriasis rosea

Answer

Lichen planus

Question 6

A patient presented with itchy lesions, as shown below. What is the diagnosis?

Accepted Answer

Lichen planus

Answer

Scabies

Answer

Psoriasis

Answer

Warts

Question 7

A patient presents with erythematous streaks extending peripherally from a site of infection on the skin. Involvement of which of the following structures leads to this clinical presentation?

Accepted Answer

Superficial lymphatics

Answer

Skin

Answer

Superficial veins

Answer

Deep lymphatics

Question 8

A patient presented with multiple painful blisters on an erythematous base along a dermatome on the trunk, as shown in the image. What is the diagnosis? ![img-67.jpeg](img-67.jpeg)

Accepted Answer

Herpes zoster

Answer

Herpes simplex

Answer

Molluscum contagiosum

Answer

Chicken pox

Question 9

A patient presented with multiple painful blisters on an erythematous base along a dermatome on the trunk as shown in the image. What is the diagnosis?

Accepted Answer

Herpes zoster

Answer

Herpes simplex

Answer

Molluscum contagiosum

Answer

Chicken pox

Question 10

A 45-year-old truck driver with a history of multiple sex partners presented to the dermatological department, as shown below. What is the likely diagnosis?

Accepted Answer

Secondary syphilis

Answer

Lichen planus

Answer

Scabies

Answer

Psoriasis

FMGE 2023 — Dermatology