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Read this pdf and teach me all the qs duscussed in it one by one.it is dermatology exam mcqs

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I have the full OCR text from all 21 pages. Let me now decode every question carefully using the garbled OCR text combined with my dermatology knowledge, and teach them one by one.
I've extracted all 21 pages of your March 2025 Dermatology MCQ paper. The PDF is handwritten/scanned so the OCR is distorted, but I've decoded every question. Here they are taught one by one with the correct answer and explanation:

Dermatology MCQ Paper - March 2025

All Questions Taught One by One

Q1 - Xanthelasma + Coral Color Fluorescence

Scenario: Xanthelasma. Which antibiotic shows coral-pink fluorescence under Wood's lamp? Options: 1. Tetracycline 2. Clarithromycin 3. Ciprofloxacin
Answer: 1. Tetracycline
  • Tetracycline deposits in tissues and fluoresces coral-pink/yellow under Wood's lamp.
  • This property is used in Mohs surgery and bone studies.
  • Erythrasma (caused by Corynebacterium minutissimum) also shows coral-red fluorescence, but that is due to coproporphyrin III, not tetracycline.

Q2 - Man with Itching in Groin

Scenario: Male patient with itching in groin, erythema + moist lesion, surrounding edge with papules. Diagnosis? Options: 1. Hailey-Hailey disease 2. Tinea cruris 3. Contact dermatitis
Answer: 2. Tinea cruris
  • Tinea cruris = dermatophyte infection of groin, shows active scaly advancing border with central clearing
  • Satellite papules/pustules at periphery are classic
  • Hailey-Hailey shows maceration in flexures but is vesicular/eroded, not the leading edge papule pattern

Q3 - Steroid Formulations

Scenario: Which steroid formulation matches these concentrations: 0.1% tretinoin, 0.1% dexamethasone, 0.05%, 0.1%?
Key fact: This tests knowledge of steroid potency groups and concentrations.
  • Clobetasol = 0.05% (super-potent, Group I)
  • Betamethasone dipropionate = 0.05% or 0.1%
  • Hydrocortisone = 0.5%, 1%, 2.5%
  • Triamcinolone = 0.025%, 0.1%, 0.5%

Q4 - Acne Vulgaris - Treatment Failure

Scenario: Patient with acne vulgaris on doxycycline 3 weeks. He stops treatment after a few weeks. Chest/back acne.
Answer: After 3 weeks of doxycycline, if acne is not responding OR patient has primarily comedonal/truncal acne + pustular:
  • Consider adding topical benzoyl peroxide to prevent resistance
  • Consider switching to isotretinoin if severe nodulocystic
  • Doxycycline is used 12 weeks minimum - stopping at 3 weeks is inadequate
Key teaching: Antibiotic monotherapy should NEVER be used for acne - always combine with benzoyl peroxide to prevent Cutibacterium acnes resistance.

Q5 - Perioral Dermatitis - Treatment

Scenario: Perioral dermatitis (papules around mouth, nasolabial area, periorbitally). Options: 1. Topical metronidazole 2. Topical clobetasol 3. Topical steroid
Answer: 1. Topical metronidazole
  • Perioral dermatitis is WORSENED by topical steroids (especially fluorinated)
  • First-line treatment: topical metronidazole 0.75% or 1%, or topical erythromycin
  • Systemic doxycycline 100mg for moderate-severe cases
  • Stop all topical steroids ("zero therapy")

Q6 - Knuckle Papules + Diagnosis

Scenario: Papules over knuckles. Options: 1. Olmsted syndrome 2. Bart syndrome 3. Wohlfart-Kugelberg-Welander syndrome
Answer: 1. Olmsted syndrome (if associated with PPK - palmoplantar keratoderma)
  • Olmsted syndrome: mutilating PPK + periorificial keratotic plaques + knuckle pads
  • OR if the question shows Gottron's papules: Dermatomyositis
  • Gottron's papules are violaceous flat-topped papules over MCP/IP joints

Q7 - Adult Patient - Flaccid Blisters + Histopathology Split Above Basal Layer

Scenario: Adult patient with flaccid blisters. Histopathology shows split above the basal layer. Diagnosis? Options: 1. Bullous impetigo / 2. Pemphigus vulgaris
Answer: Split ABOVE basal layer (suprabasal) = Pemphigus vulgaris
  • PV: suprabasal acantholysis, "row of tombstones" appearance of basal layer
  • Bullous pemphigoid: subepidermal split
  • Dermatitis herpetiformis: subepidermal with neutrophilic microabscesses at dermal papillae

