Download PGI PG 2020 May Dermatologist Solved Question Paper

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1. The following statement is TRUE for Pityriasis Rosea:

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a) Self limiting
b) Chronic relapsing
c) Life threatening infection
d) Caused by dermatophytes
e) None

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Correct Answer - A
Ans. A. Self limiting
Pityriasis rosea is an acute exanthematous papulosquamous
eruption often with a characteristic self limiting course.
The etiology is not known. HHV-7 more

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frequently, Ht{V-6 less frequently (It is not
caused by dermatophytes).
It is present during the spring and fall.
Morphology:
Herald patch, Fir tree or Christmas tree appearance

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Site:
Trunk along line of cleavage; sometimes (20%) lesions occur
predominantly on extremities & neck (inverse pattern)
Ref: Harrison's Principles of Internal Medicine 16thEdition
Page 292; Roxburgh's-Common Skin disease 17th Edition

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Page 17; Fitzpatrick's Dermatology 5th Edition Page 7369;
Illustrated Textbook of Dermatology: Pasricha 3rd Edition Page
7134; Illustrated Synopsis of Dermatology & STDs, Neena
Khanna 1st Edition Page 742-44
Accordign to ananthanarayan microbiology book 9th ed/p.595:

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Causatiye agent: yeast like fungus malassezia furfur (formely Pityro
sp orum orbiculare) .
Site: Upper trunk, neck 6 upper arm .
This a chronic, usually asytnptomatic, invohtement of the startum
corneum .

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The old name tinea versicolor should be discarded as pityrtasis
eersicolor is not caused by dermatophytes.

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2. Langerhan's cells are reduced in?

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a) Oral lichen planus
b) Basal cell carcinoma
c) Contact dermatitis
d) Langerhan's cell histiocytosis
e) Sarcoidosis

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Correct Answer - B:E
Ans. is'b'i.e. Basal cell carcinoma &'e'i.e. Sarcoidosis Ref:
"Langerhans cells play a role in cell-mediated immune reactions
which are often depressed in sarcoidosis".
"We have shown that the number of Langerhans cells is

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considerably lower in cutaneous basal and squamous cell
carcinomas, compared with their number in the normal
skin.
Reduced in,
Ageing

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Basal cell carcinoma skin
Squamous cell carcinoma skin
Sarcoidosis
HIV/AIDS
HPV infection

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Lichenoid drug eruptions
Increased in,
Gingivitis and periodontitis
Oral LP
Contact hvpersensitivily

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Recurrent aphthous stomatitis
Behcet's disease
Oral cancers
Langerhans cell histiocytosis ( LCH )

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3. Which of the following not a sub-type of

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lichen planus?
a) Lichen planus hypertrophicus
b) Lichen planus pigmentosus
c) Ulcerative lichen planus
d) Lichen nidatus

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e) Lichen scrofulosorum
Correct Answer - D:E
Ans. is 'd'i.e., Lichen nitidus &'e' i.e. Lichen scrofulosorum
Ref: Neena Khanna 3'd/e p. 52-53; Behl l$h/e p.265; Rook Vhelp.
5.13; IADVL textbook of dermatology 3'd /e p.1070; en.wikipedia.org

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Forms:
Annular, Linear, Hvoerlroohic, Atrophic, Bullous, Pigmented.
Overlap syndromes:
Lupus erythematosus overlap syndrome.
Lichen sclerosus overlap syndrome,

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Other variants of cutaneous LP mav include:
Lichen planus pemphigoides
Keratosis lichenoides chronica ("Nekam's disease")
Lichenoiil keratosis (Benign lichenoid keratosis/Solitary lichen
planus)

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Lichenoid dermatitis.
Lichen nitidus:
Uncommon inflammatory skin condition that usually presents with
tiny skin-coloured bumps in children.
Although it has been considered a variant of lichen planus.

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Lichen nitidus is now believed to be a separate and distinct entity!.
Lichen scrofulosorum (tuberculosis cutis lichenoides):

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Rare tuberculid that presents as a lichenoid eruPtion of minute
papules in children and adolescents with tuberculosis.

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4. Nail changes in psoriasis include?
a) Pitting

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b) Pterygium formation
c) Subungual hyperkeartosis
d) Thinning of nails
e) Oil spots
Correct Answer - A:C:E

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Ans. is 'a' i.e., Pitting, 'c' i.e. Subungual hyperkeratosis &'e'
i.e. Oil spots
Ref: Neena Khanna 4th/e p. 40-4$ Roxburgh p. 128-42;
Venkataram little p. 49)
Associated clinical features in psoriasis

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Nail changes
Occurs in 10-50% of patients.
The characteristic changes are : -
Pitting (thimble pitting) > Most common nail change.
Other changes > Oil spots, nail plate thickening,

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Subungualhyperkeratosis, Onycholysis, Yellow-brown discoloration

