INI-CET High Yield Questions for Dermatology

Mastering the INI-CET demands a strategic approach to preparation, with an emphasis on high-yield topics proving to be a successful tactic. This blog zeroes in on exactly that – a curated list of high-yield questions in Dermatology that are highly likely to appear on the INI-CET. By acquainting yourself with these questions and their detailed explanations, you'll deepen your understanding of Dermatology concepts, enhancing your confidence and readiness for exam day.

1.Identify the histological structure:

A. Stratum granulosum

B. Stratum basale

C. Stratum corneum

D. Stratum spinosum

Correct Option A- Stratum granulosum:

• The stratum granulosum is a histological layer found in the epidermis seen in the image, which is the outermost layer of the skin. It is located above the stratum spinosum and below the stratum corneum. This layer consists of flattened cells with distinct granules in their cytoplasm.
• The primary function of the stratum granulosum is the production and secretion of lipids, which contribute to the waterproofing and barrier function of the skin. These lipids are synthesized within the cells' granules and released into the extracellular space. The lipids help to prevent water loss from the skin and protect the underlying tissues from external pathogens and irritants.

Incorrect Options:

Options B, C, and D:  Refer to the explanation of option A.

2. A 7-year-old child presents with multiple light-brown, well-defined macules on the trunk and extremities. These macules have irregular borders and vary in size. The patient's family history is significant for similar skin findings in close relatives. Which of the following conditions is most likely to be associated with these skin findings?

A. Cafe au lait macules associated with Neurofibromatosis type 1 (NF1)

B. Vitiligo associated with autoimmune disorders

C. Cutis Marmorata associated with vascular malformations

D. Erythema Toxicum Neonatorum in newborns

Correct Option A - Cafe au lait macules associated with Neurofibromatosis type 1 (NF1):

• Cafe au lait macules are light-brown pigmented skin lesions with well-defined borders. They are typically benign and do not cause symptoms. However, when multiple cafe au lait macules are present and associated with other features like neurofibromas and Lisch nodules, it suggests Neurofibromatosis type 1 (NF1), also known as von Recklinghausen's disease. NF1 is a genetic disorder that affects the development and growth of nerve cell tissue. The presence of cafe au lait macules, along with a family history of similar skin findings, increases the likelihood of NF1.

Incorrect Options:

Option B - Vitiligo associated with autoimmune disorders:

• Vitiligo is a skin condition characterized by depigmented patches due to the destruction of melanocytes. It is not associated with cafe au lait macules or NF1.

Option C - Cutis Marmorata associated with vascular malformations:

• Cutis marmorata is a vascular condition characterized by a reticulated, mottled appearance of the skin due to blood vessel abnormalities. It is not related to cafe au lait macules or NF1.

Option D - Erythema Toxicum Neonatorum in newborns:

• Erythema toxicum neonatorum is a common benign rash in newborns, presenting as small red papules or pustules with surrounding erythema. It resolves on its own and is unrelated to cafe au lait macules or NF1.

3. A 14-year-old boy presents with multiple small, skin-colored, flat-topped papules on his trunk and upper extremities. The lesions are asymptomatic and have been gradually increasing in number over the past few months. On examination, there are no other abnormalities. A Mantoux test is positive. What is the most likely diagnosis?

A. Lichen planus

B. Lichen nitidus

C. Lichen scrofulosorum

D. Lichen simplex chronicus

Correct Option C- Lichen scrofulosorum:

• Lichen scrofulosorum is a rare form of tuberculid that occurs in individuals with tuberculosis. It is characterized by multiple small, skin-colored, flat-topped papules that typically appear on the trunk and upper extremities. The lesions are asymptomatic and may gradually increase in number. A positive Mantoux test, which indicates exposure to Mycobacterium tuberculosis, supports the diagnosis of lichen scrofulosorum.

Incorrect Options:

Option A - Lichen planus: Lichen planus is a common inflammatory skin condition that is not associated with tuberculosis. It typically presents with pruritic, polygonal, flat-topped papules that may be violaceous in color. The lesions of lichen planus are usually symmetrical and commonly appear on the flexor surfaces of the wrists, forearms, and lower legs. Unlike lichen scrofulosorum, lichen planus is not associated with a positive Mantoux test.

