A patient suffered from following type of infection(as seen in the image) in the foot after wearing occlusive foot wear daily for a long duration.Identify the type of infection ?
A. Tinea unguium.
B. Tinea glabrosa.
C. Tinea pedis.
D. Tinea cruris.
Correct Answer » C
Ans:C. Tinea pedis.
The condition shown in the photograph above represents Tinea pedis(Athlete’s Foot)
Tinea pedis(Athlete’s Foot)
It is the term used for a dermatophyte infection of the soles of the feet and the interdigital spaces.
The fungal infection is called athlete’s foot because it’s commonly seen in athletes.
Tinea pedis is most commonly caused by Trichophyton rubrum.
Using enzymes called keratinases, dermatophyte fungi invade the superficial keratin of the skin, and the infection remains limited to this layer. Dermatophyte cell walls also contain mannans, which can inhibit the body’s immune response.
Commonly, tinea pedis patients describe pruritic, scaly soles and, often, painful fissures between the toes. Less often, patients describe vesicular or ulcerative lesions.
A hot, humid, tropical environment and prolonged use of occlusive footwear, with the resulting complications of hyperhidrosis and maceration, are risk factors for all types of tinea pedis. Certain activities, such as swimming and communal bathing, may also increase the risk of infection.
An eleven year old boy visited a clinician with a condition as shown in the picture below on his scalp. The most appropriate line of treatment is ?
A. Oral griseofulvin therapy.
B. Topical griseofulvin therapy.
C. Shaving of the scalp.
D. Selenium sulphide shampoo.
Correct Answer » A
Ans:A. Oral Griseofulvin therapy.
The patient is having tinea capitis on his scalp as shown in the picture above. The most appropriate line of treatment is Oral griseofulvin.
Ringworm of the scalp occurs in children exclusively.
The disease is primarily caused by dermatophytes in the Trichophyton and Microsporum genera that invade the hair shaft.
From the site of inoculation, the fungus grows down into the stratum corneum, where it invades keratin. Dermatophytes are unique in that they produce keratinase, which enables them to use keratin as a nutrient source. Infected hairs become brittle, and after three weeks, the clinical presentation of broken hairs is evident.
It may appear as thickened, scaly, and sometimes boggy swellings, or as expanding raised red rings (ringworm). Common symptoms are severe itching of the scalp, dandruff, and bald patches where the fungus has rooted itself in the skin.
Sometimes with a ‘black dot’ pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching.It is easily spread by the sharing of hairbrushes.
There are three types of infection:
Ectothrix: Characterized by the growth of fungal spores (arthroconidia) on the exterior of the hair shaft. Infected hairs usually fluoresce greenish-yellow under a Wood lamp.
Endothrix: Similar to ectothrix, but characterized by arthroconidia restricted to the hair shaft, and restricted to anthropophilic bacteria. The cuticle of the hair remains intact and clinically this type does not have florescence.
Favus: Causes crusting on the surface of the skin, combined with hair loss. Associated with Trichophyton schoenleini.
Tiniea capitis may be difficult to distinguish from other skin diseases that cause scaling, such as psoriasis and seborrhoeic dermatitis; the basis for the diagnosis is positive microscopic examination and microbial culture of epilated hairs.
The treatment of choice is Griseofulvin.This compound is fungistatic and works by affecting the microtubular system of fungi, interfering with the mitotic spindle and cytoplasmic microtubules. The recommended pediatric dosage is 10 mg/kg/day for 6–8 weeks
Identify the congenital uterine anomaly shown in the picture below ?
Correct Answer » C
The congenital uterine anomaly as shown in the picture above represents septate uterus.
A septate uterus forms during embryological development when the tubes that eventually become one uterus don’t fuse together properly.
The cause of this genetic abnormality is unknown.
Women with a septate uterus can have a normal reproductive life, but it may add complications to pregnancy. There is a higher risk for miscarriage, premature labour or breech presentation (when the baby’s feet come out first), which usually requires a Caesarean section.
A 51 year old male patient presented with a reddish mass in his right nasal cavity, with frequent bleeding episodes, for the past five months.Histopathological examination shows the following picture.
What can be the most possible diagnosis?
A. Inverted Papilloma
Correct Answer » B
Marked Cellular infiltrates consisting of plasma cells and lymphocytes.There are many macrophages with clear to foamy cytoplasm(Mikulicz Cells) .Plasma Cells with eccentric nucleus and deep eosin staining cytoplasm(Russel Bodies).
Rhinoscleroma is a progressive granulomatous disease of the upper respiratory tract.
It is caused by the gram-negative coccobacillus K rhinoscleromatis or Frish Bacillus.
The disease probably begins in areas of epithelial transition such as the vestibule of the nose, the subglottic area of the larynx, or the area between the nasopharynx and oropharynx.
It is a chronic infection of the nose characterised by sclerosis and stenosis of the nasal passage.
Rhinoscleroma may be found in all age groups, but typically young adults 20–30 years old are most frequently affected.
Both sexes are equally affected.
The disease is endemic in several parts of world.
In India, it is seen more often in northern than in the southern parts.
Airborne transmission combined with poor hygiene, crowded living conditions, and poor nutrition contributes to its spread.
PATHOLOGY OF RHINOSLEROMA
The disease is characterized by presence of granulations which infiltrate the submucosa ,with scattered Mikulicz cells(large vacuolated foamy cells containing a central nucleus and acid fast Frisch bacilli),Rusell bodies(resmbling plasma cells with an eccentric nucleus and deep eosin staining cytoplasm) and lymphocytes in dense fibrous tissue.
CLINICAL FEATURES IN A CASE OF RHINOSCLEROMA
Blocking of the nose,Nasal Discharge,Headache,Epistaxis
A 35-year-old presents with unilateral hearing loss that has been gradual but progressive over the last 6 months.Autoscopic picture is shown in the image. Appropriate treatment of the above condition consists of
A. Prolonged antibiotics for up to 4 weeks.
B. Decongestant and antihistamine administration.
C. Corticosteroid treatment for 2 weeks.
Correct Answer » D
Image shows:Attic Cholesteatoma.
Presence of keratinizing squamous epithelium in the middle ear or mastoid – cholesteatoma
Cholesteatoma is skin in wrong place
Most common site of origin – posterior epitympanum.It is seen in Atticoantral type of CSOM.
Signs and symptoms
The majority (98%) of patients with cholesteatoma have ear discharge or hearing loss or both in the affected ear.
Theories of Cholesteatoma
Presence of congenital cell rests
Wittmaack’s theory→ invagination of TM from the attic or posterior-superior par tof pars tensa in the
form of retraction pockets
Ruedi’s theory→ basal cell hyperplasia
Habermann’s theory → epithelial invasion
Sade’s theory → metaplasia
Surgery is the mainstay of treatment:Tympanomastoidectomy
Hairy leukoplakia is a white patch on the side of the tounge with a corrugated or hairy appearance. It is seen in severe defects of immunity, particularly in HIV infection. The cause of this condition is an opportunistic infection by Epstein Barr virus.
Epstein–Barr virus (EBV) infections in the oral cavity may present as a primary infection (infectious mononucleosis).
Hairy leukoplakia is an unusual presentation of recrudescent EBV in the oral cavity, where this normally lymphotropic virus is present within the epithelium.
In patients with established HIV/AIDS, hairy leukoplakia is usually associated with a low CD4 count and high viral load.