Erysipelas and Cellulitis — MCQs
All of the following are true about erythema infectiosum EXCEPT?
What is the diagnosis of a child with a small abrasion over the face who develops fever with chills, induration, and fiery red swelling over the face extending to the ear?
In case of PSGN complication commonly seen are all except :
A diabetic patient developed cellulitis due to S. aureus, which was found to be methicillin resistant on the antibiotic sensitivity testing. All of the following antibiotics will be appropriate except ?
A farmer presents you with a cauliflower-shaped mass on foot, which developed after a minor injury. Microscopy shows copper penny bodies. What is the most likely diagnosis?
Cellulitis is characterized as:
A 53 year-old male presented with erythematous, edematous plaques on his face over pre-existing hypoesthetic patches. He has been experiencing pain for the last 10 days and has been on multibacillary multidrug therapy (MBMDT) for leprosy for the past two months. What is the most likely diagnosis based on the image?
All are true about this lesion seen in a child with epilepsy except:
A patient presents with multiple hypopigmented and hypesthetic patches on the lateral aspect of the forearm, with abundant acid-fast bacilli (AFB) and granulomatous inflammation on histology. What is the most likely diagnosis?
Erysipelas is caused by which bacterium?
Erysipelas and Cellulitis Indian Medical PG Practice Questions and MCQs
Question 1: All of the following are true about erythema infectiosum EXCEPT?
- A. Caused by parvovirus
- B. Known as 'fifth disease'
- C. Rash initially appears on trunk (Correct Answer)
- D. Slapped cheek appearance seen
Explanation: ***Rash initially appears on trunk*** - Erythema infectiosum (fifth disease) characteristically begins with a **'slapped cheek' rash** on the face. - The rash then spreads to the trunk and extremities, taking on a **lacy, reticulated appearance**, but it does not initially appear on the trunk. *Caused by parvovirus* - Erythema infectiosum is caused by **Parvovirus B19**, which primarily infects erythroid progenitor cells. - This virus is highly contagious and spreads via respiratory secretions. *Known as 'fifth disease'* - Erythema infectiosum is one of the classic childhood exanthems and is historically known as **'fifth disease'**. - The numbering sequence refers to the order in which these common childhood rashes were identified. *Slapped cheek appearance seen* - A prominent feature of erythema infectiosum is the classic bright red rash on the cheeks, giving the child a distinctive **'slapped cheek' appearance**. - This facial rash often precedes the lacy rash on the body.
Question 2: What is the diagnosis of a child with a small abrasion over the face who develops fever with chills, induration, and fiery red swelling over the face extending to the ear?
- A. Anthrax
- B. Carbuncle
- C. Cellulitis
- D. Erysipelas (Correct Answer)
Explanation: ***Erysipelas*** - The presentation of **fiery red swelling** with well-demarcated, raised borders, rapidly extending from a small abrasion, especially on the face and involving the ear, is classic for erysipelas. - It also includes systemic symptoms like **fever and chills** and **induration**, which are characteristic of this superficial skin infection usually caused by **Streptococcus pyogenes**. *Anthrax* - Cutaneous anthrax typically presents with a papule that develops into a **vesicle**, then a painless ulcer with a distinctive **black eschar**, which is not described here. - While it can cause fever, the characteristic skin lesion is distinct from the red, spreading swelling seen in this case. *Carbuncle* - A carbuncle is a deep infection involving multiple hair follicles, presenting as a painful, interconnected lesion with **multiple draining sinuses**. - It is typically more localized, deeper, and pus-filled than the superficial, rapidly spreading, fiery red swelling described. *Cellulitis* - Cellulitis is a deeper infection of the dermis and subcutaneous fat, presenting with redness, warmth, and tenderness, but its borders are typically **less well-demarcated** and not as raised as in erysipelas. - While it can also occur on the face and cause systemic symptoms, the description of "fiery red" and "extending to the ear" with sharp borders makes erysipelas a more precise diagnosis.
