Bacterial Skin Infections Practice Questions

Q: The following image is diagnostic of which STD?

LGV. ***LGV*** - The image shows significant **inguinal lymphadenopathy** and **swelling** in the groin region, suggestive of buboes commonly seen in Lymphogranuloma Venereum (LGV). - LGV, caused by *Chlamydia trachomatis* serovars L1, L2, or L3, characteristically presents with unilateral or bilateral painful **inguinal lymph nodes** (buboes) that can rupture to form fistulas. *Herpes simplex* - Herpes simplex typically presents with painful **vesicles** or **ulcers** on erythematous bases, which often recur. - While it can cause inguinal lymphadenopathy, the prominent, large, fluctuant swelling visible in the image is not typical of primary herpes infection. *Chancroid* - Chancroid presents as one or more **painful, soft chancres** with irregular, undermined borders and a purulent base. - It also causes painful inguinal lymphadenopathy, but the primary lesion (soft chancre) is usually more prominent than the diffuse swelling seen here. *Donovanosis* - Donovanosis (granuloma inguinale) is characterized by **painless, beefy red, friable ulcerative lesions** that tend to bleed easily and slowly enlarge. - While it can cause pseudobuboes due to subcutaneous granulomas, the image does not show the typical ulcerative lesions associated with Donovanosis.

Q: A 30-year-old male patient presents with painful genital lesion after unprotected sexual intercourse. He is non cooperative during genital manipulation done to take culture specimen. All are true about the condition shown except:

Granulomatous lesion associated with endarteritis. ***Granulomatous lesion associated with endarteritis*** - This histopathological description is characteristic of **syphilitic chancre** (primary syphilis) or **gumma** (tertiary syphilis), NOT chancroid - Syphilis shows **granulomatous inflammation** with **obliterative endarteritis** (inflammation and narrowing of blood vessels) - **Chancroid** lesions are **non-granulomatous**, showing acute inflammatory infiltrate with lymphocytes, plasma cells, and neutrophils - This is the feature that is **NOT true** about chancroid, making it the correct answer to this "except" question *Phagedenic ulcer* - TRUE for chancroid - refers to rapidly destructive and spreading ulcers - Severe chancroid can present with extensive tissue destruction and sloughing - The aggressive nature of *Haemophilus ducreyi* infection can lead to phagedenic (rapidly spreading) ulceration *Autoinoculation* - TRUE for chancroid - the infection commonly spreads from existing lesions to other parts of the patient's body through direct contact - Results in multiple or satellite lesions around the primary ulcer - This is a well-recognized feature of *H. ducreyi* infection *Azithromycin single dose treatment* - TRUE for chancroid - **Azithromycin 1g orally as a single dose** is a **recommended first-line treatment** for chancroid - CDC and WHO guidelines support single-dose azithromycin as effective therapy - Other treatment options include ceftriaxone 250mg IM single dose, ciprofloxacin 500mg BD for 3 days, or erythromycin 500mg TDS for 7 days

Q: What is the diagnosis based on the image shown below?

Donovanosis. ***Donovanosis*** - The image displays genital lesions characterized by **slowly progressive, painless, nodular, ulcerative lesions** which bleed easily on contact, typical of Donovanosis. - This condition is caused by *Klebsiella granulomatis* and often presents with **beefy-red, friable granulation tissue** on the genitals or perineum. *Syphilis* - Primary syphilis typically presents as a **single, painless ulcer (chancre)** with a clean base and sharply demarcated, indurated borders. - While an ulcer is present in the image, its **granulomatous and friable appearance** does not align with a syphilitic chancre. *Chancroid* - Chancroid is characterized by **multiple, painful, soft ulcers** with ragged, undermined edges and a grayish, purulent base. - The lesion in the image appears to be a **painless, proliferative, and highly vascular** type, which is not characteristic of chancroid. *Lymphogranuloma Venereum* - LGV usually begins as a **small, transient, painless papule or vesicle** that often goes unnoticed, followed by painful inguinal lymphadenopathy (buboes). - The prominent **granulomatous ulceration** seen in the image is not the primary presentation of LGV, which is more focused on lymphatic involvement and systemic symptoms.

Q: A 25-year-old woman presents with skin lesion on left supra-orbital margin. Eye examination is within normal limits. CXR done was normal. Diascopy shows apple jelly nodules. The image shows presence of:

Lupus vulgaris. ***Lupus vulgaris*** - The presence of **apple-jelly nodules** on diascopy is a classic and highly characteristic feature of **lupus vulgaris**, a type of cutaneous tuberculosis. - The lesion's location on the **supra-orbital margin** is a common site for this chronic, progressive skin infection. *Lupus pernio* - **Lupus pernio** is typically associated with **sarcoidosis**, presenting as violaceous plaques on the nose, cheeks, ears, and fingers. - It does not show **apple-jelly nodules** on diascopy. *Erythema marginatum* - **Erythema marginatum** is a transient, non-pruritic rash with red margins and clear centers, classically associated with **acute rheumatic fever**. - It does not manifest as nodular lesions or show translucency on diascopy. *Leprosy* - **Leprosy** can cause various skin lesions, but **apple-jelly nodules** on diascopy are not typical of its presentation; instead, thickened nerves and sensory loss are key features. - While it can affect the face, the specific description of diascopy findings points away from leprosy.

