Epstein-Barr Virus Manifestations — MCQs
LMP 1 gene plays a role in oncogenesis induced by
A child presented with bluish-white spots in the mouth followed by a rash. What is the genome of the most likely causative agent?
A baby presents with recurrent ear infections with discharge, seborrheic dermatitis, hepatosplenomegaly, and cystic skull lesions. What is the most likely diagnosis?
All of the following are strongly associated with AIDS except:
Which virus is associated with Hodgkin's lymphoma?
An 8-year-old boy from an impoverished inner-city area has never been vaccinated appropriately. He develops fever, cough, and coryza. The next day, blue white spots develop on the buccal mucosa. On the third day, an erythematous, nonpruritic maculopapular rash develops on the face and spreads over the entire body. Which of the following is the most likely complication?
The following are true about Epstein-Barr virus (EBV) except which of the following?
In infectious mononucleosis, which cell type shows the most significant pathological changes?
A 22-year-old woman presents with painless cervical lymphadenopathy, night sweats, and generalized pruritus. An enlarged cervical lymph node is removed for diagnosis, which shows broad bands of fibrosis on cut surface and histologically contains a mixture of cells, including lymphocytes, histiocytes, eosinophils, plasma cells, and scattered large cells with prominent nucleoli. Which of the following is the most likely condition?
Genital warts are caused by:
Epstein-Barr Virus Manifestations Indian Medical PG Practice Questions and MCQs
Question 1: LMP 1 gene plays a role in oncogenesis induced by
- A. Hepatitis B virus
- B. Human T cell leukemia virus type 1
- C. Human papilloma virus
- D. Epstein Barr virus (Correct Answer)
Explanation: ***Epstein Barr virus*** - The **LMP1 (Latent Membrane Protein 1)** gene is a key **oncogene** encoded by the **Epstein-Barr virus (EBV)**. - LMP1 acts as a **constitutively active receptor**, mimicking CD40 and leading to the activation of several cellular signaling pathways (**NF-κB, JNK/p38, PI3K/Akt**) crucial for cell proliferation, survival, and differentiation. *Hepatitis B virus* - **Hepatitis B virus (HBV)** is associated with **hepatocellular carcinoma (HCC)**, but its oncogenic mechanisms primarily involve the **HBx protein**, which deregulates cell cycles and impacts host gene expression. - HBV does not encode an LMP1 equivalent; its oncogenesis is linked to chronic inflammation, hepatocyte regeneration, and integration of viral DNA. *Human T cell leukemia virus type 1* - **Human T-cell leukemia virus type 1 (HTLV-1)** is linked to **Adult T-cell Leukemia/Lymphoma (ATL)**, with its primary oncogene being **Tax**. - **Tax protein** activates NF-κB and other pro-proliferative pathways, but HTLV-1 does not have an LMP1 gene. *Human papilloma virus* - **Human papillomavirus (HPV)** is responsible for cervical and other anogenital cancers, with major oncogenes being **E6 and E7**. - **E6 targets p53** for degradation, and **E7 inactivates Rb**, leading to uncontrolled cell division; HPV does not encode an LMP1 gene.
Question 2: A child presented with bluish-white spots in the mouth followed by a rash. What is the genome of the most likely causative agent?
- A. Enveloped virus with single-stranded RNA (Correct Answer)
- B. Double stranded Naked RNA
- C. Naked virus with single-stranded RNA
- D. Double stranded Enveloped RNA
Explanation: ***Enveloped virus with single-stranded RNA*** - Bluish-white spots in the mouth (**Koplik spots**) followed by a rash are pathognomonic for **measles**, which is caused by the **measles virus**. - The measles virus is a **paramyxovirus**, characterized as an **enveloped, negative-sense, single-stranded RNA virus**. *Double stranded Naked RNA* - No major human pathogen belongs to this specific genomic and structural classification. - Most **dsRNA viruses** like **rotavirus** are **naked** but cause gastroenteritis, not measles. *Naked virus with single-stranded RNA* - Viruses like **rhinovirus** (common cold) or **poliovirus** fit this description but do not cause Koplik spots or measles. - **Naked viruses** lack a lipid envelope, making them generally more resistant to environmental factors. *Double stranded Enveloped RNA* - There are no known medically significant human viruses that are both **enveloped** and contain **double-stranded RNA**. - Viral genomes are typically either DNA or RNA, and RNA viruses are usually single-stranded (positive or negative sense) or double-stranded, with or without an envelope.
