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  1. How long is skin doubling time?
    About 4 weeks - It takes about 28 days form the division of basal cells to the formation of mature horn cells.
  2. What are the layers of epidermis?
    • Epidermis layers From surface to base: ƒ
    • Stratum Corneum (keratin)ƒ
    • Stratum Lucidumƒ - present only in palm and soles
    • Stratum Granulosumƒ
    • Stratum Spinosum (spines = desmosomes)
    • ƒStratum Basale (stem cell site)

    [@ Country Looks Green Since Bhadra]

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  3. What is keratohyalin?
    Keratohyalin is a protein structure found in granules in the stratum granulosum of the epidermis, which may be involved in keratinization.  In the stratum granulosum, the protein Keratohyalin forms dense cytoplasmic granules that promote dehydration of the cell as well as aggregation and cross-linking of the keratin fibers. The nuclei and other organelles then disintegrate, and the cells die. Further dehydration creates a tightly interlocked layer of cells that consists of keratin fibers surrounded by keratohyalin.
  4. What is stratum granulosum?
    The stratum granulosum (or granular layer) is a thin layer of cells in the epidermis. Keratinocytes migrating from the underlying stratum spinosum become known as granular cells in this layer. These cells contain keratohyalin granules, which are filled with proteins that promote hydration and crosslinking of keratin
  5. What is the neural crest cells in epidermis known as ?
    • Melanocytes. Melanocytes are  located among the cells of stratum basale. [PGI 99]
    • Melanin secreted form melanocytes is responsible for pigmentation of skin. [UP 99]
  6. Which is the antigen presenting cells in the skin?
    Langerhans cells located in the stratum spinosum layer of skin. [IOM 01,08]  Due to the presence of cell surface class II molecules, Langerhans' cells are extremely efficient in antigen presentation and are thought to be the most important antigen presenting cells [AI 97,98] in the body.
  7. What are apocrine and eccrine glands?
    • eccrine - (of exocrine glands) producing a clear aqueous secretion without releasing part of the secreting cell; important in regulating body temperature
    • apocrine - (of exocrine glands) producing a secretion in which part of the secreting cell is released with the secretion; "mother's milk is one apocrine secretion"
  8. What is the difference between the eccrine and apocrine glands?
    • Eccrine/Apocrine –
    • Location – essentially everywhere/axillary, areolar, and anal region,
    • Site of opening – skin surface/hair follicels.
    • Discharge type – watery/viscous, so odour producing
    • Innervations – cholinergic/adrenergic
  9. What is hydradenitis suppurativa?
    Hydradenitis suppurativa is a chronic disease of the apocrine sweat glands [AIIMS 99, JIPMER 02]  which causes chronic scarring and pus formation of  the axilla and groin areas.

    • Apocrine sweat glands open into hair follicles.
    • Eccrine sweat glands open directly onto the surface of the skin.

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  10. What are the various phases of hair growth cycle?
    • Anagen - growth stage of hair development.  [PGI 97]  
    • Catagen - It is the intermediate phase between anagen and telogen
    • Telogen  - resting phase of hair growth cycle.
  11. Heat loss from the body depends mostly on [IOM 10]
    A) Thermoregulatory center 
    B) Environmental temperature 
    C) Radiation and evaporation
    D) Warming of air during inspiration 
    B) Environmental temperature
    (this multiple choice question has been scrambled)
  12. Substances applied to skin surface may enter the skin freely through [IOM 09]
    A) Hair follicles 
    B) Sweat glands 
    C) Stratum corneum 
    D) Glomus cells
    A) Hair follicles
    (this multiple choice question has been scrambled)
  13. Which of the following statements about cutaneous shunt vessels is true: [AI 09]
    A. These vessels are evenly distributed throughout the skin
    B. Not under the control of autonomic nervous system
    C. Perform nutritive function
    D. Have a role in thermoregulation
    D. Have a role in thermoregulation

    Cutaneous shunt vessels are short muscular vessels that connect arterioles and venules in the dermis. In cold conditions these shunt vessels dilate so that large volumes of blood are directed through these, a valuable mechanism to prevent tissue freezing (role in thermoregulation).
    They are under the control of sympathetic nervous system.
    These vessels are not evenly distributed, they are primarily concentrated in tissues with a small surface area to volume ratio, such as fingers, toes, ears, and nose.

    Locations of cutaneous shunt vessels:
    - Hands (palms and fingers)
    - Feet (soles and toes)
    - Face (ears, nose, lips)
    (this multiple choice question has been scrambled)
  14. What are lines of Blaschko?
    • - Lines of Blaschko represent non-random developmental lines of the skin, [AI 11] fundamentally differing from the system of dermatomes.
    • - These lines essentially represent patterns assumed by many different naevoid and acquired skin disease.
    • - These lines characteristically do not follow the underlying nervous, vascular or lymphatic structures in the skin.
    • - These lines are not ordinarily visible, but are recognized in several cutaneous disorders, that follow these parallel streaks.

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    • Fig: Lines of Blaschko
  15. Various terms used to describe skin lesions.
    • Macule - <1cm diameter area of abnormal color. 
    • Papules - Small superficial raised abnormalities <1 cm
    • Nodules - Raised Larger lesions (> 1 cm)
  16. Medically important form of UV radiation is 
    A) UV-A
    B) UV-B
    C) UV-C
    D) None
    B) UV-B

    Pyrimidine dimers are produced as a result of the absorption of UV-B by DNA. These structural change are repaired by mechanism that result in their recognition, excision and re-establishment of normal base sequence. The repair of these structural changes are crucial because individuals with defective DNA repair are at high risk for development of cutaneous cancer. 

    Patients with xeroderma pigmentosum are characterized by decreased repair of UV-induced photoproducts, as a result their skin develop the xerotic appearence of photo-aging as well as basal cell and squamous and melanoma in the first two decades of life.
    (this multiple choice question has been scrambled)
  17. What is scratch test?
    Placement of an appropriate dilution of a test material, suspected of being an allergen, in a lightly scratched area of the skin is known as scratch test. If the material is an allergen, a wheal will develop within 15 minutes.
  18. What is Patch test?
    Patch tests detect type IV (delayed or cell-mediated) hyper-sensitivity. A ‘battery’ of around 20 common antigens, including common sensitisers such as nickel, rubber and fragrance mix, are applied to the skin of the back under aluminium discs for 48 hours. The sites are examined for a positive reaction 48 hours later. [AI 99] An eczematous reaction in the absence of an irritant reaction suggests a type IV hyper-sensitivity to that particular allergen.
  19. What is the confirmatory test for photodermatitis? [AI 06]
    • Photopatch test is the test for confirmation.
    • Suspected photosensitizers are placed on the skin in duplicate for 24 hours. One patch is irradiated with UVA and one is not. Patches are examined for eczema upto 72 hours after irradiation. Positive irradiated patch confirms diagnosis/negative control patch rules out contact dermatitis
    • It is the diagnostic method of choice in contact dermatitis[AI 93]
    • Note that, contact dermatitis is diagnosed by Patch test and atopic dermatitis is diagnosed by cllinical examination.
  20. What type of antihistaminics do you use in urticaria and    anaphylaxis?
    Anaphylaxis – sedative antihistaminics like Diphenhydramine, hydraxazine to prevent the hypotension. We use the strong antihistaminics, we don’t care the sedative effect of the drug. 

