Leprosy — MCQs
Asymmetrical nerve thickening with several hypoesthetic macules on skin indicates which stage of leprosy:
Thalidomide is not used in
What is the first symptom of leprosy?
A 35-year-old female presented with multiple inverted saucer-shaped ulcers over the body, with sensations near normal. The SSS test was positive, and the lepromin test was negative. What is the most appropriate management for this patient?
Multiple hypoaesthetic, hypopigmented macules on right lateral forearm with numerous acid-fast bacilli is indicative of:
26-year-old man from Bihar presents with erythematous papules on the face and back of the neck, which are hypopigmented and normoaesthetic, with no nerve thickening. A history of prolonged fever in childhood is present. What is the diagnosis?
Punched out lesion or inverted saucer appearance are characteristic of which type of leprosy?
The patient with leprosy had slightly erythematous, anesthetic plaques on the trunk and upper limbs. He was treated with paucibacillary multidrug therapy (PB-MDT) for 6 months. At the end of 6 months, he had persistent erythema and induration in the plaque. According to the World Health Organization (WHO) guidelines, what is the next recommended step of action for this patient?
A 45-year-old Ulcerative colitis patient presents with multiple painful lesions on both legs. What is the diagnosis?
A 24-year-old male presents with a lesion at the site shown in the image for 4 years. He says it has increased in thickness over the years. Diagnosis is:
Leprosy Indian Medical PG Practice Questions and MCQs
Question 1: Asymmetrical nerve thickening with several hypoesthetic macules on skin indicates which stage of leprosy:
- A. Tuberculoid leprosy
- B. Borderline lepromatous
- C. Borderline borderline leprosy
- D. Borderline tuberculoid (Correct Answer)
Explanation: ***Borderline tuberculoid (BT)*** - 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 or more) asymmetrically distributed hypoesthetic macules or plaques** with well-defined borders, reflecting a strong but not complete cell-mediated immune response. - The combination of asymmetrical nerve involvement with multiple skin lesions is **classic for BT leprosy**, making it more stable than BB and with more lesions than pure TT. *Tuberculoid leprosy (TT)* - Characterized by **very few skin lesions (1-5)**, typically solitary or up to 5 well-demarcated hypopigmented or erythematous macules with complete anesthesia. - While asymmetrical nerve thickening occurs, the key differentiator is the **fewer number of lesions** - "several" macules suggests more than the typical TT presentation. *Borderline borderline (BB)* - Represents the **most unstable form** in the borderline spectrum, with numerous (often 10-30) moderately defined lesions. - Nerve involvement is present but **less prominently asymmetrical** than in BT, with features intermediate between tuberculoid and lepromatous poles. - The emphasis on "asymmetrical nerve thickening" in the question stem points away from BB toward the tuberculoid end of the spectrum. *Borderline lepromatous (BL)* - Marked by **many poorly defined lesions (often >30)** that are becoming more **symmetrically distributed**. - Nerve thickening is less prominent and **more symmetrical** than in BT or BB, reflecting a weaker cell-mediated immune response. - The asymmetrical pattern described in the question is not characteristic of BL.
Question 2: Thalidomide is not used in
- A. HIV associated Oral ulcers
- B. HIV associated neuropathy (Correct Answer)
- C. ENL
- D. Behçet's syndrome
Explanation: HIV associated neuropathy - Thalidomide is generally **not used** to treat HIV-associated neuropathy because it can **worsen peripheral neuropathy**; it is a known adverse effect and a contraindication. - Its immunomodulatory and anti-inflammatory effects are not beneficial for this condition and pose a **risk of exacerbation**. *Behçet's syndrome* - **Thalidomide** is effective in treating various manifestations of Behçet's syndrome, particularly **recurrent oral and genital ulcers**, due to its anti-inflammatory and immunomodulatory properties. - It helps reduce the frequency and severity of these **mucocutaneous lesions**. *HIV associated Oral ulcers* - Thalidomide has been successfully used to treat **severe and refractory oral ulcers** in HIV-positive patients, due to its **immunomodulatory effects** [1] that reduce inflammation and promote healing. - It suppresses the inflammatory response implicated in the pathogenesis of these **chronic ulcers**. *ENL* - **Erythema Nodosum Leprosum (ENL)** is a severe inflammatory complication of leprosy, and **thalidomide is the drug of choice** for its treatment [1] due to its potent anti-inflammatory and immunomodulatory actions. - It resolves the **painful skin nodules, fever, and systemic symptoms** associated with ENL.
