Exam Recall Series (INI-CET May '26) - Dermatology

Added: 2026-05-31

[00:00:00]Dear students, I welcome all of you to this dermatology questions discussions which appeared in the recently concluded INIC 2026 examination. In the subject of dermatology, these are the questions that we had. We had two questions from bulis disorders, two from the topic of infections, three from sexually transmitted diseases, one from genodermatitosis and one from miscellaneous topics. Let us first begin with the first two questions of bull diseases. Question number one, match the following signs with the conditions. One positive Nikolski sign, two pseudonyikolski sign, three false nikolski sign and four cerebri form tum and across we have pmpigus vulgaris, Steven Johnson syndrome, bullis pmpigoid and pmpigus vegetance. Now we are looking at different types of nikolski.

[00:00:46]So positive nikolski sign generally is indicative of eanthlyis indicative of eantoolyis and is demonstrable in pmpigus vulgaris. So one is a pseudonic sign happens because of keratinoide necrosis in drug reactions like Steven Johnson syndrome and toxic epidermal necrolysis. So two becomes B false nikolski sign also known as shelo sign this is also known as shelo sign is demonstrable in subepidermal blistering disorders like bullis pimpoid so 3 is C and finally cerebri form tongue is a characteristic oral leion which is seen in pimpigus vegetance so four is d so the correct answer for this question is option number C. Now let us quickly look at the different types of Nikolski sign. So we have three types of Nikolski sign. You have true Nikolski, pseudonicolski and false Nikolski sign.

[00:01:50]Nikolski sign is a sign whereining tangential pressure is applied over the skin. So if tangential pressure is being applied over the normal unaffected skin.

[00:02:00]They may call this true Nikolski saying.

[00:02:02]And what happens is when you put the tangential pressure on the normal looking skin upper layers of the epidermis are going to separate from the lower layers of the epidermis. And this is seen because of echantoises in peigus vulgaris.

[00:02:15]So seen in peigus folicious pfigus vulgaris and stafylocal scalded skin syndrome. So these are the bottom causes of positive true nicolski sign. Pseudonicolski sign is elicited over affected arymatatter skin. So again the same tangential pressure but you're eliciting it on affected arymatic skin. This is called a pseudonic sign. The mechanism here is keratinosite necrosis keratinosite necrosis and the example is sgsn.

[00:02:54]This is a new question which is asked which is false nikolski. Now in false nicotine what do we do is now imagine this is the blister this is a ruptured blister and what you're doing is you are dragging the roof of the ruptured blister. So on pulling the roof of the ruptured blister what happens is if the erosion extends into the normal skin that means there is a subepidermal cleft and it is extending along the dermmo epidermal junction. This sign is called as a false nikolski sign. And please remember everybody this is demonstrable in subepidermal blistering disorders like bulas pmpigoid mucus membrid.

[00:03:32]So please keep these things in mind. And apart from that a new thing which has also been asked is the cerebary form tongue. Now cerebary form tongue is also known as primla sign which was described by Dr. Premla from Tamil Nadu. So here if you see the dorsal surface of the tongue you have this pattern of deep groove that is sulkai and gay like the surface of the brain that's why it's called a cerebri form tongue and this cerebri form tongue is seen in a condition called as pmpigus vegetance please remember everybody pmpigus vegetance is a variant of pmpigus fulg it's a variant of pmpigus fulgis now we move on to the next question Now another question from bulis disorders. A new unit is brought with the lesion which is seen in the image. The baby is feeding normally. There's no fever, hypotension or signs of shock. What is the most probable diagnosis? So when you see this picture, you can see some bullless lesions over here. You can see a erosion over here. So there's a bulless lesion and there's a erosion here. And these are our options. Stafyloccus carniskin syndrome. Option B is bullis pmpigoid.

[00:04:37]Option C is epidermalyis bulosa and option D is pmpigus due to transplasental antibiotics. Now when we look at the options what is very very important to remember here is there are no systemic signs here. There's no fever there's no hypotension there's no signs of shock. That means what you can straight away eliminate is stafylocal scalded skin syndrome. So stafylocus card syndrome they usually have systemic features and it's a neonate in the question wherein bulispigoid is very rare in a neonatal period infantile bulispigoid can be seen there are case reports neonatal bulis pimpigoid is very very rare. Option number C, epidermalis bulosa. If the examiner would want you to mark epidermalis bulosa, what would be given is trauma induced blisters. Since this is not mentioned in the question, the correct answer for this question is option number D which is pmpigus due to transplantal antigys. This is a new question very very important in the upcoming exam. Now this question students was picked up from this article which was published in the British medical journal case reports neonal pimpigus walgaris by arunamandar sir atal who is one of the very famous pediatric dermatologist from karnataka and you can see this was their publication and from there this picture was picked up. So neonatal pemphfigus vulgaris is usually seen in the context of a mother having pmpigus vulgaris and this passive transfer of antibodies auto antibodies especially which target desmogly number three producing a blistering eruption in a neonate and please remember here new m newal lesions are relatively uncommon. Now further looking at other features this neonal pimpus vulgaris as I mentioned to you the mother will have pimpigus vulgaris the auto antibodies predominantly target desmoblin 3. Once they target desmoglin 3 they're going to cross the placenta.

