Leprosy

Leprosy

Q. 1

Leprosy spreads by ‑

 A

Skin to skin contact

 B

Blood transfusion

 C

Droplet spread

 D

a and c

Q. 1

Leprosy spreads by ‑

 A

Skin to skin contact

 B

Blood transfusion

 C

Droplet spread

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Skin to skin contact; ‘c’ i.e., Droplet spread 


Q. 2

Neurological involvement is pronounced in which type leprosy –

 A

Tuberculoid

 B

Lepromatous

 C

Borderline

 D

Lucio leprosy

Q. 2

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. 3

Single skin lesion is seen in which type of leprosy

 A

LL

 B

TT

 C

BL

 D

BL

Q. 3

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. 4

The characteristic finding in a case of leprosy is –

 A

Culture test is positive in 2-3 months in U media

 B

Long contact with tuberculoid leprosy can transmit the disease

 C

CMI is seen in Lepromatous leprosy

 D

Macule lesion heals spontaneously

Q. 4

The characteristic finding in a case of leprosy is –

 A

Culture test is positive in 2-3 months in U media

 B

Long contact with tuberculoid leprosy can transmit the disease

 C

CMI is seen in Lepromatous leprosy

 D

Macule lesion heals spontaneously

Ans. B

Explanation:

Ans. is ‘b’ i.e., Long contact with tuberculoid leprosy can transmit the disease 

.   Multibacillary cases (Lepromatous and broderline lepromatous) are the most important sources of infection in the community. The role of individuals with tuberculoid forms of the disease as a source of infection is not clear and if these cases possess only a limited capacity to infect others they may be important because a relatively large number of this form of leprosy occurs in endemic communities. The current view is that all patients with “active leprosy” must be considered infectious.

.    The infectivity of patients with paucibacillary (tuberculoid) leprosy is much lower. – Greenwood 16th/e p. 213. From above statements it is clear that the risk of transmission in a case of tuberculoid leprosy is small but still they can transmit the disease.

About other options

Option ‘a’

.   Lepra bacilli can not be cultivated invitro.

Option ‘c’

.   Cell mediated immunity is deficient in lepromatous leprosy.

Option ‘d’

“The first sign of leprosy is a non specific or determinate skin lesion, which often heal spontenously. If the

disease progresses, its clinical manifestation is determined by specific immune responsiveness of the patient to

the bacillus and there is distinct immunological spectrum (from T.T. to L.L.)” – Greenwood 16th/e p. 210

From above statement it seems that skin lesions often heal spontenously before tuberculoid leprosy i.e., in indeterminate form.

Macular lesion is seen in tuberculoid leprosy, so it will not regress spontaneously.


Q. 5

The following test is not used for diagnosis of leprosy –

 A

Lepromin test

 B

Slit skin smear

 C

Fine needle aspiration cytology

 D

Skin biopsy

Q. 5

The following test is not used for diagnosis of leprosy –

 A

Lepromin test

 B

Slit skin smear

 C

Fine needle aspiration cytology

 D

Skin biopsy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lepromin test 

-The clinical diagnosis is confirmed by histological examination of skin biopsies and by the detection of acid fast bacilli in nasal discharges, scrapings from the nasal mucosa and slit-skin smears.

– A minimum of seven sites should be examined

1)  Smears from 4 skin lesions

2)  Smears from both ear lobes

3)  One nasal swab

Sample from the skin should be obtained from the edges of the lesion rather than from the centre.

  • Lepromin Test is not used to diagnose leprosy, nor does it indicate prior contact with lepra bacilli. I-1( althy persons in nonendemic areas with no chance of contact with the bacillus may give a positive lepromin test.

Q. 6

In the management of leprosy, lepromin test is most useful for – 

 A

Herd immunity 

 B

Prognosis

 C

Treatment

 D

Epidemological investigatins

Q. 6

In the management of leprosy, lepromin test is most useful for – 

 A

Herd immunity 

 B

Prognosis

 C

Treatment

 D

Epidemological investigatins

Ans. B

Explanation:

Ans. is ‘b’ i.e., Prognosis 

Uses of lepromin test

1)       To classify the lesion

Tuberculoid                                Positive

Lepromatous                              Negative

Borderline                                   Variable

2)       To assess the prognosis

Positive                        —0         Good prognosis

Negative                                      Bad prognosis

3)       To assess the response to treatment

Conversion to lepromin positive during treatment is evidence of improvement.

4)       To assess the resistance of individuals to leprosy.

5)       To verify the identity of candidate lepra bacilli.

Remember

. The lepromin test is not used to diagnose leprosy.

. BCG vaccination can convert lepra reaction from negative to positive

. In the first 6 months of life, most children are lepromin negative. Some may become postive by the the end of first year.


Q. 7

Exacerbation of lesions in patients of borderline leprosy is seen in –

 A

ENL (erythema nodosum leprosum)

 B

Lepra reaction type 1

 C

Jarisch-Herxheimer reaction

 D

Resolving leprosy

Q. 7

Exacerbation of lesions in patients of borderline leprosy is seen in –

 A

ENL (erythema nodosum leprosum)

 B

Lepra reaction type 1

 C

Jarisch-Herxheimer reaction

 D

Resolving leprosy

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lepra reaction type I 

Lepra reactions

.Though leprosy is a chronic disease, sometimes sudden appearance of signs and symptoms occur. . These are due to lepra reactions.

. Skin and nerve become inflamed and nerves may become extremely painful and tender due to acute neuritis. There are two types of lepra reactions :-

i)         Type 1 reaction (Down grade or reversal reaction).

ii)       Type 2 reaction (Erythma nodosum leprosum)


Q. 8

Under leprosy eradication programme the managment of single lesion is –

 A

Single dose of Rifampicin and Dapsone

 B

Rifampicin and Dapsone for 6 months

 C

Rifampicin, ofloxacin and minocycline single dose

 D

Rifampicin and minocycline for 6 months

Q. 8

Under leprosy eradication programme the managment of single lesion is –

 A

Single dose of Rifampicin and Dapsone

 B

Rifampicin and Dapsone for 6 months

 C

Rifampicin, ofloxacin and minocycline single dose

 D

Rifampicin and minocycline for 6 months

Ans. C

Explanation:

Ans. is ‘c’ i.e., Rifampicin, ofloxacin and minocyclin single dose 

For patients with single – lesion paucibacillary leprosy, the who recommends as an alternative a single dose of rifampicin, ofloxacin and minocycline.


Q. 9

Subtype of leprosy with maximum number of TH -1 cells –

 A

TT

 B

BB

 C

LL

 D

Borderline leprosy

Q. 9

Subtype of leprosy with maximum number of TH -1 cells –

 A

TT

 B

BB

 C

LL

 D

Borderline leprosy

Ans. A

Explanation:

Ans. is ‘a’ i.e., TT 

  • TT —4. Max. no. of CD4 – T cells (TH -1)
  • 11, —II. Max. no. of CD8 – T cells

Q. 10

Lepra cells found in lepromatous leprosy are ‑

 A

Neutrophils

 B

Lymphocytes

 C

Macrophages 

 D

Plasma cells

Q. 10

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. 11

In Leprosy most common renal lesion seen is ‑

 A

MGN

 B

MPGN

 C

Focal glomeruloselerosis

 D

Diffuse glomerulosclerosis

Q. 11

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. 12

Fastest acting drug in leprosy is –

 A

Rifampicin

 B

Dapsone

 C

Clofazimine

 D

Ethionamide

Q. 12

Fastest acting drug in leprosy is –

 A

Rifampicin

 B

Dapsone

 C

Clofazimine

 D

Ethionamide

Ans. A

Explanation:

Ans. is `a’ i.e., Rifampicin

“Rifampicin is the most active agent for leprosy”.


Q. 13

In leprosy, the best bacteriocidal agent is‑

 A

Clofazimine

 B

Dapsone

 C

Rifampicin

 D

Ethionamide

Q. 13

In leprosy, the best bacteriocidal agent is‑

 A

Clofazimine

 B

Dapsone

 C

Rifampicin

 D

Ethionamide

Ans. C

Explanation:

Ans. is ‘c’ i.e., Rifampicin


Q. 14

Which of the following drug is not used in the treatment of leprosy?

 A

Rifampicin

 B

Dapsone

 C

Kanamycin

 D

Clofazimine

Q. 14

Which of the following drug is not used in the treatment of leprosy?