Question 3: What is the first symptom of leprosy?
- A. Decreased vibration & position sense
- B. Decreased pain (Correct Answer)
- C. Decreased temperature
- D. Decreased light touch
Explanation: Decreased pain - Leprosy primarily targets Schwann cells in peripheral nerves, leading to sensory loss [1]. - The sensation of pain is typically affected earliest, often presenting as areas of numbness [1]. Decreased vibration & position sense - These sensations are typically carried by larger myelinated fibers, which tend to be affected later in the disease progression of leprosy. - While eventually involved, they are not usually the first symptom of sensory loss. Decreased temperature - Temperature sensation is also an early modality affected in leprosy, as it's carried by small, unmyelinated or thinly myelinated fibers [1]. - However, pain is often cited as the very first sensory loss, even preceding temperature changes in some cases. Decreased light touch - Light touch sensation is generally an early loss, similar to pain and temperature, due to damage to nerve fibers in the skin. - But, when distinguishing the absolute first symptom, pain perception often shows impairment even before light touch in affected areas.
Question 4: A 35-year-old female presented with multiple inverted saucer-shaped ulcers over the body, with sensations near normal. The SSS test was positive, and the lepromin test was negative. What is the most appropriate management for this patient?
- A. T.Rifampicin 600 mg and T.Clofazimine 300 mg once a month, T.Clofazimine 100 mg daily, and T.Dapsone 100 mg daily for 12 months.
- B. T.Rifampicin 600 mg and T.Clofazimine 300 mg once a month, T.Clofazimine 50 mg daily, and T.Dapsone 100 mg daily for 6 months.
- C. T.Rifampicin 600 mg and T.Clofazimine 300 mg once a month, T.Clofazimine 50 mg daily, and T.Dapsone 1000 mg daily for 12 months.
- D. T.Rifampicin 600 mg and T.Clofazimine 300 mg once a month, T.Clofazimine 50 mg daily, and T.Dapsone 100 mg daily for 12 months. (Correct Answer)
Explanation: ***Correct WHO MDT-MB regimen (Rifampicin 600 mg + Clofazimine 300 mg monthly, Clofazimine 50 mg daily, Dapsone 100 mg daily for 12 months)*** - The clinical presentation (multiple inverted saucer-shaped ulcers, near normal sensations, positive **SSS test**, negative **lepromin test**) is characteristic of **lepromatous leprosy** (multibacillary leprosy). - The standard WHO-recommended multidrug therapy (MDT) for multibacillary leprosy is **Rifampicin 600 mg once monthly**, **Clofazimine 300 mg once monthly** plus **50 mg daily**, and **Dapsone 100 mg daily for 12 months**. - This regimen ensures adequate bacterial clearance and prevents relapse in multibacillary cases. *Incorrect: Clofazimine 100 mg daily dose* - The daily dose of **Clofazimine** (100 mg) is incorrect, as the standard daily dose for multibacillary leprosy is **50 mg**, not 100 mg. - While other components (Rifampicin, Dapsone doses) and 12-month duration are correct, the incorrect daily clofazimine dose makes this option unsuitable. *Incorrect: 6-month duration* - The duration of treatment for multibacillary leprosy is **12 months**, not 6 months. - A 6-month regimen is indicated for **paucibacillary leprosy** only. - Inadequate treatment duration increases the risk of **relapse and drug resistance** in multibacillary cases. *Incorrect: Dapsone 1000 mg daily dose* - The daily dose of **Dapsone** (1000 mg) is significantly higher than the recommended **100 mg daily**, risking severe toxicity. - High doses of Dapsone can lead to **hemolytic anemia**, **methemoglobinemia**, and other serious adverse effects.
