Question: Copper penny bodies are seen in

Ans: a (Chromoblastomycosis)Ref: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed.Chromoblastomycosis is a chronic infection of the skin and soft tissue.Characterized by the presence of muriform fungal structures called sclerotic bodies (copper penny bodies) within the infected tissues.


Question: In pemphigus vulgaris, antibodies are present against


Question: Normal turnover time of epidermis (skin doubling time) is


Question: Thin zone of Grentz is seen in

Ans: a (Lepromatous leprosy) Ref: Harrison, 16th ed, p. 966Sub epidermal free zone or Grentz zone is seen in lepromatous leprosyNBRIDGEMicro Munro abcess is related to psoriasis.Pautriers micro abcess is related to mycosis fimgoidesLEPROMATOUS LEPROSYEpidermis may be normal or atrophicSub epidermal free zone - Grentz zoneAbundant bacilli in clumps or globiMacrophages show foamy appearance - foam cells or lepra cellsPerineural cell proliferation - onion peel appearancePresence of neural involvement is mandatory to differentiate it from other granulomatous inflammatory conditions like tuberculosis and sarcoidosisNote:Early involvement of'7th and 5th cranial nerve is a feature of BT/TT leprosyLagophthalmos (due to 7th c.n) and comeal anaesthesia (due to 5th c.n) is present.Cause of blindness in LL- iridocyclitisCause of blindness in TT- exposure keratitisSatellite lesions are present in BTDiffuse non nodular type of LL is lucio leprosy.Lepromin test is positive in TT, BTLepromin test is negative in LL, BL, BB


Question: Treatment of choice in Pustuar psoriasis


Question: A young boy had itchy, excoriated papules on the forehead and the exposed pas of the arms and legs for three years. The disease was most severe in the rainy season improved completely in winter. The most likely diagnosis is

Ans. a. Insect bite hypersensitivity A young boy had itchy, excoriated papules on the forehead and the exposed pas of the arms and legs for three years. The disease was most severe in the rainy season improved completely in winter. The most likely diagnosis is insect bite hypersensitivity. Insect Bite Hypersensitivity: Predominance of lesions on exposed pa of body indicate the role of an external gent in the causation rather than an endogenous agent Increased incidence in rainy season as insect bites are more common in rainy season due to increased breeding


Question: Cellmediated immunity is maximum suppressed in


Question: Keratoderma is/are seen in

C i.e. Pityriasis rubra pilaris Keratoderma is seen in PRP, psoriasis, Reiter's syndrome (keratoderma blenorrhagica), arsenic and Haxthausen's disease.


Question: Most common organisim causing T. capitis is


Question: Psoriasis is characterised by

(B) Auspitz sign # Auspitz Sign: Psoriasis (pin point bleeding from a lesion when rubbed with a spatula to remove loose scales which indicated patch thinning of epidermis overlying papillary process of dermis.


Question: In congenital dystrophic variety of epidermolysis bullosa, mutation is seen in the gene coding for aEUR'

Collagen type 7 [Ref .- Neeta Khanna 151/e p. 28-291 Epidermolysis bullosa (EB) is a group of inherited diseases that are characterised by blistering lesions on the skin and mucous membranes. These may occur anywhere on the body but most commonly appear at sites of friction and minor trauma such as the feet and hands. Blisters may also occur on internal organs, such as the oesophagus, stomach and respiratory tract, without any apparent. friction. EB should be distinguished from epidermolysis bullosa acquisita (EBA), which is an autoimmune blistering disease that is not inherited and often doesn't develop until adult life. The EB conditions result from genetic defects of molecules in the skin concerned with adhesion. Loss of adhesion results in blister, .formation. There are 3 major types of EB based on different sites of blister formation within the skin structure : Epidermolysis bullosa Site of blister formation within the skin Known targeted protein * Epidermolysis bullosa Intraepidermal Keratin 4 and 14 simplex (epidermolytic) plectin a 6134 inte? grin plakophillin -1 desmoplakin * Junctional epidermolysis Intra-lamina Weida Laminin - 332 bullosa (lamina lucidolytic) (laminin 5) : type XVII collagen, a 6134 integrin * Dystrophic epidennolysis Sublamina densa Type VII collagen bullosa (dermolytic)


Question: Lupus vulgaris

A. i.e. (Skin tuberculosis) (46 - Roxburg 17th)LUPUS VULGARIS - Slowly progressive granulomatous plaque on the skin caused by the tubercle bacillus* It often has a thickenedpsoriasi form appearance but blanching with a glass microscope slide (diascopy) will reveal grey - green foci ("apple jelly nodule**") due to the underlying granulomatous inflammation* Lupus pernio - is a particular type of sarcoidosis that involves the tip of nose & earlobes with lesions that are violaceous in colour* Spina ventosa - Tuberculosis of bone in which bone is expanded & the cortex thins eg digits*** Scrofuloderma - Tuberculosis first develops in a lymph node or bone producing a swelling and subsequently ruptures through the overlying skin* The classic renal manifestation of tuberculosis is the presence of microscopic pyuria with a sterile urine culture or "sterile pyuria" (826 - CMDT - 09)


Question: The following drug is not used for the treatment of type II lepra reaction


Question: Most common cause of psoriasis

Ans A (autoimmune) Ref IADVL text book of Dermatology P1022, Harrisons 17th ed pg 315,It is a T cell mediated autoimmune chronic inflammatory disease.The evidence implicating a key role for an immune pathogenesis relates to:*the association with certain HLA groups (HLA Cw6)*the success of certain immunosuppressive drugs (such as cyclosporin) in improving the clinical state of the disease*reports of the development of psoriasis in recipients of bone marrow transplants from donors with a history of psoriasis.Over 50% of patients with psoriasis report a positive family history.Psoriatic lesions demonstrate infiltrates of activated T cells that are thought to elaborate cytokines responsible for keratinocyte hyperproliferation, which results in the characteristic clinical findings.The etiology of psoriasis is still poorly understood, but there is clearly a genetic component to the disease.Type I (Heriditary)Strong HLA association (HLA CW6)Severe course and early onset, arthropathy more common.Type IISporadicHLA unrelatedMild course and late onsetThe number of cycling cells are increased 7 fold in psoriasis. There is no shortening of the cell cycle.The most important locus for psoriasis susceptibility is Psors 1 (psoriasis susceptibility locus on chr 6p 21.3.T cells(helper) are fundamental in activating the disease process.The trigger to their activation may be conventional antigens or bacterial superantigens.Clinical features of psoriasis-imp featuresMost common clinical type is chronic plaque type.Salmon coloured papules and plaques with silvery scales.Auspitz sign- multiple bleeding points on scraping of psoriatic plaques.Candle sign- charecteristic coherence of scales in psoriasis causes a feeling as if scraping on a candle.The halo ring ofworonoff- around the psoriaric plaque due to deficiency of pgE2.Annulus migrans-mucus membrane lesion in psoriasis.Most common nail change is pitting.Pustular psoriasis- most severe type is von-zumbushtype of generalized pustular psoriasis. It gets precipitated by treatment with irritants& sudden withdrawal of corticosteroids.Skin gets studded with minute sterile pustules which later may fuse to form lakes of pus.Histopathology of psoriasisParakeratosisMicro munro abscess- collection of neutrophils in stratum comeumSpongiform pustules of kogoj- aggregates of neutrophil in stratum spinosum.Acanthosis with regular elongation of rete ridges- camel foot appearance.Edema of dermal papillae with dilated& tortuous capillaries.Treatment of choice for generalized pustular psoriasis & psoriatic erythroderma is-AcetretinBiological therapy of psoriasisDirected at selected targets integral to the pathogenesis of psoriasis.The hyperproliferation seen in psoriasis is due to activated T cells & their cytokines. Biological agents are also used in rheumatoid arthritis, crohn's disease.T cell targetingAlefacept,Efalizumab,Daclizumab,BasiliximabCytokine blockersInfliximab, EtanerceptEtanercept-Human dimenc fusion protein -Anti TNF agentInfliximab-Chimeric monoclonal antibody.For further explanation refer PG HUNT p183, 2008 skin, 2005 Q258


Question: Cutis marmorata occurs due to exposure to

(A) Cold temperature[?]CUTIS MARMORATA:It is a transient cyanotic mottling of the skin which occurs as a physiological response to cold exposure and disappears with warming.It is usually encountered in healthy infants and resolves during the first year of life.Involvement of the trunk as well as the limbs is common.Physiological livedo reticularis rarely occurs in adults.Transient mottling when infant is exposed to decreased temperature.Acrocyanosis:Cyanosis of hands & feet.A common response to cold.An underlying cardiac defect should be suspected if acrocyanosis is persistent or more intense in the feet than hands.Benign cutaneous vascular phenomena seen in neonates as an accentuated physiologic vasomotor response to cold.Reticulate, bluish mottling of skin on trunk and extremities.Usually disappear as the infants is rewarmed.It's persistence is seen in Downs syndrome, trisomy-18, hypothyrioidism.Resolves quickly with warming.Onset during first 2 to 4 weeks of life.Due to immaturity of the autonomic nervous system of newborns.If persists after the infant is warmed implies an obstruction to blood flow such as hyperviscosity or vasculitis.Persistence beyond neonatal period is a possible marker for trisomy 18, Down syndrome, hypothyroidismDDX from sepsis and hypovolemia.Cutis marmorata telangiectatica congenita (CMTC):It is an uncommon, congenital, vascular malformation, first described by Van Lohuizen, comprising a fixed reticulate erythema which may resemble physiological cutis marmorata.Aetiology of CMTC is unknown.Histopathology of the vascular abnormality reveals dilated capillaries, venous & capillary lakes, and dilated veins in the dermis and subcutis.Clinical features:The vascular abnormality is a reticulate erythema producing the marbling that is akin to the physiological marbling seen in neonates.This is fixed and does not disappear after warming (unlike physiological cutis marmorata).Limbs are more commonly affected than other sites, & a sharp demarcation line is common.Associated atrophy (more common) or hypertrophy of the underlying subcutaneous tissue.Other congenital anomalies:Common: Aplasia cutis, developmental delay & cleft palate.Less common: Macrocephaly, glaucoma, hypothyroidism, scoliosis & anogenital abnormalities.Treatment: Rarely require treatment as many children improve in the first 2 years of life.


