Hansens

Question 1

countries that account for 80% of cases world wide

Answer 1

Brazil; India, Indonesia

Question 2

How many percent of persons infected w m leprae are able to resist infection

Answer 2

90%

Question 3

genetic susceptibility to acquire hansens disease

Answer 3

Monozygotic twins 60-85%

dizygotic 15-25%

Question 4

latency period for paucibacillary and multi

Answer 4

5 yrs- paucibacillary

10 yrs- Multibacillary

Question 5

M leprae grows in what temp

Answer 5

Below 30 degrees. the core body temp of humans.

Question 6

spares what area?

Answer 6

Sparing midline and scalp

Question 7

organism may be cultivated where?

Answer 7

Mouse footpads

Question 8

surface ycolipid unique to leprosy

Answer 8

PGL1 (phenolic glycolipid) 1

Question 9

M lepromatosus is isolated from where?

Answer 9

Mexico

Question 10

Diffuse type of lepromatous leprosy

Answer 10

Lucio leprosy.

Question 11

smears are speific how many percent of hansens disease have negative smears?

Answer 11

70%

smears are taken from lesions and cooler areas of the skin such as earlobes, elbows, knees

Question 12

skin smears of paucibacilliary and multibacillary

Answer 12

Paucibacillary- negative

Multibacillary/ organisms found on skin smears

Question 13

enlarged nerves are found in how kany percent multi and pauci

Answer 13

Multi- More than 90%

pauci- 75-85

Question 14

Classification name

Answer 14

Ridley and Jopling scale

Question 15

1st clinical manif in 90% of pxs.

Answer 15

Numbness

Question 16

earliest sensory changes

Answer 16

loss if senses of temperature and light touch most often in the feet or hands.

Question 17

1st lesion noted

Answer 17

Solitary poorly defined hypopigmented macule

Question 18

histo

Answer 18

Lymphocytic infiltrate without granulomas sometimes w involvement of cutaneous nerves

Question 19

jsolitary few in number asymmetrical
hypopogmented or erythematous usually dry scaly and hairless.
“saucer right side up”
mosy common loc: face limb or trunk,

scalp axillae groin; perineum not involved.

Answer 19

Tuberculoid leprosy

Question 20

tuberculoid lesion

Answer 20

Anesthetic or hypesthetic and anhidrotic. and superficial peripheral nerves serving or proximal to the lesion are enlarged tender or both. greater auricular nerve and sup peroneal nerve may be visibly enlarged.
atrophy.
spont remission in 3 years.

Question 21

diff tuberculoid leprosy from borderline tuberculoid.

Answer 21

Borderline tuberculoid are more smaller and more numerous. Satellite lesions around large macules or plaques are characteristic.

Question 22

Desc Borderline borderline leprosy BB

Answer 22

Skin lesions are numerous but countable and consist or red, irreg shaped plaques. generalized but asymmetric.
Nerves be thickened and tender.

Question 23

Borderline lepromatous leprosy (BL)

Answer 23

symmetric and numerous too many to count. include macules, papules, plaques, and nodules.
nerves are large tender or both. sensation or sweating normal.

Question 24

Lepromatous leprosy

Answer 24

Pale macules. diffuse infiltration of skin.
divided into polar and subpolar.
macular lesions dist diffusely and symmetrically over the body.
small and numerous. poorly defined, show no change in skin texture.
minimal or no loss of sensatioj over lesions
no nerve thickening
no change in sweating.
loss of hair on outer third of eyebrows.
nodules called lepromas. most often in actal parts: ears brows nose chin elbows hands buttocks or knees.
nerve involvement occurs very slowly.
nerve disease us bilaterally symmetric- stocking glove pattern.

Question 25

uncommon form if multibacillary hansens wc skin lesions appear as large yellow red shiny papules and nodules on dermis or subcutaneous tissue. resemble molluscum.

Answer 25

Histoid leprosy

Question 26

histopathologic hllmark of hansens disease

Answer 26

neurotropism

Question 27

nerve involvement in Pauci and multi

Answer 27

Pauci- anesthesia within skin lesions. | multi/ lepromatous- progressive stocking glove peripheral neuropathy.

Question 28

neuropathy is termed : what in who grade 1 and 2

Answer 28

Who grade 1: primary impairments | 2: Secondary or visible impairments.

Question 29

neuropathy is present in how many percent of pauci and multi

Answer 29

1. 3-3.5% of pauci | 7. 5-24% of multi.

Question 30

secondary impairments occur in how many perfent of multi

Answer 30

33-56%

Question 31

first symptom

Answer 31

inability to distinguish hot and cold.

