Redness and scaling over more than 90% of the body surface in an adult most often result from which cause?

Sezary syndrome (T-cell lymphoma)

Urticaria, skin tumours and cutaneous emergencies

22 NEET-PG practice questions on Urticaria, skin tumours and cutaneous emergencies, part of Dermatology. The first 22 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Pits on the palms, jaw cysts removed twice, calcification of the falx on skull X-ray and more than twenty basal cell carcinomas by the age of 30 are found in a man whose father had the same. Surgery is no longer practical for all his tumours. Which drug acts on the pathway his mutation disturbs?
1. AVismodegib
2. BImatinib
3. CVemurafenib
4. DSirolimus
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Answer: A · Vismodegib
Multiple early BCCs with palmar pits, odontogenic keratocysts and falx calcification are Gorlin (naevoid basal cell carcinoma) syndrome, from germline loss of PTCH1. Normally PTCH1 holds back Smoothened; without it the hedgehog pathway is constantly active. Vismodegib and sonidegib inhibit Smoothened and shrink BCCs in this syndrome and in advanced or metastatic BCC, though muscle cramps, taste loss and hair loss limit their use. Key point: Gorlin syndrome is PTCH1 loss; Smoothened inhibitors (vismodegib) treat its multiple BCCs.
- B: Imatinib targets BCR-ABL and KIT.
- C: Vemurafenib targets BRAF V600 in melanoma.
- D: Sirolimus inhibits mTOR and is used in tuberous sclerosis.
Question 2 · Easy
Redness and scaling over more than 90% of the body surface in an adult most often result from which cause?
1. AA reaction to a new drug
2. BA flare of psoriasis or eczema
3. CSezary syndrome (T-cell lymphoma)
4. DPityriasis rubra pilaris
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Answer: B · A flare of psoriasis or eczema
Erythroderma (exfoliative dermatitis) is redness and scaling of 90% or more of the skin. In adults, the commonest cause is a flare of an existing skin disease, chiefly psoriasis and eczema, often after abrupt steroid withdrawal or irritant treatment. Drugs are next, then cutaneous T-cell lymphoma, and some cases stay idiopathic. Key point: Adult erythroderma is most often a flare of psoriasis or eczema; drugs come next.
- A: Drugs are the second commonest cause, not the first.
- C: Sezary syndrome is an important but less common cause.
- D: Pityriasis rubra pilaris is a rare cause.
Question 3 · Medium
Comparing staphylococcal scalded skin syndrome (SSSS) with toxic epidermal necrolysis (TEN): 1. SSSS splits the epidermis at the granular layer. 2. Mucous membranes are usually spared in SSSS. 3. TEN is caused by an exfoliative toxin that cleaves desmoglein 1. 4. Frozen-section skin biopsy helps tell them apart. Which statements are correct?
1. A1, 2, 3 and 4
2. B2 and 3 only
3. C1, 2 and 4 only
4. D1, 3 and 4 only
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Answer: C · 1, 2 and 4 only
SSSS, mostly in young children, is caused by staphylococcal exfoliative toxins that cleave desmoglein 1, giving a superficial split at the granular layer; mucosae are spared and healing is without scarring. TEN is a drug-induced, T-cell-mediated full-thickness epidermal necrosis with mucosal involvement and a high mortality. A frozen section of the peeled skin shows a superficial split in SSSS and full-thickness necrosis in TEN. Key point: SSSS splits at the granular layer (toxin on desmoglein 1); TEN is full-thickness, drug-induced and involves mucosa.
- A: Statement 3 is wrong, so all four cannot be correct.
- B: Statement 3 is wrong and statements 1 and 4 are true.
- D: Statement 3 is wrong: the toxin causes SSSS, not TEN.
Question 4 · Medium
Liver metastases are found in a man treated a year ago for a 3 mm thick melanoma of the back, and molecular testing of the tumour shows a BRAF V600E mutation. Which targeted combination is most appropriate?
1. AImatinib with interferon-alpha
2. BCetuximab with cisplatin
3. CDabrafenib with trametinib
4. DVismodegib with sonidegib
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Answer: C · Dabrafenib with trametinib
About half of cutaneous melanomas carry an activating BRAF V600 mutation, which drives the MAPK pathway. A BRAF inhibitor (dabrafenib, vemurafenib, encorafenib) paired with a MEK inhibitor (trametinib, cobimetinib, binimetinib) gives fast responses and delays resistance better than either alone. Immune checkpoint inhibitors such as nivolumab with ipilimumab are the other main first-line choice. Key point: BRAF V600-mutant metastatic melanoma: BRAF plus MEK inhibitor, or checkpoint immunotherapy.
- A: Imatinib is for KIT-mutant tumours, and interferon is outdated.
- B: Cetuximab is an EGFR antibody for colorectal and head and neck cancer.
- D: Vismodegib and sonidegib treat advanced basal cell carcinoma.
Question 5 · Hard
