INI CET Dermatology Syllabus

Dermatology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Dermatology in INI CET, not a summary of it.

1. 1

   Introduction to Dermatology

   2 topics

   • Anatomy and physiology of the skin
     • Layers of the skin (epidermis, dermis, subcutaneous tissue)
     • Appendages (hair, nails, sweat glands)
     • Functions of the skin (protection, thermoregulation, sensation)
   • Classification of skin lesions
     • Primary lesions (macule, papule, plaque, nodule, vesicle, bulla)
     • Secondary lesions (scale, crust, erosion, ulcer, atrophy)
2. 2

   Basic Dermatological Procedures

   3 topics

   • Skin Biopsy
     • Techniques (punch biopsy, shave biopsy, incisional biopsy)
     • Indications
     • Interpretation of histopathological findings
   • Patch Testing
     • Diagnosis of allergic contact dermatitis
     • Interpretation of patch test results
   • Dermoscopy
     • Use of dermoscopy for the diagnosis of melanocytic lesions
     • Use of dermoscopy for the diagnosis of non-melanocytic lesions
     • Use of dermoscopy for the diagnosis of inflammatory skin conditions
3. 3

   Inflammatory Skin Disorders

   3 topics

   • Psoriasis
     • Clinical features
     • Plaque psoriasis
     • Guttate psoriasis
     • Pustular psoriasis
     • Topical therapy
     • Phototherapy
     • Systemic therapy
   • Eczema (Atopic Dermatitis)
     • Clinical features
     • Acute eczema
     • Subacute eczema
     • Chronic eczema
     • Emollients
     • Topical corticosteroids
     • Calcineurin inhibitors
   • Acne Vulgaris
     • Pathogenesis
     • Comedones
     • Papules
     • Pustules
     • Nodules
     • Topical retinoids
     • Benzoyl peroxide
     • Oral antibiotics
4. 4

   Infectious Skin Disorders

   3 topics

   • Bacterial infections
     • Impetigo
     • Cellulitis
     • Erysipelas
     • Folliculitis
     • Furuncles
     • Carbuncles
   • Viral infections
     • Herpes simplex virus (HSV) infection
     • Herpes zoster (shingles)
     • Molluscum contagiosum
     • Common warts
     • Plantar warts
   • Fungal infections
     • Dermatophytosis
     • Candidiasis
     • Pityriasis versicolor
5. 5

   Autoimmune and Connective Tissue Disorders

   3 topics

   • Lupus erythematosus
     • Systemic lupus erythematosus (SLE)
     • Discoid lupus erythematosus (DLE)
     • Subacute cutaneous lupus erythematosus (SCLE)
   • Dermatomyositis
     • Clinical features
     • Skin manifestations (heliotrope rash, Gottron's papules)
     • Management
   • Scleroderma
     • Localized scleroderma (morphea)
     • Systemic sclerosis (limited cutaneous, diffuse cutaneous)
6. 6

   Pigmentary Disorders

   3 topics

   • Vitiligo
     • Pathogenesis
     • Clinical features
     • Depigmented macules
     • Patches
     • Topical corticosteroids
     • Phototherapy
   • Melasma
     • Clinical features
     • Topical depigmenting agents
     • Chemical peels
   • Post-inflammatory hyperpigmentation
     • Causes
     • Clinical features
     • Management
7. 7

   Hair and Nail Disorders

   3 topics

   • Alopecia areata
     • Pathogenesis
     • Clinical features (well-defined patches of non-scarring alopecia)
     • Management (topical corticosteroids, intralesional corticosteroids)
   • Androgenetic alopecia
     • Clinical features
     • Pattern of hair loss (male pattern baldness, female pattern hair loss)
     • Management (topical minoxidil, oral finasteride)
   • Onychomycosis
     • Fungal nail infection
     • Clinical features (thickened, discolored nails)
     • Management (oral antifungal therapy, topical therapy)
8. 8

   Genodermatoses

   2 topics

   • Epidermolysis bullosa
     • Clinical features
     • Epidermolysis bullosa simplex
     • Dystrophic epidermolysis bullosa
     • Wound care
     • Genetic counseling
   • Neurofibromatosis
     • Neurofibromatosis type 1 (von Recklinghausen disease)
     • Clinical features
     • Management
9. 9

