Basic Dermatology Practice Questions

Q: The condition shown in the color plate can be seen in which of the following syndromes?

Both Melkersson-Rosenthal syndrome and Down syndrome. ***Both Melkersson-Rosenthal syndrome and Down syndrome*** - **Fissured tongue** (scrotal tongue/lingua plicata) is a characteristic feature of both **Melkersson-Rosenthal syndrome** and **Down syndrome**. - In **Melkersson-Rosenthal syndrome**, it forms part of the classic triad with **facial paralysis** and **granulomatous cheilitis**, while in **Down syndrome**, it occurs in approximately **80%** of patients alongside other oral manifestations. *Melkersson-Rosenthal syndrome* - While **fissured tongue** is indeed present in this syndrome, it occurs alongside **facial nerve palsy** and **granulomatous lip swelling**. - This option is incomplete as it doesn't acknowledge that **Down syndrome** also commonly presents with **fissured tongue**. *Down syndrome* - Although **fissured tongue** is highly prevalent in Down syndrome patients (up to **80%**), this option alone is insufficient. - It fails to recognize that **Melkersson-Rosenthal syndrome** also characteristically presents with **fissured tongue** as part of its diagnostic triad. *Pierre Robin syndrome* - This syndrome is characterized by **micrognathia**, **cleft palate**, and **glossoptosis** (posterior displacement of tongue). - **Fissured tongue** is **not** a recognized feature of **Pierre Robin syndrome**, making this option incorrect.

Q: A young male presented with scaly truncal lesions. On examination, genital lesions along with oral 'lace-like' lesions are seen. What is the most likely diagnosis?

Lichen planus. ### Explanation The clinical presentation of scaly truncal lesions associated with oral and genital involvement is classic for **Lichen Planus (LP)**. **1. Why Lichen Planus is correct:** Lichen planus is a chronic inflammatory condition characterized by the "6 Ps": **P**lanar (flat-topped), **P**urple, **P**olygonal, **P**ruritic, **P**apules, and **P**laques. * **Oral Lesions:** The "lace-like" white reticular pattern described is known as **Wickham striae**, a pathognomonic feature of oral LP. * **Genital Involvement:** LP frequently affects the glans penis (often in an annular configuration). * **Scaly Lesions:** While LP papules have a thin, adherent scale, the combination of mucosal and cutaneous involvement strongly points toward this diagnosis. **2. Why other options are incorrect:** * **Psoriasis:** Presents with silvery-white micaceous scales and the Auspitz sign. While it can affect the genitals, it rarely involves the oral mucosa (except in very rare geographic tongue-like patterns). * **Secondary Syphilis:** Known as the "Great Mimicker," it presents with a generalized maculopapular rash involving palms and soles. Oral lesions are typically "snail-track ulcers" or mucous patches, not a reticulate lace-like pattern. * **Behcet’s Disease:** Characterized by the triad of painful aphthous oral ulcers, genital ulcers, and uveitis. It does not typically present with scaly truncal papules or Wickham striae. **Clinical Pearls for NEET-PG:** * **Koebner Phenomenon:** Development of lesions at sites of trauma (also seen in Psoriasis and Vitiligo). * **Histopathology:** Shows "saw-tooth" rete ridges, basal cell degeneration (liquefaction necrosis), and a band-like lymphocytic infiltrate at the dermo-epidermal junction. * **Civatte Bodies:** Degenerated keratinocytes found in the lower epidermis/upper dermis. * **Treatment:** Topical corticosteroids are the first-line treatment.

Q: A 38-year-old woman presented with a 2-week history of tender, swollen nodules on her lower legs. Her only current medication was a triphasic oral contraceptive. She denies any history of inflammatory bowel disease, sarcoidosis, or chronic infections. Physical examination revealed erythematous nodular swellings on the anterior lower legs. A punch biopsy specimen obtained from a lesion on the left anterior tibia reveals a septal inflammation of subcutaneous fat. What is the best description of this rash?

