Q-1. 26 year old man from Bihar comes with papules and nodules over face, over back. There was hypo-pigmentation, normo-aesthetic macules with no nerve thickening with history of prolonged fever present in childhood. Diagnosis is
a) Tuberculoid leprosy
b) Post Kala Azar dermal leishmaniasis
c) Lepromatous leprosy
d) Mycosis fungoides
Answer: Post Kala Azar dermal leishmaniasis
Explanation:
Post Kala Azar dermal leishmaniasis:
Endemic in Bihar and Africa
Usually develops 6 months-5 years following untreated or incompletely treated visceral leishmaniasis
Presence of juicy erythematous nodule on central part of the face
Hypo-pigmented macules on the trunk
No nerve involvement
Q-2. A 23 years old pregnant lady comes with lake of pus lesions all over body. Appropriate treatment is
a) Cycloserine
b) Methotrexate
c) Retinoids
d) Azathioprine
Answer: Cycloserine
Explanation:
Generalized pustular psoriasis:
It is rare and serious condition accompanied by high fever, chills and tachypnea and characterized by presence of generalized fiery red erythema followed by appearance of tiny waves of superficial pustules which become confluent to form circinate lesions and lakes of pus.
Treatment options in generalized pustular psoriasis:
Methotrexate (Drug of choice)
Acitretin
Cyclosporine A
Oral steroid (Drug of choice in pregnant women)
Important point:
Methotrexate and acitretin are teratogenic drugs and contra-indicated in pregnancy.
Cyclosporine A is Category-C drug and can ve used in severe life threatening situations in pregnancy.
Q-3. A picture with hyper-pigmented margins with central hypo-pigmentation whose margins looked like punched out lesion. Diagnosis is
a) LL
b) BL
c) BT
d) BB
Answer: BB
Explanation:
BB Leprosy:
Lesions are characteristically erythematous, raised plaques with central clearing and sloping edge (Inverted saucer appearance or looked like punched out lesion)
Lesions are hypo-esthetic.
Lesions are distributed asymmetrically.
Multiple, asymmetrically thickened nerve
Q-4. A lady came with complaints of a bluish lesion over left side of forehead and left eye as depicted in image below. Diagnosis is
a) Nevus of Ota
b) Nevus of Ito
c) Becker’s nevus
d) Mongolian spot
Answer: Nevus of Ota
Explanation:
Nevus of Ota:
Peri-orbital slate grey confluent patches, ocular bluish macules which persist
Nevus of Ito:
Slate grey confluent patches over acromio-clavicular region
Becker’s nevus:
Splashed light dark brown hyper-pigmentation over chest and shoulder
Mongolian spot:
Congenital gray blue macular lesions characteristically located in lumbo-sacral region and disappear in early childhood
Q-5. A child came with pinhead papular lesion over dorsum of hands, elbows, shaft of penis. Diagnosis
a) Lichen nitidus
b) Lichen planus
c) Scabies
d) Lichen scrofulosorum
Answer: Lichen nitidus
Explanation:
Lichen nitidus:
Lichen nitidus is a relatively rare, chronic skin eruption that is flat-topped, skin-colored micro-papules (Pinpoint to pinhead size).
Lichen nitidus mainly affects children and young adults.
The most common sites of involvement are the trunk, flexor aspects of upper extremities, dorsal aspects of hands, and genitalia.
Lichen nitidus is usually an asymptomatic eruption; however, patients occasionally complain of pruritus.