Question: Berkeley membrane is seen in


Question: Multidrug therapy is given for


Question: Only definitive indication of systemic steroids in psoriasis is

D i.e. Impetigo herpetiformis - Systemic steroids should be avoided in routine care of psoriasis Q because the disease usually breaks through, requiring progressively higher doses to control symptoms and withdrawl of drug is usually associated with frequent relapse in form of life threatening erythrodermic psoriasis (with exfoliative dermatitis) and pustular psoriasis (with pus lakes)Q. - However, systemic steroids may have a role in management of Persistent, otherwise uncontrollable (e.g. with metabolic complications), psoriatic erythroderma and in fulminant generalized pustular psoriasis (von Zumbusch type) if other drugs are ineffective or contraindicatedQ. Pustular psoriasis in pregnancy is called impetigo herpatiformis. In pregnancy, safest drug for treatment of pustular psoriasis is prednisoloneQ. Severe psoriatic polyahritis threatening severe irreversible joint damageQ. Pustular psoriasis may develop after strong topical or systemic steroids have been used and then abruptly withdrawnQ. It presents with development of generalized pustules all over the bodyQ. Erythematous skin rash with multiple pus lakes suggests a diagnosis of generalized pustular psoriasis. As retinoids, methotrexate & PUVA cannot be used (or contraindicated) in pregnancy. Coicosteroids form the mainstay of treatment for generalized pustular psoriasis in pregnancyQ. Localized disease is best treated with topical steroid & fulminating generalized disease is best treated with systemic prednisolone (oral).


Question: Condylomata latae are seen in


Question: Karion is seen in


Question: DOC in type I lepra reaction with severe neuritis


Question: Inveed saucer shaped lesion is found in


Question: The syndromic management of urethral discharge includes

Ans. c. Neisseria gonorrhoeae and Chlamydia trachomatisSyndromic ManagementUrethral discharge: Neisseria gonorrhoeae and Chlamydia trachomatisGenital ulcer disease: Syphilis and Chancroid

Neisseria gonorrhoeae and herpes genitalis

Chlamydia trachomatis and herpes genitalis


Question: Condyloma acuminatum is caused by

(A) HPV # Condyloma acuminatum refers to an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV). Approximately 90% of condyloma acuminata are related to HPV types 6 and 11.> These 2 types are the least likely to have a neoplastic potential. Risk for neoplastic conversion has been determined to be moderate (types 33, 35, 39, 40, 43, 45, 51-56, 58) or high (types 16, 18), with many other isolated types.> Buschke-Lowenstein tumor (i.e., giant condyloma) is a fungating, locally invasive, low-grade cancer attributed to HPV.


Question: Spontaneous remission is most frequent with


Question: Epitheliod granuloma is characterstic of


Question: 19 years old girl has multiple papulo pustular erythematous lesions on face and neck, the likely diagnosis is


Question: Necrolytic migratory erythema is a skin manifestation of

Glucagonomas are pancreatic islet tumors. Treatment consists of tumor removal and intravenous amino acids. The eruption, necrolytic migratory erythema, is characterized by eczematous papules and vesicles, located mainly around the orifices and in the flexures.


Question: Child with h/o hypopigmented macule on back, infantile spasm and delayed milestone has


Question: DOC for Tenia Ungum


Question: Least common site involvemnet in psoriasis is


Question: Donovanosis/granuloma venerum is caused by


Question: Most common age group to suffer from T. Cruris


Question: An otherwise healthy male presents with a creamy curd like white patch on the tongue. The probable diagnosis is


Question: A 3 yr old child has eczematous dermatitis on extensor surfaces. His mother has a history of bronchial asthma. Diagnosis could be


Question: The characteristic clinical sign of alopecia areata is

Ans) a (exclamutory marl-: hair) Ref Rook "s text hook of dermatology 7th ed page no 63,42The onset of alopecia areata may be at any age, peaking between the second and fourth decades. The sex incidence is probably equal. The characteristic initial lesion is a circumscribed, totally bald, smooth patchIt is often noticed by chance by a parent, hairdresser or friend.The skin within the bald patch appears normal or slightly reddened. Short, easily extractable broken hairs, known as exclamation mark hairs, are often seen at the margins of the bald patches during active phases of the disease,ie gradual thinning of broken stub towards the base which consists of an unpigmented telogen club


Question: Vitamin D analogue calcitriol is useful in the treatment of


Question: A 45 year old male has multiple grouped vesicular lesions present on the T10 segment dermatome associated with pain. The most likely diagnosis is


Question: Flaky paint appearence of skin is seen in


Question: A 40 year old female presented with numerous, nonitchy, erythematous scaly papules (lesions) on trunk, with few oral white mucosal plaques. She also had erosive lesions in perianal area. The probable diagnosis is

B i.e. Secondary syphilis Secondary syphilis presents with generalized, symmetrical, nonitchy, coppery red maculoppular lesions (+- scales) on trunk, extremities and even palm and solesQ. Oral and genital superficial mucosal erosion (patches) are painless silver-grayQ surrounded by red periphery. And warm, moist, interiginous areas (such as perianal area, vulva and scrotum) show large, hyperophic, coalesced gray-white, highly infections papules (Condylomata lata)Q.


Question: A pinkish red Flurorescence of urine with wood's Lamp is seen in


Question: Koenen's periungal fibroma is seen in


Question: Multiple hypoaesthetic, hypopigmented macules on right lateral forearm with numerous acid fast bacilli is indicative of

Ans. d. Borderline leprosy Multiple hypoaesthetic, hypopigmented macules on right lateral forearm with numerous acid-fast bacilli is indicative of borderline lepromatous leprosy. Multiple lesions and numerous AFB bacilli indicate either lepromatous or borderline lesions, and hypoesthesia and hypopigmentation narrows it fuher to borderline (actually borderline lepromatous), as sensation is normal in lepromatous leprosy


Question: Most specific test for syphilis


Question: Lymphadenopathy is seen is A/E


Question: Adenoma sebaceum is seen in

i.e. (Tuberous sclerosis): (96Q-CMDT-11) (1798 -1000-H17th)* Adenoma sebaceum subungual fibromas, shagreen patches (leathery plaques of subepidermal fibrosis) and leaf shaped hypopigmented spots - cutaneous abnormalities seen in TUBEROUS - SCLEROSIS* Renal abnormalities includes - Renal cysts, Angiolipomas, Renal cell carcinoma***TUBEROUS - SCLEROSIS* TS - is an Autosomal dominant inheritance* *** Mutations that inactivating in either the TSCJ gene encoding tuberin or the TSC2 gene encoding hamartin* CNS hamartomas can cause seizures, mental retardation and autism* Associated abnormalities includes - retinal lesions, benign rhabdomyomas of the heart, lung cysts, benign tumours in the viscera and bone cysts* Classical Triad -(i) Seizures(ii) Mental retardation(iii) Adenoma sebacium* The characteristic brain lesion is a "Cortical Tuber" The most common neurological manifestations include seizures, cognitive impairment and behavioral abnormalities including autism


Question: A patient has Bullous Lesion; on Tzank smear


Question: An 8 yr old boy presents with boggy swelling and easily pluckable hair, Diagnosis is


Question: Immediately after eating, a man develops swelling of face and lips, respiratory distress, intense pruiritis, hypotension and feeling of impending doom. The most likely diagnosis is


Question: DOC for a pregnant woman in 2" trimester with pustular psoriasis is


Question: Streptomycin is useful in treatment of


Question: Characterstic nail finding in lichen planus


Question: In psoritic ahropathy TOC is


Question: A 24 year old unmarried woman has multiple nodular, cystic, pustular and comadonic lesions on face, upper back and shoulders for 2 years. The drug of choice for her treatment.

