Herpes Simplex Virus Infections — MCQs
Multinucleated giant cell on Tzanck smear is not seen in?
Herpes virus involves which lobe?
A child with a fever of 102°F and vesicles in the oral cavity is probably suffering from:
How does HSV establish latency in the host?
A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?
Which of the following is TRUE regarding herpes simplex virus (HSV) in pregnancy?
In which condition are Bull's eye lesions typically found?
The Tzanck test is positive in the following conditions, except:
A young man presented with painful vesicular lesions distributed along a dermatomal pattern on one side of his body. What is the likely diagnosis?
What type of cell are Tzanck cells commonly associated with in skin conditions?
Herpes Simplex Virus Infections Indian Medical PG Practice Questions and MCQs
Question 1: Multinucleated giant cell on Tzanck smear is not seen in?
- A. Herpes simplex
- B. Molluscum contagiosum (Correct Answer)
- C. Varicella
- D. Herpes zoster
Explanation: **Molluscum contagiosum** - Tzanck smear typically reveals **Henderson-Paterson bodies**, which are large eosinophilic intracytoplasmic inclusions within epithelial cells. - **Multinucleated giant cells** are not characteristic findings in lesions caused by the molluscum contagiosum virus (a poxvirus). *Herpes simplex* - Tzanck smear often shows **multinucleated giant cells** and **acantholytic cells**, which are specific cytopathic effects of HSV. - The presence of these cells helps in the rapid diagnosis of **herpes simplex viral infections**. *Varicella* - Similar to herpes simplex, **varicella-zoster virus (VZV)** infection also produces **multinucleated giant cells** on Tzanck smear. - These cells are a hallmark of **herpesvirus infections**, indicating viral cytopathic effects in epithelial cells. *Herpes zoster* - Herpes zoster, caused by the **reactivation of VZV**, also presents with **multinucleated giant cells** on Tzanck smear. - This finding aids in confirming the diagnosis of **shingles**, distinguishing it from other vesicular rashes.
Question 2: Herpes virus involves which lobe?
- A. Occipital
- B. Parietal
- C. Temporal (Correct Answer)
- D. Frontal
Explanation: ***Temporal*** - Herpes virus (specifically **HSV-1**) often causes **encephalitis**, and the **temporal lobes** are the most common and severely affected regions [1]. - This predilection for the temporal lobes often leads to characteristic symptoms such as **memory deficits**, **aphasia**, and **behavioral changes** [1]. *Occipital* - While encephalitis can be diffuse, direct and primary involvement of the **occipital lobe** as the main site of herpes simplex encephalitis is **uncommon**. - Conditions like **posterior reversible encephalopathy syndrome (PRES)** or **cerebral amyloid angiopathy** are more typically associated with occipital involvement. *Parietal* - Although the **parietal lobe** can be affected in severe or widespread encephalitis, it is **not the primary or most frequent site** of herpes simplex encephalitis. - Damage to the parietal lobe would typically result in **sensory deficits**, **spatial disorientation**, or **neglect**. *Frontal* - The **frontal lobes** can be involved in herpes simplex encephalitis, often as part of a more extensive disease affecting the temporal lobes. - However, the **temporal lobes are more consistently and severely impacted**, accounting for the majority of the characteristic clinical presentation [1].
Question 3: A child with a fever of 102°F and vesicles in the oral cavity is probably suffering from:
- A. Herpes simplex type-I
- B. Neutropenia
- C. Juvenile periodontitis
- D. Acute herpetic gingivostomatitis (Correct Answer)
Explanation: ***Acute herpetic gingivostomatitis*** - This condition is caused by **Herpes simplex virus (HSV-1)** and typically presents in young children with a **high fever**, malaise, and characteristic **vesicular lesions** in the oral cavity that quickly rupture to form painful ulcers. - The combination of **fever** and widespread **oral vesicles** strongly indicates acute herpetic gingivostomatitis. *Herpes simplex type-I* - While HSV-1 is the **etiologic agent** for acute herpetic gingivostomatitis, simply stating "Herpes simplex type-I" as the diagnosis is less specific than the clinical presentation. - HSV-1 can cause various oral conditions, but the described symptoms are best captured by the more specific diagnosis of **acute herpetic gingivostomatitis**. *Neutropenia* - **Neutropenia** is a reduction in neutrophils, which can lead to increased susceptibility to infections and oral ulcers, but it does not directly cause the characteristic **vesicular lesions** described. - The primary presentation would be recurrent severe infections, not necessarily acute fever with widespread oral vesicles. *Juvenile periodontitis* - **Juvenile periodontitis** (now often termed aggressive periodontitis) is a localized form of periodontal disease characterized by rapid **attachment loss** and **bone destruction** around permanent teeth in otherwise healthy adolescents. - It does not present with acute fever and vesicular lesions in the oral cavity.
Question 4: How does HSV establish latency in the host?