Question 3: In case of PSGN complication commonly seen are all except :
- A. Hypertensive encephalopathy
- B. Bleeding diathesis (Correct Answer)
- C. Hyperkalemia
- D. LVF
Explanation: ***Bleeding diathesis*** - **Post-streptococcal glomerulonephritis (PSGN)** typically does not cause **bleeding diathesis**. Bleeding diathesis is primarily associated with **liver disease**, **bone marrow suppression**, or certain genetic disorders, not directly with PSGN. - While severe kidney failure can indirectly affect coagulation, it's not a common or direct complication leading to **bleeding diathesis** in PSGN. *Hypertensive encephalopathy* - PSGN often leads to **fluid overload** and **renin-angiotensin system activation**, causing severe **hypertension** [1]. - Uncontrolled hypertension can result in **hypertensive encephalopathy**, characterized by headaches, seizures, and altered mental status. *Hyperkalemia* - Renal insufficiency, common in PSGN, impairs the kidneys' ability to excrete **potassium**. - This can lead to **hyperkalemia**, a life-threatening electrolyte imbalance that can cause cardiac arrhythmias. *LVF* - **Fluid overload** and severe **hypertension** in PSGN can overwhelm the heart's pumping capacity [1]. - This can precipitate **left ventricular failure (LVF)**, leading to symptoms like dyspnea and pulmonary edema.
Question 4: A diabetic patient developed cellulitis due to S. aureus, which was found to be methicillin resistant on the antibiotic sensitivity testing. All of the following antibiotics will be appropriate except ?
- A. Vancomycin
- B. Teicoplanin
- C. Linezolid
- D. Imipenem (Correct Answer)
Explanation: ***Imipenem*** - **Imipenem** is a carbapenem antibiotic that is effective against many Gram-positive and Gram-negative bacteria, but it is **not active against MRSA (methicillin-resistant *Staphylococcus aureus*)**. - MRSA strains are resistant to all beta-lactam antibiotics, including penicillins, cephalosporins, and carbapenems like imipenem, due to the presence of the **mecA gene** which encodes for an altered penicillin-binding protein (PBP2a). *Vancomycin* - **Vancomycin** is a glycopeptide antibiotic that is a primary choice for treating **MRSA infections**, including cellulitis. - It inhibits cell wall synthesis by binding to the D-Ala-D-Ala precursor, preventing cross-linking, and is specifically active against **Gram-positive bacteria**. *Teicoplanin* - **Teicoplanin** is another glycopeptide antibiotic, similar to vancomycin, and is also considered a suitable agent for treating **MRSA infections**. - It works by inhibiting bacterial cell wall synthesis and has a **longer half-life** than vancomycin, allowing for less frequent dosing. *Linezolid* - **Linezolid** is an oxazolidinone antibiotic known for its activity against **Gram-positive bacteria**, including **MRSA** and vancomycin-resistant enterococci (VRE). - It inhibits protein synthesis by binding to the 50S ribosomal subunit, preventing the formation of the initiation complex.
Question 5: A farmer presents you with a cauliflower-shaped mass on foot, which developed after a minor injury. Microscopy shows copper penny bodies. What is the most likely diagnosis?
- A. Sporotrichosis
- B. Blastomycosis
- C. Chromoblastomycosis (Correct Answer)
- D. Phaeohyphomycosis
Explanation: **Chromoblastomycosis** - The characteristic "cauliflower-shaped" lesion on the foot following a minor injury, especially in a farmer (indicating outdoor exposure), is highly suggestive of chromoblastomycosis. - The presence of **copper penny bodies** (also known as **sclerotic** or **muriform cells**) on microscopy is **pathognomonic** for chromoblastomycosis. *Blastomycosis* - Blastomycosis typically presents with **granulomatous lesions** that can ulcerate but are rarely described as cauliflower-shaped. - Microscopic examination would reveal **broad-based budding yeast cells**, not copper penny bodies. *Sporotrichosis* - Sporotrichosis usually presents as **subcutaneous nodules** that can ulcerate and spread lymphatically, forming a chain of lesions. - Microscopy shows **cigar-shaped budding yeasts** within macrophages or neutrophils, which are distinct from copper penny bodies. *Phaeohyphomycosis* - Phaeohyphomycosis encompasses a broad group of infections by dematiaceous fungi that produce **dark-walled hyphae** or yeast-like cells in tissue. - While it can cause subcutaneous nodules or cysts, the presence of distinct copper penny bodies points away from phaeohyphomycosis as the primary diagnosis.
