Leprosy Classification-Madrid and Ridley and Jopling Classification

Leprosy Classification-Madrid and Ridley and Jopling Classification

Q. 1

Neurological involvement is pronounced in which type leprosy –

 A

Tuberculoid

 B

Lepromatous

 C

Borderline

 D

Lucio leprosy

Q. 1

Neurological involvement is pronounced in which type leprosy –

 A

Tuberculoid

 B

Lepromatous

 C

Borderline

 D

Lucio leprosy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Tuberculoid 

“In tuberculoid leprosy neural involvement occurs early and may be pronounced, leading to deformity, particularly hands and feet”.

Spectrum and clinical features of leprosy

.  Incubation period —÷    3-5 years or more for lepromatous leprosy

(Tuberculoid leprosy has shorter I.P.)

.   Clinically the spectrum from polar tuberculoid (TT ) to border line tuberculoide (BT) to mid border line (BT) to border line lepromatous (BL) to polar lepromatous (LL) is associated with evolution from assymetric localized macules and plaques to nodular indurated symmetric generlized skin manifestations, an increasing bacterial load and loss of M. leprae – specific cellular immunity.


Q. 2

Single skin lesion is seen in which type of leprosy

 A

LL

 B

TT

 C

BL

 D

BL

Q. 2

Single skin lesion is seen in which type of leprosy

 A

LL

 B

TT

 C

BL

 D

BL

Ans. B

Explanation:

Ans. is ‘b’ i.e., TT 

  • The skin lesions of tuberculoid leprosy consist of one or a few hypopigmented macules or plagues.
  • As the spectrum moves from tuberculoid leprosy to lepromatous leprosy, the number of lesions is increased.

Q. 3

Lepra cells found in lepromatous leprosy are ‑

 A

Neutrophils

 B

Lymphocytes

 C

Macrophages 

 D

Plasma cells

Q. 3

Lepra cells found in lepromatous leprosy are ‑

 A

Neutrophils

 B

Lymphocytes

 C

Macrophages 

 D

Plasma cells

Ans. C

Explanation:

Ans. is ‘c’ i.e., Macrophages 

.    Virchow’s cells (lepra or foamy cells) are large undifferentiated histocytes. Note : Histocytes are tissue macrophages


Q. 4

In Leprosy most common renal lesion seen is ‑

 A

MGN

 B

MPGN

 C

Focal glomeruloselerosis

 D

Diffuse glomerulosclerosis

Q. 4

In Leprosy most common renal lesion seen is ‑

 A

MGN

 B

MPGN

 C

Focal glomeruloselerosis

 D

Diffuse glomerulosclerosis

Ans. A

Explanation:

Ans is ‘a’ i.e., MGN

Most of the infectious causes lead to membranous glomerlonephritis like Hepatic B & C, syphilis, malaria, Leprosy, filariasis & schistasomiasis.


Q. 5

Characteristic feature of borderline leprosy

 A

Inverted saucer lesion

 B

ENL

 C

Hypopigmented macule & plaques all over body

 D

Glove & stocking anesthesia

Q. 5

Characteristic feature of borderline leprosy

 A

Inverted saucer lesion

 B

ENL

 C

Hypopigmented macule & plaques all over body

 D

Glove & stocking anesthesia

Ans. A

Explanation:

A i.e. Inverted saucer lesion


Q. 6

All lesions are seen in leprosy except

 A

Erythematous Macule

 B

Hypo pigmented patch

 C

Vesicles

 D

Flat & raised patches

Q. 6

All lesions are seen in leprosy except

 A

Erythematous Macule

 B

Hypo pigmented patch

 C

Vesicles

 D

Flat & raised patches

Ans. C

Explanation:

C i.e. Vesicles


Q. 7

All are features of lepromatous leprosy except:

 A

Gynaecomastia

 B

Madarosis

 C

Saddle nose

 D

Perforating Ulcer

Q. 7

All are features of lepromatous leprosy except:

 A

Gynaecomastia

 B

Madarosis

 C

Saddle nose

 D

Perforating Ulcer

Ans. D

Explanation:

D i.e. Perforating Ulcer

Leprosy and acquired syphilis are not vesico-bullous disordersQ (i.e. there is no vesicle and bullae formation, which can be seen in congenital syphilis).

Neuropathic / Trophic /Perforating / Plantar – ulcer is a frequent complication (not clinical feature) of lepromatous leprosyQ because sensory impaiment appears before motor weakness and patient continues to miisuse his feet and hands.