Erythema nodosum. **Explanation:** The clinical presentation and histopathology are classic for **Erythema Nodosum (EN)**. EN is the most common form of **septal panniculitis** without vasculitis. It typically presents as tender, erythematous, non-ulcerated nodules on the pretibial (anterior) area of the lower legs. In this patient, the use of **oral contraceptives** is a well-known trigger, alongside other common causes like Streptococcal infections, Sarcoidosis, and IBD. **Why the other options are incorrect:** * **Koebner phenomenon:** Refers to the development of skin lesions at sites of trauma (seen in Psoriasis, Lichen Planus, and Vitiligo). It does not describe a specific nodular rash. * **Livedo racemosa:** A permanent, broken, lace-like purple pattern on the skin caused by impaired blood flow. It is associated with Sneddon syndrome or SLE, not tender subcutaneous nodules. * **Cutaneous Lupus Erythematosus (CLE):** Typically presents with photosensitive malar rashes (Acute CLE) or scarred, discoid plaques (Chronic CLE). While Lupus Profundus involves fat, it usually presents as firm, depressed areas on the face or proximal limbs, not acute pretibial nodules. **NEET-PG High-Yield Pearls:** * **Histopathology Gold Standard:** Septal panniculitis with **Miescher’s radial granulomas** (small nodules of spindle-shaped cells around a central cleft). * **Most Common Cause:** Idiopathic (up to 50%), followed by Streptococcal pharyngitis. * **Key Associations:** Pregnancy, OCPs, Sarcoidosis (Lofgren’s Syndrome: EN + Bilateral hilar lymphadenopathy + Arthralgia), and Tuberculosis. * **Clinical Course:** Lesions do not ulcerate and heal without scarring, often changing color like a bruise (**Erythema contusiforme**).

Q: A young lady presents with white lacy lesions in the oral cavity and her proximal nail fold has extended onto the nail bed. What is the likely diagnosis?

Lichen planus. **Explanation:** The clinical presentation describes two classic features of **Lichen Planus (LP)**: **Wickham striae** (white lacy lesions in the oral cavity) and **Pterygium formation** (extension of the proximal nail fold onto the nail bed). 1. **Lichen Planus (Correct):** LP is a chronic inflammatory condition affecting the skin, mucous membranes, and nails. The oral lesions are typically reticulate, white, and lacy (Wickham striae). Nail involvement occurs in 10% of cases; the hallmark is **dorsal pterygium**, where the nail fold fuses with the nail matrix/bed due to scarring, leading to a V-shaped extension and permanent nail loss. 2. **Psoriasis:** While it affects nails, it typically presents with **pitting**, onycholysis, and "oil spots." Oral involvement is rare and usually manifests as geographic tongue, not lacy striae. 3. **Geographic Tongue:** Also known as benign migratory glossitis, it presents as red patches with white borders on the tongue that change shape. It does not cause nail pterygium. 4. **Candidiasis:** Oral candidiasis (thrush) presents as white curd-like plaques that **can be scraped off**, leaving an erythematous base. It does not cause the scarring nail changes described. **High-Yield Clinical Pearls for NEET-PG:** * **The 6 P’s of LP:** Planar, Purple, Polygonal, Pruritic, Papules, and Plaques. * **Koebner Phenomenon:** Development of lesions at sites of trauma (also seen in Psoriasis and Vitiligo). * **Histopathology:** Characterized by "saw-tooth" rete ridges, Civatte bodies (apoptotic keratinocytes), and a band-like lymphocytic infiltrate at the dermo-epidermal junction. * **Drug-induced LP:** Commonly caused by NSAIDs, Beta-blockers, and Thiazides.

Q: What is the most common malignancy associated with ichthyosis?

Hodgkin's disease. **Explanation:** The question refers to **Acquired Ichthyosis**, a cutaneous marker of internal systemic disease. Unlike hereditary ichthyosis, which appears at birth or in early childhood, acquired ichthyosis develops in adulthood and is frequently a **paraneoplastic manifestation**. **1. Why Hodgkin’s Disease is Correct:** **Hodgkin’s Lymphoma (HD)** is the most common malignancy associated with acquired ichthyosis. The skin changes typically manifest as generalized dryness and fish-like scaling, often appearing before, during, or after the diagnosis of the lymphoma. The severity of the ichthyosis often correlates with the activity of the underlying malignancy. **2. Analysis of Incorrect Options:** * **Mycosis Fungoides (MF):** While MF is a cutaneous T-cell lymphoma that can present with "ichthyosiform" lesions (Ichthyosiform Mycosis Fungoides), it is not the most common systemic malignancy associated with the sudden onset of acquired ichthyosis. * **Kaposi’s Sarcoma:** This is a vascular tumor associated with HHV-8 and HIV/AIDS. It does not typically present with ichthyosis as a paraneoplastic feature. * **Carcinoma Breast:** While solid tumors (lung, breast, colon) can occasionally cause acquired ichthyosis, they are statistically less common triggers compared to lymphoproliferative disorders, specifically Hodgkin’s disease. **Clinical Pearls for NEET-PG:** * **Acquired Ichthyosis:** If a middle-aged or elderly patient presents with a sudden onset of ichthyosis without a family history, the first step is to screen for occult malignancy (most commonly **Hodgkin’s Lymphoma**). * **Other Associations:** Apart from malignancy, acquired ichthyosis can be seen in **HIV infection**, hypothyroidism, sarcoidosis, and as a side effect of drugs like nicotinic acid or clofazimine. * **Triad to remember:** Sudden onset ichthyosis + Pruritus + Lymphadenopathy = High suspicion for Hodgkin’s Disease.