Question 3: A baby presents with recurrent ear infections with discharge, seborrheic dermatitis, hepatosplenomegaly, and cystic skull lesions. What is the most likely diagnosis?
- A. Hemophagocytic lymphohistiocytosis
- B. Multiple myeloma
- C. Langerhans cell histiocytosis (Correct Answer)
- D. Acute lymphoblastic leukemia (ALL)
Explanation: ***Langerhans cell histiocytosis*** - This classic presentation involves a constellation of symptoms including **seborrheic dermatitis-like rash**, recurrent ear infections with discharge (due to infiltration of the mastoid bone), hepatosplenomegaly, and **cystic skull lesions**, all highly suggestive of Langerhans cell histiocytosis (LCH). - LCH is a rare disorder characterized by the proliferation of abnormal Langerhans cells, which can affect various organs and systems. *Hemophagocytic lymphohistiocytosis* - While patients with Hemophagocytic Lymphohistiocytosis (HLH) can present with **hepatosplenomegaly** and recurrent infections, they typically have high fevers, cytopenias, and poor clinical condition. - HLH does not typically cause **seborrheic dermatitis-like rashes** or **cystic bone lesions**. *Multiple myeloma* - Multiple myeloma is a **plasma cell malignancy** that predominantly affects older adults and is characterized by bone pain, anemia, renal failure, and hypercalcemia. - It does not present with recurrent ear infections, seborrheic dermatitis, or hepatosplenomegaly in this manner, and is exceedingly rare in infants. *Acute lymphoblastic leukemia (ALL)* - ALL is the most common childhood cancer and can cause **hepatosplenomegaly**, recurrent infections (due to neutropenia), and sometimes bone pain. - However, **seborrheic dermatitis-like rash** and **cystic skull lesions** are not typical features of ALL.
Question 4: All of the following are strongly associated with AIDS except:
- A. Candidiasis
- B. Kaposi sarcoma
- C. Oral hairy leukoplakia
- D. ANUG (Correct Answer)
Explanation: ***ANUG*** - **Acute necrotizing ulcerative gingivitis (ANUG)**, also known as Vincent stomatitis or "trench mouth," is a severe form of gingivitis caused by a bacterial infection. While it can occur in immunocompromised individuals, it is not considered an AIDS-defining illness [1]. - ANUG is characterized by painful, bleeding gums, foul breath, and ulceration of the interdental papillae, but its mere presence does not automatically indicate an AIDS diagnosis [1]. *Candidiasis* - **Candidiasis**, particularly **esophageal candidiasis**, is an **AIDS-defining illness** and strongly associated with advanced HIV infection [1]. - Oral candidiasis (thrush) is also very common in HIV-positive individuals and often progresses to esophageal involvement as the immune system weakens [1]. *Kaposi sarcoma* - **Kaposi sarcoma** is an **AIDS-defining cancer** caused by **human herpesvirus 8 (HHV-8)**, and its presence strongly indicates advanced HIV disease [1]. - It manifests as vascular lesions on the skin, mucous membranes, and internal organs, and its incidence has decreased with effective antiretroviral therapy [1]. *Oral hairy leukoplakia* - **Oral hairy leukoplakia (OHL)** is a benign lesion caused by the **Epstein-Barr virus (EBV)**, commonly seen in HIV-positive individuals, signaling significant immunosuppression [1]. - While not an AIDS-defining condition itself, OHL is a strong indicator of **HIV disease progression** and impaired immune function [1].
Question 5: Which virus is associated with Hodgkin's lymphoma?
- A. Epstein-Barr virus (EBV) (Correct Answer)
- B. Cytomegalovirus (CMV)
- C. Human herpesvirus 8 (HHV8)
- D. Human herpesvirus 6 (HHV6)
Explanation: ***EBV*** - **Epstein-Barr Virus (EBV)** is strongly associated with the development of Hodgkin's lymphoma, particularly in patients presenting with mixed cellularity [1]. - EBV is found in the **Reed-Sternberg cells**, a characteristic feature of Hodgkin's lymphoma [1]. *HHV8* - **HHV8** is mainly associated with Kaposi's sarcoma and primary effusion lymphoma, not Hodgkin's lymphoma. - It typically affects immunocompromised individuals, especially those with HIV/AIDS, which differs from Hodgkin's lymphoma associations. *HHV6* - While **HHV6** can cause certain diseases like roseola in children, it is not linked to Hodgkin's lymphoma. - There is minimal evidence connecting it with lymphomagenesis in broader contexts. *CMV* - **Cytomegalovirus (CMV)** is primarily recognized for causing opportunistic infections, especially in immunocompromised patients. - Its association with Hodgkin's lymphoma is not substantiated, making it irrelevant in this context. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 616-618.