 A

Rifampicin

 B

Dapsone

 C

Kanamycin

 D

Clofazimine

Ans. C

Explanation:

Ans. is ‘c’ i.e., Kanamycin


Q. 15

Drug causing icthyosis and hyperpigmentation, when used in leprosy is –

 A

Rifampicin

 B

Dapsone

 C

Clofazimine

 D

Ethionamide

Q. 15

Drug causing icthyosis and hyperpigmentation, when used in leprosy is –

 A

Rifampicin

 B

Dapsone

 C

Clofazimine

 D

Ethionamide

Ans. C

Explanation:

Ans. is ‘c’ i.e., Clofazimine

o Adverse effects of clofazimine

1.       Skin —>     Reddish-black discolouration of skin, dryness of skin and itching, Discolouration of hair and body secretions, acneform eruptions and phototoxicity, conjuctival pigmentation.

2.         GIT –>      Enteritis with loose stools, nausea, abdominal pain, anorexia and weight loss.


Q. 16

Most common type of leprosy in India:

 A

BT

 B

TT

 C

LL

 D

BL

Q. 16

Most common type of leprosy in India:

 A

BT

 B

TT

 C

LL

 D

BL

Ans. B

Explanation:

B i.e. TT


Q. 17

Skin smear is negative in which leprosy

 A

Indeterminate

 B

Neuritic

 C

Lepromatous

 D

Borderline

Q. 17

Skin smear is negative in which leprosy

 A

Indeterminate

 B

Neuritic

 C

Lepromatous

 D

Borderline

Ans. B

Explanation:

B i.e. Neuritic 

Leprosy Type

Slit Smear & Infectivity

Neuritic

NegativeQ

Tuberculoid

–    AFB may be found from margin

–    Not infective usually

Borderline

–    AFB may be found

–    Infective

Lepromatous

–    Teeming with AFB

–    Infective

Indeterminate

–    Slit smear & lepromin test is ±

Country

Most common type of leprosy

India, Africa

TT (Polar tuberculoid)Q

Southeast Asia

BT (Borderline tuber culoid)

Mexico, Caribbea

Lepromatous (LL>BL)


Q. 18

Single lesion in skin is seen in which type of leprosy:

 A

TT

 B

BT

 C

BL

 D

LL

Q. 18

Single lesion in skin is seen in which type of leprosy:

 A

TT

 B

BT

 C

BL

 D

LL

Ans. A

Explanation:

A i.e. TT


Q. 19

Characteristic feature of borderline leprosy

 A

Inverted saucer lesion

 B

ENL

 C

Hypopigmented macule & plaques all over body

 D

Glove & stocking anesthesia

Q. 19

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. 20

All lesions are seen in leprosy except

 A

Erythematous Macule

 B

Hypo pigmented patch

 C

Vesicles

 D

Flat & raised patches

Q. 20

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. 21

All are features of lepromatous leprosy except:

 A

Gynaecomastia

 B

Madarosis

 C

Saddle nose

 D

Perforating Ulcer

Q. 21

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. 22

Commonest nerve involved in leprosy is:

 A

Ulnar

 B

Median

 C

Radial

 D

Sciatic

Q. 22

Commonest nerve involved in leprosy is:

 A

Ulnar

 B

Median

 C

Radial

 D

Sciatic

Ans. A

Explanation:

A i.e. Ulnar nerve


Q. 23

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. 23

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. 24

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. 24

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. 25

Leprosy do not involve:

 A

CNS

 B

Testis

 C

Skin

 D

Cornea

Q. 25

Leprosy do not involve:

 A

CNS

 B

Testis

 C

Skin

 D

Cornea

Ans. A

Explanation:

A i.e. CNS


Q. 26

Leprosy affects all organs except

 A

Eyes

 B

Nerves

 C

Uterus

 D

Ovary

Q. 26

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. 27

Tuberculoid leprosy is characterised by‑

 A

Non caseating granuloma in nerve

 B

Sub epidermall free zone

 C

Bacilli in skin

 D

Skin caseation

Q. 27

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. 28

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. 28

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. 29

Skin biopsy in leprosy is characterizedby:

 A

Pariappendegial bacilli

 B

Pariappendegeal lymphocytosis

 C

Perivascular lymphocytosis

 D

All of above

Q. 29

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. 30

The following test is not used for diagnosis of leprosy :

 A

Lepromin test

 B

Slit skin smear

 C

Fine needle aspiration cytology

 D

Skin biopsy

Q. 30

The following test is not used for diagnosis of leprosy :

 A

Lepromin test

 B

Slit skin smear

 C

Fine needle aspiration cytology

 D

Skin biopsy

Ans. A

Explanation:

A i.e. Lepromin test


Q. 31

Lepromin test is positive in which leprosy

 A

Lepromatous

 B

Indeterminate

 C

Histoid

 D

Tuberculoid

Q. 31

Lepromin test is positive in which leprosy

 A

Lepromatous

 B

Indeterminate

 C

Histoid

 D

Tuberculoid

Ans. D

Explanation:

D i.e. Tuberculoid


Q. 32

A 16 year old student reported for the evaluation of multiple hypopigmented macules on the trunk and limbs. All of the following tests are useful in making a diagnosis of leprosy, except:

 A

Sensation testing

 B

Lepromin test

 C

Slit smears

 D

Skin biopsy

Q. 32

A 16 year old student reported for the evaluation of multiple hypopigmented macules on the trunk and limbs. All of the following tests are useful in making a diagnosis of leprosy, except:

 A

Sensation testing

 B

Lepromin test

 C

Slit smears

 D

Skin biopsy

Ans. B

Explanation:

B i.e. Lepromin test

Lepromin test has no diagnostic value; it has only prognostic significanceQ as it tells about cell mediated immunity & classify the type of disease. Lepromin test is most positive in TT because cell mediated immunity is least suppressedQ


Q. 33

A 27-year-old patient was diagnosed to have borderline leprosy and started on multibacillary multi-drug therapy. Six weeks later, he developed pain in the nerves and redness and swelling of the skin lesions. The management of his illness should include all of the following, except:

 A

Stop anti-leprosy drugs

 B

Systemic corticosteroids

 C

Rest to the limbs affected

 D

Analgesics

Q. 33

A 27-year-old patient was diagnosed to have borderline leprosy and started on multibacillary multi-drug therapy. Six weeks later, he developed pain in the nerves and redness and swelling of the skin lesions. The management of his illness should include all of the following, except:

 A

Stop anti-leprosy drugs

 B

Systemic corticosteroids

 C

Rest to the limbs affected

 D

Analgesics

Ans. A

Explanation:

A i.e. Stop Anti leprosy drugs


Q. 34

Best meathod of treatment of ulner never abscess in case of leprosy is:

 A

High does of steroid

 B

Incision and drainage

 C

Thalidomide

 D

High does of clofazamine

Q. 34

Best meathod of treatment of ulner never abscess in case of leprosy is:

 A

High does of steroid

 B

Incision and drainage

 C

Thalidomide

 D

High does of clofazamine

Ans. B

Explanation:

B i.e. Incision & Drainage

Condition

Treatment of

choice

Accessory treatment

Neuritis in leprosy

CorticosteroidQ

Antileprotic drugs (ALD)

Nerve abscess in

leprosy

Incision &

drainageQ

f/b ALD & steroid

Type I Lepra reaction

Type II lepra reaction

CorticosteroidQ

CorticosteroidQ

 

Recurring & persistent

Type II lepra reaction

ThalidomideQ

Incision and Drainage of abscess followed by anti leprotic treatment and glucocorticoids is done for nerve abscess in leprosy.

Controversial question. In type I lepra reaction, thaladomide has no role but incision & drainage is done in nerve abscess not in acute neuritis.