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5. "Facies leprosa" is characterized by?
a) Madarosis

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b) Resorption of anterior nasal spine
c) Collapse of nasal bridge
d) Loss of upper incisors
e) Diffuce infiltration of face
Correct Answer - B:D

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Ans. is 'b' i.e., Resorption of anterior nasal spine &'d' i.e. Loss
of upper incisors Note- other mentioned facial features are also seen
in leprosy but they are not included in term 'Facies leprosa'.
Facies leprosa:
Facies leprosa is a term used to describe resorption of bone in the

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facial region of patients with leprosy, was first introduced by
Moller-Christensen and colleagues.
It is characterized by a combination of nasal change and resorption
of nasal bone, anterior nasal spine, supra-incisive alveolar region
and anterior alveolar process of the maxillae, associated with the

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loss of upper incisors teeth, according to the criteria of
radiographic interpretation.
Other facial features of leprosy
Nodules with predilection for external ears.
Madarosis (loss of lashes and eyebrows).

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Saddle Nose (Collapse of the nasal bridge) and perforation of
palate.
Testicular involvement results in loss of testicular sensation, loss of

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libido, impotence & gynaecomastia.
Leonine Face (Diffuse dermal infiltration of face.

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6. All the following are causes of scarring
alopecia except?
a) Lichen planus
b) Tinea capitis
c) DLE

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d) Sarcoidosis
e) Trichotilomania
Correct Answer - B:E
Ans. is'b'i.e., Tinea capitis &'e'i.e., Trichotillomania
[Ref Neena Kenna p. 141; Harrison lgh/e p. 355 ; Roxburgh 17/e

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p. 270
Causes of Scarring alopecia (Cicatricial alopecia):
Local cuases:
Cutaneous Lupus(DLE)
Lichen Planus

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Folliculitis decalvans
Linear scleroderma (Morphea)
radiation
Central centrifugal cicatricial alopecia
Alopecia cutis

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Congenital atrichia
Systemic causes:
SLE
Sarcoidosis
Cutaneous Metastasis

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Cicatricial alopecia is also known as pseudopelade.

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Note - Most common congenital cicatricial alopecia is cutis
congenita i.e., f<tcal absence of epidermis with or without

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other layers.

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7. Painful genital ulcers are seen in?
a) Syphilis
b) Chancroid

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c) LGV
d) Herpes genitalis
e) Granuloma inguinale
Correct Answer - B:D
Ans' is'b'i.e., Chancroid &'d'i.e., Herpes genitalis Ref,

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Neena Khanna 3d/e p. 259-60; Khopkar # /e p. 232
Primary syphilis (hard chancre)
Donovanosis (Granuloma inguinale)
Chancroid (soft chancre)
LGV

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Herpes genitalis

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8. Skin hazards of swimming are ?
a) Pyoderma gangrenosum
b) Verrucae
c) M marinum infection
d) M ulcerans infection

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e) Shigella
Correct Answer - B:C:E
Ans. is'b'i.e. Verrucae,'c' i.e., M marinum infection
&'e'i.e. Shigella
"Large outbreaks of infection due to M. marinum have been

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described in association with swimming pools (swimming
pool granuloma) and fish tanks (fish tank granuloma)"
"Verrucas, like most warts, are due to a viral infection of the growing
layers of the skin.
They get in when the skin is injured in some way.

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This is especially the case for barefoot activities surrounding
swimming pools.
The plantar skin on the base of the feet gets soggy) and is more
easily damaged.
Shigella is transmitted directly or indirectly via the fecal-oral route

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and may occur due to the ingestion of contaminated food or
water.
Of great significance is the low infective dose of between 10-100
organisms.
This disease may be acquired by swimming in contaminated surface

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waters or pools and spa.

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9. Which of the following statement(s) is/are
true about physical urticaria
a) Cholinergic urticarial is precipitated by cold

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b) Solar urticaria is skin sign of erythropoietic protoporphyria
c) Dermatographism is an example
d) Cold urticaria is precipitated by emotion
e) None
Correct Answer - B:C

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Ans. B,Solar urticaria is skin sign of erythropoietic
protoporphyria & C,Dermatographism is an example
[Ref Neena Khanna Sth/189; Harrison 19th/i6i; Roxburg 17th/74-
74 ).
Physical Urticarias:

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Patients with dermatographism exhibit linear wheals following minor
pressure or scratching of the skin.
Solar urticaria characteristically occurs within minutes of sun
exposure and is a skin sign of one systemic disease.
Cold urticaria is precipitated by exposure to the cold, and therefore

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exposed areas are usually affected.
Cholinergic urticaria is precipitated by heat, exercise, emotion and is
characterized by small wheals with relatively large flares.