Ans. B. IsotretinoinAcitretin* It is used to help relieve and control severe skin disorders, such as severe psoriasis.* It works by allowing normal growth and development of the skin.* Acitretin must not be used to treat women who are able to bear children unless other forms of treatment have been tried first and failed.* Acitretin must not be taken during pregnancy because it causes birth defects in humansIsotretinoin* It is used to treat the most severe form of acne (nodular acne) that cannot be cleared up by any other acne treatments, including antibiotics* Birth defects (deformed babies), loss of baby before birth (miscarriage), death of baby, and early (premature) births. Female patients who are pregnant or who plan to become pregnant must not take isotretinoin.Female patients must not get pregnant:* For 1 month before starting isotretinoin,* While taking isotretinoin* For 1 month after stopping isotretinoin


Question: Ring worm fungi live in

A i.e. Stratum corneum Dermatophytosis is caused by trichophyton, epidermophyton & microsporumQ; and it infects superficial topmost layer of skin (stratum corneum or keratin layer), hair and nailsQ. Cutaneous mycosis (Tenia or Ring worm or Dermatophytosis) infect stratum corneum, hair & nailsQ and do not penetrate living tissues.


Question: Tuberculides are seen in

(Lichen scrofulosorum) (202-Behl lCfh, 1756-Dorland 28th, 219- Neena khanna)TUBERCULIDES - Group of disease where the evidence for a tuberculous etiology is not definite {May be hypersensitivity reaction) but which show a tuberculous granuloma on histology and respond to ATT)Conditions included in TuberculidsCutaneous Tuberculosis (Non Tuberculides)* Lichen scrofulosorum* Lupus vulgaris* Erythema- induratum* Sacrofuloderma* Papulonecrotc tuberculides (Acne-scrafulosorum)* Tubercularis cutis verrucosus* Lupus miliaris disseminatus faciei* Miliary tuberculosis and metastatic tuberculosis* Rosaceous tuberculide* Miliary tuberculosis and metastatic tuberculosis abscess may also present as cutaneous tuberculosis(According to 'Behl' Erythema - nodosum is also a tuberculide while some texts do not include it as a tuberculide)Features of TB in AIDS patients* |Sputum positivity *** Little or no cavitation*** |ed extra pulmonary tuberculosis *** Negative PPD skin test*** Lack of classic granuloma* Atypical CXR- Diffuse interstitial or military infiltrate* Response to short course chemotherapy is similar*** but adverse effects may be more pronounced including severe or even fatal skin disease* High rate of reactivation Indications of pulmonary resection in tuberculosis / haemoptysis areAbsoluteRelative* Massive haemoptysis (600cc/24 hours)* Destroyed lung, positive sputum* Bronchopleural fistula* Suspicion of carcinoma* Haemoptysis* Bronchial stenosis* Persistent positive sputum* Open negative cavity* T.B. Empyema* Atypical tuberculus infections* Aspergilloma (Fungus balls)Lupus - vulgaris - is a form of cutaneous tuberculosis that is seen in previously infected and sensitized individualsLupus- pernio - is a particular type of sarcoidosis that involves the tip of nose & earlobes with lesions that are violaceous in colourSpino- ventosa - Tuberculosis of bone in which bone is expanded & the cortex thins eg digitsScrofuloderma - Tuberculosis first develops in a lymph node or a bone producing a swelling and subsequently ruptures through the overlying skinFalse negative tuberculin skin test - reactions may result from improper testing technique - concurrent infections, malnutrition advanced age, immunologic disorders, lymphoreticular malignancies, corticosteroid therapy, CRF, HIV infections and fulminant tuberculosis


Question: 23 year old lady sony develops brown macular lesions over bridge of nose and cheek following exposure to light. The probable diagnosis is


Question: TOC in mycosis fungoides


Question: Duration of treatment in pauci bacillary leprosy is


Question: Flaccid Bullae lesions with oral mucosal lesion. The finding in immunofluoscence is aEUR'

Fish net IgG in epidermis Child with multiple flaccid bullae along with oral mucosal lesions suggests pemphigus. All patients suspected of having pemphigus should be evaluated inzmunopathologically. Immunofluorescene findings in common billions disorders Direct immunotlorescence Indirect immunoflorescence * Petriphigig IgG intercellular depositsQ Circulating IgG to cell in epidermis "(fish net pattern)" surface of epidermal cells These titres correlate with disease activity. * MMus C3 and IgG linear hand at Circulating IgG (in 70% pemphigoid Dermoepidermal junction2 patients that hind to base? ment inenthrone. * Chronic hull ous IgA, linear band at denno- Low titre of circulating disease of child- epidennaljunctionQ IgA hood (Linear IgA dermatosis of childhood) * Dermatitis IgA (-1- 0), granular deposit Circulating immune herpetiformis at dermal papillary tipsdeg complexes in less than 50%


Question: Multiple painful bleeding ulcers with inguinal bubo is seen with


Question: Dennie Morgan folds are seen in

Ans. b (Atopic dermatitis) (Ref. H - 18th/pg. 52, 52)Half of patients with Atopic dermatitis (AD) present within the first year of life, and 80% present by 5 years of age. About 80% ultimately coexpress allergic rhinitis or asthma. The infantile pattern is characterized by weeping inflammatory patches and crusted plaques on the face, neck, and extensor surfaces. The childhood and adolescent pattern is marked by dermatitis of flexural skin, particularly in the antecubital and popliteal fossae. AD may resolve spontaneously, but approximately 40% of all individuals affected as children will have dermatitis in adult life. The distribution of lesions may be similar to those seen in childhood; however, adults frequently have localized disease, manifesting as lichen simplex chronicus or hand eczema (see below). In patients with localized disease, AD may be suspected because of a typical personal history, family history, or the presence of cutaneous stigmata of AD such as perioral pallor, an extra fold of skin beneath the lower eyelid (Dennie-Morgan folds), increased palmar skin markings, and an increased incidence of cutaneous infections, particularly with Staphylococcus aureus. Regardless of other manifestations, pruritus is a prominent characteristic of AD in all age groups and is exacerbated by dry skin. Many of the cutaneous findings in affected patients, such as lichenification, are secondary to rubbing and scratching.SKIN FEATURES OF ATOPIC DERMATITIS# Atopic Pleat (Dennie-Morgan fold): An extra fold of skin that develops under the eye.# Cheilitis: Inflammation of the skin on and around the lips.# Hyperlinear Palms: Increased number of skin creases on the palms.# Hyperpigmented Eyelids: Eyelids that have become darker in color from inflammation or hay fever.# Ichthyosis: Dry, rectangular scales on the skin.# Keratosis Pilaris: Small, rough bumps, generally on the face, upper arms, and thighs.# Lichenification: Thick, leathery skin resulting from constant scratching and rubbing.# Papules: Small raised bumps that may open when scratched and become crusty and infected.# Urticaria: Hives (red, raised bumps) that may occur after exposure to an allergen, at the beginning of flares, or after exercise or a hot bath.# White dermographism: excessive redness along line of stroke with thin objecteTYPES OF ECZEMA (DERMATITIS)# Allergic contact eczema (dermatitis): A red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions.# Atopic dermatitis: A chronic skin disease characterized by itchy, inflamed skin.# Contact eczema: A localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, a cleaning agent, or other chemical.# Dyshidrotic eczema: Irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and bum.# Neurodermatitis: Scaly patches of the skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that become intensely irritated when scratched.# Nummular eczema: Coin-shaped patches of irritated skin--most common on the arms, back, buttocks, and lower legs--that may be crusted, scaling, and extremely itchy.# Seborrheic eczema: Yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body.# Stasis dermatitis: A skin irritation on the lower legs, generally related to circulatory problems.


Question: Nail are involved in


Question: 22 years women with diffuse hair loss for 1 month, with past history of enteric fever, before 4 months, likely cause

Ans. is 'b' i.e. Telogen effluvium * Diffuse hair loss for 1 month with a history of enteric fever before 4 months suggest the diagnosis of Telogen effluvium.* To understand telogen effluvium, we need to have some knowledge of the hair growth cycle.Hair does not grow continuously on the human scalp.The anagen (growing) phase for terminal hair can extend 3 to 7 years and is a reflection of the size of the hair follicle.Catagen is the transitional portion of the hair growth cycle, between anagen and telogen and lasts only 1 to 2 weeks.During this time, there is a rapid involution and regression of the hair follicle. The hair follicle then enters the telogen phase, which is a relatively fixed period of time, approximately 100 days, regardless of the size of the hair follicle. There is no growth of the hair shaft during this phase. It is at the end of the telogen phase that the entire hair shaft, also often referred to as the club hair, will spontaneously shed, while a new hair shaft is forming within the hair canal. The white bulb at the end of the hair, along with the loosely attached collection of friable debris gives the shed hair its characteristic appearance. In the scalp of the healthy, young human adult, approximately 90% of the hair will be in the anagen (growth) phase and approximately 10% will be in the telogen (dormancy) phase.Less than 1% will be in the catagen (transitional) phase.What is Telogen Effluvium??When excessive amounts of hair simultaneously switch from anagen (growth) into telogen (dormancy) and subsequently shed several months later, the phenomenon is referred to as a telogen effluvium.Telogen effluviums can be acute or chronic.What causes Telogen Effluvium?In order to cause a large number of hair follicles to simultaneously switch from the anagen (growing) phase into the telogen (resting) phase, the body has to undergo some systemic insult.A telogen effluvium is not caused by topical medications. But because there is a required time lapse of several months between the inciting cause and the excessive shedding of hair, the exact cause of the telogen effluvium is often not positively identified.A typical and common case of telogen effluvium would be the episode of severe shedding of hair that may occur approximately 100 days after a woman has given birth. The inciting factor is probably the abrupt hormonal changes that occur at the end of pregnancy. All of the hair grows back within a year.Other causes of telogen effluvium include illness,major physicaltrauma,menopause,crash diets,severe psychological stress,major surgery (especially with general anesthesia),hypo- or hyperthyroidism,anemia's,acute and severe blood loss,heavy metal poisoning, etc.Chronic illness such as malignancy, and any chronic debilitating illness,such as systemic lupus erythematosus,end-stage renal disease, - or liver disease can cause telogen effluvium.InfectionsTyphoid, malaria, dengue Anagen effluviumAnagen effluvium is the loss of anagen hair which typically happens after radiation therapy of chemotherapy especially with alkylating agents.