Q8 - Leukocytoclastic Vasculitis

Scenario: Leukocytoclastic vasculitis features - bad life infiltrate, arteries, medial calcification
Key teaching:
  • LCV = small vessel vasculitis, affects postcapillary venules
  • NOT medium or large arteries (those = PAN or GCA)
  • Medial calcification = Monckeberg's sclerosis, unrelated to LCV
  • DSG (desmoglein) and ANA are not diagnostic for LCV
  • LCV diagnosed by skin biopsy: neutrophilic infiltrate, fibrinoid necrosis, nuclear dust

Q9 - ANA Test in Specific Disease

Question: DSG 10 ANA - tested in which disease?
  • ANA: used in SLE, dermatomyositis, scleroderma
  • DSG1: Pemphigus foliaceus
  • DSG3: Pemphigus vulgaris
  • DSG1+3: Pemphigus vulgaris with mucosal involvement

Q10 - Behcet's Disease + OCT

Question: Behcet's disease - which test to perform / which need is involved?
Key teaching - Behcet's disease:
  • Criteria: recurrent oral ulcers (major) + 2 of: genital ulcers, ocular lesions, skin lesions, pathergy test
  • Ocular involvement: posterior uveitis, hypopyon uveitis (can cause blindness)
  • Test: Pathergy test (hyperreactivity to needle prick)
  • Treatment: colchicine, dapsone, thalidomide, anti-TNF for severe

Q11 - Palmoplantar Pustulosis - Treatment

Scenario: Palmoplantar pustulosis (PPP) - first-line treatment? Options: 1. NB-UVB 2. Topical steroids 3. PRP (Retinoids first line) 4. Systemic retinoids
Answer: Systemic retinoids (acitretin) - first-line for PPP
  • NB-UVB also used
  • Topical super-potent steroids as adjunct
  • Biologics (IL-17 inhibitors, IL-23 inhibitors) for refractory

Q12 - Pityriasis Rosea Scenario

Q12: Pityriasis rosea scenario
Key teaching:
  • Herald patch appears 1-2 weeks before generalized eruption
  • Christmas tree pattern on back
  • Caused by HHV-6/HHV-7 reactivation
  • Resolves spontaneously in 6-8 weeks
  • Treatment: oral acyclovir can shorten course; NB-UVB for pruritus

Q13 - Eczema Herpeticum Complication

Scenario: Complication of eczema herpeticum - which treatment?
Answer: Acyclovir (systemic/IV)
  • Eczema herpeticum = Kaposi's varicelliform eruption: HSV superinfection of eczematous skin
  • Punched-out erosions, monomorphic vesicles
  • Treatment: IV acyclovir (severe), oral acyclovir (mild)
  • Can be life-threatening - septicemia, encephalitis, hepatitis

Q14 - Patch Test

Question: Which test for contact dermatitis? Options: i. Patch test (closed) ii. Patch test (open) iii. Scratch test iv. Photo-patch test
Answer: i. Patch test (closed) = standard epicutaneous patch test
  • Applied for 48 hours, read at 48 and 96 hours
  • Detects Type IV (delayed) hypersensitivity
  • Photo-patch test: for photocontact dermatitis (sunscreens, fragrances)
  • Prick/scratch test: for Type I (IgE-mediated) allergy

Q15 - TEN (Toxic Epidermal Necrolysis) - Causative Drug

Q15: TEN - causative drugs
Key teaching - most common drugs causing TEN/SJS:
  1. Allopurinol (most common worldwide)
  2. Carbamazepine (HLA-B*1502 in Asians)
  3. Lamotrigine
  4. Sulfonamides
  5. NSAIDs (oxicam group)
  6. Nevirapine

Q16 - Relapsing Polychondritis

Q16: Relapsing polychondritis scenario - chronic presentation
Key teaching:
  • Relapsing polychondritis: inflammation of cartilaginous structures
  • Ear (spares earlobe - no cartilage!), nose (saddle nose), larynx/trachea (dangerous)
  • Diagnosis: clinical; biopsy shows loss of basophilic staining of cartilage matrix
  • Treatment: dapsone (mild), systemic steroids, methotrexate

Q17 - Leprosy - Multibacillary

Q17: Leprosy multibacillary - patient on treatment, how long to take, when to follow up, when to appear
Key teaching - WHO MDT for Leprosy:
  • Paucibacillary (PB): Rifampicin 600mg monthly + Dapsone 100mg daily x 6 months
  • Multibacillary (MB): Rifampicin 600mg monthly + Clofazimine 300mg monthly + 50mg daily + Dapsone 100mg daily x 12 months
  • Follow-up: 5 years for MB after completing MDT to detect relapse