[00:06:26]The IGG antibodies will cross the placenta and they going to target the neonatal skin. It is going to target desmog number three and produce a neonatal pep figures. Very very important. But please keep it in mind this neolentric pigus is a transient disease. That means it is self-limiting.

[00:06:43]Within 3 to 4 weeks the disease is going to resolve on its own. So the treatment of this condition is just symptomatic.

[00:06:51]As I've already mentioned to you, stafyloccus card syndrome should have had systemic features or you should have features of tenderness. Skin tenderness is very very important. Next you have the option number B which is bulis penfigoid which is rare in a neonates and epidermalis bulus. So I've already mentioned you have history of trauma induced blisters and usually consangity will be mentioned on the exam and history of similar complaints in the mother. We move on to the next segment of infections. Let us take up question number one. So this person is talking about a patient who presents with well- definfined scaly plarks over the scalp associated with scaly. So scales are important here and you can see an image here. So this image is showing multiple scaly plugs and very important if you carefully observe there is loss of hair.

[00:07:38]So scaly plugs with loss of hair is the clinical presentation here and these are our options. So option A oral antibiotics, option B oral antifungals, option C is topical corticosteroids and option D method A. In the context of a patient with scaly plaques associated with alopecia, our first differential will be tenia capitus.

[00:08:02]And this clinical presentation is consistent with non-inflammatory tenial capitus which is gray patch and hence the correct answer for this question is oral antifungals. So oral antifungals is the correct answer for this question. The drug of choice please remember everybody the drug of choice if they mention as an overall option. So the overall drug of choice in denia capitus is grisopulin.

[00:08:34]If the question is specifically asked in the context of dinia capitus drug of choice due to triricopyon species drug of choice due to tririccoyon species then the answer is going to be turbine.

[00:08:52]So the take-h home message is in the context of tenina capitus it's always going to be oral antifarks. So just to summarize the same thing usually the question is going to be asked about a child presenting with patchy alopecia.

[00:09:03]There's the diffused dull gray adherent scales which are there on the scalp of the child. It's non-inflammatory tenia capitus and the generally the most common organism here is microsphorum cancer the next question. A child presents with intensely itchy arythmatus vesicular lesions on both palms and soles. What is the most likely diagnosis? Option A, auto attopic dermatitis. Option D bulis impitigo. Option C is scabies. And option D is psoriasis. So here when we look at the picture, you can see this itchy papulo vesicular rash. So when the question comes of papillovesicular rash vycles on the pawns and soles is very characteristic of option number C which is going to be scabies. And the right answer here has to be infantile scales.

[00:10:01]So one thing we should remember infantile scabies is a special form of scabbies for the simple reason that this is one scabbies which tends to involve palms and soles. So generally we have webspace involvement. We have important sites like you have the axillary area per umbilical area. Usually we say face is not involved in the context of inf in the context of scabies but in infantile scabies pump and souls can have vicycles and faces involved and as we have already discussed in the video lectures what is the mechanism why faces involving infantile scabies is because of decreased activity of sebaceious glac due to which if you're treating an infant with scabies you should always treat the face Especially in the context of using permethine 5% cream. Now let us look at the other options. Atoic dermatitis also was an option. But please remember palms and souls is not a common sight of involvement of attopic dermatitis. Etopy is basically the genetic tendency to develop allergy.

[00:11:03]Usually it is involving the phase extensor aspect in case of infants and shifts to the flexural aspect in older children. The next option was bulis impetigo. Now bulis impet again is not a common disease of the palms and souls.

[00:11:17]It mainly involves the inter trigenous area and the trunk.

[00:11:27]The characteristic crusting which we get in bula sympatico is warnish crust. You get flaccid boule here. Crusting is going to be warnish. Whereas in non- bulisetico we already know you get honey colored crust. Here psoriasis is going to present with well-defined arythmatus plaques with silvery white scales. So psoriasis can involve pabs and souls but you do not get recycled. So very important is the rash in psoriasis is paples and plugs. You do not get fycles here. We next go to the segment of sexually transmitted infections. Three questions have been asked from this segment. A male presents with three-day old history of multiple painful vesicular lesions on the genital area.

