Patch test phytodermatitis itchy erythematous papular lesions on face, neck, ‘V’ area of chest, dorsum of hands and forearms

069. A 45-year-old farmer has itchy erythematous papular lesions on face, neck, ‘V’ area of chest, dorsum of hands and forearms for 3 years. The lesions are more severe in summers and improve by 75% in winters. The most appropriate test to diagnose the condition would be:

1. Skin biopsy

2. Estimation of IgE levels in blood

3. Patch test

4. Intradermal prick test

Answer

3. Patch test

Reference

Rook Textbook of Dermatology Chapter 20

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Discussion

In phytodermatitis, the pattern of dermatitis varies depending on the source. Typically, it involves the hands, forearms, face and genitals. Often it is acute and vesicular. Involvement of the eyelids is common. Sometimes, the hands only are involved, with fissuring and hyperkeratosis of the fingertips and subungual hyperkeratosis (as with tulip bulbs, garlic, etc.). At other times the dermatitis may be of a volatile pattern and may present as a light-aggravated or 'exposed site' dermatitis (as with Compositae dermatitis). The principal types of phytodermatitis are:

1. irritant contact phytodermatitis-both chemical and physical
2. allergic contact phytodermatitis-both immediate and delayed;
3. phytophototoxic dermatitis;
4. pseudophytophotodermatitis, for example Ranunculaceae;
5. allergic contact phytodermatitis with secondary photo-sensitivity, for example Compositae, lichens, etc.

Explanation

The allergen may be localized anywhere in the plant, but usually the leaves are used for patch testing. Primin occurs in minute glandular hairs most closely set on the surface of small leaves A 1 cm piece of leaf can be used for patch testing, but false-negative reactions are common, and patch-test sensitization occurs in 0.8% of those tested. It is therefore preferable to test with a standardized extract of primin and Compositae.

Comments

Active sensitization is uncommon when such extracts are used. The risk of patch-test sensitization from plants other than Primula and poison ivy has not yet been systemically studied.

Tips

The condition is more common in men. Broad spectrum photoprotection and light avoidance are beneficial.

Barberio’s test is used to detect semen

074. Which of following tests is used to detect semen?

1. Phenolphthalein test

2. Reine’s test

3. Barberio’s test

4. Paraffin test

Answer

3. Barberio’s test

Reference

Parikh 6^th Edition Page 7.26

Apoorva Nandy 1^st Edition Page 128

Reddy 17^th Edition Page 328

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The tests used for Chemical Examination of seminal fluid are

Ä Florence test : dark brown crystals due to the formation of chlorine periodide

Ä Barberio’s test (Barbario) : tests spermine in semen, with picric acid

Ä Acid Phosphatase test : Quantitative test

Ä Test for Creatine Phosphokinase : Levels of more than 400 units/ml

Ä Choline and Spermine Test

Ä Gel Electrophoresis test :

Ä LDM Isoenzyme Method

Ä Acid Phosphatase Isoenzyme Test

Ä Ammonium Molybdate Test (Phosphorus)

Ä Semen Specific Glycoprotein (P30 ) Test

Ä Enzyme-linked immunosorbent assay (ELISA), the SEMA® assay, for a seminal vesicle-specific antigen (SVSA)

Explanation

1. Phenolphthalein test (Kastle Meyer test), Benzedine test, Leucomalachite green test, Orthotolidine (Blue or green) test (Kohn and O’kelly test) and Luminal test are used to detec blood

2. Reine’s test ??? - Rinne's test compares the patients ability to hear a tone conducted via air and bone - the mastoid process.

3. Barberio’s test is to detect semen.

4. Paraffin test (also known as the dermal nitrate test) uses the reagent diphenylamine to detect gun powder

Comments

Basis of Berberio’s Test: Detection of Spermine

Procedure: A few drops of Berberio’s reagent when added to spermatic fluid produces crystals of sperm in picrate (needle shaped, rhombic & of yellow colour).

For various valid reasons, like non-specificity and lack of reproducibility, the florence and berberio’s tests have not been accepted universally.

