Hand, Foot, and Mouth Disease — MCQs
Hand-foot-mouth disease is caused by:
Neurological complications of meningitis include all of the following except:
Which of the following is not a poxvirus?
After a renal transplant, what is the most common opportunistic infection?
What is the primary disease associated with Enterovirus 71?
A 35-year-old professional businesswoman notices the appearance of several hyperkeratotic, well-demarcated growths on the palmar surface of her index finger and on her toe. They do not change in size and cause her only minimal discomfort. A biopsy of one of the lesions, viewed at 40x magnification, is shown. Which of the following viruses is the most likely etiologic agent?
A 7 year old boy presented with generalized edema. Urine examination revealed marked albuminuria. Serum biochemical examinations showed hypoalbuminemia with hyperlipidemia. Kidney biopsy was undertaken. On light microscopic examination, the kidney appeared normal. Electron microscopic examination is most likely to reveal
Which of the following is the correct combination?
A 7-year-old boy presented with generalized edema. Urine examination revealed marked albuminuria. Serum biochemical examinations showed hypoalbuminemia with hyperlipidemia. Kidney biopsy was undertaken. On light microscopic examination, the kidney appeared normal. Electron microscopic examination is most likely to reveal:
Which of the following conditions is primarily treated by sympathectomy?
Hand, Foot, and Mouth Disease Indian Medical PG Practice Questions and MCQs
Question 1: Hand-foot-mouth disease is caused by:
- A. Coxsackie-B virus
- B. EBV
- C. CMV
- D. Coxsackie-A virus (Correct Answer)
Explanation: ***Coxsackie-A virus*** - Hand-foot-mouth disease (HFMD) is most commonly caused by **Coxsackievirus A16** within the species **Human enterovirus A**. - Other **Coxsackievirus A serotypes** can also cause HFMD, particularly **A6, A10**, and **Enterovirus A71**. *Coxsackie-B virus* - **Coxsackievirus B** is known to cause a range of illnesses, including **myocarditis**, **pleurodynia (Bornholm disease)**, and **pericarditis**. - While it belongs to the same genus (Enterovirus), it is not the typical causative agent of HFMD. *EBV* - **Epstein-Barr Virus (EBV)** is a herpesvirus that causes **infectious mononucleosis**, **Burkitt's lymphoma**, and **nasopharyngeal carcinoma**. - It is transmitted through saliva and is **not associated with HFMD**. *CMV* - **Cytomegalovirus (CMV)** is a common virus that can cause a wide spectrum of diseases, especially in immunocompromised individuals and congenitally. - It is known for causing mononucleosis-like syndrome, congenital infections, and retinitis, but it is **not associated with HFMD**.
Question 2: Neurological complications of meningitis include all of the following except:
- A. Increased intracranial pressure
- B. Brain abscess
- C. Subdural effusions
- D. Cerebral hamartoma (Correct Answer)
Explanation: Cerebral hamartoma - A cerebral hamartoma is a benign, tumor-like malformation of abnormally organized mature brain tissue; it is a developmental anomaly and not a complication of meningitis. - Unlike the other options, it does not represent an inflammatory, infectious, or pressure-related sequela of meningeal infection. Increased intracranial pressure - Increased intracranial pressure (ICP) is a common and serious complication of meningitis due to cerebral edema, hydrocephalus, or vasodilation. - Elevated ICP can lead to herniation, neurological deficits, and even death if not managed promptly. Brain abscess - A brain abscess is a localized collection of pus within the brain parenchyma that can develop as a focal complication of bacterial meningitis, particularly in cases of hematogenous spread or direct extension of infection [1]. - This serious condition causes focal neurological deficits and requires aggressive treatment. Subdural effusions - Subdural effusions are accumulations of sterile or infected fluid in the subdural space, most commonly seen in infants and young children with bacterial meningitis. - While they can be asymptomatic, large effusions may cause increased ICP or focal neurological signs requiring drainage.
Question 3: Which of the following is not a poxvirus?