Q. 8

Commonest nerve involved in leprosy is:

 A

Ulnar

 B

Median

 C

Radial

 D

Sciatic

Q. 8

Commonest nerve involved in leprosy is:

 A

Ulnar

 B

Median

 C

Radial

 D

Sciatic

Ans. A

Explanation:

A i.e. Ulnar nerve


Q. 9

In leprosy nerves commonly involved are:

 A

High ulnar, low median

 B

High median, low ulnar

 C

Triple nerve palsy

 D

High radial, low median

Q. 9

In leprosy nerves commonly involved are:

 A

High ulnar, low median

 B

High median, low ulnar

 C

Triple nerve palsy

 D

High radial, low median

Ans. A

Explanation:

A i.e. High ulnar & low median


Q. 10

In Leprosy which of the following is not seen:

 A

Abnormal EMG

 B

Voluntary muscle wasting

 C

Decreased Proprioception

 D

Decreased response to tactile sensation

Q. 10

In Leprosy which of the following is not seen:

 A

Abnormal EMG

 B

Voluntary muscle wasting

 C

Decreased Proprioception

 D

Decreased response to tactile sensation

Ans. C

Explanation:

C i.e. Decreased proprioception

–    Nerves commonly involved in leprosy are. 

–    Posterior tibial is the most frequently affected nerve f/b ulnarQ, median, lateral popliteal and facial. Ulnar & median nerve lesions are usually lowQ, causing small muscles but not deep flexor weakness, & anesthesia of two halves of hand (Rook – 32.13)

–       The most commonly affected nerve trunk is ulnar nerve at elbowQ. Insensitivity affects fine touch, pain and heat receptors but generally spares position & vibrating appreciationQ (Harrison 1383)

 

Generation time of lepra bacilli is 12 – 13 days. Maximum no. of bacilli is shed in nasal secretions. Virchow cells are diagnostic. Lepra cells (Foam cells) are large undifferentiated histiocytesQ. Ist involved is Schwann cell. Ist sensation lost is temperature & pain.

Propioception is carried by Goll & Burdech tract (posterior column) which is not involved in leprosyQ. Temperature & painQ lost earlier than touch & pressure. Leprosy mainly affects peripheral nerves, eventually lit muscle wasting. Myopathy, muscle wasting may Vt abnormal EMGQ.

  1. Posterior tibial (most common)Q.
  2. Ulnar (2″ most common, most commonly Vt abscess)Q
  3. Peroneal/lateral popliteal
  4. Median & Facial
  5. Posterior auricular
  6. Supra orbital, supraclavicular, 

Q. 11

Leprosy affects all organs except

 A

Eyes

 B

Nerves

 C

Uterus

 D

Ovary

Q. 11

Leprosy affects all organs except

 A

Eyes

 B

Nerves

 C

Uterus

 D

Ovary

Ans. C

Explanation:

C i.e. Uterus

In lepromatous leprosy (LL) bacilli are plentiful in circulating blood and widely disseminated in all organ systems except the lungs and central nervous systemQ (Harrison 18/1362)

Leprosy affects nerves (posterior tibial > ulnar), eyesQ (lagopthalmos, corneal insensitivity, ulcer, uveitis, iritis, blindness), testisQ (TFSH/LH, decreased testosterone, aspermia/hypospermia, impotence & infertility),larynx (hoarseness d/t vocal nodule), nose (rhinitis, septal perforation, nasal collapse), kidney, liver, spleen, peripheral lymph nodes, bone marrow, bone (osteoporosis, cyst, fracture) and nails.

– Skin lesions may be anywhere apart from hairy scalp, axillae, groins and perineum (regions of skin with highest temperature)- Rook’s 8/e p. 32.10

Female genital tract is rarely involved in leprosy. But when involved ovary is the commonest site to be involvedQ causing TFSH/LH/prolactin and infertility due to ovarian failure.

Pregnancy precipitates leprosy b/o altered immunity. When pregnant, LL and BL patients are predisposed to develop ENL d/t reduced immunity, but post-partum they are predisposed to develop DTH reaction (Jopling’s type I reaction; upgrading, reversal or downgrading) d/t restored immunity.

Untreated lactating BL and LL mothers have viable bacilli in their milk, but no risk has been identified in infants ingesting such bacilli. Dapsone in mother’s mother’s milk may produce hemolysis in the baby (Fitzpatric-1790).


