Metabolic skin signs: 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 · Metabolic skin signs

Sample item

An obese adolescent has velvety, thickened, dark skin over the nape of the neck and in the axillae. Which underlying abnormality is the most likely?

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

The answer and the reasoning

C. Insulin resistance with hyperinsulinaemia

Acanthosis nigricans is a marker of insulin resistance, where high insulin levels stimulate keratinocyte and fibroblast growth through insulin-like growth factor receptors. Abrupt, extensive onset in an older adult should raise suspicion of an internal malignancy, commonly gastric.

Option by option

  • A. Iron deficiency anaemia

    Iron deficiency causes pallor, koilonychia and angular stomatitis rather than velvety flexural plaques.

  • B. Hyperthyroidism

    Hyperthyroidism may cause warm moist skin and pretibial myxoedema, not acanthosis nigricans.

  • C. Insulin resistance with hyperinsulinaemia (correct)

    Correct. Hyperinsulinaemia drives the velvety thickening in flexures.

  • D. Primary adrenal insufficiency

    Adrenal insufficiency causes generalised or pressure-area hyperpigmentation, but it does not produce velvety thickening.

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, Insulin resistance with hyperinsulinaemia. Acanthosis nigricans is a marker of insulin resistance, where high insulin levels stimulate keratinocyte and fibroblast growth through insulin-like growth factor receptors.

Why is "Iron deficiency anaemia" not the answer?

Iron deficiency causes pallor, koilonychia and angular stomatitis rather than velvety flexural plaques.

Why is "Hyperthyroidism" not the answer?

Hyperthyroidism may cause warm moist skin and pretibial myxoedema, not acanthosis nigricans.

Why is "Primary adrenal insufficiency" not the answer?

Adrenal insufficiency causes generalised or pressure-area hyperpigmentation, but it does not produce velvety thickening.

What concept does this question test?

It tests Metabolic skin signs in Dermatology. Abrupt, extensive onset in an older adult should raise suspicion of an internal malignancy, commonly gastric.

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 Metabolic skin signs?

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.