NEET-PG 2017 - Dermatology Practice Questions

Q: A 41-year-old male complains of itching on the upper chest for one month. What is the most likely diagnosis?

Pityriasis rosea. ***Pityriasis rosea*** - This condition often starts with a **herald patch**, followed by a widespread rash of smaller, oval, pinkish-brown patches, often on the trunk, back, and upper extremities. - The lesions classically align along skin cleavage lines forming a **Christmas tree pattern**, and are frequently associated with pruritus (itching). *Dermatitis herpetiformis* - Characterized by intensely pruritic, **grouped vesicles and papules**, most commonly symmetrical on extensor surfaces like elbows, knees, and buttocks. This presentation is not typical of the provided image. - It is strongly associated with **celiac disease** and is usually seen in younger individuals. *Erythema marginatum* - This is a rare, transient, and **non-pruritic rash** characterized by rapidly enlarging, ring-shaped lesions with a raised, red border and clear center. - It's a key diagnostic criterion for **acute rheumatic fever** and does not typically present with the widespread itchy lesions seen in the image. *Dermatomyositis* - This is an inflammatory myopathy presenting with characteristic skin rashes such as **Gottron's papules** (over knuckles), a heliotrope rash (periorbital edema with a violaceous discoloration), and photosensitivity. - While it can cause itching, the primary skin lesions are distinct from those seen in the image and it is usually accompanied by **muscle weakness**.

Q: A patient presents with intensely pruritic vesicular lesions on extensor surfaces. What is the most likely diagnosis based on the clinical image?

Dermatitis herpetiformis. ***Dermatitis herpetiformis*** - This image shows **urticarial plaques** and **grouped vesicles/bullae**, which are classic features of **dermatitis herpetiformis**. - These lesions are typically **extremely pruritic**, often appearing symmetrically on extensor surfaces like the elbows, knees, and buttocks. *Psoriasis* - Psoriasis typically presents as well-demarcated, **erythematous plaques** with **silvery scales**, predominantly on extensor surfaces and the scalp. - While it can involve various morphologies, the vesicular nature seen in the image is not characteristic of typical psoriasis. *Erythema marginatum* - Erythema marginatum is characterized by **pink or red macular lesions** with **raised, serpiginous borders** that are typically non-pruritic and rapidly migratory. - It is a minor criterion for **rheumatic fever** and looks distinctly different from the vesicular eruption shown. *Lichen planus* - Lichen planus presents with "6 Ps": **pruritic, purple, polygonal, planar, papules, and plaques**, often with **Wickham's striae** (fine white lines). - It usually affects the wrists, ankles, and oral mucosa, and does not typically feature the prominent vesicles or bullae seen in the image.

Q: A 20-year-old male with no history of any sexual contact presents with following lesions on his penis. What is the diagnosis?

Lichen nitidus. ***Lichen nitidus*** - The image shows numerous small, shiny, **pin-head sized papules** on the penis, which are characteristic of lichen nitidus. - This condition is often **asymptomatic** and benign, and it can occur on the penis without any sexual contact history. *Lichenoides keratosis* - This term is broad and often refers to a benign **inflammatory process** with lichenoid features affecting keratinocytes, usually solitary and often in older adults; it does not typically present as widespread, uniform papules on the penis. - Lichenoides keratosis is often a more **solitary lesion** or a reaction pattern, not a diffuse eruption of small papules like those pictured. *Epstein pearls* - **Epstein pearls** are small, white or yellow cysts found in the mouths of newborns, specifically on the gums or palate, and are remnants of epithelial tissue. - They are a normal finding in neonates and are **not found on the penis** or in a 20-year-old male. *Molluscum contagiosum* - Molluscum contagiosum lesions typically present as **dome-shaped, flesh-colored papules with central umbilication**. - While they can appear on the penis and are sexually transmitted, the lesions in the image lack the characteristic **umbilication** of molluscum contagiosum.

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

Dermatomyositis. ***Dermatomyositis*** - The image displays a characteristic **heliotrope rash** (violaceous/purple-red discoloration) around the eyes and periorbital area, which is pathognomonic for dermatomyositis. - This condition is an **inflammatory myopathy** distinguished by distinct cutaneous manifestations (including Gottron's papules, shawl sign, and V-sign) alongside proximal muscle weakness. - The periorbital violaceous erythema with associated edema is highly characteristic and helps differentiate it from other facial rashes. *Acne rosacea* - Characterized by **facial erythema**, papules, pustules, and telangiectasias, primarily affecting the central face (cheeks, nose, chin, forehead). - Does not typically involve the marked periorbital (heliotrope) rash with violaceous discoloration seen in dermatomyositis. - Usually presents with flushing and visible blood vessels rather than periorbital edema. *Dermatitis herpetiformis* - Presents with intensely **pruritic (itchy) papules and vesicles** (blisters), typically symmetrical on extensor surfaces like elbows, knees, buttocks, and scalp. - Strongly associated with **celiac disease** (gluten-sensitive enteropathy). - Does not present as facial erythema or periorbital discoloration; the lesions are vesicular and intensely itchy. *Erythema marginatum* - A skin manifestation of **acute rheumatic fever**, characterized by an evanescent, **serpiginous (snake-like) migratory rash** with distinct, raised borders and clear centers. - Typically appears on the trunk and proximal limbs, sparing the face. - Does not present as periorbital discoloration and has a distinctive migrating, annular pattern.

Question 1

A 41-year-old male complains of itching on the upper chest for one month. What is the most likely diagnosis?

Accepted Answer

Pityriasis rosea

Answer

Dermatitis herpetiformis

Answer

Erythema marginatum

Answer

Dermatomyositis

Question 2

A patient presents with intensely pruritic vesicular lesions on extensor surfaces. What is the most likely diagnosis based on the clinical image?

Accepted Answer

Dermatitis herpetiformis

Answer

Psoriasis

Answer

Erythema marginatum

Answer

Lichen planus

Question 3

A 20-year-old male with no history of any sexual contact presents with following lesions on his penis. What is the diagnosis?

Accepted Answer

Lichen nitidus

Answer

Lichenoides keratosis

Answer

Epstein pearls

Answer

Molluscum contagiosum

Question 4

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

Accepted Answer

Dermatomyositis

Answer

Acne rosacea

Answer

Dermatitis herpetiformis

Answer

Erythema marginatum

NEET-PG 2017 — Dermatology