Varicella-Zoster Virus Infections — MCQs
A patient presents with painful vesicles in the ear and tongue. He also complains of facial weakness and hearing loss. What is the diagnosis?
Herpes zoster in geniculate ganglion causes?
A 25-year-old male presents with a cluster of vesicles along the dermatome on his chest and back. He complains of burning pain in the same area. What is the most likely diagnosis?
The Tzanck test is positive in the following conditions, except:
A 60-year-old patient presents with unilateral vesicular lesions in a dermatomal distribution on the torso. The lesions are painful and appeared over the past 2-3 days, progressing from erythematous patches to fluid-filled vesicles. The patient reports prodromal burning and tingling sensation in the affected area. Which of the following is the most likely diagnosis?
After a renal transplant, what is the most common opportunistic infection?
What type of cell are Tzanck cells commonly associated with in skin conditions?
A 40-year-old man underwent kidney transplantation. Two months after transplantation, he developed fever and features suggestive of bilateral diffuse interstitial pneumonia. Which of the following is the most likely etiologic agent?
Genital warts are caused by which virus?
Congenital varicella infection causes all except:
Varicella-Zoster Virus Infections Indian Medical PG Practice Questions and MCQs
Question 1: A patient presents with painful vesicles in the ear and tongue. He also complains of facial weakness and hearing loss. What is the diagnosis?
- A. Fungal infection
- B. Chicken pox
- C. Ramsay hunt syndrome (Correct Answer)
- D. None of the options
Explanation: ***Ramsay hunt syndrome*** - This syndrome is characterized by a **herpes zoster oticus** (shingles affecting the ear) combined with **facial nerve palsy**, leading to **facial weakness** [1], [2]. - Symptoms include painful vesicular rash in the external auditory canal (ear), sometimes extending to the tongue or soft palate, **ipsilateral facial paralysis**, and often **hearing loss** or **vertigo** [1]. *Fungal infection* - Fungal infections in the ear (otomycosis) typically cause **itching**, discharge, and pain, but rarely present with **vesicles**, **facial weakness**, or widespread vesicular lesions on the tongue. - They are not associated with nerve palsies like **facial weakness** and **hearing loss** in the manner seen in Ramsay Hunt syndrome. *Chicken pox* - **Chickenpox (varicella)** is a generalized vesicular rash that is typically widespread over the body [3], while Ramsay Hunt syndrome involves **localized vesicular lesions** with associated cranial nerve dysfunction. - While caused by the same virus (**Varicella-Zoster Virus**), chickenpox is the primary infection whereas Ramsay Hunt syndrome is a reactivation [1], [3]. *None of the options* - This option is incorrect as Ramsay Hunt syndrome perfectly matches the described clinical presentation of **painful vesicles** in the ear and tongue, **facial weakness**, and **hearing loss**.
Question 2: Herpes zoster in geniculate ganglion causes?
- A. Melkersson-Rosenthal syndrome
- B. Ramsay Hunt syndrome (Correct Answer)
- C. Bell's palsy
- D. Ophthalmic zoster
Explanation: ***Ramsay Hunt syndrome*** - This syndrome is caused by the **reactivation of varicella-zoster virus (VZV)** within the **geniculate ganglion**, leading to inflammation of the facial nerve (cranial nerve VII). - Key features include **ipsilateral facial paralysis**, **ear pain**, and a **vesicular rash in the external auditory canal** or on the auricle. *Melkersson-Rosenthal syndrome* - This is a rare neurological disorder characterized by a triad of symptoms: **recurrent facial paralysis**, **persistent orofacial swelling**, and **fissured tongue**. - It is not directly related to viral infection or the geniculate ganglion. *Bell's palsy* - Bell's palsy is an **idiopathic facial paralysis** that results from inflammation of the facial nerve, but the exact cause is unknown and it does not involve a vesicular rash. - While it shares some symptoms with Ramsay Hunt syndrome, the **absence of vesicles** distinguishes it. *Ophthalmic zoster* - Ophthalmic zoster occurs when VZV reactivates in the **trigeminal ganglion** (cranial nerve V), specifically affecting the ophthalmic division. - It presents with a **vesicular rash on the forehead, eyelids, and nose** (Hutchinson's sign), and can lead to serious ocular complications, but does not involve the facial nerve directly.