Q18 - Juvenile Plantar Dermatosis - Management

Q18: Juvenile plantar dermatosis management Options: Cotton socks, leather shoes exchange
Answer: Management of Juvenile Plantar Dermatosis:
  • Change to leather shoes (avoid synthetic/rubber footwear)
  • Wear cotton socks (avoid nylon)
  • Emollients
  • Caused by repeated wetting and drying of the foot (friction + occlusion)

Q19 - Scabies - Persistent

Q19: Patient with scabies - has taken multiple treatments, not responding. What investigation?
Answer: If scabies is not responding to multiple treatments, suspect Norwegian/Crusted Scabies
  • Investigation: Skin scraping + KOH microscopy - shows massive mite burden
  • Also check: immunosuppression (HIV, steroids), misdiagnosis
  • Treatment: Oral ivermectin (weight-based, repeated) + topical permethrin

Q20 - Blau Syndrome

Q20: Blau syndrome scenario
Key teaching:
  • Blau syndrome = NOD2/CARD15 gene mutation
  • Triad: granulomatous arthritis + uveitis + rash (camouflage pattern)
  • Onset in childhood (<4 years)
  • Autosomal dominant
  • Differential: early-onset sarcoidosis (sporadic form of Blau)

Q21 - FMF (Familial Mediterranean Fever) - Complication

Q21: FMF complication asked
Answer: AA Amyloidosis is the most feared complication of FMF
  • FMF: MEFV gene mutation, episodic fever + serositis (peritonitis, pleuritis, synovitis)
  • Skin: erysipelas-like erythema over lower legs
  • Treatment: colchicine (prevents attacks AND amyloidosis)

Q22 - TRAPS (TNF Receptor-Associated Periodic Syndrome) - Complication

Q22: TRAPS complication asked
Answer: AA Amyloidosis (same as FMF)
  • TRAPS: TNFRSF1A gene mutation
  • Longer attacks (>1 week), migratory myalgia, periorbital edema
  • Skin: migratory erythematous plaques overlying myalgia

Q23 - Cutaneous Mastocytosis - Adults

Q23: Cutaneous mastocytosis in adults - what age, bone marrow involvement?
Key teaching:
  • Adult mastocytosis: most are systemic - bone marrow almost always involved
  • Pediatric mastocytosis: usually limited to skin, often resolves at puberty
  • Serum tryptase >20 ng/mL suggests systemic disease
  • Diagnosis: bone marrow biopsy (compact mast cell clusters, CD25+, CD117+)
  • Mutation: KIT D816V

Q24 - Erythema Marginatum Scenario

Q24: Erythema marginatum scenario
Key teaching:
  • Erythema marginatum = evanescent, migratory, non-pruritic erythema
  • Major criterion for Acute Rheumatic Fever (Jones criteria)
  • Pink rings with central clearing, extends outward
  • Spares the face
  • Comes and goes with fever

Q25 - Necrolytic Migratory Erythema

Q25: Scenario of necrolytic migratory erythema
Key teaching:
  • NME = skin manifestation of Glucagonoma (alpha-cell pancreatic tumor)
  • Features: cyclical migratory erosive rash in perineum/groin/legs, glossitis, angular stomatitis
  • Also: diabetes, weight loss, DVT, normochromic anemia
  • Diagnosis: elevated serum glucagon; CT abdomen for tumor
  • Treatment: octreotide, surgical resection

Q26 - Latex Allergy

Q26: Latex allergy patient - should avoid (cross-reactive foods)
Answer: Latex-fruit syndrome - cross-reactive foods include:
  • Banana, avocado, kiwi, chestnut (high association)
  • Also: papaya, tomato, potato, apple

Q27 - Vibrant Baby / Banana (Latex cross-reaction)

Continuation of Q26 above - banana is the classic latex cross-reactive food to avoid.

Q28 - Behcet's Syndrome

Q28: Behcet's syndrome features
Diagnostic criteria (ISG):
  • Recurrent oral ulcers (≥3x/year) - MANDATORY
  • Plus 2 of: genital ulcers, eye lesions (uveitis), skin lesions (EN, pseudofolliculitis, acneiform), positive pathergy test

Q29 - Scleroderma - Specific Antibodies

Q29: Scleroderma diagnosis asked, oral ulcers, further workup, antibody
Antibodies in Scleroderma:
  • Anti-Scl-70 (anti-topoisomerase I): diffuse cutaneous SSc, ILD
  • Anti-centromere (ACA): limited cutaneous SSc (CREST), PAH
  • Anti-RNA polymerase III: diffuse SSc, renal crisis
  • ANA: positive in >95%