Tips

Semen consist of the following

1. Spermatozoa (10%)

2. Seminal Plasma (90%)

3. Epithelial Cell (<>

Scab or Crust of abrasion appears brown Between 2-3 days

073. Scab or Crust of abrasion appears brown:

1. Between 12-24 hours

2. Between 2-3 days

3. Between 4-5 days

4. Between 5-7 days

Answer

2. Between 2-3 days

Reference

Parikh 6^th Edition Page 4.3

Apoorva Nandy 1^st Edition Page 213

Reddy 17^th Edition Page 138

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From abrasions, the time of assault can be roughly assessed

Ä When fresh, an abrasion is red with evidence of oozing of serum and a little blood. There is no scab

Ä By 8 to 24 hours, there is a reddish scab formation

Ä By 2^nd and 3^rd day, the scab is reddish brown

Ä By 4^th and 5^th Day, it is dark brown

Ä By 6^th Day, it is blackish and it starts falling off from the margins. Epithelium grows underneath the scab

Ä After 7 Days, Scab dries, shrinks and falls off.

Ä By A big scab may take a few more days to fall off

Explanation

Self Explanatory

Comments

Except Apoorva Nandy, the other books do not talk about the 4^th and 5^th Day evolution of scab

Tips

Difference between antemortem and post mortem abrasion

Trait	Antemortem abrasion	Post mortem abrasion
Site	Anywhere on the body	Usually over bony prominences
Colour	Bright reddish brown	Yellowish, translucent and parchment like
Exudation	More; scab slightly raised	Less; Scab often lies slightly below the level of the skin
Microscopic feature	Intravital reaction and congestion seen	No intravital reaction and no congestion

Medical qualifications awarded by institutions out side India and recognized by MCI are registered in

072. Medical qualifications awarded by institutions out side India and recognized by MCI are registered in:

1. First schedule of Indian Medical Council Act 1956

2. Second schedule of Indian Medical Council Act 1956

3. Part I of third schedule of Indian Medical Council Act 1956

4. Part II of third schedule of Indian Medical Council Act 1956

Answer

4. Part II of third schedule of Indian Medical Council Act 1956

Reference

Parikh 6^th Edition Page 1.24

Apoorva Nandy 1^st Edition Page 18

Reddy 17^th Edition Page 21

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The Indian Medical Council maintains three schedules.

Ä The first schedule contains the list of different medical degrees offered by different Universities or Institutions inside India, which are recognized by the Council and Government of India

Ä The Second Schedule contains the list of medical degrees conferred outside India and are recognized by the Medical Council of India and Government of India

Ä The Third Schedule has two parts

o Part A of the third schedule contains the list of medical qualifications conferred by Indian Universities or Institutions but not yet included in the First Schedule.

o Part B of the third schedule includes the list of standard medical qualifications of foreign countries which are recognized when Indian citizens possess the qualifications

Explanation

Self Explanatory

Comments

If an Indian national obtains a foreign qualification which is not included in part II of THrid Schedule, he can apply to the Central government. The candidate is required to provide full information with regard to the course of study, syllabus, and duration of course etc. This is forwarded to IMC which has authority to enter into negotiations with any of the medical councils of the foreign countries and can recognize such foreign qualifications on reciprocal basis. The Central Government, may, by notification in the Official Gazette, amend the part II of the Third Schedule so as to include such qualification there in

Tips

Dr.B.C.Roy was the first Indian to be the president of MCI in 1939. Hope you all know about B.C.Roy. His birthday July 1^st is being observed as Doctors Day

Spalding’s sign occurs after Death of foetus in uterus

071. Spalding’s sign occurs after:

1. Birth of live foetus

2. Death of foetus in uterus

3. Rigor mortis of infant

4. Cadaveric spasm

Answer

2. Death of foetus in uterus

Reference

Parikh 6^th Edition Page 2.36, 5.75

Apoorva Nandy 1^st Edition Page 422

Reddy 17^th Edition Page 341

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In intrauterine maceration, the skull vault bones may partly overlap each other. This is called as Spalding’s sign and is also detectable by X Ray examination before the birth of the dead fetus

Explanation

Self Explanatory

Comments

Maceration is a process of aseptic autolysis of a fetus dead in utero. It occurs when the dead fetus remains in the utero for 3 to 4 days surrounded by liquor amnii but with exclusion of air. It does not occur if the dead fetus is born within 24 hours. It is characterized by softening and degeneration of tissues. The process is aseptic because the fetus being enclosed in the membranes is in a sterile condition.

Tips

Mummification results when death of a fetus occurs from deficient supply of blood or when liquor amnii is scanty and when no air has entered the uterus. In this condition the fetus is dried up and shriveled.

Finger Print Bureau was first established in Writer's Building at Calcutta in the year 1897

070. Finger Print Bureau was first established in:

1. England

2. China

3. India

4. Singapore

Answer

3. India

Reference

http://ncrb.nic.in/cfpb.htm

Parikh 6^th Edition Page 2.15

Apoorva Nandy 1^st Edition Page 92

Reddy 17^th Edition Page 67

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