- A. Molluscum contagiosum
- B. Orf virus
- C. Vaccinia virus
- D. Coxsackie virus (Correct Answer)
Explanation: ***Coxsackie virus*** - The **Coxsackie virus** belongs to the family **Picornaviridae**, not Poxviridae. - It is known for causing diseases such as **hand, foot, and mouth disease**, herpangina, and myocarditis. *Vaccinia virus* - **Vaccinia virus** is a well-known member of the **Poxviridae** family, historically used in the smallpox vaccine. - It is a **large, complex DNA virus** that replicates in the cytoplasm of infected cells. *Molluscum contagiosum* - **Molluscum contagiosum virus (MCV)** is a **poxvirus** that causes a mild skin infection characterized by raised, pearly, umbilicated lesions. - It primarily infects **humans**, causing localized lesions that are spread through direct contact. *Orf virus* - **Orf virus**, also known as contagious pustular dermatitis virus, is a **poxvirus** that primarily affects sheep and goats. - It can be transmitted to humans, causing single papular or nodular lesions, usually on the fingers, hands, or forearms.
Question 4: After a renal transplant, what is the most common opportunistic infection?
- A. Varicella Zoster Virus (VZV)
- B. Coxsackie Virus
- C. Epstein-Barr Virus (EBV)
- D. Cytomegalovirus (CMV) (Correct Answer)
Explanation: ***Cytomegalovirus (CMV)*** - **CMV** is the most common opportunistic infection after renal transplantation, particularly in the first 6 months due to immunosuppression [1]. - It can cause a range of clinical syndromes, including **fever**, **leukopenia**, **gastroenteritis**, **pneumonitis**, and **hepatitis**, and can also have indirect effects that increase the risk of graft rejection. *Varicella Zoster Virus (VZV)* - While VZV can cause opportunistic infections in transplant recipients (e.g., **shingles**), it is less common than CMV [1]. - VZV typically occurs later post-transplant and is characterized by a **vesicular rash** in a dermatomal distribution. *Coxsackie Virus* - **Coxsackie virus** infections are less frequently reported as significant opportunistic infections in renal transplant recipients compared to other viral pathogens. - They are generally associated with hand-foot-and-mouth disease, herpangina, or myocarditis, which are not the most common post-transplant complications. *Epstein-Barr Virus (EBV)* - **EBV** can cause post-transplant lymphoproliferative disorder (PTLD), which is a serious complication, but EBV infection itself is not the most common opportunistic infection overall [1]. - PTLD is more common in the first year after transplant and often presents with **lymphadenopathy**, **fever**, or **graft dysfunction**.
Question 5: What is the primary disease associated with Enterovirus 71?
- A. Hepatitis E
- B. Hepatitis G
- C. Hand, foot, and mouth disease (Correct Answer)
- D. Hepatitis C
Explanation: ***Hand, foot, and mouth disease*** - **Enterovirus 71** is a major causative agent of **hand, foot, and mouth disease (HFMD)**, especially in severe cases involving neurological complications. - HFMD is characterized by **fever**, **oral lesions**, and a **rash** on the hands and feet, particularly common in young children. *Hepatitis E* - **Hepatitis E** is caused by the **Hepatitis E virus (HEV)**, a distinct RNA virus, not an enterovirus. - It primarily causes **acute viral hepatitis**, particularly transmitted via the fecal-oral route. *Hepatitis G* - **Hepatitis G virus (HGV)**, also known as **GBV-C**, is a flavivirus, which is distinct from enteroviruses. - Its clinical significance and role in causing hepatitis are still debated, and it's not a primary cause of symptomatic liver disease. *Hepatitis C* - **Hepatitis C** is caused by the **Hepatitis C virus (HCV)**, an RNA virus belonging to the *Flaviviridae* family, genetically distinct from enteroviruses. - HCV is a major cause of **chronic hepatitis**, cirrhosis, and hepatocellular carcinoma.
Question 6: A 35-year-old professional businesswoman notices the appearance of several hyperkeratotic, well-demarcated growths on the palmar surface of her index finger and on her toe. They do not change in size and cause her only minimal discomfort. A biopsy of one of the lesions, viewed at 40x magnification, is shown. Which of the following viruses is the most likely etiologic agent?