Question: Chloroquin is indicated in treatment of

D i.e. DLE Chloroquine is used in treatment of DLE & SLE and it does not produce lupus like pictureQ. Chloroquine is drug of choice for malaria caused by all plasmodium ovale/malariae/knowlesi and chloroquine sensitive P. falciparum & P. vivax. Chloroqione is also useful in? nic Use of chloro uine Dr = DLE S SLE, SarcoidosisQ, Severe polymorphous light eruption M Malaria Pandey = Porphyria cutanea tarda (PCT) Has Entered = Hepatic (Extraintestinal) amoebiasis In = Infectious mono nucleosis Labour = Lepra reactionQ Room = Rheumatoid ahritis


Question: Total skin electron irradiation is used for of

B i.e. Mycoses fungoides Mycosis fungoides is an indolent cutaneous T - cell lymphomaQ with patients often having several years of eczematous or dermatitis skin lesion before the diagnosis is finally established. But the disorder is inevitably fatalQ, although the rate of progression is quite variable. Mycosis Fungoides and Sezary Syndrome are T-Cell neoplasmQ. Mycosis fungoides (a T Cell malignancy) has skin manifestations like uicatia, erythema, eczema, itching & liard nodules which later on ulcerate containing fungating granulation. Pauterier's microabscessQ is histological features of mycosis fungoides. TOC is electron beam radiationQ


Question: M.C. cause of Nongonococcal Urethritis


Question: Koebner's phenomenon is characteristic of


Question: Sabre Tibia

D i.e. Syphilis Recurrence of the chancre in its original place due to relapse (not re-infection) in early syphilisQ is called chancre redux. - Vesico - Bullous lesion are charcterstically seen in early congenital syphilisQ & not found in other stages of syphilis. Interstitial keratitis, along with 8th nerve deafness & hutchinson's teeth (pegged central upper incisors)Q -form Hutchinson's triad; which is seen in late congential syphilis. Sabre tibiaQ, saddle nose, mulberry molars, bull dog jaws, frontal bossing of parrot and rhagades are other features of late congenital syphilis.


Question: A lady develops pigmentation on the bridge of nose and cheeks on exposure to sunlight. The most likely diagnosis is


Question: Patchy hair loss with velvety skin points to the diagnosis of

Ans. is 'c' i.e., Hypehyroidism Hair loss in combination with velvety skin is seen in patients with excess of thyroid hormone production; thus the most probable answer is hypehyroidism


Question: Thimble pitting of nails is seen in


Question: A patient with multiple hypopigmented & hypesthetic patches on lateral aspect of forearm with abundance of AFB and granulomatous inflammation on histology. The diagnosis is


Question: Treatment of nodulocystic acne is


Question: DOC of pustular psoriasis


Question: Leprosy does NOT affect axilla, groin and scalp because

(A) They are warmer regions of the body > Parts of the body that might be affected by leprosy are the cool areas, which can include superficial peripheral nerves, the anterior chamber of the eyes, the testes, the chin, malar eminences, earlobes, and knees. From this stage of leprosy, most lesions evolve into the tuberculoid, borderline, or lepromatous types


Question: Pseudo Bubo is seen in


Question: Scabies in children differs from that in adults in that it affects


Question: Recalcitrant Pustular Acne is treated by


Question: Genodermal disease that can cause skin malignancy are


Question: Most common precipitant of contact dermatitis is


Question: Hanifin & Rajke is the diagnostic criteria for

Ans. is 'a' i.e., Atopic dermatitis Hanifin and Rajka criteria is for diagnosis of atopic dermatitis. Diagnostic criteria (Hanifin and Rajka) Based mainly on clinical experience Major criteria Family history of atopy Chronicity Pruritus Typical morphology and distribution Minor criteria Dry skin Chelitis Elevated edge Dennie's line/dennie morgan fold (infra orbital fold) White dermographism Peripheral eosinophillia Immediate (type i) hypersensivity Facial pallor, orbital darkening Food intolerance Conjunctivitis (recurrent), keratoconus, cataract Pityriasis alba Hand dermatitis Recurrent infections At least 3 major or 2 major plus 2 minor criteria are necessary for diagnosis


Question: Drug of choice in scabies

(A) Permethrin # Creams and lotions for Scabies:> Two most widely used treatments for scabies are permethrin cream and malathion lotion. Permethrin is usually recommended first, and malathion lotion is used if the permethrin cream proves ineffective.> Both medications contain insecticides that kill the scabies mite.


Question: An infant presented with erythematous lesions on cheek, extensor aspect of limbs, mother has history of bronchial asthma, the probable diagnosis is


Question: Nail involvement is not a feature of


Question: Characteristic lesion in scabies

Ans is 'a' i.e., Burrows Burrow is serpentine (S.shaped), thread like grey brown line which represents the intraepidermal tunnel created by moving female mite in stratum corneum. Burrow is pathognomic sign of scabies. Burrows are very difficult to demonstrate in infants. Also See explanation-3 of session-6 of Skin of All India 2014-15 pattern of this book.


Question: Eczema herpeticum seen with


Question: IgA deposits on skin biopsy


Question: A 3 year old child has eczematous dermatitis on extensor surfaces. His mother has a history of Bronchial asthma. Diagnosis should be

Atopic dermatitis Eczematous dermatitis on extensor surface and the history of bronchial asthma suggests the diagnosis of Atopic dermatitis. Atopic dermatitis Etiology and pathogenesis Genetic predisposition is very impoant but the precise mode of inheritence is unceain. Atopic diseases tend to run true to type within each family. In some families the affected members predominantly have eczema while in others respiratory problems predominate. This is probably because the dermatitis and asthma are inherited through separate though closely related genetic pathways. Immunological changes Elevated /gE level seen in 80% of the patients. Abnormalities in lymphocytes are also seen. Clinical features Clinical picture varies with the age of the patient (i) Infantile Begins at about 3 months Severely itchy exudative lesions on face and other pas. (ii) Childhood Itch leathery flexural lesions, sometimes extensor lesions occur. (iii) Adult Lichnefied itchy lesions Seen in cubital and popliteal fossa. Seborrhic dermatitis Caused by an yeast, Malassezia futfur Usually seen in adults, sometimes in infants but not in children. The lesions involve the scalp, face (nasolabial folds, eyebrows and eyelashes) presternal and interscapular regions and major flexures (axilla, groin and inframammary region) umbilicus and natal cleft. This distribution of seborrhic dermatitis is very characteristic and is called "seborrhic distribution". Contact dermatitis It develops due to contact with chemicals.


Question: On membrane removal of a lesion, Sign (Arrows) seen in Psoriasis

Auspitz sign (Feature: Bleeding points on removal of membrane in Psoriasis)


Question: Nodular scabies is found in


Question: Recurrent genital ulcer is caused by

Ans. is 'b' i.e., HSV 2 o Most common cause of recurrent genital ulcer is HSV.o Infact, the characteristic feature of Herpes genitalis is that it is recurrent,o Genital ulcer is caused by HSV 2.


Question: Non Palpable purpura is seen in A/E


Question: Intraepidermal lgG deposition is seen in


Question: Podophylline is used in treatment of


Question: Erythema nodosum is seen in A/E


Question: Drug of choice in Herpes zoster


Question: Test not used for diagnosis of syphilis

D i.e. Frie - test - Most specific test is TPI > FTA -ABSQ Non treponemal test becomes non reactive after t/t; the Treponemal test often remain reactive & therefore not helpful in determining the infection status of person with past syphilis Q. Response to treatment in early syphilis is seen by sequential VDRL or RPR titerQ as they become negative after treatment. CSFVDRL is highly specific but insensitive test; may be nonreactive in symptomatic progressive neuro syphilis. It's sensitivity is highest in meningovascular syphilis & paresis.