Q30 - EBA (Epidermolysis Bullosa Acquisita)

Q30: EBA scenario - IgG deposition, dermal
Key teaching - EBA:
  • Autoantibodies against type VII collagen (anchoring fibrils)
  • IIF: u-serrated pattern at BMZ
  • Salt-split skin: IgG on dermal side (floor of blister) - distinguishes from BP (roof)
  • Associated with Crohn's disease
  • Dx also asked about Pemphigoid gestationis: IgG anti-BP180

Q31 - Linear IgA Disease - Causative Drug

Q31: Linear IgA disease - causative drug asked Answer: Vancomycin is the most common drug causing Linear IgA bullous dermatosis
  • Others: lithium, NSAIDs, phenytoin, captopril
  • "String of pearls/rosette" pattern of blisters
  • IgA deposits linear at BMZ

Q32 - Prolonged PR Interval - Drug to Avoid

Q32: Patient with prolonged PR interval - which drug to avoid?
Answer: Avoid drugs that further prolong the PR interval:
  • Hydroxychloroquine (used in lupus/dermatomyositis) - can cause AV block
  • Also: chloroquine, amiodarone
  • This is important in SLE/dermatomyositis patients on antimalarials

Q33 - Small Cell Lymphoma

Q33: Small monomorphic cells, <D20, CD3+, BCL2+, diagnosis asked. Diffuse B cell lymphoma?
Key teaching - Skin Lymphomas:
  • CD20+, CD3-: B-cell lymphoma
  • CD3+, CD20-: T-cell lymphoma (MF/Sezary)
  • BCL2+: follicle center lymphoma vs DLBCL
  • Small monomorphic B cells: consider MALT lymphoma or mantle cell lymphoma

Q34 - SLE - Progression to Systemic

Q34: Progression of SCLE (Subacute Cutaneous Lupus) face involved - to SLE rate
Key teaching:
  • SCLE: anti-Ro/SSA antibodies (in 70%)
  • ~10-15% of SCLE patients develop SLE
  • Drug-induced SCLE: hydrochlorothiazide, terbinafine, CCBs

Q35 - SLE - Most Common Respiratory Involvement

Q35: Most common respiratory system involvement in SLE Answer: Pleuritis/Pleurisy
  • Pleuritis is the most common pulmonary manifestation of SLE (~50%)
  • Others: lupus pneumonitis, diffuse alveolar hemorrhage, shrinking lung syndrome, PAH

Q36 - APLA (Antiphospholipid Antibody Syndrome) - Treatment in Pregnancy

Q36: APLA syndrome patient with recurrent abortions - treatment in pregnancy
Answer: Low molecular weight heparin (LMWH) + low-dose aspirin
  • Warfarin is TERATOGENIC (avoid in 1st trimester)
  • LMWH throughout pregnancy + aspirin
  • After delivery: convert to warfarin

Q37 - Scleredema - Specific Staining

Q37: Scleredema - specific staining of ANA antibodies
Key teaching - Scleredema:
  • Scleredema (Buschke): thickening of skin of upper back/neck
  • Three types: post-streptococcal, diabetes-associated, paraproteinemia
  • Histology: thickened dermis with collagen bundles separated by mucin
  • Special stain: Alcian blue or colloidal iron for mucin

Q38 - Drug-Induced ANA

Q38: Drug-induced anti-histone antibodies / SLE
Drugs causing Drug-Induced Lupus (DIL):
  • Hydralazine (most common)
  • Procainamide
  • Isoniazid
  • Minocycline (anti-histone + anti-dsDNA)
  • Anti-histone antibodies are characteristic of DIL

Q39 - CEP (Congenital Erythropoietic Porphyria) - Transplant

Q39: CEP scenario - treatment asked, transplant involvement
Answer:
  • CEP (Gunther's disease): UROS gene mutation, autosomal recessive
  • Most severe porphyria: photomutilation, hemolytic anemia, pink urine (uroporphyrin I)
  • Definitive treatment: bone marrow/stem cell transplant (corrects the enzyme defect)
  • Supportive: sun protection, blood transfusions, splenectomy

Q40 - Sjogren's Syndrome - Eye Manifestations

Q40: Sjogren's syndrome - ophthalmic/salivary nodes
Key teaching - Sjogren's:
  • Keratoconjunctivitis sicca (dry eyes), xerostomia (dry mouth)
  • Skin: purpura (cryoglobulinemia), annular erythema, RP
  • Antibodies: anti-Ro/SSA (most sensitive), anti-La/SSB
  • Treatment dry eyes: artificial tears, punctal plugs, cyclosporine eye drops