Ten days after stopping oral prednisolone given by a local practitioner for 'allergy', a man with long-standing plaque psoriasis develops redness and fine scaling over 95% of the body, with chills. Temperature is 35.6 °C, pulse 108/min, ankle oedema is present and serum albumin is 2.6 g/dL (normal 3.5-5.0). He is admitted, kept warm in a side room and given fluids, emollients and wet wraps, with strict input-output charting. Blood cultures are sterile. He has normal renal function and BP, and he is not planning children. Which systemic drug gives the fastest control?
1. AMethotrexate
2. BCyclosporine
3. CAcitretin
4. DRestart oral prednisolone
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Answer: B · Cyclosporine
Steroid withdrawal is a classic trigger of erythrodermic psoriasis, which brings hypothermia, fluid and protein loss, high-output cardiac strain and sepsis risk. Supportive care comes first, and cyclosporine is the systemic drug with the fastest onset, often within 1-2 weeks, provided kidney function and blood pressure are normal; infliximab is the other rapid option. Methotrexate and acitretin act more slowly, and restarting steroids leads to a further rebound when they are stopped. Key point: Erythrodermic psoriasis needing rapid control: cyclosporine (or infliximab); never systemic steroids.
- A: Methotrexate works but more slowly than cyclosporine.
- C: Acitretin is slow and better for stable disease.
- D: Systemic steroids caused this flare and would cause another rebound.
Question 6 · Easy
Itchy wheals that come and go within hours have appeared on most days for 4 months in a bank cashier, without swelling of the lips or any clear trigger. Each wheal fades within a day without a mark. Which drug is the first-line treatment?
1. AMontelukast alone
2. BA 2-week course of oral prednisolone
3. CA daily non-sedating second-generation H1 antihistamine
4. DChlorpheniramine at bedtime
Answer and explanation in LearnFree account
Question 7 · Medium
On the sole of the right foot of a 60-year-old farmer from Tamil Nadu is a dark-brown, irregular, 2.5 cm patch with uneven colour that has grown over a year; a new raised nodule has appeared in it, and the adjacent nail fold is pigmented. Which subtype of melanoma is this most likely to be?
1. ASuperficial spreading melanoma
2. BPigmented basal cell carcinoma
3. CAcral lentiginous melanoma
4. DLentigo maligna melanoma
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Question 8 · Medium
Biopsy-proven infiltrative basal cell carcinoma of 1.2 cm on the ala of the nose is found in a retired postman. The margins are ill-defined clinically. Which treatment gives the highest cure rate while sparing tissue?
1. ATopical imiquimod cream
2. BMohs micrographic surgery
3. CCryotherapy with liquid nitrogen
4. DStandard excision with 4 mm margins
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Question 9 · Medium
After swimming in a cold mountain stream on a trek, a student developed wheals over the arms and trunk, then felt faint and needed help out of the water. Which test confirms the likely diagnosis?
1. AFirm stroking test of the back
2. BAutologous serum skin test
3. CExercise challenge test
4. DIce cube test on the forearm
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Question 10 · Medium
Statements about keratinocyte cancers: 1. Actinic keratosis can progress to squamous cell carcinoma. 2. Organ-transplant recipients have a far higher risk of SCC than of BCC. 3. Basal cell carcinoma commonly spreads to regional lymph nodes. 4. Arsenic in drinking water raises the risk of both BCC and SCC. Which are correct?
1. A1, 2, 3 and 4
2. B1, 2 and 4 only
3. C1 and 3 only
4. D2 and 3 only
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Question 11 · Easy
A non-healing ulcer with an everted, rolled edge is growing in an old burn scar on the leg. Which tumour is it most likely to be?
1. ASquamous cell carcinoma
2. BDermatofibrosarcoma protuberans
3. CBasal cell carcinoma
4. DMalignant melanoma
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Question 12 · Medium
Follow-up at 4 weeks: a schoolteacher with chronic spontaneous urticaria still has daily wheals despite fexofenadine 180 mg every morning, taken regularly. Thyroid function, CBC and CRP are normal, and there is no angioedema. What is the recommended next step?
1. AAdd a sedating antihistamine at night
2. BStart a 3-month course of oral prednisolone
3. CIncrease the same antihistamine up to four times the dose
4. DSwitch to a different standard-dose antihistamine
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Question 13 · Hard
On the third day of a scrotal swelling, a man with poorly controlled diabetes (glucose 412 mg/dL) arrives in the casualty with pain far out of proportion to the redness, a dusky, blistering patch spreading onto the perineum, crepitus under the skin and a foul discharge. His temperature is 39.2 °C, pulse 124/min and BP 94/60 mmHg; total count 24,000/µL and sodium 129 mmol/L. IV fluids, an insulin infusion and broad-spectrum antibiotics have been started, and the duty radiologist offers a contrast CT of the pelvis within the next 3 hours. What is the most important next step?