Question: DOC for LGV


Question: Desmoglein is an Autoantigen in

Ans. is 'a' i.e., Pemphigus Desmosomes o Desmosomes are the major adhesion complex in the epidermis, anchoring keratin intermediate filaments (IFs) to the cell membrane and bridging adjacent keratinocytes, and allowing cells to withstand trauma. o The main components of desmosomes consist of the products of three gene superfamilies : - Desmosomal cadherins They are calcium ion-dependent cell adhesion molecules that show homophilic adhesions (i.e. a cadherin molecule of one cell binds to the same molecule on another cell.) They include Desmogleins 1-4 (Dsgl-Dsg4) Desmocollins 1-3 (Dscl-Dsc3) Armadillo proteins Plakoglobins (Pgs) Plakophilin (Pkps 1-3) 3) Plakins Desmoplakins (DPS). Ptectin Envoplakin Periplakin Antigen defect Disease Dsg 1 Pemphigus violaceus Dsg 3 Pemphigus Vulgaris Dsc 1 Subcorneal pustular dermatosis Dpk 1& 2 Erythema multi forme Envoplakin & Periplakin Perineoplastic pemphigus


Question: Presumably, the Varicella zoster virus infects

(A) Dorsal root ganglion[?]Varicella-Zoster Virus (VZV):Herpes Zoster Herpes zoster (shingles) is a sporadic disease that results from reactivation of latent VZV from dorsal root ganglia.Most patients with shingles have no history of recent exposure to other individuals with VZV infection.Herpes zoster is characterized by a unilateral vesicular dermatomal eruption, often associated with severe pain. The dermatomes from T3 to L3 are most frequently involved.If the ophthalmic branch of the trigeminal nerve is involved, zoster ophthalmicus results.The onset of disease is heralded by pain within the dermatome, which may precede lesions by 48-72 h; an erythematous maculopapular rash evolves rapidly into vesicular lesions.In a few patients, characteristic localization of pain to a dermatome with serologic evidence of herpes zoster has been reported in the absence of skin lesions, an entity known as zoster sine herpetica.In Ramsay Hunt syndrome, pain and vesicles appear in the external auditory canal and patients lose their sense of taste in the anterior two-thirds of the tongue while developing ipsilateral facial palsy.The geniculate ganglion of the sensory branch of the facial nerve is involved.CNS involvement may follow localized herpes zoster. Many patients without signs of meningeal irritation have CSF pleocytosis and moderately elevated levels of CSF protein. Symptomatic meningoencephalitis is characterized by headache, fever, photophobia, meningitis and vomiting.Human alpha-herpesvirus Causes varicella (chickenpox) and herpes zoster (shingles) Primary VZV infection leads to chicken pox VZV establishes latency in dorsal root ganglia after primary infection VZV can reactivate at a later time, causing herpes zoster. A. Alpha herpes viruses (E.g. HSV-1, VZV, PRV) infect pseudounipolar sensory neurons of PNS ganglia. CNS spread is rare and requires anterograde axonal transport of progeny virions toward the spinal cord.B. RABV and poliovirus spread via Neuromuscular Junctions (NMJ) from muscles into somatic motor neurons in the spinal cord.C. Several viruses may infect receptor neurons in the nasal olfactory epithelium. Spread to the CNS requires anterograde axonal transport along the olfactory nerve into the brain.D. Infiltration through the blood-brain barrier (BBB). The BBB is composed of brain microvascular endothelium cells (BMVEC) with specialized tight junctions, surrounding basement membrane, pericytes, astrocytes, and neurons. Infected leukocytes can traverse this barrier carrying virus into the brain parenchyma.E Alternatively, virus particles in the bloodstream can infect BMVECs, compromising the BBB.


Question: Itchy polygonal violaceous (itchy/prusitic) palpules seen rn


Question: A patient presented with scarring alopecia, thinned nails, hypopigmented macular lesions over the trunk and oral mucosa. The diagnosis is


Question: 'Coral red' color on Wood's lamp is seen in

Ans. a (Erythrasma) (Ref. Harrison 18th/ p 289)D/D of erythrasma1ConditionOrganismSymptoms/MorphologyDiagnosisTreatment2ErythrasmaCorynebacteriumminutissimumOften asymptomatic+/- pruritus+ intertriginous areasWoods's light shows coral-red fluorescenceTopical: erythromycin 2%, clindamycin 1% or keratolytic agentsOral: erythromycin or clarithromycinIntertrigoCandida albicansErythematous pustules, papules and/or plaques +/- satellite lesions at periphery +pruritus + pain/tenderness +intertriginous areasKOH examination shows septate hyphae and pseudohyphaeTopical: allylamines, azoles, ciclopirox, nystatinOral: azolesTinea corporisEpidermophyton species,Microsporum species,Trichophyton speciesAnnular scaly erythematous plaques often with central clearingKOH examination shows segmented hyphaeTopicals: allylamines, azoles, ciclopiroxOral: azoles, griseofulvin, terbinafine hcl1Abbreviations: KOH, 10% potassium hydroxide preparation; +, present; not present.2This is only a partial therapeutic agentsWOOD'S LIGHT# A Wood's lamp generates 360-nm ultraviolet (or "black") light that can be used to aid the evaluation of certain skin disorders. (MHSSCET 2009)# Normally the skin does not fluorosence or shine under ultraviolet light.The different infections and conditions showing different colors are:DiseaseColor on Wood's Lamp (360 nm uV light used)1Erythrasma (Corynebacterium minutissimum)Coral red color2Tinea versicolorGolden yellow3Tinea capitis (Microsporum canis or M. audouini)Yellow fluorescence4Trichophyton schoenleiniPale green5Microsporum audouinii or M. canisYellow fluorescence6Pseudomonas aeruginosaPale blue/ Aquagreen1Tuberous sclerosisAsh-leaf-shaped spot8Porphyria cutanea tardaPink to pink-orange9LeprosyBlue white10HypopigmentationPale white11HyperpigmentationPurple brown12Depigmentation - VitiligoTotally white13AlbinismBright white14Pigmented lesions of the epidermis such as frecklesAre accentuated under a Wood's light15dermal pigment such as postinflammatory hyperpigmentationFades under a Wood's lightAdditional Educational points:Q. Ans.1"White dermographism"=>Atopic dermatitis2Dennie's line (extra fold of skin beneath lower eyelid) & perioral pallor=>Atopic dermatitis3"Winter itch,"=>Asteatotic eczema4"Cradle cap"=>Seborrheic dermatitis5"Fir tree"-like appearance=>Pityriasis rosea6Interface dermatitis, Wickham's striae=>Lichen planus7"Spaghetti and meatballs" KOH preparation=>Malassezia furfur


Question: A 3 year old child has eczematous dermatitis on extensor surfaces. His mother gives history of bronchial asthma. Diagnosis is

Ans: a (Atopic dermatitis)Ref: Rook, Vol. 1, 7th ed. pg. 18.2Criteria for atopic dermatitisMajor criteriaAn itchy skin condition (plus 3 or more of the following)1. Onset below 2 years2. History of skin crease involvement (including cheeks in children under 10 years)3. History of generally dry skin4. History of other atopic diseases5. Visible flexural dermatitis.Atopic dermatitis could be established if 3 of the major and 3 of the 23 minor criteria are present.Contact dermatitis is unlikely in this age group.Seborrhic dermatitis - The seborrheic areas like scalp, nasolabial fold, retroauricular areas are affected.


Question: 'Coral red' fluorescence on Wood's lamp is seen in

Ans. a (Erythrasma) (Ref. H-17/p. 312)A Wood's lamp generates 360-nm ultraviolet (or "black") light that can be used to aid the evaluation of certain skin disorders. For example, a Wood's lamp will cause erythrasma (a superficial, intertriginous infection caused by Corynebacterium minutissimum) to show a characteristic coral pink color.Color changes in Wood's Lamp (360-nm UV)ConditionsFindingErythrasma (C.Minutissimum)Coral RedTinea (Pityriasis) VersicolorDull YellowFrecklesAccentuatedPost inflammatory (Dermal)FadesVitiligoTotally whiteTinea CapitisBrilliant GreenTinea Capitis by Microsporum canisYellowTinea Capitis by M. audouiniYellowPseudomonasPale Blue/GreenTuberous Sclerosis (Ash Leaf)Blue whiteUrine in Porphyria Cutanea TardaPinkish RedERYSIPELAS# is due to S. pyogenes# is characterized by an abrupt onset of fiery-red swelling of the face or extremities.# Infants and elderly adults are most commonly afflicted.# The severity of systemic toxicity varies.# The distinctive features of erysipelas are well-defined indurated margins, particularly along the nasolabial fold; rapid progression; and intense pain.# Flaccid bullae may develop during the second or third day of illness, but extension to deeper soft tissues is rare.# Treatment with penicillin is effective.


Question: In Wood's lamp examination, green fluorescence detects

(Pseudomonas) (287-88-H 16th) (312, 326-H17th)WOOD'S LIGHT - A wood's lamp generates 360 nm ultraviolet (or black) light that can be used to aid the evaluation of certain skin disorders- Examples.* Erythrasm caused by corynebacterium minutis-simum) to show characteristic coral red color.* Wound colonized by Pseudomonas to appear pale blue.* T.capitis caused by dermatophytes such as Microsporum canis or M. audouini exhibits a yellow fluorescence* Post inflammatory hyperpigmentation fades under Wood's light.* Vitiligo appears totally white under a Wood's lamp.* A Wood lamp may also aid in the demonstration of tinea versicolor and in recognition of ash led spots with tuberous sclerosis.


