1. IGNQPP Megafinals 2015, Mangalore

2. DR. VIJAY ZAWAR MD, DNB, DVD, FAAD Consultant Dermatologist Skin Diseases Centre Nashik, Maharashtra. DR. BIJU VASUDEVAN MD Associate Professor INHS ASVINI Mumbai, Maharashtra.

3. Round 1 BASICS

4. Identify this structure? Originally known as band 6 protein Forms a part of the desmosome Affected in variants of: – Ectodermal dysplasia with skin fragility variant – EBS suprabasal variant TEAM A

6. Answer Plakophilin

7. Dye extracted from lichen Used as a special stain Stains elastin brown Fixed with acetic acid TEAM B Identify this stain?

9. Answer Acid orcein Other colours produced – Collagen: Pink – Melanin: Black – Haemosiderin: Green/yellow – Amyloid: Light blue – Mast cell granules: Purple

10. Identify the marker Also known as neural cell adhesion molecule It is a marker specifically for Natural killer cell It s also a tumour marker for multiple myeloma, myeloid leukemia, neuroendocrine tumours, Wilm’s tumour TEAM C

12. Answer CD56

13. Name the technique demonstrated here TEAM D Protein samples Direction of Protein transfer Polyacramide gel membrane Polyacramide gel Primary & sec antibodies membrane Gel electrophoresis Transfer to membrane Detection

15. Western Blot Technique

16. Audience What’s this on the tongue? Audience Question

17. Who proposed it?

19. Premlata S, Jayakumar S, Yesudian P, et al. Cerebriform tongue-a clinical sign in pemphigus vegetans. Br J Dermatol 1981; 104 : 587-591

20. Round 2 PEDIATRIC DERMATOLOGY

21. A boy age 4; slowly progressive plaque on left shoulder Occasional mild pruritus What is the COMPLETE diagnosis? Team B

23. BCG Lupus Vulgaris : is a rare complication of BCG vaccination BCG vaccination uses live attenuated vaccine. It can rarely induce localised and generalised tuberculids, TBVC and Lupus vulgaris at the site of vaccination. Answer

24. Newborn baby with history of infection in mother antenatally and these lesions on face, was admitted in NICU What are these eruptions? Team C

26. Blue-Berry Muffin lesions Magenta coloured papulonodular eruptions, the Blue-berry muffin lesions, are suggestive of dermal hematopoiesis (Extra-medullary hematopoeisis) Intrauterine infections: TORCH: Congenital CMV Hematologic dyscrasias (V Mehta, C Balachandran, V Lonikar. Blue berry muffin lesions in baby. Pictoral differential diagnosis. Dermatology Online Journal. 2008; 14 (2): 8 Answer

27. A young girl has recurrent scaly crusted eruptions for 2 yrs. Intermittent exacerbations. Unresponsive to antibiotics or steroids Team D

29. Genetic disease: AR; Danbolt & Closs, 1943; gene mapped to 8q24 Only known human disease due to trace metal Zn deficiency. Defective uptake of Zinc in duodenum and jejunum Typically presents soon after weaning. CF: The rash is characteristic. Overlap between psoriasis and atopic dermatitis. Diagnosis: S. Zinc; S. Alkaline phosphatase(Zn-dependent enzyme) Histopath: Not diagnostic but supportive. Zinc replacement therapy : 3 mg/kg/day of elemental zinc 50 mg of elemental zinc per 220 mg zinc sulfate. Pts may require a higher doses in the initial phase of Rx. Answer: Acrodermatitis Enteropathica

30. M:3, Febrile and irritable child H/o- High grade fever and LRTI- respiratory infection- one week Team A

32. Antiphospholipid Antibody Syndrome (APLAS) Hughes Syndrome, Sticky Blood Syndrome Lupus Anticoagulant Syndrome Hypercoagulability with recurrent thrombosis Skin manifestations: 1.Livedo reticularis 2.Skin ulcers 3.Digital ischaemia 4.Purpura 5.Necrosis 6.Microthrombosis 7.Splinter haemorrhages Diagnosis: Lupus anticoagulant: defined by a functional, clot-based assay using the ISTH guidelines. Anticardiolipin : IgG/ IgM antibody. Anti-b 2 glycoprotein 1: IgG or IgM antibody. --Measured on 2 or more occasions at least 12 weeks apart. Answer

33. Hyperpigmented, hyperkeratotic papules distributed over the upper back and pinna of a young girl. What is it? Audience Question (www.ijdvl.com)www.ijdvl.com

35. Mudichood (which literally means "heat of the hair" in Malayalam language), was first described by Sugathan and Nair in 1972. It is reported mainly from Kerala state in India where the climate is hot and humid. It is thought to be due to the habit of leaving residual coconut oil and other medicated (Ayurvedic) oils in the hair after bath, which on coming in contact with the skin, produces this peculiar reaction pattern.

