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Answer2440. #EXPLANATION Sweet’s Syndrome: ACUTE FEBRILE NEUTROPHILIC DERMATOSES ● A constellation of symptoms and findings: the acute onset of fever, neutrophilia, erythematous, and tender skin lesions that typically show an upper dermal infiltrate of mature neutrophils. ● Cardiovascular, central nervous system, gastrointestinal, hepatic, musculoskeletal, ocular, oral, otic, pulmonary, renal, and splenic organs can be involved. ● Classic Sweet syndrome may be associated with infection of the upper respiratory and/or gastrointestinal tract, inflammatory bowel disease, and pregnancy. ● Malignancy-associated Sweet syndrome occurs in individuals with previously undiagnosed or relapsing hematologic malignancies and solid tumors; in these patients, Sweet syndrome appears as a cutaneous paraneoplastic syndrome. ● Drug-induced Sweet syndrome describes the onset of the dermatosis in patients after the initiation of certain medications—most commonly granulocyte-colony stimulating factor (G-CSF). ● Cytokines may have an important role in the pathogenesis. ● The first-line oral systemic agents for treating Sweet syndrome are corticosteroids, potassium iodide, and colchicine. ● Topical application of high potency corticosteroids or intralesional corticosteroids may be efficacious for treating localized lesions. Histopathology: ● Typically, a dense perivascular infiltrate composed largely of neutrophils is seen assuming a band-like distribution throughout the papillary dermis. ● Some of the neutrophils may show nuclear fragmentation (Leuko cytoclasis). ● In addition, the infiltrate may contain scattered lymphocytes and histiocytes and occasional eosinophils. ● The density of the infiltrate varies and may be limited in a small proportion of cases. ● Vasodilation and swelling of endothelium with moderate erythrocyte extravasation, as well as prominent edema of the upper dermis, are characteristic. ● In later stages, lymphocytes and histiocytes may predominate. Reference: Rook’s Textbook of Dermatology, 9th Edition, Page No. 147.9 Ans. A. Sweet’s syndrome.

Answer2439. #EXPLANATION ● Lymphedema present at birth is known as Milroy disease and it is an autosomal dominant condition. #HIGHYIELD: ● Milroy disease is characterized by lower-limb lymphedema, present as pedal edema at (or before) birth or developing soon after. ● The severity of edema shows both inter- and intrafamilial variability. Swelling is usually bilateral but can be asymmetric ● The diagnosis of Milroy disease is established in a proband with congenital or infantile-onset lower-limb lymphedema accompanied by lack of uptake of radioactive colloid in the ilioinguinal lymph nodes on lymphoscintigraphy and/or by identification of a heterozygous pathogenic variant in FLT4 by molecular genetic testing. OTHER OPTIONS: ● Option: A. Secondary lymphedema usually results from a disease process that causes obstruction of the lymphatic system. ● Option: B. Lymphedema is classified as praecox if the age of onset is between 1 and 35 years. Meigs’ disease is the familial form of primary lymphedema praecox, with onset around puberty. ● Option: D. If the onset of primary lymphedema is after 35 years of age, it is called lymphedema tarda. Reference: Schwartz’s principle of Surgery, 11th Edition, Page No. 2015 Reference: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 21st Edition, Page No. 1836 Ans. C. Milroy Disease

Answer2438. #EXPLANATION ● Spontaneous remission is much more common in indeterminate leprosy (75%) than in tuberculoid leprosy. #HIGHYIELD Other options: ● Option: A. About 85-90% of patients do not resolve spontaneously after bacilli exposure. ● Option: B. Spontaneous remission indeed occurs in leprosy but is variable in children; hence cannot be considered to be more common in adults, where a fixed value can be easily seen. ● Option: D. Spontaneous remission does occur in indeterminate leprosy. Reference: Rook’s Textbook of Dermatology - 9th Edition, - volume I - Page No. 28.1, 28.3, 28.12 Ans. C. Indeterminate leprosy resolves more often than tuberculoid

Answer2436. #EXPLANATION The presence of delusions of persecution and circumstantial speech, along with the duration of symptoms, supports the diagnosis of Schizophrenia. Cannabis usage is a risk factor of developing schizophrenia. #High yield Symptoms of schizophrenia: ● positive symptoms – ○ Delusion and ○ Hallucination ● Negative symptoms – ○ avolition, ○ alogia, ○ anhedonia, ○ attention deficit and ○ asocial. Other symptoms include: ● Disorganized speech, ● Disorganized behavior. ● Catatonic Behaviour According to DSM 5 and ICD 11 update, schizophrenia is characterized presence of two symptoms out of the five symptoms in which at least one is a positive symptom. Other Options: ● Option: A. Schizotypal disorder usually has ideas of reference and persecution. ● Option: C. Brief psychotic disorder symptoms persists for less than 1 month. ● Option: D. MDP is an episodic illness. (Another Name of BPAD) Reference: Kaplan & Sadock’s Synopsis of Psychiatry, 11th Edition, Page No. 300 Ans. B. Schizophrenia

Answer2437. #EXPLANATION ● The metastatic potential of BCC is very low with rates ranging from 0.0028 to 0.1%, The head and neck region is the most frequent location of the primary tumor with regional lymph nodes being the most common site of metastasis. ● The lungs, bone, liver, and pleural are also potential sites of metastasis #HIGHYIELD Basal cell carcinoma ● Most common skin cancer ● Found in sun-exposed part of the body: around upper lip ● Locally invasive, but rarely metastasize Features: ● Waxy, pink, pearly nodule that may start as small macula or papule ● Telangiectasias may be present ● Rolled out borders ● Central crusting and ulceration ● History of bleeding while itching may be present Histopathology: ● Basal cell tumors shows palisading nuclei. Treatment: ● Moh’s microscopic surgery ● Hedgehog pathway inhibitor: Vismodegib, Sonedigib Other Options: ● Option: A. Squamous cell carcinoma: Second most common skin cancer. It forms an indurated and ulcerated nodule located below the lower lip. ● Option: C. Melasma: It is a common acquired skin disorder that presents as a bilateral, blotchy, brownish facial pigmentation. ● Option: D. Discoid lupus erythematosus: DLE is a sub-type of chronic cutaneous lupus erythematosus. It is characterized by persistent scaly plaques on the scalp, face, and ears which subsequently can progress to scarring, atrophy, depigmentation, and permanent hair loss in affected hair-bearing areas. Reference: Rook's Textbook of Dermatology, Chapter 146: Skin Cancer in the Immunocompromised Patient, 9th Edition, Page No. 267 Ans. B. Regional lymph nodes