Previous year question on pemphigus vulgaris based on neet pg, usmle, plab and fmge or mci screening exams

A 27-year-old sexually active male develops a vesiculobullous lesion on the glans soon after
taking tablet paracetamol for fever. The lesion healed with hyperpigmentation. The most
likely diagnosis is:
A: Behcet's syndrome
B:
Herpes
genitalis
C: Fixed drug eruption
D: Pemphigus vulgaris
Correct Ans:C
Explanation
An adverse cutaneous reaction to an ingested drug with characteristic clinical features is
fixed drug eruption. Presentation with a solitary lesion in the genital skin that heals with
hyperpigmentation. Soon after ingestion of paracetamol, one of the most commonly
implicated agents for FDE, leads to the diagnosis of FDE.
Ref: Anthony Du Vivier, Phillip H. McKee, Chapter 17, “Reactive Disorder of The Skin and
Drug Eruptions”, In the book, “Atlas of Clinical Dermatology”, Elsivier Publication, 2002,
3rd Edition, Spain, Page 367
Sample Previous Year Question on Pemphigus vulgaris based on previous Year
Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit
www.medicoapps.org for more such Quizzes
A 22 year old female presents with dirty warty papules in the seborrheic areas especially in
the summer. Her father also gives a h/o similar lesions. What is the most probable
diagnosis?
A: Pemphigus foliaceus
B:
Keratosis
pilaris
C: Darier’s disease
D: Seborrheic dermatitis
Correct Ans:C
Explanation
It is also known as Keratosis follicularis with autosomal dominant inheritance.

The “dilapidated brick wall” appearance is classically seen in the histopathology of the
following?
A: Hailey Hailey disease
B:
Pemphigus
vulgaris
C: Darier's disease
D: Bullous pemphigoid
Correct Ans:A
Explanation
Hailey Hailey disease/familial benign chronic pemphigus has full thickness partial
acantholysis resulting in this appearance.
Ref: Rook Textbook of Dermatology, 8th Edition, Page 39.33.
Koebner's phenomenon is seen in all of the following conditions, EXCEPT:
A: Lichen planus
B:
Ichthyosi
s
C: Psoriasis
D: Pemphigus
Correct Ans:B
Explanation
Koebner’s phenomenon refers to development of morphologically identical lesions in the
traumatized uninvolved skin of the patients who have cutaneous diseases. It is also known
as isomorphic phenomenon.
Conditions associated with Koebner’s phenomenon are:
 Warts

 Molluscum contagiosum
 Autoimmune (vitiligo)
 Psoriasis
 Pemphigus
 Lichen planus
Ref: An Aid to the MRCP: Essential Lists, Facts and Mnemonics By Nicholas Boeckx, page
184.
A 30 year old pregnant woman presents to a physician with painful oral ulcers. Physical
examination demonstrates widespread erosions of her mucous membranes. Close
examination reveals a friable mucosa, but no well-defined aphthous ulcers. Biopsy of
perilesional mucosa demonstrates acantholysis; direct immunofluorescence demonstrates
an intraepidermal band of IgG and C3. Which of the following is the most likely diagnosis?
A: Bullous pemphigoid
B: Dermatitis herpetiformis
C: Herpes simplex I
Correct Ans:D
Explanation
This is pemphigus vulgaris, in which autoantibody directed against transmembrane
cadherin adhesion molecules induced acantholysis (breakdown of epithelial cell-cell
connections) with resulting intraepidermal blister formation. It may develop spontaneously
or following triggers such as drugs (thiols, penicillamine), physical injury (burns), cancer,
pregnancy, other skin diseases, and emotional stress. Pemphigus vulgaris is a relatively
rare blistering disease; it is seen more commonly in patients with Jewish or Mediterranean
heritage. In addition to the usually prominent oral ulcers, uncomfortable skin erosions can
also occur when the blisters rupture rapidly and are not observed. The epidermis at the
edge of these erosions is often easily disrupted by sliding pressure (Nikolsky sign).
Bullous pemphigoid is characterized by deeper blisters, occurring at the dermal-epidermal
junction.
Dermatitis herpetiformis is characterized by severe, intense pruritus and groups of papules
and vesicles.
Herpes simplex I or II can show multinucleated giant cells on scrapings of the ulcer base.
Ref: Suurmond D. (2009). Section 34. Disorders of the Mouth. In D. Suurmond
(Ed), Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e.