Q. 35

ENL is seen in which form of leprosy:

 A

Indeterminate

 B

BT

 C

LL (lepromatous leprosy)

 D

A AND B

Q. 35

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. 36

The first line antileprosy drugs include all except‑

 A

Dapsone

 B

Thiacetazone

 C

Clofazimine

 D

Rifampicin

Q. 36

The first line antileprosy drugs include all except‑

 A

Dapsone

 B

Thiacetazone

 C

Clofazimine

 D

Rifampicin

Ans. B

Explanation:

B. i.e. Thiacetazone


Q. 37

One of the following is a side effect of clofazimine used in leprosy therapy‑

 A

Hyperpigmentation

 B

Erythema

 C

Discoloration of body secretions

 D

a and c

Q. 37

One of the following is a side effect of clofazimine used in leprosy therapy‑

 A

Hyperpigmentation

 B

Erythema

 C

Discoloration of body secretions

 D

a and c

Ans. D

Explanation:

A i.e. Hyperpigmentation C i.e. Discolouration of body secretions


Q. 38

Control of TB and leprosy is by:

 A

Isolation of cases

 B

Specific protection

 C

Early diagnosis and treatment

 D

Elimination of reservoirs

Q. 38

Control of TB and leprosy is by:

 A

Isolation of cases

 B

Specific protection

 C

Early diagnosis and treatment

 D

Elimination of reservoirs

Ans. C

Explanation:

C. i.e. Early diagnosis & treatment


Q. 39

WHO regime for paucibacillary leprosy:

 A

100 mg Dapsone daily + Rifampcin monthly (600 mg)

 B

Dapsone daily + Rifampcin daily

 C

Dapsone + Rifampcin + Clofazemine daily

 D

Rifampcin + Clofazamine daily

Q. 39

WHO regime for paucibacillary leprosy:

 A

100 mg Dapsone daily + Rifampcin monthly (600 mg)

 B

Dapsone daily + Rifampcin daily

 C

Dapsone + Rifampcin + Clofazemine daily

 D

Rifampcin + Clofazamine daily

Ans. A

Explanation:

A i.e. 100 mg Dapsone daily + Rifampcin 600 mg monthly


Q. 40

Duration of treatment in pauci bacillary leprosy is

 A

6 months

 B

9 months

 C

2 years

 D

Till sumptoms subside

Q. 40

Duration of treatment in pauci bacillary leprosy is

 A

6 months

 B

9 months

 C

2 years

 D

Till sumptoms subside

Ans. A

Explanation:

A. i.e. 6 months


Q. 41

Average duration of treatment in multibacillary leprosy is

 A

1 year

 B

2 year

 C

3 year

 D

Life long

Q. 41

Average duration of treatment in multibacillary leprosy is

 A

1 year

 B

2 year

 C

3 year

 D

Life long

Ans. A

Explanation:

A i.e. 1 year

– Control of leprosy and tuber culosis (TB) is done by early diagnosis and treatment with multidrug therapyQ WHO regimen for paucibacillary leprosy is dapsone 100mg daily unsupervised + rifampicin 600mg monthly supervised for total duration of 6 monthsQ and followup upto 2year.

WHO regimen for multibucillary leprosy is dapsone (100mg) and clofazimien (50mg) daily self-administered + rifapian (600mg) and clofazimine (300mg) monthly supervised for 1 year duration (new recommendation) and follwoup upto 5years.


Q. 42

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

 A

Uterus

 B

Ovary

 C

Testes

 D

Eye

Q. 42

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

 A

Uterus

 B

Ovary

 C

Testes

 D

Eye

Ans. A

Explanation:

Ans. is ‘a’ i.e., Uterus 

Leprosy

o Leprosy (Hansen’s disease) is a chronic infectious disease caused by M. leprae.

o It effects mainly the peripheral nerves, but may also affect skin, muscle, eyes, bones, testes and internal organs (Liver, spleen, kidney).

o Leprosy is clinically characterised by one or more of the following cardinal features :‑

a)  Hypopigmented patches

b)  Partial or total loss of cutaneous sensation

c)  Presence of thickened nerves

d)  Presence of acid-fast bacilli in the skin or nasal smear.

About option a & b

The female genital tract is rarely involved in leprosy, when involved ovary is the most common gynaecological site to be involved.


Q. 43

True about leprosy in India –

 A

Prevalence decreasing in past decade

 B

Incidence highest in 1-5 yrs age group

 C

Highly pathogenic

 D

All

Q. 43

True about leprosy in India –

 A

Prevalence decreasing in past decade

 B

Incidence highest in 1-5 yrs age group

 C

Highly pathogenic

 D

All

Ans. A

Explanation:

Ans. is ‘a’ i.e., Prevalence decreasing in past decade 

o Over the years, prevalence increased from 8.4 cases per, 10,000 population in 1966 to a peak of 12 per 10,000 in 1985. o Since then there has been a steady decline, and at the beginning of 2008, the number of leprosy cases in the world

was around 212, 802 and global prevalence rate of leprosy was below 1 per 10,000 population.

Epidemiological determinants of leprosy

o Agent –> M. leprae

o Source of infection —> Multibacillary cases (most important), subclinical infections. The role of individuals with tuberculoid forms of the disease sources of infection is not clear. The current view is that all patients with active leprosy must be considered infectious.

o Infectivity —> Leprosy is a highly infectious (communicable) disease with low pathogenicity. An infectious patient can be rendered non-infectious by treatment with dapsone for about 90 days, or with rifampicin for 3 weeks. Local application of rifampicin (drop or spray) might destroy all the bacilli within 8 days.

o Age —> Peak incidence between 10-20 years.


Q. 44

True about epidemiology of leprosy – 

 A

If high prevalence of cases seen in childhood, it means disease is under control

 B

Lepra bacilli cannot survive outside hman body

 C

Bacterial load is high in tuberculoid variety

 D

Insect can transmit the disease

Q. 44

True about epidemiology of leprosy – 

 A

If high prevalence of cases seen in childhood, it means disease is under control

 B

Lepra bacilli cannot survive outside hman body

 C

Bacterial load is high in tuberculoid variety

 D

Insect can transmit the disease

Ans. D

Explanation:

Ans. is ‘d’ i.e., Insect can transmit the disease

o “Leprosy is not particularly a disease of children as was once believed. However, the presence of leprosy in child population is of considerable epidemiological importance. A high prevalence of infection among children means that the disease is active & spreading” – Park 20th 278.

o Lepra bacilli can survive for long periods of time in soil under favourable environmental condition. There is now evidence that natural infection with M. leprae are present in wild animals e.g. armadillos, managabey monkeys & chimpanzees.

o The tuberculoid type of lesions are bacteriologically negative. The role of individuals with tuberculoid forms of the disease as sources of infection is not yet clear.

“Bacterial load is highest in lepromatous cases whereas tuberculoid type is bacteriologically negative”.

o “Bacilli may also be transmitted by insect vectors or by tattoing needles. However, there is no evidence that any of these transmission route is important in nature” – Park 20th 279

o “Relapse rate is one of the best indicators of the efficacy of the drug regimen” – Park 20th 288


Q. 45

All of the following are the mode of transmission of leprosy except –

 A

Breast milk

 B

Breast milk

 C

Transplacental spread 

 D

Droplet infection

Q. 45

All of the following are the mode of transmission of leprosy except –

 A

Breast milk

 B

Breast milk

 C

Transplacental spread 

 D

Droplet infection

Ans. C

Explanation:

Ans. is ‘c’ i.e., Transplacental spread 


Q. 46

“Multibacillary” is a spectrum of disease, seen in-

 A

Leprosy

 B

TB

 C

Tetanus

 D

Trachoma

Q. 46

“Multibacillary” is a spectrum of disease, seen in-

 A

Leprosy

 B

TB

 C

Tetanus

 D

Trachoma

Ans. A

Explanation:

Ans. is ‘a’ i.e., Leprosy 


Q. 47

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. 47

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. 48

The characteristic finding in a case of leprosy is –

 A

Culture test is positive in 2-3 months in Li media

 B

Long contact with tuberculoid leprosy can transmit the disease.

 C

CMI is seen in Lepromatous leprosy

 D

Macule lesion heals spontaneously

Q. 48

The characteristic finding in a case of leprosy is –

 A

Culture test is positive in 2-3 months in Li media

 B

Long contact with tuberculoid leprosy can transmit the disease.

 C

CMI is seen in Lepromatous leprosy

 D

Macule lesion heals spontaneously

Ans. B

Explanation:

Ans. is ‘b’ i.e., Long contact with tuberculoid leprosy can transmit the disease 

o Multibacillary cases (Lepromatous and broderline lepromatous) are the most important sources of infection in the community. The role of individuals with tuberculoid forms of the disease as a source of infection is not clear and if these cases possess only a limited capacity to infect others they may be important because a relatively large number of this form of leprosy occurs in endemic communities. The current view is that all patients with “active leprosy” must be considered infectious.

o The infectivity of patients with paucibacillary (tuberculoid) leprosy is much lower. – Greenwood 16th/e p. 213. From above statements it is clear that the risk of transmission in a case of tuberculoid leprosy is small but still they can transmit the disease.

About other options

Option ‘a’

o Lepra bacilli can not be cultivated invitro.

Option ‘c’

o Cell mediated immunity is deficient in lepromatous leprosy.

