Last 5 Year PYQs in Dermatology for FMGE

Q1. A patient presents with the given rash after he had taken NSAIDs for his knee pain. He reported that he developed the same rash in the same location 6 months ago when he took the same drugs for back pain. What is the most likely diagnosis?

1. Drug hypersensitivity
2. Post inflammatory hyperpigmentation
3. Fixed drug eruption
4. Drug-induced hyper melanosis

Correct Answer 3 : Fixed drug eruption

Fixed drug eruption is an Adverse drug Exanthematous reaction with Maculopapular rash.

Type of HS	Type 4 hypersensitivity reaction
Characteristics	Same place, same morphology, same lesionsWhen the same drug is taken regularly
Pathogenesis	Memory T-cells
drugs	Co-trimoxazole, tetracyclines, and NSAIDs

• The image shows circular, well defined plague, violaceous,enthymemes,hyperpigmented and with an overlined blister. It heals, leaving behind bad post-inflammatory hyperpigmentation. It can occur on genital area where it appears as erosion. The treatment given is topical steroids and antibiotics combinations.

Q2. What is the term used to describe the distinctive finding shown in the image below, which is pathognomonic for Psoriasis?

1. Nail pitting
2. Subungual oil drop sign
3. Thinning of nails
4. Pterygium

Correct Answer 2 - Subungual oil drop sign:

• Subungual oil drop sign: A circular area of discoloration involving the nail bed of the right fifth digit, known as the oil drop sign. The oil drop sign is caused by nail bed parakeratosis and psoriasiform hyperplasia and is a physical finding of psoriasis.
• Salmon patch (Oil drop sign) is the most specific manifestation of Nail psoriasis. Translucent yellow-red discoloration in the nail bed proximal to onycholysis. The Nail bed parakeratosis and psoriasiform hyperplasia is seen.

Q3. What is the name of the clinical sign shown in the picture below?

1. Dermographism
2. Nikolsky sign
3. Koebner’s phenomenon
4. Auspitz sign

Correct Answer 1  - Dermographism:

• Dermatographism is also known as dermographism urticaria, or urticaria factitia, is an urticarial eruption upon pressure or trauma to the skin. This is the most common physical urticaria.
• Derma means skin and graphism means writing, together means writing on skin. Physical urticaria is caused by physical force, like sun, water, heat, etc. Linear streaks of urticaria on lines of stroking.

Q4. Identify the disease shown in the image below:

1. Syphilis
2. Leprosy
3. Elephantiasis
4. Leishmaniasis

Correct Answer 3 : Elephantiasis 

• Lymphatic filariasis, commonly known as elephantiasis, is a painful and profoundly disfiguring disease. It is caused by infection with parasites classified as nematodes (roundworms) of the family Filarioidea that are transmitted through the bites of infected mosquitos.
• Lymphoedema cannot be cured, but can manage the swelling by keeping the area clean by washing it with soap and water every day. elevating the limb to drain the fluid. The main symptom of elephantiasis is gross enlargement and swelling of an area of the body because of the accumulation of fluid. The arms and legs are the areas most often affected. An entire arm or leg may swell to several times its normal size resembling the thick, round appearance of an elephant's leg.

Q5. A farmer presented to the outpatient department with a swelling over his palm as shown in the photo. A few months back he got injured with a thorn. What is the presentation given below?

1. Ameloblastoma
2. Embryogenic dermoid
3. Sequestration dermoid
4. Implantation dermoid

Correct Answer 4 : Implantation dermoid 

• Implantation dermoid : This is an acquired condition that occurs as the result of implantation of epidermal fragments into the dermis by a penetrating injury. The epidermis continues to grow and forms a cyst lined with stratified squamous epithelium and filled with keratin.
• Histologically, the inclusion epidermoid cysts are lined with stratified squamous epithelium with granular cell layer and are filled with eosinophilic lamellated keratinous material. The inflammatory response may or may not be present and, in the cysts of long duration, calcification may be seen. The surgical treatment is needed for symptomatic cysts causing interference with function. The treatment requires careful complete excision, removal of the entire cyst wall is necessary to avoid the recurrence.

Q6. A 45-year-old male presents to the dermatology clinic with an itchy skin rash. Physical examination reveals flat-topped, polygonal, purplish papules with fine white lines on the surface. The lesions are primarily located on the inner wrists and forearms, as well as on the lower back. The patient reports that he has been experiencing oral discomfort and noticed white, lacy patches on the inside of his cheeks. There is no family history of similar conditions. What is the most likely diagnosis?

1. Psoriasis
2. Eczema
3. Lichen planus
4. Tinea corporis

Correct Answer 3  - Lichen planus:

• Lichen planus is a chronic inflammatory condition that presents with flat-topped, polygonal papules often arranged in a characteristic pattern.
• The purplish hue, fine white lines (Wickham's striae), and involvement of the inner wrists, forearms, lower back, and oral mucosa are classic features of lichen planus, which aligns with the patient's presentation of characteristic flat-topped papules with fine white lines (Wickham's striae) and mucosal involvement. The other options do not match the clinical features described.