    Urticaria - non sedative antihistaminics like cetrizine, fexofenadine, Loratadine.
  21. What are the various types of dermatitis?
    • • Atopic
    • • Seborrhoeic
    • • Discoid
    • • Irritant
    • • Allergic
    • • Asteatotic
    • •Gravitational
    • • Lichen simplex
    • • Pompholyx
  22. Atopic dermatitis can be best diagnosed by [AI 99]
    A) Patch test 
    B) Clinical evaluation 
    C) Biopsy 
    D) IgE level
    B) Clinical evaluation
    (this multiple choice question has been scrambled)
  23. What are the clinical features of atopic dermatitis? [AI 04,07]
    • 1) Severly itchy, erythematous papular or papulo-vesicular lesions
    • - Infantile pattern - weeping inflammatory patches and crusted plaques that occurs on face, neck and extensor 
    • - Childhood and adolescent patern - flexural skin, particularly in antecubital fossa and popliteal fossa

    • 2) Perpetual rubbing and scratching leading to 
    • - Excoriation (simple linear scratch marks) 
    • - Lichenification (exaggaration of skin markings) 
    • - Xeroderms 
    • - Denny Morgan fold (extrafold of skin beneath lower eyelid)   [KARNATAKA 96] 

    • 3) Increased tendency of vasoconstriction 
    • - Pallor on skin especially cheeks (Perioral pallor) 
    • - White dermatographism (running of a blunt object like a key on affected skin produces a white line) 

    4) Personal or family history of atopy like asthma, chronic urticaria, eczema, hay fever 

    5) Clinical course lasting longer than 6 weeks 

    6) Course is marked by exacerbations and remissions

    • 7) Associated features 
    • - Alopecia areata 
    • - Increases susceptibility to infection
  24. What is the management of Atopic Dermatitis?
    • Don’t dry yourself. Don’t itch and scratch to prevent infection.
    • Antihistaminics
    • Topical steroids
    • Tacrolimus, Sirolimus, Pimecrolimus – these are specific T cell inhibitors.These drugs are steroid like but has very less side effects compared to steroids.
  25. What is 'Cradle cap'?
    • Cradle cap is a special form of Seborrheic dermatitis. It becomes evident within the first few weeks of life. It occurs in  the scalp (cradle cap), face or groin. 
    • (Cradle is the earliest period of life)
  26. What is the management of seborrheic dermatitis (dandruff)?
    It is the hypersensitivity of the skin to the fungus. It can be treated by both steroids and antifungals.
  27. What is Berloque dermatitis?
    Berloque dermatitis is a skin condition in which patients develops a brownish to reddish discoloration of the neck and sometimes the arms due to applying perfumes or cologne to the skin.
  28. What is the management of contact dermatitis?
    • Remove the source like Nickel. Nickel is the most common precipitant of contact dermatitis. [AI 93] 
    • Topical corticosteroids if really bad.
  29. What is Asteatotic Eczema?
    • It is Xerosis or dry skin.
    • Also k/a Winter itch
    • Mild form of eczematous dermatitis of the lower legs of elderly persons during dry periods of the year
  30. What are the features of exfoliative dermatitis?
    The cardinal features of exfoliative dermatitis are redness, desquamation, thickening, and universal distribution. 

    • Exfoliative dermatitis is seen in [AI 02]
    • - Psoriasis 
    • - Drug eruption 
    • - Seborrheic dermatitis 
    • - Atopic eczema 
    • - Varicose dermatitis.
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  31. Should you lubricate your skin or make dry in Atopic dermatitis, Psoriasis and Xerosis?
    • Atopic dermatitis – stay lubricated , dont use soap
    • Psoriasis – stay lubricated , don’t use soap
    • Xerosis – stay lubricated.
  32. What is cholinergic urticaria?
    • Cholinergic urticaria is a very common form of hives. It manifest as multiple, small, 2-3mm red hives on the upper trunk and arms, although it can occur from the neck to the thighs. 
    • These hives appear in response to a rise in body temperature from exercise, overheating, sunlight exposure  or stress. [AIIMS 00,04]
  33. What is mastocytosis?
    • Mastocytosis is characterized by abnormal accumulation of mast cells in skin and/or organs. 
    • The most common manifestation of mastocytosis is called Urticaria pigmentosa which starts during infancy and consists of multiple, irregular, hyperpigmented macules on trunk and extremities.
    • Mast cells degranulate [JIPMER 01]  by stimuli such as rubbing or heat and this leads to the formation of localized urticaria called as Darier's sign. 
    • (skin changes produced when skin lesion in urticaria pigmentosa is rubbed briskly)
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  34. A 5 year old child has multiple hyperpigmented macules over the trunk. On rubbing the lesions with the rounded pen, he developed urticarial wheal., confined to the border of the lesion. The most likely diagnosis is [AI 04]
    A) Lichen planus 
    B) Urticarial vasculitis
    C) Fixed drug eruption 
    D) Urticarial pigmentosa 
    D) Urticaria pigmentosa
    (this multiple choice question has been scrambled)
  35. Dyskeratosis is a feature of [PGI 00]
    A) Psoriasis 
    B) Darier's disease 
    C) Pemphigus vulgaris 
    D) Lichen planus
    B) Darier's disease
    (this multiple choice question has been scrambled)
  36. What is Quincke's disease?
    • Quincke's disease is also known as angioneurotic edema
    • It is immunologically mediated, rapidly appearing, recurrentnon-pitting edema of the subcutaneous and/or submucosal tissues.
    • Reduced levels of C1 esterase inhibitors are associated  with hereditary angioneurotic  edema. [AIIMS 05]
    • Reduced C1 esterase inhibitor leads to:
    • 1. Increased activity of C1:
    • - increased breakdown of C2 and C4 (reduced C2,C4 in circulation, Normal C1 level)
    • - increased C2 kinins (proteolytic fragments of C2), which promote edema
    • 2. Increased activity of kallikrein and factor XII:
    • - increased production of bradykinin, which also promotes edema.
  37. All of the following statements about Hereditary AngioNeurotic Oedema (HANO) are true, except: [AI 12]
    A. Associated with decreased complement substrates C2 and C4
    B. Associated with increased levels of Bradykinin
    C. Pitting edema of face is common
    D. Most commonly caused by C1 esterase deficiency
    C. Pitting edema of face is common
    (this multiple choice question has been scrambled)
  38. A pt presents with history of episodic painful edema of face and larynx. Which of the following is likely to be deficient? [AI 09]
    A. Complement C5
    B. Complement C3
    C. Propderidin
    D. C1 esterase inhibitor
    D. C1 esterase inhibitor
    (this multiple choice question has been scrambled)
  39. Immediately after eating, a man develops swelling of face and lips, respiratory distress, intense pruritus, hypotension and feeling of impending doom. The most likely diagnosis is: [AI 09]
    A. Angioneurotic edema
    B. Myocardial infarction
    C. Anaphylaxis
    D. Food stuck in throat
    C. Anaphylaxis