Question: The only indication of giving coicosteroids in pustular psoriasis is

A i.e. Psoriatic erythroderma with pregnancy

Psoriasis in a pt. With alchoholic cirrhosis


Question: Multibacillary leprosy is treated by

Ans C (Rifampicin +dap......) Ref Handbook of leprosy Jopling Pill, Ref: Park p.267Chemotherapy for leprosy- WHO recommendations:MULTIBACILLARY LEPROSY12 months to be completed within 18 months*Rifampicin- 600mg once monthly under supervision*Clofazimine- 300 mg once monthly under supervision - 50 mg daily self administered*Dapsone-100 - mg daily self administeredPAUCIBACILLLARY LEPROSY6 months to be completed within 9 months*Rifampicin 600mg once monthly supervised* Dapsone 100 mg daily self administered.PAUCIBACILLARY LEPROSY SINGLE LESION (Single dose)Ofloxacin 400 mg, Rifampicin 600 mg,Minocycline 100 mgLeprosy is a highly infectious disease of low pathogenicity. It is effectively made non-infectious by treatment with rifampicin for 3 weeks ( KERALA 2007)and by dapsone for 90 days. Local application of rifampicin (drops or spray) may destroy all the bacilli within 8 days.Anti-leprotic drugsRIFAMPICINIt is bactericidal to M.leprae and rapidly renders leprosy patients noncontagious. Up to 99.99% M.leprae are killed in 3-7 days.MOA-Rifampicin binds to the beta subunit of bacterial DNA-dependent RNA polymerase and thereby inhibits RNA synthesisOther indications include tuberculosis, prophylaxis of meningococcal and H.influenza meningitis and carrier state,combined with doxycycline in brucellosis, 2nU/3rd choice drug in MRSA,diphtheroids and legionella.Adverse effectsImparts a harmless orange color to urine, sweat, tears, and contact lenses .Rashes, thrombocytopenia, and nephritis.Cholestatic jaundice and occasionally hepatitis.Rifampin commonly causes light-chain proteinuria.If administered less often than twice weekly, rifampicin causes a flu-like syndrome characterized by fever, chills, myalgias, anemia, and thrombocytopenia and sometimes is associated with acute tubular necrosis. Rifampin strongly induces most cytochrome P-450 isoforms.DAPSONE (DDS)-Dapsone (diaminodiphenylsulfone).Like the sulfonamides, inhibits folate synthesis. It is leprostatic at low concentrations, and at relatively higher concentrations arrests the growth of many other bacteria sensitive to sulfonamides.Other uses1) In combination with pyrimethamine, dapsone is used for treatment of chloroquine-resistant malaria.2) It is used to prevent and treat Pneumocystis jirovecipneumonia in AIDS patients.Adverse effectsMany patients develop some hemolysis, particularly if they have glucose-6-phosphate dehydrogenase deficiency.Methemoglobinemia is common..Gastrointestinal intolerance, fever, pruritus, and various rashes also occur.Allergic rashes, fixed drug eruption, hypermelanosis, phototoxicity, and exfoliative dermatitis are the various cutaneous reactions seen.CLOFAZIMINEIt is a dye with leprostatic and anti-inflammatory properties.Its MOA is unknown but may involve DNA binding.Adverse effectsSkin-The most prominent untoward effect is skin discoloration ranging from red-brown to nearly black.Dryness of skin and itching is also seenAcneform eruptions and photoxicity have been notedGIT-Gastrointestinal intolerance occurs occasionally.Other antibiotics used are ofloxacin, minocycline and clarithromycin.


Question: Minor clinical feature in diagnosis of atopic dermatitis A/E


Question: TOC for penicillin resistant gonorrhoea

B i.e. Ceftriaxone Neisseria gonorrhea is a gram negative, aerobic, non-motile, non-sporeforming, diplo/mono-cocciQ, exclusively a human pathogen that principally infects host columnar epithelium. It is oxidase positive like other Neisseria species, from which it is distinguished by their ability to grow on selective media & to utilize glucose but not maltose, sucrose or lactose. Gonorrhoea is, the second most common (after Chlamydia trachomatis which is the most common) genital /sexually transmitted infection in US, UK and other developed countriesQ (Harrison 1442; Rook's 34.24). The incidence of gonorrhea is higher in developing countriesQ than industrialized nations predominantly affecting young, nonwhite, unmarried, less educated urban population. (Harrison 1220) Chlamydia trachomatis is the most common cause of non gonococcal urethritis (NGU) and postgonococcal urethritis (PGU)Q. PGU refers to NGU developing in men 2-3 weeks after treatment of gonococcal urethritis with single doses of agents such as penicillin or cephalosporins which lack activity against Chlamydia. In US most of acute urethritis cases are NGU and C. trachomatis is implicated in most (30-50%) of these casesQ. The other causes of NGU are Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas vaginalis and herpes simplex virus (HSV). Gonorrhoea is a STD which commonly manifests as cervicitis (primary site of infection in females), urethritis (most common/primary site of infection in males presenting as rapid onset severe burning dysuria with profuse purulent discharge)Q, proctitis & conjunctivitis. If untreated it can 1/t local complications such as endometritis, salpingitis, tuboovarian abscessQ, baholinitis, peritonitis and perihepatitis (Fitz-Hugh Cuis Syndrome) in females; peri urethritis and epididymitisQ in male patients and ophthalmia neonatorum in new borns. Disseminated gonococcemia is uncommon & 1/t skin lesions, tenosynovitis, ahritis and in rare cases endocarditis & meningitis. Because of ascending spread of infection testis is spared or (uncommonly) last to be involvedQ only after urethritis, prostatitis, epididymitis in gonorrhea. Single dose regimens of 3rd generation cephalosporins ceftriaxone (IM) and cefixime (oral) are the mainstays of therapyQ for uncomplicated gonococcal infection of urethra, cervix, rectum, or pharynx. Septinomycin is an alternative (2nd) regimen for uncomplicated gonococcal infections in penicillin allergic patients. All 3 drugs are suitable for pregnant & breast feeding women. The new management for complaints of urethral discharge involves a combined modality of treatment for N. gonorrhea and C. trachomatisQ as most cases are d/t coinfection with both pathogens and incorporate an agent eg. azithromycin or doxycycline that is effective agenist chlamydial infection. Pregnant women who should not take doxycycline, should receive concurrent treatment with a macrolide antibiotic for possible chlamydial infection. Feature Gonococcus Syphilis Infect/ EpididymisQ TestisQ Involve Resistant structure (not involve) TestisQ EpididymisQ Infection Urethrae Blood spread (i.e. (i.e. testis is through Epididymis is involved & involved & epididymis is testis is spared) spared)


Question: A 29 years old male with a history of long leisure trip presented with right knee pain and swollen join with foreign


Question: Male with patchy loss of scalp hair and grey hair in the eyebrows and beard diagnosis is

B i.e. Alopecia areataSingle or multiple circumscribed smooth patchy hair loss, most obviously on scalp but frequently involving any hair bearing skin eg beard, eyebrows, eye lashes, with pathognomic "exclamation mark" & "going gray overnigth" phenomenon ( i.e., white or gray hairs are frequently spared)Q indicate the diagnosis of alopecia areata. Scanty stumps form 'Exclamation mark (!) in alopecia areata


Question: Frie test is done in


Question: Acantholysis is due to destruction of


Question: Butterfly rash is seen in

(A) Systemic lupus erythematosus # SLE:> Characteristic Malar (Butterfly) rash seen as fixed erythematous rash over the cheeks, & bridge of nose (photosensitive but scarring is absent) Patchy scalp hair loss is seen & Hair usually regrow in SLE (but not in DLE) Raynaud's phenomenon is present in 10%; Antibodies against double-stranded DNA (Anti ds DNA) & Anti Sm are most specific Where as Antinuclear antibody (Anti SS DNA) test is most sensitive; ANF (Antinuclear factor) is positive in 98% Treatment: Antimalarials (Chloroquine, Hydroxychloroquine) are used when skin & joint disease predominate; Steroids with Ccytotoxic immunosuppressants (Azathioprine, Cyclophosphamide, Methotrexate) may be required when NSAIDS & Antimalarials are insufficient to control symptoms 11 criteria for diagnosis of SLE are: Malar rash; Discoid rash; Photosensitivity; Oral ulcers; Arthritis; Serositis (pleuritis, pericarditis); Renal disorder; Neurological disorder (Seizures or Psychosis); Haematological disorder (Haemolytic anaemia, Leukopenia, Thrombocytopenia); Immunological disorder;Antinuclear antibody. SLE may cause Libman Sach's Verrucous type of endocarditis


Question: Porphyrins are synthesized mainly in


Question: Subepidermal lesions are seen in

Ans: (b) Pemphigoid bullaeHarrison 19th ed. / 371-72* Pemphigus has intraepidermal bullae* Pemphigoid has subepidermal bullaeDifference between Pemphigus and Pemphigoid BullaeFeaturesPemphigusPemphigoid* Row of Tomb stonePresentAbsent* Nikolsky SignPresentAbsent* Bullae locationIntraepidermal - flaccid BullaeSubepidermal & tense Bullae* Mucosa involvementPresent (common)Absent or less common* AcantholysisPresentAbsent* PrognosisPoorGood


Question: Herpes resistant to acyclovir is treated by

A. i.e. Foscarnet Acyclovir is drug of primary choiceQ for herpes infection and foscarnet is drug of choice for acyclovir resistance HSV, herpes zoster & varicella zoster infectionQ.