Q7. A newborn infant is brought to the pediatric clinic due to the presence of a sac-like protrusion on the lower back. The protrusion is covered by a thin membrane and contains spinal cord tissue and nerves. The infant's lower limbs exhibit weakness and impaired sensation. The mother reports inadequate prenatal folic acid intake during pregnancy. Which of the following conditions is the most likely diagnosis?

1. Cleft lip and palate
2. Down syndrome
3. Gastroschisis
4. Spina bifida

Correct Answer 4 - Spina bifida:

• As the clinical presentation and maternal history of inadequate folic acid intake strongly suggest a neural tube defect.,

Spina bifida refers to a neural tube defect where the neural tube, which forms the spinal cord, fails to close properly during embryonic development. In this case, the presence of a sac-like protrusion on the lower back containing spinal cord tissue and nerves, along with lower limb weakness and sensory impairments, is indicative of a form of spina bifida known as myelomeningocele.

Q8. A patient presented with lesions, as shown in the image below, and later developed arthritis also. What is the treatment of choice for this condition?

1. PUVA
2. Steroids
3. Methotrexate
4. Infliximab

Correct Answer 3  - Methotrexate

• The condition shown in the image is indicative of psoriatic arthritis.
• The drug of choice used to treat Psoriatic arthritis is methotrexate..
• Methotrexate belongs to a class of drugs called disease-modifying anti-rheumatoid drugs (DMARDs). It reduces inflammation and alleviates the symptoms of arthritis.

Q9. What could be the potential diagnosis for a 7-year-old boy with intellectual disability who has developed extensive warty crusts on the trunk, hands, and feet, along with severe fissuring and scaling on the soles of his feet?

1. ​Scabies incognito
2. Animal scabies
3. Nodular scabies
4. Norwegian scabies

Correct Answer 4  - Norwegian scabies:

• Norwegian Scabies, also called crusted scabies, are a type of scabies seen in patients with neurological disorders. These patients cannot scratch as scratching is a protective phenomenon, and it is the most severe form of scabies. Due to the absence of scratching, burrows accumulate, and crusts are formed, as indicated in the image.

Q10. What is the causative agent responsible for causing acne fulminans among the following options?

1. Actinomyces
2. Propionibacterium
3. Mobiluncus
4. Bifidobacterium

Correct answer 2 - Propionibacterium

• An abnormal immune response to the bacterium Propionibacterium acnes is thought to be the cause of the rare and severe form of acne known as acne fulminans. The exact cause of acne fulminans, on the other hand, is still poorly understood. Genetic predisposition, hormonal imbalances, and certain medications like isotretinoin are additional factors that could contribute to the onset of this condition.
• The genus of bacteria known as Propionibacterium is commonly found on human skin, particularly in areas of the face, scalp, and upper back that produce a lot of oil. These Gram-positive bacteria are anaerobic or facultatively anaerobic and do not produce spores. Propionibacterium acnes is known to be engaged with the improvement of skin breakout, in spite of the fact that it is likewise a typical occupant of the skin microbiome and plays other helpful parts in the body. 

Q11. What is the probable diagnosis for a pregnant woman of age 30 who visits the dermatology outpatient department (OPD) with the following condition?

1. Systemic lupus erythematosus
2. Viral infection
3. Rosacea
4. Chloasma

Correct answer 4 -  Chloasma

• A common skin condition that can occur during pregnancy is chloasma, also known as the "mask of pregnancy." The appearance of brownish or grayish patches on the face, particularly on the cheeks, nose, forehead, and upper lip, is a hallmark of this condition. Chloasma is brought on by hormonal changes during pregnancy, particularly an increase in estrogen and progesterone levels, both of which can encourage the skin to produce more melanin.

Q12. Which of the following does not exhibit the Koebner's phenomenon?

1. Vitiligo
2. Psoriasis
3. Lichen planus
4. Herpes

Correct Answer - 4 Herpes

• The development of skin lesions in areas of trauma or injury is referred to as Koebner's phenomenon, also known as the isomorphic response. It is a typical finding in a few skin conditions, including psoriasis, lichen planus, vitiligo, and morphea.
• Koebner's peculiarity isn't found in all skin conditions, nonetheless, and one condition in which it is commonly not noticed is rosacea.

Q13. Identify the type of psoriasis in the given picture.

1. Guttate
2. Erythrodermic
3. Pustular
4. Inverse

Correct Answer 1  - Guttate psoriasis:

• A type of psoriasis known as guttate psoriasis is characterized by skin lesions in the shape of small drops. These sores are generally under 1 centimeter in measurement and show up on the storage compartment, appendages, and scalp. 

Q14. Which diagnostic tool is used to identify the condition depicted in the image below?

