Bacterial Skin Infections Practice Questions

Q: Asymmetrical nerve thickening with several hypoesthetic macules on skin indicates which stage of leprosy?

Borderline tuberculoid. ***Borderline tuberculoid*** - This stage is characterized by **prominent asymmetrical nerve thickening**, which is a hallmark feature distinguishing it from other borderline forms. - Patients typically present with **several (5-10) hypoesthetic macules** with well-defined borders and **satellite lesions** around the main lesion, reflecting a strong cell-mediated immune response. *Borderline lepromatous* - Marked by **many poorly defined lesions** that are becoming more **symmetrically distributed**. - Nerve thickening is less prominent and **more symmetrical** than in BT, reflecting a weaker cell-mediated immune response. *Tuberculoid leprosy* - Characterized by **very few skin lesions (1-5)** with **complete anesthesia** (not hypoesthesia) and well-demarcated borders. - While asymmetrical nerve thickening occurs, it lacks **satellite lesions** which are characteristic of BT leprosy. *Borderline borderline leprosy* - Represents the **most unstable form** with numerous (10-30) moderately defined lesions. - Nerve involvement is present but **less prominently asymmetrical** than in BT, with symmetry intermediate between tuberculoid and lepromatous poles.

Q: A 45-year-old male had multiple hypoesthetic, mildly erythematous large plaques with elevated margins on trunk and extremities. His ulnar and lateral popliteal nerves on both sides were enlarged. The most probable diagnosis is:

Borderline tuberculoid leprosy. ***Borderline tuberculoid leprosy*** - The clinical presentation of **multiple hypoesthetic, large plaques with elevated margins** is characteristic of **BT leprosy**, which features **well-demarcated lesions with raised, sloping edges** - **Prominent bilateral nerve enlargement** (ulnar and lateral popliteal nerves) with relatively **few to moderate lesions** is a hallmark of BT leprosy - BT shows **strong cell-mediated immunity** resulting in well-defined plaques with **marked hypoesthesia** and **asymmetric nerve involvement** - The **mildly erythematous** appearance and **elevated margins** indicate active cellular immune response typical of the tuberculoid end of the spectrum *Borderline lepromatous leprosy* - BL presents with **numerous, poorly demarcated lesions** (many more than described) including dome-shaped plaques, papules, and nodules - Lesions in BL have **punched-out centers** rather than elevated margins - Nerve involvement is less prominent relative to the **high number of skin lesions** - The description of well-demarcated plaques with elevated margins points away from the lepromatous pole *Lepromatous leprosy* - LL shows **numerous, diffuse, symmetrical lesions** that are poorly demarcated (macules, papules, nodules, diffuse infiltration) - Lesions are **not hypoesthetic** in early stages due to preserved sensory function until late nerve damage - No elevated margins; lesions are typically smooth, shiny, and dome-shaped *Borderline leprosy* - This is **mid-borderline (BB)** leprosy, which presents with **moderate to numerous lesions** that are more uniform and less well-demarcated than BT - BB has **dimorphous** features without the clear plaques with elevated margins described - The clinical description of elevated margins and prominent nerve involvement with moderate lesion count is more specific for BT

Q: Slit smear negative leprosy is:

All of the options. ***All of the options*** - All mentioned types of leprosy—**neuritic**, **tuberculoid**, and **indeterminate**—are characterized by being **slit smear negative**. - This indicates a **paucibacillary** form of the disease with a low bacterial load, making direct detection of bacilli difficult. *Neuritic type* - This type primarily affects **nerves** with minimal or no skin lesions, making it difficult to find bacilli in skin smears. - Due to the low bacterial load, it is typically **slit smear negative**. *Tuberculoid type* - Characterized by **strong cell-mediated immunity**, which effectively contains the infection and results in a low bacillary index. - The few, well-defined skin lesions usually yield **negative slit smears** due to the scarcity of *Mycobacterium leprae*. *Indeterminate type* - This is an early stage of leprosy, often presenting with a single or few poorly defined skin lesions. - The bacterial load is very low, making it almost always **slit smear negative**.

Q: The hard chancre is seen in:

Syphilis. ***Syphilis*** - The **hard chancre** is the characteristic lesion of **primary syphilis**, appearing at the site of infection. - It is typically a **painless, indurated ulcer with raised borders and a clean base**, which often heals spontaneously even without treatment. - Associated with **non-tender regional lymphadenopathy**, distinguishing it from the painful ulcers of chancroid. *Chancroid* - Chancroid is caused by *Haemophilus ducreyi* and presents with **soft, painful ulcers** (soft chancre) that bleed easily. - Unlike the hard chancre of syphilis, these lesions are multiple and often associated with **tender, suppurative lymphadenopathy**. *Granuloma inguinale* - This condition, caused by *Klebsiella granulomatis*, is characterized by **beefy-red, granulomatous lesions** that are typically painless and highly vascular. - It does not present with a chancre, but rather with progressive ulcerative lesions that can be destructive if untreated. *LGV* - **Lymphogranuloma venereum** (LGV) is caused by specific serovars of *Chlamydia trachomatis* and initially presents as a **transient, small, often unnoticed papule or ulcer**. - The most prominent feature of LGV is later development of significant **inguinal lymphadenopathy** (buboes) rather than a firm chancre.

