Viral Skin Infections Practice Questions

Q: All are true about the lesion shown in the image except:

Henderson-Patterson bodies are intranuclear bodies. ***Henderson-Patterson bodies are intranuclear bodies*** - **Henderson-Patterson bodies** are characteristic **eosinophilic viral inclusion bodies** found in cells infected with **molluscum contagiosum virus**. - These inclusion bodies are typically found within the **cytoplasm** (intracytoplasmic), not the nucleus. *Giant extensive lesions in HIV positive patients* - Patients with **compromised immune systems**, such as those who are **HIV positive**, can develop unusually large and extensive lesions. - This is due to their inability to mount an effective immune response against the **molluscum contagiosum virus**. *Auto-innoculated lesions* - **Molluscum contagiosum** lesions can spread to other areas of the body through **self-scratching** or contact. - This process, known as **auto-inoculation**, leads to new lesions appearing where the virus made contact with previously unaffected skin. *Needle extirpation followed by trichloro-acetic acid application* - **Needle extirpation** (pricking the central core of the lesion) followed by the application of **trichloroacetic acid (TCA)** is a common treatment method for molluscum contagiosum. - This approach aims to destroy the infected cells and prevent further viral spread.

Q: All are true about the lesion shown in the image except:

Henderson-Patterson bodies are intranuclear bodies. ***Henderson-Patterson bodies are intranuclear bodies*** - **Henderson-Patterson bodies** are characteristic **eosinophilic intracytoplasmic inclusions** found in keratinocytes infected with Molluscum contagiosum virus, not intranuclear. - This statement is incorrect because the inclusions are cytoplasmic. *Giant extensive lesions in HIV positive patients* - In **immunocompromised individuals**, particularly those with **HIV**, molluscum contagiosum lesions can be unusually large, numerous, and widespread. - This is due to a compromised immune response that prevents the effective clearance of the virus. *Auto-innoculated lesions* - **Molluscum contagiosum** lesions can spread rapidly from one area of the body to another through **scratching** or rubbing, a process known as auto-inoculation. - This characteristic explains the common presentation of multiple lesions in different sites. *Needle extirpation followed by trichloro-acetic acid application* - **Needle extirpation** (pricking the lesion with a sterile needle to express the core) followed by the application of a chemical cauterant like **trichloroacetic acid** is a common and effective treatment method for molluscum contagiosum. - This combination helps destroy the viral particles and prevent recurrence.

Q: A 25-year-old athlete presents with the following painless lesions in the sole of the foot. The aetiology is:

HPV-2. ***HPV-2*** - The image shows **plantar warts** (verruca plantaris), which are rough, grainy growths on the soles of the feet caused by **human papillomavirus (HPV)**. - **HPV-2** is a well-established cause of plantar warts, along with HPV-1, HPV-4, and HPV-63. - The black dots visible in the lesions are **thrombosed capillaries**, a hallmark feature of warts, distinguishing them from calluses. - Among the given options, **HPV-2 is the only viral etiology** that causes plantar warts. *HSV-2* - **Herpes simplex virus type 2 (HSV-2)** primarily causes **genital herpes**, characterized by painful blisters and ulcers in the genital area. - HSV-2 lesions are typically recurrent, painful, and vesicular, which is distinct from the painless, hyperkeratotic plantar lesions shown. *Candida* - **Candida** infections (candidiasis) can manifest as various skin conditions but rarely as discrete, rough, hyperkeratotic lesions on the sole of the foot. - Fungal infections on the feet typically present as **athlete's foot (tinea pedis)**, characterized by scaling, redness, and itching between toes, not as verrucous lesions. *Neuropathic ulcer* - **Neuropathic ulcers** are common in patients with **peripheral neuropathy** (e.g., from diabetes), often occurring at pressure points of the foot. - These ulcers are typically open sores with surrounding calluses and, while painless due to neuropathy, their appearance is distinct from the verrucous, papillomatous lesions of plantar warts.

Q: Which is not correct about the lesion shown below?

