National Leprosy Eradication Program MCQs With Answer

The National Leprosy Eradication Programme (NLEP) is India’s flagship public health initiative targeting elimination of leprosy through early diagnosis, effective treatment, disability prevention and community rehabilitation. This introduction covers key aspects relevant for B. Pharm students: epidemiology, program goals, WHO and national case definitions, laboratory diagnosis, classification systems, multi-drug therapy (MDT) regimens, drug mechanisms (dapsone, rifampicin, clofazimine), adverse effects, monitoring, post-exposure prophylaxis and programmatic management including surveillance and reporting. Understanding these topics helps pharmacists contribute to drug supply management, adverse event monitoring and patient counselling. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which organism is the primary causative agent of leprosy targeted by the NLEP?

• Mycobacterium tuberculosis
• Mycobacterium leprae
• Treponema pallidum
• Staphylococcus aureus

Correct Answer: Mycobacterium leprae

Q2. What is the WHO operational classification used in NLEP to decide MDT regimen?

• Paucibacillary and Multibacillary
• Primary and Secondary
• Acute and Chronic
• Localised and Dissemi­nated

Correct Answer: Paucibacillary and Multibacillary

Q3. Which drug in MDT is primarily bactericidal and given monthly supervised in MB and PB regimens?

• Dapsone
• Rifampicin
• Clofazimine
• Ethambutol

Correct Answer: Rifampicin

Q4. What is the standard WHO MDT duration for multibacillary (MB) leprosy endorsed by NLEP?

• 6 months
• 12 months
• 24 months
• Lifelong

Correct Answer: 12 months

Q5. Which adverse effect is most characteristically associated with dapsone therapy that pharmacists must monitor?

• Hepatotoxicity
• Oxidative haemolysis in G6PD deficiency
• Ototoxicity
• Hyperpigmentation

Correct Answer: Oxidative haemolysis in G6PD deficiency

Q6. Clofazimine commonly causes which visible adverse effect important for patient counselling?

• Photosensitivity rash
• Scleroderma-like skin tightening
• Skin hyperpigmentation and ichthyosis
• Nail discoloration only

Correct Answer: Skin hyperpigmentation and ichthyosis

Q7. Which immunological reaction in leprosy is characterized by painful erythematous nodules and systemic features, requiring thalidomide or steroids?

• Type 1 (reversal) reaction
• Type 2 (erythema nodosum leprosum) reaction
• Immune reconstitution inflammatory syndrome
• Serum sickness

Correct Answer: Type 2 (erythema nodosum leprosum) reaction

Q8. For B. Pharm students, which mechanism best describes rifampicin’s action against Mycobacterium leprae?

• Inhibition of DNA gyrase
• Inhibition of mycolic acid synthesis
• Inhibition of DNA-dependent RNA polymerase
• Cell wall lysis via autolysins

Correct Answer: Inhibition of DNA-dependent RNA polymerase

Q9. Which laboratory test is most specific for detecting acid-fast bacilli load in leprosy patients?

• Slit-skin smear bacillary index
• Complete blood count
• Montenegro skin test
• ELISA for IgM

Correct Answer: Slit-skin smear bacillary index

Q10. What is the primary public health indicator used by NLEP to measure leprosy burden historically?

• Incidence rate per 1000 population
• Prevalence rate per 10,000 population
• Case fatality rate
• Hospital admission rate

Correct Answer: Prevalence rate per 10,000 population

Q11. Which of the following is a correct adult WHO MDT regimen for paucibacillary (PB) leprosy?

• Rifampicin monthly and daily dapsone for 6 months
• Rifampicin, dapsone and clofazimine for 12 months
• Dapsone monotherapy for 24 months
• Rifampicin and ofloxacin for 6 months

Correct Answer: Rifampicin monthly and daily dapsone for 6 months

Q12. Single-dose rifampicin (SDR) is used in NLEP for which purpose?

• Treatment of MB leprosy
• Post-exposure prophylaxis for contacts
• Management of ENL reactions
• Eradication of drug-resistant strains

Correct Answer: Post-exposure prophylaxis for contacts

Q13. Which classification system is more detailed for clinical and immunopathological classification but less used programmatically than WHO classification?

• Ridley-Jopling classification
• Levinson scale
• Jones-Miller classification
• WHO MB/PB only

Correct Answer: Ridley-Jopling classification

Q14. Which monitoring parameter is most relevant for evaluating response to MDT in MB patients?

• Serial slit-skin smear bacillary index decrease
• Periodic chest X-ray
• Urine microscopy
• Hemoglobin levels only

Correct Answer: Serial slit-skin smear bacillary index decrease

Q15. Drug resistance in leprosy is most commonly detected using which molecular target for rifampicin resistance?

• rpoB gene mutations
• katG gene mutations
• gyrA gene mutations
• embB gene mutations

Correct Answer: rpoB gene mutations

Q16. Which adverse effect necessitates baseline G6PD testing or caution before starting dapsone?