Question 6: Cellulitis is characterized as:
- A. Suppurative and invasive
- B. Nonsuppurative and non-invasive
- C. Nonsuppurative and invasive (Correct Answer)
- D. Suppurative and non-invasive
Explanation: ***Nonsuppurative and invasive*** - Cellulitis is considered **nonsuppurative** as it typically lacks macroscopic pus formation, distinguishing it from abscesses. - It is **invasive** because it involves the dermal and subcutaneous tissues, spreading through fascial planes. *Suppurative and invasive* - This description is more indicative of conditions like an **abscess**, which involves localized collections of pus. - While abscesses are invasive, cellulitis characteristically lacks the discrete pus collection. *Nonsuppurative and non-invasive* - Conditions that are nonsuppurative and non-invasive might include self-limiting skin rashes or superficial inflammatory processes. - Cellulitis involves deeper tissue infection, which inherently makes it invasive. *Suppurative and non-invasive* - A condition that is suppurative but non-invasive would be rare and contradictory, as pus formation often indicates a tissue response that is at least locally invasive. - Superficial pustules might be considered suppurative and relatively non-invasive, but cellulitis clearly extends beyond such superficial lesions.
Question 7: A 53 year-old male presented with erythematous, edematous plaques on his face over pre-existing hypoesthetic patches. He has been experiencing pain for the last 10 days and has been on multibacillary multidrug therapy (MBMDT) for leprosy for the past two months. What is the most likely diagnosis based on the image?
- A. Type 1 Lepra reaction (Correct Answer)
- B. Erythema Nodosum Leprosum (ENL)
- C. Cellulitis of the face
- D. Erysipelas
Explanation: ***Type 1 Lepra reaction*** - The patient presents with **erythematous, edematous plaques on pre-existing hypoesthetic patches** on the face, along with pain and current treatment with **multibacillary multidrug therapy (MBMDT)**. This clinical picture is classic for a type 1 lepra reaction, which is a **delayed-type hypersensitivity reaction** to *Mycobacterium leprae* antigens, often seen during or after treatment. - The image shows significant **facial edema** and **erythema**, particularly around the eyes and nose, consistent with the acute inflammation of a type 1 reaction affecting existing skin lesions and nerves, leading to pain. *Erythema Nodosum Leprosum (ENL)* - ENL is a **Type 2 lepra reaction**, characterized by the appearance of **painful, tender, erythematous nodules** over normal skin, often affecting the limbs and trunk, not typically pre-existing hypoesthetic patches. - It is an **immune complex-mediated reaction** and usually presents more acutely with systemic symptoms like fever and malaise, along with the characteristic nodules, which are not primarily visible in the photograph as widespread edematous plaques. *Cellulitis of the face* - Cellulitis is a **bacterial infection** of the deep dermis and subcutaneous tissue, presenting as a **spreading, warm, red, tender area** with poorly defined borders, often associated with fever and lymphadenopathy. - While there is erythema and edema, the chronic nature of the underlying hypoesthetic patches, the patient's history of leprosy, and the specific distribution suggest a reaction related to leprosy rather than a typical acute bacterial infection. *Erysipelas* - Erysipelas is a **superficial bacterial skin infection**, typically caused by *Streptococcus pyogenes*, characterized by a **sharply demarcated, raised, red, warm, and tender plaque**, often on the face, with characteristic "peau d'orange" texture. - Although it causes facial erythema and edema, the clearly defined borders of erysipelas are not evident, and the association with pre-existing hypoesthetic patches in a leprosy patient points more strongly towards a lepra reaction.
Question 8: All are true about this lesion seen in a child with epilepsy except:
- A. Collagenoma
- B. Minor criteria for diagnosis (Correct Answer)
- C. Peau d'orange appearance
- D. Predominantly seen over trunk
Explanation: ***Minor criteria for diagnosis*** - The presented lesion is a **Shagreen patch**, which is considered a **major diagnostic criterion** for **Tuberous Sclerosis Complex (TSC)**, not a minor one. - A definitive diagnosis of TSC requires two major criteria or one major and two minor criteria. *Collagenoma* - A Shagreen patch is a type of dermal **collagenoma**, characterized by an overgrowth of connective tissue, primarily collagen. - These lesions often feel like **roughened or leathery plaques** on the skin. *Peau d'orange appearance* - The Shagreen patch is often described as having a **'peau d'orange'** or orange peel-like texture due to its irregular surface. - This characteristic texture helps in its clinical identification. *Predominantly seen over trunk* - Shagreen patches are typically located on the **trunk**, especially in the lumbosacral region, as seen in the image. - They are one of the distinctive cutaneous manifestations of TSC.
