Cutaneous Larva Migrans — MCQs
Which among the following occupations is a risk factor for cutaneous larva migrans?
Pompholyx affects:
Mass Drug Administration is NOT routinely used as the primary strategy for:
Cutaneous larva migrans is due to ?
Ivermectin is indicated in the treatment of:
Identify the parasite shown in the image.
Which of the following conditions is characterized by the sign of the groove?
A young female presents with a history of fever and a nodular lesion over the shin. Histopathology reveals foamy histiocytes with neutrophilic infiltration. There is no evidence of vasculitis. What is the most probable diagnosis?
A young tourist presents with an erythematous lesion on the cheek with central crusting after visiting a region endemic for a specific protozoal infection. What is the likely dermatological condition?
What is characteristic of donovanosis?
Cutaneous Larva Migrans Indian Medical PG Practice Questions and MCQs
Question 1: Which among the following occupations is a risk factor for cutaneous larva migrans?
- A. A poultry worker
- B. A kennel worker
- C. A lifeguard in a swimming pool
- D. Farmer (Correct Answer)
Explanation: ***Farmer*** - Farmers are at high risk due to frequent direct contact with **contaminated soil** or sandy environments where animal feces, especially from dogs and cats, might be present. - Exposure to **larvae of hookworms** such as *Ancylostoma braziliense* and *Ancylostoma caninum*, which can penetrate unprotected skin (e.g., bare feet while working) from the soil. *A lifeguard in a swimming pool* - Lifeguards primarily work in **chlorinated water** or on clean, well-maintained pool decks, which do not typically harbor hookworm larvae. - While they might be exposed to other skin conditions, **cutaneous larva migrans** is not a common risk associated with this occupation. *A poultry worker* - Poultry workers are primarily exposed to avian environments, where hookworm species that cause cutaneous larva migrans in humans are typically **not found**. - Their work environment generally does not involve direct contact with soil contaminated by **canine or feline feces**. *A kennel worker* - While kennel workers handle dogs and cats, which are carriers of hookworms, their primary exposure is to the animals themselves or their immediate cleaned environments, not typically **soil contaminated with larvae**. - The mode of transmission for cutaneous larva migrans is through **soil contact** rather than direct animal handling in a controlled kennel setting.
Question 2: Pompholyx affects:
- A. Groin
- B. Scalp
- C. Trunk
- D. Palms and soles (Correct Answer)
Explanation: ***Palms and soles*** - **Pompholyx**, also known as **dyshidrotic eczema**, is characterized by recurrent outbreaks of **vesicles and bullae** predominantly on the palms and soles. - These lesions are typically very **itchy** and can cause significant discomfort. *Groin* - Conditions like **tinea cruris** (jock itch) or **intertrigo** commonly affect the groin, presenting with erythema and scaling rather than vesicles. - While eczema can occur in the groin, classical pompholyx has a predilection for the acral regions. *Scalp* - The scalp is more commonly affected by conditions such as **seborrheic dermatitis** or **psoriasis**, which manifest as scaling, redness, and flaking. - Vesicular eruptions are rare on the scalp unless due to specific conditions like herpes zoster. *Trunk* - The trunk is a common site for various dermatoses, including **atopic dermatitis**, **psoriasis**, or **pityriasis rosea**, but these typically present with different morphologic features (e.g., plaques, patches). - Pompholyx is specific to palms and soles and does not usually involve the trunk.
Question 3: Mass Drug Administration is NOT routinely used as the primary strategy for:
- A. Vitamin A Deficiency
- B. Scabies (Correct Answer)
- C. Lymphatic Filariasis
- D. Worm infestation
Explanation: ***Scabies*** - While **mass drug administration with oral ivermectin** has shown effectiveness in specific endemic outbreak settings, MDA is generally **not the primary recommended strategy** for routine scabies control in most public health contexts. - Scabies control typically prioritizes **case finding, contact tracing, simultaneous household treatment, and environmental decontamination**—which are more complex to implement than standard MDA programs. - Unlike the other conditions listed, scabies lacks well-established **routine MDA programs** at the scale of national public health initiatives, making it the least suitable option for MDA among these choices. *Vitamin A Deficiency* - **Vitamin A supplementation** through MDA is a **highly effective and widely implemented** WHO-recommended strategy to combat Vitamin A deficiency in at-risk populations, particularly children under 5 years. - Regular mass supplementation helps prevent **xerophthalmia** and reduces morbidity and mortality from infectious diseases. - This is a cornerstone of routine public health programs globally. *Lymphatic Filariasis* - **Lymphatic filariasis** is a classic example where MDA with anti-filarial drugs like **diethylcarbamazine (DEC), albendazole,** or **ivermectin** is the cornerstone strategy for interrupting transmission. - MDA is the **primary WHO-recommended approach** to achieve elimination of lymphatic filariasis, with established national programs in endemic countries. *Worm infestation* - **Mass deworming programs** using drugs like **albendazole** or **mebendazole** represent highly effective and well-established forms of MDA for controlling **soil-transmitted helminth infections**. - These routine programs significantly reduce disease burden in school-aged children, improving nutritional status, growth, and learning outcomes.