- A. Adenovirus
- B. HPV (Correct Answer)
- C. Molluscum contagiosum virus
- D. Echovirus
Explanation: ***HPV*** - The clinical description of **hyperkeratotic**, **well-demarcated growths** on the palmar surface and toe is highly characteristic of **warts** (verrucae), which are caused by **Human Papillomavirus (HPV)**. - The biopsy likely shows **koilocytes** (HPV-infected keratinocytes with perinuclear vacuolization), which are pathognomonic for HPV infection in the skin. *Adenovirus* - Adenovirus typically causes **respiratory tract infections**, **conjunctivitis**, or **gastroenteritis**, and less commonly skin lesions. - Skin manifestations from adenovirus are usually non-specific rashes, not hyperkeratotic growths like those described. *Molluscum contagiosum virus* - **Molluscum contagiosum** is caused by the **Molluscum contagiosum virus (MCV)** and presents as **umbilicated papules**, differing morphologically from the described hyperkeratotic warts. - Histologically, molluscum contagiosum lesions are characterized by **Molluscum bodies** (large eosinophilic cytoplasmic inclusions), which are different from koilocytes. *Echovirus* - Echoviruses are enteroviruses primarily associated with a wide range of syndromes including **aseptic meningitis**, **exanthems (rashes)**, and **respiratory illnesses**. - They do not typically cause localized, hyperkeratotic skin growths like warts.
Question 7: A 7 year old boy presented with generalized edema. Urine examination revealed marked albuminuria. Serum biochemical examinations showed hypoalbuminemia with hyperlipidemia. Kidney biopsy was undertaken. On light microscopic examination, the kidney appeared normal. Electron microscopic examination is most likely to reveal
- A. Rarefaction of glomerular basement membrane
- B. Fusion of foot processes of the glomerular epithelial cells (Correct Answer)
- C. Deposition of electron dense material in the basement membrane
- D. Thin basement membrane
Explanation: ***Fusion of foot processes of the glomerular epithelial cells*** - The clinical presentation of generalized edema, marked albuminuria, hypoalbuminemia, and hyperlipidemia in a young child strongly indicates **minimal change disease** (MCD), which is the most common cause of **nephrotic syndrome** in children [1]. - While light microscopy is normal in MCD, electron microscopy characteristically reveals **effacement or fusion of the foot processes** of the podocytes, which leads to increased glomerular permeability to proteins [1]. *Rarefaction of glomerular basement membrane* - **Rarefaction** or thinning of the glomerular basement membrane is associated with **Alport syndrome** or diseases causing basement membrane injury, which typically present with progressive kidney disease and hematuria. - This finding is not characteristic of minimal change disease or the nephrotic syndrome described. *Deposition of electron dense material in the basement membrane* - The deposition of **electron-dense material** within the glomerular basement membrane is characteristic of immune complex-mediated diseases like **membranoproliferative glomerulonephritis** (MPGN) or **post-infectious glomerulonephritis**. - These conditions often present with hematuria and are not typically associated with normal light microscopy in the context of nephrotic syndrome. *Thin basement membrane* - A **thin basement membrane** is a defining feature of **thin basement membrane disease** (also known as benign familial hematuria). - This condition is primarily associated with **microscopic hematuria** and does not typically cause nephrotic range proteinuria or generalized edema. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-923.
Question 8: Which of the following is the correct combination?
