Gastroenterology and hepatology: porphyria cutanea tarda: practice question

A General Medicine 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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General Medicine · Gastroenterology and hepatology: porphyria cutanea tarda

Sample item

A 50-year-old man with chronic hepatitis C has fragile blisters, erosions and hypertrichosis on the sun-exposed backs of his hands, and his urine is pink-brown. What is the most likely diagnosis?

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

The answer and the reasoning

B. Porphyria cutanea tarda

Porphyria cutanea tarda results from reduced uroporphyrinogen decarboxylase activity in the liver, triggered by iron overload, alcohol, oestrogens and hepatitis C. It causes photosensitive blistering with scarring and hypertrichosis, and treatment includes phlebotomy and sun protection.

Option by option

  • A. Dermatitis herpetiformis

    Dermatitis herpetiformis causes itchy grouped vesicles on extensor surfaces with coeliac disease.

  • B. Porphyria cutanea tarda (correct)

    Correct. Photosensitive blisters with hypertrichosis in hepatitis C suggest porphyria cutanea tarda.

  • C. Pellagra

    Pellagra causes photosensitive dermatitis with diarrhoea and dementia, without blisters on the hands.

  • D. Pemphigus vulgaris

    Pemphigus vulgaris causes flaccid blisters on mucosa and skin, unrelated to sun exposure.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Porphyria cutanea tarda. Porphyria cutanea tarda results from reduced uroporphyrinogen decarboxylase activity in the liver, triggered by iron overload, alcohol, oestrogens and hepatitis C.

Why is "Dermatitis herpetiformis" not the answer?

Dermatitis herpetiformis causes itchy grouped vesicles on extensor surfaces with coeliac disease.

Why is "Pellagra" not the answer?

Pellagra causes photosensitive dermatitis with diarrhoea and dementia, without blisters on the hands.

Why is "Pemphigus vulgaris" not the answer?

Pemphigus vulgaris causes flaccid blisters on mucosa and skin, unrelated to sun exposure.

What concept does this question test?

It tests Gastroenterology and hepatology: porphyria cutanea tarda in General Medicine. It causes photosensitive blistering with scarring and hypertrichosis, and treatment includes phlebotomy and sun protection.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Gastroenterology and hepatology: porphyria cutanea tarda?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.