Leprosy: nerve involvement across the spectrum: practice question

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Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. In lepromatous disease nerve damage is symmetrical and appears late, while in tuberculoid disease it is early and asymmetrical

In tuberculoid disease a strong cell-mediated response damages a few nerves early and asymmetrically. In lepromatous disease bacilli spread widely, so damage is symmetrical and builds up late, producing glove-and-stocking sensory loss.

Option by option

• A. In lepromatous disease nerves are damaged early and asymmetrically, while tuberculoid disease spares nerves

  This reverses the true pattern and wrongly says tuberculoid disease spares nerves.

• B. In both polar forms the nerve involvement is symmetrical and appears at the same time

  The polar forms differ in timing and symmetry of nerve involvement.

• C. In lepromatous disease nerve damage is symmetrical and appears late, while in tuberculoid disease it is early and asymmetrical (correct)

  Correct. Tuberculoid damage is early and asymmetrical, and lepromatous damage is late and symmetrical.

• D. Nerve damage occurs only during lepra reactions and never at presentation

  Nerve damage can be present at diagnosis, and silent neuropathy can occur without reactions.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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