36. SCORES PLEASE......

37. ROUND 3 CLINICAL SIGNS

38. Team C

39. M:40; admitted in ICU with altered sensorium and high grade fever Bilateral worsening infiltrates on Chest X Ray

41. Immunosuppression in a chronically sick patient may unmask a quiescent Strongyloides infection and allow Strongyloides hyperinfection to occur, resulting in repeated bacteremia caused by the parasite repeatedly breaching the gut. Death occurs from multiorgan failure. 2. Periumbilical parasitic thumbprint purpura is a characteristic sign of Strongyloides stercoralis hyperinfection syndrome in the immunocompromised host. 3. It is important to consider Strongyloidiasis infection in an immunocompromised host with GI symptoms so that prompt treatment can be given. The role of screening for Strongyloides infection prior to immunosuppressants can be considered, especially in endemic countries. Answer: Strongyloidosis hyperinfection: Periumbilical purpura: “Thumb print sign”

42. Police brought this 19 yrs old female pt to hospital. She was found unconcious on street. CMO found some skin lesions on her legs. What is the diagnosis Team D She was in sinus rhythm with normal vital signs and paresthesia in both legs. The electrocardiogram was normal. Serum levels of creatine kinase and troponin I and the electrolyte panel were within the normal range.

44. Litchenberg figures -due to strike of lightening A 19-year-old woman was brought to the emergency department after a nearby lightning strike in which her Great Dane dog had been instantly killed. She briefly lost consciousness and found herself on the wet ground, calling for help. On arrival at the hospital, she was in sinus rhythm with normal vital signs and paresthesia in both legs. The electrocardiogram was normal. Serum levels of creatine kinase and troponin I and the electrolyte panel were within the normal range. The clinical examination revealed several painless erythematous cutaneous marks in a fern-leaf pattern on the inner sides of both legs, so-called Lichtenberg figures (Panels A and B). When the patient was discharged 18 hours later, the branching cutaneous erythema had completely disappeared. Answer Lichtenberg figures and lightning: case reports and review of the literature. Cherington M, McDonough G, Olson S, Russon R, Yarnell PR. Cutis. 2007 Aug;80(2):141-3. Review.

45. 54-yrs old man was admitted in cardiac ICU 3 weeks ago. He presented with myalgia, altered sensorium & skin findings bilaterally on feet. Team A

47. Cholesterol embolism Defined by occlusion of small- and medium-caliber arteries (100-200 μ m in diameter) by cholesterol crystals. Skin findings can facilitate clinical diagnosis, since about 88% of patients with CCE have them, most commonly livedo reticularis and cyanotic changes of the toes. Cholesterol emboli is a rare potentially devastating complication of atherosclerosis, usually appearing as an iatrogenic event in a vascular procedure in the course of anticoagulant or thrombolytic therapy or after trauma Answer

48. M:28; Diffuse colicky abdominal pains for six months. -Remained undiagnosed Oral cavity exam He worked in a recycling factory for last one year. Team B

50. On Investigations: Liver, Kidney, Hematologic functions were normal. USG and/pelvis-NAD His Serum Lead levels were: 81 ng/dl (N=<10 ng/dl) Rapid response to Penicillamine chelation therapy. Dramatic response to abdominal pains and disappearance of Burton’s lines! Occupational exposure is the main cause of lead poisoning Answer: Burton’s lines

51. spontaneous transient erythema occuring during mentruation in certain young women and girls with vitiligo is known as..... Audience Question

53. Punshi SK, Abroal SK, Liv 52 in Vitiligo. Probe. 1970;1:12–3. Punshi’s sign

54. ROUND 4 DERMATOPATHOLOGY BUZZER

55. M: 25, Asymptomatic plaque on nose Gradually progressive Did not respond to anti- leprosy treatment or Anti- tubercular treatment Question 1

