Q-1. A patient has 2 fingernails and 1 toenail tunneling since 1 year. Rapid Diagnosis is done by
a) Woods Lamp Examination
b) KOH Mount
c) Slit Smear Examination
d) Gram Stain
Answer: KOH Mount
Explanation:
Onychomycosis means fungal infection of the nail. It is the most common disease of the nails and constitutes about a half of all nail abnormalities.
This condition may affect toenails or fingernails, but toenail infections are particularly common. The prevalence of Onychomycosis is about 6–8% in the adult population.
The three main approaches are potassium hydroxide smear, culture and histology. This involves microscopic examination and culture of nail scrapings or clippings.
Recent results indicate the most sensitive diagnostic approaches are direct smear combined with histological examination, and nail plate biopsy using periodic acid-Schiff stain.
Q-2. A boy had itchy, excoriated papules on the forehead and the exposed parts of the arms and legs since 3 years. The disease was most severe in rainy season and improved completely in winter. The most likely diagnosis is
a) Insect Bite Hypersensitivity
b) Scabies
c) Urticaria
d) Atopic Dermatitis
Answer: Insect Bite Hypersensitivity
Explanation:
Atopic dermatitis worsens in winter season.
Itchy, excoriated papules on the forehead and the exposed parts of body rule out scabies and urticaria.
Papular urticaria is defined by chronic or recurrent eruptions of pruritic papules, vesicles, and wheals resulting from a hypersensitivity reaction to biting or stinging insects.
The lesions are most commonly grouped in linear clusters and present on exposed areas with sparing of the genital, peri-anal, and axillary regions.
Intense pruritis accompanies the eruption, resulting in excoriations, secondary infection, scarring, and permanent hyper-pigmentation and/or hypo-pigmentation, particularly in darkly pigmented individuals.
Q-3. Which of the following is related to sunlight exposure?
a) Actinic Keratosis
b) Seborrheic Keratosis
c) Molluscum contagiosum
d) Syringoma
Answer: Actinic Keratosis
Explanation:
Actinic Keratosis (AK) or Solar Keratosis is a UV light–induced lesion of the skin that may progress to invasive squamous cell carcinoma.
It is by far the most common lesion with malignant potential to arise on the skin.
Q-4. A 23 year lady develops brownish pigmentation on cheeks and bridge of nose on exposure to sun. Diagnosis is
a) Photo-dermatitis
b) SLE
c) Chloasma
d) Rosacea
Answer: Chloasma
Explanation:
Melasma (Chloasma) is a tan or dark skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications.
The symptoms of melasma are dark, irregular well demarcated hyper-pigmented macules to patches commonly found on the upper cheek, nose, lips, upper lip, and forehead.
Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun.
Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.
Q-5. A 24 year old man had multiple small hypo-pigmented patches on upper chest and back. Macules were with fine scaling which coalesced later. Patient had similar lesions one year ago which subsided with treatment. Investigation to be done is
a) KOH preparation
b) Tzanck test
c) Slit Skin Smear
d) Skin biopsy of coalesced lesion
Answer: KOH preparation
Explanation:
The most common appearance of Tinea versicolor is as numerous, well-marginated, finely scaly, oval-to-round macules scattered over the trunk and/or the chest, with occasional extension to the lower part of the abdomen, the neck, and the proximal extremities.
Pityriasis versicolor may be diagnosed by a potassium hydroxide (KOH) preparation and lesions may fluoresce copper-orange when exposed to Wood’s lamp.
Q-6. A child has itchy papulo-vesicular lesion on face and palm & soles. Possible diagnosis is
a) Scabies
b) Seborrheic dermatitis
c) Psoriasis
d) Congenital syphilis
Answer: Scabies
Explanation:
Scabies usually shows up as red lumps and threadlike ‘tracks’ on the skin, especially between the fingers and toes, on the insides of wrists, on the backs of elbows, in the armpits, around the belly button and groin, and on the buttocks.
In babies, itchy papulo-vesicular lesion often appears on the palms of the hands and soles of the feet.
Scabies is extremely itchy, especially at night, or after a hot bath or shower.
Scratching affected areas sometimes leads to secondary infection.
Q-7. A patient has multiple hypo-aesthetic and hypo-pigmented patches on lateral aspect of forearm. Abundance of Acid fast bacilli and Granulomatous inflammation is seen. Diagnosis is
a) Lepromatous Leprosy
b) Tuberculoid Leprosy
c) Indeterminate Leprosy
d) Borderline Leprosy
Answer: Borderline Leprosy
Explanation:
The first skin lesion is usually the indeterminate type, which causes one or a few hypo-pigmented (pale) spots before evolving into the borderline, tuberculoid or lepromatous types.
Tuberculoid:
The initial lesion is one or few and often a sharply demarcated hypo-pigmented macule that is ovoid, circular, or serpiginous. The lesions may be somewhat elevated with a dry scaly center and erythematous borders.
Common lesion sites include the buttocks, face, and extensor surfaces of limbs.
Superficial nerves that lead from the lesions tend to enlarge and are sometimes palpable. The patient may experience severe neuropathic pain. Nerve involvement can also lead to trauma and muscle atrophy.
Borderline tuberculoid leprosy:
The lesions are few or moderate and asymmetric with almost complete anesthesia.
Peripheral nerves are often involved and thickened asymmetrically, and cutaneous nerves are sometimes enlarged.
Mid-borderline leprosy:
The number of skin lesions is moderate, and they are asymmetrical and somewhat anesthetic.
Inverted saucer shaped lesion
Peripheral nerves may be somewhat symmetrically enlarged, but cutaneous nerves are not.
Borderline lepromatous leprosy:
Moderate to numerous slightly asymmetrical skin lesions appear with minor or no anesthesia.
Inverted saucer shaped lesion
Peripheral nerves are often enlarged symmetrically, but cutaneous nerves are not.
Lepromatous leprosy:
This form is characterized by extensive bilaterally symmetric cutaneous involvement, which can include macules, nodules, plaques, or papules. Multiple flat hypo-pigmented lesions are seen.
Hoarseness, loss of eyebrows and eyelashes, and nasal collapse secondary to septa perforation may occur in advanced cases of disease.
The leonine facies associated with leprosy develop as the disease progresses, and the facial skin becomes thickened and corrugated.
Axillary and inguinal adenopathy may develop, in addition to scarring of the testes and subsequent gynecomastia and sterility.
Nerve involvement in lepromatous leprosy is not as severe as in tuberculoid leprosy, since nerves, although visibly thickened and highly infected, still function reasonably well in early stages of the disease.
Q-8. Characteristic of Borderline Leprosy is
a) Inverted Saucer shaped lesions
b) Erythema Nodosum Leprosum
c) Hypo-pigmented macules/plaques all over the body
d) Glove and Stocking Anesthesia
Answer: Inverted Saucer shaped lesions
Explanation:
See above explanation