Tzanck preparation is used for the following skin conditions, EXCEPT:
A: Pemphigus
B: SSS syndrome
C: Senear Usher syndrome
D: Fungal infections
Correct Ans:D
Explanation
Microscopic examination of cells obtained from the base of vesicles (Tzanck preparation)
may reveal the presence of acantholytic cells in the acantholytic diseases (e.g., pemphigus
or SSS syndrome) or of giant epithelial cells and multinucleated giant cells (containing 10–
12 nuclei) in herpes simplex, herpes zoster, and varicella. Material from the base of a
vesicle obtained by gentle curettage with a scalpel is smeared on a glass slide, stained with
either Giemsa or Wright stain or methylene blue, and examined to determine whether there
are acantholytic or giant epithelial cells, which are diagnostic.
Pemphigus erythematosus is also known as Senear-Usher syndrome.
Ref: (2013). Introduction. In Wolff K, Johnson R, Saavedra A.P. (Eds), Fitzpatrick’s Color
Atlas and Synopsis of Clinical Dermatology, 7e.
A 30 year old male presents with itchy papulo-vesicular lesions on the extremities, knees,
elbows and buttocks since one year. Direct immunofluorescence staining of the lesions
showed IgA deposition at dermoepidermal junction. Which of the following represents the
most probable diagnosis?
A:
Pemphigus
vulgaris
B: Bullous pemphigoid
C: Dermatitis herpetiformis
D: Nummular eczema
Correct Ans:C
Explanation

Patient is showing features of dermatitis herpetiformis. Dermatitis herpetiformis is a chronic, intensely
itchy blistering disease characterized by the presence of papules and vesicles occurring predominantly
on the extensor surfaces of the body such as the elbows, knees, buttocks and scapula. It is seen in
association with gluten sensitive enteropathy.
Diagnosis is made by the presence of IgA deposits in the dermoepidermal junction by direct
immunoflouresence examination of a perilesional or normal appearing skin biopsy sample. Treatment
includes dapsone and gluten free diet.
Ref: NORD Guide to Rare Disorders: National Organization for Rare Disorders, Page 103; Atlas of
Clinical Dermatology By Anthony Du Vivier, 3rd Edition, Pages 418, 426; Dermatology in
Clinical Practice By S. W. Lanigan, Page 170
A 40 year old male developed persistant oral ulcers followed by multiple flaccid bullae on
trunk and extremities. Direct immunofluorescence examination of a skin biopsy showed
intercellular IgG deposits in the epidermis. The most probable diagnosis is:
A:
Pemphigus
vulgaris
B: Bullous Pemphigoid
C: Bullous Lupus erythematosus
D: Epidermolysis bullosa acquisita
Correct Ans:A
Explanation
It is an autoimmune intraepidermal blistering disease due to antibodies against desmoglein
3. It begins as painful oral erosions followed by flaccid blisters on the trunk, face, scalp.
Ref: Current Literature Dermatology By Pasricha, Pages 197, 202; Rook’s Textbook of
Dermatology, 8th Edition.
Which of the following disorder is associated with acantholysis?
A: Pemphigoid
B: Pemphigus vulgaris
C: Erythema multiforme