Question 4: Cutaneous larva migrans is due to ?
- A. W.bancrofti
- B. B. Malayi
- C. D. medinensis
- D. Ancylostoma braziliense (Correct Answer)
Explanation: ***Ancylostoma braziliense*** - **Cutaneous larva migrans** is primarily caused by the larvae of **dog and cat hookworms**, especially *Ancylostoma braziliense*. - Humans become **accidental hosts** when these larvae penetrate the skin but cannot complete their life cycle, leading to **serpiginous tracks**. *W. bancrofti* - This parasite, **Wuchereria bancrofti**, is a filarial nematode that causes **lymphatic filariasis** (elephantiasis). - Its effects are characterized by **lymphedema** and **hydrocele**, not migrating skin lesions. *B. Malayi* - **Brugia malayi** is another filarial nematode responsible for **lymphatic filariasis** in humans, similar to *W. bancrofti*. - It primarily causes **swelling of the limbs** and scrotum, not cutaneous larva migrans. *D. medinensis* - **Dracunculus medinensis** is the parasite that causes **dracunculiasis**, also known as **Guinea worm disease**. - This infection is characterized by a **painful blister** and subsequent emergence of the adult worm, which is distinct from creeping eruptions.
Question 5: Ivermectin is indicated in the treatment of:
- A. Scabies (Correct Answer)
- B. Dermatophytosis
- C. Tuberculosis
- D. Syphilis
Explanation: ***Scabies*** - **Ivermectin** is an effective oral antiparasitic agent used to treat **scabies**, particularly in cases of widespread infestation, crusted scabies, or when topical treatments fail. - It acts by paralyzing and killing the **Sarcoptes scabiei mites** responsible for the infestation. *Dermatophytosis* - **Dermatophytosis** (ringworm) is a **fungal infection** of the skin, hair, or nails. - It is typically treated with **antifungal medications** (e.g., azoles, terbinafine), not ivermectin. *Tuberculosis* - **Tuberculosis** is a bacterial infection caused by **Mycobacterium tuberculosis**, primarily affecting the lungs. - Treatment involves a multi-drug regimen of **antibiotics** (e.g., rifampin, isoniazid), for several months. *Syphilis* - **Syphilis** is a sexually transmitted bacterial infection caused by **Treponema pallidum**. - The primary treatment for syphilis is **penicillin**, usually administered via injection.
Question 6: Identify the parasite shown in the image.
- A. Trichuris trichiura (Correct Answer)
- B. Ancylostoma duodenale
- C. Strongyloides stercoralis
- D. Paragonimus westermani
Explanation: ***Trichuris trichiura*** - The image displays characteristic **lemon-shaped** or **barrel-shaped eggs** with distinctive **polar plugs** at each end, which are pathognomonic for *Trichuris trichiura* (whipworm) eggs. - These eggs are thick-shelled and typically measure 50-55 µm by 20-25 µm, containing an undeveloped larva when passed in feces. *Ancylostoma duodenale* - Eggs of *Ancylostoma duodenale* (Old World hookworm) are **oval-shaped** with blunt ends, and a **thin shell**. - They typically contain a **segmented ovum** or an early-stage larva, lacking the polar plugs seen in the image. *Paragonimus westermani* - *Paragonimus westermani* (lung fluke) eggs are generally **oval-shaped** with a **flattened operculum** at one end, which is not visible in the image. - They are larger than *Trichuris* eggs, often measuring around 80-120 µm by 45-70 µm, and are often coughed up in sputum or passed in feces. *Strongyloides stercoralis* - *Strongyloides stercoralis* primarily produces **larvae** (rhabditiform or filariform) in stool samples rather than eggs. - If eggs are seen (rarely, in cases of severe diarrhea), they are small, thin-shelled, and typically contain a developed larva, unlike the eggs shown.