Bilaterally symmetrical dermatomal vesicular eruption. ***Bilaterally symmetrical dermatomal vesicular eruption*** - The image shows a **unilateral, dermatomal vesicular eruption**, characteristic of herpes zoster (shingles). - Herpes zoster lesions are typically restricted to **one side of the body** and follow a single dermatome, making bilateral symmetry incorrect. *The lesions are infectious to seronegative individuals* - The vesicles of herpes zoster contain **live varicella-zoster virus (VZV)**, which can be transmitted through direct contact. - Individuals who have not previously had chickenpox (seronegative for VZV) can contract **chickenpox** (not shingles) from exposure to these lesions. *Can be associated with meningoencephalitis* - Although rare, disseminated herpes zoster can lead to severe complications, including **meningoencephalitis** if the virus spreads to the central nervous system. - This complication is more likely in **immunocompromised individuals**. *Geniculate ganglion is involved in Ramsay hunt syndrome* - **Ramsay Hunt syndrome (Herpes zoster oticus)** is a specific complication of VZV reactivation involving the **geniculate ganglion** of the facial nerve. - This involvement leads to facial nerve palsy, ear pain, and typical vesicular rash in the ear canal or on the auricle.

Q: A 28-year-old lady has asymptomatic dome-shaped small lesions on the forehead for the past 2 months. She lives with her 2-year-old daughter who also is having similar lesions. What is the causative agent of these lesions?

Poxvirus. ***Poxvirus*** - The description of asymptomatic, **dome-shaped small lesions** and their presence in both a mother and her young child strongly suggests **molluscum contagiosum**, which is caused by a **poxvirus**. - Molluscum contagiosum lesions are typically **umbilicated**, which often appears dome-shaped, and are highly contagious, commonly spread through close contact. *HSV* - **Herpes Simplex Virus (HSV)** typically causes clusters of **painful vesicles** on an erythematous base, which later crust over. - The lesions described are asymptomatic and dome-shaped, not vesicular or painful. *HPV* - **Human Papillomavirus (HPV)** causes **warts**, which are rough, verrucous papules or plaques, not smooth dome-shaped lesions. - While warts can spread through close contact, their morphology differs significantly from the lesions described. *VZV* - **Varicella-Zoster Virus (VZV)** causes **chickenpox** (widespread itchy vesicles) or **shingles** (painful dermatomal rash). - The lesions described do not fit the characteristic presentation of either chickenpox or shingles, as they are asymptomatic and dome-shaped.

Q: Which of the following is INCORRECT regarding genital warts (condyloma acuminata)? 1. It is usually single. 2. It is related to HPV Types 6 and 11. 3. It can be transmitted sexually. 4. It can involve vagina and anus.

It is usually single.. ***It is usually single.*** - **Genital warts (condyloma acuminata)** caused by Human Papillomavirus (HPV) are typically **multiple lesions**, not single. - They often appear as **clusters** or "cauliflower-like" growths in the anogenital region. *It can involve vagina and anus.* - **Genital warts** can indeed involve the **vagina, anus, vulva, penis, perineum, and cervix**, as these are common areas of HPV infection. - The type of sexual activity influences the location of the lesions. *It is related to HPV Types 6 and 11.* - **HPV types 6 and 11** are indeed the most common causes of **genital warts**, accounting for approximately 90% of cases. - These are considered **low-risk HPV types** because they are rarely associated with cancer. *It can be transmitted sexually.* - **Genital warts** are a classic example of a **sexually transmitted infection (STI)**. - Transmission occurs through **skin-to-skin contact** during sexual activity.

Q: Which of the following statements about molluscum contagiosum is FALSE?