Q: A child presents with the skin lesions shown in the image. The most likely diagnosis is:

Impetigo contagiosa. ***Impetigo contagiosa*** - The image shows **honey-colored crusted lesions** around the mouth, which are highly characteristic of **impetigo contagiosa (non-bullous impetigo)**. - This form of impetigo is typically caused by *Staphylococcus aureus* or *Streptococcus pyogenes* and primarily affects superficial layers of the epidermis. *Bullous impetigo* - Characterized by **flaccid bullae** (blisters) that rupture to leave a thin, varnish-like crust, rather than the thick honey-colored crusts seen here. - It is exclusively caused by **Staphylococcus aureus** strains producing exfoliative toxins. *Ritter disease* - Also known as **Staphylococcal Scalded Skin Syndrome (SSSS)**, this condition involves widespread **erythema and exfoliation** resembling a burn. - It is a severe, systemic illness with widespread skin involvement, not localized crusted lesions like those pictured. *Ecthyma* - This is a more **deep-seated skin infection** that penetrates into the dermis, characterized by **"punched-out" ulcers** with thick, adherent crusts and often leaves scars. - While also caused by *Staphylococcus aureus* and/or *Streptococcus pyogenes*, its lesions are typically more severe and destructive than what is depicted.

Q: The following appearance under Wood's lamp is seen in:

Pseudomonas. ***Pseudomonas*** - The image depicts a **greenish-yellow fluorescence** under Wood's lamp, which is characteristic of *Pseudomonas aeruginosa* infection, often due to the production of **pyoverdin**. - This is commonly seen in conditions like **green nail syndrome** or in wounds infected with Pseudomonas. *Tinea capitis* - Certain species of *Tinea capitis* (e.g., *Microsporum canis*, *Microsporum audouinii*) can fluoresce, typically emitting a **bright green fluorescence** under Wood's lamp. - However, the appearance in the image is more diffuse and granular, less typical for fungal hyphae seen in tinea capitis. *Pityriasis -Versicolor* - *Pityriasis versicolor* (caused by *Malassezia furfur*) can show a **pale yellow to coppery-orange fluorescence** under Wood's lamp, due to the production of porphyrins. - The fluorescence in the image is distinctly greenish-yellow, not typical for pityriasis versicolor. *Cutaneous amyloidosis* - **Cutaneous amyloidosis** typically does not exhibit any specific fluorescence under Wood's lamp. - Diagnosis usually involves **biopsy with Congo Red staining** to reveal amyloid deposits.

Q: The following appearance on Wood's lamp is seen in?

Erythrasma. ***Erythrasma*** - Erythrasma, caused by *Corynebacterium minutissimum*, is characterized by a **coral-red fluorescence** under Wood's lamp due to the production of **porphyrins**. - The image clearly shows this characteristic coral-red and purplish fluorescence, which is pathognomonic for erythrasma. *Erythroderma* - Erythroderma is a serious inflammatory skin condition affecting more than 90% of the body surface with **generalized redness and scaling**. - It does not exhibit any specific fluorescence under Wood's lamp; the diagnosis is purely clinical. *Ecthyma* - Ecthyma is a **deep skin infection** resembling impetigo but extending into the dermis, forming **ulcers** with a crusted surface. - It does not produce a characteristic fluorescence under Wood's lamp; diagnosis is based on clinical appearance of ulcerative lesions. *Erysipelas* - Erysipelas is a **superficial cellulitis** primarily involving the upper dermis and superficial lymphatics, typically presenting as a rapidly spreading, erythematous, raised, and warm plaque with a distinctive border. - While it is a bacterial skin infection, it does not show any specific fluorescence under Wood's lamp.

Q: Which nerve is thickened in this patient of Hansen disease?