Question 5: Multiple hypoaesthetic, hypopigmented macules on right lateral forearm with numerous acid-fast bacilli is indicative of:
- A. Borderline leprosy
- B. Tuberculoid leprosy
- C. Lepromatous leprosy (Correct Answer)
- D. Indeterminate leprosy
Explanation: ***Lepromatous leprosy*** - The hallmark feature is **numerous acid-fast bacilli (AFB)** in skin smears, indicating a **high bacterial load** characteristic of lepromatous leprosy (bacterial index 4-6+). - Lepromatous leprosy is **multibacillary** with **poor cell-mediated immunity**, allowing uncontrolled bacterial multiplication (10⁶-10⁹ bacilli per gram of tissue). - While typically presenting with **widespread, symmetrical lesions**, early lepromatous leprosy can present with **multiple hypopigmented macules** before progressing to diffuse infiltration. - **Sensory loss** may be present but is typically **less pronounced** initially compared to tuberculoid leprosy, as nerve damage occurs gradually. *Borderline leprosy* - Represents the **unstable middle spectrum** (BT, BB, BL) with **moderately impaired immunity** and **variable bacterial load**. - Borderline tuberculoid (BT) has **few AFB**, borderline lepromatous (BL) has **moderate AFB**, but the term "numerous AFB" more specifically indicates lepromatous leprosy. - Lesions are typically **asymmetrical** with variable sensory loss depending on the subtype. *Tuberculoid leprosy* - Characterized by **paucibacillary disease** with **strong cell-mediated immunity** that effectively contains bacterial proliferation. - Skin smears show **few or no detectable AFB** (bacterial index 0-1+) due to robust immune response. - Presents with **few well-defined lesions (1-5)** with **marked sensory loss** and thickened nerves. *Indeterminate leprosy* - The **earliest stage** of leprosy, presenting as a **single hypopigmented or erythematous macule** with minimal sensory changes. - Shows **few or no AFB** on skin smears and may evolve into any form of leprosy or resolve spontaneously. - Not consistent with multiple lesions and numerous bacilli.
Question 6: 26-year-old man from Bihar presents with erythematous papules on the face and back of the neck, which are hypopigmented and normoaesthetic, with no nerve thickening. A history of prolonged fever in childhood is present. What is the diagnosis?
- A. Tuberculoid leprosy
- B. Lepromatous leprosy
- C. Lupus vulgaris
- D. Dermal leishmaniasis (PKDL) (Correct Answer)
Explanation: ***Dermal leishmaniasis (PKDL)*** - PKDL presents with **erythematous papules** on the face and neck, which are **hypopigmented and normoaesthetic** (intact sensation), fitting the patient's description perfectly. - A history of **prolonged fever in childhood** in Bihar is highly suggestive of prior **visceral leishmaniasis (kala-azar)**, after which PKDL typically develops (months to years post-treatment). - The **absence of nerve thickening** and **normal sensation** are key features distinguishing PKDL from leprosy. - Bihar is an **endemic area** for visceral leishmaniasis in India. *Tuberculoid leprosy* - Characterized by **hypopigmented, anaesthetic patches** with **thickened nerves** - both features are absent in this case. - The **normoaesthetic** nature of lesions here rules out tuberculoid leprosy. - Lesions are typically **well-demarcated** and few in number. *Lepromatous leprosy* - Involves widespread, symmetrical lesions that are often **erythematous nodules** or **diffuse infiltrations**, with multiple nerve involvements. - Would show **nerve thickening** and eventual sensory loss, which are not present here. - The clinical picture does not match lepromatous leprosy. *Lupus vulgaris* - A form of **cutaneous tuberculosis** presenting as red-brown plaques with an **"apple-jelly" appearance** on diascopy. - While it can occur on the face, there is no history of fever or connection to visceral leishmaniasis. - The morphology (papules vs plaques) and epidemiological context favor PKDL.
