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Pinta (skin disease) is caused by Treponema carateum

2. Symmetrical normoaesthetic macules are seen in-
1.
Lepromatous leprosy-------------------ans Discussion-

Leprosy- (P-264 Park)
Cardinal signs-
•
Anesthetic--> first goes temperature (cold first) Enlargement of nerve--> ulnar nerve--> claw hand BI*- Bacteriological Index (Used for classification) MI- Morphological Index (Live bacilli--> therapeutic response) Paucibacillary: 1-5 skin lesion : BI < 2 : TT, BT Multibacillary: >5 skin lesion: BI > 2 : BB, BL, LL Ridley Jopling classification- Depending on CMI- TT--> Anesthetic + anhidrosis + complete loss of hair, saucer right way up lesions BT--> Satellite lesions
BB--> Inverted saucer, Punched out, Swiss cheese, Lepromin test -ve BL--> Onion peel/cut onion--> Nerve LL--> Leonine fascies, Glove+Stocking, BI 6+, globi, Genz zone (cell free zone below Indian classification- Madr id classification + Pure neuritic form High immunity (TT,BT)
Low immunity (LL,BL)
immunity--> higher loss), AFB -/less, Plaques Prevalence of leprosy--> 0.6 (1.34 per 10,000 › Ck PARK P-265) Generation time › 12-14 days (longest) Nerves involved in 100% cases--> Ulnar, Radial, Facial(in that order) Leprosy affects everything except--> CVS, CNS, Ovary (affects uterus)--> ck C/F--> Intermediate Leprosy (M/C INDIA)--> Facial les ions, no nerve thickening, smear negative Histoid leprosy- Seen in INDIA--> Cause--> dapsone monotherapy resistence. Dome shaped nodes on normal skin, linear elongated bacilli. Lazar ine leprosy--> Synonym for Lucio's leprosy › Malnutrition, HIV--> Severe skin destruction
Leprosy treatment-
•
MB- R/D/C 1 Yr
(FDT- Fixed duration therapy--> earlier MDT) Leprosy is only disease where I+D not done--> nerve damage will occur Harr ison is good for all except leprosy.
Lepra reaction-
1.
Type I(Reversal reaction)- BT/BB, Type IV HS, IL-1,2; IFN-gamma, Neuritis› Steroid Type II(ENL)- BL/LL—> TNF-alpha --> Thalidomide(inhibits TNF-alpha so DOC)-->other

9. A young man aged 19 years developed a painless penile ulcer 9 days after sexual intercourse
with a professional sex worker; likely diagnosis is:
1.
Discussion- if in place of sex worker there is normal married male with painful ulcer then-->4

25. A case with bilateral inguinal swelling comes to the STD clinic what organism will you
provisionally treat-
1.
LGV-------------------ans (Inguinal bubo- LGV and chancroid)
45. DOC for tertiary syphilis-
1.
Discussion: Congenital/Neuro Syphilis--> Crystalline pennicillin

49. All are seen in Lepromatous Leprosy except-
1.
Inflammatory reaction is sparse---------------------ans Surface of the skin lesions is smooth and shiny
58. What is the time period required for the MI of a patient on treatment to become 0 on MDT-
1.
67. A case of Urethral discharge comes and the smear shows Intracellular Diplococci with PMN.
How will you treat this case-
1.
Doxycycline 100 mg orally twice a day for 7 days NGU- Scanty, Mucoid, Odourless, >5 PMN, M/C Chlamydia (McCoy cell line) Rx: GU- Profuse, yellow, foul smelling, >5 PMN + Intracellular diplococci, Culture-BA; Rx: Gonorrhoea- Cefixime 400mg, Ceftriaxone 250 mg stat
68. Persistent painless bleeding ulcer that spreads by inoculation is seen in-
1.

69. In HIV positive patient of syphilis what treatment will you give in early syphilis-
1.
Benzathine penicillin G, 2.4 million units IM--------------ans Benzathine penicillin G, 2.4 million units IM one dose weekly for 3 weeks Doxycycline, 100 mg PO, twice daily for 15 days Doxycycline, 100 mg PO, twice daily for 30 days Discussion- H/17 P-1044; Option 2--> late

71. How will you treat a case of chancroid with HIV-
1.
Doxycycline 100 mg orally twice a day for 7 days Erythromycin 500 mg QID for 7 days-------------------ans Discussion- 1 gm Azithromycin or 250 mg i. m. Ceftriaxone. In HIV 500 mg oral erythromycin 4 times per day for seven days

Source: http://www.rxpg.com/files/leox/15.%20Venerology.pdf