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10. Wavelength of UVB is :
a) 250-280 nm
b) 280-320 nm

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c) 320-400 nm
d) 400-700 nm
e) 100-200 nm
Correct Answer - B
Ans. B. 280-320 nm

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The wavelength found most effective in treating skin disease with
phototherapy is UVB with warden gfh of 311 (+- 2nm) (narrow
band UVB, NBUVB).
The wavelengths between 4(N and 7AO nm are visible to the human
eye.

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11. Cicatrical alopecia is/are seen in:
a) Lichen planopilaris
b) Discoid lupus erythematous

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c) Andogen efflyum
d) Lichen planus
e) Trichotillomania
Correct Answer - A:B:D
Ans. A.Lichen planopilaris B,Discoid lupus erythematous

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& D,Lichen planus
[Ref Neena Khanna 5th/141; Hanison 19th/355; Roxburg 17th/
270] Thichotillomania (compulsive hair-pulling) is characterized by
noticeable hair loss caused by person! persistent & recurrent
failure to resist impulse to pull out hairs.

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Nonscarring alopecia
A. Primary cutaneous disorders
l.Telogen effluvium
Androgenetic alopecia
Alopecia areata

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Tinea capitis
Traumatic alopecia
B. Drugs
C. Systemic diseases
Systemic lupus erythematosus

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Secondary syphilis
Hypothyroidism
Hyperthyroidism
Hypopituitarism

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Deficiencies of protein, iron, biotin, and zinc

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ll. Scarring alopecia
A. Primary cutaneous disorders
Cutaneous lupus (chronic discoid lesions)
Lichen planus
Central centrifugal cicatricial alopecia

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Folliculitis decalvans
Linear scleroderma (morphea)
B. Systemic diseases
Discoid lesions in the setting of systemic lupus erythematosus
Sarcoidosis

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Cutaneous metastases

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12. Acneiform eruption is/are side effect of :
a) Tetracycline
b) Phenytoin
c) Isoniazid

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d) Steroid
e) Potassium iodide
Correct Answer - B:C:D:E
Ans: B,Phenytoin C,Isoniazid D,Steroid & E,Potassium iodide
[Ref Neena Khanna 5th/125; Harrison 19th/356; Harrison

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14th/425; Roxbug 17th/Ea-55
Drug-induced Acneiform Eruptions:
Steroids (corticosteroids, androgens, anabolic steroids), oral
antieMEtics, anti tubercular drugs, anticonvulsants, halides
(iodides. bromides).

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Trunk especially back, face nay be involved.
Lesions are monomorPhic, consisting of papules sometimes pustule

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13. True about skin:
a) Epidermis is highly vascular
b) Melanocyte is derived from neural crest
c) Sebaecous gland- holocrine & absent in palm

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d) Apocrine gland presents in axilla & groin
e) Hiraadenitis suppurita is infection of apocrine gland
Correct Answer - B:C:D:E
Ans: B,Melanocyte is derived from neural crest C,Sebaecous
gland- holocrine & absent in palm D,Apocrine gland presents

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in axilla & groin & E,Hiraadenitis suppurita is infection of
apocrine gland
Roxburgh tTth/ 4-11; General Anatomy by BD Chaurasia 5th/254-60
Hidradenitis suppurativa (Synonym- apocrine acne): Axillary
apocrine sweat gland infection

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Sebaceous glands are holocrine in nature,
The pigment cells (melanocyte) of the skin are derived from neural
crest .
Apocrine sweat glands drains directly into hairfollicles in the axillae
& groins

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Sebaceous gland are located throughout the skin except on palms &
soles.
Glands made up of acini of lipid containing cells, which secrete
sebum as a holocrine secretion.
Eccrine sweat glands present all over body, especially on palms,

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soles & in axillae. Human have 2-24 million eccrine sweat glands

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14. Which of the following is/are used in
psoriasis:
a) High dose oral dexamethasone
b) Methotrexate

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c) TNF-alpha inhibitor
d) Acitretin
e) Narrow band UVB
Correct Answer - B:C:D
Ans. B,Methotrexate C,TNF-alpha inhibitor D,Acitretin

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Ref;. Neena Khanna 5th/54-59; Hartison 19th/348;
Roxburg 17th/138- 42).
Systemic corticosteroids are only indicated for generalized pustular
psoriasis in pregnancy (impetigo herpetiformis).
Biological response modifiers used to treat psoriasis include: T cell

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inhibitors (alefacept, adalimumab, itolizumab).
Oral glucocorticoids should not be used in the treatment of psoriasis
due to the potential for developing life-threatening pustular
Psoriasis when therapy is discontinued.

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15. Acantholysis is /are not seen in :
a) Lichen planus

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b) Bullous pemphigoid
c) Dermatitis herpetiformis
d) Hailey-Hailey disease
e) Pemphigus vulgaris
Correct Answer - A:B:C

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Ans. (A) Lichen planus (B) Bullous pemphigoid (C) Dermatitis
herpetiformis
Acantholysis:
Separation of epidermal cells from each other.
Acantholytic disorders includes Pemphigus family (including

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paraneoplastic pemphigus), eosinophilic spongiosis, Darier's
disease , Hailey-Hailey's disease (Familial benign chronic
pemphigus) and transient acantholytic dermatosis (Grouer's
disease), as well as specific histological patterns such as
focal acantholytic dyskeratosis and epidermolytic

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hyperkeratosis.