Option ‘d’

“The first sign of leprosy is a non specific or determinate skin lesion, which often heal spontenously. If the

disease progresses, its clinical manifestation is determined by specific immune responsiveness of the patient to

the bacillus and there is distinct immunological spectrum (from T.T. to L.L.)” – Greenwood 16th/e p. 210

From above statement it seems that skin lesions often heal spontenously before tuberculoid leprosy i.e., in indeterminate form.

Macular lesion is seen in tuberculoid leprosy, so it will not regress spontaneously.


Q. 49

Slit smear negative leprosy is-

 A

Neuritic type

 B

Tuberculoid type

 C

Indeterminate type

 D

All

Q. 49

Slit smear negative leprosy is-

 A

Neuritic type

 B

Tuberculoid type

 C

Indeterminate type

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., Neuritic type; ‘b’ i.e., Tuberculoid type & ‘c’ i.e., Indeterminate type

o Indeterminate type, tuberculoid type, Pure neuritic type Bacteriologically negative.

o Borderline Bacteriologically variable

o Lepromatous type —> Bacteriologically positive.


Q. 50

Not true about lepromine test is – 

 A

Helps in classification of leprosy

 B

Negative in most of the child in 1st 6 month of life

 C

It is a diagnostic test

 D

BCG vaccination converts lepra reaction from negative to positive

Q. 50

Not true about lepromine test is – 

 A

Helps in classification of leprosy

 B

Negative in most of the child in 1st 6 month of life

 C

It is a diagnostic test

 D

BCG vaccination converts lepra reaction from negative to positive

Ans. C

Explanation:

Ans. is ‘c’ i.e., It is a diagnostic test 


Q. 51

In the management of leprosy, Lepromin test is most useful for –

 A

Herd immunity

 B

Prognosis

 C

Treatment

 D

Epidemiological investigations

Q. 51

In the management of leprosy, Lepromin test is most useful for –

 A

Herd immunity

 B

Prognosis

 C

Treatment

 D

Epidemiological investigations

Ans. B

Explanation:

Ans. is ‘b’ i.e., Prognosis 


Q. 52

Which of the following statements about lepromin test is not true ‑

 A

It is negative in most children in first 6 months of life

 B

It is a diagnostic test

 C

It is an important aid to classify type of leprosy disease

 D

BCG vaccination may convert lepra reaction from negative to positive

Q. 52

Which of the following statements about lepromin test is not true ‑

 A

It is negative in most children in first 6 months of life

 B

It is a diagnostic test

 C

It is an important aid to classify type of leprosy disease

 D

BCG vaccination may convert lepra reaction from negative to positive

Ans. B

Explanation:

Ans. is ‘b’ i.e., It is a diagnostic test 


Q. 53

Lepromin test is used for all of the following except-   

 A

Classify the lesions of leprosy patients 

 B

Determine the prognosis of disease

 C

Assess the resistance of individuals to leprosy

 D

Diagnosis of leprosy

Q. 53

Lepromin test is used for all of the following except-   

 A

Classify the lesions of leprosy patients 

 B

Determine the prognosis of disease

 C

Assess the resistance of individuals to leprosy

 D

Diagnosis of leprosy

Ans. D

Explanation:

Ans. is ‘d’ i.e., Diagnosis of leprosy 


Q. 54

Duration of treatment in multibacillary leprosy according to WHO is –

 A

6 months

 B

1 year

 C

2 years

 D

5 years

Q. 54

Duration of treatment in multibacillary leprosy according to WHO is –

 A

6 months

 B

1 year

 C

2 years

 D

5 years

Ans. B

Explanation:

Ans. is ‘b’ i.e., 1 year 


Q. 55

A 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. The next step of action recommended by the World Health Organization (WHO) in such a patient is

 A

Stop antileprosy treatment

 B

Continue PB-MDT till erythema subsides

 C

Biopsy the lesion to document acitivity 

 D

Continue dapsoen alone for another 6 months

Q. 55

A 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. The next step of action recommended by the World Health Organization (WHO) in such a patient is

 A

Stop antileprosy treatment

 B

Continue PB-MDT till erythema subsides

 C

Biopsy the lesion to document acitivity 

 D

Continue dapsoen alone for another 6 months

Ans. A

Explanation:

Ans. is ‘a’ i.e., Stop antileprosy treatment 

o WHO recommends that

“In paucibacillary leprosy, the multidrug therapy is stopped after 6 months of treatment regardless of the presence of clinically active disease”.

o According to Indian leprologists

“The t/t with both Rifampicin and dapsone must be continued till all signs of activity have been subsided”.

o It is believed that these patients are virtually always cleared of viable bacteria in 6 months with the WHO-MDT regime.

o Therefore the attainment of clinical inactivity should not be the condition guiding the continuation of multidrug therapy in paucibacillary leprosy.

o The lesions may be present but they will be cleared of all the organisms.

o The clinical activity dos not correlate with bacterial multiplication.

o Incidence of relapse in paucibacillary patients is very low and follow up studies in paucibacillary patients demonstrates that complete clearing of lesions takes 1-2 years after t/t discontinuation.


Q. 56

Treatment of severe ulnar neuritis in borderline tuberculoid leprosy is –

 A

MDT only

 B

MDT + steroid

 C

Wait and watch

 D

Wait and watch

Q. 56

Treatment of severe ulnar neuritis in borderline tuberculoid leprosy is –

 A

MDT only

 B

MDT + steroid

 C

Wait and watch

 D

Wait and watch

Ans. B

Explanation:

Ans. is ‘b’ i.e., MDT + Steroids 

o The pharmacological treatment for severe neuritis in leprosy involves elemination of infection by the organism with MDT and altering the immune response with steroid to prevent further nerve damage.

o Neuritis implies pain in the affected nerve (or nerves) together with swelling and tenderness and carries a risk of disturbance of function depending on the type of nerve affected.

o Steroids act by dispersing intraneural oedema and by doing so relieve pressure on nerve fibres. It is important to continue antileprosy drugs. (MDT) 


Q. 57

For treatment of paucibacillary leprosy drugs used are –

 A

Rifampicin & dapsone

 B

Rifampicin, dapsone, steroids

 C

Rifampicin, clofazimine, dapsone

 D

None

Q. 57

For treatment of paucibacillary leprosy drugs used are –

 A

Rifampicin & dapsone

 B

Rifampicin, dapsone, steroids

 C

Rifampicin, clofazimine, dapsone

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., Rifampicin & dapsone 


Q. 58

According to WHO latest treatment of leprosy is‑

 A

2 yrs. or negative slit smear negative (PGI 96) which ever is longer for multibacillar

 B

Life long treatment

 C

Six months treatment for paucibacillary

 D

Not specified

Q. 58

According to WHO latest treatment of leprosy is‑

 A

2 yrs. or negative slit smear negative (PGI 96) which ever is longer for multibacillar

 B

Life long treatment

 C

Six months treatment for paucibacillary

 D

Not specified

Ans. C

Explanation:

Ans. is ‘c’ i.e., Six months treatment for paucibacillary 


Q. 59

In multibacillary leprosy the follow up examination after adequate treatment should’be done yearly for –

 A

3 years

 B

2 years

 C

5 years

 D

10 years

Q. 59

In multibacillary leprosy the follow up examination after adequate treatment should’be done yearly for –

 A

3 years

 B

2 years

 C

5 years

 D

10 years

Ans. C

Explanation:

Ans. is ‘c’ i.e., 5 years

Surveillance after treatment

o Clinical surveillance of cases after completion of treatment is an important part of the current recommendations for

multidrug therapy.

o It is essential for the assurance of long term success of treatment and for the early detection of any relapses.

o The recommendations are –

i)      Paucibacillary leprosy clinical examination at least once a year for a minimum period of 2 years after completion of treatment.

ii)     Multibacillary leprosy clinical examination at least once a year for a minimum period of 5 years after completion of treatment.


