Vesiculobullous disorders: coma blisters: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Vesiculobullous disorders: coma blisters

Sample item

A young man is found unconscious after a drug overdose and later develops tense bullae over the ankles, wrists and buttocks, which were in contact with the floor. Biopsy is most likely to show which feature?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Necrosis of eccrine sweat glands with a subepidermal blister

Coma blisters occur over pressure points in patients unconscious from sedatives, barbiturates, opioids or carbon monoxide. Histology shows necrosis of eccrine sweat glands and ducts with a subepidermal or intraepidermal blister, and DIF is negative. They heal with supportive care.

Option by option

  • A. Eosinophil-rich spongiosis with linear IgG

    Eosinophilic spongiosis with linear basement membrane IgG belongs to bullous pemphigoid.

  • B. Necrosis of eccrine sweat glands with a subepidermal blister (correct)

    Correct. Eccrine gland necrosis at pressure sites is the typical histology of coma blisters.

  • C. Suprabasal acantholysis with tombstone basal cells

    Suprabasal acantholysis with tombstoning is the pattern of pemphigus vulgaris.

  • D. Subcorneal pustules filled with neutrophils

    Subcorneal neutrophilic pustules are seen in subcorneal pustular dermatosis and impetigo.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is B, Necrosis of eccrine sweat glands with a subepidermal blister. Coma blisters occur over pressure points in patients unconscious from sedatives, barbiturates, opioids or carbon monoxide.

Why is "Eosinophil-rich spongiosis with linear IgG" not the answer?

Eosinophilic spongiosis with linear basement membrane IgG belongs to bullous pemphigoid.

Why is "Suprabasal acantholysis with tombstone basal cells" not the answer?

Suprabasal acantholysis with tombstoning is the pattern of pemphigus vulgaris.

Why is "Subcorneal pustules filled with neutrophils" not the answer?

Subcorneal neutrophilic pustules are seen in subcorneal pustular dermatosis and impetigo.

What concept does this question test?

It tests Vesiculobullous disorders: coma blisters in Dermatology. Histology shows necrosis of eccrine sweat glands and ducts with a subepidermal or intraepidermal blister, and DIF is negative. They heal with supportive care.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vesiculobullous disorders: coma blisters?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.