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16. Cutaneous marker(s) of internal
malignancy is/are all except:
a) Tripe palms

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b) Sign of Leser-Trelat
c) Dermatomyositis
d) Migratory thrombophlebitis
e) Seborrheic patch at back
Correct Answer - E

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Ans. E. Seborrheic patch at back
Cutaneous Markers of Internal Malignancies :
Causes:
Metastases: To skin.
Genodermatoses: With an increased predisposition to internal

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neoplasia.
Exposure to carcinogens: Which result in skin changes as well as
internal neoplasia.
Paraneoplastic syndromes: Are cutaneous reaction patterns
associated with internal neoplasia.

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17. True about acute paronychia:
a) Pus under nail bed
b) Pus may extend to base of nail
c) Swelling of nail fold
d) Candida is most common causative organism

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e) None
Correct Answer - A:B:C
Ans. A,Pus under nail bed B,Pus may extend to base of nail &
C,Swelling of nail fold
Acute Paronychia:

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Paronychia: Inflammation of nail folds.
Etiology: StaphyLococcus enter the nail fold
Clinical feature: Nail fold is swollen, red and tender. Pus visible
under nail fold / nail bed.

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18. Nikolsky's sign is/are seen in all except :
a) Pemphigus
b) Hailey-Hailey disease

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c) Staphylococcal scalded skin syndrome
d) Toxic epidermal necrolysis
e) Grover disease
Correct Answer - D:E
Ans. (D) Toxic epidermal necrolysis

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Nikotsky's sign:
Application of tangential pressure on normal skin(usually on pretibial
area) results in formation of new bulla.
Seen in:
Staphylococcal scalded-skin syndrome

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Epidermal necrolysis.
Pemphigus
Stevens-Johnson syndrome.
Grover's disease

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19. Which of the following are not true
regarding genital ulcerations ?

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a) Syphilis has a large single nontender ulcer with
indurated margins
b) Multiple erythematous lesions with tender lymphadenaopathy
is seen in LGV
c) Beefy red ulcer with indurated ulcer is seen in donovanosis

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d) Multiple painful bleeding ulcer with tender lymphadenopathy
in Chancroid
e) Multiple painful ulcers in HSV
Correct Answer - A:C:D:E
Ans. (A) Syphilis has a large single nontender ulcer with

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indurated margins (C) Beefy red ulcer with indurated ulcer
is seen in donovanosis (D) Multiple painful bleeding ulcer
with tender lymphadenopathy in Chancroid (E) Multiple
painful ulcers in HSV
[Ref: Khopkar's 6/e p. 232]

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Lesion of primary syphilis:
Chancre (Hard chancre) - punched out ulcer
Lesion characteristics:
. Single lesion
. Painless

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. Avascular(non-bleeding)
. Firm induction
. Lymphadenopathy which is painless, firm and nonsuppurative.
Sites of involvement are penis in heterosexual males; rectum, anal

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canal, mouth in homosexual males; and cemix and labia in females.
Lesions of LGV:

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First stage (Primary LGV) : - Self limited, Single, asymptomatic,
painless, nonbleeding genital ulcer.
Secondary stage:
Painful inguinal lymphadenopathy (Remember ) Wcer is painless but
lymphadenopathy is tender & painful).

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Swollen lymph nodes coalesce to form bubos,i.e., matted lymph
nodes.
Buboes may rupture to form discharging sinus.
Groove's sign > Enlarge lymph nodes both above and below the
inguinal ligament.

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Tertiary LGV (genitorectal syndrome) : - Characterized By
proctocolitis.
Lesions of Donovanosis:
. Painless
. Bleeding with red granulation tissue

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. Indurated
. Red & velvety (beefy red)
Subcutaneous granulomas of inguinal region in Donovanosis looks
like enlarged lymph node, but these are not enlarged lymph nodes.
Therefore, these are known as pseudo buboes.

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Sites of lesions are genitalia (90%), inguinal (10%o) and anal
regions.
Complications of Donovanosis are pseudo elephantiasis, phimosk,
paraphimosis.
Characterized by painful ulcers, bubo formation and painful inguinal

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lymphadenopathy.
. Multiple ulcers.
. Non-indicated or soft induration
. Paintul (Tender)
. Bleed easily

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. Undermined, sloughed erythematous edges
. Painful suppurative inguinal lymphadenopathy
Lesion of HSV:
Often asymptomatic when symptomatic it present as multiple

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vesicles, very painful,
bilateral painful inguinal lymphadenopathy.
Characteristic feature of herpes genitalis is its frequent recurrence.