    Pruritus, vascular collapse (hypotension), rapid progression of symptoms suggests anaphylaxis.
    (this multiple choice question has been scrambled)
  40. What is Psoriasis?
    Psoriasis is a non-infectious, chronic inflammatory disease of the skin, characterised by well-defined erythematous plaques with silvery scale, with a predilection for the extensor surfaces [SGPGI 02] and scalp, and a chronic fluctuating course.
  41. What are the pathological features of psoriasis?
    • The keratinocytes hyperproliferate with a grossly increased mitotic index and an abnormal pattern of differentiation, leading to the retention of nuclei in the stratum corneum (parakeratosis), not normally present as the stratum corneum cells are dead.
    • There is a large inflammatory cell infiltrate - collection of neutrophils in the stratum corneum produce the characteristic Munro's microabscesses. [PGI 99,JIPMER 02] 
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  42. What are the factors that exacerbate Psoriasis?
    • Infections 
    • Stress 
    • Drugs: Lithium, Beta-blockers, Antimalarials [UP 01] [@BAL]
    • Disease worsens during winter.
  43. What are the various forms  of Psoriasis?
    • Stable plaque psoriasis
    • Guttate psoriasis
    • Erythrodermic psoriasis
    • Pustular psoriasis
  44. What are the sites involved in psoriasis? [AI 98]
    • 1. Extensors - elbows, knees and lower back 
    • 2. Scalp - Scalp is involved in almost all cases. But remember that psoriasis of scalp never cause loss of hair and baldness. 
    • 3. Nails - show multiple small pits resembling thimble,[JIPMER 01] appearence of translucent areas in the nails give 'oil drop' phenomenon, [AP 96] Nail may detach from its bed (onycholysis) over its distal  half, the affected portion being opaque, friable and discolored. 
    • 4. Flexures, natal cleft and submammary and axillary folds. Lesions are  red, shiny and symmetrical and not scaly
    • 5. Palm 
    • 6. Joints - Psoriatic arthropathy.
  45. What is Auspitz's sign?
    A finding typical of psoriasis in which removal of a scale leads to pinpoint bleeding.
  46. What is parakeratoisis?
    • The stratum corneum is thickened and unlike in normal skin, nuclei in the cells in this layer are often retained, a pattern termed as parakeratosis. 
    • Parakeratosis is seen in 
    • - Normal finding - mucus membrane of mouth, vagina 
    • - Pathological finding - Psoriasis, Actinic keratosis [AI 06]
  47. Psoriasis is characterized by all except
    A) Commonly involves knees and elbows
    B) Men and women are equally involved 
    C) Definite pink plaque with clear margin
    D) Always associated with nail infection 
    D) Always associated with nail infection
    (this multiple choice question has been scrambled)
  48. What are the medications that can be used in psoriasis?
    • Local corticosteroids. Causes thinning of skin due to inhibition of collagen synthesis. Systemic steroids are not recommended for psoriasis. 
    • Vitamin A/D locally. These vitamins compel the immature cells for differentiation into the mature normal cells. These agents are preferred because they have less side effects as compared to steroids.
    • Biologial agents – locally - like Infliximab, adatimumab, efalizumab.
    • UV light – if the disease is diffuse and application of Local applicatons is inefficient. So, used to cover large surface areas. Psoralen with UV-A (PUVA) also called as Photochemotherapy)  is extremely effective. [AI 93,SGPGI 03] 
    • Coal tar -
    • Methotrexate – if other agents fail. It causes liver fibrosis.
    • Cyclosporine - If there is abnormal LFT on methotrexate, stop methotrexate and start cyclosporine. [UP 98]
  49. What is the drug of choice for psoriasis?
    • Drug of choice for psoriasis is PUVA. 
    • Methotrexate is the drug of choice in psoriasis in following conditions 
    • - Psoriatic arthropathy 
    • - Psoriatic erythroderma 
    • - Pustular psoriasis [AI 94]
  50. What is the use of systemic corticosteroids in psoriasis?
    • Systemic corticosteroids are not recommended for psoriasis because the disease tends to recur in more severe form after cessation of therapy. Nevertheless, systemic corticosteroids can have dramatic short term effectiveness.These can thus be used in following conditions as a life saving measure when other drugs are contraindicated or ineffective 
    • - Generalised pustular psoriasis [AI 05] 
    • - Persistant, otherwise uncontrollable, erythrodermic psoriasis causing complications (but not in pregnancy) 
    • - Severe psoriatic polyarthritis threatening severe irreversible joint damage (not in moderate arthritis)
  51. Treatment of erythematous skin rash with multiple pus lakes in a pregnant woman is: [AI 10]
    A. Retinoids
    B. Corticosteroids
    C. Methotrexate
    D. Psoralen with PUVA
    B. Corticosteroids

    Presence of erythematous skin rash with multiple pus lakes suggests a diagnosis of generalized pustular psoriasis.
    Localized disease in pregnancy is best treated with topical corticosteroids and fulminating generalized disease is best treated with oral prednisolone.
    Other options above cannot be used in pregnancy.
    (this multiple choice question has been scrambled)
  52. A patient with psoriasis was started on systemic steroids. After stopping treatment, the patient developed generalized pustules all over his body. The most likely cause is [AIIMS 01,AI 02]
    A) Drug induced reaction 
    B) Bacterial infections 
    C) Septicemia 
    D) Pustular psoriasis
    D) Pustular psoriasis

    Pustular psoriasis is precipitated by 
    - Withdrawal of steroids 
    - Infections
    - Irritant applications
    (this multiple choice question has been scrambled)
  53. What is the mode of action of Psoralen?
    • In photochemotherapy, the topically applied or systemically administered psoralen are combined with UV-A.
    • Psoralen are tricyclic furocoumarins, that, when intercalated into DNA and exposed to UV-A, forms adducts with pyrimidine bases and eventually forms DNA cross-links. These structural changes decrease DNA synthesis and are related to improvement that occurs in patients of psoriasis.
  54. Name the conditions that benefit from PUVA (psoralen + UV-A) therapy? [KARNATAKA 94]
    • Psoriasis
    • Generalized vitiligo [JIPMER 91] 
    • Mycosis fungoides
  55. How do you treat erythrodermic psoriasis?
    • An important point in treatment of erythrodermic psoriasis is not to irritate the skin further and therefore, anthralin and other irritating compounds are relatively contraindicated.
    • Bland topical steroids [SGPGI 99]  such as 1% hydrocortisone in an oinment base applied liberally can be useful.
  56. How do you treat Pustular psoriasis?
    Treatment generally involves the use of potent topical steroids [AIIMS 02]  but Pustular psoriasis is extremely resistant to therapy and Methotrexate is the treatment of choice. [AI 94]
  57. What is Koebner's phenomenon?
    Koebner's phenomena also called as isomorphic response is a cutaneous response seen in certain dermatoses, manifested by the appearance on uninvolved skin of lesions typical of the skin disease at the site of trauma, on scars, or at points where articles of clothing produce pressure. 

    • It is commonly seen in 
    • - Psoriasis [AI 91,KERELA 99] 
    • - Lichen planus [AI 93,SGPGI 02] 
    • - Plain warts
  58. What is lichen planus?
    Lichen planus is a rash characterised by intensely itchy polygonal papules with a violaceous (violet) hue [AI 98,UP 00] involving the skin and, less commonly, the mucosae, hair and nails. [JIPMER 02]Image Upload
  59. What is the etiopathogenesis of Lichen planus?
    • Aetiology - autoimmune pathology [AI 00] 
    • There is hyperkeratosis, [AI 00] a prominent granular layer, basal cell degeneration [JIPMER 02, 93,PGI 99] and a heavy T-lymphocyte infiltration in the upper dermis.
    • Hyperpigmentation [AI 00] in Lichen planus is due to the shedding of melanin from the damaged epidermis into the dermis, where it is engulfed by macrophages. 
    • Degenerating basal cells are seen as colloid (apoptotic) bodies.
    • The T cell–basal cell interaction leaves a ‘sawtooth’ dermo-epidermal junction, suggesting an immune reaction to an unknown epidermal antigen.
  60. What is hyperkeratosis?
    Hyperkeratosis is thickening of the stratum corneum, often associated with the presence of an abnormal quantity of keratin.
  61. What are the clinical features of Lichen planus? [AIIMS 99]
    The typical lesion of Lichen Planus is a Pruritic, Purple, Polygonal, Plain topped, Papular/Plaque, hyperPigmented lesion which have a characteristic fine white network on their surface (Wickham’s striae). [AI 02]

    • Sites involved -
    • a) Skin - front of the wrist along with skin of limbs and trunk. 
    • b) Mucous membrane is often affected and lesion in mouth are seen in upt 30% cases. Lacy white spots and streaks [AI 12] are present on inner surface of cheeks which cause no symptoms. 
    • c) Nails -thinning and distal splitting of nail plates, longitudinal groove, tenting of nail plate. Rarely, the matrix can be permanently destroyed with prominent pterygium formation. [AIIMS 01, AI 10,06]

    New lesions may appear at the site of trauma (Köbner phenomenon).

