Leprosy

Question 1

Most severe form

Answer 1

Lepromatous leprosy

Question 2

Skin lesions are Symmetric, multiple infiltrated nodules and plaques, xanthoma-like or dermatofibroma papules; leonine facies and eyebrows

Answer 2

Lepromatous leprosy

tuberculous: assymetric with tendency to central clearing

Question 3

Presence of nerve abscesses and skin lesions are anesthetic early; lesions are usually dry, scay and anhidrotic

Answer 3

Tuberculous leprosy

Question 4

Hyperesthesia is a late sign

Answer 4

Lepromatous leprosy

Question 5

AFB usually up to 4-6+

Answer 5

Lepromatous leprosy

Question 6

Presence of Langerhans giant cells (on H&E stain)

Answer 6

Tuberculous leprosy

Question 7

Positive lepromin skin test

Answer 7

Tuberculous leprosy

Question 8

Higher rate of M.leprae PGL-1 antibodies

Answer 8

Lepromatous leprosy

Question 9

Incubation period

Answer 9

2-40 years

Question 10

Pathognomonic for leprosy

Answer 10

T cell mediated destruction of Schwann cells

Question 11

Presence of foam cells

Answer 11

Lepromatous leprosy

Question 12

Immunologically-mediated inflammatory states that cause considerable morbidity, may precede diagnosis and occur even after initiation of appropriate chemotherapy

Answer 12

Lepta reactions

Question 13

Type 1 Lepra Reactions

Answer 13

Downgrading and Reversal reactions

borderline forms 50%

Question 14

Most dramatic manifestation of Type 1 Lepra reactions

Answer 14

Foot drop (Peroneal nerve involvement)

Question 15

Nerve trunk commonly involved in type 1

Answer 15

Ulnar nerve at the elbow

Tx: GCs

Question 16

When reactions precede initiation of appropriate antibiotics

Answer 16

Downgrading

Question 17

When reactions occur after initiation of therapy

Answer 17

Reversal

Question 18

Most characteristic microscopic feature of type 1 lepra

Answer 18

Edema

Question 19

Type 2 Lepra Reactions

Answer 19

Erythema Nodosum Leprosum

near the lepromatous end

Question 20

MC features of type 2

Answer 20

Crops of painful spontaneously resolving but recurring lesions

Question 21

Tx for recurrent and persistent ENL despite 2 courses of GC therapy

Answer 21

Thalidomide

Question 22

Unusual reaction seen exclusively in patients from the Carribean and Mexico who have diffuse lepromatosis form of untreated lepromatous leprosy

Answer 22

Lucio’s phenomenon

Question 23

MC site of nerve abscesses

Answer 23

Ulnar nerve

Question 24

Most frequent complication of leprous neuropathy

Answer 24

Plantar ulceration (metatarsal heads)

Question 25

Saddle-nose deformity or anosmia

Answer 25

Lepromatous leprosy

Question 26

Confirmatoy diagnosis for leprosy

Answer 26

Histopathology

Question 27

Bactericidal treatment

Answer 27

Rifampin

Question 28

Treatment which is primarily bacteriostatic

Answer 28

Sulfones (dapsone): mainstay of therapy

Question 29

Treatment for paucibacillary leprosy

Answer 29

Intensive: Dapsone x 5 years

Dapsone + Rifampin x 6 months

Question 30

Treatment for multibacillary leprosy

Answer 30

Intensive: Rifampin c 3 years