Bacterial Skin Infections Practice Questions

Q: Moth-eaten alopecia is seen with:

Syphilis. ***Syphilis*** - **Moth-eaten alopecia** is a characteristic but non-specific finding in **secondary syphilis**, occurring due to immune-mediated inflammation targeting hair follicles. - It presents as patchy, non-scarring hair loss, predominantly on the scalp, eyebrows, and beard area. *Cylindroma* - **Cylindroma** is a benign adnexal tumor of the skin, typically presenting as multiple fleshy nodules on the scalp and face. - It is not associated with hair loss patterns like moth-eaten alopecia; rather, large lesions can cause pressure atrophy of hair follicles leading to localized hair loss. *Fungal infection* - **Fungal infections** of the scalp, such as tinea capitis, typically cause patches of **scaling, erythema, and broken hairs**, sometimes leading to **black dot tinea**. - While they can cause patchy hair loss, the description of "moth-eaten" is not the characteristic presentation for fungal infections. *Leprosy* - **Leprosy** can cause hair loss, particularly loss of the **lateral eyebrows** (madarosis) and body hair. - This hair loss is typically due to nerve damage leading to atrophy of hair follicles or direct granulomatous infiltration, not diffuse patchy "moth-eaten" alopecia.

Q: False about syphilis is :

Syphilitic ulcers(Chancre) are extremely painful. ***Syphilitic ulcers (Chancre) are extremely painful*** - **Syphilitic chancres** are typically **painless** ulcers, which is a key diagnostic feature differentiating them from other genital ulcers [1]. - The absence of pain often leads individuals to delay seeking medical attention, contributing to disease progression. *Secondary syphilis is due to hematological dissemination* - **Secondary syphilis** arises from the **hematogenous (bloodstream) and lymphatic dissemination** of Treponema pallidum throughout the body [1]. - This widespread dissemination accounts for the **systemic symptoms** and mucocutaneous lesions observed in secondary syphilis [1]. *"General paresis of Insane" is due to CNS involvement in tertiary syphilis.* - **General paresis of the insane** (or **paretic neurosyphilis**) is a manifestation of **tertiary neurosyphilis**, resulting from chronic inflammation and atrophy of the brain parenchyma. - It leads to progressive **cognitive decline, personality changes, and neurological deficits** due to central nervous system (CNS) damage by the spirochete. *Incubation period is 9-90 days* - The **incubation period** for syphilis, from exposure to the appearance of a **chancre**, typically ranges from **9 to 90 days**, with an average of about 21 days. - This variability depends on factors such as the inoculum size and the individual's immune response.

Q: All of the following organs may be involved in Leprosy except -

Uterus. ***Uterus*** - The **uterus** is generally considered resistant to infection by *Mycobacterium leprae* due to its internal environment and typical host immune responses. - Leprosy primarily affects tissues with a **lower core body temperature**, and the uterus does not fit this criterion. *Eye* - Ocular involvement in leprosy is common, particularly in **lepromatous leprosy**, and can lead to significant morbidity including blindness. [1] - Complications can include **keratitis**, **iritis**, and lagophthalmos due to facial nerve damage. [1] *Nasal mucosa* - The **nasal mucosa** is a very common site of early involvement in leprosy, often serving as a primary entry point and shedding site for the bacteria. - Chronic nasal obstruction, epistaxis, and ultimately nasal septal perforation and **saddle nose deformity** can occur. [1] *Testes* - The **testes** are frequently affected in lepromatous leprosy, as the cooler temperature of the scrotum creates a favorable environment for *M. leprae*. - Testicular involvement can lead to **atrophy**, infertility, and hypogonadism due to inflammation and destruction of testicular tissue. [1]

Q: Which of the following drugs can produce dramatic improvement in patients with type 2 lepra reaction?

Thalidomide. **Thalidomide** - **Thalidomide** is highly effective in managing **type 2 lepra reactions (erythema nodosum leprosum)**, leading to rapid resolution of symptoms. - Its anti-inflammatory and immunomodulatory properties directly address the inflammatory cascade characteristic of this reaction. *Steroids* - While **steroids** are effective in treating **type 1 lepra reactions** and severe type 2 reactions, they do not produce the same dramatic, rapid improvement seen with thalidomide in typical type 2 reactions. - Long-term steroid use carries significant side effects, making them less ideal for primary management of type 2 reactions when thalidomide is available. *Dapsone* - **Dapsone** is a crucial component of **multi-drug therapy (MDT)** for leprosy itself, but it does not treat reactions. - It has no significant anti-inflammatory effect on the acute immune-mediated processes of lepra reactions. *Clofazimine* - **Clofazimine** is an anti-inflammatory drug used in lepromatous leprosy treatment and sometimes as an alternative for steroid-resistant type 2 reactions. - However, its effect is generally slower and less dramatic compared to thalidomide in the acute management of typical type 2 lepra reactions.

