Viral Skin Infections Practice Questions

Q: A patient developed fever and perioral vesicles. What is the diagnosis?

Herpes simplex. ***Herpes simplex*** - The combination of **fever** and **perioral vesicles** suggests a **viral infection**, with herpes simplex being a classic presentation. - Herpes simplex lesions typically appear as clusters of small, painful **vesicles** on an erythematous base, often affecting the lips and perioral area. *Impetigo* - Impetigo is a **bacterial skin infection** characterized by **honey-colored crusted lesions**, not clear vesicles. - It does not typically present with systemic symptoms like fever unless it is widespread or severe. *Molluscum contagiosum* - Molluscum contagiosum presents as **flesh-colored, dome-shaped papules** with a characteristic **umbilicated center**, not fluid-filled vesicles. - While it's a viral infection, systemic symptoms like fever are rare, and the lesion morphology is distinct. *Bullous pemphigoid* - Bullous pemphigoid is an **autoimmune blistering disease** characterized by large, tense bullae, usually in older adults. - It is not typically associated with acute onset of fever or travel history in this manner and lacks the clustered perioral vesicular appearance.

Q: A 28-year-old lady has asymptomatic dome shaped small lesions on the forehead for the last 2 months as shown in the image. She has a 2-year-old daughter with similar lesions. What is the causative agent? (AIIMS May 2016)

Poxvirus. ***Poxvirus*** - The description of **asymptomatic, dome-shaped small lesions** (suggesting **molluscum contagiosum**), especially with transmission from a child to a parent, is classic for **Molluscum contagiosum virus (MCV)**, which belongs to the **Poxviridae family**. - **Molluscum contagiosum** lesions can appear anywhere but are often seen on the face, neck, trunk, and extremities in children, and may be transmitted through close contact. *Papillomavirus* - **Papillomavirus** causes **warts**, which are typically **rough, verrucous** (cauliflower-like) lesions, not smooth, dome-shaped papules. - While warts can also be transmitted through close contact, their morphology is distinct from the lesions described. *Herpes virus* - **Herpes simplex virus (HSV)** causes **vesicular eruptions** (cold sores or fever blisters) that evolve into ulcers or crusts, often associated with pain, burning, or itching. - The lesions described as "asymptomatic dome-shaped" do not fit the typical presentation of herpes infections. *Coxsackie virus* - **Coxsackievirus** most commonly causes **hand-foot-and-mouth disease (HFMD)**, characterized by **fever**, **oral ulcers**, and a **rash of macules or vesicles** on the hands and feet. - This clinical picture is not consistent with the localized, dome-shaped papules on the forehead.

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.

Question 1

A patient developed fever and perioral vesicles. What is the diagnosis?

Accepted Answer

Herpes simplex

Answer

Impetigo

Answer

Bullous pemphigoid

Answer

Molluscum contagiosum

Question 2

A 28-year-old lady has asymptomatic dome shaped small lesions on the forehead for the last 2 months as shown in the image. She has a 2-year-old daughter with similar lesions. What is the causative agent? (AIIMS May 2016)

Accepted Answer

Poxvirus

Answer

Papillomavirus

Answer

Herpes virus

Answer

Coxsackie virus

Question 3

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 4

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 5

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 6

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 7

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 8

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 9

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 10

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

Viral Skin Infections — MCQs

Viral Skin Infections — MCQs

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