Q. 60

2 yrs duration in terms of leprosy is with regard to –

 A

Rx of paucibacillary leprosy

 B

Rx of multibacillary leprosy

 C

Post Rx surveillance of paucibacillary leprosy

 D

Post Rx surveillance of multibacillary leprosy

Q. 60

2 yrs duration in terms of leprosy is with regard to –

 A

Rx of paucibacillary leprosy

 B

Rx of multibacillary leprosy

 C

Post Rx surveillance of paucibacillary leprosy

 D

Post Rx surveillance of multibacillary leprosy

Ans. C

Explanation:

Ans. is ‘c’ i.e., Post Rx surveillance of paucibacillary leprosy 


Q. 61

Multibacillary leprosy follow up for – 

 A

12-18 months 

 B

2 years

 C

5 years

 D

10 years

Q. 61

Multibacillary leprosy follow up for – 

 A

12-18 months 

 B

2 years

 C

5 years

 D

10 years

Ans. C

Explanation:

Ans. is ‘c’ i.e., 5 years 

o Follow-up in paucibacillary leprosy —> 2 years

o Follow-up in multibacillary leprosy —> 5 years


Q. 62

Immunoprophylaxis of leprosy includes-

 A

BCG

 B

MMR

 C

ICRC bacillus 

 D

a and c both

Q. 62

Immunoprophylaxis of leprosy includes-

 A

BCG

 B

MMR

 C

ICRC bacillus 

 D

a and c both

Ans. D

Explanation:

Ans. is ‘a’ i.e. BCG, ‘c’ i.e. ICRC bacillus

Leprosy Vaccine (1mmunoprophylaxisl

o In view of the variable protective effect of BCG vaccine against leprosy, several alternative vaccine preparations are under development. These should be appropriately called “candidate vaccines”.

o All the reported “candidate” vaccines have shown a similar degree of lepromin conversions in lepromatous patients (50-70 %) and lepromin negative healthy individuals (90 %)

()Maximum work has been done with BCG + heat killed M. leprae. However, none of the candidate have attained as yet “vaccinehood”.


Q. 63

Strategies in National Leprosy Control programme‑

 A

Early detection of cases

 B

Short course multi drug therapy

 C

Rehabilitation

 D

All

Q. 63

Strategies in National Leprosy Control programme‑

 A

Early detection of cases

 B

Short course multi drug therapy

 C

Rehabilitation

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., Early detection of cases; ‘b’ i.e., Short course multi drug therapy; ‘c’ i.e., Rehabilitation

Piational I.eprosv Eradication Programme (INTLEP)

National leprosy Control Programme was launched in 1955 by Government of India. as a centrally aided programe to achieve control of leprosy through early detection of cases and dapsone monotherapy on an ambulatory basis.

o In 1983 the control programme was redesignated National Leprosy Eradication Programme with the goal of eradicating the disease by the turn of the century.

  • The aim was to reduce case load to I or less than 1 per 10000 population.
  • Revised strategy (NLEP) was based on

i)   Early detection of case

ii)  Short term multi-drug therapy

iii)        Health education

iv)       Ulcer and deformity care

v)   Rehabilitation activities

o NLEP provided : ‑

i)  Domiciliary treatment in endemic districts through specially trained staff.

ii) In moderate to low endemic districts, services through mobile leprosy treatment units and primary health care persons.


Q. 64

FALSE about Leprosy eradication programme is ‑

 A

Early detection of cases

 B

Disability limitation

 C

Long term multi drug therapy

 D

Health education

Q. 64

FALSE about Leprosy eradication programme is ‑

 A

Early detection of cases

 B

Disability limitation

 C

Long term multi drug therapy

 D

Health education

Ans. C

Explanation:

Ans. is ‘c’ i.e., Long term multidrug therapy 

o In leprosy eradication programme the multidrug therapy is not long term but short term therapy.

o Shorter therapy has added advantage of patient compliance, cost-effectiveness and decreased work load.


Q. 65

Effective leprosy control programme may be indicated bn all of the following except ‑

 A

Increasing number of children affected

 B

Decreased grade 2 disability 

 C

Low MDR resistant, multibacillary cases

 D

High new case detection rate

Q. 65

Effective leprosy control programme may be indicated bn all of the following except ‑

 A

Increasing number of children affected

 B

Decreased grade 2 disability 

 C

Low MDR resistant, multibacillary cases

 D

High new case detection rate

Ans. A

Explanation:

Ans. is ‘a’ i.e. Increasing number of children affected’ 

FNaluation of programme:

here are two main types of indicators in leprosy control

a)       Operational indicators

These are related to case-finding, treatment, relapses & disabilities for e.g.

o Relapse rate – One of the best indicators of the efficacy of drug regimen

o Case detection ratio – No. of cases registered / no. of cases estimated.

o Proportion of children among newly detected cases.

o Proportion of multibacillary cases on regular treatment during the year.

o Proportion of female cases among newly detected cases.

o Treatment completion/cure rate.

o Proportion of new cases presenting with grade 2 disability/impairment at the time of diagnosis. o Proportion of treatment defaulters.

o Proportion of patients who develop new/additional disability during MDT.

b)       Epidemiological indicators:

To assess the impact of the actions taken with regard to the problem reduction.

o Incidence rate – most sensitive index of transmission of disease. Only index for measuring the effectiveness of the measure taken i.e. reduction of transmission.

o Prevalence – This provides a measure of case load & is useful in planning of the treatment services.

High new case detection rate comes under operational indicators which shows that the Leprosy Control Programme is effective in detecting new cases from the already pool of leprosy cases. Thus these new cases could be treated to reduce further transmission of disease.


Q. 66

Elimination ofleprosy is defined as prevalance

 A

< 1 per 1000

 B

< 1 per 10000

 C

< 1 per I lakh

 D

< 1 per 100

Q. 66

Elimination ofleprosy is defined as prevalance

 A

< 1 per 1000

 B

< 1 per 10000

 C

< 1 per I lakh

 D

< 1 per 100

Ans. B

Explanation:

Ans. is “b’ i.e., < 1 per 10000

“As a result of the hard work and meticulously planned and executed activities, the country achieved the goal of elimination of leprosy s public health problem, defined as less than 1 ease per 10000 population. at the National level in the month of December, 2005. As on 31st December 2005. prevalence rate recorded in the country was 0.95/10,000 population”



Q. 67

As per WHO, leprosy is a public health problem if prevalence is

 A

0.1%

 B

0.01%

 C

0.5 %

 D

1%

Q. 67

As per WHO, leprosy is a public health problem if prevalence is

 A

0.1%

 B

0.01%

 C

0.5 %

 D

1%

Ans. B

Explanation:

Ans. is ‘b’ i.e., .01% Leprosy is defined as public health problem w hen Prevalence rate is 1 or more per 10,000 population (.01%).

“AN a result r the hard work and meticulously planned and executed activities. the country achieved the goal of elimination tylepros), as public health problem. defined as less than 1 COA eper 100(/0 population. at the National level in the month of December. 2005..-as on 31st December 2005, prevalence rate recorded in the country 4vas 0,95/10,000 pop Ulaiion‑ 1 Only 3 states/UTs are yet to achieve elimination -3 Bihar, Chattisgarh, and Dadra & Nagar haveli.


Q. 68

SET centres are established if prevalence leprosy Is –

 A

0.5- 1/1000

 B

1 – 5

 C

5 – 10

 D

10

Q. 68

SET centres are established if prevalence leprosy Is –

 A

0.5- 1/1000

 B

1 – 5

 C

5 – 10

 D

10

Ans. B

Explanation:

Ans. is ‘b’ i.e., 1-5


Q. 69

Best mode to control leprosy eradication-programme is –

 A

Mass chemotherapy

 B

Early diagnosis and treatment

 C

High risk chemotherapy

 D

Health education

Q. 69

Best mode to control leprosy eradication-programme is –

 A

Mass chemotherapy

 B

Early diagnosis and treatment

 C

High risk chemotherapy

 D

Health education

Ans. B

Explanation:

Ans. is `b’ i.e., Early diagnosis and treatment 

  • Early diagnosis & Treatment is the most important part of NLEP.

Note:

Other diseaes for which early diagnosis & treatment is the most important step in control  TB, STD.


Q. 70

National Leprosy Eradication Programme was started in –

 A

1949

 B

1955

 C

1973

 D

1983

Q. 70

National Leprosy Eradication Programme was started in –

 A

1949

 B

1955

 C

1973

 D

1983

Ans. D

Explanation:

Ans. is ‘d’ i.e., 1983


Q. 71

Which one of the following statements is not correct regarding National Leprosy Eradication Programme(NLEP)-

 A

Multibacillary leprosy treatment is recommended for one year

 B

Skin smear examination is done for classification into paucibacillary and multibacillary

 C

Special Action Project for Elimination of leprosy is for rural areas

 D

Surveillance for two years for a treated case of paucibacillary leprosy to be carried out

Q. 71

Which one of the following statements is not correct regarding National Leprosy Eradication Programme(NLEP)-

 A

Multibacillary leprosy treatment is recommended for one year

 B

Skin smear examination is done for classification into paucibacillary and multibacillary

 C

Special Action Project for Elimination of leprosy is for rural areas

 D

Surveillance for two years for a treated case of paucibacillary leprosy to be carried out

Ans. B

Explanation:

Ans. is ‘b’ i.e., Skin smear examination is done for classification into paucibacillary and multibacillary

Treatment for multibacillary leprosy is for 1 year with surveillance for 5 years after treatment.

o Treatment for paucibacillary leprosy is for 6 months with surveillance for 2 years after treatment.

