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

answer b. indeterminate leprosy

*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
vitiligo.
*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

answer c. cyclosporine

*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
d. MCSF

answer c. TNF-alpha

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

answer b,c and e

*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
c. FNAC
d. Skin biopsy

answer a. lepromin test

*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

answer a. stop anti-leprosy drugs

*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.

answer d. PSVT.

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

answer c and d. BL and LL.

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

answer b. Lepromin test

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

answer d. Borderline lepromatous leprosy

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

answer d. Tuberculoid

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

answer c. Borderline 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

answer b. indeterminate leprosy

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

answer d. clofazimine

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

answer a. rifampicin

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

answer b. incision and drainage

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

answer c. borderline 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

answer b. tuberculoid leprosy

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

answer d. perforating ulcer

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

answer a. ULNAR nerve

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

answer b. LL

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

answer a. 1 year

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

answer c. LL

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

answer a. steroids

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

answer a. steroid

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

answer a and d

*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

answer d. PSVT.

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

answer b. Rifampicin

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

answer c. Indeterminate leprosy

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

answer c. Borderline tuberculoid leprosy

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

answer c. both

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

answer d. all the above

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

answer b. neuritic leprosy

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

answer c. vesicles.

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

answer a. Rifampicin 600mg per month and dapsone 100 mg daily

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

answer b. Clofazimine.

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

answer 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

answer c. Thalidomide and 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

answer b. leprosy.

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

answer a. TT.

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

answer a,c.

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

answer c,d.

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

answer a. CNS. Ovaries also.

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

answer a. High ulnar, low median

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

answer a. Temperature.

35 - Acrochordon (Skin Tags)

An acrochordon (plural acrochorda, and also known as a cutaneous skin tag, skin tag, fibroepithelial polyp, cutaneous papilloma, fibroma molluscum, fibroma pendulum, papilloma colli, , or soft fibroma, is a small benign tumour that forms primarily in areas where the skin forms creases, such as the neck, armpit, and groin. They may also occur on the face, usually on the eyelids. Acrochorda are harmless and typically painless, and do not grow or change over time. Though tags up to a half-inch long have been seen, they are typically the size of a grain of rice. The surface of an acrochordon may be smooth or irregular in appearance and is often raised from the surface of the skin on a fleshy stalk called a peduncle. Microscopically, an acrochordon consists of a fibro-vascular core, sometimes also with fat cells, covered by an unremarkable epidermis. However, tags may become irritated by shaving, clothing or jewelry. Very large skin tags may burst under pressure.
It is believed that skin tags occur due to skin rubbing up against skin, since they are so often found in skin creases and folds.They are more common in people who are overweight, have diabetes and in pregnant women. Acrochorda have been reported to have an incidence of 46% in the general population. A causal genetic component is thought to exist.Rarely, they can be associated with the Birt-Hogg-Dubé syndrome and polycystic ovary syndrome.

Because tags are benign, treatment is unnecessary unless the tags become frequently irritated or present a cosmetic concern. If removal is desired or warranted, a dermatologist or similarly trained professional may use cauterization, cryosurgery, surgical ligation or excision to remove the acrochorda.
There is now an over-the-counter solution that causes skin tag removal. This method freezes the skin tag which results in the skin tag "falling off" in approximately 7-10 days, which is similar to over-the-counter wart removal.
In Britain doctors recommend applying a knotted piece of string to deny the skin tag circulatory blood until the skin cells die and it falls off.
Skin tags (acrochordons). (What's Your Assessment?): An article from: Dermatology Nursing