D: Dermatitis herpetiformis
Correct Ans:B
Explanation
Acantholysis refers to loss of cohesion between epidermal cells as a result of destruction of
intercellular substance. Acantholytic cells are round cells with large hyperchromatic nuclei
and perinuclear halo. The primary lesion of pemphigus vulgaris is acantholysis in the
epidermis. Its histologic hallmark is acantholysis which is suprabasal, and the basal cells
remain attached to the basement membrane.
Ref: Tropical Dermatopathology By Singh, Page 121; Pathology of The Head and Neck By
Antonio Cardesa, Page 74.
A 45 yr old female developed recurrent oral erosions followed by multiple flaccid bullae on
trunk and extremities. A tzanck smear showed acantholytic cells and direct
immunofluoroscence showed intercellular IgG deposits in the epidermis. The most probable
diagnosis is:
A: Bullous Pemphigoid
B: Stevens Johnson syndrome
C: Herpes simplex 1 infection
Correct Ans:D
Explanation
Recurrent, painful oral lesions and cutaneous lesions in the form of flaccid bullae are
characteristic of phemphigus vulgaris. Positive Tzanck smear, IgG deposits on direct
immunofluoroscence positive nikolsky’s sign are features of phemphigus vulgaris.
Ref: Textbook of Dermatology, Venereology and Leprology By Devinder Mohan Thappa, 2nd
Edition, Chapter 12, Pages 152-53; Dermatology (A coloured Hand Textbook) By R. J. G.
Rycroft, S. J. Robertson, Sarah H. Wakeli, 2nd Edition, Part 1, Pages 54, 55

Itching associated with linear IgA deposition in dermal papillae is a feature of:
A: Bullous disease of childhood
B:
Lichenoid bullous
disease
C: Dermatitis herpetiformis
Correct Ans:C
Explanation
The cutaneous lesions of Dermatitis herpetiformis (DH) in childhood resemble those in adult and are
severely pruritic papulovesicles. DH is associated with granular deposition of IgA antibody within the
dermal papillae.
Ref: Cambridge Textbook of Accident and Emergency Medicine edited by David V. Skinner, Andrew
Swain, Colin Robertson, J. W. Rodney Peyton, 1997, Page 1051
Which of the following drug is not associated with drug induced pemphigus?
A: Rifampicin
B:
Penicilli
n
C: Captopril
D: Furosemide
Correct Ans:D
Explanation
Penicillin, cephalosporins, penicillamine, rifampicin, captopril, piroxicam, phenylbutazone
are drugs commonly associated with drug induced pemphigus.
Pemphigus vulgaris is characterized by all, except:

A: Positive Nikolsky’s sign
B:
Oral
erosions
C: Subepidermal bulla
D: Tzanck smear showing acantholytic cells
Correct Ans:C
Explanation
Pemphigus vulgaris is an intraepidermal blistering disease.
Scenario: A 35 year old lady is diagnosed with Pemphigus Vulgaris by her dermatologist.
Assertion: Pemphigus vulgaris presents with flaccid blisters and oral erosions in a middle aged
person.
Reason: It is a intraepidermal blistering disorder due to antibodies against desmogleins.
A: Both Assertion and Reason are true, and Reason is the correct explanation for Assertion
B:
Both Assertion and Reason are true, and Reason is not the
correct explanation for Assertion
C: Assertion is true, but Reason is false
D: Assertion is false, but Reason is true
Correct Ans:A
Explanation
Pemphigus vulgaris is an intraepidermal blistering disease due to antibodies against
desmogleins (epidermal attachment complexes). It presents with flaccid blisters and oral
erosions in a middle aged person. The subepidermal blistering disorders present with tense
blisters.
Ref: Rook’s Textbook of Dermatology, 8th Edition, Page 40.3

A person presents with hemorrhagic fluid in a tense blister at dermoepidermal junction.
Most probable diagnosis is:
A: Pemphigoid
B: Pemphigus vulgaris
C: Pemphigus vegetans
D: Drug induced pemphigus
Correct Ans:A
Explanation
The pemphigoid group includes a series of chronic diseases in which blisters form within
the lamina lucida of the basement membrane dermoepidermal junction). The blister roof is
thus the entire epidermis so it is stable. Frequently the blisters are hemorrhagic, fluid filled
and tense. No accantholysis occurs, so the Tzanck test is negative. Antibodies are directed
against various components of the basement membrane zone.
Characteristic of pemphigus vulgaris is an intradermal blister occurring immediately above
the basal cell layer and associated with acantholytic cells. The blisters rapidly ruptures,
leaving non healing, painful erosions.
Pemphigus vegetans usually presents clinically as serpiginous ulcers. Microscopically, the
epithelium tends to proliferate and become verruciform. Acantholytic cells may not be
conspicuous and eosinophil microabscesses are the most typical histological feature.
Drug induced pemphigus can present as pemphigus foliaceous, pemphigus erythematosus,
or as pemphigus vulgaris. Moist erythematous crusted scaling plaques and superficial
friable blisters are seen. Common drugs responsible are thiol compounds, drugs having a
sulph-hydryl group, penicillamine.
Fogo selvagem is a type of:
A:
Pemphigus
vulgaris
B: Pemghigus vegetans
C: Pemphigus foliaceus
D:
Bullous
pemphigoid
Correct Ans:C
Explanation