  • Special action project for elimination (SAPEL ) is for rural areas.
  • Leprosy elimination campaigns (LECs) for urban Areas.



Q. 72

Globi is seen in ……………..  leprosy ‑

 A

Tuberculoid

 B

Lepromatous

 C

Border line

 D

Borderline tuberculoid

Q. 72

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. 73

Which of the following parts of the body is not affected by leprosy –

 A

Testes

 B

Ovary

 C

Nasal mucosa

 D

Axilla

Q. 73

Which of the following parts of the body is not affected by leprosy –

 A

Testes

 B

Ovary

 C

Nasal mucosa

 D

Axilla

Ans. B

Explanation:

Ans. is ‘b’ i.e., Ovary 


Q. 74

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

 A

Tuberculoid

 B

Borderline 

 C

Lepromatous 

 D

Borderline tuberculoid

Q. 74

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. 75

Most commonly affected peripheral nerve in leprosy is ‑

 A

Ulnar

 B

Radial

 C

Medial

 D

Lateral Popliteal

Q. 75

Most commonly affected peripheral nerve in leprosy is ‑

 A

Ulnar

 B

Radial

 C

Medial

 D

Lateral Popliteal

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ulnar 

Although any peripheral nerve may be enlarged (including small digital and supraclavicular nerves), those most commonly affected are the ulnar, posterior auricular, peroneal, and posterior tibial nerves, with associated hypesthesia and myopathy.- Harrison 17/e


Q. 76

Trophic ulcers are caused by ‑

 A

Leprosy

 B

Buerger’s disease

 C

Syringomyelia

 D

a and c

Q. 76

Trophic ulcers are caused by ‑

 A

Leprosy

 B

Buerger’s disease

 C

Syringomyelia

 D

a and c

Ans. D

Explanation:

Answer is ‘a’ i.e. Leprosy; ‘c’ i.e. Syringomyelia 

  • Trophic ulcers develop as the result of repeated trauma to the insensitive part of the body. So some neurological disturbance is usually the cause behind this ulcer formation.
  • These neurological disorders are :

– spinal or peripheral nerve injury                      – diabetic neuropathy

leprosy                                                        – tabes dorsalis

syringomyelia                                                – transverse myelitis, etc.

Trophic ulcers are commonly seen on the heel and ball of the foot when the patient is ambulatory and on the buttocks and back of heel if the pt. is bed ridden (k/a bed sores)


Q. 77

Secondary amyloidosis occurs in ‑

 A

Chronic osteomyelitis

 B

Rheumatoid arthritis

 C

Leprosy

 D

All

Q. 77

Secondary amyloidosis occurs in ‑

 A

Chronic osteomyelitis

 B

Rheumatoid arthritis

 C

Leprosy

 D

All

Ans. D

Explanation:

Ans. Three options are correct i.e., ‘a, b & c’ 


Q. 78

Depressed bridge of the nose may be due to any of the following except:

 A

Leprosy

 B

Syphilis

 C

Thalassemia

 D

Acromegaly

Q. 78

Depressed bridge of the nose may be due to any of the following except:

 A

Leprosy

 B

Syphilis

 C

Thalassemia

 D

Acromegaly

Ans. D

Explanation:

Q. 79

Septal perforation is not seen in:

 A

Septal abscess

 B

Leprosy

 C

Rhinophyma

 D

Trauma

Q. 79

Septal perforation is not seen in:

 A

Septal abscess

 B

Leprosy

 C

Rhinophyma

 D

Trauma

Ans. C

Explanation:

Q. 80

In Leprosy most common renal lesion seen is:

 A

MGN

 B

MPGN

 C

Focal glomeruloselerosis

 D

Diffuse glomerulosclerosis

Q. 80

In Leprosy most common renal lesion seen is:

 A

MGN

 B

MPGN

 C

Focal glomeruloselerosis

 D

Diffuse glomerulosclerosis

Ans. A

Explanation:

Ans:A.)MGN

  • The most common renal manifestation in leprosy patients is glomerulonephritis..
    • Glomerulonephritis is a renal disease in which immune-mediated glomerular damage is the initiating factor. Proliferative glomerulonephritis is characterized by proliferation of the mesangial cells with an influx of inflammatory cells. Membranous glomerulonephritis is characterized by accumulation of matrix and thickening of the glomerular basement membrane (GBM) and capillary wall.
    • A study , with 72 leprosy patients undergoing renal biopsy found the following histopathological patterns: membranous nephropathy (31.5%) and mesangioproliferative glomerulonephritis (11.1%).
  • Other renal lesions that have been described include amyloidosis, tubulointerstitial disease, acute renal failure, and functional defects in the absence of identifiable histologic abnormalities.

Q. 81

‘Iris-pearls’ are seen in:

 A

Syphilis

 B

Leprosy

 C

Sarcoidosis

 D

Tuberculosis

Q. 81

‘Iris-pearls’ are seen in:

 A

Syphilis

 B

Leprosy

 C

Sarcoidosis

 D

Tuberculosis

Ans. B

Explanation:

Ans. Leprosy


Q. 82

Ocular lesions of leprosy include all of the following except

 A

Avascular keratitis

 B

Interstitial keratitis

 C

Fascicular keratitis

 D

Neuroparalytic keratitis

Q. 82

Ocular lesions of leprosy include all of the following except

 A

Avascular keratitis

 B

Interstitial keratitis

 C

Fascicular keratitis

 D

Neuroparalytic keratitis

Ans. C

Explanation:

Ans. Fascicular keratitis


Q. 83

Robert Koch is associated with all of the following

EXCEPT: March 2013

 A

Discovery of bacillus tuberculosis

 B

Discovery of vibrio cholerae

 C

Discovery of leprosy bacillus

 D

Postulated Koch’s criteria

Q. 83

Robert Koch is associated with all of the following

EXCEPT: March 2013

 A

Discovery of bacillus tuberculosis

 B

Discovery of vibrio cholerae

 C

Discovery of leprosy bacillus

 D

Postulated Koch’s criteria

Ans. C

Explanation:

Ans. C i.e. Discovery of leprosy bacillus

Hansen (1874) described leprosy bacillus

Robert Heinrich Herman Koch

  • December 11, 1843 – May 27, 1910
  • He is considered to be the founder of modern bacteriology
  • He is known for his role in identifying the specific causative agents of tuberculosis, cholera, and anthrax and for giving experimental support for the concept of infectious disease.
  • His research led to the creation of Koch’s postulates, a series of four generalized principles linking specific microorganisms to particular diseases which remain today the “gold standard” in medical microbiology
  • As a result of his groundbreaking research on tuberculosis, Koch received the Nobel Prize in Physiology or Medicine in 1905

Q. 84

Thalidomide is useful in:           

March 2007

 A

Treatment of leprosy

 B

Treatment of type II lepra reaction

 C

Treatment of type I lepra reaction

 D

Treatment of neuritic leprosy

Q. 84

Thalidomide is useful in:           

March 2007

 A

Treatment of leprosy

 B

Treatment of type II lepra reaction

 C

Treatment of type I lepra reaction

 D

Treatment of neuritic leprosy

Ans. B

Explanation:

Ans. B: Treatment of type II lepra reaction

Thalidomide is a sedative-hypnotic, and multiple myeloma medication. The drug is a potent teratogen. Thalidomide was chiefly sold during the late 1950s and early 1960s to pregnant women, as an antiemetic to combat morning sickness.

Children were born with severe malformities, including phocomelia, because their mothers had taken thalidomide during pregnancy.

Apart from its infamous tendency to induce birth defects and peripheral neuropathy, the main side effects of thalidomide include fatigue and constipation.

It also is associated with an increased risk of deep vein thrombosis especially when combined with dexamethasone,for treatment of multiple myeloma. In multiple myeloma patients, concomitant use with zoledronic acid may lead to increased incidence of renal dysfunction.

High doses can lead to pulmonary oedema, atelectasis, aspiration pneumonia and refractory hypotension.