Question 32

result from involvement if 7th cranial nerve

Answer 32

Corneal erosions exposure kerstitis ulcerations

Question 33

of multi pxs, how many percent are blind at dx and will have potentially blinding orocess

Answer 33

2.8% -4.6 Blind at diagnosis. | 11%a Potentially blinding process

Question 34

most freq involved kucous membrane

Answer 34

nasal mucosa

Question 35

organs not contain leprsoy bacilli

Answer 35

GI lungs brain

Question 36

visceral infection is restricted mostly to what system

Answer 36

reticuloendothelial system

Question 37

pregnancy affect on leprosy

Answer 37

exacerbation or reactivation after apparent cure

Question 38

hansens dx reported in the fr organ transplant

Answer 38

renal liver heart bm

Question 39

immunopathogenesis in leprosy

Answer 39

tuberculoid lesions : good cell mediated immunity with IFN gamma and IL2 present. lepromatous: cytokines reduced. IL4/5 /10 . ytokines that downregulate cell med immunity and enhance suppressor function Nd antibody prod

Question 40

what stain used for demonst m leprae

Answer 40

frite fraco

Question 41

histo of lepromatous leprosy comp of

Answer 41

bacilli laden and lipid laden histiocytes so called lepra cells or foam cells of virchow. infiltrate is kocalized in dermis and may be purely perivascular or sheet like and seprated from the epidermis by a well dfined grenz zone AFB are abundant and appear as round clumps (globi)

Question 42

type of reaction w represent an enhanced cell mediated immune response to m leprae

Answer 42

Type 1 reacuton

Question 43

if rxns occur w antibiotic chemo theybare called what

Answer 43

reversal reactions

Question 44

Type 1 rxns clinically represent as:

Answer 44

Inflammatioj of excisting lesions no systemic symptoms such as fever chills or arthralgias. lesions swell become erythematous and sometimes tender simulating cellulitis. severe cases; ulceration.

Question 45

histo of type 1 rxn

Answer 45

Perivascular and perineural edema and large num of lymphocytes. severe rxns may demonstrate tissue necrosis. bacilli reduced. PBL- 1

Question 46

other name for type 2 rxn

Answer 46

Erythema nodosum leprosum

Question 47

type 2 rxn char

Answer 47

Multisystem involvement systemic sx (fever myalgia arthralgia anorexia) skin lesions are char erythematous subcutaenous dermal nodules severe skin lesions ulcerate.

Question 48

Type 2 histo

Answer 48

ENL demosntrate a leukoclastic vasculitis:

Question 49

is an uncommon and unusual rxn that occurs in pxs w diffuse lepromatous leprosy of the "la bonita" most often in western mexico. lacks neutrophilia and systemic symptoms. pruritic macules evolve to bullous lesions thy rapidly ulcerate spec below the knees.

Answer 49

Lucio phenomenon

Question 50

lucio histo

Answer 50

Bacilli are numerous and in add to being in the dermis are seen within blood vessel walls w thrombosis of middermal vessels resulting in cutaneous infarction.

Question 51

tx. dapsone monotherapy promotes

Answer 51

resistance

Question 52

std tx

Answer 52

MDT

Question 53

WHO defines paucibacillary disease as presence of

Answer 53

No bacilli on smears or biopsy and <=5 lesions

Question 54

tx for rifampin resistant patients

Answer 54

MCCM moxifloxacin 400mg Clofazimine 50mg Clarithromycin 500mg minocycline 100mg daily for6 months

Question 55

continuous phase for rifampin resistant

Answer 55

MCM moxifloxacin 400mg Clarithromycin 1000mg minocycline 200mg once monthly supervised for another 18 mos

Question 56

Type 1 rxns tx

Answer 56

Systemic steroids. | prednisone orally starting dise 40-60mg/day.

Question 57

neuritis and eye lesions aee urgent indications for

Answer 57

systemic steroid therapy

Question 58

used if steroids fail or as a steroid sparingagent

Answer 58

cyclosporine

Question 59

tx of choice for ENL

Answer 59

Thalidomide . initial recomm dose is up to 400 mg/day in pxs more than 50kg.

Question 60

thalidomide SE

Answer 60

Teratogen . long term use assoc w risk w sensory neuropathy. and short term use assoc w risk of thromboembolic phenomena also constipation

Question 61

given to pxs w enl when thalidomide cannot be used or to avoid the use of systemic steroids to manage severe enl.

Answer 61

Comb of pentoxifylline 400-800mg twice a day and clofazimine 300mg/day

Question 62

poorly resposive to both steroid and thalidomide

Answer 62

Lucio phenomenon

Question 63

BCG prov how many percent protectioj against m leprae

Answer 63

34-80%