Dermatology AIIMS NOV 2012

Q-1. A young man with asymptomatic macules and papule over trunk and reddish patch over palate with a flat, moist lesion on glans penis. Patient has generalized lymph-adenopathy. What is line of management?
a) Ceftriaxone
b) Benzathine penicillin
c) Acyclovir
d) Fluconazole

Answer: Benzathine penicillin
Explanation:
Syphilis develops in four stages, each with a different set of symptoms.
Primary stage
In men, a chancre often appears in the genital area, usually (but not always) on the penis. These sores are often painless.
In women, chancres can develop on the outer genitals or on the inner part of the vagina. A chancre may go unnoticed if it occurs inside the vagina or at the opening to the uterus (cervix). The sores are usually painless and are not easily seen.
Swelling of the lymph nodes may occur near the area of the chancre.
A chancre may also occur in an area of the body other than the genitals.
The 2010 CDC STD treatment guidelines support the use of penicillin as the preferred drug for treating all stages of syphilis. Penicillin is the only therapy used widely for neuro-syphilis, congenital syphilis, or syphilis during pregnancy.

Q-2. 50 yrs old male presents with flaccid bulla on body and oral mucosa. Lesion present in
a) Intra-dermal
b) Supra-basal
c) Epidermal
d) Sub-corneal

Answer: Supra-basal
Explanation:
Pemphigus vulgaris: It is an autoimmune disease caused by antibodies directed against both desmoglein 1 and desmoglein 3 resulting in the loss of cohesion between keratinocytes in the epidermis, classified as a type II hypersensitivity reaction.
It is characterized by extensive flaccid blisters and muco-cutaneous erosions.
It arises most often in middle-aged or older people, usually starting with a blister that ruptures easily. The lesions can become quite extensive.
The pathogenesis of the disease involves auto-antibodies against desmosome proteins, separating keratinocytes from the basal layer of the epidermis.
On histology, the basal keratinocytes are usually still attached to the basement membrane leading to the appearance and thus the term, “tombstoning”. Transudative fluid accumulates in between the keratinocytes and basement membrane (supra-basal split), forming a blister and resulting in what is known as a positive Nikolsky’s sign.
This is a contrasting feature from bullous pemphigoid, where the detachment occurs between the epidermis and dermis (sub-epidermal bullae).

Q-3. Patient with urticaria on sun exposure.
a) Cholinergic urticaria
a) Atopic reaction
b) Photo dermatitis
c) Solar Urticaria

Answer: Cholinergic urticaria
Explanation:
Cholinergic urticaria is one of the physical urticarias brought on by a physical stimulus.
Although this stimulus might be considered to be heat, the actual precipitating cause is sweating.