Endemic pemphigus foliaceus common in rural parts of South America, particularly certain
states of Brazil is known as fogo selvagem (wild fire) caused by bite of black fly.
Ref: Rook's textbook of dermatology, 8th edition, Pg 40.13
FTU is a measure of:
A: Area involved in severe drug reactions
B:
Amount of topical drug to be
applied
C: Mucosal involvement in pemphigus
D: Concentration of drug in topical preparations
Correct Ans:B
Explanation
An approximate practical measure of topical medication is the fingertip unit, the quantity of
ointment, extruded from a tube with a nozzle of 5 mm diameter extending from the distal
crease of the forefinger to ventral aspect of the fingertip. This unit weighs approximately
0.49 g in males and 0.43 g in females and covers, on average, an area of approx 300 cm2.
Which of the following presents with a "string of pearl appearance"?
A:
Pemphigus
vulgaris
C: Linear IgA disease
Correct Ans:C
Explanation

The lesions in Linear IgA disease with a bimodal age distribution ie <5yrs & > 60 yrs
comprise of urticated plaques and papules, and annular, polycyclic lesions often with
blistering around the edge, the string of pearls sign/cluster of jewels sign.
A biopsy of affected skin in Pemphigus vulgaris would show which of the following?
A: Acantholysis
B: Balloon degeneration
C: Reticular changes
D: Spongiosis
Correct Ans:A
Explanation
The pathologic changes in pemphigus vulgaris are acantholysis, clefts, and blister formation
in the intraepidermal areas. Acantholysis is the separation of keratinocytes from one
another. The loss of cohesion or contact between cells begins with the detachment of
tonofilaments from desmosomes. Evidence indicates that an IgG autoantibody actually
induces these changes.
Good to know:
 Balloon degeneration and reticular changes are both histologic markers
of herpes simplex viral-induced lesions.
 Spongiosis is a general term referring to serous exudates between cells of
the epidermis, with an inflammatory infiltrate in the dermis. This is
frequently seen indermatitis lesions.
Ref:Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J.L., Loscalzo J. (2012).
Chapter 54. Immunologically Mediated Skin Diseases. In D.L. Longo, A.S. Fauci, D.L. Kasper,
S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
Which of the following tests would be MOST useful for confirmation of Pemphigus vulgaris?

A: Bacterial culture
B: Complete blood count
C: Fungal culture
D: Tissue biopsy with direct immunofluorescence
Correct Ans:D
Explanation
Direct immunofluorescence (DIF) is of great value in the early diagnosis of pemphigus
vulgaris. DIF shows intercellular IgG throughout the epidermis or the oral epithelium. IgG
is found in both involved and clinically normal skin in nearly all patients with pemphigus. In
acantholytic areas, C3 deposition is also reliably found. DIF results remain positive for a
long time and may still be positive many years after clinical remission.
 Bacterial culture is helpful in superinfected lesions, but does not help in
confirming a diagnosis of pemphigus.
 Complete blood count is helpful in infectious processes.
 Fungal culture is used in tinea lesions.
Ref: Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J.L., Loscalzo J. (2012).
Patient with gluten-sensitive enteropathy has a lifelong history of periodic crops of
intensely pruritic, grouped, papular or vesicular lesions on the elbows, knees, sacrum, and
shoulders. Because the vesicles are intensely pruritic, the patient routinely scratches the
top off them, which relieves the pruritus. Which of the following is the most likely
diagnosis?
A: Bullous pemphigoid
B: Dermatitis herpetiformis
C: Herpes simplex I
Correct Ans:B
Explanation
The condition described is dermatitis herpetiformis, which is strongly associated with
gluten-sensitive enteropathy (celiac sprue), and often has a life-long, intermittent course.
Clinically, patients have (excoriated) groups of papules and vesicles on an erythematous
base. The lesions tend to involve the extensor surfaces of the extremities and the buttocks.
Microscopically, the lesions show subepidermal papillary dermal neutrophilic abscesses,

