NEET-PG 2017 - Dermatology Practice Questions

Q: A 25-year-old construction worker presents with following skin lesions. All are true about the image shown except: (Recent NEET Pattern 2016-17)

Oral terbinafine is drug of choice. ***Correct Answer: Oral terbinafine is drug of choice*** - **Oral terbinafine is NOT the drug of choice** for tinea versicolor, making this the correct answer to the "EXCEPT" question - **Malassezia species lack the enzyme** (squalene epoxidase) necessary to convert terbinafine into its active form - Terbinafine is primarily used for **dermatophyte infections** (tinea corporis, cruris, pedis), not Malassezia infections - **Drug of choice for tinea versicolor**: Topical azoles (ketoconazole shampoo, selenium sulfide) or oral azoles (fluconazole, itraconazole) for extensive disease *Incorrect: Wood's lamp will produce yellow fluorescence* - This statement is TRUE, so it is not the exception - Wood's lamp examination reveals characteristic **yellow-gold to coppery-orange fluorescence** in tinea versicolor - The fluorescence is due to production of **porphyrins (malassezin)** by the *Malassezia* organism *Incorrect: KOH mount shows spaghetti and meat ball appearance* - This statement is TRUE, so it is not the exception - **KOH mount** of skin scrapings shows short, stubby **hyphae** (spaghetti) and round **spores** (meatballs) - This is the **pathognomonic microscopic finding** for *Malassezia furfur* *Incorrect: Caused by Malassezia furfur* - This statement is TRUE, so it is not the exception - The image shows **hypopigmented and hyperpigmented patches** on the trunk, characteristic of tinea versicolor - Caused by dimorphic yeast ***Malassezia furfur*** (also *M. globosa*, *Pityrosporum ovale*) - Normal skin commensal that becomes pathogenic in hot, humid conditions

Q: A 1-year-old unimmunised child with HbsAg positivity is having following skin lesions. What is the diagnosis?

Gianotti-Crosti syndrome. ***Gianotti-Crosti syndrome*** - This syndrome is characterized by a **papular acrodermatitis** of childhood, typically presenting as monomorphic, erythematous papules on the face, buttocks, and extensor surfaces of the extremities. - It is strongly associated with **viral infections**, particularly **Hepatitis B virus (HBV)** and Epstein-Barr virus (EBV), which aligns with the HbsAg positivity in this unimmunized child. *Erythema infectiosum* - This condition is caused by **Parvovirus B19** and typically presents with a "slapped cheek" rash on the face, followed by a lacy, reticulated rash on the trunk and extremities. - The rash in the image does not demonstrate the characteristic lacy pattern or typical "slapped cheek" appearance. *Pityriasis alba* - This is a common, mild, and often asymptomatic skin condition characterized by **hypopigmented (lighter) patches** with fine scales, predominantly on the face and arms. - The lesions in the image are erythematous (red) and papular, not hypopigmented. *Pityriasis rosea* - This condition typically begins with a single, larger "herald patch" followed by smaller, oval-shaped, pinkish-red patches with a characteristic **"Christmas tree" pattern** on the trunk and proximal extremities. - The rash in the image does not show a herald patch or the distinct distribution and morphology of pityriasis rosea.

Q: Identify the lesion shown in the image:

Molluscum contagiosum. ***Molluscum contagiosum*** - The image shows **multiple, discrete, flesh-colored to pink, dome-shaped papules** with a characteristic **umbilicated center**. These features are classic for **molluscum contagiosum**. - This viral skin infection is caused by the **molluscum contagiosum virus (MCV)**, a Poxvirus, and is highly contagious, often affecting children or sexually active adults. *Herpes simplex* - Herpes simplex typically presents as **grouped vesicles on an erythematous base**, which later erode and crust. - The lesions seen in the image are **solid papules with central umbilication**, not fluid-filled vesicles or erosions. *Pityriasis rosea* - Pityriasis rosea characteristically begins with a **'herald patch'**, followed by a generalized eruption of smaller, oval, pinkish-red patches with fine scale arranged in a **'Christmas tree' pattern** on the trunk. - The depicted lesions are small, umbilicated papules, not scaly patches with a characteristic distribution. *Gianotti-Crosti syndrome* - Gianotti-Crosti syndrome, also known as papular acrodermatitis of childhood, presents with **monomorphic, flesh-colored to reddish-brown papules** or papulovesicles primarily on the **cheeks, buttocks, and extensor surfaces** of the extremities. - While papular, the lesions in the image have a distinct **umbilicated appearance** not typical for Gianotti-Crosti syndrome, and their distribution is not clearly suggestive of acrodermatitis.

