Leprosy and Cutaneous Tuberculosis MCQs

Dermatology · 38 free questions with answers & explanations.

1. A 28-year-old man from a leprosy-endemic area presents with a single hypopigmented, anaesthetic patch on his left forearm with loss of hair and anhidrosis over it. Skin smear from the lesion is negative. Slit-skin smear BI is 0. Which type of leprosy does he have?
2. A 35-year-old patient with untreated multibacillary leprosy suddenly develops painful erythematous nodules over the face and limbs with fever, malaise, and tender peripheral nerve thickening. The nodules are not present over anaesthetic patches. What is this reaction called?
3. A leprosy patient on WHO multidrug therapy develops sudden facial swelling with thickening of earlobes, loss of eyebrows and eyelashes, and a positive slit-skin smear showing globi. Which form of leprosy is this?
4. A 40-year-old woman presents with a warty plaque over the right knee for 3 years. The plaque has a central atrophic scar with active verrucous borders. Biopsy shows caseating granulomas with Langhans giant cells. Mantoux test is strongly positive. What is the diagnosis?
5. A child with cervical lymphadenopathy develops a discharging sinus over the neck with undermined edges and non-healing ulceration overlying a cold abscess. Biopsy shows caseating granulomas and Ziehl-Neelsen stain is positive. What is the diagnosis?
6. A patient with borderline tuberculoid leprosy develops a sudden, painful, erythematous swelling of existing skin lesions along with fever and nerve tenderness. This is classified as a Type 1 lepra reaction. Which immunological mechanism underlies this?
7. Histoid leprosy is a distinct clinicopathological entity. Which of the following best describes its characteristic features?
8. A 30-year-old man presents with lupus vulgaris — an apple-jelly nodule on the cheek. Which investigation best confirms the diagnosis and also helps assess the extent of systemic disease?
9. The bacteriological index (BI) in leprosy measures which of the following?
10. A histopathological section from a leprosy patch shows an unbroken grenz zone, solid-staining bacilli in foamy macrophages (Virchow cells), and no lymphocytic infiltration. The Ridley-Jopling classification for this lesion is:
11. A patient on MDT for multibacillary leprosy develops a sudden onset of painful red nodules on the face and extremities with fever and neutrophilia. Histopathology shows neutrophilic infiltrate and immune complex deposition. Which immunological mechanism underlies this reaction?
12. A child presents with a single warty plaque on the knee with central clearing. AFB staining is positive and biopsy shows pseudoepitheliomatous hyperplasia with mixed granulomatous infiltrate. The most likely diagnosis is:
13. In which type of leprosy is the pure neuritic (primary neuritic leprosy) form most commonly classified, and what is the characteristic histopathological finding in the nerve biopsy?
14. A 40-year-old man with borderline tuberculoid (BT) leprosy develops painful erythematous skin nodules, neuritis, and fever over 3 days. His reaction is classified as Type 1 (reversal reaction). The immunological basis of this reaction is:
15. Lucio phenomenon is a severe form of leprosy reaction characterized by necrotizing arteritis. It occurs exclusively in patients with which type of leprosy?
16. In the histopathology of lupus vulgaris (cutaneous TB), the characteristic finding is:
17. Which of the following cutaneous TB variants is considered the most common form in India and shows the highest bacterial load among all cutaneous TB types?
18. A patient with borderline tuberculoid (BT) leprosy on MDT develops sudden onset painful swelling of leprosy patches with new patches appearing, accompanied by nerve pain and tenderness. Systemic symptoms are absent. This reaction type and its management are:
19. Histopathology of tuberculoid (TT) leprosy demonstrates which specific combination that distinguishes it from other granulomatous dermatoses?
20. Lupus vulgaris (the most common form of cutaneous tuberculosis in India) shows which pathognomonic clinical sign on diascopy?
21. Which subtype of cutaneous tuberculosis represents a high bacterial load state (paucity of immunity) and is analogous to lepromatous leprosy in the spectrum concept?
22. A patient with borderline lepromatous (BL) leprosy on multi-drug therapy develops sudden painful erythematous nodules and plaques with fever, malaise, and nerve tenderness. Histopathology of the nodule shows lymphocytic infiltrate around vessels and nerves without foam cells. The most likely diagnosis and treatment is:
23. Lupus vulgaris (cutaneous tuberculosis) most commonly affects which anatomical region in India, and what is the characteristic histopathological feature?
24. A 35-year-old man from a leprosy-endemic area presents with a single hypopigmented macule with loss of sensation and a single thickened nerve. Slit-skin smear is negative. The WHO classification for treatment purposes is:
25. Which statement correctly distinguishes tuberculoid leprosy (TT) from indeterminate leprosy histopathologically?
26. In leprosy, the Ridley-Jopling classification grades disease on an immunological spectrum. A patient with 2 hypopigmented patches showing reduced sensation, no bacilli on slit-skin smear, and a strongly positive lepromin test is classified as:
27. Type 1 lepra reaction (reversal reaction) occurs in which part of the Ridley-Jopling spectrum and is immunologically mediated by:
28. Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis in India. Its characteristic lesion is an 'apple-jelly' nodule seen on:
29. A 40-year-old patient presents with a large, hypopigmented anaesthetic plaque on the trunk with well-defined, raised, erythematous borders and satellite lesions. Slit-skin smear is negative. Nerve near the lesion shows inflammatory thickening. What is the Ridley-Jopling classification of this leprosy?
30. Type 2 lepra reaction (Erythema Nodosum Leprosum, ENL) is characterised by which immunological mechanism?
31. Scrofuloderma is a form of cutaneous tuberculosis caused by which mechanism, and which test most accurately distinguishes it from other cutaneous TB forms?
32. A leprosy patient on MDT (dapsone + clofazimine + rifampicin) develops sudden onset of tender erythematous nodules on the face and limbs with fever and arthralgia. His lepromin test is negative. Histology of a nodule shows edema in the dermis with neutrophilic and eosinophilic infiltrate around vessels, without classic granuloma formation. He had been classified as lepromatous leprosy. This reaction is best treated with:
33. A patient presents with a chronic verrucous plaque on the buttock with central scarring. He has worked as a butcher. Biopsy shows tuberculous granuloma with caseation. Mantoux test is strongly positive (22 mm). ZN staining is negative. The diagnosis and route of infection are:
34. A borderline lepromatous (BL) patient on MDT develops upgrading (Type I reversal) reaction involving a facial nerve trunk with progressive foot drop. The minimal duration of corticosteroid therapy recommended by WHO to treat and prevent nerve function impairment in this reaction is:
35. A child presents with grouped papulo-vesicular lesions on the face that ulcerate, forming tuberculid-like lesions. He has strongly positive Mantoux test and the lesions resolve spontaneously leaving depressed scars. There is no active internal TB. This condition is:
36. A patient with borderline tuberculoid (BT) leprosy on MDT develops sudden worsening of existing skin lesions with new tenderness and erythema of the lesions, painful peripheral nerve thickening, and neuritis. There is no fever and no new skin lesions. This is consistent with:
37. Lupus vulgaris, the most common form of cutaneous tuberculosis in India, is characterised by which pathognomic clinical sign?
38. A patient treated for lepromatous leprosy with MDT develops painful, tender erythematous nodules on the face, trunk, and limbs, accompanied by fever, acute iritis, and painful epididymo-orchitis. The Mitsuda (lepromin) test is negative. What is the first-line treatment for this reaction?