57. Lupus pernio is a plaque sarcoidosis affecting the nose XRC for hilar L’pathy and ACE levels may give a clue. Answer

58. Question 2 A 54 year-old woman with a history of monoclonal gammopathy of the IgA type presents with a vesiculopustular eruption spreading outward from the axilla

60. Answer Sneddon-Wilkinson disease Subcorneal pustular dermatosis Chronic, relapsing vesiculopustular eruption Flexural and intertriginous areas Subcorneal pustules filled with neutrophils and an occasional eosinophiL

61. Question 3 A 65 year-old man with a life-time of sun exposure presents to his dermatologist with a well-demarcated, erythematous, mildly scaly plaque on his forehead.

63. Answer Bowen’s disease Full-thickness keratinocyte atypia Lesional keratinocytes large and pleomorphic Atypical mitoses Loss of granular layer with hyper-/parakeratosis May exhibit a prominent "pagetoid" growth pattern

64. Question 4 A 32 year-old female presents to her dermatologist with painless, skin-colored papules on her hand

66. Answer Granuloma annulare

67. Who was the first Honorary secretary of the IADVL? Audience Question

68. Clue

70. Answer Dr LK Bhutani

71. SCORES PLEASE......

72. ROUND 5 THERAPEUTICS

73. Team D: Identify the drug It is the first recombinant human C1 esterase inhibitor developed and FDA approved for the treatment of acute angioedema attacks in HAE.

75. Answer Ruconest Ru - Recombinant C - C One - 1 Est - esterase inhibitor

76. Team C: Identify the drug Specific inhibitor of phosphodiesterase 4 and approved by USFDA in 2014 for treatment of psoriasis and psoriatic arthritis

78. Answer Apremilast It is the first oral agent that is FDA-approved for the treatment of psoriatic arthritis It inhibits spontaneous production of TNFα from human synovial cells and has anti- inflammatory activity.

79. Team B This human IgG1 monoclonal antibody selectively binds to the interleukin-17A cytokine and inhibits its interaction with the IL-17 receptor. Approved by FDA in Jan 2015, identify this biologic?

81. Answer Secukinumab Brodalumab (Amgen), secukinumab (Novartis) and ixekizumab (Eli Lilly) all work by interfering with the IL-17 pathway. Secukinumab and ixekizumab target IL-17, while brodalumab targets a specific receptor that binds to the IL-17 cytokine.

82. Team A Name any one integrase strand transfer inhibitor (ISTF)/ integrase inhibitor which are one of the latest FDA approved drugs in ART?

84. Answer Raltegravir Dolutegravir Elvitegravir

85. English anatomist and surgeon most notable for his illustrations in the book, Gray's Anatomy.Gray's Anatomy He undertook the first scientific endeavour to study dermatoses in the Indian subcontinent. Audience Question

86. Clue 22 May 1831- 4 May 1897 In 1858, he joined the Indian Medical Service and moved to Bombay where he took up the post of Professor of Anatomy at Grant Medical College.Indian Medical ServiceBombayGrant Medical College

88. Answer Henry Vandyke Carter 22 May 1831- 4 May 1897 In 1858 Carter joined the Indian Medical Service and moved to Bombay where he took up the post of Professor of Anatomy at Grant Medical College.Indian Medical ServiceBombayGrant Medical College

89. ROUND 6 CLINICAL CONNECT

90. Team C: Link

92. Answer Dego’s disease Atrophic papules, central porcelain white scars Intestinal perforation Scleral and conjunctival involvement Renal artery stenosis

93. Team B: Link Erythrokeratoderma variabilis KID syndrome Clouston’s syndrome Charcot Marie Tooth disease

95. Answer All are due to connexin gene defects Others Vohwinkel syndrome

96. Team A: Link

98. Answer Bazex syndrome Bazex–Dupré–Christol syndrome Follicular atrophoderma Basal cell carcinomas Milia Congenital hypotrichosis

99. Team D: Link a common clinical manifestation of these photosensitive conditions Degos- Touraine syndrome Rothmund Thomsun syndrome DermatomyositisSLE

101. Answer Poikiloderma

102. Audience: Link

104. Answer Organisation of the first All-India Conference of Dermatologists and Venereologists, on December 27 and 28, 1947, at JJ Hospital, Bombay

