How to decide type of leprosy in an MCQ

Armadillos are often used in the study of leprosy, since they are among the few known species that can contract leprosy like us. Humans can acquire a leprosy infection from armadillos

Look for these "pointer words" in MCQs on leprosy diagnosis

What happens from TT------------------------------------>  LL ?

TT	BT	BB	BL	LL
1) Single lesion 2) Single thick nerve	1) Satellite lesion/ Few lesions 2) Few non symmetrical nerve thickenings	1)Punched out lesions/ Swiss-cheese lesions 2) Inner border of lesions- Well defined, Outer border- ill defined	1) Multiple lesions- Almost symmetrical on both sides on midline 2) Multiple bilaterally thick nerves	1) Multiple lesions/ diffuse infiltration/nodules 2) Perfectly symmetrical on both sides on midline 3) Glove and stocking anesthesia 4) Grenz zone on histopathology 5) Onion peel appearance of nerve 6) no hypopigmentation 7) normal sensations on patches 8) Ear-lobe infiltration 9) Trophic ulcers
1) Number of lesions---------------------------------------------> gradually increase 2) Well defined, elevated margins  ---------------------> gradually margin becomes ill-defined 3) Single thickened nerve, unilateral---> gradually more nerves involved, bilaterally involvement 4) Slit Skin Smear (SSS) negative ---------------------------> gradually SSS positive                                                                      (TT/BT = SSS -ve, BB/BL/LL= SSS +ve) 5) Anesthesia--------------------------------> gradually sensations recover on the patches                               (LL has normal sensations on lesions but hand and foot sensations-lost) 6) Hypopigmentation/ Erythematous lesions.....>gradually more erythema,less  hypopigmentation                                           (LL has no hypopigmentation, only erythema) 7) Tuberculoid granuloma--->gradually, tuberculoid granulomas disappear and foam cells increase

Sample questions:

1) A 45 year old male had multiple hypoaesthetic mildly erythematous large plaques with elevated margins on trunk and extremities. His ulnar and lateral popliteal nerves on both sides are enlarged. Most probable diagnosis is

A) LL

B) TT

C) BT

D) BL

Ans: BL

Expl: First try and decide which side this leprosy is (tuberculoid side or lepromatous side). Multiple patches/bilateral nerves indicates its on the lepromatous side (either BL or LL). Since, LL will  not have hypoaesthesia, closest is BL

2) A patient comes with a few hypopigmented, hypoaesthetic plaques on the body. His ulnar nerve on left side and lateral popliteal nerve on right side is enlarged. The probable diagnosis is

A) LL

B) TT

C) BT

D) BL

Ans: BT


3) A patient has diffuse infiltration over face, ear lobes and trunk. Few nodular lesions are seen on forehead. He is noticing gradual loss of sensations over hands and feet. Diagnosis is

A) LL

B) TT

C) BT

D) BL

Ans: LL