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20. A young male developed ulceration over
shaft which bleeds easily on touch, is
tender with bilateral lymphadenopathy.
The following are true regarding the
condition -

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a) Bilateral drainage of lymph nodes is essential
b) School of fish appearance is seen with smear microscopy
c) Medical treatment with antibiotics is mainstay of treatment
d) Azithromycin is the drug of choice
e) It is a case of Hard-chancre

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Correct Answer - B:C:D
Ans. (B) School of fish appearance is seen with smear
microscopy (C) Medical treatment with antibiotics is
mainstay of treatment (D) Azithromycin is the drug of choice
Chancroid is STD characterized by painful ulcers, bubo formation

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and painful inguinal lymphadenopathy.
Caused by H.ducreyi, a gram negative coccobacilli which is
arranged in parallel chains giving a "School of fish" or "railroad
track" appearance.
Incubation period of chancroid is 1-7 days.

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Clinically it is characterized by: -
. Multiple ulcers.
. Non-indicated or soft induration
. Painful (Tender)
. Bleed easily

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. Undermined, sloughed erythematous edges
. Painful suppurative inguinal lymphadenopathy
Diagnosis & Treatment
Gram's staining of swab from the lesion may reveal a predominance
of characteristic gram-negative coccobacilli.

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An accurate diagnosis relies on cultures of H.ducreyi from the lesion.
Azithromycin is the DOC for treatment.
Ceftriaxone, Ciprofloxacin, erythromycin are alternatives.

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21. Which of the following organism is
involved in causation of Pityriasis

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rosaceae?
a) Propionibacterium
b) Pityrosporum ovale
c) Malasezia furfur
d) Human herpes virus-6

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e) Human herpes virus-7
Correct Answer - D:E
Ans. (D) Human herpes virus-6 (E) Human herpes virus-7
P. rosea is a common scaly disorder, occurring usually in children
and young adults (10-j5 years). Characterized by round/oval pink

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brown patches with a superficial, centrifugal scale, distributed
over trunk in a Christmas tree pattern.
The disease is thought to be viral disease, is self limiting, and
subsides in 6-12 weeks.
The exact etiology is not known, but it is considered to be a viral

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disease; Human Herpesvirus 6 (HHV 6) and}Jtrrnian Herpesvirus
7 (HHV 7) may play a role.

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22.

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Spongiosis involves which part of skin ?
a) Dermis

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b) Epidermis
c) Stratum spinosum
d) Stratum corneum
e) Prickle cell layer
Correct Answer - B:C:E

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Ans. (B) Epidermis (C) Stratum spinosum (E) Prickle cell layer
Spongiosis involves stratum spinosum (prickle cell layer) of the
Epidermis.

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23. Koebner's phenomenon is seen in ?
a) Pemphigus vulgaris
b) DLE
c) Lichen planus

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d) Acne rosae
e) Genital warts
Correct Answer - B:C:E
Ans. (B) DLE (C) Lichen planus (E) Genital warts

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24. Dermatologic manifestation of lithium
is/are -
a) Rash

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b) Psoriasis exacerbation
c) Acneiform eruptions
d) Pustular dermatoses
e) Pemphigus
Correct Answer - B:C:D

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Ans. (B) Psoriasis exacerbation (C) Acneiform eruptions
(D) Pustular dermatoses
[Ref. NeenaKhanna p. 45; KDT 7e/e p. 449]
Dermatological side effects of lithium
Acneiform eruptions

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Exacerbation Of Psoriasis
DLE
Pustular dermatosis
Alopecia, thinning & drying of hair
Itching skin

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25. Subepidermal blisters is/are seen in -
a) Pemphigus vulgaris
b) Pemphigus vegetans
c) Pemphigoid

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d) Dermatitis hepetiformis
e) Pemphigus foliaceus
Correct Answer - C:D
Ans. (C) Pemphigoid (D) Dermatitis hepetiformis
[Rel Neena l(hanna 5e/e p. 76]

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Subepidermal (Dermo-epidermal)
Functional (At Basal lamina)
Junctional epidermolysis bullosa
Bullous pemphigoid
Toxic epidermal necrolysis

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Dermolytic (Below Basal lamina)
Epidermolysis bullosa acquisita
Epidermolysis bullosa dystrophica
Dermatitis Herpetiformis
Deep burns

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Porphyria cutanea tarda

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26. Desmoglein is associated with ?
a) Arrhythomogenic right ventricular cardiomyopathy

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b) Hypertrichosis
c) Pemphigus vulgaris
d) Psoriasis
e) Keratoderma with wooly hair
Correct Answer - A:C:E

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Ans. (A) Arrhythomogenic right ventricular cardiomyopathy
(C) Pemphigus vulgaris (E) Keratoderma with wooly
hair Desmoglein:
Pemphigus foliaceus,
pemphigus vulgaris (mucocutaneous type) paraneoplastic

