| What are the characteristic features of discoid lupus erythematosus? | Erythematous to depigmented plaques with atrophy, scaling and follicular plugs | Investigations: • Trichoscopy, scalp biopsy for histopathology, direct immunofluorescence, workup to rule out SLE Treatment: • Photoprotection • Topical steroids • Hydroxychloroquine 5mg/kg/day after baseline ocular examination; usually required for 6-12 months Discoid lupus erythematosus Erythematous to depigmented plaques with atrophy, scaling and follicular plugs Folliculitis decalvans Dissecting cellulitis of scalp | 290 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | Investigations: • Trichoscopy, scalp biopsy for histopathology, direct immunofluorescence, workup to rule out SLE Treatment: • Photoprotection • Topical steroids • Hydroxychloroquine 5mg/kg/day after baseline ocular examination; usually required for 6-12 months Discoid lupus erythematosus Erythematous to depigmented plaques with atrophy, scaling and follicular plugs Folliculitis decalvans Dissecting cellulitis of scalp | 10 | page=10,block=58 | 0.700 | valid |
| What are the characteristics of blisters that may indicate autoimmune blistering diseases? | Appearance of fluid-filled, itchy or painful blisters (either flaccid or tense) on skin, over a normal or erythematous base | WHEN TO SUSPECT? • Pemphigus vulgaris/ variants • Pemphigus foliaceus/ variants • Bullous pemphigoid • Pemphigoid gestationis • Mucous membrane pemphigoid • Linear IgA bullous diseases/ chronic bullous disease of childhood • Dermatitis herpetiformis • Epidermolysis bullosa acquisita • Bullous systemic lupus erythematosus CORRECT DIAGNOSIS; PREVENTION/ TREATMENT OF SEPSIS; AND REGULARITY OF TREATMENT BRINGS BEST RESULTS Appearance of fluid-filled, itchy or painful blisters (either flaccid or tense) on skin, over a normal or erythematous base Appearance of raw, erythematous erosions ± crusting on skin Appearance of erosions/ blisters inside oral cavity, eyes, nose and genitals | 423 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | WHEN TO SUSPECT? • Pemphigus vulgaris/ variants • Pemphigus foliaceus/ variants • Bullous pemphigoid • Pemphigoid gestationis • Mucous membrane pemphigoid • Linear IgA bullous diseases/ chronic bullous disease of childhood • Dermatitis herpetiformis • Epidermolysis bullosa acquisita • Bullous systemic lupus erythematosus CORRECT DIAGNOSIS; PREVENTION/ TREATMENT OF SEPSIS; AND REGULARITY OF TREATMENT BRINGS BEST RESULTS Appearance of fluid-filled, itchy or painful blisters (either flaccid or tense) on skin, over a normal or erythematous base Appearance of raw, erythematous erosions ± crusting |
| What are the clinical features of a carbuncle? | Confluence of multiple closely spaced furuncles + pus draining from multiple follicular orifices | CARBUNCLE CLINICAL FEATURES Confluence of multiple closely spaced furuncles + pus draining from multiple follicular orifices Commonly nape of neck> breasts, buttocks in uncontrolled diabetes 6. CUTANEOUS ABSCESS CLINICAL FEATURES Painful, warm, red fluctuant skin swelling | 28 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | CARBUNCLE CLINICAL FEATURES Confluence of multiple closely spaced furuncles + pus draining from multiple follicular orifices Commonly nape of neck> breasts, buttocks in uncontrolled diabetes 6. | 11 | page=11,block=2 | 0.700 | valid |
| What are the clinical features of a cutaneous abscess? | Painful, warm, red fluctuant skin swelling | CARBUNCLE CLINICAL FEATURES Confluence of multiple closely spaced furuncles + pus draining from multiple follicular orifices Commonly nape of neck> breasts, buttocks in uncontrolled diabetes 6. CUTANEOUS ABSCESS CLINICAL FEATURES Painful, warm, red fluctuant skin swelling | 230 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | CUTANEOUS ABSCESS CLINICAL FEATURES Painful, warm, red fluctuant skin swelling | 11 | page=11,block=2 | 0.700 | valid |
| What are the clinical features of guttate psoriasis? | Shower of numerous erythematous papules < 1 cm on the trunk and extremities | CLINICAL FEATURES • Shower of numerous erythematous papules < 1 cm on the trunk and extremities • Seen more commonly in younger patients Primary health centre/Level • Antibiotics for streptococcal infection Secondary Level • Same as primary level care • Psoralen ultraviolet A Solar (PUVAsol) Tertiary Level • Same as primary level care • Narrow band UVB • Refractory cases- consider systemic treatments including novel small molecules Chronic erythematous well defined plaques symmetrically on palms and soles, and occassional nail involvement to be differentiated from palmoplantar eczema | 20 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | CLINICAL FEATURES • Shower of numerous erythematous papules < 1 cm on the trunk and extremities • Seen more commonly in younger patients Primary health centre/Level • Antibiotics for streptococcal infection Secondary Level • Same as primary level care • Psoralen ultraviolet A Solar (PUVAsol) Tertiary Level • Same as primary level care • Narrow band UVB • Refractory cases- consider systemic treatments including novel small molecules Chronic erythematous well defined plaques symmetrically on palms and soles, and occassional nail involvement to be differentiated from palmoplantar eczema |
| What causes rebound tenderness at the right iliac fossa? | pain at RIF with sudden withdrawal of the maintained pressure with hand | Muscle guard at right iliac fossa (RIF) 5. Rovsing’s sign – pain at RIF with sudden thurst of palpation at left flank of abdomen 6. Rebound tenderness – pain at RIF with sudden withdrawal of the maintained pressure with hand 7. | 153 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | Rebound tenderness – pain at RIF with sudden withdrawal of the maintained pressure with hand 7. | 36 | page=36,block=3 | 0.700 | valid |