Laboratory confirmation is required for diagnosis. ***Laboratory confirmation is required for diagnosis*** - The diagnosis of **molluscum contagiosum** is primarily **clinical**, based on the characteristic appearance of the lesions (small, flesh-colored, dome-shaped papules with central umbilication). - While histology can confirm the diagnosis by revealing **molluscum bodies**, it is **not routinely required** for typical cases. *Lesions contain characteristic inclusion bodies* - This statement is **true**. Histological examination of molluscum contagiosum lesions reveals large, eosinophilic cytoplasmic inclusions, known as **molluscum bodies** or **Henderson-Paterson bodies**, within infected epidermal cells. - These inclusion bodies contain viral particles and are a **hallmark of the infection**. *Autoinoculation can spread the infection to new sites* - This statement is **true**. Molluscum contagiosum is highly contagious, and scratching or touching existing lesions can lead to the spread of the virus to previously unaffected skin areas on the same individual. - This process of **autoinoculation** explains why lesions often appear in clusters or linear arrays (Koebner phenomenon). *It is caused by a poxvirus* - This statement is **true**. Molluscum contagiosum is caused by the **molluscum contagiosum virus (MCV)**, which belongs to the **Poxviridae family**. - Poxviruses are known for their relatively large size and the ability to replicate entirely in the cytoplasm of host cells.

Q: A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?

Acyclovir 400mg orally TID for 7-10 days. Acyclovir 400mg orally TID for 7-10 days - The patient's presentation with painful genital ulcers and vesicles, fever, malaise, and tender inguinal lymphadenopathy is highly suggestive of primary herpes simplex virus (HSV) infection [1]. - Acyclovir is an antiviral medication that effectively reduces the duration and severity of symptoms in primary HSV outbreaks [1]. Azithromycin 1g orally as single dose - Azithromycin is primarily used to treat bacterial infections, particularly chlamydia and gonorrhea, which typically present with urethritis or cervicitis, not painful vesicles. - It is ineffective against viral infections such as HSV. Benzathine penicillin G 2.4 million units IM - Benzathine penicillin G is the treatment of choice for syphilis, which causes a painless chancre in its primary stage, not painful vesicles. - This antibiotic has no efficacy against HSV. Doxycycline 100mg orally BID for 14 days - Doxycycline is an antibiotic used for various bacterial infections, including chlamydia, lymphogranuloma venereum, and granuloma inguinale [1]. - These conditions typically present with different clinical features (e.g., painless ulcers, buboes) and not the vesicular rash seen in HSV.

Q: What is the primary route of transmission for molluscum contagiosum in adults?

Sexual contact. ***Sexual contact*** - In adults, **molluscum contagiosum** is predominantly transmitted through **direct skin-to-skin contact**, especially during sexual activity. - The lesions are often found in the **genital**, **perineal**, and **lower abdominal areas** in sexually active individuals. *Fecal-oral route* - This route of transmission is associated with infections spread through contaminated food or water, such as **Hepatitis A** or **gastroenteritis**, not molluscum contagiosum. - Molluscum contagiosum is a **poxvirus** that infects the skin directly, and is not shed in feces. *Respiratory droplets* - Diseases like the **common cold**, **influenza**, and **COVID-19** are typically spread via respiratory droplets, which involve airborne transmission from coughing or sneezing. - Molluscum contagiosum is a **dermal infection** and is not transmitted through the air. *Vector-borne transmission* - Vector-borne diseases are transmitted by living organisms, such as **mosquitoes** (e.g., malaria, dengue) or **ticks** (e.g., Lyme disease). - Molluscum contagiosum has no known insect or animal vector involved in its transmission.

Q: A 30-year-old man with recurrent genital warts has undergone multiple treatments without success. Which of the following treatments would be most appropriate to try next?