Question 7: Which of the following conditions is characterized by the sign of the groove?
- A. Lymphogranuloma venereum (Correct Answer)
- B. Granuloma inguinale
- C. Syphilis
- D. Chancroid
Explanation: **Explanation:** **Lymphogranuloma venereum (LGV)** is caused by the **L1, L2, and L3 serovars of *Chlamydia trachomatis***. The "Sign of the Groove" (Greenblatt’s sign) is a pathognomonic clinical finding in the secondary stage of LGV. It occurs when the inguinal and femoral lymph nodes enlarge simultaneously, separated by the rigid **inguinal ligament**. This creates a visible depression or "groove" between the two groups of inflamed lymph nodes. **Analysis of Incorrect Options:** * **B. Granuloma Inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents with painless, beefy-red, velvety ulcers. It is characterized by "pseudobuboes" (subcutaneous granulation tissue) rather than true lymphadenopathy. * **C. Syphilis:** Primary syphilis presents with a painless, indurated "hard chancre." While it causes bilateral inguinal lymphadenopathy, the nodes are discrete, rubbery, and do not form a groove. * **D. Chancroid:** Caused by *Haemophilus ducreyi*. It presents with painful, soft ulcers and painful inflammatory buboes that are usually unilateral and may suppurate, but they do not form the characteristic groove sign. **High-Yield Clinical Pearls for NEET-PG:** * **Stages of LGV:** Primary (painless papule/ulcer), Secondary (Inguinal syndrome with the Groove sign), and Tertiary (Genito-anorectal syndrome/Elephantiasis). * **Diagnosis:** Frei test (historical), NAAT (current gold standard), and **Donovan bodies** (safety-pin appearance) are seen in Donovanosis, NOT LGV. * **Treatment:** Doxycycline (100 mg BID for 21 days) is the drug of choice for LGV.
Question 8: A young female presents with a history of fever and a nodular lesion over the shin. Histopathology reveals foamy histiocytes with neutrophilic infiltration. There is no evidence of vasculitis. What is the most probable diagnosis?
- A. Sweet's Syndrome
- B. Erythema nodosum (Correct Answer)
- C. Erythema nodosum leprosum
- D. Behcet's syndrome
Explanation: ### Explanation **Correct Answer: B. Erythema nodosum** **Why it is correct:** Erythema nodosum (EN) is the most common form of **septal panniculitis**. Clinically, it presents as tender, erythematous nodules typically located over the **pretibial area (shins)**, often accompanied by fever and malaise. Histopathologically, early lesions show edema and neutrophilic infiltration of the septa. As the lesion evolves, it is characterized by **Miescher’s radial granulomas**—small clusters of spindle-shaped or **foamy histiocytes** surrounding a central cleft. The absence of vasculitis is a hallmark feature that distinguishes EN from other forms of panniculitis. **Why the other options are incorrect:** * **A. Sweet’s Syndrome:** This is a neutrophilic dermatosis characterized by "juicy" erythematous plaques and high fever. Histology shows dense dermal neutrophilic infiltrate with papillary dermal edema, but it is not a primary panniculitis and does not typically present with foamy histiocytes in the septa. * **C. Erythema nodosum leprosum (ENL):** While ENL also presents with tender nodules and fever, it is a Type 2 Lepra reaction. Histologically, it is a **lobular panniculitis** and, crucially, it **must show evidence of vasculitis** (leukocytoclastic vasculitis) and the presence of *M. leprae* (AFB positive). * **D. Behcet’s syndrome:** While it can cause EN-like lesions, the systemic involvement (oral/genital ulcers, uveitis) and the characteristic histopathology (often showing vasculitis) do not fit the isolated description provided. **NEET-PG High-Yield Pearls:** * **Most common cause of EN:** Idiopathic (followed by Streptococcal infections, Sarcoidosis, and TB). * **Histopathology Key:** Septal panniculitis **without** vasculitis = Erythema Nodosum. * **Löfgren Syndrome:** Triad of EN, bilateral hilar lymphadenopathy, and arthritis (highly suggestive of Sarcoidosis). * **Miescher’s Radial Granulomas:** Pathognomonic histological finding for EN.
