Tropical Dermatology Practice Questions

Q: Type-II lepra reaction is most commonly found in:

LL. ***LL*** - **Type 2 lepra reactions (ENL)** are most commonly seen in the **lepromatous spectrum** of leprosy, particularly in **LL (lepromatous leprosy)** and sometimes in **BL (borderline lepromatous) leprosy**. - These reactions are an **immune complex-mediated hypersensitivity reaction** to M. leprae antigens, leading to acute inflammation. *BL* - While **Type II lepra reactions (ENL)** can occur in **borderline lepromatous (BL) leprosy**, they are **less frequent** and generally less severe than in LL. - Patients with BL leprosy are more prone to **Type I lepra reactions (reversal reactions)**, reflecting shifts in cell-mediated immunity. *BT* - **Borderline tuberculoid (BT) leprosy** patients primarily experience **Type I lepra reactions (reversal reactions)**, which are cell-mediated immune responses. - **Type II lepra reactions (ENL)** are generally **not seen** in the tuberculoid spectrum due to the robust cell-mediated immunity. *None of the options* - This option is incorrect because **LL (lepromatous leprosy)** is a well-established and common site for Type II lepra reactions. - The other options represent different classifications within the leprosy spectrum, and LL is indeed recognized for this specific reaction.

Q: Delhi boil refers to:

L. tropica sore. ***L. tropica sore*** - Delhi boil is a common name for cutaneous **leishmaniasis**, specifically caused by **Leishmania tropica**. - This condition presents as a **skin lesion** or sore, primarily in endemic regions like Delhi. *Solar Keratosis* - Solar keratosis is a **precancerous skin lesion** caused by long-term exposure to ultraviolet (UV) radiation from the sun. - It presents as a **rough, scaly patch** on sun-exposed areas and is not associated with parasitic infection. *Venereal ulcer* - A venereal ulcer is a **genital sore** typically caused by sexually transmitted infections (STIs) such as syphilis, herpes, or chancroid. - These ulcers are localized to the genital area and have a different etiology and clinical presentation than Delhi boil. *Malignant pustule* - A malignant pustule is a term sometimes used historically to describe **anthrax skin lesions** due to their necrotic and often black center, but more generally refers to a pustular lesion with malignant or highly aggressive characteristics. - It is not a synonym for Delhi boil, which is a parasitic infection with a distinct clinical course and etiology.

Q: In Ainhum, constriction develops usually at the level of the interphalangeal joint of which toe?

5th toe. ***5th toe*** - **Ainhum** is a condition characterized by progressive concentric constrictions, typically leading to autoamputation. - It most commonly affects the **fifth digit of the foot** (little toe), at the level of the **interphalangeal joint**. - The characteristic constriction band typically begins on the **plantar-medial aspect** of the fifth toe. *Great toe* - While other toes can be affected, the great toe is less commonly involved in Ainhum. - The disease shows a strong predilection for the lateral digits, particularly the fifth toe. *2nd toe* - The second toe is not the most common digit for the constriction band to develop in Ainhum. - The progression of the disease occurs more frequently in the outermost digits. *4th toe* - While the fourth toe can occasionally be affected, it is much less common than the fifth toe. - Ainhum demonstrates a characteristic pattern favoring the fifth toe in over 90% of cases.

Q: In which condition is an ulceronecrotic nodule typically observed?

Lucio's leprosy. ***Lucio's leprosy*** - This is a rare, diffuse variant of **lepromatous leprosy** characterized by widespread, diffuse infiltration of the skin without distinct nodules. - The distinctive feature is the occurrence of **necrotizing vasculitis**, leading to painful, irregular ulcers and scars, known as **Lucio phenomenon** or erythema necroticans. *Lepromatous leprosy* - Characterized by **multiple, symmetrical nodules**, plaques, and diffuse infiltration, but typically without the profound ulceronecrotic changes seen in Lucio's leprosy. - The immune response is weak, leading to high bacterial load and widespread involvement, but usually not spontaneous ulceration. *Indeterminate leprosy* - This is an **early, undifferentiated form** of leprosy, characterized by a single or a few hypopigmented or erythematous macules. - Distinct nodules or ulceronecrotic lesions are not a feature of indeterminate leprosy, as the disease has not yet progressed to develop specific clinical manifestations. *Histoid leprosy* - A rare variant of lepromatous leprosy that presents with **cutaneous nodules** and papules that often resemble dermatofibromas or xanthomas. - These nodules are firm, smooth, and have a unique histological appearance, but they do not typically undergo spontaneous ulceronecrotic changes like those in Lucio's leprosy.

Q: 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?

Dermal leishmaniasis (PKDL). ***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 1

Type-II lepra reaction is most commonly found in:

Accepted Answer

LL

Answer

BL

Answer

BT

Answer

None of the options

Question 2

Delhi boil refers to:

Accepted Answer

L. tropica sore

Answer

Solar Keratosis

Answer

Venereal ulcer

Answer

Malignant pustule

Question 3

What factors contribute to the higher prevalence of tinea versicolor in tropical climates?

Accepted Answer

Increased sweating promotes fungal growth

Answer

Fungal spores are commonly found in tropical environments

Answer

UV exposure suppresses local skin immunity

Answer

Higher humidity levels facilitate fungal growth

Question 4

In Ainhum, constriction develops usually at the level of the interphalangeal joint of which toe?

Accepted Answer

5th toe

Answer

Great toe

Answer

2nd toe

Answer

4th toe

Question 5

In which condition is an ulceronecrotic nodule typically observed?

Accepted Answer

Lucio's leprosy

Answer

Lepromatous leprosy

Answer

Indeterminate leprosy

Answer

Histoid leprosy

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?

Accepted Answer

Dermal leishmaniasis (PKDL)

Answer

Tuberculoid leprosy

Answer

Lepromatous leprosy

Answer

Lupus vulgaris

Question 7

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?

Accepted Answer

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.

Answer

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.

Answer

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.

Answer

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.

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?

Accepted Answer

Stop antileprosy treatment

Answer

Continue PB-MDT till erythema subsides

Answer

Biopsy the lesion to document activity

Answer

Continue dapsone alone for another 6 months

Tropical Dermatology — MCQs

Tropical Dermatology — MCQs

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