[00:12:06]So we can see the lesions over here. You can see some grouped erosions. Okay.

[00:12:11]What you see here everybody is the presence of drooped erosions which was probably preceded by a vesicular rash on the genital. The question is asking which is the most likely causitive organism. Option A herpes simplex virus, option B hemophilus decree, option C cleavia trachomatis and option D is tripoparadum. Vasicular rash is classically seen in the genital study called as genital herpes.

[00:12:48]So the correct answer for this question is option number a herpes simplex wires.

[00:12:52]A very important remember is hemophilus ducy produces shankroy which can also have multiple type of ulcers but there is no preceding vicular rashure. Clamdia trachomeatis L1 L2 L3 is going to be producing lymphogranoma varium. But please remember lymphogranoma presents with a painless transiate ulcer. Triple paladum produces primary syphilis characterized by a hard shanker characterized by a hard shanker.

[00:13:23]We move on to the next question. A 32-year-old female with 5day history of increased vaginal discharge vulnerus presents to you and on speculum examination the vaginal mucosa is see to be arithmatus this profuse frothy greenish color discharge. So froy discharge greenish color discharge and the question is also telling you that the vift test was negative. What is the microscopic finding in this clinical sceno? A motile flagagillate organisms, B presence of clue cells, C gram negative diplocy or D p sudah and sports. So when the question is going to tell you that whiff test is negative bacterial bajinosis is ruled out. So obviously presence of true cells cannot be the answer and then gram negative diplocy is probably in the context of gono cocky. Gono cocky is going to produce mucopuralid cervicitis.

[00:14:20]Here we are mainly talking about a vaginal discharge syndrome and pseudohight and spores are for candida candida albbeans which produces volvo vaginal candiasis. Curie white discharge should I be there? The correct answer for this question is option number A which is motile flagagillate organisms.

[00:14:38]Which organism I'm talking about? I'm talking about tricomonus vaginal.

[00:14:44]So it is motile usually has a jerky motility.

[00:14:51]So this is tririccomonus vaginalis.

[00:14:53]Always remember tricommonus vaginalis can also produce nonunoccal electritis. So we have already seen the options. Two cells are squamous epipedial cells. More than 20% on wet mode is for bacterial vaginosis. Gram negative diplo I mentioned to you is going to be in the context of gonoria producing mucoporalent cervicitis and pseudohify and spores are for woaginal candidates we move to the next question why are non-riponyimal tests preferred in syphilis option A they have more sensitivity in the earlier stages option B it uses antigens diluted in serum from other non-specific tryponymal stains option C quantitative results are useful in monitoring response to treatment or option D they remain positive irrespective of recovery from current infection a very interesting question very practical question I would say generally in the context of syphilis we ask for the non- triponimal test is we ask for VDRL or RPR which is generally the screening test and for confirmation we use triponimal test we generally use triponimma paladum hemoglutinational test so the question is asking about non- triponal test the most important utility of nontributable tests is option number C. The quantitative results are going to help you to monitor response to therapy because I always believe in this situation where there are clinical scenarios the most important objective is therapy for patients. So if you look at the utility of the non-tripponal test the first point to remember here is non-triponal test generally take around 2 to 3 weeks after the infection that is where it is going to become positive and usually when we ask for a BDR or RTR in a syphilis patient we ask the lab to mention the titer and in this situation what becomes important is if there is a patient before treatment if the titer of the patient is 1 is to 32 if you have to say that the patient is adequately respond on there should be a fourfold decline in the titer. So 32 divided by 4 you should have 1 is to8 titer. So very important is the patient comes to you with a 1 is to 32 titer if you have given him adequate treatment four-fold decrease in the titer. So the titer should drop to 1 is to 8 and when will you look for it? If a patient is of primary or secondary syphilis, you make this assessment at 6 months. And if the patient is of latent syphilis, this assessment is to be done at one year duration. So very very important is four-fold decline in non-tripolony titus. Looking at the other options, so uses antigens diluted in serum is not correct because non-ripolonyimal tests are going to use cardipin lecithin cholesterol antigen. So this is what is used and uh they remain positive irrespective of recovery is also incorrect. Triponimal tests are lifelong positive because usually we see there are a lot of people who want to go abroad and triple tests always come positive. That's usually they are not able to clear the initial immigration part itself because of this problem in the health checkup they are not able to clear because triponimal test will always come positive. lifelong positive whereas non-ripal tests are used by dermatologist to monitor therapy. Next we go to the one question very simple question from go genertosis. There's a child presenting with skin lesions as shown in the image. What are you seeing here? So in terms of of themology you can see the presence of these nodular lesions. These are called as lis iris nodules.

