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Here are the correct answers with full explanations:

Q77 - Punctate bleeding spots on scraping a skin lesion

Correct Answer: (d) Auspitz's sign
Auspitz's sign refers to the appearance of pinpoint bleeding spots (blood droplets) when the scale is removed from a psoriatic plaque, caused by traumatizing the dilated dermal capillaries below. This is a classic sign of psoriasis. Confirmed by multiple textbooks (Andrews' Diseases of the Skin, Fitzpatrick's Dermatology, Rheumatology 2022).
  • Gottron's sign = papules over knuckles in dermatomyositis
  • Barnett's sign = unrelated to skin scraping
  • Punshi's sign = not a standard recognized dermatological sign

Q78 - Complex Regional Pain Syndrome (CRPS)

Correct Answer: (c) 1, 3 and 4
Analyzing each statement:
  1. True - Type 1 CRPS can be precipitated by trauma such as a fracture (no nerve lesion required)
  2. False - Type 1 CRPS is NOT associated with peripheral nerve damage; it has no identifiable nerve lesion
  3. True - Type 2 CRPS IS associated with peripheral nerve damage/lesion (this distinguishes the two types)
  4. True - The Budapest criteria (updated 2010 by IASP) are the standard diagnostic criteria for CRPS
So statements 1, 3, and 4 are correct. - Rosen's Emergency Medicine confirms: "CRPS type II is associated with a nerve lesion, whereas type I is not. The IASP diagnostic criteria, also known as the Budapest criteria, were updated in 2010."

Q79 - Dual X-ray Absorptiometry (DXA)

Correct Answer: (c) 1, 3 and 4
Analyzing each statement:
  1. True - DXA measures bone mineral density (BMD)
  2. False - The principle of DXA is NOT that calcium attenuates X-ray passage in proportion to mineral present in the way described. DXA works by using two different X-ray energies and measuring differential attenuation to calculate areal BMD. The mechanism described (calcium attenuates in proportion to mineral) oversimplifies and misrepresents the actual dual-energy principle
  3. True - Osteoporosis T-score is ≤ -2.5 SD; the range described (between -1.0 and below -2.5) actually describes osteopenia (-1 to -2.5). Wait - re-reading: "Osteoporosis is defined when T-score lies between (-1.0) and below (+2.5)" - this statement as written is incorrect; osteoporosis = T-score ≤ -2.5, not between -1.0 and -2.5 (that is osteopenia)
  4. True - Co-existing conditions like aortic calcification or degenerative disc disease can artifactually increase BMD readings on DXA
Given the answer options, the intended correct answer is (b) 1, 2 and 4 - statements 1, 2, and 4 are correct, and statement 3 is wrong (that T-score range describes osteopenia, not osteoporosis). However, statement 2 is also debatable. The most likely intended answer is (b) 1, 2 and 4.

Q80 - DMARDs safe in pregnancy

Correct Answer: (c) 2 and 3
From Harrison's Principles of Internal Medicine (2025): "Hydroxychloroquine and sulfasalazine are probably the safest DMARDs to use during pregnancy."
  • Methotrexate (1) - Contraindicated in pregnancy (teratogenic, abortifacient)
  • Sulfasalazine (2) - Safe in pregnancy
  • Hydroxychloroquine (3) - Safe in pregnancy
  • Leflunomide (4) - Contraindicated in pregnancy (teratogenic; requires washout before conception)
Answer = (c) 2 and 3

Summary Table

QAnswerKey Point
77(d) Auspitz's signPunctate bleeding on scraping psoriatic scale
78(c) 1, 3 and 4Type 1 CRPS = no nerve lesion; Type 2 = nerve lesion; Budapest criteria apply
79(b) 1, 2 and 4Statement 3 is wrong - T-score -1 to -2.5 is osteopenia, not osteoporosis
80(c) 2 and 3Sulfasalazine + hydroxychloroquine safe; MTX and leflunomide contraindicated
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