Q41 - Nifedipine vs Diltiazem

Q41: Raynaud's phenomenon - nifedipine vs diltiazem
Answer: Nifedipine (dihydropyridine CCB) is first-line for Raynaud's phenomenon
  • Nifedipine (long-acting) = first-line
  • Diltiazem = alternative if nifedipine not tolerated
  • Others: sildenafil, bosentan (for digital ulcers in SSc)

Q42 - Linear Morphea - Treatment

Q42: Linear morphea treatment
Answer: Methotrexate + oral prednisolone (combination)
  • Most effective for active linear morphea (especially "en coup de sabre" on face)
  • UVA1 phototherapy also effective
  • Topical tacrolimus for superficial limited disease

Q43 - PUVA Therapy

Q43: PUVA - which combination? UVA + psoralen; complication
Key teaching - PUVA:
  • Psoralen (8-MOP or 5-MOP) + UVA
  • Used for: psoriasis, vitiligo, CTCL, hand eczema
  • Complications: nausea, cataracts (wear UV-protective glasses), squamous cell carcinoma (long-term), phototoxicity

Q44 - Epidermolysis Bullosa - CDED Complication

Q44: EB with complication including GI, destructive arthritis, cardiomyopathy
Answer: In Epidermolysis Bullosa:
  • GI involvement: esophageal strictures, constipation, anal fissures (especially RDEB)
  • Dilated cardiomyopathy - rare complication of RDEB
  • Destructive arthritis: NOT typical of EB - this suggests another diagnosis (e.g., OMIM syndrome)

Q45 - Rectal Biopsy - Which Disease

Q45: Can be diagnosed by rectal biopsy - scenario
Answer: Diseases diagnosed by rectal biopsy:
  • Systemic amyloidosis (AA, AL) - rectal biopsy for amyloid deposits
  • Mastocytosis - mucosal biopsy
  • Hirschsprung disease (rectal biopsy: absence of ganglion cells)

Q46 - REM (Reticular Erythematous Mucinosis) Treatment

Q46: REM treatment asked
Answer: Hydroxychloroquine (antimalarials) - first-line for REM
  • REM: persistent reticular/net-like erythema on chest/back
  • Sun avoidance important
  • Responds well to chloroquine/hydroxychloroquine

Q47 - Scleromyxedema - Underlying Disease

Q47: Scleromyxedema - underlying disease
Answer: Multiple myeloma (IgG lambda paraproteinemia)
  • Scleromyxedema = lichen myxedematosus + systemic manifestations
  • Underlying: monoclonal gammopathy (IgG lambda most common)
  • Histology: mucin deposition, fibroblast proliferation, fibrosis
  • Treatment: IV immunoglobulin (IVIG), thalidomide, bortezomib

Q48 - Pellagra - Investigation

Q48: Pellagra investigation, diagnosis asked
Key teaching - Pellagra (Niacin/B3 deficiency):
  • The 4 D's: Dermatitis, Diarrhea, Dementia, Death
  • Dermatitis: photosensitive, symmetric ("Casal's necklace" on neck)
  • Investigation: 24-hour urine N-methylnicotinamide (decreased)
  • Associated with: corn-based diet, carcinoid syndrome, isoniazid therapy, Hartnup disease

Q49 - Vitamin D - Deficiency

Q49: Vitamin D deficiency - correlation asked
Key dermatology relevance:
  • Vitamin D produced in skin: 7-dehydrocholesterol → pre-Vit D3 (UVB) → Vit D3
  • Low Vit D associated with: psoriasis, atopic dermatitis, alopecia areata
  • Serum 25-OH vitamin D: normal >30 ng/mL

Q50 - Mastocytosis - Darier's Sign

Q50: Mastocytosis scenario - Darier's sign
Key teaching:
  • Darier's sign: stroking a mast cell lesion causes urtication (wheal and flare)
  • Pathognomonic for mastocytosis
  • KIT D816V mutation
  • Tryptase elevated
  • Treatment: antihistamines, cromolyn sodium, avoid triggers

Q51 - Rosacea - Corneal Changes + Complication

Q51: Rosacea scenario - post-fixed PR + corneal change. Complication asked: i. Blindness ii. Behavioral changes
Answer: i. Blindness - due to ocular rosacea
  • Ocular rosacea: blepharitis, recurrent chalazion, keratitis
  • Rosacea keratitis can lead to corneal scarring and blindness
  • Treatment: oral doxycycline, topical cyclosporine eye drops, lid hygiene

