Psoriasis Practice Questions

Q: All are true about psoriasis except:

Very pruritic. ***Very pruritic*** - While psoriasis can be itchy, it is generally not characterized as "very pruritic" compared to other dermatological conditions like **eczema** or **scabies**. - **Pruritus** in psoriasis tends to be mild to moderate, and it is not a defining characteristic that differentiates it from other skin disorders. *Parakeratosis & acanthosis* - **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological hallmarks of psoriasis. - These features reflect the rapid epidermal turnover characteristic of the condition. *Pitting of nails* - **Nail pitting**, onycholysis, and subungual hyperkeratosis are common and characteristic manifestations of psoriasis, affecting up to 50% of patients. - These nail changes are highly indicative of **psoriatic involvement**. *Joint involvement in 5–10%* - **Psoriatic arthritis**, involving inflammation of the joints, affects approximately 5-30% of individuals with psoriasis. - This statistic makes joint involvement a significant comorbidity of psoriasis.

Q: Which statement about systemic steroids in psoriasis is correct:

No definitive indication exists. ***No definitive indication exists*** - Systemic steroids have **no established therapeutic role** in psoriasis management and are **strongly avoided** in clinical practice. - They can cause severe **rebound flares** upon withdrawal and may precipitate life-threatening **pustular psoriasis** or **erythrodermic psoriasis**. - While not absolutely contraindicated in every conceivable scenario, they provide **no long-term benefit** and actively worsen disease control by masking symptoms and creating dependency. - This statement most accurately reflects the medical consensus: systemic steroids lack definitive indications and should be avoided. *Systemic steroids are contraindicated in all forms of psoriasis* - While systemic steroids are strongly discouraged, the absolute term "contraindicated in **all forms**" is **too extreme**. - There may be rare emergency situations where short-term use under specialist care is considered when safer alternatives are unavailable. - The statement overstates the position; "no definitive indication" is more medically accurate. *Only as bridge therapy in rare cases* - Bridge therapy with systemic steroids is **not recommended** in psoriasis due to high risk of disease exacerbation. - Unlike other inflammatory conditions, psoriasis responds poorly to steroid withdrawal, making bridge therapy particularly dangerous. *Emergency situations under specialist supervision only* - This suggests systemic steroids have a defined role in emergencies, which is **misleading**. - Even in urgent situations, alternative treatments like **cyclosporine**, **methotrexate**, or **biologics** are strongly preferred. - The rare exceptions don't constitute a "definitive indication."

Q: Nail changes are found in about ______ cases of psoriasis:

One half. ***One half*** - Approximately **50% of patients with psoriasis** will experience nail changes, which can be a key diagnostic feature. - Nail involvement is even higher, around **80-90%**, in patients with **psoriatic arthritis**. *Two thirds* - While a significant proportion, **two-thirds (roughly 66%)** is a slight overestimate of the general prevalence of nail changes in psoriasis. - This figure might be seen in specific populations or more severe cases, but not overall. *One third* - **One-third (roughly 33%)** is an underestimation of the frequency of nail changes in psoriasis. - Nail involvement is a very common manifestation of the disease. *All cases* - It is incorrect to state that **all cases of psoriasis** have nail changes. - While common, nail involvement is not universal and can range from mild to severe, or be entirely absent.

Q: Bleeding spots seen on removal of scales in psoriasis is called:

Auspitz sign. ***Auspitz sign*** - This sign is characterized by the appearance of **pinpoint bleeding** after the removal of psoriatic scales due to the thinning of the epidermis covering the **dilated capillaries** in the dermal papillae. - It's a classic clinical finding in **psoriasis**, indicating active disease. *Punctuate hemorrhage* - This term is a generalized description for **small, pinpoint bleeding** spots. - While the Auspitz sign involves punctate hemorrhages, it's a more specific term for this phenomenon in the context of **psoriasis** and scale removal. *Darier sign* - This sign involves the formation of a **urticarial wheal** or a visible edema response when a skin lesion is rubbed. - It is classically associated with **urticaria pigmentosa** (cutaneous mastocytosis) and not psoriasis. *Nikolsky's sign* - This sign describes the **detachment of the epidermis** from the underlying dermis with slight lateral pressure on seemingly normal skin, leading to blister formation. - It is characteristic of conditions like **pemphigus vulgaris** and **toxic epidermal necrolysis**, not psoriasis.