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pemphigus
Staphylococcal scalded skin syndrome
Bullous impetigo
Striate palmoplantar keratoderma

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27. Kobner's phenomenon can occur in :
a) Lichen planus
b) Vitiligo
c) Psoriasis
d) Bullous pemphigoid

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e) Dicoid lupus erythematosus
Correct Answer - A:B:C:E
Ans. (A) Lichen planus (B) Vitiligo (C) Psoriasis (E) Dicoid
lupus erythematosus
[Ref: Neena Khanna 5th/45; Harrison 19th/i47,1269; Roxbutg

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17th/ 130]
Kobne/s phenomenon is characteristic of psoriasis but it is also seen
in lichen planus & discoid lupus erythematosus.
New lesion of original disease develops at sites of trauma(scratches,
surgical incisions 6 injury)

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This phenomenon is seen in psoriasis, lichen planus & vitiligo
Inactivates active disease

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28. All are true about pompholyx except:
a) It is a form of hand/foot eczema

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b) Also called as dyshidrotic eczema
c) Vesicle & blisters are present
d) Secondary bacterial infection are common
e) Steroids should not be used as it can exacerbate the condition
Correct Answer - E

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Ans. E. Steroids should not be used as it can exacerbate
the condition
[Ref Neena Khanna 5th/ 115 - 116; www. der mn etnz. org]
Pompholyx:
Aetiology

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Unknown.
Some patients with pompholyx develop a Vesicular palmoplantar
eruption on ingestion of minute amount of nickel
Clinical Features
Summer aggravation

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Recurrent episodes of deep seated, bland (without inflammation)
vesicles (sometimes blister). Each episode self-limiting but fresh
crops of vesicles Develop successively, leaving patient
symptomatic for long periods
Lesions occasionally get secondarily infected.

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Fingers & palms & sometimes sola
Point for diagnosis: Based on
Recurrent episode
Presence of land vesicles
Presence on fingers, palms & soles

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Treatment
Saline soaked followed by topical steroids

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Appropriate antibiotics, if bacterial infection present

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29. True about Campbell de Morgan spots:
a) Benign
b) Malignant
c) Proliferation of blood vessel
d) Very painful

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e) Cherry red in color
Correct Answer - A:C:E
Ans. (A) Benign (C) Proliferation of blood vessel (E) Cherry
red in color
Campbell De Morgan spots:

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Also known as campbell de morgan angiomas, cherry angiomas,
cherry spots and senile angiomas, are benign (non-cancerous)
skin growths made ofblood vessels.
Growths are bright red, often described as"cherry-ret'.
Hence they are often referred to as cherry angiomas.

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They can appear anywhere on the body, but most often appear on
thc torso
Causes:
Hereditary
Hormonal changes during pregnancy.

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Appear most commonly in adults over the age of 30 but people of
any age can get them.

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30.
Which of the following disease is

associated with hepatitis C infection:
a) Lichen planus

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b) Psoariasis
c) Sjogren's syndrome
d) HUS
e) HSP
Correct Answer - A:C

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Ans. (A) Lichen planus (C) Sjogren's syndrome
[Ref: Neena Khanna 4th/56; Ilarrison 19th/2041; Roxburg
16th/; Hepatology by Kuntz 2nd/443]
Hepatitis C Associated disease:
Attention has been drawn as well to associations between hepatitis

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C and such cutaneous disorders as Porphyria cutanea tarda and
lichen planus.
Extrahepatic manifestations in Viral Hepatitis C:
Agranulocytosis
Aplastic anaemia

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Corneal ulceration
CryoglobulinaemiaQ
Diabetes mellitus (type I)
Erythema exsudativum multiforme
GlomerulonephritisQ

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Guillain-Barre syndrome
Hyperlipasaemia
Lichen Planus

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Non-Hodgkin lymphoma
Polyarteritis nodosa
Polyarthritis
Polyneuritis
Porphyria cutanea tardaQ

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Sialadenitis
Sjogren syndrome/Sicca syndrome
Thrombocytopenia
Thyroiditis

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31. Which of the following statement is/are
correct about Scabies:
a) Number of lesion correspondent to number of mite
b) Ivermectin not used for treatment

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c) Itching worsen at night
d) Not involve face in children
e) None
Correct Answer - C
Ans. C. Itching worsen at night

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[Ref: Neena Khanna 4th/341-<14, 3rd/297; Harrison 19th/27t14-
45; KDT 6th/863-64]
The number of mites normally present in an individual patient varies,
being less than 7-8 in an adult.
Most lesions in scabies are due to hypersensitivity.