Option B - Lichen nitidus: Lichen nitidus is a benign skin condition characterized by small, shiny, flesh-colored or slightly erythematous papules that typically occur on the trunk and extremities. The lesions of lichen nitidus are usually asymptomatic and may be arranged in a linear or grouped pattern. Lichen nitidus is not associated with tuberculosis and does not cause a positive Mantoux test.

Option D - Lichen simplex chronicus: Lichen simplex chronicus Is a chronic dermatitis that results from repetitive scratching or rubbing of the skin. It typically presents as thickened, leathery plaques that are often accompanied by excoriation and lichenification. Lichen simplex chronicus is not associated with tuberculosis and does not cause a positive Mantoux test.

4. A 25-year-old sexually active woman presents to her healthcare provider with symptoms of vaginal discharge and lower abdominal pain. Testing confirms a diagnosis of chlamydia infection. Which of the following antibiotics is considered the first-line treatment for uncomplicated genital chlamydia infection?

A. Ciprofloxacin

B. Doxycycline

C. Azithromycin

D. Ampicillin

Correct Option C - Azithromycin:

• Azithromycin is often prescribed as a single dose and is highly effective in treating chlamydia. Doxycycline is an alternative treatment option, but it typically involves a longer course of antibiotic therapy.

Incorrect Options:

Option A - Ciprofloxacin: Ciprofloxacin is not the first-line treatment for uncomplicated genital chlamydia infection. While it is effective against certain bacterial infections, it is not the preferred antibiotic for chlamydia.

Option B - Doxycycline: Doxycycline is an effective treatment for chlamydia; however, it typically involves a longer course of antibiotic therapy (usually a week) compared to azithromycin, which can be taken as a single dose. In some cases, doxycycline may be used as an alternative treatment when azithromycin is not suitable.

Option D - Ampicillin: Ampicillin is not a recommended treatment for chlamydia. It is an antibiotic commonly used to treat certain bacterial infections, but it is not the first-line choice for chlamydia.

5. A skin biopsy from a patient's lesion reveals the following image. These histological findings are most characteristic of which dermatological condition?

A. Psoriasis

B. Lichen nitidus

C. Lichen planus

D. Pityriasis rosea

Correct Option C- Lichen planus:

• Lichen planus is a dermatological condition characterized by pruritic, purple, polygonal papules and plaques. Histologically, lichen planus shows a "saw-tooth" pattern at the dermo-epidermal junction, which refers to a band-like lymphocytic infiltrate that dips down into the epidermis in a saw-tooth appearance. Additionally, the presence of fine, white lines or dots on the surface of the purple papules and plaques is known as Wickham's striae, which is a characteristic histological finding of lichen planus.

Incorrect Options:

Option A- Psoriasis: 

• Psoriasis is a chronic skin condition characterized by well-defined, red, scaly plaques. Histologically, psoriasis typically shows acanthosis (epidermal hyperplasia), parakeratosis (retained nuclei in the stratum corneum), and Munro's microabscess, which are collections of neutrophils within the stratum corneum.

Option B- Lichen nitidus: 

• Lichen nitidus is a benign skin condition characterized by small, discrete, flat-topped papules. Histologically, lichen nitidus shows focal lymphocytic infiltration and the presence of "clue cells" or "colloid bodies," which are cells with pale-staining nuclei lacking surrounding cytoplasm.

Option D- Pityriasis rosea: 

• Pityriasis rosea is a self-limited skin rash that typically starts with a "herald patch" followed by the appearance of smaller, scaly, oval-shaped lesions. Histologically, pityriasis rosea shows superficial perivascular lymphocytic infiltrates.

Also Read: INI-CET Previous Year Question Papers

6. A 7-year-old child presents with a history of seizures, developmental delay, and multiple skin lesions. On physical examination, the child has hypopigmented macules on the trunk, angiofibromas on the face, and Shagreen patches on the back. Which of the following skin findings is typically associated with this condition.