1. AUrgent radical surgical debridement in theatre
2. BIV antibiotics and review in 24 hours
3. CCT scan of the pelvis before any surgery
4. DHyperbaric oxygen therapy first
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Question 14 · Hard
Hereditary angioedema was diagnosed 2 years ago in a college student (low C4 and low C1-inhibitor level). She now arrives in the casualty with a hoarse voice, difficulty swallowing and swelling of the tongue that began 2 hours ago. There are no wheals. She has been given IM adrenaline, IV chlorpheniramine and hydrocortisone in the ambulance without improvement, and SpO2 is 96%. Which treatment should be given now?
1. AOral tranexamic acid
2. BC1-inhibitor concentrate or icatibant
3. CA second dose of IM adrenaline
4. DIV hydrocortisone at a higher dose
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Question 15 · Medium
Several reddish-brown macules and papules have been present on the trunk of a toddler since infancy. When one lesion is rubbed firmly with the blunt end of a pen, it becomes red, raised and itchy within minutes, while normal skin nearby shows no wheal. Which cell is responsible for this reaction?
1. AMast cell
2. BLangerhans cell
3. CEosinophil
4. DMelanocyte
Answer and explanation in LearnFree account
Question 16 · Medium
Numerous freckles and dry skin appeared on the sun-exposed skin of a boy before age 2, with severe sunburn after minimal exposure. At 10 he already has two basal cell carcinomas and a squamous cell carcinoma on the face, and he has photophobia. His parents are first cousins. Which process is defective?
1. ABase excision repair of oxidised bases
2. BHomologous recombination of double-strand breaks
3. CMismatch repair of replication errors
4. DNucleotide excision repair of UV-induced DNA damage
Answer and explanation in LearnFree account
Question 17 · Hard
Six months of daily wheals with weekly lip and eyelid swelling continue in a software engineer with chronic spontaneous urticaria despite levocetirizine at four times the standard dose for 2 months, taken regularly. The disease is ruining her sleep and work (UAS7 score 32). She has had three short steroid courses this year, and each time the wheals returned within a week of stopping. Physical triggers have been excluded by history and challenge tests. Her CBC, TSH and CRP are normal, and she is not pregnant. Which treatment is recommended next?
1. AAdd omalizumab injections every 4 weeks
2. BSwitch to chlorpheniramine four times daily
3. CAdd montelukast and ranitidine
4. DLong-term prednisolone at 10 mg daily
Answer and explanation in LearnFree account
Question 18 · Easy
Near the inner canthus of a coconut climber, a shiny, pearly papule with fine surface vessels and a raised margin has enlarged over 3 years and now bleeds and crusts in its centre. No nodes are palpable. What would a biopsy most likely show?
1. AKeratin pearls with intercellular bridges
2. BBasaloid nests with peripheral palisading
3. CNests of atypical melanocytes at the junction
4. DA crater filled with a central keratin plug
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Question 19 · Easy
In a primary cutaneous melanoma without metastasis, which factor best predicts survival?
1. ADiameter of the lesion
2. BDegree of pigmentation
3. CBreslow thickness
4. DClark level of invasion
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Question 20 · Hard
Histopathology report from an excision biopsy of a changing mole on the calf of a woman of 42: superficial spreading melanoma, Breslow thickness 1.6 mm, not ulcerated, mitoses 2/mm², deep margin clear by 1 mm. Clinical examination and ultrasound of the groin show no enlarged nodes, and staging CT is clear. What is the most appropriate next step?
1. AAdjuvant radiotherapy to the scar
2. BElective groin lymph node dissection
3. CWide local excision with 5 mm margins only
4. DWide local excision with 1-2 cm margins and sentinel node biopsy
Answer and explanation in LearnFree account
Question 21 · Medium
Burning rather than itchy wheals, each lasting 2-3 days and leaving a bruise-like stain as it fades, have recurred for 3 months in a woman with joint pains. ESR is 62 mm/h and serum C3 and C4 are low. Antihistamines have not helped. Which investigation is most useful next?
1. ASerum total IgE level
2. BSkin biopsy of a fresh wheal
3. CAutologous serum skin test
4. DPatch testing with a standard series
Answer and explanation in LearnFree account
Question 22 · Medium
In the casualty at 11 p.m., a man with hypertension has swelling of the tongue and lower lip for 3 hours, without wheals or itch. He has taken enalapril for 2 years and has had two milder episodes in recent months. He has no stridor and saturations are normal. IV chlorpheniramine and hydrocortisone have not helped. What is the most important step in his management?
1. AOrder serum C1-inhibitor levels
2. BStop enalapril permanently
3. CSwitch enalapril to ramipril
4. DStart oral cetirizine for prevention
Answer and explanation in LearnFree account