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  62. Cicatrising alopecia with perifollicular blue-gray patches is most commonly associated with: [AI 11]
    A. Discoid plaques in the face
    B. Arthritis
    C. Pitting of nails
    D. Whitish lesions in the buccal mucosa
    D. Whitish lesions in the buccal mucosa

    Cicatrising alopecia is seen both in Lichen planus and DLE. Presence of perifollicular blue-gray patches favour lichen planus. And whitish lesions in buccal mucosa (lacy pattern) is characteristic of lichen planus, and likely to be associated with cicatrising alopecia with perifollicular blue-gray patches.
    (this multiple choice question has been scrambled)
  63. Mouth lesion is seen in which of the following [AI 94]
    A) Psoriasis
    B) Icthyosis vulgaris 
    C) Lichen planus 
    D) Basal cell carcinoma 
    C) Lichen planus

    Mucosal involvement is characteristic in 
    - Lichen planus 
    - Pemphigus (not pemphigoid)
    (this multiple choice question has been scrambled)
  64. What are various types of Pityriasis?
    Pityriasis is a group of skin diseases in humans characterized by branlike scales on the skin surface. Type of pityriasis are- 

    • Predominant trunk involvement: 
    • - Non erythematous - Pityriasis/tinea versicolor 
    • - Erythematous - Pityriasis rosea 

    • Predominant involvement of face: 
    • - Orange hue erythema - Pityriasis rubra piloris 
    • - Non erythematous (or mild) - Pityriasis alba
  65. What are the clinical feature of tinea versicolor?
    • - Sudden onset 
    • - Young adults 
    • - Pale or brown pink scaly macule (not erythematous) 
    • - Hypopigmented macule in backs 
    • - More common in cushing syndrome 
    • - Macule start around the hair follicle and then mearge with each other to form large areaImage Upload
  66. What is Pityriasis rosea?
    Pityriasis rosea is an acute exanthematous papulosquamous eruption often with a characteristic self limiting course. [AI 07]  The etiology is not known. Herpes virus is the suspected etiological agent.
  67. What is herald patch?
    The word Herald means one that gives a sign or indication of something to come. It is the first big red scaly macule  that appears in Pityriasis rosea [AI 91,SGPGI 99,03, JIPMER 00] and later disseminates to form the typical leion of Pityriasis rosea.

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  68. What are the sign and symptoms  of pityriasis rosea?
    • - Predominant involvement is limited to the trunk. 
    • - The first feature is a single annular plaque usually on the trunk (Herald patch)  [AI 91, SGPGI 99,JIPMER 00]
    • - Within a few days to several weeks (average, 7 to 14 days) the disease enters the eruptive phase.
    • - Many of the earliest lesions are papular, but in most cases the typical 1-2 cm oval plaques appear.  A fine, wrinkled, tissue-like scale remains attached within the border of the plaque giving the characteristic ring of scale, called collarette scale. [AI 12,05,02] 
    • - Principal lesion are oval or circular with long axis of oval lesion following the lines of cleavage in a Christmas tree/Fir tree pattern
    • - Itching is the only symptom and is never severe.

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  69. What is the difference between Pityriasis Rosea and secondary syphilis?
    • These both look very similary but
    • Pityriasis rosea- Negative VDRL, not on hands and feet, has Herald Patch
    • Seconday syphilis – Positive VDRL, present in hands and feet, no herald patch.
  70. What are the clinical features of Pityriasis rubra piloris?
    • - Characteristic orange hue erythema 
    • - Palmer thickening due to hyperkeratosis with yellow discoloration
    • - Islands of white spared skin
    • - Follicular eruption
  71. What is Pityriasis alba?
    • Pityriasis alba is a common disorder that is characterized by an recurrent scaly hypopigmented macules  on the face  [AI 98,01,03 AIIMS 99, 00] with indistinct borders.
    • It is not a varient of vitiligo. [PGI 01] 
    • Common  in young children. 
    • The condition, which affects the face , lateral upper arms , and thighs. 
    • It is often misdiagnosed as tinea versicolor or corporis, each of which can be readily excluded by KOH examination of surface scales
    • Lesions wax and wane and eventually disappear. No active treatment is required.
  72. An adult male presents with oval, scaly, hypopigmented macules over the chest and the back. The diagnosis is [AI 93]
    A) Lichen planus
    B) Lupus vulgaris 
    C) Pityriasis versicolor 
    D) Leprosy
    C) Pityriasis versicolor
    (this multiple choice question has been scrambled)
  73. A boy aged 8 years from Tamil Nadu presents with a white, non anesthetic, non scaly, hypopigmented macule on his face. Likely diagnosis is [AI 01]
    A) Indeterminate leprosy 
    B) Pure neuritic leprosy
    C) Pityriasis alba 
    D) Pityriasis versicolor 
    A) Indeterminate leprosy

    Sensation is often preserved in early lesions, particularly those on the face. 
    The same question if asked with the omission of 'non scaly' or with the inclusion of 'scaly' hypopigmented macule, it should be answered as Pityriasis alba.
    (this multiple choice question has been scrambled)
  74. List the conditions showing isomorphic phenomenon and pseudo-isomorphic phenomenon.
    • A. Isomorphic phenomenon = Kobner's phenomenon
    • - Psoriasis (characteristic)
    • - Lichen planus
    • - Kaposi sarcoma
    • - Molluscum contagiosum
    • - Warts
    • - Vitiligo
    • - Discoid lupus

    • B. Pseuod-isomorphic phenomenon
    • - Plane warts [AI 11]
    • - Molluscum contagiosum
    • - Eczematous lesions
  75. What are the skin diseases by staphylococcus?
    • Scalded skin syndrome [UP 97,96]
    • Toxic shock syndrome [AI 93, UP 96,IOM 10]
    • Furuncle [UP 95]
  76. What are the diseases caused by Streptococcus?
    • Scarlet fever [PGI 99]
    • Erysipelas [AI 97,MANIPAL 01],  
    • Toxic shock-like syndrome (TSLS)
    • Streptococcal toxic shock syndrome (STSS).
  77. All of the following may be caused by staphylococcus except [AI 97]
    A) Ecthyma 
    B) Scalded skin syndrome
    C) Erysipelas 
    D) Impetigo 
    C) Erysipelas
    (this multiple choice question has been scrambled)
  78. Streptococci cause toxic shock syndrome due to [AIIMS 98,03,AI 01]
    A) Pyrogenic exotoxin A
    B) Streptolysin -O
    C) Streptolysin-S
    D) M protein 
    A) Pyrogenic exotoxin A

    Note that, staphylococcal toxic shock syndrome  is due to enterotoxin F produced by StaFylococcus aureus. [AIIMS 97]
    (this multiple choice question has been scrambled)
  79. What is Impetigo?
    • It is the infection of just epidermis caused by GABHS with honey (golden yellow) colored crusty, weeping, oozing lesions.
    • It is the most common skin infection in children
    • Types: 
    • - Impetigo contagiosa 
    • - Bullous impetigo

    • Ecthyma is a varient of impetigo that generally occurs on the lower extremity and causes punched out ulcerative lesions. 
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  80. How do you  differentiate the impetigo caused by staphylococcus or streptococcus?
    Pour hydrogen peroxide. Staphylococcus causes bubbling because it is catalase positive. Streptococcus  do not cause bubbling.
  81. What is Erysipelas and cellulitis?
    • Cellulitis is inflammation, usually infective, of subcutaneous tissue. 
    • Erysipelas is a more superficial involvement of the subcutaneous tissue [JIPMER 90] and lower dermis. It is an acute inflammation of lymphatics of skin.
    • Millian's ear sign is positive(distinguishing feature for erysipelas, since this region does not contain deeper dermis tissue). 
    • The distinction between the two conditions can be difficult.
    • The most common organism causing both these conditions is group A Streptococcus pyogenes. [AIIMS 02]
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  82. False regarding erysipelas is 
    A) Margins are raised 
    B) Streptococcal infection
    C) Flaccid bullae may develop
    D) Contagious and infectious 
    D) Contagious and infectious