Q: All are true about the features of erythromelalgia, EXCEPT:

Treatment is steroids. **Explanation:** **Erythromelalgia** is a rare neurovascular peripheral pain syndrome characterized by the triad of **erythema (redness), burning pain, and increased skin temperature**, typically affecting the extremities (feet more than hands). **Why Option D is the Correct Answer (The "Except"):** The mainstay of treatment for erythromelalgia is **not steroids**. Management depends on the subtype. For primary cases, sodium channel blockers (like mexiletine) or neuropathic agents (gabapentin) are used. For secondary cases associated with myeloproliferative disorders, **Aspirin** is the drug of choice as it provides dramatic relief. Steroids have no proven role in the pathophysiology or management of this condition. **Analysis of Other Options:** * **A. Unknown etiology:** True. Primary erythromelalgia is often idiopathic or associated with a mutation in the **SCN9A gene** (voltage-gated sodium channel). * **B. Thrombocytosis is seen:** True. Secondary erythromelalgia is frequently associated with **myeloproliferative neoplasms**, most commonly **Essential Thrombocythemia** and Polycythemia Vera. * **C. Digital infarction is seen:** True. In secondary cases related to thrombocytosis, platelet aggregation can lead to microvascular occlusion, resulting in digital ischemia, cyanosis, and potentially infarction/gangrene. **Clinical Pearls for NEET-PG:** * **The "Cold Water" Sign:** Patients often seek relief by immersing their limbs in ice-cold water (a diagnostic clue). * **Primary vs. Secondary:** Primary is often bilateral and symmetrical; secondary is associated with hematological malignancies. * **Key Association:** Always screen a patient with erythromelalgia for an underlying blood disorder using a Complete Blood Count (CBC).

Q: A 40-year-old woman presents with a burning sensation in the mouth. Clinical examination reveals lesions consisting of radiating white striations in a retiform arrangement affecting the buccal mucosa, tongue, lips, and gingiva bilaterally. An incisional biopsy is suggestive of lichen planus. Which of the following is NOT a clinical form of Lichen Planus?

Verrucous Lichen Planus. **Explanation:** The correct answer is **D. Verrucous Lichen Planus**. In dermatology, terminology is precise. While **Hypertrophic Lichen Planus** (Option B) is a well-recognized variant characterized by thick, itchy, verrucous-like plaques (typically on the shins), the term "Verrucous Lichen Planus" is not a standard clinical classification. Instead, "Verrucous" is a morphological description often used for viral warts or other conditions like *Lichen Planus Hypertrophicus*, but it is not the formal name of a clinical subtype. **Analysis of Incorrect Options:** * **A. Atrophic Lichen Planus:** A recognized variant where there is thinning of the epidermis. It often presents as well-demarcated, erythematous, atrophic plaques, commonly seen on the legs or in intertriginous areas. * **B. Hypertrophic Lichen Planus:** The most common cutaneous variant after the classic form. It presents as intensely pruritic, thickened, purplish-grey plaques, usually on the pretibial areas. * **C. Bullous Lichen Planus:** A rare variant where vesicles or bullae develop within existing lichen planus lesions due to extensive liquefaction degeneration of the basal layer. **High-Yield Clinical Pearls for NEET-PG:** * **Oral Lichen Planus (OLP):** The question describes **Wickham’s Striae** (reticulate white lines), which is the hallmark of the reticular type of OLP. * **Histopathology:** Look for the "Big Four": Hyperkeratosis, Wedge-shaped hypergranulosis, Saw-tooth rete ridges, and a Band-like lymphocytic infiltrate at the dermo-epidermal junction. * **Civatte Bodies:** These are apoptotic keratinocytes found in the basal layer, also known as colloid or hyaline bodies. * **Koebner Phenomenon:** Lichen Planus is "Koebner positive" (lesions appear at sites of trauma).

Q: What is the characteristic histological feature of lichen planus?