with granular deposits of IgA and C3 in dermal papillary tips. Patients may respond
dramatically to dapsone therapy.
Bullous pemphigoid produces large, tense blisters.
Herpes simplex I is characterized by crops of vesicles, but is not particularly associated
with gluten-sensitive enteropathy.
Pemphigus vulgaris usually shows prominent oral involvement.
Ref: DeWitt C.A., Buescher L.S., Stone S.P. (2012). Chapter 153. Cutaneous Manifestations
of Internal Malignant Disease: Cutaneous Paraneoplastic Syndromes. In L.A. Goldsmith, S.I.
Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in
General Medicine, 8e.
'Bulla spread sign' is seen in which of the following condition?
A: Herpes gestationalis
C: Pemphigus vulgaris
D: Herpes simplex
Correct Ans:C
Explanation
Pemphigus vulgaris is associated with positive Nikolsky sign and Asboe- Hansen sign or
Bullae spread sign. In positive bullae spread sign, pressing the top of existing bullae will
lead to spread of bullae to adjacent normal appearing skin. Positive Nikolsky sign refers to
shearing of the epidermis by exerting lateral pressure on the normal skin adjacent to an
active blister.
Pemphigus vulgaris is an acquired chronic disease in which blisters develop on normal
appearing skin and mucous membrane. In this condition the pemphigus antibodies attach
to extracellular domain of desmoglein and interfere with its attachment to similar domains
on other cells reducing cell cell adherence. It is characterised by the development of flaccid
clear blister which rupture and evolve into an inflamed erosion.
Ref: Blistering Skin Diseases By Lawrence S. Chan page 26.
A 30 year old male presented with itchy, papulovesicular lesions in the extensor aspect of
elbows and knees. Biopsy of the lesion showed dermoepidermal blister with micro-

abscesses. Immunofluorescence showed deposits of IgA in the tips of dermal papillae. What
is the MOST likely diagnosis?
A: Bullous Impetigo
Correct Ans:D
Explanation
sensitive enteropathy. In this condition absorption of gluten induces the formation of
circulating immune complexes which deposit in the dermal papillae causing inflammation
and dermoepidermal split.
Skin lesions are in the form of extremely itchy grouped papulovesicular lesions that develop
on normal or erythematous skin. The most frequently involve the extensors(elbow, knee,
buttocks, shoulder and sacral area). Biopsy shows: dermoepidermal blister with collection
of polymorphs at the tip of dermal papillae.Immunofluorescence showed deposits of IgA in
the tips of dermal papillae. Serology: Anti endomysial and anti reticulin antibodies are
present in most patients.
Ref: Illustrated Synopsis Of Dermatology & Sexually Transmitted Diseases (3Nd By Khanna
page 71.
Intraepidermal bullae formation occur in which of the following condition?
A: Bullous Impetigo
Correct Ans:C
Explanation
Pemphigus vulgaris is an intraepidermal bullous disorder where the split is suprabasal.
Pemphigus is an autoimmune disorder characterised by the production of IgG
autoantibodies against desmoglein which are involved in intercellular adhesion. These
antibodies induce keratinocytes to release serine proteases which dissolve the intercellular
substance.
The site of split in 4 main variants of pemphigus are:

 Pemphigus vulgaris: split is suprabasal
 Pemphigus vegetans: split is suprabasal
 Pemphigus foliaceus: blister is either in the granular layer or just below the
horny layer
 Pemphigus erythematosus: blister is either in the granular layer or just
below stratum corneum
Ref: Illustrated Synopsis Of Dermatology & Sexually Transmitted Diseases By Khanna page
64.
A 30 year old male presents to the dermatologist with silvery, scaling plaques on his elbows
and knees. His mother has been afflicted with the same condition in the past. The most
likely diagnosis is ?
A:
Acne
rosacea
B: Acne vulgaris
D: Psoriasis vulgaris
Correct Ans:D
Explanation
Psoriasis vulgaris usually appears on the nails, knees, elbows, and scalp. It does not
generally affect the mucous membranes. Lesions are well-demarcated coral-colored
plaques with a white or silvery scale (classic clue). Histologically, epidermal hyperplasia
causing thickening and lengthening of the rete ridges is apparent, as is thinning of the
epidermis over the dermal papillae. There is a recognized genetic component to this
condition. Peak incidence is at age 30.
Here's a point-saving strategy: It is easy to get confused on this question because of the
similar looking answer choices, especially under time pressure. Be extra careful in such
cases to mark the proper choice on your answer grid.
Acne rosacea affects the central face. Erythema, telangiectasias, acneform lesions (papules,
cysts, pustules), and rhinophyma (telangiectasias and hyperplasia of nasal soft tissue) are
found in various combinations. It is common from ages 30-50. Women are affected three
times more frequently than men, but the syndrome is more severe in the latter.
Acne vulgaris causes comedones, papules, and cysts. It may be related to hormones, drugs,
diet, irritants, and genetic factors. Allergy to Propionibacterium acnes has been found to
contribute to this condition.
Pemphigus vulgaris starts with small vesicles, usually on the oral or nasal mucosa, then
spreads to other parts of the body. Bullae are delicate and flaccid. The condition is due to
autoantibodies to intercellular junctions between keratinocytes. Nikolsky's sign (production

of blistering by light stroking or rubbing of the skin) is positive. Pemphigus is most common
from ages 40-60.
Ref: Suurmond D. (2009). Section 3. Psoriasis. In D. Suurmond (Ed), Fitzpatrick's Color
Atlas & Synopsis of Clinical Dermatology, 6e.
A 60 year old male presents to the dermatologist with a complaint of tender blisters on his
arm and flank. Physical examination reveals blisters and flaccid bullae; a few have
ruptured, leaving red, sore, denuded areas. Which of the following findings would suggest
the diagnosis of pemphigus vulgaris as opposed to bullous pemphigoid?
A: Eosinophils within bullae
B: IgA deposits on basement membrane
C: Negative Nikolsky sign
D: Oral mucosal lesions
Correct Ans:D
Explanation
Pemphigus vulgaris is associated with chronic, severe bullae formation on the skin and oral
mucosa. Mucosal lesions are extremely rare in bullous pemphigoid. This can be used
clinically to guide therapy, although a skin biopsy should be taken to confirm the diagnosis.
Both diseases are characterized by formation of tender bullae that can rupture,leaving red,
raw areas. Pemphigus vulgaris patients eventually became febrile and lose weight, and if
untreated, most will die within one year. Bullous pemphigoid lesions tend to heal and the
patients do very well. This prognostic difference is an important distinction in
dermatological medicine.
Eosinophils within blisters provide an important clue supporting bullous pemphigoid as the
diagnosis which must be ascertained with histologic examination. The vesicles in
pemphigus vulgaris mostly contain rounded acantholytic keratinocytes "floating" within.
IgA deposits seen with immunofluorescence on the basement membrane is characteristic of
a third bullae-forming disease known as dermatitis herpetiformis. Vesicles form between
the dermal-epidermal junction. The disease is associated with gluten sensitivity and celiac
disease.
IgG autoantibody activity is common to both pemphigus vulgaris and bullous pemphigoid.
Ref: Payne A.S., Stanley J.R. (2012). Chapter 54. Pemphigus. In K. Wolff (Ed),Fitzpatrick's
Dermatology in General Medicine, 8e.