- A. Through retrograde axonal transport to dorsal root ganglia (Correct Answer)
- B. By forming spores in epithelial cells
- C. Through persistent viremia
- D. By integrating into host DNA
Explanation: ***Through retrograde axonal transport to dorsal root ganglia*** - HSV establishes latency by traveling via **retrograde axonal transport** from the site of infection to the sensory **dorsal root ganglia (DRG)**. - In the DRG, the virus remains dormant within the neuronal cells, expressing only latency-associated transcripts (LATs) rather than replicating. *By forming spores in epithelial cells* - HSV is a **DNA virus** and does not form spores, which are typically found in bacteria and fungi as survival structures. - While HSV infects epithelial cells initially, its latency phase is established in neurons, not by forming spores in epithelial tissues. *Through persistent viremia* - **Persistent viremia** refers to the continuous presence of viruses in the bloodstream, which is characteristic of some chronic viral infections but not how HSV establishes latency. - HSV latency involves viral DNA remaining dormant within specific neuronal cells, not actively circulating in the blood. *By integrating into host DNA* - While some viruses (like retroviruses) integrate their genetic material into the host genome, **HSV does not integrate its DNA** during latency. - HSV DNA typically remains as an **episome** (a circular, independent piece of DNA) within the nucleus of the infected neuron during latency.
Question 5: A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?
- A. Wait & watch
- B. Acyclovir & elective cesarean section (C-section) (Correct Answer)
- C. Acyclovir & allow spontaneous progression of labor
- D. Induction of labor
Explanation: ***Acyclovir & elective cesarean section (C-section)*** - Active **genital herpetic lesions** at the time of delivery pose a significant risk of transmitting **herpes simplex virus (HSV)** to the neonate. - **Acyclovir** can help suppress viral replication, but a **cesarean section** is necessary to prevent direct contact with the lesions during birth, which could lead to severe neonatal HSV infection. *Wait & watch* - This approach is inappropriate due to the high risk of **vertical transmission** of HSV to the neonate if lesions are active during vaginal delivery, potentially causing life-threatening complications. - **Neonatal HSV** can result in significant morbidity and mortality, including neurological damage and disseminated disease. *Acyclovir & allow spontaneous progression of labor* - While **acyclovir** can reduce viral load, it does not completely eliminate the risk of transmission from active lesions during a vaginal birth. - The primary concern is protecting the neonate from direct contact with the **active lesions** in the birth canal. *Induction of labor* - **Induction of labor** does not mitigate the risk of **vertical transmission** from active lesions during a vaginal delivery. - The focus should be on preventing contact with the lesions, not on expediting vaginal birth once active lesions are present.
Question 6: Which of the following is TRUE regarding herpes simplex virus (HSV) in pregnancy?
- A. Transmission risk is highest with first-episode primary infection near delivery (Correct Answer)
- B. Neonatal transmission risk is similar for HSV-1 and HSV-2
- C. Cesarean delivery is recommended for all HSV-positive women
- D. Suppressive therapy is contraindicated during pregnancy
Explanation: ***Transmission risk is highest with first-episode primary infection near delivery*** - A **primary HSV infection** in an expectant mother, especially close to delivery, poses the greatest risk of neonatal transmission due to the high viral load and lack of maternal-acquired antibodies. - This scenario leads to a higher probability of the fetus being exposed to the virus during passage through the **birth canal**. *Neonatal transmission risk is similar for HSV-1 and HSV-2* - **HSV-2** is responsible for the majority of **neonatal herpes cases** and has a significantly higher transmission rate during vaginal birth compared to HSV-1. - While both can cause neonatal infection, **HSV-2 is more frequently associated with severe neonatal disease and mortality**. *Cesarean delivery is recommended for all HSV-positive women* - A Cesarean delivery is only recommended for HSV-positive women who have **active genital lesions** or **prodromal symptoms** indicative of an impending outbreak at the time of labor. - For women with a history of HSV but no active lesions or symptoms, a **vaginal delivery is considered safe**. *Suppressive therapy is contraindicated during pregnancy* - **Antiviral suppressive therapy** (e.g., acyclovir, valacyclovir) is often recommended during the last month of pregnancy for women with recurrent HSV to reduce the risk of an outbreak during labor. - This therapy is **safe and effective** in preventing neonatal transmission and is not contraindicated.
Question 7: In which condition are Bull's eye lesions typically found?
- A. Erythema nodosum
- B. Erythema gangrenosum
- C. Erythema multiforme (Correct Answer)
- D. Erythroderma
Explanation: ***Erythema multiforme*** - **Bull's eye lesions**, also known as **target lesions**, are the hallmark clinical finding in erythema multiforme. - These lesions feature a central dusky or blistered area, surrounded by a pale edematous ring, and an outermost erythematous halo. *Erythema nodosum* - Characterized by tender, red, subcutaneous nodules, typically located on the **shins**. - It represents a form of **panniculitis** (inflammation of subcutaneous fat) and does not exhibit targetoid morphology. *Erythema gangrenosum* - A specific skin lesion associated with **Pseudomonas aeruginosa** septicemia, characterized by hemorrhagic bullae that progress to necrotic ulcers with a black eschar. - It represents **necrotizing vasculitis** and does not present with bull's eye or target lesions. *Erythroderma* - Defined as generalized redness and scaling affecting more than **90% of the body surface area**. - This condition involves widespread inflammation of the skin and does not present with discrete target lesions.