Q: Secondary syphilis occurs after:

6 weeks. 6 weeks - **Secondary syphilis** typically manifests about **6 to 8 weeks** after the appearance of the primary chancre, making 6 weeks a common presentation window [1]. - This stage is characterized by systemic symptoms such as a **rash**, **lymphadenopathy**, and **constitutional symptoms**, indicating dissemination of the bacteria [1]. *13 weeks* - While secondary syphilis can *persist* for several weeks, its onset is usually earlier than **13 weeks**. Without treatment, the rash may last for up to 12 weeks [1]. - A duration of **13 weeks** might encompass the later phases of secondary syphilis or the transition to latent syphilis. *9 weeks* - **9 weeks** falls within the typical timeframe for secondary syphilis, but **6 weeks** is a more precise and common initial presentation. - The range for secondary syphilis onset is usually **6 weeks to 6 months** after primary infection. *1 week* - **One week** after initial infection is too early for the development of secondary syphilis; this period is usually when the primary chancre might just be appearing or in its early stages of development [1]. - Secondary syphilis is a systemic stage, requiring more time for bacterial multiplication and dissemination.

Q: Pseudo bubo is caused by:

Donovanosis. ***Donovanosis*** - **Donovanosis**, caused by *Klebsiella granulomatis*, leads to **subcutaneous granulation tissue** that mimics a true bubo but is not an inflamed lymph node, hence the term **pseudo bubo** [1]. - This condition is characterized by **chronic, progressive ulcerative lesions** primarily affecting the genital and perianal areas [1]. *Syphilis* - **Syphilis**, caused by *Treponema pallidum*, typically presents with a **painless chancre** in its primary stage and can lead to systemic symptoms. - It does not cause pseudo buboes; lymphadenopathy, if present, is usually **generalized and non-suppurative**. *Chancroid* - **Chancroid**, caused by *Haemophilus ducreyi*, results in **painful genital ulcers** and often leads to **true, painful, suppurative inguinal lymphadenopathy** (buboes) [1]. - These buboes can rupture and drain pus, which is distinct from the granulomatous lesions of pseudo buboes. *LGV* - **Lymphogranuloma venereum (LGV)**, caused by specific serotypes of *Chlamydia trachomatis*, is characterized by painful and often **suppurative inguinal lymphadenopathy** (buboes) [1]. - These are true buboes that can become fluctuant and drain, unlike the pseudo bubo of donovanosis.

Q: True about LGV ?

Proctocolitis in 2nd stage. ***Proctocolitis in 2nd stage*** - **Proctocolitis** can occur during the **secondary stage** of LGV, particularly in cases involving receptive anal intercourse where the primary inoculation occurs in the rectal mucosa. - Patients present with **bloody rectal discharge, pain, tenesmus, and diarrhea** due to lymphatic spread. - While chronic proctocolitis with strictures occurs in late-stage disease, acute proctocolitis is a manifestation of the secondary stage. *Groove's sign in 3rd stage* - **Groove sign** is actually characteristic of the **second stage**, not the third stage of LGV. - It represents the depression created when enlarged inguinal lymph nodes are separated by the inguinal ligament during the acute lymphadenopathy phase. - The third stage involves chronic complications like strictures and elephantiasis, not acute groove sign. *Bubos in 1st stage* - **Bubos** (painful, swollen regional lymph nodes) are characteristic of the **second stage** of LGV, not the first. - The first stage typically features a transient, small, painless papule or ulcer that often goes unnoticed. *Bleeding ulcer in 1st stage* - The primary lesion of LGV (first stage) is usually a **small, painless papule, vesicle, or ulceration** that is typically non-bleeding. - The primary lesion is often transient and may go unnoticed before lymphadenopathy develops.

Q: Asymmetrical nerve thickening with several hypoesthetic macules on skin indicates which stage of leprosy?

Borderline tuberculoid. ***Borderline tuberculoid*** - This stage is characterized by **prominent asymmetrical nerve thickening**, which is a hallmark feature distinguishing it from other borderline forms. - Patients typically present with **several (5-10) hypoesthetic macules** with well-defined borders and **satellite lesions** around the main lesion, reflecting a strong cell-mediated immune response. *Borderline lepromatous* - Marked by **many poorly defined lesions** that are becoming more **symmetrically distributed**. - Nerve thickening is less prominent and **more symmetrical** than in BT, reflecting a weaker cell-mediated immune response. *Tuberculoid leprosy* - Characterized by **very few skin lesions (1-5)** with **complete anesthesia** (not hypoesthesia) and well-demarcated borders. - While asymmetrical nerve thickening occurs, it lacks **satellite lesions** which are characteristic of BT leprosy. *Borderline borderline leprosy* - Represents the **most unstable form** with numerous (10-30) moderately defined lesions. - Nerve involvement is present but **less prominently asymmetrical** than in BT, with symmetry intermediate between tuberculoid and lepromatous poles.