Q. 12

Tuberculoid leprosy is characterised by‑

 A

Non caseating granuloma in nerve

 B

Sub epidermall free zone

 C

Bacilli in skin

 D

Skin caseation

Q. 12

Tuberculoid leprosy is characterised by‑

 A

Non caseating granuloma in nerve

 B

Sub epidermall free zone

 C

Bacilli in skin

 D

Skin caseation

Ans. A

Explanation:

A. i.e. Non caseating granuloma in nerve


Q. 13

All are true lepromatous leprosy except- 

 A

Presence of globi

 B

Subepidermal free zone

 C

Decreased cell mediated immunity

 D

Presence of granulomas subdermally

Q. 13

All are true lepromatous leprosy except- 

 A

Presence of globi

 B

Subepidermal free zone

 C

Decreased cell mediated immunity

 D

Presence of granulomas subdermally

Ans. D

Explanation:

D. i.e. Presence of granulomas subdermally


Q. 14

Skin biopsy in leprosy is characterizedby:

 A

Pariappendegial bacilli

 B

Pariappendegeal lymphocytosis

 C

Perivascular lymphocytosis

 D

All of above

Q. 14

Skin biopsy in leprosy is characterizedby:

 A

Pariappendegial bacilli

 B

Pariappendegeal lymphocytosis

 C

Perivascular lymphocytosis

 D

All of above

Ans. D

Explanation:

D i.e. All of above

Skin Biopsy of Leprosy

–           Lymphocytes, epitheloid cells, granuloma, Langhans type giant cell infiltration around blood vessels, appendages & nervesQ

–           Foam cells which consists of histiocytes loaded with lipid globules derived from the leprosy bacilli; (in LL)

–           Z – N stain show large no. of lepra bacilliQ in dermal infiltrate & foam cells. (in LL)

Lepromatous Leprosy (LL)

– Histology: Thinning of epidermis, and flattening of rate ridges above a clear (free) subepidermal grenz zoneQ. The papillary layer of dermis appears as clear band whilst deeper in dermis lies diffuse leproma consisting of dense, uniform, foamy macrophage infiltrate, with a addition of few pseudo follicular aggregates of lymphocytes, plasma cells and mast cells. The dermis contains enormous number of AFB, singly or in clumps (globi) Q. There is asymptomatic bacillation of schwann cells Vt foamy degenerationQ. Demyelinaton, damage and destruction of axis cylinder are prominent features lit Wallerian degeneration. Despite large numbers of bacilli in nerve there is only a small inflammatory responseQ; ultimately the nerve fibroses and hyalinized. In LLs there is an onion skin perineurial lamination but not infiltration. In LLp perineurium is undisturbed.

Diffuse erythema becoming worse on exposure to sun; Mucous membrane involvement & ulceration; Regurgitation due to perforation of palate.


Q. 15

ENL is seen in which form of leprosy:

 A

Indeterminate

 B

BT

 C

LL (lepromatous leprosy)

 D

A AND B

Q. 15

ENL is seen in which form of leprosy:

 A

Indeterminate

 B

BT

 C

LL (lepromatous leprosy)

 D

A AND B

Ans. C

Explanation:

C i.e. LL (lepromatous leprosy)


Q. 16

Ridley jopling leprosy classification is a type of-

 A

Clinical, bacteriological, immunological, epidemiological classification

 B

Clinical, bacteriological, immunological, therapeutic classification

 C

Clinical, bacteriological, immunological, histological classification

 D

Operational classification

Q. 16

Ridley jopling leprosy classification is a type of-

 A

Clinical, bacteriological, immunological, epidemiological classification

 B

Clinical, bacteriological, immunological, therapeutic classification

 C

Clinical, bacteriological, immunological, histological classification

 D

Operational classification

Ans. C

Explanation:

Ans. is ‘c’ i.e., Clinical, bacteriological, immunological, histological classification 

o Ridley Jopling classification is based on Immuno-histological scale.