Q52 - Toxic Shock Syndrome

Q52: Toxic shock syndrome - cause asked
Key teaching - TSS:
  • Staphylococcal TSS: TSST-1 superantigen, associated with tampon use
  • Streptococcal TSS: M-protein, associated with necrotizing fasciitis
  • Features: fever >38.9°C, hypotension, diffuse macular rash, desquamation (hands/feet after 1-2 weeks)
  • Treatment: clindamycin (stops toxin production) + beta-lactam

Q53 - Parvovirus B19 / Erythema Infectiosum

Q53: Scenario parvovirus B19 juvenile
Key teaching:
  • Erythema infectiosum (5th disease): "slapped cheek" rash
  • Caused by Parvovirus B19
  • Gloves and socks syndrome: acral purpuric eruption
  • In pregnancy: hydrops fetalis (aplastic crisis in fetus)

Q54 - Granuloma Inguinale (Donovanosis)

Q54: Granuloma inguinale - glands asked
Key teaching:
  • Caused by Klebsiella granulomatis (formerly Calymmatobacterium granulomatis)
  • Painless, beefy red, progressive ulcerative lesion
  • Diagnosis: Donovan bodies in tissue smear (macrophages containing bipolar staining bacteria)
  • Stain: Giemsa or Wright stain

Q55 - Chancroid Scenario

Q55: Chancroid scenario
Key teaching:
  • Caused by Haemophilus ducreyi
  • Painful genital ulcer + painful unilateral inguinal lymphadenopathy (bubo)
  • Gram stain: "school of fish" pattern
  • Treatment: azithromycin 1g single dose OR ceftriaxone 250mg IM

Q56 - Neisseria Meningitidis Scenario

Q56: N. meningitidis scenario
Dermatology relevance:
  • Meningococcemia: petechial/purpuric rash (non-blanching)
  • Purpura fulminans: extensive DIC, skin necrosis
  • Waterhouse-Friderichsen syndrome: bilateral adrenal hemorrhage
  • Treatment: IV penicillin/ceftriaxone immediately

Q57 - Tinea Pedis + Erythrasma

Q57: Tinea pedis scenario + erythrasma
Key teaching:
  • Erythrasma: Corynebacterium minutissimum, coral-red Wood's lamp fluorescence
  • Tinea pedis: KOH positive, Wood's lamp negative
  • Both can coexist in toe web spaces

Q58 - Linear Morphea - Methotrexate + Prednisolone

(See Q42 above for linear morphea treatment)

Q59 - PUVA - UVA + Psoralen

(See Q43 above)

Q60 - Porphyria - CDED Complication

Q60: Erythropoietic protoporphyria (EPP) with morphea/linear - which complication is inhibited? Options: i. GI bleed ii. Destructive arthritis iv. Cardiomyopathy
Answer: The key complication of EPP is hepatic disease/liver failure (protoporphyrin accumulation in liver)
  • GI bleed: less common
  • Cardiomyopathy: occurs in RDEB, not EPP

Q61 - Sezary Syndrome / CTCL

Q61: Scenario + oral ulcers
Key teaching - Sezary Syndrome:
  • Sezary triad: erythroderma + lymphadenopathy + circulating Sezary cells (CD4+CD7- cerebriform lymphocytes)
  • 1000 Sezary cells/mm³ or CD4:CD8 ratio >10
  • Oral ulcers suggest a systemic process - Behcet's vs SLE vs Sezary

Q62 - Acrodermatitis Enteropathica

Q62: Acrodermatitis enteropathica - underlying nutrient
Answer: Zinc deficiency
  • Autosomal recessive: SLC39A4 gene mutation (zinc transporter ZIP4)
  • Triad: dermatitis (perioral, perianal, acral) + diarrhea + alopecia
  • Also seen in: breastfed infants, TPN without zinc, alcoholics
  • Treatment: oral zinc supplementation

Q63 - Langerhans Cell Histiocytosis

Q63: Langerhans cell histiocytosis - Goblet cell scenario, oral ulcers
Key teaching - LCH:
  • CD1a+, CD207 (Langerin)+, S100+
  • Birbeck granules on EM ("tennis racket" shaped)
  • Can present with: seborrheic-like scalp rash, bone lesions (lytic), diabetes insipidus, oral/mucosal lesions
  • Classification: single system vs multisystem

Q64 - Argyria

Q64: Argyria - hyperpigmentation, etiology, other causes of slate-gray pigmentation
Key teaching - Argyria:
  • Argyria: silver deposition → blue-gray pigmentation (photodistributed, especially nose, ears, sclerae)
  • Other causes of blue-gray pigmentation: amiodarone, minocycline (type I-III), chlorpromazine, antimalarials
  • Mechanism in lichen planus: incontinence of melanin into dermis

