Vesiculobullous disorders: 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 · Vesiculobullous disorders

Sample item

A middle-aged man has flaccid blisters and painful oral erosions. A biopsy shows suprabasal acantholysis. What is the expected direct immunofluorescence finding on perilesional skin?

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

The answer and the reasoning

D. Intercellular IgG deposition in the epidermis (chicken-wire pattern)

Pemphigus vulgaris is caused by IgG autoantibodies against desmogleins, which cause suprabasal acantholysis. Direct immunofluorescence shows IgG (and often C3) deposited between keratinocytes in a net-like or chicken-wire pattern.

Option by option

  • A. Linear IgA deposition along the basement membrane zone

    Linear IgA along the basement membrane is the finding in linear IgA bullous dermatosis.

  • B. Granular IgA deposits in the dermal papillary tips

    Granular IgA in the papillary tips is the finding in dermatitis herpetiformis.

  • C. Linear IgG and C3 along the basement membrane zone

    Linear IgG and C3 at the basement membrane is the pattern of bullous pemphigoid, where the split is subepidermal.

  • D. Intercellular IgG deposition in the epidermis (chicken-wire pattern) (correct)

    Correct. Autoantibodies bind the desmosomal adhesion proteins between keratinocytes.

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 D, Intercellular IgG deposition in the epidermis (chicken-wire pattern). Pemphigus vulgaris is caused by IgG autoantibodies against desmogleins, which cause suprabasal acantholysis.

Why is "Linear IgA deposition along the basement membrane zone" not the answer?

Linear IgA along the basement membrane is the finding in linear IgA bullous dermatosis.

Why is "Granular IgA deposits in the dermal papillary tips" not the answer?

Granular IgA in the papillary tips is the finding in dermatitis herpetiformis.

Why is "Linear IgG and C3 along the basement membrane zone" not the answer?

Linear IgG and C3 at the basement membrane is the pattern of bullous pemphigoid, where the split is subepidermal.

What concept does this question test?

It tests Vesiculobullous disorders in Dermatology. Direct immunofluorescence shows IgG (and often C3) deposited between keratinocytes in a net-like or chicken-wire 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 Vesiculobullous disorders?

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.