Q: A 45-year-old male had multiple hypoesthetic, 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:

Borderline tuberculoid leprosy. ***Borderline tuberculoid leprosy*** - The clinical presentation of **multiple hypoesthetic, large plaques with elevated margins** is characteristic of **BT leprosy**, which features **well-demarcated lesions with raised, sloping edges** - **Prominent bilateral nerve enlargement** (ulnar and lateral popliteal nerves) with relatively **few to moderate lesions** is a hallmark of BT leprosy - BT shows **strong cell-mediated immunity** resulting in well-defined plaques with **marked hypoesthesia** and **asymmetric nerve involvement** - The **mildly erythematous** appearance and **elevated margins** indicate active cellular immune response typical of the tuberculoid end of the spectrum *Borderline lepromatous leprosy* - BL presents with **numerous, poorly demarcated lesions** (many more than described) including dome-shaped plaques, papules, and nodules - Lesions in BL have **punched-out centers** rather than elevated margins - Nerve involvement is less prominent relative to the **high number of skin lesions** - The description of well-demarcated plaques with elevated margins points away from the lepromatous pole *Lepromatous leprosy* - LL shows **numerous, diffuse, symmetrical lesions** that are poorly demarcated (macules, papules, nodules, diffuse infiltration) - Lesions are **not hypoesthetic** in early stages due to preserved sensory function until late nerve damage - No elevated margins; lesions are typically smooth, shiny, and dome-shaped *Borderline leprosy* - This is **mid-borderline (BB)** leprosy, which presents with **moderate to numerous lesions** that are more uniform and less well-demarcated than BT - BB has **dimorphous** features without the clear plaques with elevated margins described - The clinical description of elevated margins and prominent nerve involvement with moderate lesion count is more specific for BT

Q: Slit smear negative leprosy is:

All of the options. ***All of the options*** - All mentioned types of leprosy—**neuritic**, **tuberculoid**, and **indeterminate**—are characterized by being **slit smear negative**. - This indicates a **paucibacillary** form of the disease with a low bacterial load, making direct detection of bacilli difficult. *Neuritic type* - This type primarily affects **nerves** with minimal or no skin lesions, making it difficult to find bacilli in skin smears. - Due to the low bacterial load, it is typically **slit smear negative**. *Tuberculoid type* - Characterized by **strong cell-mediated immunity**, which effectively contains the infection and results in a low bacillary index. - The few, well-defined skin lesions usually yield **negative slit smears** due to the scarcity of *Mycobacterium leprae*. *Indeterminate type* - This is an early stage of leprosy, often presenting with a single or few poorly defined skin lesions. - The bacterial load is very low, making it almost always **slit smear negative**.

Question 1

Moth-eaten alopecia is seen with:

Accepted Answer

Syphilis

Answer

Cylindroma

Answer

Fungal infection

Answer

Leprosy

Question 2

False about syphilis is :

Accepted Answer

Syphilitic ulcers(Chancre) are extremely painful

Answer

Secondary syphilis is due to hematological dissemination

Answer

"General paresis of Insane" is due to CNS involvement in tertiary syphilis.

Answer

Incubation period is 9-90 days

Question 3

All of the following organs may be involved in Leprosy except -

Accepted Answer

Uterus

Answer

Eye

Answer

Nasal mucosa

Answer

Testes

Question 4

Which of the following drugs can produce dramatic improvement in patients with type 2 lepra reaction?

Accepted Answer

Thalidomide

Answer

Steroids

Answer

Dapsone

Answer

Clofazimine

Question 5

Secondary syphilis occurs after:

Accepted Answer

6 weeks

Answer

9 weeks

Answer

13 weeks

Answer

1 week

Question 6

Pseudo bubo is caused by:

Accepted Answer

Donovanosis

Answer

Syphilis

Answer

Chancroid

Answer

LGV

Question 7

True about LGV ?

Accepted Answer

Proctocolitis in 2nd stage

Answer

Bubos in 1st stage

Answer

Groove's sign in 3rd stage

Answer

Bleeding ulcer in 1st stage

Question 8

Asymmetrical nerve thickening with several hypoesthetic macules on skin indicates which stage of leprosy?

Accepted Answer

Borderline tuberculoid

Answer

Tuberculoid leprosy

Answer

Borderline lepromatous

Answer

Borderline borderline leprosy

Question 9

A 45-year-old male had multiple hypoesthetic, 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:

Accepted Answer

Borderline tuberculoid leprosy

Answer

Borderline lepromatous leprosy

Answer

Lepromatous leprosy

Answer

Borderline leprosy

Question 10

Slit smear negative leprosy is:

Accepted Answer

All of the options

Answer

Neuritic type

Answer

Tuberculoid type

Answer

Indeterminate type

Bacterial Skin Infections — MCQs

Bacterial Skin Infections — MCQs

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