Q: All these drugs are known to exacerbate psoriasis, except:

Ciclosporin. ***Ciclosporin*** - **Ciclosporin** is an immunosuppressant often used to **treat severe psoriasis**, not exacerbate it. - It works by inhibiting the activation of T-cells, which are central to the pathogenesis of psoriasis. *Beta blocker* - **Beta-blockers**, particularly non-selective ones like **propranolol**, can worsen existing psoriasis or induce new lesions. - The mechanism is thought to involve effects on beta-adrenergic receptors in the skin, leading to inflammation. *Hydroxychloroquine* - **Hydroxychloroquine**, an antimalarial and immunosuppressant, can trigger or exacerbate psoriasis, especially **pustular psoriasis**. - It likely affects keratinocyte proliferation and immune responses in the skin. *Lithium* - **Lithium** is a mood stabilizer that is known to exacerbate or trigger various forms of psoriasis, including **plaque psoriasis** and **pustular psoriasis**. - The mechanism is believed to involve alterations in cyclic AMP metabolism and arachidonic acid pathways within keratinocytes.

Q: Psoriasis typically seen after β-hemolytic streptococcal infection is

Guttate psoriasis. ***Guttate psoriasis*** - This form of psoriasis is classically triggered by an antecedent **streptococcal pharyngitis** (often β-hemolytic streptococcal infection), presenting as small, **tear-drop shaped lesions** scattered over the trunk and proximal extremities. - The onset is typically **acute**, occurring a few weeks after the infection. *Psoriasis vulgaris* - This is the **most common form** of psoriasis, characterized by well-demarcated, erythematous plaques with silvery scales. - While infections can exacerbate psoriasis vulgaris, it is **not typically triggered de novo** by streptococcal infections in the same way guttate psoriasis is. *Erythrodermic psoriasis* - This is a **severe and rare form** of psoriasis where nearly the entire skin surface becomes red and scaly, often accompanied by systemic symptoms like fever and malaise. - It represents a generalized inflammatory response and is usually a **flare of existing psoriasis** rather than an initial presentation following bacterial infection. *Pustular psoriasis* - This presentation involves widespread or localized pustules, often on a red, tender skin base, and can be associated with systemic symptoms. - While infections can be a trigger, **streptococcal infections** are not the classic trigger for pustular psoriasis outbreaks as they are for guttate psoriasis.

Q: All of the following are used in systemic therapy of psoriasis except

Oral glucocorticoids. ***Oral glucocorticoids*** - **Oral glucocorticoids** are generally avoided in psoriasis because they can precipitate severe **rebound flares** upon discontinuation or during dose tapering. - While they can temporarily suppress inflammation, the risk of worsening psoriasis and other systemic side effects makes them unsuitable for long-term systemic therapy. *Methotrexate* - **Methotrexate** is a commonly used systemic agent for psoriasis due to its **immunosuppressive** and **anti-proliferative effects**, targeting rapidly dividing cells. - It works by inhibiting dihydrofolate reductase and is typically given once weekly for chronic plaque psoriasis. *Cyclosporine* - **Cyclosporine** is an effective systemic immunosuppressant used for severe, resistant psoriasis, particularly when rapid control is needed. - It primarily acts by inhibiting **T-cell activation** and proliferation, thereby reducing the inflammatory response in psoriasis. *Acitretin* - **Acitretin** is an oral retinoid derivative of vitamin A, used in severe forms of psoriasis, especially **pustular** and **erythrodermic** types. - It works by modulating **keratinocyte differentiation** and proliferation, helping to normalize skin cell growth.

Q: Antibiotics are indicated in which type of psoriasis?