    Erysipelas is caused by Streptococcal pyogenes and is characterized by a sudden onset of red swelling of the face or extremities. The distinctive features of erysipelas are 
    - Well defined indurated margins,particularly along the nasolabial fold. 
    - Rapid progression
    - Intense pain
    - Flaccid bullae may develop during the second or third day of illness, but extension to deeper soft tissue is rare.
    (this multiple choice question has been scrambled)
  83. How do you treat Impetigo, Erysepelas and cellulitis?
    • Impetigo is a superficial lesion and hence can be treated by topical agents like bacitracin or mupirocin. 
    • Erysepelas and cellulitis need systemic antibiotics like -oxacilins, naficillins. Methicillin is not used because it causes allergic glomerulonephritis.
  84. Patients with lymphedema are prone to recurrent cellulitis with 
    A) E. coli
    B) Streptococcus pyogens
    C) Proteus mirabilis
    D) Staphylococcus aureus
    B) Streptococcus pyogens
    (this multiple choice question has been scrambled)
  85. What is the  difference between  folliculitis, furuncle and carbuncle?
    These three represent three different  degree of severity of of staphylococcal  infection occurring around hair follicle

    • Folliculitis – simple  superficial infection around the hair follicle 
    • Furuncle (Boil) [SGPGI 96]  – a small collection of infected material 
    • Carbuncle – several furuncles become confluent  into a single lesion.

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    • Folliculitis
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    • Foruncle
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    • Carbuncle
  86. What is carbuncle?
    • It is infective gangrene of subcutaneous tissue caused by staphylococcus.
    • Diabetics are prone to have carbuncle.
    • Most commonly on the back of neck,  shoulders, hips, and thighs, typically in middle-aged or elderly men
    • There is intense inflammation of surrounding and underlying connective tissue, and illness may be complicated by septicemia.
  87. How do  you treat folliculitis,  furuncle and carbuncle?
    • Folliculitis -  topical mupirocin 
    • Furuncle, carbuncle – systemic antibiotics
  88. What is Erythrasma?
    • Erythrasma is a superficial infection of the skin, most typically in the skin folds and is caused by Corynebacterium minutissimum. 
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  89. Leprosy may involve all of the following organs except: [AI 07]
    A. Uterus
    B. Eye
    C. Testes
    D. Ovary
    A. Uterus

    Organs involved in leprosy:
    - Eye
    - Larynx
    - Liver, spleen, kidney
    - Testes
    - Bone
    - Female genital tract is rarely involve, when involved ovary is the most common site involved.
    (this multiple choice question has been scrambled)
  90. Which classes of leprosy of Ridley-Jopling, classification are included in Paucibacillary and Multibacillary leprosy?
    • Multiibacillary leprosy (>5 skin lesions), bacteriological index(BI) ≥ 2 at any site in the initial skin smears. 
    • - Polar lepromatous (LL),
    • - Borderline lepromatous (BL) and
    • - Mid-borderline (BB)

    • Paucibacillary leprosy (1-5 skin lesions), bacteriological index oI < 2 at all sites in initial  skin smears. 
    • - Indeterminate (l),
    • - Borderline tuberculoid (BT) [UP 96]
    • - Polar tuberculoid (TT) 

    Neuritic type doesnot find a place in Ridley-Jopling classification. [JIPMER 01]

    Dharmendra's scale is a type of grading used for reporting Bacterial Index in leprosy. [AI 08]
  91. What are the clinical features of Tuberculoid leprosy?
    • In tuberculoid leprosy, there is maximum host resistance and the bacteria is very difficult to find in the lesion. 
    • The patient is almost or completely noninfectious and the histological picture is that of sarcoid granuloma.
    • It presents as one or more [AI 93] assymetrical, acutely defined slightly scaly areas of pale skin in which pigmentation is not completely lost.
    • Prognosis is good. 
  92. What are the important features of borderline tuberculoid leprosy?
    • Borderline tuberculoid leprosy is a cutaneous condition similar to tuberculoid leprosy except the skin lesions are smaller and more numerous
    • Presence of small satellite lesions [AIIMS 99,AI 99,UP 00]  help to classify a lesion clinically as borderline tuberculoid.

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  93. What are the clinical features of lepromatous leprosy?
    • Lepromatous type represent the state of  maximum supression of cell mediated immunity and maximum number of lepra bacilli seen. [PGI 93] 
    • Extensive cutaneous involvement and is roughly bilaterally symmetrical. 
    • The site of preference are face (cheeks, nose, brows),ear, wrist, elbows, buttocks and knees. 
    • Madarosis - loss of lateral portions of the eyebrows. 
    • Leonine facies - skin of face and forehead becomes thickened and corrugated. 
    • Septal perforation and nasal collapse leads to saddle nose
    • Invasion of anterior portion of the eye can result in keratitis and iridocyclitis. 
    • Gynecomastia is common. 
    • Peripheral nerves are heavily infected but often better preserved in than in tuberculoid form. 
    • Histological examination reveals a diffuse granulomatous reaction with macrophages, large foam (Virchow or lepra/foamy) cells, [PGI 92] and many intracellular bacilli, frequently in spheroidal masses (globi), but epitheloid cells and giant cells are not found.

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    • Fig:Virchow cells with globi
  94. Which type of leprosy is most infectious? [IOM 08]
    A) Lepromatous
    B) Borderline
    C) Borderline tuberculoid
    D) Tuberculoid
    A) Lepromatous
    (this multiple choice question has been scrambled)
  95. All of the following are the mode of transmission of leprosy except: [AI 04]
    A. Transplacental spread
    B. Insect bite
    C. Breast milk
    D. Droplet infection
    A. Transplacental spread

    Transplacental spread has not been mentioned as mode of transmission, however, other modes have also not been established with certainty.
    (this multiple choice question has been scrambled)
  96. What are the features of skin lesion in leprosy? [AI 97]
    • Skin lesion may be single or multiple
    • Usually less pigmented than the surrounding normal skin. 
    • Sometimes, the lesion may be reddish or copper colored. 
    • A variety of skin lesion may be seen, but macules, papules or nodules are common. 
    • Sensory loss is typical feature of leprosy.
  97. What is pure neuritic type leprosy?
    This type denotes those cases of leprosy  which show nerve involvement but do not have any lesion  in the skin. These cases are bacteriologically negative. [AI 97]
  98. What are the most common nerves involved in leprosy?
    Ulnar nerve near the elbow and Peroneal nerve.

    • Note:
    • T/t of severe ulnar neuritis in borderline tuberculoid leprosy is MDT + steroid. [AI 07]
    • MDT - to eliminate the infection, and steroid - to alter immune response and prevent further damage to nerve.
  99. Skin biopsy in leprosy is characterized by [AI 97]
    A) Periappendegeal lymphocytosis 
    B) Perivascular lymphocytosis 
    C) Periappendegeal bacilli 
    d) Any of the above
    A) Periappendegeal lymphocytosis 

    Infiltration consists of epitheloid cells, lymphocytes and giant cells. Infiltrate is localized around the blood vessels and other skin appendages.
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  100. What are the objectives of multidrug therapy in leprosy?
    • To interrupt the transmission of infection in community by sterilizing patient as early as possible by bactericidal drugs. 
    • To prevent drug resistance. [MAHE 99] 
    • To ensure detection and treatment of cases and prevent deformities.
  101. How do you treat Paucibacillary and multibacillary Leprosy?
    Among the durgs used in  WHO-multidrug therapy, rifampicin is the most important/bactericidal antileprosy drug [AI 03, AIIMS 02] and therefore included in the treatment of both types of leprosy. 