Urticaria, skin tumours and cutaneous emergencies

Pits on the palms, jaw cysts removed twice, calcification of the falx on skull X-ray and more than twenty basal cell carcinomas by the age of 30 are found in a man whose father had the same. Surgery is no longer practical for all his tumours. Which drug acts on the pathway his mutation disturbs?

Redness and scaling over more than 90% of the body surface in an adult most often result from which cause?

Liver metastases are found in a man treated a year ago for a 3 mm thick melanoma of the back, and molecular testing of the tumour shows a BRAF V600E mutation. Which targeted combination is most appropriate?

Itchy wheals that come and go within hours have appeared on most days for 4 months in a bank cashier, without swelling of the lips or any clear trigger. Each wheal fades within a day without a mark. Which drug is the first-line treatment?

On the sole of the right foot of a 60-year-old farmer from Tamil Nadu is a dark-brown, irregular, 2.5 cm patch with uneven colour that has grown over a year; a new raised nodule has appeared in it, and the adjacent nail fold is pigmented. Which subtype of melanoma is this most likely to be?

Biopsy-proven infiltrative basal cell carcinoma of 1.2 cm on the ala of the nose is found in a retired postman. The margins are ill-defined clinically. Which treatment gives the highest cure rate while sparing tissue?

After swimming in a cold mountain stream on a trek, a student developed wheals over the arms and trunk, then felt faint and needed help out of the water. Which test confirms the likely diagnosis?

A non-healing ulcer with an everted, rolled edge is growing in an old burn scar on the leg. Which tumour is it most likely to be?

Follow-up at 4 weeks: a schoolteacher with chronic spontaneous urticaria still has daily wheals despite fexofenadine 180 mg every morning, taken regularly. Thyroid function, CBC and CRP are normal, and there is no angioedema. What is the recommended next step?

Several reddish-brown macules and papules have been present on the trunk of a toddler since infancy. When one lesion is rubbed firmly with the blunt end of a pen, it becomes red, raised and itchy within minutes, while normal skin nearby shows no wheal. Which cell is responsible for this reaction?

Near the inner canthus of a coconut climber, a shiny, pearly papule with fine surface vessels and a raised margin has enlarged over 3 years and now bleeds and crusts in its centre. No nodes are palpable. What would a biopsy most likely show?

In a primary cutaneous melanoma without metastasis, which factor best predicts survival?

Burning rather than itchy wheals, each lasting 2-3 days and leaving a bruise-like stain as it fades, have recurred for 3 months in a woman with joint pains. ESR is 62 mm/h and serum C3 and C4 are low. Antihistamines have not helped. Which investigation is most useful next?