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Scabies (sarcoptes scabiei var. hominis)
Morphology:
Pruritic, erythematous papules, burrows, and vesicles in web
spaces, tolar wrtsk, waist, genitals and axillae.
Scalp,face, Palm & soles are characteristically involved in

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infants/children
Scabicides used are:
Permethrin creamQ (5%), Gamma benzene hexachloride (G-
BHCI%), Crotamiton (10%o)' Benzyl benzoate (25%) 6
ivermectin (single oral dose 200 mg/ kg)

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32. Feature (s) of Hailey Hailey disease is/are:
a) A bullous disorder

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b) Crusted erosion
c) Most commonly present in infant
d) Also called as familial benign pemphigus
e) Intraepidermal bullous disorder
Correct Answer - A:B:D:E

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Ans. (A) A bullous disorder (B) Crusted erosion (D) Also
called as familial benign pemphigus (E) Intraepidermal
bullous disorder
[Neena Khanna3rd/67]
Hailey Hailey Disease (Familial Benign Pemphigus):

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Pemphigus type of bullous disorder (Intraepidermal lesion)
Autosomal dominant inheritance
Presents in 3rd-4th decade
Presents as flaccid vesicles, crusted erosions & circinate plaques on
erythematous base. May become hypertrophic & malodorous

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Major flexures (groins, perineum, axillae & side of neck)
Treatment includes: Reduction of friction keeping area dry.
Combination of potent steroids with antibiotics (mainstay of
treatment)

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33. Skin lesion of chronic liver disease:
a) Terry nail
b) Palmar erythema

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c) Purpura
d) Spider naevi
e) None
Correct Answer - A:B:D
Ans. (A) Terry nail (B) Palmar erythema (D) Spider naevi

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[Ref Neena Khanna 3rd/330, 148; Roxburg 17th/292-93]
Skin in Liver Disease:
Hepatic disease, especially when the patient has hepatic failure,
is associated with:
Pruritus: Due to accumulation of bile salts, when there is

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obstructive jaundice
Yellowish pigmentation: Due to accumulation of bile Pigments
Spider nevi & palmar erythema: Due to accumulation of estrogen
dr progesterone
White nails: Due to hypoproteinemia

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34. Nail changes of lichen planus includes:
a) Pterygium
b) Salmon patch

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c) Subungual hyperkeratosis
d) Splinter haemorrhage
e) Thinning of nail plate
Correct Answer - A:E
Ans. (A) Pterygium (E) Thinning of nail plate

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[Ref; Neena Khanna 3rd/52-55; Harrison 19th/i49, 17th/316]
Nail Changes in Lichen Planus:
Seen in 15% of patients (most frequently in children)
Thinning 6 distal splitting of nail plates
Longitudinal grooves

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Tenting Of Nail Plate
Pterygium formation (diagnostic):
The proximal nail fold is prolonged on to the nail bed, splitting &
destroying the nail plate.

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35. True about Impetigocontagiosa:
a) Asboe- hausen sign
b) Honey coloured crust
c) Caused by staph. aureus

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d) Contagious
e) Bullous disorder
Correct Answer - B:C:D:E
Ans. (B) Honey coloured crust (C) Caused by staph. aureus
(D) Contagious (E) Bullous disorder

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[Ref: Neena Khanna 4th/245; Roxburgh\ Dermatology
17th/z!4; Harrison 1 9th/ 350; 1 8th/ 400]
Impetigo contagiosa:
Thin walled bullae (seldom seen) on an erythematous base, ruptures
raPidly to form an exudative plaque covered with honey-colored

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rust.
The primary lesion is a superficial pustule that ruptures and forms a
characteristic yellow-brown honey-colored crust
Caused by: Staph. aureus, S. pyogenes or both.
Site of predilection: Face (periorificial, especially around the mouth

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& nose), extremities & scalp
Complications: Eczematization & acute poststreptococcal
glomerulonephritis

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36. Dermatitis herpetiformis :

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a) Caused by herpes
b) Affect mainly flexor surface
c) Associated with gluten sensitive enteropathy
d) Dapsone is used in treatment
e) None

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Correct Answer - C:D
Ans. (C) Associated with gluten sensitive enteropathy
(D) Dapsone is used in treatment
[Ref: Neena Khanna 4th/80-81; Harrison 19th/3373, 18th/427-28]
Dermatitis Herpetiformis:

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Etiology:
Gluten-sensitive enteropathy is always associated & probably
responsible for skin lesions
Site:
Extensors & pressure points

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Morphology:
Grouped erythematous papules (less fre- quent), vesicles (more
frequent) & excoriated lesions (most frequent)
Treatment:
Dapsone works dramatically. A gluten free diet only slowly. So

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combine the two & then reduce dose of dapsone.

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37. Maculopapular rashs are seen in all
except:
a) Scarlet fever
b) Measles

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c) Exanthemsubitum
d) Infectious mononucleosis
e) German measles
Correct Answer - A
Ans. A. Scarlet fever

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[Ref: Neena Khanna 4th/282; Hanison 19th/128-30;
18tV149-51'Park 23ril/ 144-45, 147, 151]
Maculopapular Viral Exanthems:
Measles (Rubeola): maculopapular confluent rash which evolves in
a cranio-caudal fashion & fades with scaling.