The day after playing in the high grasses of a neighbor's fields, an 8 year old boy develops a
weeping, vesicular, erythematous, and itchy rash on his arms, legs, and neck. Which of the
following best describes this inflammatory response?
A: Erythema nodosum
B:
Pemphigu
s
C: Psoriasis
D: Spongiotic dermatitis
Correct Ans:D
Explanation
Spongiotic dermatitis is seen in cases of contact dermatitis, such as poison ivy exposure.
The accumulation of inflammatory cells in the superficial dermis causes marked edema,
which splays epidermal keratinocytes apart and giving a spongy appearance to intercellular
bridges. Grossly, the skin has a weepy appearance with frequent blistering.
Erythema nodosum is a form of panniculitis, which is chronic inflammation in the
subcutaneous fat lobules. Erythema nodosum presents as painful erythematous nodules,
often with fever and malaise. It is associated with infections and drug reactions, and is not
a contact dermatitis.
Pemphigus is a genetic blistering disorder due to the production of antibodies to the
intercellular cement substances in skin and mucous membranes.
Psoriasis is a common chronic inflammatory disease causing plaques and scales, typically
on elbows, knees, and scalp. The pathogenesis of psoriasis is still unclear; it may be a
complement-mediated autoimmune process.
Ref: McCalmont T.H. (2010). Chapter 8. Diseases of the Skin. In S.J. McPhee, G.D. Hammer
(Eds), Pathophysiology of Disease, 6e.
A patient presents with scarring Alopecia, thinned nails, hypopigmented macular lesions
over trunk and oral mucosa. The diagnosis is :
A: Psoriasis
B: Lepros

y
C: Lichen planus
D: Pemphigus
Correct Ans:C
Explanation
Lichen planus (LP) is a papulosquamous disorder that may affect the skin, scalp, nails, and
mucous membranes. The primary cutaneous lesions are pruritic, polygonal, flat-topped,
violaceous papules. Close examination of the surface of these papules often reveals a
network of gray lines (Wickham's striae). The skin lesions may occur anywhere but have a
predilection for the wrists, shins, lower back, and genitalia. Involvement of the scalp, lichen
planopilaris, may lead to scarring alopecia, and nail involvement may lead to permanent
deformity or loss of fingernails and toenails. LP commonly involves mucous membranes,
particularly the buccal mucosa, where it can present a spectrum of disease from a mild,
white, reticulate eruption of the mucosa, to a severe, erosive stomatitis. Erosive stomatitis
may persist for years and may be linked to an increased risk of oral squamous cell
carcinoma.
Ref: Harrison's Internal Medicine;Part 2. Cardinal Manifestations and Presentation of
Diseases ;Section 9. Alterations in the Skin ;Chapter 53. Eczema, Psoriasis, Cutaneous
Infections, Acne, and Other Common Skin Disorders-Eczema and Dermatitis
A patient presents with scarring Alopecia, thinned nails, hypopigmented macular lesions
over trunk and oral mucosa. The diagnosis is:
A: Psoriasis
B:
Lepros
y
C: Lichen planus
D: Pemphigus
Correct Ans:C
Explanation
Lichen planus (LP) is a papulosquamous disorder that may affect the skin, scalp, nails, and
mucous membranes. The primary cutaneous lesions are pruritic, polygonal, flat-topped,
violaceous papules. Close examination of the surface of these papules often reveals a
network of gray lines (Wickham's striae). The skin lesions may occur anywhere but have a
predilection for the wrists, shins, lower back, and genitalia. Involvement of the scalp, lichen
planopilaris, may lead to scarring alopecia, and nail involvement may lead to permanent
deformity or loss of fingernails and toenails. LP commonly involves mucous membranes,
particularly the buccal mucosa, where it can present a spectrum of disease from a mild,
white, reticulate eruption of the mucosa, to a severe, erosive stomatitis. Erosive stomatitis

may persist for years and may be linked to an increased risk of oral squamous cell
carcinoma.
Ref: Harrison's Internal Medicine;Part 2. Cardinal Manifestations and Presentation of
Diseases ;Section 9. Alterations in the Skin ;Chapter 53. Eczema, Psoriasis, Cutaneous
Infections, Acne, and Other Common Skin Disorders-Eczema and Dermatitis.
'Bulla spread sign' is seen in :
A: Herpes gestational
D: Herpes simplex
Correct Ans:C
Explanation
In the traditional "bulla spread" sign or Lutz sign, the margin of an intact bullae is first
marked by a pen. Slow, careful and unidirectional pressure applied by a finger to the bulla
causes peripheral extension of the bulla beyond the marked margin. The bulla thus
extended has an irregular angulated border in pemphigus vulgaris, while a regular rounded
border is observed in bullous pemphigoid or other subepidermal blistering disorders.
Ref :Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J.L., Loscalzo J. (2012).
Berkley membrane is seen in the following cutaneous condition:
A: Psoriasis
B: Pemphigus
C: Tinea capitis
D: Pityriasis rubra
Correct Ans:A
Explanation