| What condition involves a fracture of the humerus in children? | Supracondylar fracture of Humerus in Children | Ministry of Health and Family Welfare, Government of India Neonatology Feeds and Fluids Neonatal Hypoglycemia Neonatal Jaundice Neonatal Seizures Neonatal Sepsis Neonatal Transport Neonatal Triage Post Asphyxial Management of Neonates Respiratory Distress in Neonates Thermal Care Oncology Breast Cancer Lung Cancer Oral and Lip Cancer Ophthalmology Cataract Diabetic Retinopathy Glaucoma Orthopaedics Septic arthritis Supracondylar fracture of Humerus in Children Paediatric Surgery Acute Scrotum Constipation Empyema Hernia in children/ Congenital Hernia Undescended Testes | 419 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | Ministry of Health and Family Welfare, Government of India Neonatology Feeds and Fluids Neonatal Hypoglycemia Neonatal Jaundice Neonatal Seizures Neonatal Sepsis Neonatal Transport Neonatal Triage Post Asphyxial Management of Neonates Respiratory Distress in Neonates Thermal Care Oncology Breast Cancer Lung Cancer Oral and Lip Cancer Ophthalmology Cataract Diabetic Retinopathy Glaucoma Orthopaedics Septic arthritis Supracondylar fracture of Humerus in Children Paediatric Surgery Acute Scrotum Constipation Empyema Hernia in children/ Congenital Hernia Undescended Testes |
| What distinguishes a Type II fracture above the epicondyles of the humerus? | Displaced fracture with variable angulation, posterior cortical continuity of humerus preserved | Fracture is just above the epicondyles of humerus (upper limb) TYPE I: Undisplaced fracture TYPE II: Displaced fracture with variable angulation, posterior cortical continuity of humerus preserved TYPE III: Completely displaced fractures with cortical discontinuity. Soft tissue gap variable | 101 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | Fracture is just above the epicondyles of humerus (upper limb) TYPE I: Undisplaced fracture TYPE II: Displaced fracture with variable angulation, posterior cortical continuity of humerus preserved TYPE III: Completely displaced fractures with cortical discontinuity. | 66 | page=66,block=14 | 0.700 | valid |
| What does a full red color in the legend indicate? | two affected alleles - homozygous/ diseased (HbSS) | LEGEND • Half red color – one affected allele - carrier (HbAS) • Full red color – two affected alleles - homozygous/ diseased (HbSS) • No red color – both alleles normal • POC tests to initiate penicillin prophylaxis in baby and enrolling vaccination program • HPLC and electrophoresis, if available or at later date • In endemic pockets/ high risk population: solubility test/ POC tests for sickle cell • CBC all women in first trimester • In endemic pockets/ high risk population: solubility test/ POC tests for sickle cell • Or HPLC and electrophoresis, if available » If mother is a sickle cell carrier/ disease, » Then testing of father is mandatory, » Ideally by HPLC, if not available refer to higher center » If father tests positive, counselling and pre-natal testing should be performed (at centers with necessary facilities) to prevent risk of birth of affected newborn Target group to be screened Tests / remarks Antenatal Mothers or pre-pregnancy planning Newborn Population screening/ patient of any age | 82 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733131850_stw_vol_3_20222.pdf | LEGEND • Half red color – one affected allele - carrier (HbAS) • Full red color – two affected alleles - homozygous/ diseased (HbSS) • No red color – both alleles normal • POC tests to initiate penicillin prophylaxis in baby and enrolling vaccination program • HPLC and electrophoresis, if available or at later date • In endemic pockets/ high risk population: solubility test/ POC tests for sickle cell • CBC all women in first trimester • In endemic pockets/ high risk population: solubility test/ POC tests for sickle cell • Or HPLC and electrophoresis, if available » If mother is a sickle cell |
| What does a negative oral drug challenge test indicate? | that the patient is not allergic to the drug at the time of challenge | In the absence of any reliable in vitro test in clinical setting, oral drug challenge is the only way to detect the responsible drug Usually undertaken when drug avoidance is impractical, especially in case of polypharmacy or life saving medicines (e.g. antituberculous therapy) • Take a written consent prior to challenge • Contraindicated in active illness or pregnancy • Assess the risk benefit ratio • Caution: patients on antihistamines, oral steroids and tricy- clic antidepressants may have a modified response to the challenge • A negative test only indicates that the patient is not allergic to the drug at the time of challenge • The dose of drug for challenge depends on the severity of the previous reaction and the pharmacokinetic profile • Drug provocation should always be done - After admission/ under observation except in cases with FDE - Usually in the daytime so that the faintest erythema is appreciated - It should be treated immediately and aggressively with an appropriate dose of systemic corticosteroid which may be required for only 1-2 days - Drug provocation in cases with DRESS has to be avoided or if provoked, a prolonged retreatment is required - In case of SJS-TEN drug provocation should be done only if the drug cannot be avoided. | 568 | definition |