   Skin Cancer

   3 topics

   • Basal cell carcinoma
     • Clinical features
     • Risk factors
     • Management
   • Squamous cell carcinoma
     • Clinical features
     • Risk factors
     • Management
   • Melanoma
     • Clinical features
     • Staging
     • Management
10. 10

    Cosmetic Dermatology

    3 topics

    • Botulinum toxin injections
      • Indications (dynamic wrinkles)
      • Technique
      • Complications
      • Contraindications
    • Fillers
      • Hyaluronic acid fillers
      • Calcium hydroxylapatite fillers
      • Poly-L-lactic acid fillers
      • Volume restoration
      • Wrinkle correction
    • Chemical peels
      • Superficial peels (alpha hydroxy acids)
      • Medium-depth peels (trichloroacetic acid)
      • Deep peels (phenol)
      • Skin rejuvenation

Dermatology flashcards for INI CET

24 of 50 cards from the Dermatology deck — real questions with worked answers.

1. Name the three primary layers of the skin from superficial to deep, and the predominant cell type of the epidermis.

   Epidermis (mainly keratinocytes), dermis (collagen/elastin with fibroblasts), and subcutis/hypodermis (adipose tissue). The epidermis is composed predominantly of keratinocytes.

2. List the five layers of the epidermis from deep to superficial.

   Stratum basale (germinativum), stratum spinosum, stratum granulosum, stratum lucidum (only in thick/palmoplantar skin), and stratum corneum.

3. What is the approximate epidermal turnover (transit) time from basal layer to shedding, and how is it altered in psoriasis?

   Normal epidermal turnover is about 28 days (~28-56 days cited). In psoriasis it is markedly shortened to about 3-4 days due to hyperproliferation.

4. Differentiate the dermo-epidermal junction antigens targeted in the two major autoimmune blistering groups.

   Pemphigus targets intraepidermal desmosomal cadherins (desmoglein 1 and 3), causing acantholysis. Pemphigoid targets hemidesmosomal antigens at the basement membrane (BP180/BPAG2 and BP230), causing subepidermal blisters.

5. Define the following primary skin lesions: macule, papule, nodule, plaque, vesicle, bulla, pustule, wheal.

   Macule = flat color change <1 cm; Papule = raised <1 cm; Nodule = raised >1 cm with dermal involvement; Plaque = flat-topped elevation >1 cm; Vesicle = fluid-filled <1 cm; Bulla = fluid-filled >1 cm; Pustule = pus-filled; Wheal = transient edematous plaque (urticaria).

6. Define these secondary skin lesions: scale, crust, erosion, ulcer, lichenification, excoriation.

   Scale = flakes of stratum corneum; Crust = dried exudate/serum/blood; Erosion = loss of epidermis only (heals without scar); Ulcer = loss extending into dermis/deeper (scars); Lichenification = thickened skin with accentuated markings from chronic rubbing; Excoriation = scratch-induced linear erosion.

7. For a skin biopsy, when is a punch vs. an excisional biopsy preferred, and what is the minimum punch size for adequate dermal sampling?

   Punch biopsy (typically 3-4 mm; minimum useful ~3 mm) samples epidermis to subcutis for inflammatory dermatoses; excisional biopsy is preferred for suspected melanoma to assess full depth/Breslow thickness. Shave biopsy is for superficial/exophytic lesions.

8. Which type of biopsy and transport medium is required for direct immunofluorescence (DIF) in autoimmune bullous disease?

   A perilesional biopsy is taken and transported in Michel's medium (or normal saline if processed quickly), NOT formalin, because formalin destroys the immunoreactants needed for DIF.

9. What is patch testing used to diagnose, and which type of hypersensitivity reaction does it detect?

   Patch testing diagnoses allergic contact dermatitis. It detects Type IV (delayed, T-cell mediated) hypersensitivity.

10. Describe the standard reading schedule and grading principle for patch testing.

    Patches are applied for 48 hours, then removed; readings are done at 48 hours (Day 2) and again at 72-96 hours (Day 3-4) for delayed reactions. Reactions are graded from doubtful (?+), weak (+, erythema/papules), strong (++, vesicles), to extreme (+++, bullous/spreading).