Question 7: Punched out lesion or inverted saucer appearance are characteristic of which type of leprosy?
- A. Tuberculoid
- B. Borderline tuberculoid
- C. Lepromatous (Correct Answer)
- D. Borderline lepromatous
Explanation: ***Lepromatous*** - **Punched-out lesions**, also known as "inverted saucer appearance," are characteristic of **lepromatous leprosy** due to extensive dermal infiltration and destruction by *Mycobacterium leprae*. - This form of leprosy involves a **weak cellular immune response** allowing widespread bacterial dissemination and visible skin lesions. *Tuberculoid* - Tuberculoid leprosy is characterized by a **strong cell-mediated immune response**, resulting in few, well-demarcated skin lesions with sensory loss. - It is typically **paucibacillary**, meaning few bacteria are present in the lesions, and does not cause punched-out or inverted saucer appearances. *Borderline tuberculoid* - Borderline tuberculoid leprosy presents with **moderate cell-mediated immunity** and a few skin lesions that are more numerous and less well-defined than in tuberculoid leprosy. - While it can be more extensive than tuberculoid, it typically does not exhibit the extensive tissue destruction leading to "punched-out" lesions characteristic of the lepromatous pole. *Borderline lepromatous* - Borderline lepromatous leprosy shows a **weak cellular immune response** and numerous, ill-defined lesions, often with varying sizes and shapes. - While it shares some features of lepromatous leprosy, the classic "punched-out" or "inverted saucer" appearance is more specifically associated with the widespread and uniform dermal infiltration of **full-blown lepromatous leprosy**.
Question 8: The patient with leprosy had slightly erythematous, anesthetic plaques on the trunk and upper limbs. He was treated with paucibacillary multidrug therapy (PB-MDT) for 6 months. At the end of 6 months, he had persistent erythema and induration in the plaque. According to the World Health Organization (WHO) guidelines, what is the next recommended step of action for this patient?
- A. Stop antileprosy treatment (Correct Answer)
- B. Continue PB-MDT till erythema subsides
- C. Biopsy the lesion to document activity
- D. Continue dapsone alone for another 6 months
Explanation: ***Stop antileprosy treatment*** - According to **WHO guidelines**, paucibacillary multidrug therapy (PB-MDT) has a **fixed duration of 6 months**, after which treatment should be **stopped regardless of clinical appearance** of the lesions. - The persistent erythema and induration after completing 6 months of PB-MDT represent a **Type 1 lepra reaction (reversal reaction)**, which is an **immunological phenomenon**, not active disease requiring continued antimicrobial therapy. - **Type 1 reactions** should be managed with **corticosteroids (prednisolone 40-60 mg/day)**, not by prolonging MDT, as reactions are inflammatory rather than infectious in nature. - Continuing MDT beyond the recommended duration does **not prevent or treat lepra reactions** and unnecessarily exposes the patient to **drug toxicity and side effects**. *Continue PB-MDT till erythema subsides* - This is **not recommended by WHO guidelines**, which specify a **fixed duration** for PB-MDT (6 months) that should not be extended based on residual erythema or induration. - Persistent inflammation after completing treatment represents a **lepra reaction**, which is managed with **corticosteroids**, not continued MDT. - Extending MDT beyond 6 months for PB cases has no proven benefit and increases risk of **adverse drug reactions** without improving outcomes. *Biopsy the lesion to document activity* - While biopsy could provide histological information, the clinical scenario clearly describes a **Type 1 lepra reaction** occurring at the end of treatment. - The **diagnosis of Type 1 reaction is clinical**, based on erythema, induration, and tenderness in existing lesions after or during treatment. - Biopsy would only delay appropriate management with **corticosteroids** and is not necessary when clinical features are typical. *Continue dapsone alone for another 6 months* - **Monotherapy with dapsone** is absolutely contraindicated in leprosy management due to high risk of **drug resistance**. - After completing the fixed 6-month PB-MDT regimen, **no further antimicrobial therapy is indicated** for paucibacillary leprosy. - The persistent inflammation requires management of the **lepra reaction with corticosteroids**, not continued antimicrobial therapy.