Question: Tinea ungum effects


Question: The drug NOT used in psoriasis is

(B) Chloroquine # TREATMENT OF PSORIASIS: Locally by Topical coaltar.> Wide spread Psoriasis: by Ultraviolet fi-spectrum alone or along with coaltar (Geockerman regimen) or Anthranil (Ingram regimen)> Methotrexate Therapy: Methotrexate is drug of choice in Very Severe form of Psoriatic arthritis & Methotrexate is indicated in Psoriatic erythroderma, Generalized pustular psoriasis, Intractable & Crippling psoriasis.> Psoralens & Ultraviolet-A phototherapy (PUVA): is successful in clearing & delaying recurrence of Chronic Psoriasis.> Etritinate, & its metabolite Acitretin, are Retinoids (Vitamin A derivatives): useful for Severe Resistant Psoriasis.> Systemic drugs useful in Psoriasis: Hydroxyurea, Razoxane & Azathioprine; Cyclosporin A and Topical Vitamin-D3


Question: Defective DNA repair is a/w


Question: Rhinopyma is


Question: A 30 year old female developed diffuse hair loss 3 months after delivery of her first child. The probable diagnosis is

C i.e. Telogen effluviumDiffuse hair loss after 3 months of prolonged, high grade, recurrent fever of any cause (eg typhoid) or difficult & prolonged child hihQ indicates diagnosis - telogen effluvium. The onset of hair loss is rapid within 2-4 weeks of causes (like radio/chemotherapy, poisoning/intoxication and malnutrition) in anagen effluvium.


Question: Subepidermal lesion are


Question: The growth phase of hair is

(Anagen): (1242- Davidson 21st edition)* Hairs in humans do not grow continuosely but in a cycle with three phases* Anagen, in which the hair grows* Catagen a transitional phase* Telogen a resting stage* The individual duration of the components of the cell cycle varies by site* On the scalp, anagen will last several years, whereas catagen lasts only a few days and telogen around 3 months* Highest density of hair follicles is on the scalp, which has between 500 and 1000/cm2


Question: Only skin and nails are affected in

Ans. c (Epidermophyton floccosum) (Ref. Textbook of microbiology by Ananthanarayan 6th ed., 567)DERMATOPHYTOSISType of MycosisCausative Fungal AgentsMycosisSuperficialMalassezia speciesTinea nigraTrichosporon speciesPiedraia hortaePityriasis versicolor;Hortaea werneckiiWhite piedraBlack piedraCutaneousMicrosporum species, Trichophyton species, and Epidermophyton floccosumCandida albicans and other Candida speciesDermatophytosisCandidiasis of skin, mucosa, or nailsSubcutaneousSporothrix schenckiiPhialophora verrucosa, Fonsecaea pedrosoi, othersPseudallescheria boydii, Madurella mycetomatis, othersExophiala, Bipolaris, Exserohilum, and othersSporotrichosisChromoblastomycosisMycetomaPhaeohyphomycosis# Dermatophytes are fungi that infect skin, hair, and nails and include members of the genera Trichophyton, Mi- crosporum, and Epidermophyton.# Any dermatophyte can cause tinea corporis (annular scaly patches with raised, erythematous vesicular borders and central clearing).# Tinea faciei, like tinea corporis, can be caused by any dermatophyte. T. rubrum and E. floccosum are common causes of tinea cruris; similar lesions can be caused by Candida infection.# Tinea pedis is the most common clinical dermatophytic infection. The most common cause of tinea pedis is T. rubrum.# Tinea nigra is a rare infection of the palms caused by the dematiaceous fungus Hortaea (formerly Exophiala) werneckii. Two types of piedra characterized by nodules of fungal elements on the hair shaft have been reported:- Black Piedra caused by Piedraia hortae and- White Piedra caused by Trichosporon species.# Tinea unguium is caused by T. rubrum, T. mentagrophytes, and E. floccosum. Dermatophytes cause 80-90% of cases of onychomycosis.# Tinea capitis is a common dermatophytic disease of children. Hair may break off at the scalp ("black-dot ringworm"). Inflammatory responses may be minimal or severe, with the formation of a KERION characterized by alopecia, a tender or painful boggy scalp, purulent drainage, and localized lymphadenopathy. T. tonsurans is the most common dermatophyte associated with tinea capitis.# T. beigelii has historically been the most significant pathogen in the genus Trichosporon.# The diagnosis of tinea can be made from skin scrapings, nail scrapings, or hair by culture or direct microscopic exam with KOH or by nail PAS stain.Dermatophytic Skin DiseaseLocation of LesionsClinical featuresFungi most frequently responsibleTinea corporis(ringworm)Nonhairy, smooth skin.Circular patches with advancing red, vesiculated border and central scaling.Pruritic.T rubrum, E floccosumTinea pedis(athlete's foot)Interdigital spaces on feet of persons wearing shoes.Acute: itching, red vesicular. Chronic: itching, scaling, fissures.T rubrum, T mentagrophytes, E floccosumTinea cruris(jock itch)Groin.Erythematous scaling lesion in intertriginous area.Pruritic.T rubrum, T mentagrophytes; E floccosumTinea capitisScalp hair. Endothrix: fungus inside hair shaft. Ectothrix: fungus on surface of hair.Circular bald patches with short hair stubs or broken hair within hair follicles.Kerion rare.Microsporum-infected hairs fluoresce.T mentagrophytes, M canisTinea barbaeBeard hair.Edematous, erythematous lesion.T mentagrophytesTinea unguium(onychomycosis)Nail.Nails thickened or crumbling distaliy; discolored; lusterless.Usually associated with tinea pedis.T rubrum, T mentagrophytes, E floccosumDermatophytid(id reaction)Usually sides and flexor aspects of fingers.Palm. Any site on body.Pruritic vesicular to bullous lesions.Most commonly associated with tinea pedis.No fungi present in lesion.May become secondarily infected with bacteria.Dermatophytosis: Treatment# Topical imidazoles, triazoles, and allylamines may be effective therapies for dermatophyte infections, but nystatin is not active against dermatophytes.# Oral antifungal agents may be required for recalcitrant tinea pedis or tinea corporis, those involving the hair and nails.# Griseofulvin- is the only oral agent approved for dermatophyte infections involving the skin, hair, or nails.- Griseofulvin administered with a fatty meal is an adequate dose for most dermatophyte infections.- The usual adult dose of griseofulvin for tinea capitis is 1 g microsized or 0.5 g ultramicrosized given daily.- The duration of therapy may be# 2 weeks for uncomplicated tinea corporis,# 8-12 weeks for tinea capitis, or as long as# 6-18 months for nail infections.- Common side effects of griseofulvin include# Headache# Urticaria# Gastrointestinal distress# Oral itraconazole and terbinafine are approved for onychomycosis.Clinical FeaturesEtiologic AgentTreatment ImpetigoHoney-colored crusted papules, plaques, or bullaeGroup A Streptococcus and Staphylococcus aureusSystemic or topical antistaphylococcal antibioticsDermatophytosisInflammatory or noninflammatory annular scaly plaques; may have hair loss; groin involvement spares scrotum; hyphae on KOH preparationTrichophyton, Epidermophyton, or Microsporum sp.Topical azoles, systemic griseofulvin, terbinafine, or azolesCandidiasisInflammatory papules and plaques with satellite pustules, frequently in intertriginous areas; may involve scrotum; pseudohyphae on KOH preparationCandida albicans and other Candida speciesTopical nystatin or azoles; systemic azoles for resistant diseaseTinea versicolorHyperpigmented or hypopigmented scaly patches on the trunk; characteristic mixture of hyphae and spores on KOH preparation ("spaghetti and meatballs")Malassezia furfurTopical selenium sulfide lotion or azoles


Question: Drug of choice for syphilis in a pregnant women

B i.e. Penicillin Penicillin is the only recommended agent for treatment of syphilis in pregnancyQ. If the patient has a documented penicillin allergy, desensitization and penicillin therapy should be given.