Question 6: An 8-year-old boy from an impoverished inner-city area has never been vaccinated appropriately. He develops fever, cough, and coryza. The next day, blue white spots develop on the buccal mucosa. On the third day, an erythematous, nonpruritic maculopapular rash develops on the face and spreads over the entire body. Which of the following is the most likely complication?
- A. encephalitis
- B. bronchitis
- C. otitis media
- D. pneumonia (Correct Answer)
Explanation: ***Pneumonia*** - This scenario describes **measles** (rubeola) with the classic triad of fever, cough, and coryza (the **3 Cs**), along with pathognomonic **Koplik spots** (blue-white spots on buccal mucosa) and the characteristic **maculopapular rash** spreading cephalocaudally from the face. - **Pneumonia** is the **most common serious complication** of measles, occurring in approximately **1-6% of cases**, and is the **leading cause of measles-related mortality** in children. - It can be either **viral pneumonia** (direct measles virus infection) or **secondary bacterial pneumonia** (especially *Streptococcus pneumoniae*, *Staphylococcus aureus*, *Haemophilus influenzae*). - This is particularly common in **unvaccinated, malnourished, and immunocompromised children** from impoverished areas, as described in this case. *Otitis media* - **Otitis media** is a common complication of measles, occurring in approximately **5-9% of cases**. - While frequent, it is **less common than pneumonia** and is generally less severe in terms of mortality risk. - It typically presents with ear pain and can lead to hearing complications if untreated. *Encephalitis* - **Measles encephalitis** is a rare but severe complication, occurring in approximately **1 in 1000 cases** (0.1%). - It typically develops **1-2 weeks after rash onset**, presenting with fever, headache, seizures, altered consciousness, and neurological deficits. - While serious with significant mortality and morbidity, it is **much less common** than pneumonia. *Bronchitis* - **Bronchitis** (cough, chest congestion) is typically part of the **initial prodromal phase** of measles itself rather than a distinct complication. - The respiratory symptoms (cough, coryza) are manifestations of the primary measles infection, not secondary complications.
Question 7: The following are true about Epstein-Barr virus (EBV) except which of the following?
- A. Infects epithelial cells of pharynx
- B. It is implicated in nasopharyngeal carcinoma
- C. A member of herpes virus family
- D. The main target of virus is the T-cell lymphocytes (Correct Answer)
Explanation: ***The main target of virus is the T-cell lymphocytes*** - This statement is incorrect because **Epstein-Barr virus (EBV)** primarily targets **B-lymphocytes**, not T-cell lymphocytes. - EBV infects B cells by binding to the **CD21 receptor** on their surface. *A member of herpes virus family* - **EBV** is indeed a member of the **Herpesviridae family**, specifically **gammaherpesvirus**. - Other common herpesviruses include **herpes simplex virus (HSV)** and **cytomegalovirus (CMV)**. *Infects epithelial cells of pharynx* - EBV initially infects and replicates in **epithelial cells of the oropharynx**, contributing to viral shedding in saliva. - This initial infection allows the virus to spread to the targeted B-lymphocytes. *It is implicated in nasopharyngeal carcinoma* - EBV is strongly associated with **nasopharyngeal carcinoma (NPC)**, particularly in endemic regions. - It is also linked to other malignancies like **Burkitt lymphoma** and **Hodgkin lymphoma**.
Question 8: In infectious mononucleosis, which cell type shows the most significant pathological changes?