    • For Paucibacillary Leprosy [AI 96]  -
    • D aily -    D apsone 100 mg. (1-2mg/kg) 
    • Monthly - R ifampicin 600 mg.
    • Duration: 6 months 

    • For Multibacillary Leprosy [IOM 05]-
    • Daily -    D apsone100 mg + Clofazamine50 mg
    • Monthly - R ifampicin 600 mg [IOM 08] + C lofazamine 300 mg
    • Duration: 2 yrs [SGPGI 99] 

    • Remember this with the formula
    • D / R for paucibacillary and
    • DC/RC for multibacillary

    Explanation: The denominator is the monthly drug to be taken. In case of multibacillary leprosy, note that the dose of Clofazamine, be it monthly ordaily, is half the dose of other drug taken along with it ( 100 / 2 = 50, 600 / 2 = 300)
  102. How do you treat single lesion paucibacillary leprosy? [PGI 00, AIIMS 00,IOM 01]
    • Single dose treatment ROM -
    • - Rifampicin 600mg,
    • - Ofloxacin 400mg, and
    • - Minocycline 100mg
  103. What are the common indications of Dapsone? [AIIMS 93]
    • Leprosy
    • Malarial prophylaxis
    • Dermatitis herpetiformis 
    • Actinomycotic mycetoma 
    • Pneumocystis carinii
    • Pemphigoid 
    • SLE 

    [@Leprsoy Ma DAPPS]
  104. What is half life of dapsone?
    24 hours.
  105. What are the common side effects of dapsone?
    • Hemolytic anemia
    • Pain in back and leg or stomach
    • Loss of apetite 
    • Pale skin
  106. What are the important side effects of Clofazimine? [JIPMER 02,AI 94]
    • Loss of appetite, Diarrhoea, nausea and vomiting
    • Dry skin 
    • Discoloration of skin, stools, urine, saliva, sweat, tears, or lining of the eyelids.
    • Reversible  pink or red to brownish-black discoloration of skin [AI 96] may occur  75-100% of patients taking clofazimine within a few weeks.
    • It also produces an ichthyosis like scaling which is more pronounced over leprosy lesions.
  107. What are the types of Lepra reaction?
    • • Type 1 (reversal) reactions:
    • - These occur in 30% of borderline patients (BT, BB or BL) and are delayed hypersensitivity reactions.
    • - Skin lesions become erythematous.
    • - Peripheral nerves become tender and painful, with sudden loss of nerve function.
    • - These reactions may occur spontaneously, after starting treatment and also after completion of multidrug therapy.

    • • Type 2 (erythema nodosum leprosum—ENL) reactions:
    • - These are partly due to immune complex deposition and occur in BL and LL patients who produce antibodies and have a high antigen load.
    • - They manifest with malaise, fever and crops of small pink nodules on the face and limbs. Iritis and episcleritis.
    • .
  108. How do we manage leprae reaction?
    • Type I
    • - Mild episodes may be managed with NSAIDS. 
    • - Glucocorticoids are DOC in severe reversal reactions. [AI 95] 
    • - Antimicrobial therapy should be continued. [AIIMS 99]  
    • - Prolonged maintainence therapy is often required.
    • - Reversal reaction do not respond to thalidomide. [DEHLI 93] 

    • Type II
    • - Mild ENL is managed with antipyretics and anti-inflammatory agents and severe cases can be rapidly controlled with high doses of prednisolone.
    • - Antimicrobial therapy should be continued.
    • Thalidomide is DOC in ENL. [AI 99,JIPMER 00] The usual initial dose is 200mg twice a day.
    • Clofazimine has anti-inflammatory properties as well as antimycobacterial activity and can be valuable in the treatement of chronic ENL
  109. Treatment of choice in nerve abscess in leprosy is [AI 95]
    A) Clofazimine 
    B) Incision and drainage
    C) Systemic corticosteroid
    D) Thalidomide 
    C) Systemic corticosteroid

    Patients having pustular or ulcerative ENL, acute neuritis, orchitis, iritis, or arthritis should be treated with high dose of corticosteroids.
    (this multiple choice question has been scrambled)
  110. What is Bacteriological index and Morphological Index?
    Bacteriological index - is an expression of the extent of bacterial loads. It is calculated by counting 6-8 stained smears under 100X oil immersion by nicking the skin with a sharp scalpel and scraping it, the tissue obtained is stained with ZN stain. The BI helps to assess the state of patients at the beginning of treatment and to assess progress and drug effectiveness. [KARNATAKA 94] 

    Morphological index is calculated by counting the number of solid-staining acid-fast rods. It is not always reliable.
  111. What is lepromin test?
    It is the test to detect cell mediated immunity against leprosy bacilli.  The test is also of great value in estimating the prognosis [AI 03] in case of leprosy in all cases. 

    • The test is performed by injecting intradermally 0.1 ml of lepromin into the inner aspect of forearm of the individual.
    • Two types of positive reactions have been described - 
    • Early reaction – also called as Fernandez reaction. [@ Fernandez Fast (early)]  It is read at 48 hours. It  indicates whether or not a person has been previously sensitized by exposure to and infection by the leprosy bacilli
    • Late reaction – also called as Mitsuda reaction. Mitsuda reaction is read at 21 days. [AI 92]. It indicates cell mediated immunity.
    • [@ Mit suta 21 din samma] 

    The test is usually strongly positive in the typical tuberculoid cases, [KARNATAKA 96]  and the positivity getting weaker as one passes through the spectrum to the lepromatous end, the typical lepromatous cases being lepromin  negative  indicating  a failure  of CMI.
  112. Which of the following statements about lepromin test is not true [AI 07]
    A) It is a diagnostic test 
    B) BCG vaccination may convert lepra reaction form negative to positive
    C) It is negative in most children in first 6 months of life. 
    D) It is an important aid to classify type of leprosy disease 
    A) It is a diagnostic test
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  113. All of the following tests are useful in making a diagnosis of leprosy except [AIIMS 04]
    A) Slit smears 
    B) Lepromin test 
    C) Skin biopsy
    D) Sensation testing 
    B) Lepromin test 

    Lepromin test is not a diagnostic test but is of great value in establishing the prognosis in case of leprosy of all types.
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  114. All of the following about leprosy is true except: [AI 04]
    A. New case detection rate is an indicator for incidence of leprosy
    B. The target for elimination of leprosy is to reduce the prevalence to less than 1 per 10,000 population
    C. A defaulter is defined as a patient who has not taken treatment for 6 months or more
    D. Multibacillary leprosy is diagnosed when there are more than 5 skin patches
    C. A defaulter is defined as a patient who has not taken treatment for 6 months or more

    Defaulter has primarily been used for tubercular patient not leprosy.
    (this multiple choice question has been scrambled)
  115. What is the grading of disabilities from leprosy?
    1990/1998 WHO grading of disabilities from leprosy:

    • a. Grade 0
    • - Hand and feet -- No anaesthesia, No visible deformity or damage
    • - Eyes -- no eye problems due to leprosy, no evidence of visual loss

    • b. Grade 1:
    • - Hands and Feet -- Anaesthesia present, but No visible deformity or damage
    • - Eye -- Eye problems d/t leprosy +nt, vision not severely affected (>6/60 or better)

    • c. Grade 2:
    • - Hands and feet -- Visible deformity or damage present (E.g. claw hand [AI 12])
    • - Eyes -- Severe visual impairment, also includes lagophthalmos, iridocyclitis, and corneal opacities.
  116. A 20 year old male patient form Jaipur has erythematous lesion with central crusting on cheek: diagnosis is [AI 01]
    A) SLE 
    B) Lupus vulgaris 
    C) Chilblains
    D) Cutaneous leishmaniasis 
    D) Cutaneous leishmaniasis 

    The lesions of cutaneous leishmaniasis evolve from papular to nodular to ulcerative, with a central depression surrounded by a raised indurated border, some lesions persist as nodules or plaques.
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  117. What is the causative organism of non-tuberculous mycobacterial cervical lymphadenitis? [IOM]
    A) M. avium intracellularae 
    B) M. leprae 
    C) M. bovis
    D) M. scrofulaceum 
    D) M. scrofulaceum 