Question 9: A young tourist presents with an erythematous lesion on the cheek with central crusting after visiting a region endemic for a specific protozoal infection. What is the likely dermatological condition?
- A. Cutaneous Leishmaniasis (Correct Answer)
- B. Systemic Lupus Erythematosus
- C. Lupus vulgaris
- D. Chilblains
Explanation: ### Explanation **Correct Option: A. Cutaneous Leishmaniasis** Cutaneous Leishmaniasis (CL), often referred to as "Oriental Sore" or "Delhi Boil," is caused by the protozoan *Leishmania* species and transmitted by the bite of an infected **female sandfly (*Phlebotomus*)**. The classic presentation begins as a small erythematous papule at the inoculation site (usually exposed areas like the face), which evolves into a nodule and eventually develops **central crusting** or ulceration with a raised, indurated border. The history of travel to an endemic region is a crucial diagnostic clue. **Why Incorrect Options are Wrong:** * **B. Systemic Lupus Erythematosus (SLE):** Typically presents with a "malar rash" (butterfly distribution) that spares the nasolabial folds. It is an autoimmune condition, not associated with travel to protozoal endemic areas or central crusting. * **C. Lupus Vulgaris:** This is a chronic form of cutaneous tuberculosis. While it affects the face, it typically presents as "apple-jelly" nodules on diascopy and follows a very chronic, progressive course rather than an acute post-travel presentation. * **D. Chilblains (Pernio):** An inflammatory response to cold, damp conditions. It presents as itchy, purple-red bumps on fingers or toes, not as a crusted facial lesion following tropical travel. **High-Yield Clinical Pearls for NEET-PG:** * **Vector:** Female Sandfly (*Phlebotomus*). * **Diagnosis:** Skin biopsy or slit-skin smear showing **LD bodies** (Leishman-Donovan bodies) within macrophages. * **Treatment of Choice:** Intralesional or systemic **Sodium Stibogluconate** (Pentavalent antimonials) or Miltefosine. * **Volcano Sign:** The appearance of a crusted ulcer with a central pit is often described as the "volcano sign."
Question 10: What is characteristic of donovanosis?
- A. Pseudolymphadenopathy (Correct Answer)
- B. Penicillin is used for treatment
- C. Painful ulcer
- D. Suppurative lymphadenopathy
Explanation: **Donovanosis (Granuloma Inguinale)** is a chronic, progressive bacterial infection caused by the intracellular Gram-negative organism *Klebsiella granulomatis*. ### **Explanation of the Correct Answer** **A. Pseudolymphadenopathy:** This is the hallmark of Donovanosis. Unlike other STIs, the infection does not typically involve the regional lymph nodes. Instead, the subcutaneous granulation tissue spreads along the inguinal folds, causing firm, non-tender swellings that mimic enlarged lymph nodes. These are called **"pseudobuboes."** ### **Why Other Options are Incorrect** * **B. Penicillin is used for treatment:** Penicillin is ineffective. The CDC-recommended first-line treatment is **Azithromycin** (1g weekly or 500mg daily for at least 3 weeks). * **C. Painful ulcer:** Donovanosis is classically **painless**. It presents as beefy-red, friable (bleeds easily on touch) ulcers with rolled-out edges. Pain only occurs if there is secondary bacterial superinfection. * **D. Suppurative lymphadenopathy:** This is characteristic of **Lymphogranuloma Venereum (LGV)** or **Chancroid**, where true fluctuant buboes form. Donovanosis lacks true lymph node involvement. ### **High-Yield Clinical Pearls for NEET-PG** * **Donovan Bodies:** Diagnosis is confirmed by seeing "safety-pin" appearing organisms within large macrophages on a Giemsa or Wright stain (crush smear). * **Clinical Appearance:** Often described as "beefy-red" granulation tissue with a "velvety" texture. * **Extragenital Involvement:** Can occur in the mouth, liver, or bone via autoinoculation or hematogenous spread. * **Mnemonic:** Remember the **"4 Ps"** of Donovanosis: **P**ainless, **P**rogressive, **P**seudobuboes, and **P**olymorphic (various clinical types like ulcerogranulomatous, hypertrophic, etc.).
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