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German measles: Erythematous discrete macular rash.
Erythema infectiosum (fifth disease)
Exanthem subitum (roseola, sixth disease)
Infectious mononucleosis
Epidemic typhus

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Endemic (murine) typhus
Scrub typhus
Rickettsial spotted fevers
Human Monocytotropic ehrlichiosis
Leptospirosis

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Lyme disease
Typhoid fever

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Dengue fever
Note:
Scarlet fever:
Causes confluent desquamative erythemas.

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38. Androgenic alopecia in female is caused
by:
a) Myxedema
b) Cushing disease
c) Stein-Leventhal syndrome

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d) Addison's disease
e) None
Correct Answer - C
Ans. C. Stein-Leventhal syndrome
[Ref Neena Khanna 4th/133-34; Roxburgh's Dermatology

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17th/270; Hanison 19th/ j55, 18th/408, 2920, 2897]
Androgenetic Alopecia (Male pattern; Female pattern):
Associations
In women, features of hyperandrogenism may be present in
the form of hirsutism, acne & clitoromegaly.

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Always rule out polycystic ovary disease (PCOD).
Stein-Leventhal syndrome, also called polycystic ovary
syndrome (PCOS)
Myxedema:
Hair texture may become fine, and a diffuse alopecia occurs in up to

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40% of patients, persisting for months after restoration of
euthyroidism.

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39. Findings in psoarisis includes :
a) Parakeratosis

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b) Involving almost 100% of Basal cell in multiplication
c) Micro-munro abscess
d) Autoimmune disease with T-cell involvement
e) Frequently involving mucosal surface
Correct Answer - A:B:C:D

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Ans. (A) Parakeratosis (B) Involving almost 100% of Basal
cell in multiplication (C) Micro-munro abscess (D)
Autoimmune disease with T-cell involvement Psoriasis:
Type 1 helper T cell disease with increased Th1 cytokines (IFN-y &
IL-2) & reduction of anti-inflammatory cytokines IL-10.

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Histologically, scaly lesions show hyperkeratosis & parakeratosis.
Auspitz sign - Characteristics finding of plaque in which removal of
scales leads to pinpoint bleeding.
Grattage Tesla: on scratching scales appear.
Koebner/Isomorphic phenomenon:

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Appears at the site of minor injury such as scratch or graze.
Characteristic of psoriasis.
ln Nails
Onycholysis (separation of the nail plate from the nail bed)
Thimble-pitting of nail plate

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Brown black discoloration

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40. True about bullous pemphigoid :

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a) Nikolslcy sign positive
b) Bulla spread sign positive
c) Common in children
d) Darier sign
e) Itching is common

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Correct Answer - E
Ans. E. Itching is common
[Neena Khenna 4th/77-79]
Bullous Pemphigoid:
Autoimmune disorder

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Itchy, tense hemorrhagic blisters on skin
Mucosal lesion infrequent
Age 60-80 yr
Gender: equal incidence in male & females
Bulla spread sign & Nikolsy's sign are usually negative

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41. All are true about lichen planus except:
a) Not associated with oral ulcer

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b) Wikham'sstriae present
c) Colloid body on histology
d) Morphology can be represented by 5 'P'
e) Koebner's or isomorphic phenomenon may be present
Correct Answer - A

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Ans. A. Not associated with oral ulcer
[Ref Neena Knnna 4th/56-60; Roxburghe Dermatologist
17thll4; Harrison 1 9th/ 349, I 8tW 399-400]
Lichen Planus:
Oral lesions (Lacey reticulate pattern):

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It may be asymptomatic or patient may complain of burning
sensation especially on eating spicy foods.
When viewed under a magnifying lens, surface of the lesions has
white streaks (Wickham's striae)
Morphology (5Ps): Pruritic, Polygonal, Purple (but violaceous is the

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term to use), Plane (flat topped), papules.
Age: 10-40 year
184.Koebner or isomorphic phenomenon may be present
Histopathology: colloid body, basal cell degeneration, band like upper
dermal infiltrate, Max foseph's space, thickened granular layer

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42. Which is caused by bacteria:
a) Anal wart
b) Lymphogranuloma venereum
c) Molluscumcontagiosum

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d) Condylomatalattum
e) None
Correct Answer - B:D
Ans. (B) Lymphogranuloma venereum (D)
Condylomatalattum [Ref Neena Khanna 4th/270]

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Anogenital wart is caused by HPV-6, 11, 16, 18, 31 & 33
Lymphogranuloma venereum is caused by Chlamydia trachomatis
serovars Ll, L2 & L3
Condyloma lata: It is found in secondary syphilis (Treponema
pallidum)

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Molluscum contagiosum is caused by the pox virus.

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