[00:18:25]Okay. Lis iris nodules. These are pigmented iris hematomas. Then we can see a little bit of proptosis over here can be observed.

[00:18:34]And very important is this cutaneous skin lesion. This cutaneous lesion is called as CM. It stands for cafe olay macules.

[00:18:46]Keules.

[00:18:48]This is also considered to be a neuroutinous marker. How many should be there for the diagnosis of neurop fibromytosis type 1? Six or more. The size should be more than 5 mm. in preubital individuals more than 15 mm in post-pubal individuals. The correct answer for this question is option number B neurop fibromyitosis type 1. So neurop fibromytosis type one is also called as one reckling hosen disease one reckling hosen disease. So this is the synonym and it's a autotosomal dominant disorder. Now we'll we look at the other options stro option number a. So very important is it presents at the facial portwine stem which is usually in the triminal distribution of themologically you have to look for glaucoma because of the increased episcal venus pressure and in the brain you look for leptomenial angiomas which can present with seizures. So there is no presence of lish nodules or cafe macules in this condition. Tuberosclerosis complex is going to present with a ash leaf macules. These are oval on one side pointed on the other side and these are very important. They're hypo pigmented.

[00:20:01]We are aware that cafe macules are hyperpigmented whereas ash leaf macul of tuberous scerosis are hypopigmented.

[00:20:07]Apart from that you can have facial age of fibroas per angle fibro which are called as kunins tumors konins tumors and then you can have a shagri impact which is a leathery plaque on the lumbosacral region. CLS you can have cortical tubers, seizures and the ofological finding. You don't get le nodules here. You get retinal hammomas.

[00:20:30]And the last option D was one [ __ ] syndrome which presents with a retinal and CNS heangoblastomas. There are no skin lesions like le nodules or cafeolic macates. So with this one more miscellaneous question. A patient presents with a painless black necrotic lesion over the heel with surrounding edema as shown in the picture. What is the best investigation to confirm the diagnosis? Option A, potassium hydroxide mount. Option B, Graham stain. Option C skin biopsy or D zme smear. Now Zang smere for this investigation the sample has to be a vycle.

[00:21:05]So this cannot be the answer for Graham stain I should make a diagnosis of a bacterial infection. This does not look like a bacterial infection. So Graham stain is ruled out. What is the bare minimum criteria to do a potassium hydroxide mount? The lesion should be scaly. Since this lesion doesn't appear scaly, potassium hydroxide mount is also not the answer. The correct answer for this question is option number C skin biopsy. Now what is the diagnosis of this patient? This patient is having acral lentigenous melanoma. So when I say achel means the extremities are involved. Lentigenous means like lentigo. So lentigo is a flat lesion and later on it starts becoming irregular.

[00:21:43]What we need to remember here is whenever there is a patient, this is very very important even if you are in a PHC or you are in any outpatient department very important to remember that if a patient presents with a painless blackion on the heel especially if it is asymmetrical enlarging irregular becoming ulcerated or looking necrotic your first differential diagnosis you should be ruling out acral lentigenous meala initially it starts with a fla lesion then becomes wider it becomes darker it has an irregular border and in the Previous INIC exam teachers repeatedly keep telling you that the previous year questions are very important and the topics in the context of INIC exam. In the last INIC exam they asked the most common site of melanoma in India which was arms and souls or had in feet. This time they have shown you a picture and you had to diagnose acral latigenous melo.

[00:22:32]Now three important things for the upcoming nepg examination. Number one kindly concentrate on your content. So you've already been revising for a long time. So see that all your notes are consolidated in one place. Okay. As much as possible if you feel your content is less probably for another one month you can add on to your notes and after that you should restrict to the same content and keep revising it repeatedly. And in this phase where there are three months for the exam is very important to solve questions on a daily basis. So kindly do not keep questions towards the end. It becomes very difficult to solve at the end. Keep a target of at least 100 to 150 questions so that you will be able to look at the application part of the theory and get questions correct and see that your MCQ solving is always time bound. And finally, which everybody keeps saying again and again is to revise. See that you've drawn a good revision plan. So whatever theory, the content that you are reading is going to become futile if you don't revise it. So please see that you make a good revision program for at least 15 days. Keep looking over the theory which you have already gone through so that it'll result in good results in the exam. So wishing you all the very best for the upcoming NEPG examination.