Q. 17

Globi is seen in ……………..  leprosy ‑

 A

Tuberculoid

 B

Lepromatous

 C

Border line

 D

Borderline tuberculoid

Q. 17

Globi is seen in ……………..  leprosy ‑

 A

Tuberculoid

 B

Lepromatous

 C

Border line

 D

Borderline tuberculoid

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lepromatous 


Q. 18

Leonine facies is seen in……………. leprosy –

 A

Tuberculoid

 B

Borderline 

 C

Lepromatous 

 D

Borderline tuberculoid

Q. 18

Leonine facies is seen in……………. leprosy –

 A

Tuberculoid

 B

Borderline 

 C

Lepromatous 

 D

Borderline tuberculoid

Ans. C

Explanation:

Ans. is ‘c’ i.e., Lepromatous 


Q. 19

Which of the following is associated with leprosy:

September 2005

 A

Foamy histocytes

 B

Epitheliod cells

 C

Noncaseating granulomas

 D

All of the above

Q. 19

Which of the following is associated with leprosy:

September 2005

 A

Foamy histocytes

 B

Epitheliod cells

 C

Noncaseating granulomas

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

Histologic findings vary according to the type of leprosy.

  • Indeterminate leprosy is characterized by a few cells cuffing the dermal appendages and neurovascular bundles and a few M leprae within cutaneous nerves.
  • In TT leprosy, epithelioid cells, lymphocytes, and perhaps giant cells form noncaseating granulomas. Dermal nerves are destroyed. Normal skin organs (e.g., sweat glands, hair follicles) are lost. Bacilli are frequently absent or difficult to demonstrate.
  • In LL leprosy, the epidermis is normal and the rete flattened. A clear space separates the epidermis from diffuse granulomatous reaction with macrophages; large, foamy histiocytes (Virchow or lepra cells); and many intracellular AFB, which are frequently found in spheroidal masses (i.e., globi). Epithelioid cells and giant cells are not found. Granulomas are most numerous around blood vessels, nerves, and skin appendages. In some cases, many plasma cells are found. Dermal nerves are easily visible.
  • In BT leprosy, granulomas are epithelioid, with a preponderance of lymphocytes. Dermal nerves are mostly destroyed. Bacilli may be scanty or absent.
  • In BB leprosy, granulomas are epithelioid, dermal nerves may be visible, and bacilli are seen more often than in BT leprosy.
  • In BL leprosy, histiocytes form granulomas, dermal nerves are visible, and bacilli are seen in greater numbers than in other types.
  • In a reversal reaction, epithelioid cells and lymphocytes form granulomas. Extracellular edema is noted in the collagen of the dermis with dilated lymphatics or a proliferation of fibrocytes. As reactions clear, lesions heal with reduction or eradication of bacilli.
  • ENL reaction is characterized by a massive influx of polymorphonuclear cells. Complement and immunoglobulin may be deposited in a granular pattern around dermal vessels. Bacilli become more numerous. Histologic studies are not useful for assessing clinical activity because granuloma persists for a long time after clinical activity subsides.

Q. 20

Asmmetrical several nerves thickening with several hypoesthetic macules on skin indicates which stage of leprosy:           

March 2009

 A

Borderline lepromatous

 B

Tuberculoid leprosy

 C

Borderline borderline

 D

Borderline tubeculoid

Q. 20

Asmmetrical several nerves thickening with several hypoesthetic macules on skin indicates which stage of leprosy:           

March 2009

 A

Borderline lepromatous

 B

Tuberculoid leprosy

 C

Borderline borderline

 D

Borderline tubeculoid

Ans. C

Explanation:

Ans. C: Borderline borderline


Q. 21

Innumerable, small, normoesthetic and symmetrical skin lesions are present in which type of leprosy:

March 2009

 A

Borderline lepromatous

 B

Lepromatous

 C

Borderline tubeculoid

 D

Tuberculoid

Q. 21

Innumerable, small, normoesthetic and symmetrical skin lesions are present in which type of leprosy:

March 2009

 A

Borderline lepromatous

 B

Lepromatous

 C

Borderline tubeculoid

 D

Tuberculoid

Ans. B

Explanation:

Ans. B: Lepromatous

Tuberculoid (TT)

– Can be either one large red patch with well-defined raised borders or a large hypopigmented asymmetrical spot

– Lesions become dry and hairless

– Loss of sensation may occur at site of some lesions

– Tender, thickened nerves with subsequent loss of function are common

– Spontaneous resolution may occur in a few years or it may progress to borderline or rarely

Borderline tuberculoid (BT)

– Similar to tuberculoid type except that lesions are smaller and more numerous

– Normoesthetic and symmetrical lesions

– Disease may stay in this stage or convert back to tuberculoid form, or progress

Borderline borderline (BB)

– Numerous, red, irregularly shaped plaques

– Sensory loss is moderate

– Disease may stay in this stage, improve or worsen

– Asymmetrical thickening of several nerves.