Question: An infant has papulovesicular lesions on palms, soles, face and trunk. The diagnosis would he

Ans. a. Scabies Scabies: Primary lesions are of three types:Q Burrow: Serpentine (S-shaped) path traversed by parasite in stratum corneumQ. It is pathognomic of lesion. Papules and papulovesicles: Due to hypersensitivityto the mite Fine pin head size follicular papules Scalp, face, palms and soles are characteristically spared in adultsQ. In infants, scalp, face, palms and soles are typically involvedQ. Atopic dermatitis: In order to qualify as a case of atopic dermatitis with the UK refinement of Hanifin and Rajka's diagnostic criteria for atopic dermatitis, the child must have An itchy skin condition (or parental repo of scratching or rubbing in a child)plus Three or more of the following: Onset below age 2 years (not used if child is under 4 years) History of skin crease involvement (including cheeks in children under 10 years) History of a generally dry skin Personal history of other atopic disease (or history of any atopic disease in a first degree relative in children under 4 years) Visible flexural dermatitis (or dermatitis of cheeks/forehead and outer limbs in children under 4 years) Uicaria: Present with wheals, angioedema or both. Wheals is the descriptive term for transient, well-demarcated, superficial erythematous or pale swellings of the dermis, which are usually very itchy and are associated with a surrounding red flare initially. Angioedema swellings affect the deeper dermal, subcutaneous and submucosal tissues. They are usually painful rather than itchy, poorly defined, and pale or normal in colour Seborrhoeic Dermatitis: Occurs on hairy sites, flexures or on central trunk Characterized by itching or burning, severe dandruff, greasy yellow scales (stuck on appearance)


Question: 10 year old chid has violaceous papule and pterygium of nails. The diagnosis is


Question: Koenen's tumor is seen in

Ans- B. Periungual fibromas (Koenen's tumors):- Present in 20% of patients of tuberous sclerosis. Develop in adult life. o Small, pink, sausage-shaped growths arising from under the nail folds; may distort the nail plate.


Question: Permethrin is used in treatment of


Question: An adult presents with oval scaly hypopigmented macules over chest and back. The diagnosis is


Question: Target or Iris lesion seen in


Question: Lepromin test is strongly positive in

Ans. b (TB (Tuberculoid type)) (Ref. Park PSM 20th/158, 258; Ananthanarayan Microbiology 4th ed., 365))Rook's textbook of dermatology 29.1-29.19:Lepromin test is strongly positive in patient with good CMI, i.e., tuberculoid type, and gets weaker as one passes through the spectrum of lepromatous end, the typical lepromatous case is lepromin negative indicating a failure of CMI.LEPROMIN TEST# Nonspecific test# Positive in majority of adults in regions where leprosy is endemic.# Cannot be used as diagnostic test.# Great value in classifying a case of leprosy.# Useful tool in evaluating the immune status of leprosy patient.# Great value in estimating the prognosis in case of leprosy of all types.# Strongly positive in typical tuberculoid case0 and positivity getting weaker as one passes through the spectrum to lepromatous end.# Typical lepromatous case is Lepromin negative. Q# Mitsuda first described Lepromin test.- Intradermal injection in Lepromin antigen is typically biphasic in reaction, early Fernandez reaction characterized by erythema and induration in 24-48 hours and lasting for 3-5 days, analogous to tuberculin test, but of no significance: late is Mitsuda reaction in 4 weeks (peak) and subsides with ulceration, it is the measure of CMI.# Principle of the test: Delayed hypersensitivity reaction# Lepromin used:- Human type- Armadillo type- Dharmendra antigen# Purpose of the test:- For classification of leprosy- For assessment of prognosis and response to treatment (not used for diagnosis).0- To assess resistance of the individual- To verify the identity of candidate Lepra bacillus


Question: A 60 year's old male patient presented with blisters over trunk and thighs for 2 weeks. Lesions are mildly itchy. On examination blisters were tense with erythematous base. Nikolsky's sign is negative. There was no mucosal involvement.

Ans. is 'c' i.e. Bullous pemphigoid Points in favour of bullous pemphigoid* Age group - 60 years* Blisters over trunk and thighs.* Blisters are tense. Base is erythematous* Mild Itching.* Nikolsky's sign is negative* No mucosal involvementAbout other optionsPemphigus vulgaris* Common age group involvement for pemphigus is 20-40 years.* Blisters are flaccid on normal base.* Itching is mild or absent in pemphigus.* Nikolsky's sign is positive.* Mucosal involvement is characteristic feature in pemphigus.Pemphigus vegetans* Blisters and erosions are associated with verrucous vegetations in the intertriginous areas (the axillae, groins and inframammary folds), scalp and the face.Dermatitis herpetiformis* Age group - DH is commonly seen in 2nd to 3rd decade* Itching is very prominent (characteristic feature)* Lesions are symmetrically distributed over extensor surfaces (elbow, knees, buttocks, back, scalp, posterior neck.* Lesion is usually polymorphic and occurs in crops.


Question: DOC in chancroid is

C i.e. Erythromycin Distinguishing Features of Genital Ulcers Features Syphilis (1degchancre) Chancroid (soft chancre) Lymphogranuloma Venereum Donovanosis Granuloma venerum/inguinale) Herpes genitalis Causative agent Treponema Haemophilus Chlamydia Calymmatobacterium Herpes simplex pallidiumQ ducreyiQ trachomatisQ granulomatisQ virus type HQ (LI,L2,L3) (rarely type I) Incubation period 9 - 90 daysQ 1 - 7 days rarely > 10 days 3 days - 6 weeks 1-4 weeks (upto 6 months) 2-7 days No. of attacks Only one (1) 1 or 2 Only one (1) Only one (1) Reccurent No. of lesions Usually 1 Usually multipleQ may coalesce Usually 1 Variable MultipleQ, may coalesce Early 1deg lesion Papule Pustule Papule, pustule Papule VesicleQ Diameter 5-15 mm Variable 2-10 mm Variable 1-2 mm Depth Superficial or deep Excavated Superficial or deep Elevated Superficial Edges Sharply demarcated, elevated, round or oval Undermined, ragged, sloughedQ irregular Elevated, round or oval Elevated, irregular serpiginous Erythematous Base Smooth, non- purulent, non- vascula,Q (relatively) Purulent, bleeds easily Variable, nonvascular Red & velvety (beefy red), bleeds easily with exuberant granulation tissueQ Serous, erythematous, nonvascular. Induration FirmQ SoftQ (mostly) Occasionly firm Firm None Pain UncommonQ Usually very tender Variable Uncommon Frequenctly tenderQ Lymphadenopathy Firm, non tender, shotty, bilateralQ Tender, may suppurate, loculated, usually unilateral (Bubo) Tender, may suppurate, loculated, usually unilateral (Bubo) No lymphadenopathy pseudobuboesQ (subcutaneous nodules in inguinal region, may ulcerate) Firm, tender, often bilateral Diagnosis - Dark field - Clinical features - Demonstration of - On tissue smear & - Multinucleate microscopyQ - Serologicaltests - Gram staining (gram -ve cocco- baccili with rail road appearance) LGV as elementary & inclusion bodies - Frie's testQ - Hyper gamma- globulinemia - Complement fixation +ve histopathological microscopy using Giemsa, Wrights or Silver stain or Leishman Stain 1. Gram negative C. granulomatis may be seen within characteristic large mono nuclear cell as d giant cell on Tzank smear - Culture is confirmatory Donovan bodies 2. Donovan bodies are seen in vacuolated cytoplasm of large mono nuclear cells as bipolar inclusionsQ (safety pin or telephone handle appearance) measuring 1 to 2 um x 0.5 to 0.7 um. Drug - Benzathine/procaine - Azithro/ - Doxy / tetra DoxycyclineW tetracycline AcyclovirQ Penicillin in all erythromycin cyclineQ Azithromycin / except neurosyph- ilis & congenital syphilis in which crystalline penicillin - Ciftriaxone . - Ciprofloxacin - Erythromycin erythromycin (in pregnancy) (aqueous benzyl penicillin) is used - In penicillin sensitive patient, Tetracycline or erythromycin is used


Question: Patch test is done to document aEUR'

Delayed type of hypersensitivity Patch test Patch test is done to detect contact dermatitis. Patch test detects type IV hypersensitivity (delayed) reaction to exogenous allergens. Patch test is a very simple technique which consists of applying the suspected agent or its chemical ingredients in specified concentration on normal looking skin on the back of the patient under separate patches for 48 hours and looking if this application produces dermatitis on the area,


Question: Multiple sebaceous tumors are seen in

D i.e. Muir - Torre syndrome Muir - Torre syndrome (i.e. multiple seabecous tumors like adenoma, carcinoma or keratoacanthoma and visceral malignancy) is a genodermatoses that is cutaneous marker of internal malignancy.


Question: Diagnostic meathod of choice in contact dermatitis


Question: Acantholytic cells are seen in

Ans. (a) Pemphigus vulgarisHarrison 19th ed. / 370* The rounded keratinocytes with hyperchromatic nuclei and perinuclear halo (due to condensing of cytoplasm in periphery) are called acantholytic cells.* It is seen in case of pemphigus vulgaris* Acantholytic cells can be demonstrated in bed side Tzanck test.


Question: Thalidomide is not used in

D i.e. HIV associated neuropathy Peripheral neuropathy is a dose limiting toxicity of thalidomide & not a therapeutic indicationQ. It causes painful sensory ganglionopathy & axonal neuropathy. Indications of Thalidomide - Erythema nodosum leprosum (ENL)Q: Only FDA approved use for treatment of cutaneous manifestations . of moderate to severe ENL and for maintenance therapy for prevention and suppression of cutaneous manifestations of ENL recurrence. - Severe, recurrent apthous stomatitisQ, especially in AIDS patients is common off label use. - Behects syndromeQ - Chronic graft versus host disease. * HIV associated colitis and wasting, multiple myeloma, myelodysplasia, chronic idiopathic myelofibrosis, glucocoicosteroid refractory fistulosis-Chron's disease, sarcoidosis, prurigo, stomatitis are other rare uses.


Question: Most common side effects of retinoids is