Guttate. ***Guttate*** - **Guttate psoriasis** is frequently triggered by a preceding **streptococcal infection**, such as streptococcal pharyngitis (strep throat). - Treatment with **antibiotics** (e.g., penicillin) is indicated to eradicate the streptococcal infection, which can help in resolving the psoriatic lesions and preventing future flares. *Chronic plaque psoriasis* - This is the most common form of psoriasis, characterized by **well-demarcated, erythematous plaques with silvery scales**. - Its etiology is primarily **autoimmune**, and while infections can sometimes exacerbate it, antibiotics are not a standard part of its treatment. *Erythrodermic psoriasis* - This is a severe, generalized form of psoriasis affecting nearly the **entire skin surface**, leading to significant inflammation and desquamation. - While patients with erythrodermic psoriasis are at higher risk for **secondary infections** due to skin barrier disruption, antibiotics are only indicated for treating these secondary bacterial infections, not for the psoriasis itself. *Pustular* - **Pustular psoriasis** is characterized by the presence of sterile pustules on an erythematous base. - Though severe, it is primarily an **inflammatory condition**, and antibiotics are not used in its primary management unless a secondary bacterial infection is suspected and confirmed.

Q: Treatment of choice for Pustular psoriasis is:

Methotrexate. ***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.

Q: Which one of these should not be used in severe widespread psoriasis?

Oral glucocorticoids. ***Oral glucocorticoids*** - While they may provide temporary relief, **oral glucocorticoids** can exacerbate psoriasis upon withdrawal, leading to a severe flare-up or **pustular psoriasis**. - Their long-term use is associated with numerous side effects, making them unsuitable for widespread, chronic conditions like severe psoriasis. *Methotrexate* - **Methotrexate** is a systemic agent commonly used for severe psoriasis due to its immune-modulating and anti-proliferative effects. - It is effective in reducing inflammation and slowing down epidermal cell turnover. *Oral retinoids* - **Oral retinoids** like acitretin are effective systemic treatments for severe widespread psoriasis, especially **pustular** and **erythrodermic** forms. - They work by normalizing keratinocyte proliferation and differentiation. *Cyclosporin* - **Cyclosporin** is a potent immunosuppressant widely used for severe psoriasis, particularly when rapid disease control is needed. - It works by inhibiting T-cell activation and is highly effective in clearing psoriatic lesions.

Question 1

All are true about psoriasis except:

Accepted Answer

Very pruritic

Answer

Parakeratosis & acanthosis

Answer

Pitting of nails

Answer

Joint involvement in 5–30%

Question 2

Which statement about systemic steroids in psoriasis is correct:

Accepted Answer

No definitive indication exists

Answer

Only as bridge therapy in rare cases

Answer

Emergency situations under specialist supervision only

Answer

Systemic steroids are contraindicated in all forms of psoriasis

Question 3

Nail changes are found in about ______ cases of psoriasis:

Accepted Answer

One half

Answer

Two thirds

Answer

One third

Answer

All cases

Question 4

Bleeding spots seen on removal of scales in psoriasis is called:

Accepted Answer

Auspitz sign

Answer

Punctate hemorrhage

Answer

Darier sign

Answer

Nikolsky's sign

Question 5

All these drugs are known to exacerbate psoriasis, except:

Accepted Answer

Ciclosporin

Answer

Beta blocker

Answer

Hydroxychloroquine

Answer

Lithium

Question 6

Psoriasis typically seen after β-hemolytic streptococcal infection is

Accepted Answer

Guttate psoriasis

Answer

Psoriasis vulgaris

Answer

Erythrodermic psoriasis

Answer

Pustular psoriasis

Question 7

All of the following are used in systemic therapy of psoriasis except

Accepted Answer

Oral glucocorticoids

Answer

Methotrexate

Answer

Cyclosporine

Answer

Acitretin

Question 8

Antibiotics are indicated in which type of psoriasis?

Accepted Answer

Guttate

Answer

Chronic plaque psoriasis

Answer

Erythrodermic psoriasis

Answer

Pustular

Question 9

Treatment of choice for Pustular psoriasis is:

Accepted Answer

Methotrexate

Answer

Psoralen - UV therapy

Answer

Systemic steroid

Answer

Estrogen

Question 10

Which one of these should not be used in severe widespread psoriasis?

Accepted Answer

Oral glucocorticoids

Answer

Methotrexate

Answer

Oral retinoids

Answer

Cyclosporin

Psoriasis — MCQs

Psoriasis — MCQs

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