Papulosquamous disorders: scleromyxedema paraprotein: 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 · Papulosquamous disorders: scleromyxedema paraprotein

Sample item

A 55-year-old man has widespread firm, waxy, closely set papules in linear arrays on the hands, forearms and face with thickened glabellar furrows. Thyroid function is normal and biopsy shows dermal mucin with fibroblast proliferation. Which investigation result is expected?

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

The answer and the reasoning

C. Monoclonal IgG lambda paraprotein

Scleromyxedema (generalised lichen myxedematosus) is a mucinosis almost always associated with a monoclonal IgG, usually lambda, in serum. It is not a thyroid disease. Patients need protein electrophoresis, and treatment includes IVIG and other agents.

Option by option

  • A. Anti-topoisomerase I antibody

    Anti-topoisomerase I marks diffuse systemic sclerosis, with sclerosis rather than waxy papules and mucin.

  • B. Anti-TSH receptor antibodies

    Anti-TSH receptor antibodies belong to Graves disease, which causes localised pretibial myxoedema.

  • C. Monoclonal IgG lambda paraprotein (correct)

    Correct. A serum IgG lambda paraproteinaemia is the characteristic association of scleromyxedema.

  • D. Cryoglobulins with hepatitis C

    Cryoglobulins with hepatitis C are linked to vasculitic purpura and not to papular mucinosis.

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 C, Monoclonal IgG lambda paraprotein. Scleromyxedema (generalised lichen myxedematosus) is a mucinosis almost always associated with a monoclonal IgG, usually lambda, in serum.

Why is "Anti-topoisomerase I antibody" not the answer?

Anti-topoisomerase I marks diffuse systemic sclerosis, with sclerosis rather than waxy papules and mucin.

Why is "Anti-TSH receptor antibodies" not the answer?

Anti-TSH receptor antibodies belong to Graves disease, which causes localised pretibial myxoedema.

Why is "Cryoglobulins with hepatitis C" not the answer?

Cryoglobulins with hepatitis C are linked to vasculitic purpura and not to papular mucinosis.

What concept does this question test?

It tests Papulosquamous disorders: scleromyxedema paraprotein in Dermatology. It is not a thyroid disease. Patients need protein electrophoresis, and treatment includes IVIG and other agents.

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 Papulosquamous disorders: scleromyxedema paraprotein?

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.