Q: A 13-year-old boy presents with patchy depigmented skin on the right flank and upper thigh in segmental distribution, as shown in the image. The depigmentation started 1 year back but has been static for last 4 months. Mother reports use of topical steroids which was ineffective. Diagnosis is?

Segmental vitiligo. ***Segmental vitiligo*** - The presentation of **depigmented skin** in a **segmental distribution** on one side of the body, starting in childhood at 13 years old, is characteristic of **segmental vitiligo**. - Its **static nature** for four months, unlike progressive widespread vitiligo, and **ineffectiveness of topical steroids** further support this diagnosis. *Piebaldism* - Characterized by a **congenital absence of melanocytes** in affected areas, typically presenting at birth with a **white forelock** and symmetrically distributed patches. - Unlike the described case, piebaldism is **stable throughout life** and does not usually appear at 12 years of age or show a segmental pattern extending along dermatomes. *Hypomelanosis of Ito* - This condition is characterized by **streaky or whorled hypopigmentation** following **Blaschko's lines**, often associated with **neurological, skeletal, or ocular abnormalities**. - While it presents in early childhood in a linear or segmental pattern, the lesions are **hypopigmented (lighter than surrounding skin)**, not completely depigmented like in the clinical image, and its lesions are usually static or mildly progressive which isn't completely consistent *Hypopigmented streaks* - This is a descriptive term rather than a specific diagnosis, and while the lesions might appear streaky, the term doesn't encompass the **complete depigmentation**, **segmental distribution**, and **onset characteristics** detailed in the case. - The term "hypopigmented" refers to *reduced* pigmentation, whereas the image and description suggest *complete absence* of pigment, which is depigmentation.

Q: What is the diagnosis based on the clinical image shown?

Plexiform neurofibroma. ***Plexiform neurofibroma*** - The image displays numerous **nodular, flesh-colored to hyperpigmented lesions** predominantly on the face, characteristic of **plexiform neurofibromas**, which are often present in **Neurofibromatosis type 1 (NF1)**. - These lesions are typically soft, sometimes described as feeling like a "bag of worms" on palpation, due to the proliferation of neural tissue, and can cause significant disfigurement. *Proteus syndrome* - Proteus syndrome is characterized by **overgrowth of various tissues**, bones, and organs, leading to asymmetric and disproportionate growth. - While it can involve skin lesions such as **cerebriform connective tissue nevi**, the appearance in the image with diffuse, multiple, distinct neurofibroma-like nodules does not align with the typical presentation of Proteus syndrome. *Cruveilhier-Baumgarten disease* - This is a rare condition characterized by the presence of an **umbilical caput medusae** (dilated veins radiating from the umbilicus), due to portal hypertension with a patent umbilical vein not seen in the image. - It relates to circulatory abnormalities in the abdomen and does not present with cutaneous lesions as shown in the image. *Dermal neurofibroma* - While dermal neurofibromas are benign nerve sheath tumors that can occur on the skin, they are typically **discrete, solitary, or few in number**, often presenting as soft, sessile or pedunculated lesions. - The extensive, diffuse, and nodular appearance across the entire face in the image suggests a more widespread and deeply intertwined growth pattern characteristic of **plexiform neurofibromas**, rather than isolated dermal neurofibromas.

Q: What is the most likely diagnosis of the image provided below?