105. SCORES PLEASE......

106. ROUND 7 DERMATOSURGERY

107. Team B: What is common to? Calcium salts Extravascular location Type 3 Collagen Thrombin

109. Answer All platelet activators in PRP

110. Team A: Question Mephisto look occurs after which procedure?

112. Answer Botulinum inj into frontalis the outer end of the eyebrow is located above the inner end, possibly producing an intimidating impression. It is also referred to as a "quizzical look", "Spock's eyebrow", "a sinister look" or "'joker' face

113. Team D: Question SAFE system is used to do which procedure?

115. Answer FUE Surgically Advanced Follicular Extraction Blunt dissection to isolate the follicular units from the surrounding tissue. Device allows physician to perform precise Follicular Unit Extraction with minimal damage to follicles. By using a motorized instrument, it significantly increases the speed of the procedure. Follicular Unit Extraction

116. Team C Dr Jeffrey Klein, a dermatologic surgeon, is credited as the originator of this technique. This technique has led to lesser blood loss, allowed more amount of anesthetic to be used and with lesser complications. Which technique are we talking of?

118. Answer Tumescent liposuction

119. Audience President of Indian Academy of Medical Sciences : 1971-1973 First President of Indian Association of Dermatologists and Venereologists

121. Answer Dr RV Rajam

122. ROUND 8 LEPROSY/ STD BUZZER REMINDER FOR NEGATIVE MARKING

123. An unmarried sexually active male, age 23, presented with lesions on glans following an ulcer in coronal sulcus. Gram stain and KOH from glans lesions negative. Biopsy on right Identify lesion on glans Question 1

125. A case of primary syphilitic chancre of the Coronal sulcus with subsequent development Of balanitis is described. The histopathological picture and preponderantly Intraepidermal localization of T. Pallidum in the lesions is highly suggestive of Syphilitic Balanitis of Follman. K.LEJMAN & Z. STARZYCKI Syphilitic balanitis of Follmann developing after the Appearance of the primary chancre. Brit. J. Vener. Dis. (1975) 51, 138. Answer

126. A painful ulcer in HIV+ve man 5 days after unprotected sexual contact What is the specific ingredient required for growing this organism in culture media ? Question 2

128. Answer Giant Chancroid Hemophilus ducreyi Factor X (Haemin)

129. Name the paralysed muscle being demonstrated here? Question 3

131. Adductor pollicis Froment’s sign=Book test

132. Identify the condition? Question 4 Fever with sudden onset of eruptions

134. Answer Lucio phenomenon

135. Audience Identify personality and his contribution to Indian Dermatology

137. Answer Dr UB Narayana Rao He created an association of dermatologists for the first time In India(Bombay) Started the Indian Journal of VENEREAL Diseases in 1935VENEREAL

138. SCORES PLEASE......

139. ROUND 9 RAPID FIRE Final Round, Cheer up…

140. RULES Rapid fire round: Maximum 10 questions to be answered in a minute. Teams have to say answer/pass for getting next question 3 marks for a correct answer No going back to unanswered questions

141. Team A

142. 1.CD1a is a marker of which cell? 2.Doughnut sign is seen in? 3.Corynebacterium tenuis causes which dermatological condition? 4.Topical ophthalmological preparation recently used for treating rosacea is? 5.Tiger tail appearance of hair is seen in?

143. Team A (cont’d) 6.Wavelength of ablative Erb Yag Laser is? 7.Bean bag appearance is characteristically seen in? 8.Screwdriver teeth affects which teeth in syphilis? 9.Which ticks are characteristic vectors for Lymes disease? 10.Dot in circle sign on radiology is seen in which condition?

144. Team A: Answers CD1a is a marker of which cell? Langerhans cell Doughnut sign is seen in? Scleromyxedema Corynebacterium tenuis causes which dermatological condition? Trichomycosis axillaris Topical ophthalmological preparation used for treating rosacea is? Brimonidine

145. Team A Tiger tail appearance of hair is seen in? Trichothiodystrophy Wavelength of ablative Erb Yag Laser is? 2940nm Bean bag appearance is characteristically seen in? Histiocytic cytophagic panniculitis Screwdriver teeth affects which teeth in syphilis? Upper incisor

146. Team A Which ticks are characteristic vectors for Lymes disease Ixodes Dot in circle sign on radiology is seen in which condition? Mycetoma foot

147. Team B

148. 1.Trichosporon beigelii causes ? 2.SLURP-1 gene defect is seen in? 3.Anti cyclic citrullinated peptides (CCP) is a marker of which disease? 4.Pastia’s sign is seen in? 5.The most commonly used absorbable suture material for its excellent cosmesis is?