1. Culture
2. Wood’s lamp examination
3. Gram staining
4. Patch test

Correct Answer 2 -   Wood’s lamp examination

• Wood's light assessment is a symptomatic test utilized in dermatology to assist with recognizing different skin conditions, including contagious contaminations, bacterial diseases, and color problems like vitiligo. Dermatologists are able to observe subtle changes in the skin that might not be apparent under normal lighting conditions thanks to the use of ultraviolet light to highlight fluorescent substances in the skin.
• The patient's skin is first cleansed, and any cosmetics or lotions are removed during a Wood's lamp examination. The dermatologist applies the UV light from Wood's lamp to the patient's skin in a room that is darkened. The fluorescent substances in the skin mirror the light, making the skin seem an alternate tone, it is inspected to rely upon the condition. For instance, fungal infections can have a yellow-green appearance, while pigment disorders can have a white or blue-green appearance.

Q15. A 26-year-old male presented with a skin lesion as shown below. Biopsy shows the presence of hyperkeratosis . What is the most likely diagnosis?

1. Atopic dermatitis
2. Psoriasis
3. Pemphigus vulgaris
4. Pemphigus foliaceus

Correct answer 2 - Psoriasis

Psoriasis is a persistent immune system skin jumble that is portrayed by the fast development and shedding of skin cells. As a result, thick, scaly skin patches are often reddish or pink in color and covered in silvery-white scales. Psoriasis can affect any part of the body, but the scalp, elbows, knees, lower back, and genitals are the most common locations.

Q16. Which carcinoma is the possible diagnosis in the image given below?

1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Malignant melanoma
4. Hepatocellular carcinoma

Correct Answer 3  - Malignant melanoma

• It presents as an irregularly shaped, dark-colored lesion with uneven borders.
• Malignant melanoma has a higher potential to metastasize if not detected and treated early.
• It is crucial to catch it at an early stage for a better prognosis.

Q17. A 35-year-old patient presents to the OPD with a history of prolonged use of steroids for a skin condition. The patient complains of an expanding rash that has become less red and itchy since using the steroids. On examination, there are well-defined, slightly raised, erythematous plaques with central clearing and a scaly border on various parts of the body. What is the most likely diagnosis for this patient's condition?

1. Tinea incognito
2. Tinea corporis
3. Tinea cruris
4. Tinea pedis

Correct Answer 1  - Tinea incognito

• Tinea incognito is a term used to describe fungal infections, specifically tinea (ringworm), that have been modified or worsened due to the inappropriate use of topical steroids. In this case, the patient's history of prolonged steroid use has likely led to the modification of the typical clinical appearance of the fungal infection.
• The expanding rash, reduced redness and itchiness, well-defined slightly raised plaques with central clearing, and scaly border all point to tinea incognito.
• The use of steroids can mask the inflammatory response and alter the clinical presentation, making it challenging to recognize the underlying fungal infection.

Q18. A 3-year-old child is brought to the clinic with a generalized vesicular rash covering the entire body. The child's parents report that the rash started as red spots and quickly developed into fluid-filled blisters. The child also has a mild fever and is feeling irritable. What is the most likely diagnosis for this child's condition?

1. Varicella
2. Shingles
3. Smallpox
4. Dermatomyocytis

Correct Answer 1  – Varicella

• This is the most likely diagnosis based on the symptoms described. Varicella is a viral infection caused by the varicella-zoster virus (VZV). It typically presents with a generalized vesicular rash that starts as red spots and quickly develops into fluid-filled blisters. The child may also have a mild fever and feel irritable. Chickenpox is common in children and is highly contagious. The vesicles eventually crust over and heal. It's important to note that a vaccine is available for varicella, which has greatly reduced the incidence of the disease.

Q19. Which of the following mineral deficiency is associated with poor wound healing, dermatitis, diarrhoea and alopecia?

1. Iron
2. Calcium
3. Magnesium
4. Zinc

Correct Answer 4  - Zinc

• Zinc deficiency can indeed cause poor wound healing, dermatitis (inflammation of the skin), diarrhea, and alopecia (hair loss).
• Zinc is essential for immune function, wound healing, and maintaining healthy skin and hair.

Q20. A 45-year-old patient presents with a facial appearance that is marked by thickened, coarse, and deeply furrowed skin. The skin appears to be involved in the cheeks, forehead, and nose. The patient complains of numbness and weakness in the extremities. On examination, there are hypopigmented and erythematous patches with loss of sensation. What is the medical condition characterized by the term “Leonine facies”?

1. Lepromatous Leprosy
2. Acromegaly
3. Myasthenia gravis
4. Bells palsy

Correct Answer 1  - Lepromatous Leprosy

• "Leonine facies" is a term used to describe a specific facial appearance that can be seen in patients with advanced lepromatous leprosy. Lepromatous leprosy is a severe form of leprosy caused by the bacterium Mycobacterium leprae. It is characterized by the infiltration of the skin and other tissues by large numbers of bacilli, leading to significant tissue damage and deformities. The term "leonine" refers to the resemblance of the patient's facial features to those of a lion, with thickened, coarse, deeply furrowed skin. In addition to the distinct facial appearance, lepromatous leprosy can lead to peripheral nerve damage, resulting in sensory loss, muscle weakness, and other neurological symptoms. The hypopigmented and erythematous patches with loss of sensation mentioned in the patient's presentation are also characteristic of leprosy.

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