A. Café-au-lait macules

B. Angiofibromas

C. Spider angiomas

D. Erythematous papules with central dell

Correct Option B - Angiofibromas (adenoma sebaceum):​​​​​​​

• Bourneville's disease, also known as tuberous sclerosis complex (TSC), is a rare genetic disorder characterized by neurological, dermatological, and other systemic features, including seizures, developmental delay, hypopigmented macules, facial angiofibromas, and shahgreen patches. One of the classic skin findings associated with TSC is the presence of angiofibromas, also referred to as adenoma sebaceum.
• Angiofibromas are small, reddish to skin-colored papules that typically appear on the face, particularly around the nose and cheeks. These lesions have a characteristic appearance, often described as "adenoma sebaceum," which can be observed in the provided image.

Incorrect Options:

Option A - Café-au-lait macules: Café-au-lait macules are smooth, well-defined, light-brown pigmented skin lesions commonly seen in Neurofibromatosis type 1 (NF-1) and other conditions. They are not specific to Bourneville's disease.

Option C - Spider angiomas: Spider angiomas are a type of vascular lesion characterized by a central arteriole with radiating small vessels resembling spider legs. They are commonly seen in liver disease (e.g., cirrhosis) and are not typically associated with Bourneville's disease.

Option D - Erythematous papules with central dell: Erythematous papules with a central dell are not a specific finding of Bourneville's disease. This description could be related to various skin conditions, and it is not a classic feature of TSC.

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7. An 18-year-old patient presents with a painful, vesicular rash on the lips and perioral area. The healthcare provider suspects a viral infection and decides to perform a Tzanck smear for diagnosis. Based on the image below, what is the most likely viral infection?

A. HSV infection

B. VZV infection

C. HPV infection

D. CMV infection

Correct Option A - Herpes simplex virus (HSV) infection:

• The image of the Tzanck smear shows multinucleated giant cells and intranuclear inclusions, which are characteristic findings of a herpes simplex virus (HSV) infection. In HSV infections, Tzanck smear reveals multinucleated giant cells formed by the fusion of infected cells, as well as intranuclear inclusions (Cowdry type A inclusions) within the nuclei of infected cells.

Incorrect Options:

Option B - Varicella-zoster virus (VZV) infection: This is an incorrect answer. While VZV infections can cause multinucleated cells, the specific appearance on Tzanck smear is different from the findings seen in HSV infections.

Option C - Human papillomavirus (HPV) infection: This is an incorrect answer. HPV infections do not produce multinucleated giant cells or intranuclear inclusions on Tzanck smear.

Option D - Cytomegalovirus (CMV) infection: This is an incorrect answer. While CMV infections can cause multinucleated cells, the specific appearance on Tzanck smear is different from the findings seen in HSV infections.

8. A 6-year-old child presents with a prominent white forelock of hair at the front of the scalp and a patch of depigmented skin on the forehead. The child's parents also report hearing loss in the child's maternal grandfather. Which of the following conditions is most likely responsible for the observed clinical findings?

A. Piebaldism

B. Waardenburg Syndrome

C. Tuberous Sclerosis

D. Neurofibromatosis type 1

Correct Option B - Waardenburg Syndrome:

• The presence of a prominent white forelock of hair (poliosis) and a patch of depigmented skin on the forehead are characteristic features of Waardenburg Syndrome. This genetic disorder is associated with hearing loss and can present with various clinical findings, including changes in hair, skin, and eye pigmentation. The association of hearing loss in the maternal grandfather further supports the diagnosis of Waardenburg Syndrome.

Incorrect Options:

Option A - Piebaldism:

• Piebaldism is another genetic condition characterized by patches of depigmented skin and white hair. However, it typically presents with larger depigmented patches involving the forehead, trunk, and extremities, and is not commonly associated with hearing loss.

Option C - Tuberous Sclerosis:

• Tuberous Sclerosis is a genetic disorder that can affect multiple organ systems, including the brain, skin, and kidneys. It is characterized by the development of benign tumors and specific skin findings, such as facial angiofibromas and hypopigmented macules. The clinical presentation described in the question is not consistent with Tuberous Sclerosis.