Tinea versicolor. ***Correct: Tinea versicolor*** - The image shows **hypopigmented patches** with subtle scaling, which are characteristic features of tinea versicolor caused by *Malassezia furfur*. - The condition often presents as lighter patches on darker skin or darker patches on lighter skin, and the **fine scale** is often enhanced by scratching. - KOH mount shows **"spaghetti and meatballs" appearance** (short hyphae and round spores). *Incorrect: Tinea corporis* - This condition typically presents as **annular, erythematous lesions** with raised borders and central clearing, often referred to as "ringworm," which is not seen in the image. - Tinea corporis lesions are usually **pruritic** and can occur anywhere on the body, though their appearance is distinct from the diffuse, scaly patches shown. *Incorrect: Pityriasis alba* - Pityriasis alba presents as **ill-defined, hypopigmented macules or patches** often associated with mild scaling, primarily affecting the face, neck, and upper extremities in children and adolescents. - While it causes hypopigmentation, the texture and slight scaling in the image are more indicative of tinea versicolor, especially in an adult. *Incorrect: Vitiligo* - Vitiligo is characterized by **completely depigmented, white macules and patches** with sharply demarcated borders, due to the destruction of melanocytes. - Unlike the patchy, somewhat scaly hypopigmentation seen here, vitiligo lesions typically have a **chalk-white appearance** and lack any scale.

Q: A patient presents with oral mucosal lesions. Identify the condition shown in the image:

Lichen planus. - ***Lichen planus*** - The image exhibits **Wickham's striae**, which are characteristic fine, white, lacy patterns seen on the surface of papules and plaques in lichen planus, especially on mucosal surfaces. - Lichen planus often presents as **pruritic, purple, polygonal papules**, and this appearance is consistent with its oral manifestation. - *Dermatomyositis* - Dermatomyositis is characterized by **Gottron's papules** (violaceous papules over bony prominences, especially knuckles) and a **heliotrope rash** on the eyelids. - The lesion in the image does not show these typical features of dermatomyositis. - *Psoriasis* - Psoriasis typically presents as **erythematous plaques with silvery scales**, often on extensor surfaces, and can show pinpoint bleeding (Auspitz sign) when scales are removed. - The lacy, reticular white pattern (Wickham's striae) seen in the image is not a feature of psoriasis. - *Dermatitis herpetiformis* - Dermatitis herpetiformis is characterized by intensely **pruritic vesicles and bullae** symmetrically distributed, often on extensor surfaces, associated with celiac disease. - The lesion in the image is not vesicular or bullous, nor does it present with the characteristic distribution of dermatitis herpetiformis.

Q: Identify the lesion:

Dermatomyositis. ***Dermatomyositis*** - The image shows **Gottron's papules** over the extensor surfaces of the elbows, which are characteristic of dermatomyositis. These are violaceous, erythematous, flat-topped papules. - While typically found on the **dorsum of the hands** over the MCP and IP joints, they can also occur on elbows, knees, and ankles. *Psoriasis* - Psoriasis typically presents with **well-demarcated erythematous plaques** covered with silvery scales, especially on extensor surfaces. - The lesions in the image lack the characteristic **silvery scaling** of psoriasis. *Dermatitis herpetiformis* - This condition presents with intensely **itchy, polymorphic lesions**, including vesicles, bullae, and excoriations, arranged in a symmetrical fashion, often on extensor surfaces. - The lesions in the image are papular and nodular, not exhibiting the characteristic **vesicular or bullous eruption** of dermatitis herpetiformis. *Erythema marginatum* - Erythema marginatum is a **transient, non-pruritic erythematous rash** with serpiginous borders and central clearing, typically seen in **acute rheumatic fever**. - The lesions in the image are fixed papules/nodules without the characteristic migrating or rapidly changing appearance of erythema marginatum.

Q: Identify the lesion:

Erythema multiforme. ***Erythema multiforme*** - The image displays characteristic **“target lesions”** with concentric rings of redness and sometimes a central blister, which are hallmarks of erythema multiforme. - This condition is an acute, self-limiting inflammatory skin reaction, often triggered by infections (especially **HSV**) or medications. *Psoriasis* - Psoriasis typically presents as well-demarcated, **erythematous plaques** covered with **silvery scales**, which are not seen here. - Lesions frequently occur on extensor surfaces (elbows, knees) and the scalp. *Dermatitis herpetiformis* - Characterized by intensely **pruritic (itchy) vesicles and bullae** (blisters) that often appear in a symmetrical distribution. - It is strongly associated with **celiac disease** and typically affects the extensor surfaces and buttocks. *Erythema marginatum* - Consists of **migratory, macular, non-pruritic, erythematous lesions with central clearing** and serpiginous (wavy) borders. - It is a rare manifestation of **acute rheumatic fever** and does not typically show the concentric rings or blister formation seen in the image.