- A. B-cells
- B. Macrophages
- C. NK cells
- D. T-cells (Correct Answer)
Explanation: ***Correct: T-cells*** - In response to **Epstein-Barr virus (EBV)** infection of B-cells, there is a massive proliferation of **CD8+ cytotoxic T-lymphocytes** which are responsible for controlling the infection and mediating many of the symptoms. - These activated T-cells, known as **atypical lymphocytes** or **Downey cells**, are the characteristic pathological finding in peripheral blood smears of patients with infectious mononucleosis. - The **lymphocytosis with atypical lymphocytes** (>10% of total WBCs) is the hallmark laboratory finding. *Incorrect: B-cells* - **EBV directly infects B-cells**, leading to their proliferation, but the most significant pathological changes observed in the blood smear are due to the host's immune response. - While B-cells are the primary target of EBV, the hallmark feature of infectious mononucleosis on a peripheral blood smear is the presence of reactive T-cells, not the infected B-cells themselves. *Incorrect: Macrophages* - Macrophages play a role in clearing cellular debris and presenting antigens during an infection, but they do not show the most significant **pathological changes** or proliferative response characteristic of infectious mononucleosis. - They are generally not the predominant cell type exhibiting **atypical morphology** in the peripheral blood during this condition. *Incorrect: NK cells* - **Natural killer (NK) cells** are part of the innate immune response and contribute to controlling viral infections, including EBV. - However, they do not undergo the distinct and extensive **morphological changes** and proliferation seen in T-cells during infectious mononucleosis.
Question 9: A 22-year-old woman presents with painless cervical lymphadenopathy, night sweats, and generalized pruritus. An enlarged cervical lymph node is removed for diagnosis, which shows broad bands of fibrosis on cut surface and histologically contains a mixture of cells, including lymphocytes, histiocytes, eosinophils, plasma cells, and scattered large cells with prominent nucleoli. Which of the following is the most likely condition?
- A. Cat-scratch disease
- B. Hodgkin disease (Correct Answer)
- C. Reactive non-specific lymphadenitis
- D. Non-Hodgkin lymphoma
Explanation: ***Hodgkin disease*** - The presence of **painless cervical lymphadenopathy**, night sweats, and **generalized pruritus** is classical for Hodgkin lymphoma [3][4]. - Histological findings of **broad bands of fibrosis** and a mixture of cell types including **Reed-Sternberg cells** confirm the diagnosis [1][2][3]. *Non-Hodgkin lymphoma* - Typically presents with **rapidly enlarging lymph nodes** and is often associated with extra-nodal involvement, differing from the features in this case [3]. - Histology usually shows a more homogeneous population of **malignant lymphoid cells**, not the fibrotic bands seen in Hodgkin disease [3]. *Reactive non-specific lymphadenitis* - This condition is characterized by **hyperplastic lymphoid tissue** and **neutrophilic infiltration**, often following infection, which does not match the findings. - It typically lacks the distinct cell types and fibrosis observed in the biopsy of Hodgkin disease. *Cat-scratch disease* - Caused by *Bartonella henselae*, it often presents with **granulomatous lymphadenopathy** rather than the mixed cellular response seen in Hodgkin disease. - Symptoms usually include a history of cat exposure and may present with **fever, fatigue**, and localized lymphadenopathy, not generalized pruritus. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 616-618. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 616. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-616. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 618.
Question 10: Genital warts are caused by:
- A. Human Papilloma Virus (Correct Answer)
- B. Chlamydia trachomatis
- C. Epstein Barr virus
- D. HSV
Explanation: ***Human Papilloma Virus*** - **Human Papilloma Virus (HPV)** is the primary cause of genital warts, particularly low-risk types like **HPV-6** and **HPV-11**. - HPV infection is common and is transmitted primarily through **sexual contact**. *Chlamydia trachomatis* - **Chlamydia trachomatis** is a bacterium that causes a common sexually transmitted infection (STI), leading to **urethritis**, **cervicitis**, and pelvic inflammatory disease, but not genital warts. - It can cause symptoms like **dysuria** and **vaginal discharge**, or be asymptomatic, but does not result in wart-like lesions. *Epstein Barr virus* - **Epstein-Barr virus (EBV)** is a herpesvirus primarily known for causing **infectious mononucleosis** (glandular fever). - It is associated with certain cancers like nasopharyngeal carcinoma and lymphomas but not with sexually transmitted genital warts. *HSV* - **Herpes Simplex Virus (HSV)** causes **genital herpes**, characterized by painful **blisters** and **sores** that typically recur. - While HSV is a sexually transmitted infection, the lesions it causes are vesicular and ulcerative, distinctly different from the fleshy, wart-like lesions of HPV.
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