Basal cell degeneration. **Explanation:** Lichen Planus (LP) is a chronic inflammatory condition characterized histologically by a "saw-tooth" appearance of the epidermis. The hallmark of its pathogenesis is a T-cell mediated autoimmune attack on the basal layer of the epidermis. **Why Basal Cell Degeneration is Correct:** The primary pathological event in Lichen Planus is **liquefactive degeneration (hydropic degeneration) of the basal cell layer**. This destruction of basal keratinocytes leads to the formation of **Civatte bodies** (apoptotic keratinocytes) and the characteristic "saw-tooth" pattern of the dermo-epidermal junction. This is the most specific and diagnostic histological feature among the choices provided. **Analysis of Incorrect Options:** * **A. Acanthosis:** While LP does show irregular acanthosis (thickening of the stratum spinosum), it is a common feature in many inflammatory skin diseases (like psoriasis) and is not as pathognomonic as basal cell degeneration. * **B. Interface Dermatitis:** This is a broad histological category where inflammation occurs at the dermo-epidermal junction. While LP is the classic example of interface dermatitis, "Basal cell degeneration" is the specific cellular process defining it in this context. * **C. Non-specific:** LP has very distinct, diagnostic histological features; it is never considered non-specific. **NEET-PG High-Yield Pearls:** * **6 P’s of LP:** Planar (flat-topped), Purple, Polygonal, Pruritic, Papules, and Plaques. * **Wickham Striae:** White reticular lines on the surface of papules due to focal orthohyperkeratosis. * **Max-Joseph Spaces:** Small areas of separation between the epidermis and dermis due to extensive basal cell damage. * **Koebner Phenomenon:** Development of lesions at sites of trauma (also seen in Psoriasis and Vitiligo). * **Civatte/Colloid Bodies:** PAS-positive apoptotic keratinocytes found in the lower epidermis/upper dermis.

Question 1

The condition shown in the color plate can be seen in which of the following syndromes?

Accepted Answer

Both Melkersson-Rosenthal syndrome and Down syndrome

Answer

Melkersson-Rosenthal syndrome

Answer

Down syndrome

Answer

Pierre Robin syndrome

Question 2

A young male presented with scaly truncal lesions. On examination, genital lesions along with oral 'lace-like' lesions are seen. What is the most likely diagnosis?

Accepted Answer

Lichen planus

Answer

Psoriasis

Answer

Secondary syphilis

Answer

Behcet's disease

Question 3

A 38-year-old woman presented with a 2-week history of tender, swollen nodules on her lower legs. Her only current medication was a triphasic oral contraceptive. She denies any history of inflammatory bowel disease, sarcoidosis, or chronic infections. Physical examination revealed erythematous nodular swellings on the anterior lower legs. A punch biopsy specimen obtained from a lesion on the left anterior tibia reveals a septal inflammation of subcutaneous fat. What is the best description of this rash?

Accepted Answer

Erythema nodosum

Answer

Koebner phenomenon

Answer

Livedo racemosa

Answer

Cutaneous Lupus Erythematosus

Question 4

Thin zone of Grenz is seen in which of the following conditions?

Accepted Answer

Lepromatous leprosy

Answer

Sarcoidosis

Answer

Lymphoma

Answer

Syphilis

Question 5

A young lady presents with white lacy lesions in the oral cavity and her proximal nail fold has extended onto the nail bed. What is the likely diagnosis?

Accepted Answer

Lichen planus

Answer

Psoriasis

Answer

Geographic tongue

Answer

Candidiasis

Question 6

What is the most common malignancy associated with ichthyosis?

Accepted Answer

Hodgkin's disease

Answer

Mycosis fungoides

Answer

Kaposi's sarcoma

Answer

Carcinoma breast

Question 7

A 16-year-old female presents with a one-week history of small ulcers on her cheek and tongue, accompanied by a mild fever. Oral examination reveals multiple ulcers on the buccal and labial mucosa. She reports that her board examinations are in one week. What is the most appropriate management for this patient?

Accepted Answer

Symptomatic treatment, topical steroids, and relaxation techniques

Answer

Antibiotics and analgesics

Answer

Anti-fungal medications

Answer

Systemic steroids

Question 8

All are true about the features of erythromelalgia, EXCEPT:

Accepted Answer

Treatment is steroids

Answer

Unknown etiology

Answer

Thrombocytosis is seen

Answer

Digital infarction is seen

Question 9

A 40-year-old woman presents with a burning sensation in the mouth. Clinical examination reveals lesions consisting of radiating white striations in a retiform arrangement affecting the buccal mucosa, tongue, lips, and gingiva bilaterally. An incisional biopsy is suggestive of lichen planus. Which of the following is NOT a clinical form of Lichen Planus?

Accepted Answer

Verrucous Lichen Planus

Answer

Atrophic Lichen Planus

Answer

Hypertrophic Lichen Planus

Answer

Bullous Lichen Planus

Question 10

What is the characteristic histological feature of lichen planus?

Accepted Answer

Basal cell degeneration

Answer

Acanthosis

Answer

Interface dermatitis

Answer

Non-specific

Basic Dermatology — MCQs

Basic Dermatology — MCQs

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