Imiquimod cream. ***Imiquimod cream*** - **Imiquimod** is an **immune response modifier** that stimulates the production of **cytokines**, such as interferon-alpha, which has antiviral and antiproliferative effects, making it effective for persistent warts. - It is particularly useful for recurrent warts or those unresponsive to ablative therapies due to its mechanism of action targeting the underlying viral infection. *Electrocautery* - **Electrocautery** physically destroys the wart tissue using heat, which can be effective but carries risks of scarring and potential recurrence if not completely eradicated. - For recurrent warts, the underlying Human Papillomavirus (HPV) infection needs to be addressed, which ablative methods like electrocautery do not inherently do. *Podophyllin resin* - **Podophyllin resin** is a **cytotoxic agent** that inhibits cell division, leading to tissue necrosis; however, it can be irritating and is generally not recommended for extensive or recurrent lesions due to potential systemic absorption and toxicity. - Its mechanism primarily involves destroying the infected cells rather than stimulating a host immune response, which might be less effective for recurrent cases. *Liquid nitrogen cryotherapy* - **Liquid nitrogen cryotherapy** works by freezing and destroying the wart tissue, but it often requires multiple sessions and can be painful. - Similar to electrocautery, it is an ablative method that does not directly enhance the host's immune response to clear the Human Papillomavirus (HPV), making it less ideal for recurrent cases where host immunity might be a factor.

Question 1

All are true about the lesion shown in the image except:

Accepted Answer

Henderson-Patterson bodies are intranuclear bodies

Answer

Giant extensive lesions in HIV positive patients

Answer

Auto-inoculated lesions

Answer

Needle extirpation followed by trichloro-acetic acid application

Question 2

All are true about the lesion shown in the image except:

Accepted Answer

Henderson-Patterson bodies are intranuclear bodies

Answer

Giant extensive lesions in HIV positive patients

Answer

Auto-inoculated lesions

Answer

Needle extirpation followed by trichloro-acetic acid application

Question 3

A 25-year-old athlete presents with the following painless lesions in the sole of the foot. The aetiology is:

Accepted Answer

HPV-2

Answer

HSV-2

Answer

Candida

Answer

Neuropathic ulcer

Question 4

Which is not correct about the lesion shown below?

Accepted Answer

Bilaterally symmetrical dermatomal vesicular eruption

Answer

The lesions are infectious to seronegative individuals

Answer

Can be associated with meningoencephalitis

Answer

Geniculate ganglion is involved in Ramsay hunt syndrome

Question 5

A 28-year-old lady has asymptomatic dome-shaped small lesions on the forehead for the past 2 months. She lives with her 2-year-old daughter who also is having similar lesions. What is the causative agent of these lesions?

Accepted Answer

Poxvirus

Answer

HSV

Answer

HPV

Answer

VZV

Question 6

Which of the following is INCORRECT regarding genital warts (condyloma acuminata)?

1. It is usually single.
2. It is related to HPV Types 6 and 11.
3. It can be transmitted sexually.
4. It can involve vagina and anus.

Accepted Answer

It is usually single.

Answer

It can involve vagina and anus.

Answer

It is related to HPV Types 6 and 11.

Answer

It can be transmitted sexually.

Question 7

Which of the following statements about molluscum contagiosum is FALSE?

Accepted Answer

Laboratory confirmation is required for diagnosis

Answer

Lesions contain characteristic inclusion bodies

Answer

Autoinoculation can spread the infection to new sites

Answer

It is caused by a poxvirus

Question 8

A 19-year-old woman presents with painful genital ulcers and vesicles for 4 days, accompanied by fever, malaise, and tender inguinal lymphadenopathy. What is the most appropriate initial management?

Accepted Answer

Acyclovir 400mg orally TID for 7-10 days

Answer

Azithromycin 1g orally as single dose

Answer

Benzathine penicillin G 2.4 million units IM

Answer

Doxycycline 100mg orally BID for 14 days

Question 9

What is the primary route of transmission for molluscum contagiosum in adults?

Accepted Answer

Sexual contact

Answer

Fecal-oral route

Answer

Respiratory droplets

Answer

Vector-borne transmission

Question 10

A 30-year-old man with recurrent genital warts has undergone multiple treatments without success. Which of the following treatments would be most appropriate to try next?

Accepted Answer

Imiquimod cream

Answer

Electrocautery

Answer

Podophyllin resin

Answer

Liquid nitrogen cryotherapy

Viral Skin Infections — MCQs

Viral Skin Infections — MCQs

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