Psoriasis is characterized by well-circumscribed, sharply demarcated erythematous papules
and/or plaques. These are covered by dry, brittle, silvery or grayish white, loosely
adherent, micaceous scales. The scales are disposed in lamellar fashion. Occasionally a
white blanching ring is seen around the psoriatic lesions, known asWoronoff ring. On
grattage, silvery white scales come off in layers. After their removal, a characteristic
coherence is observed, as if one scratches on a wax candle (candle grease sign). On further
grattage, a thin peel like membrane, Berkley’s membrane, is seen which comes off as a
whole. On its removal, a wet surface with multiple pinpoint bleeding is revealed. This is
called Auspitz sign.
Ref: Textbook of Clinical Dermatology By Sehgal, 4th edition, Page 127.
Nikolsky's sign is positive in each of the following conditions, EXCEPT:
A: Pemphigus
B: Toxic epidermal necrolysis
C: staphylococcal scalded skin syndrome
D: Psoriasis
Correct Ans:D
Explanation
The Nikolsky phenomenon is positive when the epidermis is dislodged from the dermis by
lateral, shearing pressure with a finger, resulting in an erosion. It is an important
diagnostic sign in acantholytic disorders such as pemphigus or the staphylococcal scalded
skin (SSS) syndrome or other blistering or epidermonecrotic disorders, such as toxic
epidermal necrolysis.
Ref: (2013). Introduction. In Wolff K, Johnson R, Saavedra A.P. (Eds), Fitzpatrick’s Color
Atlas and Synopsis of Clinical Dermatology, 7e.
A female presented with a skin lesions all over the body which shows positive 'bulla spread
sign'. It is characteristic of:
A: Herpes gestationis

D: Herpes simplex
Correct Ans:C
Explanation
Pemphigus vulgaris is characterized by cutaneous and mucosal blisters. On application of
tangential pressure on normal skin results in formation of new bulla (Nikolsky sign) or if
applied to pre-existing bulla results in the spread of bulla (bulla spread sign). Cutaneous
lesions predominantly present on face, trunk, axillae, groins, and scalp.
Ref: Illustrated Synopsis Of Dermatology & Sexually Transmitted Diseases By Khanna, 3rd
edition, Page 64.
All of the following conditions are associated with thymoma except?
A: Myasthenia gravis
B: Pemphigus foliaceus
C: Pancytopenia
D: Hypergamma globulinemia
Correct Ans:D
Explanation
Thymoma is associated with B cell deficiency and hypogamma globulinemia. Other conditions
associated with thymoma are myasthenia gravis, autoimmune hemolytic or aplastic anemia,
pancytopenia, thrombotic thrombocytopenic purpura, pemphigus foliaceus, sjogren's syndrome,
polymyositis.
In which of the following systemic condition, conjunctival xerosis is seen as a clinical
finding?
A: Vitamin-A deficiency
B: Trachoma
C: Pemphigus

D: All of the above
Correct Ans:D
Explanation
Depending upon the etiology, conjunctival xerosis can be
divided into two groups, parenchymatous and epithelial
xerosis.
 Parenchymatous xerosis occurs following
cicatricial disorganization of the conjunctiva due
to local causes which can be in the form of,
o Widespread destructive interstitial conjunctivitis
as seen in trachoma, diphtheritic membranous
conjunctivitis, Stevens-Johnson syndrome,
pemphigus or pemphigoid conjunctivitis,
thermal, chemical or radiational burns of
conjunctiva.
o Exposure to conjunctiva to air as seen in marked
degree of proptosis, facial palsy, ectropion, lack
of blinking (as in coma), and lagophthalmos due
to symblepharon.
 Epithelial xerosis occurs due to hypovitaminosis-
A.
Ref: Ophthalmology By Khurana, 4th edition, Page
84.

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Previous year question on pemphigus vulgaris based on neet pg, usmle, plab and fmge or mci screening exams