149. Team B 6.Cimex Lectularius causes? 7.Generalised livedo reticularis with cerebrovascular disease is characteristic of which disease? 8.Enzyme defect in XLRI is ? 9.Migratory thrombophlebitis is a marker of which malignancy? 10.Superinfection by Fusarium and Bacteroides lead to which chancroid variant?

150. Team B: Answers Trichosporon beigelii causes ? White piedra SLURP-1 gene defect is seen in? Mal de meleda Anti cyclic citrullinated peptides (CCP) is a marker of which disease? Rheumatoid arthritis Pastia’s sign is seen in? Scarlet fever

151. Team B The most commonly used absorbable suture material for its excellent cosmesis is? Vicryl(Polyglactin 910) Cimex Lectularius causes? Bed bug bites Generalised livedo reticularis with cerebrovascular disease is characteristic of which disease? Sneddon’s syndrome

152. Team B Enzyme defect in XLRI is ? Steroid sulphatase Migratory thrombophlebitis is a marker of which malignancy? Pancreatic carcinoma Superinfection by Fusarium and Bacteroides lead to which chancroid variant? Phagedenic

153. Team C

154. 1.Green diaper is seen in? 2.Vasculitis due to cocaine abuse often results due to its adulteration with? 3.Mauserung phenomenon is seen in? 4.Target Chromophore for Pulse dye laser is? 5.Commonest Adverse effect of N Acetyl cystein is?

155. Team C (cont’d) 6.Mutation in gene involving endoplasmic reticulum calcium pump results in ? 7.Alizarin blue is used to stain? 8.Patients with Alpha 1 anti-trypsin deficiency often come to us for treatment of? 9.Resistance to rifampicin in leprosy involves which gene? 10.Commonest allergen in contact dermatitis due to currency notes?

156. Answers: Team C Green diaper is seen in Phenylketonuria/ Histidenimia Vasculitis due to cocaine abuse results due to its adulteration with Levamisole Mauserung phenomenon is seen in Icthy bul of siemens Target Chromophore for Pulse dye laser is Hemoglobin

157. Answers: Team C Commonest Adverse effect of N Acetyl cystein GI dist Mutation in gene involving endoplasmic reticulum calcium pump results in? Darier’s Alizarin Blue is used to stain? Calcium Patients with Alpha 1 anti-trypsin deficiency come to us for treatment of? Panniculitis

158. Team C Resistance to rifampicin in leprosy involves which gene? rpoB gene Commonest Antigen in contact dermatitis due to currency notes? Formaldehyde

159. Team D 1.Hair collar sign” is seen in? 2.Mutation in the gene SPINK-5 would clinically manifest as? 3.Mierowski phenomenon is also known as? 4.Target chromophore for Erbium Yag laser is? 5.During rescue of chemotherapy, Sweet’s syndrome is a known characteristic adverse effect of?

160. Team D 6.Dimple sign in dermatofibroma was proposed by? 7.Mefert’s sign is seen in? 8.Drug derived from Glycerrhizia glabra for melasma is? 9.Alpha lipoprotein deficiency is also known as? 10.Name rubber antigen which has Antabuse action?

161. Team D “Hair collar sign” is seen in Aplasia cutis Mutation in the gene SPINK-5 would clinically manifest as? Netherton’s syndrome Mierowski phenomenon is also known as Imm pig darkening Target chromophore for Erbium Yag laser is Water

162. Team D During rescue of chemotherapy, Sweet’s syndrome is a known adverse effect of GM-CSF Dimple sign in dermatofibroma was proposed by Fitzpatrick Mefert’s sign is seen in Fordyce’s condition

163. Team D Drug derived from Glycerrhizia glabra for melasma is Arbutin Alpha lipoprotein deficiency is also known as Tangier’s disease Name rubber antigen which was used as Antabuse Tetra Ethyl Thiouram Disulfide

164. FINAL SCORES PLEASE......

165. A FINAL THOUGHT Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer - Charles Caleb Colton (1780-1832)

166. THANK YOU