Q. 85

Thalidomide is useful in: 

March 2007

 A

Treatment of leprosy

 B

Treatment of type II lepra reaction

 C

Treatment of type I lepra reaction

 D

Treatment of neuritic leprosy

Q. 85

Thalidomide is useful in: 

March 2007

 A

Treatment of leprosy

 B

Treatment of type II lepra reaction

 C

Treatment of type I lepra reaction

 D

Treatment of neuritic leprosy

Ans. B

Explanation:

Ans. B: Treatment of type II lepra reaction

Thalidomide is a sedative-hypnotic, and multiple myeloma medication.

The drug is a potent teratogen.

Thalidomide was chiefly sold during the late 1950s and early 1960s to pregnant women, as an antiemetic to combat morning sickness.

Children were born with severe malformities, including phocomelia, because their mothers had taken thalidomide during pregnancy.

Apart from its infamous tendency to induce birth defects and peripheral neuropathy, the main side effects of thalidomide include fatigue and constipation.

It also is associated with an increased risk of deep vein thrombosis especially when combined with dexamethasone,for treatment of multiple myeloma.

In multiple myeloma patients, concomitant use with zoledronic acid may lead to increased incidence of renal dysfunction. High doses can lead to pulmonary oedema, atelectasis, aspiration pneumonia and refractory hypotension. It is very effective in dermatolgical conditions like: ENL, aphthous stomatitis, Behcet’s disease, LE, and prurigo nodularis


Q. 86

Lepromin test is positive in:      

March 2004

 A

Syphilis

 B

TB

 C

Lepromatous leprosy

 D

Tuberculoid Leprosy

Q. 86

Lepromin test is positive in:      

March 2004

 A

Syphilis

 B

TB

 C

Lepromatous leprosy

 D

Tuberculoid Leprosy

Ans. D

Explanation:

Ans. D i.e. Tuberculoid Leprosy


Q. 87

Very numerous, symmetrically distributed, erythematous or copper coloured shiny macules/papule are feature of :   

March 2013

 A

Tuberculoid leprosy

 B

Borderline borderline leprosy

 C

Lepromatous leprosy

 D

Borderline tuberculoid leprosy

Q. 87

Very numerous, symmetrically distributed, erythematous or copper coloured shiny macules/papule are feature of :   

March 2013

 A

Tuberculoid leprosy

 B

Borderline borderline leprosy

 C

Lepromatous leprosy

 D

Borderline tuberculoid leprosy

Ans. C

Explanation:

Ans. C i.e. Lepromatous leprosy

Leprosy

  • Associated cells: Virchow cells
  • 1s‘ line of drugs:

 Rifampicin,

– Clofazimine,

– Dapsone

  • DOC in neuritis: Steroids
  • Treatment of nerve abscess: Incision and drainage
  • MC nerve involved: Ulnar nerve (2″d is posterior auricular nerve)
  • Organs not involved in leprosy:

– Ovary,

– Lungs, CNS

– Uterus

  • MC type of leprosy in India: TT
  • Infective form of leprosy: Tuberculoid leprosy
  • Lepromin test indicates: Strong immunity
  • Lucio’s phenomenon: M. leprae may be associated with cutaneous ulcerations in patients with lepromatous leprosy

Lepromatous leprosy

Features:

–  Gynaecomastia,

Madarosis,

– Collapse of nasal bridge

  • Histology: Dermis contains characteristic highly vacoulated cells (Foam cells) (ABSENT/ few non-caseating granuloma)

Q. 88

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. 88

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. 89

Which of the following is true for multibacillary leprosy:

September 2006

 A

More than 5 lesions on skin smears

 B

Clofazimine is an important drug to be given

 C

Treatment is to given for 12 months

 D

All of the above

Q. 89

Which of the following is true for multibacillary leprosy:

September 2006

 A

More than 5 lesions on skin smears

 B

Clofazimine is an important drug to be given

 C

Treatment is to given for 12 months

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

In classification based on skin smears, patients with negative smears at all sites are grouped as having paucibacillary (PB) leprosy, whereas those showing positive smears at any site are grouped as having multibacillary (MB) leprosy. Persons with more than 5 patches and involvement of more than 1 nerve trunk are also considered to have MB leprosy.

The PB group includes TT and BT types, whereas the MB group includes BB, BL, and LL.

Paucibacillary leprosy should be treated for 6 months with dapsone 100 mg/day unsupervised plus rifampin 600 mg/month supervised.

Multibacillary leprosy should be treated for 12 months with dapsone 100 mg/day unsupervised, clofazimine 50 mg/day unsupervised, and rifampin 600 mg plus clofazimine 300 mg/month supervised.


Q. 90

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. 90

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. 91

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. 91

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. 92

As per WHO recommendation, duration of treatment of multibacillary leprosy is: 

September 2009

 A

3 months

 B

6 months

 C

9 months

 D

12 months

Q. 92

As per WHO recommendation, duration of treatment of multibacillary leprosy is: 

September 2009

 A

3 months

 B

6 months

 C

9 months

 D

12 months

Ans. D

Explanation:

Ans. D: 12 months

Paucibacillary leprosy should be treated for 6 months with dapsone 100 mg/day unsupervised plus rifampin 600 mg/ month supervised.

Multibacillary leprosy should be treated for 12 months with dapsone 100 mg/day unsupervised, clofazimine 50 mg/day unsupervised, and rifampin 600 mg plus clofazimine 300 mg/month supervised.


Q. 93

Most important in establishing diagnosis of leprosy is:    

March 2010

 A

Evidence of neural involvement

 B

Hypopigmented patches

 C

Slit smear for AFB

 D

Positive lepromin test

Q. 93

Most important in establishing diagnosis of leprosy is:    

March 2010

 A

Evidence of neural involvement

 B

Hypopigmented patches

 C

Slit smear for AFB

 D

Positive lepromin test

Ans. C

Explanation:

Ans. C: Slit smear for AFB

Tissue smear testing/slit-skin smears.

An incision is made in the skin, and the scalpel blade is used to obtain fluid from a lesion.

The fluid is placed on a glass slide and stained by using the Ziehl-Neelsen acid-fast method or the Fite method to look for organisms.

The bacterial index (BI) is then determined as the number of organisms at 100X with oil immersion.

Skin smears have high specificity but low sensitivity because 70% of all patients with leprosy have negative smear results. However, this test is useful because it detects the most infectious patients.

Presence of AFB in suggestive skin lesions, even in the absence of sensory deficit, confirms the diagnosis of leprosy. Lepromin test is not of diagnostic importance but is of prognostic importance.


Q. 94

Which of the following is not affected in leprosy:

September 2011

 A

Uterus

 B

Testes

 C

Nerve

 D

Eye

Q. 94

Which of the following is not affected in leprosy:

September 2011

 A

Uterus

 B

Testes

 C

Nerve

 D

Eye

Ans. A

Explanation:

Ans. A: Uterus

Main organs/ tissue involved in leprosy are skin and peripheral nerves Systemic (eyes, testes and reticuloendothelial system) involvement is common

Leprosy:

  • Hansens disease
  • Virchow cells are seen
  • CNS, ovaries, lungs are NOT commonly involved in leprosy
  • TT is the MC type of leprosy in India
  • Tuberculoid leprosy:

– Infective form

Ulnar nerve is a commonly affected nerve

– Followed by posterior auricular nerve

Lepromatous leprosy:

– Presents with gyanecomastia, madrosis, collapse of nasal bridge

– Histologically, the dermis characteristically contains highly vacuolated cells (foam cells) and fewer or absent non-caseating granuloma 1st line drug:

– Rifampicin

– Dapsone

– Clofazimine

DOC in neuritis: Steroids

Nerve abscess treated by: Incision and drainage

Lepra reaction type 1:

– Corticosteroids are the DOC

– Unresponsive to thalidomide Lepra reaction type II:

– Also known as erythema nodosum leprosum

– Seen in lepromatous leprosy

– Thalidomide is effective Lepromin test indicates strong immunity


Q. 95

The fingerprint pattern may be impaired permanently in case of:        

AIIMS 06; Al 09

 A

Eczema

 B

Scalds

 C

Scabies

 D

Leprosy

Q. 95

The fingerprint pattern may be impaired permanently in case of:        

AIIMS 06; Al 09

 A

Eczema

 B

Scalds

 C

Scabies

 D

Leprosy

Ans. D

Explanation:

Ans. Leprosy


Q. 96

Globi in leprosy consist of ‑

 A

AFB + macrophages

 B

neutrophils + AFB

 C

Platelet plug

 D

None of the above

Q. 96

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. 97

Iris pearl are seen in ‑

 A

Leprosy

 B

Tuberculosis

 C

Sarcoidosis

 D

Cat Scratch disease

Q. 97

Iris pearl are seen in ‑

 A

Leprosy

 B

Tuberculosis

 C

Sarcoidosis

 D

Cat Scratch disease

Ans. A

Explanation:

Ans. is ‘a’ i.e., Leprosy

LEPROTIC UVEITIS

  • It predominantly involves anterior uvea; more commonly in lepromatous than in the tuberculoid form of disease.

