Tuesday, May 4, 2010

37 - Drugs and Dermatology

A. Drugs causing Pityriasis rosea-like drug eruptions :
1. Beta blockers
2. ACE inhibitors
3. Gold
4. Metronidazole

B. Drugs causing lichenoid eruptions :
1. Thiazides
2. Anti-malarials
3. Gold
4. Quinidine
5. Phenothiazines
6. Sulfonyl ureas
7. ACE inhibitors

C. Drugs which can produce erythroderma :
1. Pencillins
2. Sulfonamides
3. Carbamazepine
4. Phenytoin
5. Gold
6. Allopurinol
7. Zalcitabine

D. Drugs causing alopecia :
1. Warfarin
2. Heparin
3. Propylthiouracil
4. Carbimnazole
5. Vitamin A
6. Isotretinoin
7. Acitretin
8. Lithium
9. Beta blockers
10. Colchicine
11. Amphetamines

E. Drugs which produce acneiform eruptions (or aggravate preexisting acne)
1. Topical or systemic glucocorticoids
2. Oral contraceptive pills
3. Lithium
4. Isoniazid
5. Androgenic steroids
6. Halogens
7. Phenytoin
8. Phenobarbital

Thursday, January 21, 2010

36 - Leprosy (Hensen's Disease) Mcqs

1q: An 8-year old boy from Bihar presents with a 6 month history of an ill defined hypopigmented slightly atrophic
macule on the face. What is the most likely diagnosis ?
a. Ptyriasis alba
b. Indeterminate leprosy
c. Morphacea
d. Calcium deficiency

*A hypopigmented, non-scaly anaesthetic macule with epidermal atrophy in a resident where leprosy in endemic is a feature of indeterminate leprosy.
*A hypopigmented, non-scaly macule, associated with ash leaf macules, adenoma sebaceum, seizures and mental retardation, suggests
tuberous sclerosis.
*A hypopigmented, non-scaly macule is sharply defined and associated with non-pigmented patches occuring almost anywhere in the body. Then it suggest
*A recurrent scaly macule occuring in young children on cheeks and face most commonly is Pityriasis alba (simplex).
*A recurrent scaly macule occuring in young adults on trunk and shoulder is pityriasis versicolor.

2q: The following drug is not used for the treatment of type II lepra reaction (ENL) ?
a. Chloroquine
b. Thalidomide
c. Cyclosporine
d. Corticosteroids

*Mild Type II lepra reaction is treated with NSAIDs.
*Moderate Type II lepra reaction is treated with NSAIDs, thalidomide, Chloroquin and clofazimine.
*Severe Type II lepra reaction is treated with Thalidomide, Corticosteroids (for impending nerve damage, orchitis, necrotic ENL).
- Parenteral antimony is also used in the treatment of type II lepra reaction.
*The drug of choice for both type I and type II lepra reactions is Corticosteroids.

3q: The main cytokine involved in ENL(Erythema Nodosum Leprosum) reaction is
a. IL-2
b. IFN-Gamma
c. TNF-Alpha

4q: Manifestation of ENL includes all except ?
a. Pancreatitis
b. Fever
c. Hepatitis
d. Arthritis
e. Cutaneous nodules

*ENL is a type III hypersensitivity occurs exclusively in BL,LL which usually follows therapy, but may precede therapy. Clinical features include painful erythematous papules (most common), fever, malaise, neuritis, lymphadenitis, uveitis, orchitis, glomerulonephritis, anemia, leukocytosis and abnormal liver function tests.

5q: The following test is not used for diagnosis of leprosy ?
a. Lepromin test
b. Slit skin smear
d. Skin biopsy

*Lepromin test does not help in the diagnosis of leprosy but only helps in prognosis and classification of leprosy.

6q: A 27 year old patient was diagnosed to have borderline leprosy and started on Multibacillary multi-drug therapy. Six weeks later, he developed pain in the nerves and redness and swelling of the skin lesions. The management of his illness should include all of the following except ?
a. Stop anti-leprosy drugs
b. Systemic corticosteroids
c. Rest to the limbs affected
d. Analgesics

*This is the type I lepra reaction (Downgrading and reversal reaction) which occurs in the borderline leprosy (not in polar forms)
*It is a type IV delayed hypersensitivity.
*Clinical presentation includes signs of inflammation in previous lesions, appearance of new skin lesions, neuritis and low grade fever.
*Most common nerve involved is the ulnar nerve (high), followed by posterior auricular nerve, peroneal and posterior tibial nerve.
*Leprosy treatment should not be discontinued.
*Analgesics should be given.
*Drug of choice is corticosteroids.
*Rest and splintage of the affected limb is done.
*Thalidomide has no role.

7q: ENL is seen in which form of leprosy ?
a. Indeterminate
b. BT
c. LL
d. BL
e. TT

8q: A 16 year old student reported for the evaluation of multiple hypopigmented macules on the trunk and limbs. All of the following tests are useful in making a diagnosis of leprosy except ?
a.Sensation testing
b. Lepromin test
c. Slit smears
d. Skin biopsy

9q: A 45 year old male had multiple hypoaesthetic mildly erythematous large plaques with elevated margins on trunk and extremities. His ulnar and lateral popliteal nerves on both sides were enlarged. The most probable diagnosis is ?
a. LL
b. Borderline Leprosy
c. BT
d. BL

10q: Lepromin test is positive in which leprosy ?
a. Lepromatous
b. Indeterminate
c. Histoid
d. Tuberculoid

11q: Satellite lesions are seen in ?
a. Indeterminate leprosy
b. Borderline leprosy
c. BT
d. Tuberculoid leprosy