Question 9: A patient presents with multiple hypopigmented and hypesthetic patches on the lateral aspect of the forearm, with abundant acid-fast bacilli (AFB) and granulomatous inflammation on histology. What is the most likely diagnosis?
- A. Tuberculoid leprosy
- B. Intermediate leprosy
- C. Borderline leprosy (Correct Answer)
- D. Lepromatous leprosy
Explanation: ### Explanation The correct answer is **Borderline leprosy (C)**. #### 1. Why Borderline Leprosy is Correct The diagnosis of leprosy is based on the Ridley-Jopling classification, which correlates clinical features with the host's immune response. * **Clinical Presentation:** The presence of multiple hypopigmented and **hypesthetic** (reduced sensation) patches is characteristic of the borderline spectrum. * **Histopathology:** The mention of **abundant acid-fast bacilli (AFB)** alongside **granulomatous inflammation** is the key differentiator. In the borderline spectrum (specifically Borderline Lepromatous - BL), the cell-mediated immunity is low enough to allow significant bacillary multiplication (high Bacterial Index), yet high enough to still form organized granulomas. #### 2. Why Other Options are Incorrect * **A. Tuberculoid leprosy (TT):** Characterized by high immunity. Clinically, there are very few lesions (1-3) with complete anesthesia. Histologically, granulomas are well-formed, but **AFB are absent** (paucibacillary). * **B. Intermediate leprosy:** This is an early, transitory stage. It usually presents as a single, ill-defined macule with vague sensory loss. It does not show abundant AFB or well-developed granulomatous inflammation. * **D. Lepromatous leprosy (LL):** Characterized by negligible immunity. While AFB are extremely abundant (globi), the histology shows **diffuse histiocytic infiltration** (Virchow cells/foam cells) rather than organized granulomatous inflammation. #### 3. NEET-PG High-Yield Pearls * **Pathognomonic sign:** Asymmetrical nerve enlargement is typical of Borderline Leprosy. * **Bacterial Index (BI):** TT (0), BT (0-1+), BB (3-4+), BL (4-5+), LL (5-6+). * **Lepromin Test:** Strongly positive in TT, negative in LL. It measures delayed-type hypersensitivity (prognostic, not diagnostic). * **Treatment:** WHO MDT for Multibacillary (MB) leprosy (including Borderline and LL) lasts 12 months, whereas Paucibacillary (PB) lasts 6 months.
Question 10: Erysipelas is caused by which bacterium?
- A. Staphylococcus aureus
- B. Staphylococcus albus
- C. Streptococcus pyogenes (Correct Answer)
- D. Haemophilus
Explanation: ### Explanation **Correct Answer: C. Streptococcus pyogenes** **Medical Concept:** Erysipelas is a distinct clinical variant of superficial cellulitis. It is primarily caused by **Group A Beta-hemolytic Streptococci (GABHS)**, most commonly ***Streptococcus pyogenes***. The infection involves the upper dermis and superficial lymphatics. Characteristically, it presents as a well-demarcated, fiery-red, edematous, and tender plaque. The "sharp borders" are a hallmark feature because the infection is superficial, allowing for a clear distinction between involved and uninvolved skin. **Analysis of Incorrect Options:** * **A. *Staphylococcus aureus*:** While *S. aureus* is the most common cause of **Cellulitis** (which involves the deeper dermis and subcutaneous fat), it is rarely the primary cause of classic Erysipelas. *S. aureus* is more associated with purulent infections like furuncles and abscesses. * **B. *Staphylococcus albus*:** Now known as *Staphylococcus epidermidis*, this is a commensal organism of the skin flora and is generally non-pathogenic unless it involves prosthetic implants or biofilms. * **C. *Haemophilus*:** *Haemophilus influenzae* was historically a common cause of facial cellulitis in children, but its incidence has significantly decreased due to the Hib vaccine. It does not typically cause the classic clinical picture of erysipelas. **High-Yield Clinical Pearls for NEET-PG:** * **Milian’s Ear Sign:** Erysipelas can involve the pinna (ear) because the skin is tightly adherent to the cartilage with no subcutaneous fat. Cellulitis cannot involve the pinna. * **Clinical Distinction:** Unlike cellulitis, erysipelas has **raised, sharply defined borders**. * **Common Site:** The lower limbs are the most frequent site, followed by the face (butterfly distribution). * **Treatment of Choice:** Penicillin is the first-line treatment for *Streptococcus pyogenes*.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free