    M. scrofulaceum falls under group II (scotochromogens) atypical mycobacteria and causes scrofula (cervical lymphadenitis) in children.
    (this multiple choice question has been scrambled)
  118. What are tuberculid?
    • Tuberculid include a group of skin reactions that exhibit tuberculoid features histologically.  AFB have not been isolated cultured or produced in animal inoculation. These conditions often do not respond to Antituberculous drugs but may respond to steroids. 
    • Various conditions included in tuberculides are 
    • - Lichen Scrofulosorum [PGI 00,AI 07] 
    • - Erythema induratum 
    • - Papulonecrotic tuberculides (Acne Scrofulosorum) 
    • - Rosaceous Tuberculide
  119. What are the various cutaneous tuberculosis (non tuberculides)?
    • Lupus vulgaris - most common 
    • Scrofuloderma 
    • Tubercularis Cutis Verrucosus
    • Tubercularis Cutis Orificialis 
    • Miliary tuberculosis and Metastatic tuberculosis
  120. What is Lupus vulgaris?  [UP 00]
    • Cutaneous form of tuberculosis.
    • There is no underlying active focus and the disease starts as a reddish, macule on the skin.
    • Typical skin lesion is a plaque composed of nodules with an 'apple-jelly' color. As lesions expand, there is crusting and induration peripherally  and scarring at the center. [AIIMS 04]

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  121. What is Bazin's disease?
    • Bazin's disease or erythema induratum is a chronic disease of skin in young adult females and is characterized by hard cutaneous nodules that break down to form necrotic ulcers and leave atrophic scars. The disease is invariably preceded by tuberculosis.
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  122. Cutaneous tuberculosis secondary to underlying tissue is called as  [AI 99]
    A) Lupus vulgaris 
    B) Tuberculosis verrucuosa cutis 
    C) Scrofuloderma 
    D) Spina ventosa
    C) Scrofuloderma 

    Tuberculosis resulting from extension into the skin from underlying atypical mycobacterial infection, most commonly of cervical lymph nodes. [AI 96]
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  123. What is the most common site of affection of herpes simplex?
    Oral mucosa - Gingivostomatitis and pharyngitis are the most common clinical presentation of 1st episode of HSV-1 infection.
  124. What are the important features of Herpes zoster? [AIIMS 02,04]
    • Mostly affects those past 50 years or immunocompromised individuals. 
    • It is characterised by unilateral vesicular eruption within a dermatome and it is often associated with severe pain
    • Dermatomes from T3-L3 are most frequently involved.
    • Patients with Hodgkin's disease and non-Hodgkin's Lymphoma are at greatest risk for progressive Herpes Zoster [AIIMS 02] and cutaneous dissemination develops in about 40% of these patients.

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  125. Balloning is a characteristic feature of [JIPMER 92]
    A) Pemphigus
    B) Insect bite 
    C) Pemphigoid 
    D) Herpes zoster 
    D) Herpes zoster

    - Vesicles are found in the corium and dermis with degenerative changes characterized by ballooning.
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  126. What is the DOC for herpes zoster? [UP 92]
  127. What is the drug for Acyclovir resistant  herpes? [JIPMER 02]
  128. What is the best initial test and most accurate test for viral infections?
    • Best  initial test -  Tzanck smear 
    • Most accurate test – Viral culture
  129. Name the fungi that cause superficial, cutaneous and systemic infection?
    • Superficial - malassezia furfur
    • Cutaneous - dermatophytes
    • Subcutaneous - sporothrix
    • Systemic -  blasto, histo, coccido
  130. What is the causative agent for pityriases or tinea versicolor ? [AI 93]
    Malassezia furfur
  131. What type of individuals are susceptible to tinea versicolor?
    People who constantly work in sun. Moist with sweat creates a good environment to grow.
  132. How do you diagnose Tinea versicolor?
    All fungi are diagnosed by KOH and culture but Tinea versicolor is diagnosed by wood lamp examination. Tinea versicolor fluoresces under blue UV  light.
  133. What is the treatment for tinea/pityriasis versicolor? [AI 05,02]
    Systemic (oral) - Ketoconazole, Itraconazole 

    • Local (sampoo/cream) 
    • - New treatment - Ketoconazole, [AIIMS 03] Clotrimazole, Miconazole
    • - Old treatment - White field oinment (3% salicylic acid) , selenium sulphide
  134. Name dermatophytes. [UP 99]
    Species of Trichophyton, Microsporum and Epidermophyton are called as Dermatophytes.
  135. What are the parts that are affected by dermatophytes?
    • Trichophyton - skin, hair and nails
    • Microsporum - skin and hair 
    • Epidermophyton - skin and  nails
  136. Which layer of skin do ringworm infect?
    The characteristic feature of ringworm group of fungi is their ability to 'invade' keratinized structures without being able to penetrate the deeper living cells. The disease caused by them are therefore limited to hair, nails and the stratum corneum of the epidermis.
  137. What are the various forms of ringworm or dermatophytosis?
    • Tinea corporis (involvement of the body)
    • Tinea capitis (scalp involvement)
    • Tinea cruris (groin involvement) - also known as Dhobi itch.  Adult males more commonly involved.  
    • Tinea pedis (involvement of the feet) 
    • Tinea unguium or onychomycosis (nail plate involvement) [AI 95]
  138. What are the causative organisms for Tinea capitis?
    • Trichophyton tonsurans: most common [AI 01, JHARKHAND 03] 
    • Microsporum canis
    • Microsporum audouini: causes tinea capitis in children  [JIPMER 00]
  139. Which dermatophyte infection cause 'Black dot' ring worm?
    • In endothrix, a Trichophyton infection, the hair shaft breaks off at the skin surface, leaving the hairs visible as black dots in the scalp.
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  140. What is Kerion?
    • Kerion is the result of the host's response to a fungal ringworm infection of the hair follicles of the scalp and beard accompanied by secondary bacterial infection(s).  It is usually caused by Zoophilic dermatophytes [PGI 98]  like Trichophyton verrucosum and T. mentagrophytes.
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  141. What is favus?
    • Favus is serious form of tinea capitis and is very contagious and causes permanent hair loss (literal meaning of favus is honeycomb).
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  142. An 8-year old child has localised non-cicatricial alopecia over scalp with itching and scales. Most likely diagnosis is 
    A) Tinea capitis 
    B) Lichen planus 
    C) Alopecia areata 
    D) Tinea barbae
    A) Tinea capitis
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  143. What are the important features of Tinea pedis?
    • - Also called as athlete's foot.
    • - Commonly caused by Trichophyton rubrum
    • - C/f - erythema, edema, scaling, pruritus, vesiculation. 
    • - The web space between the 4th and 5th toe is almost invariably affected.
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  144. A 36-year old factory worker developed itchy, annular, scaly plaques in both groins. Application of a corticosteroid oinment  led ot temporary relief but the plaques continued to extend at the periphery. The most likely diagnosis is [AI 05]
    A) Granuloma annulare 
    B) Erythema annulare centrifugum 
    C) Tinea cruris
    D) Annulare lichen planus 
    C) Tinea cruris

    Tinea cruris commonly affect adult males predisposed to warm, humid environment. 
    Lesions typically affect the groin and thighs. 
    Lesions are usually bilateral but asymmetrical having annular appearence. 
    Itching is a predominant feature.

    Granuloma annulare is associated with Diabetes mellitus. [AI 96]
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  145. What is the best initial test for all fungal infection?
    KOH Preparation [AIIMS 04,IOM 12] -  KOH melts away  all the epidermal cells  thus fungal hyphae  becomes visible. It is because the epidermal cells are relatively fragile compared  to wall of fungus . The wall of fungus contains Kitin that makes fungal hyphae resistant to melting by KOH.  It tells us if fungus is present or absent, but, does not tell us which fungus  is present.
  146. What  is the most accurate test for fungal infection?
    Culture  -  takes 4-6 weeks for culture .
  147. How do you manage dermatophytes?
    Non-inflammatory lesions in trunk, groin, hands and feet - twice daily application of clotrimazole, miconazole, ketoconazole, terbinafine, ciclopirox olamine cream. 