12q: A 6 year old child from Tamil Nadu presents with a solitary nonanaesthetic patch on face, the possible diagnosis is ?
a. Pityriasis alba
b. Indeterminate leprosy
c. Pityriasis versicolor
d. Tinea infection

13q: Antileprotic drug also used in lepra reaction is ?
a. Rifampicin
b. Dapsone
c. Ciprofloxacin
d. Clofazimine

14q: Most potent anti-leprotic drug is ?
a. Rifampcin
b. Dapsone
c. Clofazimine
d. Norflox

15q: Best method of treatment of ulnar nerve abscess in case of leprosy is ?
a. High doses of steroid
b. Incision and drainage
c. Thalidomide
d. High dose of clofazimine

16: Inverted saucer shaped lesion is found in ?
a. Lepromatous leprosy
b. Tuberculoid leprosy
c. Borderline leprosy
d. Indeterminate leprosy

17q: A single hypopigmented anesthetic patch with satellite lesion on forearm, likely diagnosis is ?
a. Indeterminate leprosy
b. Tuberculoid leprosy
c. Neuritic leprosy
d. Lupus vulgaris

18q: All are features of Lepromatous leprosy except
a. Gynecomastia
b. madarosis
c. saddle nose
d. perforating ulcer

19q: Commonest nerve involved in leprosy is ?
a. Ulnar
b. Median
c. Radial
d. Sciatic

20q: Cell mediated immunity is maximum suppressed in
a. BT
b. LL
c. TT
d. Indeterminate

21q: Average duration of treatment of multibacillary leprosy ?
a. 1 year
b. 2 year
c. 3 year
d. Life long

22q: ENL is seen in
a. TT
b. BT
c. Lepromatous leprosy
d. Indeterminate leprosy

23q: DOC for lepra II reaction ?
a. Steroids
b. Thalidomide
c. Clofazimine
d. Dapsone

24q: Drug of choice of ENL
a. Steroid
b. Thalidomide
c. Clofazimine
d. Aspirin

25q: ENL is seen in all except ?
a. Rheumatoid arthritis
b. TB
c. Enteric fever
d. Aspirin therapy

*ENL is seen in
- TB
- Sarcoidosis, Streptococcal infection, Salmonella (typhoid), syphilis
- Inflammatory bowel diseases like ulcerative colitis and crohn's disease
- Brucellosis, Coccidiodomycosis, Histoplasmosis, Mycoplasma, Psittacosis, Yersinia, Chlamydia
- Leprosy
- Drugs like sulfonamide, Pencillin, Contraceptives, bromide, iodide.
- Pregnancy
- Hodgkin's disease

26q: The most effective drug against M.leprae is ?
a. Dapsone
b. Rifampicin
c. Clofazimine
d. Prothionamide

27q: 8 year old boy from Tamil Nadu presents with a white, non anaesthetic, non scaly hypopigmented macule on his face. What is the likely diagnosis ?
a. Pityriasis alba
b. Pityriasis versicolor
c. Indeterminate leprosy
d. Neuritic leprosy

28q: Satellite lesions are seen in ?
a. Tuberculoid leprosy
b. Lepromatous leprosy
c. Borderline tuberculoid leprosy
d. Histoid leprosy

29q: Thalidomide is the drug of choice for ?
a. Lepra I reaction
b. Lepra II reaction
c. Both
d. Nerve abscess

30q: Skin biopsy in leprosy is characterised by ?
a. periappendegial bacilli
b. periappendegeal lymphocytosis
c. perivascular lymphocytosis
d. all of the above

31q: Skin smear is negative in which type of leprosy ?
a. Indeterminate
b. Neuritic
c. Lepromatous
d. Borderline

32q: All lesions are seen in leprosy except ?
a. Erythematous macule
b. Hypopigmented patch
c. Vesicles
d. Flat and raised patches

33q: WHO regime for paucibacillary leprosy is ?
a. 100 mg Dapsone daily + Rifampicin monthly (600 mg)
b. Dapsone daily + Rifampicn daily
c. Dapsone + Rifampcin + Clofazimine daily
d. Rifampcin + Clofazimine daily

34q: Skin pigmentation and icthyosis like side effects are seen in ?
a. Rifampcin
b. Clofazimine
c. Dapsone
d. Steroid

35q: DOC in type I lepra reaction with severe neuritis ?
a. Thalidomide
b. Clofazimine
c. Dapsone
d. Systemic corticosteroid

36q: Treatment of acute neuritis in lepra I reaction is all except ?
a. Dapsone
b. Steroid
c. Thalidomide
d. Incision and drainage

*Thalidomide is not effective in type I reaction and incision and drainage is done only in nerve abscess, not in acute neuritis.

37q: Multidrug therapy is given for ?
a. Syphilis
b. Leprosy
c. Herpetiformis
d. Icthyosis vulgaris

38q: Single lesion in skin is seen in which type of leprosy ?
a. TT
b. BT
c. BL
d. LL

39q: ENL is seen in ?
a. Lepromatous leprosy
b. Borderline tuberculoid
c. Borderline lepromatous
d. Tuberculoid

40q: In leprosy which of the following is not seen ?
a. Abnormal EMG
b. Voluntary muscle wasting
c. Decreased proprioception
d. Decreased response to tactile sensation
e. Increased response to tactile sensation

41q: Leprosy do not involve ?
a. CNS
b. Testis
c. Skin
d. Cornea

42q: In leprosy nerves commonly involved are ?
a. High ulnar, low median
b. High median, low ulnar
c. Triple nerve palsy
d. High radial, low median

43. The first sensation to be lost in leprosy is ?
a. Temperature
b. pain
c. Both at the same time
d. none

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