Author: Neelam Maurya

A 5 years old girl presented with lesion on the face for the last 3 months. A skin biopsy was performed and the findings are shown below. What is the diagnosis?

A. Squamous cell carcinoma

B. Squamous papilloma with central crater

C. Molluscum contagiosum

D. Herpes zoster

Correct Answer » C Explanation

Ans: C. Molluscum contagiosum

(Ref: Robbins 9/e p1176; Fitzpatrick 6/e p2347)

• All findings are highly suggestive of Molluscum contagiosum, which is caused by the poxvirus.

Molluscum contagiosum:

• On microscopic examination, lesions show cuplike verrucous epidermal hyperplasia. The diagnostically specific structure is the molluscum body, which occurs as a large, ellipsoid, homogeneous, cytoplasmic inclusion in cells of the stratum granulosum and the stratum corneum.
• In H&E stain, these inclusions are eosinophilic in the blue-purple stratum granulosum and acquire a pale blue hue in the red stratum corneum.
• Numerous virions are present within molluscum bodies

A 11 years old child presented with itchy and 11 per-pigmented plaques in cubital and popliteal fossa as shown below. Most probable diagnosis is

A. Atopic dermatitis

B. Psoriasis

C. Solar keratosis

D. Pemphigus vulgaris

Correct Answer » A Explanation

Answer- A. Atopic dermatitis

• Most probable diagnosis in this child, who presents with itchy and hyperpigmented plaques in cubital and popliteal fossa is atopic dermatitis.
• uAtopic Dermatitis (AD): The clinical presentation often varies with age. Half of patients with AD present wilhin the first year of life, ancl 80%, present by 5 years of age. About 80025 ultimately co-express allergic rhinitis or qsthma. The infantile pattern is characterized by weeping infammatory patches and crusted plaques on theface, neck, and extensor surfaces. The chitdhood dnd ddolescent pattem is typified by dermatitis of flexural skin, particularly in the antecubital and popliteal fossae.”

Identify the following congenital lesion on face

A. Hematoma

B. Melanoacanthoma

C. Epidermal verrucous nevi

D. Congenital melanocytic nevus

Correct Answer » D Explanation

Answer- D. Congenital melanocytic nevus

The lesion seen is clearly a hyperpigmented lesion, and is prcsent since birth. The lesion looks hairy as well, hence most

Iikely to be a congenital melanocytic nevus.

• Usually solitary, color varies from brown to black; lesions usually darken & enlarge with age
• Located in the area ofhead & neck 15% ofthe time (can occur anlrvhere on the body)

A young girl presented to the OPD with patchy hair loss for 2 weeks as shown below. There was no scarring or erythema. What is the likely cause?

A. Telogen effluvium

B. Alopecia areata

C. Trichotillomania

D. Tinea capitis

Correct Answer » C Explanation

Answer- C. Trichotillomania

“Trichotillomania (Greek, “hair pulling matlness”) is a common, but difficult to manage cause of facial scalp hair loss. It is classified as an impulse control disorder in which patients pull, pluck, or cut their hair.

A child presented with scaly plaques on head with itching, mild discharge and hair loss. What investi-gation should be done next?

A. KOH mount

B. Gram stain

C. Tzanck smear

D. Slit skin preparation

Correct Answer » A Explanation

Answer- A. KOH mount

Diagnosis:

• Diagnosis is made by first examining scale &-hair on microscope slide in potassium hydroxide (KOH) wet mount. It is single most important test for diagnosis.

A histopathological image of the skin biopsy of a patient given below is suggestive of:

A. Leprosy

B. Lichen planus

C. Pemphigus vulgaris

D. Psoriasis

Correct Answer » C Explanation

Answer- C. Pemphigus vulgaris

• Histopathological image shown above is showing a suprabasal split between the keratinocytes and basal layer. The attached basal keratinocytes give an appearance of ‘Tomb stoning’. These findings are characteristically seen in Pemphigus vulgaris. Acantholytic cells can be seen at higher power in the blister cavity and the edge of blister.

A middle-aged lady presented to the OPD with painful blisters on the skin and oral mucosa. Direct immuno fluorescence was done as shown below. All the following are true about the disease pathogenesis except?

A. Due to IgG against Desmoglein-1

B. Intercellular deposits of IgG and C3

C. Due to IgG against hemidesmosomes

D. Due to IgG against Desmoglein-3

Correct Answer » C Explanation

Answer- C. Due to IgG against hemidesmosomes

• skin as well as mucosal involvement in this patient, along with Fishnet pattern seen in DIF points towards a diagnosis of
• Pemphigas vulgaris. Pemphigus vulgaris is caused by IgG antibodies against Desmoglein I and 3, and there is intercellalar
• IgG and complement deposition inftshnet pattern IgG against hemidesmosomes and deposition in the basal layer is seen in Bullous pemphigoid.

A 37 year old female patient presented with very itchy annular scaly erythematous plaques in inframammary folds. She applied a steroid cream over it after which it started spreading towards periphery. Following is the picture of the lesion. Most likely diagnosis is?

A. Tinea corporis

B. Candidiasis

C. Inverse psoriasis

D. P.versicolor

Correct Answer » A Explanation

Ans. A. Tinea corporis

• The clinical description given in question and the picture indicate towards the diagnosis of tinea incognito i.e. tinea infection altered by steroid use.
• Tinea corporis is dermatophytosis of the trunk, legs or arms, especially on glabous skin.
• It may have a variety of appearances.
• Most easily identifiable are the enlarging raised red rings with a central area of clearing (ringworm).
• The same appearances of ringworm may also occur on the scalp (tinea capitis), beard area (tinea barbae) or the groin (tinea cruris, known as jock itch or dhobi itch).

Identify the condition?

A. Erythema multiforme

B. Palmo-planter psoriasis

C. Secondary syphilis

D. Contact dermatitis

Correct Answer » A Explanation

Ans. A. Erythema multiforme

Rel Behl 10th/e p 117]

• Given picture is showing multiple target lesions i.e. concentric rings of different shades of erythema which is characteristic of erythema multiforme.
• Palms and soles are common sites.

A child after taking medicine for fever presented with following picture. Most likely diagnosis of the following is?

A. Erythema multiforme

B. Impetigo contagiosa

C. Steven johnson syndrome

D. Staphylococcal scalded skin syndrome

Correct Answer » C Explanation

Ans. C. Steven johnson syndrome

• Showing hemorrhagic crusting of lips after taking drugs for fever, which is common clinical picture in Steven-johnson syndrome.