Bullous disorders: pemphigus histology: 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 · Bullous disorders: pemphigus histology

Sample item

A Tzanck smear from a flaccid blister base shows rounded keratinocytes separated from each other. Histology shows a suprabasal cleft with basal cells attached to the dermis. How is this appearance described?

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

The answer and the reasoning

C. Row of tombstones

In pemphigus vulgaris the basal keratinocytes remain attached to the basement membrane but lose lateral adhesion, giving a row-of-tombstones appearance. Hailey-Hailey disease gives the dilapidated brick wall pattern.

Option by option

  • A. Spongiform pustule

    A spongiform pustule of Kogoj is a feature of pustular psoriasis.

  • B. Dilapidated brick wall

    Dilapidated brick wall is the pattern of Hailey-Hailey disease.

  • C. Row of tombstones (correct)

    Correct. Tombstoning of basal cells is typical of pemphigus vulgaris.

  • D. Saw-tooth rete ridges

    Saw-tooth rete ridges characterise lichen planus.

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, Row of tombstones. In pemphigus vulgaris the basal keratinocytes remain attached to the basement membrane but lose lateral adhesion, giving a row-of-tombstones appearance.

Why is "Spongiform pustule" not the answer?

A spongiform pustule of Kogoj is a feature of pustular psoriasis.

Why is "Dilapidated brick wall" not the answer?

Dilapidated brick wall is the pattern of Hailey-Hailey disease.

Why is "Saw-tooth rete ridges" not the answer?

Saw-tooth rete ridges characterise lichen planus.

What concept does this question test?

It tests Bullous disorders: pemphigus histology in Dermatology. Hailey-Hailey disease gives the dilapidated brick wall pattern.

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 Bullous disorders: pemphigus histology?

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.