    Hyperkeratotic lesions of the palms ans soles - first treat with application of Whitfield's oinment to thin the keratin. 

    For Hair and Nail infection –Oral drugs lile terbinafine, griseofulvin must be used.  Griseofulvin is the DOC for Tinea unguium [AI 93] and Tinea capitis. [AI 03]
  148. Which of the following drugs is not suitable for dermatophytosis? [IOM 98,01]
    A) Griseofulvin 
    B) Fluconazole
    C) Nystatin 
    D) Miconazole
    C) Nystatin 

    Nystatin and amphotericin B are ineffective against dermatophytes.
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  149. How do you treat tinea capitis?
    Oral administration of Griseofulvin [AI 03] is recommended for treatment of all forms of tinea capitis. It may be necessary for 2-3 months and should be terminated only after fungal culture results are negative.
  150. Oral griseofulvin for finger nail dermatophytosis is to be given for how long? [JHARKHAND 03]
    A) 1 and a half month 
    B) 2 months 
    C) 5 months
    D) 1 months 
    C) 5 months

    Griseofulvin is used systemically only for dermatophytosis. It is ineffective topically. Systemic azoles and terbinafine are equally or more efficacious and are preferred now. Duration depends on site of infection - 
    Body skin - 3 weeks 
    Palm or soles - 4-6 weeks 
    Finger nails - 4-6 months [AI 02] 
    Toe nails - 8-12 months
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  151. What duration do  you use Terbinafine for Fingernails and toe nails?
    • Finger nails – 6 weeks 
    • Toe Nails – 12 weeks.
  152. Griseofulvin is not used in 
    A) Tinea versicolor
    B) Tinea unguium 
    C) Tinea capitis 
    D) Tinea corporis 
    A) Tinea versicolor

    Griseofulvin is the specific antimicrobial for the ringworm fungus and is active against all varients except Candida. It is ineffective topically.
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  153. What is Castellani's Paint?
    Castellani's paint is used to disinfect and to treat fungus infection of the skin. Its components are phenol, resorcinol, basic fuschin, boric acid and acetone.
  154. What is tinea incognito? [PGI 99,JIPMER 02]
    • Tinea incognito is an extensive ringworm which is caused by inappropriate use of topical corticosteroids.
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  155. What type of body parts do  dermatophytosis  and candidiasis occur?
    • Dermatophytosis occurs in dry areas. 
    • Candidiasis occurs in warm, moist areas.
  156. What are the various forms of  candidiasis?
    • Intertriginous infection – groin, gluteal folds (diaper rash), axilla, umbilicus, inframammary areas. 
    • Vulvovaginitis  -  common  in pregnant women and in diabetes. 
    • Oral candidiasis - creamy curd like white patch on tongue [AI 10]
    • Candidal paronychia.
  157. Which of the following is false regarding candidiasis [AIIMS 94]
    A) A and B
    B) Griseofulvin is effective against it
    C) Esophagus may be involved
    D) It is seen in face of healthy people 
    A) A and B

    Cutaneous candidiasis most often involve macerated skin, for example in the diapered area of infants, under pendulous breast, or on hands constantly in water. Esophageal candidiasis is seen in immunocompromised patients.
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  158. Nail involvement is not  a feature of 
    A) Lichen planus
    B) DLE 
    C) Psoriasis 
    D) Dermatophytosis 
    B) DLE
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  159. What is the most common form of fungal infection of female genitalia in diabetes?
    Vulvovaginal candidiasis.
  160. What is the drug of choice for systemic candidiasis? [JIPMER 93]
    Amphotericin B IV.
  161. How do you differentiate Leukoplakia and Oral thrush?
    • Leukoplakia  -  It does not scrap off. If is tis  taken off, it takes flesh with it  that results in bleeding. 
    • Oral thrush – scrap off.
  162. What is Wood's lamp? What are its uses? [KERELA 99]
    • A black light, also referred to Wood's lamp, or simply ultraviolet light, is a lamp which emits long wave (UV-A)  ultraviolet light of wavelength 360nm .
    • Its uses are - 
    • Fungal infections -Examination of hair in tinea capitis for  Microsporum audouini  (Yellow) [JIPMER 02]   or Microsporum canis, Tinea versicolor [AIIMS 02] (Dull yellow)
    • Bacterial infections - Corynebacterium minutissimum (coral red), Pseudomonas (yellow-green), Propionibacterium acnes(orange glow)  
    • Ethylene glycol poisoning 
    • Other - tuberous sclerosis and erythrasma (coral  red) , detection of Porphyria cutanea tarda (pinkish red fluorescence of urine)
  163. What are the clinical features of scabies? [AI 06]
    Symptoms - itching, similar symptoms in other family members. 

    Distribution - The body parts most commonly involved are the hands, between the finger, the wrist, axillae, genitalia, beneath the breasts, and inner aspects of thigh. Except in infants, the lesions do not develop on face, scalp, neck , palms and soles. [JIPMER 00,AIIMS 05]

    • Nature of lesions
    • a) Primary lesions 
    • - Burrows - located horizontally in the deeper part of stratum corneum. [KERELA 90]
    • - Papules (erythematous)
    • - Vesicles 
    • b) Secondary lesions
    • - Pustules (exudative) - secondary infection
    • - Eczematous and crusted 
    • - Nodular
  164. A child has multiple itchy papular lesions on genitalia and fingers. Similar lesions are also seen in the younger brother. Which is the most possible diagnosis
    A) Papular urticaria 
    B) Atopic dermatitis 
    C) Allergic contact dermatitis
    D) Scabies 
    D) Scabies
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  165. What is Norwegian scabies?
    • Norwegian or crusted scabies is the hyperinfestation with thousands or millions of mites. It may result from glucocorticoid use, immunideficiency disease and neurological or psychiatric illness that interfere with itching or scratching. 
    • Systemic steroids should not be used in scabies. [AI 92]
  166. How do you treat scabies?
    • For children > 8 weeks - Permethrin (5%) [AI 03]
    • For adults - Permethrin (5%) [AI 99, UP 00] or Lindane (1%). 
    • Alternatives include topical crotamiton cream, 25% benzyl benzoate,1% gamma BHC and sulfur oinments.  
    • Pregnant women or infants < 8 weeks - 6-10% precipitated sulfur in pertrolatum
    • A single dose of oral dose of ivermectin [PGI 00] effectively treats scabies in otherwise healthly individuals.
    • All the members of the family must be treated simultaneously.
    • Systemic antibiotics in secondary infection.
  167. What are the important features of pubic louse?
    • Pubic louse (Phthirus pubis) is also called as 'cosmopoitan crab'. 
    • Transmitted by sexual contact
    • Infest pubic hair, axillary hair, eyelashes and hair in other sites also. 
    • Intensly pruritic lesions and 2-3mm blue macules  called as maculae ceruleae [KARNATAKA 01,JIPMER 00]  develop at the site of bites. 
    • Blepharitis commonly accompanies infestation of eyelashes.

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  168. How do you treat pediculosis corporis?
    Treatment is directed towards disinfecting all the clothes and beddings of the patient.  The clothes should be either boiled or insufflated  with 5% DDT powder or 1% gamma BHC or 0.25% malathoin. The excoriations on trunk should be treated with application of calamine lotion or topical cortisteroids with an antibiotic along with systemic antihistaminic for pruritus.
  169. A 10 year old school girl has recurrent episodes of boils on the scalp. The boils subside with antibiotic therapy and recur after sometime. The most likely cause of recurrence is [AIIMS 05]
    A) Primary immunodeficiency syndrome 
    B) Pediculus capitis 
    C) HIV infection
    D) Juvenile diabetes mellitus 
    B) Pediculus capitis

    It is more common in poorer section of society and long haired school children regardless to their social background. The louse is passed among children by casual contact and by sharing combs and brushes. Itching is the prominent comlaint and scratching that can result secondary infection with exudation and crusting.
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2015-07-22 15:38:52
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