Question 9: A 45-year-old Ulcerative colitis patient presents with multiple painful lesions on both legs. What is the diagnosis?
- A. Pyoderma gangrenosum (Correct Answer)
- B. Febrile neutropenic dermatosis
- C. Necrotizing fasciitis
- D. Granulomatosis with polyangiitis
Explanation: ***Pyoderma gangrenosum*** - This patient has **ulcerative colitis**, which is strongly associated with **pyoderma gangrenosum**, a neutrophilic dermatosis. - The image shows characteristic **painful, rapidly expanding ulcers** with violaceous, undermined borders, typical of pyoderma gangrenosum. *Febrile neutropenic dermatosis* - This condition (also known as **Sweet syndrome**) occurs in patients with **neutropenia** and **fever**, presenting with painful erythematous plaques or nodules. - While systemic illness like ulcerative colitis can predispose to skin conditions, the specific presentation and lack of mentioned neutropenia make this less likely. *Necrotizing fasciitis* - **Necrotizing fasciitis** is a rapidly progressive, life-threatening infection of the deep fascia and subcutaneous tissue, typically presenting with severe pain, erythema, swelling, and crepitus. - The lesions in the image appear to be chronic ulcers with specific borders rather than acute, rapidly spreading infection of necrotizing fasciitis. *Granulomatosis with polyangiitis* - Also known as **Granulomatosis with polyangiitis (GPA)**, formerly **Wegener's granulomatosis**, this is an autoimmune vasculitis primarily affecting the respiratory tract and kidneys, and can cause skin lesions such as palpable purpura, nodules, or ulcers. - While skin lesions can occur, the characteristic features of **pyoderma gangrenosum** and its strong association with inflammatory bowel disease make it a more probable diagnosis in this context.
Question 10: A 24-year-old male presents with a lesion at the site shown in the image for 4 years. He says it has increased in thickness over the years. Diagnosis is:
- A. Spitz nevus
- B. Hyper-melanosis of Ito
- C. Becker's nevus (Correct Answer)
- D. Congenital melanocytic nevus
Explanation: ***Becker's nevus*** - This lesion typically presents as a **unilateral, hyperpigmented patch** that often appears during childhood or adolescence, increasing in size and thickness with associated **hypertrichosis** (increased hair growth). The image shows a large, irregularly shaped, hyperpigmented area on the torso of a young male, consistent with this description. - The history of increasing thickness over four years further supports **Becker's nevus**, as it is known to progress in thickness and texture, often becoming more indurated and sometimes verrucous. *Spitz nevus* - Spitz nevus is a benign melanocytic nevus typically presenting as a **pink or red, dome-shaped papule or nodule**, commonly on the face or limbs. - It rapidly grows but does not typically present as a large, hyperpigmented patch with associated hypertrichosis like the lesion shown. *Hyper-melanosis of Ito* - Hypermelanosis of Ito (also known as incontinentia pigmenti achromians) is characterized by **streaky or whorled hypopigmented (lighter) skin lesions**, often present at birth or in early infancy. - The image clearly shows a **hyperpigmented (darker) lesion**, which directly contradicts the characteristic hypopigmentation of hypermelanosis of Ito. *Congenital melanocytic nevus* - Congenital melanocytic nevi are typically present **at birth** or become apparent shortly thereafter. While they can be large and hyperpigmented, they usually do not have the prominent feature of increasing thickness and hypertrichosis developing many years later in adolescence or early adulthood in the same way as Becker's nevus. - The description of a lesion appearing during adolescence and increasing in thickness and hairiness for four years makes Becker's nevus a more specific diagnosis than a general congenital melanocytic nevus.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free