Q65 - CGD (Chronic Granulomatous Disease)

Q65: CGD - action asked
Key teaching - CGD:
  • X-linked (most common) or autosomal recessive
  • Defect in NADPH oxidase → failure to produce reactive oxygen species
  • Recurrent bacterial (Staph aureus, Serratia, Burkholderia) and fungal (Aspergillus) infections
  • Skin: perianal/perirectal abscesses, suppurative lymphadenitis, lupus-like rash in carriers
  • Diagnosis: dihydrorhodamine (DHR) flow cytometry or NBT test

Q66 - Munchausen Syndrome + Olanzapine

Q66: Munchausen syndrome - olanzapine
Key teaching:
  • Dermatitis artefacta (factitious dermatitis): self-inflicted skin lesions
  • Delusional parasitosis (Ekbom syndrome): fixed belief of infestation
  • Treatment of delusional parasitosis: risperidone or olanzapine (atypical antipsychotics)
  • "Matchbox sign": patient brings in samples of "parasites" in a container

Q67 - Aortic Stenosis - Simple

Q67: Aortic stenosis associated skin finding
Answer: Heyde's syndrome - aortic stenosis + angiodysplasia + bleeding
  • Also: Osler-Weber-Rendu (HHT) - telangiectasias
  • Pseudoxanthoma elasticum: angioid streaks, arterial disease

Q68 - Melanoma - Back of Leg

Q68: MC melanoma at back of leg + type
Answer: Nodular melanoma or Superficial spreading melanoma
  • Superficial spreading melanoma: most common overall (70%)
  • Nodular melanoma: most aggressive, back/trunk/legs common locations
  • Acral lentiginous melanoma: MC in dark-skinned individuals (palms, soles, nails)
  • Lentigo maligna melanoma: face/sun-damaged skin in elderly

Q69 - Molluscum Contagiosum - Rafat Scenario

Q69: Molluscum contagiosum - treatment scenario
Key teaching:
  • Caused by Molluscum contagiosum virus (Poxvirus)
  • Umbilicated papules
  • Treatment: cryotherapy, curettage, topical imiquimod, cantharidin, potassium hydroxide 10%
  • In immunosuppressed: extensive, giant lesions

Q70 - Isotretinoin - CBC (Cholesterol)

Q70: Isotretinoin - check CBC, cholesterol reduction test
Monitoring on Isotretinoin:
  • Before starting: pregnancy test, LFTs, lipid profile, CBC
  • During treatment (monthly): LFTs, lipid profile, pregnancy test
  • Triglycerides: most affected (can rise significantly)
  • Stop if triglycerides >500 mg/dL (risk of pancreatitis)

Q71 - Hexheimer Reaction

Q71: Jarisch-Herxheimer reaction
Key teaching:
  • Occurs after treating spirochetal infections (syphilis, Lyme, leptospirosis)
  • Caused by release of lipoproteins from dying spirochetes → TNF-alpha surge
  • Presents: fever, chills, hypotension, worsening rash within 2-4 hours of first antibiotic dose
  • Treatment: supportive (antipyretics), NOT stopping antibiotics

Q72 - Morphological Indices - Independent Repeated Question

Q72: Morphological indices in leprosy (repeated question)
Key teaching:
  • Morphological Index (MI): percentage of solid-staining bacilli (viable)
  • Bacteriological Index (BI): total bacilli count (log scale 0-6+)
  • MI decreases before BI in treatment response
  • Used to monitor multibacillary leprosy treatment

Q73 - Monilethrix Scenario

Q73: Monilethrix scenario
Key teaching - Monilethrix:
  • Autosomal dominant hair shaft abnormality
  • Beaded hair with periodic narrowings (internodes) where the hair breaks
  • Gene: KRT81, KRT83, KRT86 (type II hair keratins) or DSG4
  • Short, fragile hair that breaks off; keratosis pilaris-like follicular papules
  • No cure; improves spontaneously, biotin may help

Q74 - Phaces Syndrome

Q74: Phaces syndrome - stork becker, median cleft
Key teaching - PHACES syndrome:
  • P: Posterior fossa brain malformations
  • H: Hemangioma (large, segmental, face/scalp)
  • A: Arterial anomalies
  • C: Cardiac defects + aortic coarctation
  • E: Eye anomalies
  • S: Sternal cleft / Supraumbilical raphe
  • Associated with: midline developmental defects, large plaque facial hemangiomas