11. In dermoscopy, what is the pigment network and what does a typical (regular) vs. atypical network suggest?

    The pigment network is a honeycomb-like grid of brown lines (melanin in rete ridges). A regular, uniform network suggests a benign melanocytic nevus; an atypical/irregular network with variable thickness and abrupt cutoff raises suspicion for melanoma.

12. What classic dermoscopic features differentiate basal cell carcinoma from a melanocytic lesion?

    BCC shows arborizing (branching) telangiectatic vessels, blue-gray ovoid nests, leaf-like areas, spoke-wheel structures, and ulceration, with absence of a pigment network.

13. Name three classic clinical signs of psoriasis (including the bleeding-point sign).

    Auspitz sign (pinpoint bleeding when scale is removed), Koebner phenomenon (lesions at sites of trauma), and the candle-grease sign (waxy scale on scratching). Histology shows Munro microabscesses.

14. What is the histopathological hallmark tetrad of plaque psoriasis?

    Parakeratosis, acanthosis with regular elongation of rete ridges, thinning of suprapapillary plates, Munro microabscesses (neutrophils in stratum corneum), and dilated dermal capillaries. Spongiform pustules of Kogoj may be present.

15. State the diagnostic criteria framework and characteristic morphology/distribution of atopic dermatitis in adults vs. infants.

    Diagnosed by Hanifin and Rajka criteria (pruritus is essential). Infants: face, scalp, and extensor surfaces. Adults/children: flexural involvement (antecubital and popliteal fossae). It is part of the atopic triad with asthma and allergic rhinitis.

16. What is the role of filaggrin in atopic dermatitis pathogenesis?

    Loss-of-function mutations in the filaggrin (FLG) gene impair the skin barrier, increasing transepidermal water loss and allergen penetration, predisposing to atopic dermatitis and ichthyosis vulgaris.

17. Outline the four key pathogenic factors in acne vulgaris.

    (1) Follicular hyperkeratinization (comedo formation), (2) increased sebum production (androgen-driven), (3) colonization by Cutibacterium acnes (formerly Propionibacterium acnes), and (4) inflammation.

18. What is the primary (non-inflammatory) lesion of acne, and what is the first-line topical agent that targets it plus its mechanism?

    The comedo (open = blackhead, closed = whitehead) is the primary lesion. Topical retinoids (e.g., adapalene, tretinoin) are first-line and act as comedolytics by normalizing follicular keratinization.

19. What are the monitoring requirements and main contraindication for oral isotretinoin?

    Monitor liver enzymes and fasting lipids (triglycerides). It is a potent teratogen — absolutely contraindicated in pregnancy; pregnancy prevention/iPLEDGE-type programs with two contraception methods are mandatory.

20. Name the causative organisms and key features of impetigo (contagiosa) vs. erysipelas.

    Impetigo: Staphylococcus aureus and Streptococcus pyogenes; superficial, honey-colored crusts. Erysipelas: Streptococcus pyogenes; sharply demarcated, raised, bright-red plaque of the upper dermis (commonly face/legs) with fever.

21. What organism causes staphylococcal scalded skin syndrome (SSSS) and what is the target of its toxin?

    Staphylococcus aureus producing exfoliative (epidermolytic) toxins A/B, which cleave desmoglein 1, causing superficial subcorneal splitting and a positive Nikolsky sign, sparing mucosae.

22. Distinguish the lesions of herpes simplex, varicella, and herpes zoster.

    HSV: grouped vesicles on an erythematous base (recurrent, localized). Varicella (chickenpox): generalized lesions in different stages simultaneously ('dew drop on a rose petal'). Herpes zoster (shingles): painful dermatomal vesicles from VZV reactivation.

23. What virus causes molluscum contagiosum, and what is its characteristic histologic inclusion body?

    Molluscum contagiosum virus (a poxvirus). Lesions are umbilicated papules; histology shows intracytoplasmic Henderson-Paterson (molluscum) inclusion bodies.

24. How do you confirm a dermatophyte infection at the bedside, and what is the classic morphology of tinea corporis?

    KOH (potassium hydroxide) mount of skin scrapings shows septate branching hyphae. Tinea corporis presents as an annular plaque with a raised, scaly, active advancing border and central clearing ('ringworm').

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