Greater auricular. ***Greater auricular nerve*** - The image shows a **thickened, cord-like structure** indicative of a hypertrophied nerve, characteristic of **Hansen's disease (leprosy)** affecting a peripheral nerve. The location points towards the greater auricular nerve. - The **greater auricular nerve** is a common site for thickening in leprosy due to its superficial course, making it susceptible to the inflammatory response caused by *Mycobacterium leprae*. *Transverse cervical nerve* - While it is a superficial cervical nerve, involvement of the **transverse cervical nerve** in leprosy is less common or prominent for palpation compared to the greater auricular nerve. - Thickening of this nerve might present with sensory changes over the anterior neck, but it is not typically as clearly palpable as the greater auricular nerve in its common course. *Greater occipital nerve* - The **greater occipital nerve** would be located more posteriorly on the scalp and neck, supplying sensation to the posterior scalp. - Its thickening would typically cause pain or sensory changes in the occipital region, which does not align with the visibly thickened nerve shown in the image. *Lesser occipital nerve* - The **lesser occipital nerve** is also located more posteriorly and superiorly in the neck, innervating the skin behind the ear. - While it can be affected in leprosy, its anatomical position and typical presentation of thickening are distinct from the prominent cord visible in the image, which is clearly positioned more anteriorly and inferiorly near the earlobe.

Q: A child presents with the following lesion in the neck folds. The gram stain from the lesion is shown below. Comment on the diagnosis.

Erythrasma. **Erythrasma** - The image shows a **reddish-brown, finely wrinkled lesion** in an intertriginous area (neck folds), consistent with erythrasma. - The gram stain reveals **long, filamentous Gram-positive bacilli**, characteristic of *Corynebacterium minutissimum*, the causative agent of erythrasma. *Impetigo contagiosa* - This typically presents as **honey-colored crusted lesions** or vesicles, often caused by *Staphylococcus aureus* or *Streptococcus pyogenes*. - Gram stain would show **Gram-positive cocci** (clusters for staph, chains for strep), not filamentous bacilli. *Scrofuloderma* - This is a form of **cutaneous tuberculosis**, typically presenting as **nontender subcutaneous nodules** that eventually ulcerate and discharge caseous material. - Diagnosis is confirmed by identifying acid-fast bacilli or histology showing granulomas; the gram stain and lesion appearance are not consistent. *Scrum pox* - This is a **viral skin infection** (often herpes simplex virus) seen in wrestlers, presenting as **vesicular or ulcerative lesions**. - It would not show filamentous Gram-positive bacilli on a bacterial gram stain.

Question 1

The following image is diagnostic of which STD?

Accepted Answer

LGV

Answer

Herpes simplex

Answer

Chancroid

Answer

Donovanosis

Question 2

A 30-year-old male patient presents with painful genital lesion after unprotected sexual intercourse. He is non cooperative during genital manipulation done to take culture specimen. All are true about the condition shown except:

Accepted Answer

Granulomatous lesion associated with endarteritis

Answer

Phagedenic ulcer

Answer

Azithromycin single dose treatment

Answer

Autoinoculation

Question 3

What is the diagnosis based on the image shown below?

Accepted Answer

Donovanosis

Answer

Syphilis

Answer

Chancroid

Answer

Lymphogranuloma Venereum

Question 4

A 25-year-old woman presents with skin lesion on left supra-orbital margin. Eye examination is within normal limits. CXR done was normal. Diascopy shows apple jelly nodules. The image shows presence of:

Accepted Answer

Lupus vulgaris

Answer

Lupus pernio

Answer

Erythema marginatum

Answer

Leprosy

Question 5

A child presents with the skin lesions shown in the image. The most likely diagnosis is:

Accepted Answer

Impetigo contagiosa

Answer

Bullous impetigo

Answer

Ritter disease

Answer

Ecthyma

Question 6

The following appearance under Wood's lamp is seen in:

Accepted Answer

Pseudomonas

Answer

Tinea capitis

Answer

Pityriasis versicolor

Answer

Cutaneous amyloidosis

Question 7

The following appearance on Wood's lamp is seen in?

Accepted Answer

Erythrasma

Answer

Erythroderma

Answer

Ecthyma

Answer

Erysipelas

Question 8

Which nerve is thickened in this patient of Hansen disease?

Accepted Answer

Greater auricular

Answer

Transverse cervical nerve

Answer

Greater occipital nerve

Answer

Lesser occipital nerve

Question 9

A child presents with the following lesion in the neck folds. The gram stain from the lesion is shown below. Comment on the diagnosis.

Accepted Answer

Erythrasma

Answer

Impetigo contagiosa

Answer

Scrofuloderma

Answer

Scrum pox

Question 10

Which one of the following statements is correct regarding leprosy?

Accepted Answer

Type 2 Leprosy Reaction is an immune complex mediated syndrome also known as erythema nodosum leprosum

Answer

Nose is the last site of involvement in lepromatous leprosy

Answer

Type 1 Leprosy Reaction is also called erythema nodosum leprosum

Answer

'Lion face' appearance is seen in tuberculoid leprosy

Bacterial Skin Infections — MCQs

Bacterial Skin Infections — MCQs

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