Q: A patient presents with violaceous papules over the knuckles and mottled pigmentation on the dorsum of hands. Identify the lesion:

Dermatomyositis. ***Dermatomyositis*** - The image exhibits **Gottron's papules**, which are violaceous, erythematous papules over the **dorsal aspects of the interphalangeal joints** (knuckles), a **pathognomonic cutaneous finding** in dermatomyositis - Additionally, the **spotted hyperpigmentation and hypopigmentation** (poikiloderma) on the dorsum of the hands is another common skin manifestation of dermatomyositis, especially in sun-exposed areas - Dermatomyositis is an **idiopathic inflammatory myopathy** with characteristic cutaneous and muscular involvement *Vitiligo* - Vitiligo presents as **well-demarcated depigmented macules or patches** due to destruction of melanocytes, resulting in a stark **white/chalky appearance** - The lesions in the image are **papular and violaceous** with combination of hyper- and hypopigmentation, not uniform complete depigmentation - Lacks the characteristic milky-white patches of vitiligo *Dermatitis herpetiformis* - Characterized by **intensely pruritic, grouped vesicles** on erythematous base, mainly on extensor surfaces (elbows, knees, buttocks) - Associated with **celiac disease** (gluten sensitivity) - The lesions in the image lack the typical **vesicular/blistering** appearance and are located specifically over the knuckles, not the classic distribution *Erythema marginatum* - Presents as **migratory, transient, non-pruritic, erythematous macules** with clear centers forming annular/serpiginous patterns - Classic cutaneous manifestation of **acute rheumatic fever** (Jones criteria) - The lesions in the image are **papular, fixed, and violaceous**, not flat erythematous rings

Question 1

A 25-year-old construction worker presents with following skin lesions. All are true about the image shown except: (Recent NEET Pattern 2016-17)

Accepted Answer

Oral terbinafine is drug of choice

Answer

Wood's lamp will produce yellow fluorescence

Answer

KOH mount shows spaghetti and meat ball appearance

Answer

Caused by Malassezia furfur

Question 2

A 1-year-old unimmunised child with HbsAg positivity is having following skin lesions. What is the diagnosis?

Accepted Answer

Gianotti-Crosti syndrome

Answer

Erythema infectiosum

Answer

Pityriasis alba

Answer

Pityriasis rosea

Question 3

Identify the lesion shown in the image:

Accepted Answer

Molluscum contagiosum

Answer

Herpes simplex

Answer

Pityriasis rosea

Answer

Gianotti-Crosti syndrome

Question 4

A 13-year-old boy presents with patchy depigmented skin on the right flank and upper thigh in segmental distribution, as shown in the image. The depigmentation started 1 year back but has been static for last 4 months. Mother reports use of topical steroids which was ineffective. Diagnosis is?

Accepted Answer

Segmental vitiligo

Answer

Piebaldism

Answer

Hypomelanosis of Ito

Answer

Hypopigmented streaks

Question 5

What is the diagnosis based on the clinical image shown?

Accepted Answer

Plexiform neurofibroma

Answer

Proteus syndrome

Answer

Cruveilhier-Baumgarten disease

Answer

Dermal neurofibroma

Question 6

What is the most likely diagnosis of the image provided below?

Accepted Answer

Tinea versicolor

Answer

Tinea corporis

Answer

Pityriasis alba

Answer

Vitiligo

Question 7

A patient presents with oral mucosal lesions. Identify the condition shown in the image:

Accepted Answer

Lichen planus

Answer

Dermatomyositis

Answer

Psoriasis

Answer

Dermatitis herpetiformis

Question 8

Identify the lesion:

Accepted Answer

Dermatomyositis

Answer

Psoriasis

Answer

Dermatitis herpetiformis

Answer

Erythema marginatum

Question 9

Identify the lesion:

Accepted Answer

Erythema multiforme

Answer

Psoriasis

Answer

Dermatitis herpetiformis

Answer

Erythema marginatum

Question 10

A patient presents with violaceous papules over the knuckles and mottled pigmentation on the dorsum of hands. Identify the lesion:

Accepted Answer

Dermatomyositis

Answer

Vitiligo

Answer

Dermatitis herpetiformis

Answer

Erythema marginatum

NEET-PG 2017 — Dermatology