• Peripheral neuropathy
• Severe haemolytic anemia
• Nephrotoxicity
• Hypoglycemia

Correct Answer: Severe haemolytic anemia

Q17. Which strategy is essential for disability prevention in NLEP and requires pharmacist involvement?

• Provision and counselling on MDT only
• Early detection, prompt MDT, wound care and physiotherapy
• Isolation of all patients until smear negative
• Monthly hospitalisation for all cases

Correct Answer: Early detection, prompt MDT, wound care and physiotherapy

Q18. Which drug interaction is of greatest concern when prescribing rifampicin in MDT for leprosy?

• Rifampicin inhibits CYP3A4 causing increased drug levels
• Rifampicin induces CYP enzymes causing reduced levels of many drugs
• Rifampicin potentiates anticoagulants causing bleeding
• Rifampicin blocks renal excretion of aminoglycosides

Correct Answer: Rifampicin induces CYP enzymes causing reduced levels of many drugs

Q19. Which type of nerve involvement is characteristic and must be assessed in leprosy patients?

• Peripheral mononeuritis multiplex with sensory and motor deficits
• Central demyelination in spinal cord
• Cranial nerve VIII isolated involvement
• Autonomic neuropathy only

Correct Answer: Peripheral mononeuritis multiplex with sensory and motor deficits

Q20. What is the role of BCG vaccination related to leprosy control considered in NLEP context?

• No role; increases leprosy risk
• Provides partial protective effect against leprosy
• Complete protection equivalent to MDT
• Used therapeutically to treat MB leprosy

Correct Answer: Provides partial protective effect against leprosy

Q21. Which record or activity is crucial for program surveillance and follow-up in NLEP at peripheral level?

• Monthly national reports only
• Active case detection, line-listing and treatment registers
• Annual vaccination logs
• Hospital bed occupancy records

Correct Answer: Active case detection, line-listing and treatment registers

Q22. Which of the following is the recommended management for type 1 (reversal) reactions in leprosy?

• High-dose corticosteroids to control inflammation
• Immediate thalidomide for all cases
• Stop MDT and observe
• Start high-dose dapsone only

Correct Answer: High-dose corticosteroids to control inflammation

Q23. Which pharmacokinetic property of clofazimine explains its prolonged tissue persistence and slow onset of action?

• High renal clearance
• Extensive tissue accumulation and lipophilicity
• Rapid plasma elimination half-life
• Poor absorption leading to short action

Correct Answer: Extensive tissue accumulation and lipophilicity

Q24. In programmatic terms, elimination of leprosy is defined by WHO as reduction of prevalence to what threshold?

• Less than 1 case per 1000 population
• Zero cases nationwide
• Less than 1 case per 10,000 population
• Less than 10 cases per 100,000 population

Correct Answer: Less than 1 case per 10,000 population

Q25. Which test can be used in reference laboratories to detect low levels of Mycobacterium leprae DNA and support diagnosis?

• PCR targeting specific M. leprae sequences
• Rapid antigen test for protein A
• Serum cryptococcal antigen
• ASO titre

Correct Answer: PCR targeting specific M. leprae sequences

Q26. Which of the following is a major challenge for NLEP that pharmacists can help mitigate?

• Overuse of surgical interventions
• Maintaining uninterrupted MDT drug supply and pharmacovigilance
• Excessive quarantine of contacts
• High cost of MDT for patients

Correct Answer: Maintaining uninterrupted MDT drug supply and pharmacovigilance

Q27. Which indicator suggests possible relapse or treatment failure in a patient after completing MDT?

• Gradual decrease in skin lesions and negative smear
• New or enlarging skin lesions with rising bacillary index
• Persistent hyperpigmentation only
• Resolution of nerve thickening

Correct Answer: New or enlarging skin lesions with rising bacillary index

Q28. Which counseling point is essential for patients starting clofazimine as part of MDT?

• Expect immediate improvement in skin color within days
• Skin discoloration may occur and can be long-lasting
• Stop drug if pigmentation begins
• There are no notable side effects

Correct Answer: Skin discoloration may occur and can be long-lasting

Q29. Which public health approach improves early detection and reduces disability burden in leprosy?

• Mass drug administration to entire population annually
• Community-based active case finding and contact screening
• Only tertiary hospital-based diagnosis
• Exclusive reliance on patient self-reporting

Correct Answer: Community-based active case finding and contact screening

Q30. As B. Pharm students involved in NLEP, which activity is within pharmacy scope to enhance program outcomes?

• Prescribe second-line anti-leprosy drugs without oversight
• Ensure correct dispensing of MDT, report adverse events and counsel patients
• Perform skin biopsies in field clinics
• Decide national elimination targets

Correct Answer: Ensure correct dispensing of MDT, report adverse events and counsel patients

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