Q: Hutchinson's syphilitic triad includes all except

Cardiovascular anomalies . ***Cardiovascular anomalies*** - **Hutchinson's syphilitic triad** specifically includes **interstitial keratitis**, **nerve deafness**, and **Hutchinson's teeth (notched incisors)** [1]. - **Cardiovascular anomalies** like **aortic regurgitation** or **aneurysm** are manifestations of **tertiary syphilis** and not part of the distinct triad affecting congenital syphilis. *Interstitial keratitis* - This is a key component of **Hutchinson's triad**, representing inflammation of the cornea without primary involvement of the epithelium or endothelium. - It is a common ocular manifestation of **congenital syphilis**, often leading to significant vision impairment if untreated [1]. *Nerve deafness* - This refers to **sensorineural hearing loss** and is another characteristic feature of **Hutchinson's triad**. - It results from damage to the **vestibulocochlear nerve** or inner ear structures due to syphilitic infection. *Notched incisor teeth* - Also known as **Hutchinson's teeth**, these are specifically malformed upper central incisors with characteristic notches [1]. - This dental anomaly is a classic sign of **congenital syphilis** and part of the triad.

Q: Treatment of lepra reaction includes:

Corticosteroids. ***Corticosteroids*** - **Corticosteroids** are the cornerstone of treatment for both Type 1 (reversal reactions) and Type 2 (erythema nodosum leprosum) lepra reactions due to their potent **anti-inflammatory** and **immunosuppressive** effects [1]. - They effectively reduce the severe inflammation, pain, and nerve damage that characterize these immune-mediated reactions, with **prednisolone** being a commonly used agent [1]. *Stoppage of drug* - Stopping anti-leprosy drugs is generally **not recommended** during a lepra reaction, as the reaction is an immune response to the presence of Mycobacterium leprae [1]. - Continuing **multi-drug therapy (MDT)** is crucial to eliminate the bacteria and prevent relapse, while corticosteroids manage the inflammatory reaction [1]. *Chloroquine* - **Chloroquine** is an antimalarial drug with some anti-inflammatory properties, but it is **not a primary treatment** for lepra reactions. - Its efficacy in managing the specific immune mechanisms involved in lepra reactions is limited compared to corticosteroids. *All of the options* - This option is incorrect because stopping anti-leprosy drugs is generally avoided, and chloroquine is not a primary therapeutic agent for lepra reactions. - The main treatment involves **corticosteroids** to control the immune-mediated inflammation.

Q: Which of the following is true regarding leprosy?

MBL recommended treatment for 12 months duration. ***MBL recommended treatment for 12 months duration*** - **Multibacillary leprosy (MBL)** requires a longer treatment regimen to effectively eradicate the higher bacterial load and prevent relapse. - The standard **WHO multidrug therapy (MDT)** for MBL involves **Rifampicin, Dapsone**, and **Clofazimine** for **12 months**. *All deformity cases are MBL* - Deformities can occur in both **Paucibacillary (PB)** and **Multibacillary (MBL)** leprosy, particularly due to **nerve damage** from inflammation or reactions. - The presence of deformity alone does not automatically classify a case as MBL; the **bacteriological index (BI)** and clinical presentation are crucial for classification. *Grenz zone is absent in Lepromatous leprosy* - The **Grenz zone** is a clear, uninvolved band of dermis separating the epidermis from the granulomatous infiltrates, and it is a characteristic histological feature often seen in **lepromatous leprosy**. - Its presence helps distinguish lepromatous leprosy from other dermal inflammatory conditions, as it indicates the spared superficial dermis. *Any positive smear 1+ is MBL* - While a positive smear indicates the presence of *Mycobacterium leprae*, the classification as **MBL** or **PB** depends on the **Bacteriological Index (BI)**. - A **BI of 2+ or more** at any site is typically used to classify a case as MBL, along with the number of skin lesions.