Option D - Neurofibromatosis type 1:

• Neurofibromatosis type 1 is a genetic disorder characterized by the development of multiple neurofibromas, café-au-lait spots (light-brown patches), and other clinical features. It is not typically associated with depigmented patches or white forelock of hair as described in the question.

9. Sarah, a 6-month-old baby, is brought to the pediatrician by her parents due to concerns about a growth on her nose. Upon examination, the pediatrician observes a red, raised, and lumpy lesion on Sarah's nose, which has been gradually increasing in size over the past few weeks. The parents are worried and seek further guidance from the doctor. Which of the following characteristics differentiates infantile hemangioma from other nasal growths

A. Pale coloration

B. Fluctuating size

C. Itching and scaling

D. Presence of pustules

Correct Option B - Fluctuating size:

• Infantile hemangioma is a benign vascular tumor that commonly occurs in infants and young children. One of the key characteristics that differentiate infantile hemangioma from other nasal growths is the fluctuating size. Unlike many other growths, infantile hemangiomas tend to go through a dynamic phase of growth, which is often followed by a spontaneous regression phase. During the growth phase, the hemangioma increases in size, becoming more pronounced and prominent. However, over time, it gradually starts to shrink and fade away, sometimes leaving little to no visible trace behind.

Incorrect Options:

Option A - Pale coloration: Infantile hemangiomas typically have a bright or deep red coloration. The term "hemangioma" itself is derived from "heman," meaning blood, and "angioma," meaning tumor composed of blood vessels. The rich vascular supply gives the lesion its characteristic red color, which is different from having a pale coloration.

Option C - Itching and scaling: Itching and scaling are not typical features of infantile hemangiomas. Instead, they usually have a smooth and non-scaly surface. Itching and scaling are more commonly associated with inflammatory or allergic conditions rather than vascular tumors like infantile hemangioma.

Option D - Presence of pustules: Pustules are small, inflamed, and pus-filled lesions that are often seen in certain skin conditions, such as bacterial or fungal infections. They are not a characteristic feature of infantile hemangioma, which presents as a well-defined vascular growth without the presence of pustules.

10. A 35-year-old woman presents to the dermatology clinic with complaints of irregular brown patches on her cheeks and forehead. She states that these patches have become more prominent over the past few months and are especially noticeable during the summer months. The patient has a history of using birth control pills for the past two years. Upon examination, the dermatologist diagnoses her with melasma. What treatment option is most suitable for managing her melasma?

A. Sunscreen with SPF 15 applied daily

B. Kligman formula

C. Chemical peels using glycolic acid

D. Topical vitamin C serum

Correct Option B - Kligman formula:

• The Kligman formula is a treatment approach for melasma that involves a combination of hydroquinone, tretinoin (a retinoid), and a corticosteroid cream. This combination therapy has been shown to be effective in reducing pigmentation and improving the appearance of melasma. Hydroquinone helps to lighten the dark patches, tretinoin promotes skin cell turnover, and the corticosteroid helps to reduce inflammation and irritation that may occur with the use of hydroquinone and tretinoin.

Incorrect Options:

Option A - Sunscreen with SPF 15 applied daily:

• While sunscreen is crucial in managing melasma, using SPF 15 alone may not provide sufficient protection from the sun's harmful UV rays. Melasma is a condition characterized by the overproduction of melanin triggered by sun exposure. To effectively manage melasma, a higher SPF (e.g., SPF 30 or higher) and broad-spectrum sunscreen should be used along with other treatment options like the Kligman formula.

Option C - Chemical peels using glycolic acid:

• Chemical peels, including those with glycolic acid, can be helpful in improving skin texture and reducing pigmentation. However, chemical peels alone may not be the first-line treatment for melasma. The Kligman formula, which combines hydroquinone, tretinoin, and a corticosteroid, has been shown to be more effective in addressing the underlying cause of melasma and lightening the pigmented patches.

Option D - Topical vitamin C serum:

• Vitamin C is an antioxidant and can provide some benefits for the skin, including brightening the complexion. However, using a topical vitamin C serum alone may not be sufficient to treat melasma effectively. The Kligman formula, with its combination of hydroquinone, tretinoin, and a corticosteroid, targets the overproduction of melanin and helps to fade the dark patches characteristic of melasma.

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