Cutaneous tuberculosis: papulonecrotic tuberculid: 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 · Cutaneous tuberculosis: papulonecrotic tuberculid

Sample item

A young adult with pulmonary tuberculosis has symmetric crops of dusky papules with central necrosis on the extensors of the limbs, healing with varioloform scars. Biopsy shows a wedge-shaped necrosis with vasculitis. What is the diagnosis?

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

The answer and the reasoning

A. Papulonecrotic tuberculid

Papulonecrotic tuberculid is a hypersensitivity reaction to tuberculous antigen with leukocytoclastic or granulomatous vasculitis. It heals with scars and clears with antitubercular therapy.

Option by option

  • A. Papulonecrotic tuberculid (correct)

    Correct. Necrotic papules with varioloform scars in a TB patient fit this tuberculid.

  • B. Secondary syphilis

    Secondary syphilis gives palmoplantar macules and positive serology.

  • C. Pityriasis lichenoides et varioliformis acuta

    PLEVA resembles it but has no TB association and shows lymphocytic vasculitis.

  • D. Lymphomatoid papulosis

    Lymphomatoid papulosis shows atypical CD30 positive cells and self-heals.

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 A, Papulonecrotic tuberculid. Papulonecrotic tuberculid is a hypersensitivity reaction to tuberculous antigen with leukocytoclastic or granulomatous vasculitis.

Why is "Secondary syphilis" not the answer?

Secondary syphilis gives palmoplantar macules and positive serology.

Why is "Pityriasis lichenoides et varioliformis acuta" not the answer?

PLEVA resembles it but has no TB association and shows lymphocytic vasculitis.

Why is "Lymphomatoid papulosis" not the answer?

Lymphomatoid papulosis shows atypical CD30 positive cells and self-heals.

What concept does this question test?

It tests Cutaneous tuberculosis: papulonecrotic tuberculid in Dermatology. It heals with scars and clears with antitubercular therapy.

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 Cutaneous tuberculosis: papulonecrotic tuberculid?

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.