Question 8: The Tzanck test is positive in the following conditions, except:
- A. Herpes Simplex
- B. Varicella
- C. EBV (Correct Answer)
- D. Herpes Zoster
Explanation: ***EBV*** - The **Tzanck test** is used to detect **multinucleated giant cells** and **acantholytic cells**, which are characteristic cytopathic effects of **herpes group viruses** on epithelial cells. - **Epstein-Barr Virus (EBV)** is a herpesvirus that causes infectious mononucleosis and is associated with various cancers, but it does not typically cause mucocutaneous lesions with the classic cytopathic changes detectable by a Tzanck test. *Herpes Zoster* - **Herpes Zoster**, caused by the **varicella-zoster virus (VZV)**, is a herpesvirus that causes **shingles** and produces characteristic **vesicular lesions** in a dermatomal distribution. - The **Tzanck test** will be positive in herpes zoster due to the presence of **multinucleated giant cells** and **acantholytic cells** in the vesicular fluid or scrapings. *Herpes Simplex* - **Herpes Simplex Virus (HSV)** causes **cold sores**, **genital herpes**, and other mucocutaneous lesions characterized by **vesicles** and **ulcers**. - A positive **Tzanck test** in HSV infections reveals **multinucleated giant cells** and **intranuclear inclusions**, confirming viral cytopathic effects. *Varicella* - **Varicella**, also known as **chickenpox**, is caused by the **varicella-zoster virus (VZV)** and manifests as widespread **vesicular rash**. - The **Tzanck test** is positive in varicella infections, showing the presence of **multinucleated giant cells** and **acantholysis** within the vesicular lesions.
Question 9: A young man presented with painful vesicular lesions distributed along a dermatomal pattern on one side of his body. What is the likely diagnosis?
- A. Lymphangioma circumscriptum
- B. Molluscum contagiosum
- C. Herpes simplex
- D. Herpes Zoster (Correct Answer)
Explanation: ***Herpes Zoster*** - This condition is characterized by a **unilateral rash** that respects the **dermatomal distribution**, meaning it follows the path of a single nerve. - The lesions are typically **painful vesicles** and crusts, often associated with a burning sensation due to reactivation of the **varicella-zoster virus** (chickenpox virus). *Lymphangioma circumscriptum* - This is a rare **lymphatic malformation** presenting as clusters of **vesicles** or papules, often described as 'frog spawn' or 'tapioca pudding' in appearance. - While it can be painful, it usually does not follow a dermatomal pattern and is a congenital condition, not an acute viral eruption. *Molluscum contagiosum* - This is a viral skin infection producing small, firm, **umbilicated papules** that are typically flesh-colored or pearly. - While contagious, these lesions are generally **asymptomatic** and do not present with the acute pain, blistering, or dermatomal distribution characteristic of herpes zoster. *Herpes simplex* - This infection causes localized clusters of painful **vesicles** on an erythematous base, most commonly around the mouth (cold sores) or genitals. - Unlike herpes zoster, herpes simplex lesions typically recur in the same small area and do **not follow a dermatomal distribution**.
Question 10: What type of cell are Tzanck cells commonly associated with in skin conditions?
- A. Keratinocyte (Correct Answer)
- B. Neutrophil
- C. Lymphocyte
- D. Fibroblast
Explanation: ***Keratinocyte*** - **Tzanck cells** are **acantholytic keratinocytes** characterized by loss of intercellular connections, resulting in rounded cells with **large nuclei** and **perinuclear halos**. - They are classically seen in **pemphigus vulgaris** and other acantholytic disorders on **Tzanck smear** preparation. - The Tzanck smear is a simple bedside diagnostic test where the base of a blister is scraped and examined microscopically after staining. *Fibroblast* - **Fibroblasts** are mesenchymal cells in the **dermis** that produce **collagen** and extracellular matrix components. - They are not epithelial cells and do not undergo acantholysis to form Tzanck cells. *Neutrophil* - **Neutrophils** are polymorphonuclear leukocytes involved in acute inflammatory responses and fighting bacterial infections. - They may infiltrate skin lesions but do not transform into Tzanck cells, which are specifically altered keratinocytes. *Lymphocyte* - **Lymphocytes** (T cells and B cells) are immune cells involved in **adaptive immunity**. - They are not the cell type from which Tzanck cells originate; Tzanck cells are acantholytic epidermal keratinocytes.
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