Q75 - Kaposi Sarcoma

Q75: Kaposi sarcoma - DLSO, nail changes
Key teaching:
  • Caused by HHV-8 (KSHV)
  • Types: classic (elderly Mediterranean men), endemic (Africa), iatrogenic (transplant), epidemic (HIV-AIDS)
  • Spindle cell tumor with slit-like vascular spaces
  • Treatment: HAART (for AIDS-KS), radiotherapy, vinblastine, liposomal doxorubicin

Q76 - Erosive Pustular Dermatosis

Q76: Erosive pustular dermatosis
Key teaching:
  • Occurs in elderly, chronic sun-damaged scalp
  • Preceded by trauma, cryotherapy, or topical 5-FU
  • Presents: lakes of pus, crusted erosions on scalp → scarring alopecia
  • Treatment: topical tacrolimus or potent topical steroids; oral zinc

Q77 - CO2 Laser Complication

Q77: CO2 laser complication - hypopigmentation
Key teaching - CO2 laser complications:
  • Hypopigmentation (most common long-term complication)
  • Infection (HSV reactivation - prophylaxis with acyclovir required)
  • Prolonged erythema
  • Scarring
  • Milia formation
  • Post-inflammatory hyperpigmentation (in darker skin types)

Q78 - Which Laser Avoided in Rosacea

Q78: Which laser is avoided in Beckett heroin disease + rosacea? Options: PDL (Pulsed Dye Laser)
Answer: Actually, PDL is the TREATMENT of choice for rosacea telangiectasia - NOT avoided
  • CO2 laser may worsen rosacea
  • For Port wine stains: PDL is gold standard
  • For rosacea: PDL, KTP laser, IPL

Q79 - Ancylostoma braziliensis

Q79: Ancylostoma braziliensis
Key teaching - Cutaneous Larva Migrans:
  • Caused by Ancylostoma braziliensis (dog/cat hookworm)
  • "Creeping eruption" - serpiginous, intensely pruritic track
  • Usually on feet, buttocks (contact with contaminated sand)
  • Treatment: oral albendazole or ivermectin (topical thiabendazole also used)

Q80 - Sebopsoriasis / Inverse Psoriasis

Q80: Inverse psoriasis scenario, diagnosis
Key teaching:
  • Inverse/flexural psoriasis: affects intertriginous areas (axillae, groin, inframammary)
  • Salmon-pink plaques WITHOUT scale (moisture inhibits scale)
  • Treatment: low-potency topical steroids, calcineurin inhibitors (tacrolimus/pimecrolimus)

Q81 - Darier Disease Complication

Q81: Darier disease complication
Key teaching - Darier disease (Keratosis follicularis):
  • ATP2A2 gene mutation (SERCA2 calcium pump)
  • Greasy keratotic papules in seborrheic distribution, palmar pits, nail changes (V-shaped notching)
  • Complications: eczema herpeticum (Kaposi's VE) - most feared complication
  • Also: secondary bacterial infection, intellectual disability (in some)
  • Worsened by: heat, sunlight, friction, lithium

Q82 - CO2 Laser for Neurofibromas - Complication

Q82: CO2 laser for neurofibromas - complication
Answer: Hypopigmentation (same as Q77)
  • Also: recurrence of neurofibromas after CO2 laser
  • Multiple sessions often required in NF1

Q83 - Cyclic Neutropenia

Q83: Cyclic neutropenia scenario - what next step? No carboxylated feud + porphyrins next step + riboflavin
Key teaching:
  • Cyclic neutropenia: ELANE gene mutation, 21-day cycle
  • During nadir: oral ulcers, fever, lymphadenopathy, skin infections
  • Diagnosis: serial CBC twice weekly for 6-8 weeks
  • Treatment: G-CSF (filgrastim)

Q84 - Subcutaneous Fat Necrosis of Newborn

Q84: Subcutaneous fat necrosis - hypocalcemia/hypercalcemia
Key teaching:
  • Subcutaneous fat necrosis of the newborn (SCFN)
  • Firm, indurated nodules/plaques in neonates after birth asphyxia/hypothermia
  • Most important complication: hypercalcemia (can be severe, life-threatening)
  • Caused by: excess 1,25-dihydroxyvitamin D production by macrophages in the lesion
  • Monitor: serum calcium for months after lesions resolve
This covers all the identifiable questions from all 21 pages of your March 2025 Dermatology exam paper.
A note on the PDF: The paper appears to be handwritten notes/recall, so some questions had incomplete options or partial text. I've taught each one comprehensively based on what was decipherable.
Would you like me to:
  1. Drill you on any specific questions (quiz format)?
  2. Go deeper on any topic (e.g., blistering diseases, vasculitis, drug reactions)?
  3. Group questions by topic (e.g., autoimmune, infections, hair disorders)?
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