Leprosy

Question 1

Cardinal signs of leprosy?

Answer 1

1 of 3 required
1. Skin patch with loss of sensation
2. enlarged peripheral nerve with loss of sensation
3. positive slit-skin smear

Question 2

Describe the skin patch with loss of sensation?

Answer 2

1. Hypopigmented
2. Erythematous
3. Streaming and satellite lesions

Question 3

How to test loss of sensation?

Answer 3

1. Light touch
2. Pain (pin prick)
3. Temperature discrimination

Question 4

Describe the enlarged peripheral nerve?

Answer 4

Routinely palpate:
1. Great auricular n.
2. Ulnar n.
3. Radial cutaneous n.
4. Median n.
5. Lateral popliteal n.
6. Posterior tibial n.

Question 5

Paralysis of the intrinsic foot muscles will?

Answer 5

1. influence the architecture of the longitudinal and transverse arches which aid in the distribution of mechanical stress during walking
2. while clawing of e.g the hallux shifts the fat pad to distal and exposes the MTP-I joint area to undue stress during push-off

Question 6

Consequences of paralysis of the intrinsic foot muscles?

Answer 6

1. unstable gait
2. flattening of the arches
3. arthrotic changes
4. arthritis
5. impairment
6. ulceration
7. deformity

Question 7

Describe the slit skin smear?

Answer 7

The slit and scrape method
Incision, turn the blade 90 degrees
Active edge of lesion
LL: sites with high probability of demonstrating AFB’s

Question 8

Where to get the slit and acrape sample?

Answer 8

1. Earlobe
2. Chin
3. Extensor forearm
4. Dorsal fingers
5. Buttocks
6. Knees

Question 9

Technique of smear taking?

Answer 9

Smear, dry, fix, stain (Ziehl-Neelsen)

Question 10

What is indeterminate leprosy?

Answer 10

Indeterminate lesion occurring in endemic areas and in children with
contact with active leprosy.
Carefully describe and record the suspect leprosy lesion and see the
patient back in 3 months

Question 11

What is lepromatous leprosy?

Answer 11

• No loss of sensation
• Skin smear positive

Question 12

Multi drug treatment for leprosy?

Answer 12

1. Rifampicin: 600 mg once a month
2. Clofazimine: 300 mg once a month, and 50 mg daily
3. Dapsone: 100 mg daily

Question 13

Durtion of treatment for leprosy?

Answer 13

Pauci-bacillary (PB) leprosy : 6 months
Multi-bacillary (MB) leprosy : 12 months

Question 14

Prevention?

Answer 14

For adults and children (aged above 2 years) who are in regular contact with leprosy patients, the guidelines recommend the use of single-dose rifampicin

Question 15

Leprosy reactions?

Answer 15

1. type I
2. type II

Question 16

Type I leprosy reaction?

Answer 16

Type I= reversal reactie (RR)
– Type IV Coombs & Gell
– Delayed type hypersensitivity
– Chronic course

Question 17

Type II leprosy reaction?

Answer 17

Type II = Erythema nodosum leprosum (ENL)
– Type III Coombs & Gell
– Immune complexes
(cutaneous and systemic
vasculitis)
– Intermittent of continuous

Question 18

Type I leprosy reaction treatment?

Answer 18

prednisolone
- alternative = ciclosporin

Question 19

Type II leprosy reaction?

Answer 19

1. Fever, myalgia, malaise
2. Arthralgia
3. Iridocyclitis
4. Hepato-splenomegaly
5. Orchitis
6. Lymphadenitis
7. Glomerulonephritis
8. Skin nodules

Question 20

Leprosy stigmata?

Answer 20

1. lagophtalmos
2. claw hands
3. dropfeet
4. absorption of fingers and toes
5. ulceration
6. blindness