– Lesions looking like inverted saucers are common

Borderline lepromatous (BL)

– Numerous lesions of all kinds, plaques, macules, papules and nodules.

– Hypoesthetic

– Symmetrical nerve thickening; glove and stocking anesthesia

Lepromatous (LL)

– Early nerve involvement may go unnoticed

– Normoesthetic, small, symmetrical and numerous lesions of all kinds, plaques, macules, papules and nodules

– Early symptoms include nasal stuffiness, discharge and bleeding, and swelling of the legs and ankles

– Left untreated, the following problems may occur:

  • Skin thickens over forehead (leonine facies), eyebrows and eyelashes are lost, nose becomes misshapen or collapses, ear lobes thicken, upper incisor teeth fall out
  • Eye involvement causing photophobia (light sensitivity), glaucoma and blindness
  • Skin on legs thickens and forms ulcers when nodules break down
  • Testicles shrivel causing sterility and enlarged breasts (males)
  • Internal organ infection causing enlarged liver and lymph nodes
  • Voice becomes hoarse due to involvement of the larynx
  • Slow scarring of peripheral nerves resulting in nerve thickening and sensory loss.
  • Fingers and toes become deformed due to painless repeated trauma.

Q. 22

Globi in leprosy consist of ‑

 A

AFB + macrophages

 B

neutrophils + AFB

 C

Platelet plug

 D

None of the above

Q. 22

Globi in leprosy consist of ‑

 A

AFB + macrophages

 B

neutrophils + AFB

 C

Platelet plug

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., AFB + Macrophages

The bacilli are clumped together by a lipid – like substance, the glia, these masses are known as globi.

“In clinical material from lepromatous patient they (lepra) bacilli are typically found within the macrophages in dense clump”


Q. 23

A patient presented with the following seen on examination. This lesion is common in which type of leprosy?

 A

Tuberculoid leprosy

 B

Lepromatous leprosy

 C

Borderline tuberculoid leprosy

 D

Histoid leprosy

Q. 23

A patient presented with the following seen on examination. This lesion is common in which type of leprosy?

 A

Tuberculoid leprosy

 B

Lepromatous leprosy

 C

Borderline tuberculoid leprosy

 D

Histoid leprosy

Ans. C

Explanation:

It is more common in Borderline Tuberculoid leprosy.

Borderline tuberculoid leprosy (BT). The BT cases resemble tuberculoid leprosy in that they are single or a few lesions only, but margin of the lesion is not so sharply demarcated from the surrounding normal skin, and there may be a few satellite lesions around the main lesions.


Q. 24

Following is/ are the clinical feature/ s of lepromatous leprosy ‑

 A

Leonine facies

 B

Loss of libido and impotence

 C

Saddle nose

 D

All the above

Q. 24

Following is/ are the clinical feature/ s of lepromatous leprosy ‑

 A

Leonine facies

 B

Loss of libido and impotence

 C

Saddle nose

 D

All the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., All the above

Important clinical features of lepromatous leprosy

  • Diffuse erythema, tingling, nasal stuffiness or epistaxis are earliest manifestations.
  • Nodules with predeliction for external ears.
  • Madarosis (loss of eye lashes and eye brows).
  • Saddle nose (Collapse of nasal bridge) and perforation of palate.
  • Testicular involvement results in loss of testicular sensation, loss of libido, impotence & gynaecomastia.
  • Leonine face (Diffuse dermal infiltration of face).
  • Symmetrical thickening of peripheral nerve.?
  • Trophic ulcer/neuropathic ulcer/Perforating ulcer develop frequently in lepromatous leprosy because sensory impairment appears before motor weakness and the patient continues to misuse his hands and feet.
  • Systemic involvement :- Lymphadenopathy, Hepatomegaly, ocular involvement.

Q. 25

A type of Leprosy is shown in the image.All of the following are its features except:

 A

Lepromin test positive

 B

Lepra bacilli few.

 C

Present with distant sensory disturbance

 D

Less immune response

Q. 25

A type of Leprosy is shown in the image.All of the following are its features except:

 A

Lepromin test positive

 B

Lepra bacilli few.

 C

Present with distant sensory disturbance

 D

Less immune response

Ans. D

Explanation:

Ans:D.)Less immune response

Image shows:Tuberculoid leprosy (TT). Granuloma eroding the basal layer of the epidermis. The granuloma is composed of epithelioid cells with sparse Langhans’ giant cells and lymphocytes.



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