- A. Cane fibre-Farmers lung
- B. Cold-Trench foot (Correct Answer)
- C. Light-Miner's nystagmus
- D. Pressure-Caisson's disease
Explanation: ***Correct Option: Cold-Trench foot*** - **Trench foot** is an occupational cold injury caused by prolonged exposure to **cold and wet conditions** - Commonly seen in soldiers, agricultural workers, and those working in cold, damp environments - Results in **non-freezing cold injury** with tissue damage from vasoconstriction and ischemia - This represents a valid occupational exposure-disease combination *Incorrect: Cane fibre-Farmers lung* - **Cane fibre (bagasse)** causes **Bagassosis**, NOT Farmer's lung - **Bagassosis**: Hypersensitivity pneumonitis from exposure to moldy sugarcane bagasse - **Farmer's lung**: Hypersensitivity pneumonitis from exposure to moldy hay or grain - While both are forms of extrinsic allergic alveolitis, they are distinct conditions with different causative agents *Incorrect: Light-Miner's nystagmus* - **Miner's nystagmus** is associated with working in **darkness or poor lighting**, not light exposure - Caused by prolonged work in dim illumination in underground mines - Involves involuntary oscillatory eye movements due to disruption of the oculomotor system - This combination is backwards - the exposure is lack of light, not light itself *Incorrect: Pressure-Caisson's disease* - **Caisson disease** (decompression sickness) is caused by **rapid reduction in ambient pressure**, not pressure exposure itself - Occurs when dissolved inert gases (nitrogen) form bubbles during rapid decompression - Seen in divers, tunnel workers, and caisson workers - The exposure is more accurately described as "pressure changes" or "decompression" rather than simply "pressure"
Question 9: A 7-year-old boy presented with generalized edema. Urine examination revealed marked albuminuria. Serum biochemical examinations showed hypoalbuminemia with hyperlipidemia. Kidney biopsy was undertaken. On light microscopic examination, the kidney appeared normal. Electron microscopic examination is most likely to reveal:
- A. Deposition of electron dense material in the basement membrane
- B. Rarefaction of glomerular basement membrane
- C. Thin basement membrane
- D. Fusion of foot processes of the glomerular epithelial cells (Correct Answer)
Explanation: ***Fusion of foot processes of the glomerular epithelial cells*** - This finding, also known as **effacement of podocyte foot processes**, is the characteristic electron microscopic feature of **minimal change disease (MCD)** [1]. - MCD is the most common cause of **nephrotic syndrome** in children, presenting with generalized edema, marked albuminuria, hypoalbuminemia, and hyperlipidemia, with a normal appearance on light microscopy [1]. *Deposition of electron dense material in the basement membrane* - This suggests diseases like **membranous nephropathy** or **post-infectious glomerulonephritis**, which typically involve immune complex deposition. - These conditions usually show abnormalities on **light microscopy** (e.g., thickened capillary loops in membranous nephropathy) and differ clinically [1]. *Rarefaction of glomerular basement membrane* - **Rarefaction** or thinning of the glomerular basement membrane is associated with conditions like **Alport syndrome** or **thin basement membrane disease**. - These are typically associated with **hematuria**, which is not mentioned as a primary symptom in this case, and often have a genetic component. *Thin basement membrane* - A **thin basement membrane** is the hallmark of **thin basement membrane disease** (also known as benign familial hematuria). - This condition primarily presents with **microscopic hematuria** and does not typically cause the complete nephrotic syndrome found in this child [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 919-923.
Question 10: Which of the following conditions is primarily treated by sympathectomy?
- A. Buerger's disease
- B. Acrocyanosis
- C. Hyperhidrosis (Correct Answer)
- D. Raynaud's disease
Explanation: ***Hyperhidrosis*** - **Sympathectomy** (especially thoracic sympathectomy) is a definitive treatment for severe, localized **hyperhidrosis** (excessive sweating) that has not responded to conservative therapies. - The procedure aims to interrupt the sympathetic nerves responsible for stimulating sweat glands, commonly in the palms, soles, or axillae. *Buerger's disease* - While **sympathectomy** was historically used, its efficacy in **Buerger's disease** (thromboangiitis obliterans) is questionable and largely replaced by smoking cessation and other treatments for limb salvage. - The primary issue is **inflammation** and **thrombosis** of small and medium-sized arteries and veins, not primarily sympathetic overactivity. *Acrocyanosis* - **Acrocyanosis** is a benign condition characterized by persistent, painless, blue discoloration of the extremities due to vasospasm of small skin arteries and arterioles. - Treatment is generally reassurance and avoidance of cold, and **sympathectomy** is rarely, if ever, indicated or effective due to the non-progressive and cosmetic nature of the condition. *Raynaud's disease* - **Raynaud's disease** is a vasospastic disorder, but **sympathectomy** is usually reserved for severe cases with impending tissue loss or critical ischemia that fail medical management. - Medical management with calcium channel blockers is the primary treatment, as the condition involves episodic vasospasm of digital arteries.
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