If a person is having _____ skin patches with definite sensory deficit and/or more than one definite thickened and tender peripheral nerves then it is a case of Multibacillary (MB) leprosy?

1. A

   1 one

2. B

   2 two

3. C

   3 three

4. D

   5 five

Appeared in: Maharashtra CHO - 2020

Explanation

• The WHO classifies leprosy into two main types for treatment purposes: Paucibacillary (PB) and Multibacillary (MB).
• Multibacillary (MB) leprosy is diagnosed if a patient presents with either six or more skin lesions OR involvement of more than one peripheral nerve.
• Paucibacillary (PB) leprosy is diagnosed if a patient has one to five skin lesions AND no more than one nerve involved.
• The number 'five' represents the upper limit for PB classification based on skin lesions. Therefore, having more than five lesions is a key criterion for an MB diagnosis.

Why Other Options Were Wrong

• Option A: Having only one skin patch, with no more than one nerve involved, would be classified as Paucibacillary (PB) leprosy, not Multibacillary (MB).
• Option B: Having two skin patches, with no more than one nerve involved, falls under the definition of Paucibacillary (PB) leprosy.
• Option C: Having three skin patches, with no more than one nerve involved, is also classified as Paucibacillary (PB) leprosy.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain WHO clinical classification of leprosy (Paucibacillary vs. Multibacillary) as background academic context rather than a clinical decision trigger.
• Correct classification of leprosy is critical for patient outcomes as it determines the type and duration of Multi-Drug Therapy (MDT).
• MB leprosy requires a 12-month course of three drugs (rifampicin, clofazimine, and dapsone), whereas PB leprosy requires a 6-month course of two drugs (rifampicin and dapsone).
• A nurse's role includes careful assessment of skin lesions (counting them) and palpating for thickened peripheral nerves to ensure the correct diagnosis and initiation of the appropriate MDT blister pack.

How to Approach the Question

• First, identify the core concept being tested, which is the classification of leprosy.
• Recall the WHO criteria for Paucibacillary (PB) and Multibacillary (MB) leprosy.
• Focus on the numerical cutoffs for skin lesions: 1-5 for PB, and 6 or more for MB.
• Note the 'and/or' in the question, indicating two separate criteria for an MB diagnosis: skin lesions OR nerve involvement.
• Analyze the options. The number '5' is the key threshold that separates the two classifications based on skin lesions.
• Conclude that 'five' is the most logical answer as it represents the upper limit for PB, beyond which the classification changes to MB.

Concept Tested & Keywords

• Concept Tested: WHO clinical classification of leprosy (Paucibacillary vs. Multibacillary).
• Stem keywords: skin patches, sensory deficit, thickened and tender peripheral nerves, Multibacillary (MB) leprosy
• Lead-in keywords: If a person is having
• Clinical cues: The 'and/or' in the stem indicates that either the skin lesion count or the nerve involvement count can independently determine the classification.

Question ID

QpPNvS0LfH92eUfVhPQYyi

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 1 p. 1447-1449