Clinical types

  • Lepromatous uveitis may occur as acute iritis (non-granulomatous) or chronic iritis (granulomatous).
  1. Acute iritis : It is caused by antigen-antibody deposition and is characterised by severe exudative reaction.
  2. Chronic granulomatous iritis : It occurs due to direct organismal invasion and is characterised by presence of small glistening’iris pearls’ near the pupillary margin in a necklace form; small pearls enlarge and coalesce to form large pearls. Rarely, a nodular lepromata may be seen.
  • Treatment : Besides usual local therapy of iridocyclitis antileprotic treatment with Dapsone 50-100 mg daily or other drugs should also be instituted.

Q. 98

Leprosy is not targeted for global eradication because

 A

No effective vaccine

 B

Highly infectious but low pathogenicity

 C

Only humans are reservoir

 D

Long incubation period

Q. 98

Leprosy is not targeted for global eradication because

 A

No effective vaccine

 B

Highly infectious but low pathogenicity

 C

Only humans are reservoir

 D

Long incubation period

Ans. D

Explanation:

Ans. d. Long incubation period


Q. 99

Which of the following is a characteristic feature of borderline leprosy

 A

Extensive glove and stocking anesthesia

 B

Inverted saucer shaped lesions

 C

Erythema nodosum leprosum

 D

Facial lesions

Q. 99

Which of the following is a characteristic feature of borderline leprosy

 A

Extensive glove and stocking anesthesia

 B

Inverted saucer shaped lesions

 C

Erythema nodosum leprosum

 D

Facial lesions

Ans. B

Explanation:

Ans. b. Inverted saucer shaped lesions

Often a single lesion is present surrounded by several smaller ones. Skin and nerves are the only directly affected tissues in BL (Borderline Lepromatous). The skin lesions consist of erythematous macules or plaques. Inverted saucer-shaped annular lesions are characteristic


Q. 100

Multiple hypoaesthetic, hypopigmented macules on right lateral forearm with numerous acid fast bacilli is indicative of

 A

Tuberculoid leprosy

 B

Lepromatous leprosy

 C

Indeterminate leprosy

 D

Borderline leprosy

Q. 100

Multiple hypoaesthetic, hypopigmented macules on right lateral forearm with numerous acid fast bacilli is indicative of

 A

Tuberculoid leprosy

 B

Lepromatous leprosy

 C

Indeterminate leprosy

 D

Borderline leprosy

Ans. D

Explanation:

Ans. d. Borderline leprosy

Multiple hypoaesthetic, hypopigmented macules on right lateral forearm with numerous acid-fast bacilli is indicative of borderline lepromatous leprosy.

Multiple lesions and numerous AFB bacilli indicate either lepromatous or borderline lesions, and hypoesthesia and hypopigmentation narrows it further to borderline (actually borderline lepromatous), as sensation is normal in lepromatous leprosy


Q. 101

The Ridley -Jopling classification for leprosy is based on which of the following parameters?

 A

Clinical, bacteriological, immunological

 B

Histopathological, clinical, therapeutic

 C

Histopathological, epidemiological, therapeutics

 D

Histopathological, clinical, epidemiological

Q. 101

The Ridley -Jopling classification for leprosy is based on which of the following parameters?

 A

Clinical, bacteriological, immunological

 B

Histopathological, clinical, therapeutic

 C

Histopathological, epidemiological, therapeutics

 D

Histopathological, clinical, epidemiological

Ans. A

Explanation:

Ans. a. Clinical, bacteriological, immunological

Ridley-Jopling Classification for Leprosy is based on Clinical (skin and nerve involvement), bacteriological (bacteriological/ morphological index in skin and nasal smears) and immunological criteria (Lepromin test).


Q. 102

Punched out lesion or inverted saucer appearance are characteristic of which stage of leprosy‑

 A

Tuberculoid

 B

Borderline tuberculoid

 C

Borderline lepromatous

 D

Lepromatous

Q. 102

Punched out lesion or inverted saucer appearance are characteristic of which stage of leprosy‑

 A

Tuberculoid

 B

Borderline tuberculoid

 C

Borderline lepromatous

 D

Lepromatous

Ans. C

Explanation:

Ans. is ‘c’ i.e., Borderline lepromatous 


Q. 103

Patient with leprosy, smear sample taken show 10 – 100 bacilli in one field. Bacterial index is ‑

 A

1+

 B

2+

 C

3+

 D

4+

Q. 103

Patient with leprosy, smear sample taken show 10 – 100 bacilli in one field. Bacterial index is ‑

 A

1+

 B

2+

 C

3+

 D

4+

Ans. D

Explanation:

Ans. is ‘d’ i.e., 4+

Bacteriological Index For Leprosy

  • It is a rough index expressing probable number of acid fast bacilli for standardized microscopic field in skin smear.
  • It is indicative of the load of bacteria at the site from which smear is taken.
  • It does not differentiate between live and dead bacilli.
  • It is not an indication of total bacillary load in the body.
  • Ridleys scale is followed to calculate the bacterial index.
  • = no bacilli in 100 fields

1+ = 1 – 10 bacilli in 100 fields 2+ = 1 – 10 bacilli in 10 fields 3+ = 1 – 10 bacilli in 1 fields 4+ = 10 – 100 bacilli in 1 field 5+ = 100 – 1000 bacilli in 1 field 6+ = >1000 bacilli in 1 field.

  • Our patient has 10 – 100 bacilli in 1 field thus the bacteriological index is – 4+

Q. 104

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. 104

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. 105

Ulceronecrotic nodule is seen in ‑

 A

Lucio leprosy

 B

Lucio leprosy

 C

Indeterminate leprosy

 D

Histoid leprosy

Q. 105

Ulceronecrotic nodule is seen in ‑

 A

Lucio leprosy

 B

Lucio leprosy

 C

Indeterminate leprosy

 D

Histoid leprosy

Ans. A

Explanation:

Ans. is ‘a i.e., Lucio leprosy

Lucio phenomenon

  • It is found in lucio leprosy with type 2 lepra reaction. It is prevalent in mexico.
  • Characterized by painful tender red patches particularly on extremities which later on become necrotic and finally develop into brown black eschar.
  • Ulcers are more persistent on legs.
  • Tuberculoid and indeterminate leprosy are characterized by hyperpigmented macule with impairment of sensations.
  • In histoid leprosy, classical feature is erythematous shiny red subcutaneous or cutaneous nodules, esp over the extensor aspect of extremities, back, buttocks & face. Ulceration is unusual.

Q. 106

Nerves are not involved in ‑

 A

Tuberculoid leprosy

 B

Lepromatous leprosy

 C

Indeterminate leprosy

 D

Borderline tuberculoid leprosy

Q. 106

Nerves are not involved in ‑

 A

Tuberculoid leprosy

 B

Lepromatous leprosy

 C

Indeterminate leprosy

 D

Borderline tuberculoid leprosy

Ans. C

Explanation:

Ans. is ‘c’ i.e., Indeterminate leprosy


Q. 107

If a claw hand develops in a patient with Leprosy, th deformity is ‑

 A

Grade 0

 B

Grade I

 C

Grade II

 D

Grade III

Q. 107

If a claw hand develops in a patient with Leprosy, th deformity is ‑

 A

Grade 0

 B

Grade I

 C

Grade II

 D

Grade III

Ans. C

Explanation:

Ans. is `c’ i.e., Grade II 


Q. 108

Most sensitive index of transmission in leprosy is‑

 A

Incidence

 B

Detection rate

 C

Disability rate

 D

Prevalence

Q. 108

Most sensitive index of transmission in leprosy is‑

 A

Incidence

 B

Detection rate

 C

Disability rate

 D

Prevalence

Ans. A

Explanation:

Ans. is ‘a’ i.e., Incidence 

Incidence rate

  • It is the only index for measuring the effectiveness of the measures taken. 
  • It is the most sensitive index of transmission of the disease.
  • Prevalence
  • It provides a measure of the ‘case-load’.
  • It is useful in the planning of treatment services.
  • The efficacy of the drug regimen is best indicated by relapse rate.


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