Q: Loss of lateral 1/3rd of eyebrow is seen in -

Lepromatous leprosy. ***Lepromatous leprosy*** - **Loss of the lateral one-third of the eyebrow** (also known as **madarosis**) is a characteristic feature of **lepromatous leprosy** due to chronic inflammation and nerve damage affecting hair follicles. - This, along with diffuse skin infiltration and nodule formation, is part of the typical presentation of the **multibacillary form** of the disease. *Tetanus* - Tetanus is characterized by **muscle spasms** and **lockjaw** due to the action of tetanus toxin on inhibitory neurotransmitters. - It does not cause hair loss or specific dermatological lesions like eyebrow loss. *Tinea capitis* - Tinea capitis is a **fungal infection of the scalp** that causes scaling, itching, and patchy hair loss on the head. - It does not typically affect the eyebrows or cause isolated loss of the lateral one-third part. *Tuberculosis* - Tuberculosis primarily affects the **lungs** but can manifest in various extrapulmonary sites. - While systemic symptoms and skin lesions (e.g., **lupus vulgaris**) can occur, **eyebrow loss** is not a characteristic feature of tuberculosis.

Q: In secondary syphilis all are seen except -

Interstitial keratitis. ***Interstitial keratitis*** - **Interstitial keratitis** is a hallmark manifestation of **congenital syphilis**, not secondary syphilis. - It involves non-ulcerative inflammation of the cornea, leading to scarring and vision loss. *Arthritis* - **Arthritis** can occur in secondary syphilis, typically presenting as a **non-inflammatory polyarthritis** affecting large joints. - This is due to the systemic effects of widespread spirochete dissemination. *Proteinuria* - **Proteinuria** can be a feature of **syphilitic glomerulonephritis**, which can occur during the secondary stage. - This renal involvement is a less common but recognized complication. *Condyloma lata* - **Condyloma lata** are highly infectious, raised, grayish-white lesions found in moist areas, such as the anogenital region and oral mucosa [1]. - They are a classic and highly characteristic skin manifestation of **secondary syphilis** [1].

Question 1

Asymmetrical nerve thickening with several hypoesthetic macules on skin indicates which stage of leprosy?

Accepted Answer

Borderline tuberculoid

Answer

Tuberculoid leprosy

Answer

Borderline lepromatous

Answer

Borderline borderline leprosy

Question 2

A 45-year-old male had multiple hypoesthetic, mildly erythematous large plaques with elevated margins on trunk and extremities. His ulnar and lateral popliteal nerves on both sides were enlarged. The most probable diagnosis is:

Accepted Answer

Borderline tuberculoid leprosy

Answer

Borderline lepromatous leprosy

Answer

Lepromatous leprosy

Answer

Borderline leprosy

Question 3

Slit smear negative leprosy is:

Accepted Answer

All of the options

Answer

Neuritic type

Answer

Tuberculoid type

Answer

Indeterminate type

Question 4

The hard chancre is seen in:

Accepted Answer

Syphilis

Answer

Chancroid

Answer

Granuloma inguinale

Answer

LGV

Question 5

Hutchinson's syphilitic triad includes all except

Accepted Answer

Cardiovascular anomalies

Answer

Interstitial keratitis

Answer

Nerve deafness

Answer

Notched incisor teeth

Question 6

Treatment of lepra reaction includes:

Accepted Answer

Corticosteroids

Answer

Stoppage of drug

Answer

Chloroquine

Answer

All of the options

Question 7

Which of the following is true regarding leprosy?

Accepted Answer

MBL recommended treatment for 12 months duration

Answer

All deformity cases are MBL

Answer

Grenz zone is absent in Lepromatous leprosy

Answer

Any positive smear 1+ is MBL

Question 8

Loss of lateral 1/3rd of eyebrow is seen in -

Accepted Answer

Lepromatous leprosy

Answer

Tetanus

Answer

Tinea capitis

Answer

Tuberculosis

Question 9

Which of the following regimens is recommended for multibacillary leprosy in children of 10 to 14 years of age?

Accepted Answer

Rifampicin 450 mg once a month (under supervision)+ Dapsone 50 mg daily (self-administered)+ Clofazimine 150 mg once a month (under supervision) and 50 mg every alternate day

Answer

Rifampicin 600 mg once a month (under supervision) + Dapsone 50 mg daily (self-administered)

Answer

Rifampicin 600 mg once a month (under supervision)+ Dapsone 100 mg daily (self-administered)+ Clofazimine 50 mg once a month (under supervision) and 25 mg every alternate day

Answer

Rifampicin 450 mg once a month (under supervision) + Dapsone 50 mg daily (self-administered)

Question 10

In secondary syphilis all are seen except -

Accepted Answer

Interstitial keratitis

Answer

Arthritis

Answer

Proteinuria

Answer

Condyloma lata

Bacterial Skin Infections — MCQs

Bacterial Skin Infections — MCQs

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