Question 3: A 25-year-old male presents with a cluster of vesicles along the dermatome on his chest and back. He complains of burning pain in the same area. What is the most likely diagnosis?
- A. Herpes zoster (Correct Answer)
- B. Contact dermatitis
- C. Herpes simplex
- D. Impetigo
Explanation: ***Herpes zoster*** - The classic presentation of **vesicular rash along a dermatome** with **burning pain** is highly characteristic of herpes zoster (shingles). - This condition is caused by the **reactivation of the varicella-zoster virus (VZV)**, which lies dormant in sensory ganglia. *Contact dermatitis* - This condition typically presents as an **itchy, erythematous rash** that appears after contact with an allergen or irritant. - While vesicles can be present, the rash is usually not strictly confined to a single dermatome and **burning pain is less common** than itching. *Herpes simplex* - Herpes simplex virus (HSV) typically causes **localized clusters of vesicles** on mucosal surfaces (e.g., oral, genital) or skin. - It does not usually present with a **dermatomal distribution** on the trunk as described in the vignette. *Impetigo* - Impetigo is a **bacterial skin infection** characterized by **honey-crusted lesions** or pustules. - While it can involve vesicles, it does not follow a **dermatomal pattern** and is caused by bacteria, not a viral reactivation.
Question 4: 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 5: A 60-year-old patient presents with unilateral vesicular lesions in a dermatomal distribution on the torso. The lesions are painful and appeared over the past 2-3 days, progressing from erythematous patches to fluid-filled vesicles. The patient reports prodromal burning and tingling sensation in the affected area. Which of the following is the most likely diagnosis?
- A. Herpes zoster infection (Correct Answer)
- B. Irritant contact dermatitis
- C. Allergic contact dermatitis
- D. Herpes Simplex Infection
Explanation: ***Herpes zoster infection*** - The patient's presentation of **unilateral vesicular lesions** in a **dermatomal distribution**, accompanied by severe pain and a **prodromal burning and tingling sensation**, is classic for herpes zoster (shingles). - Herpes zoster results from the **reactivation of latent varicella-zoster virus (VZV)** in a sensory ganglion, leading to painful rash along the affected nerve path. *Irritant contact dermatitis* - This condition involves inflammation due to direct contact with an irritating substance, often presenting with **eczematous lesions**, redness, itching, and sometimes vesicles. - However, it typically lacks the characteristic **dermatomal distribution** and severe neuropathic pain seen in herpes zoster. *Allergic contact dermatitis* - Allergic contact dermatitis is an immune-mediated reaction to an allergen, causing intensely pruritic, erythematous, and often **vesicular or bullous eruptions** that tend to spread beyond the initial contact area over time. - While it can cause vesicles, it does not follow a **dermatomal pattern** and is usually very itchy, rather than primarily painful and burning, with a distinct prodrome. *Herpes Simplex Infection* - Herpes simplex virus (HSV) infections also cause **vesicular lesions** but typically present as clusters of vesicles on an **erythematous base** in a localized area, often around the mouth (cold sores) or genitals. - Unlike herpes zoster, HSV lesions are usually **recurrent** in the same small area and typically do not exhibit a widespread, **unilateral dermatomal pattern** or the associated severe, persistent neuropathic pain.
Question 6: 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 7: 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.
Question 8: A 40-year-old man underwent kidney transplantation. Two months after transplantation, he developed fever and features suggestive of bilateral diffuse interstitial pneumonia. Which of the following is the most likely etiologic agent?
- A. Varicella zoster virus
- B. Cytomegalovirus (Correct Answer)
- C. Herpes simplex virus
- D. Epstein-barr virus
Explanation: ***Cytomegalovirus*** - **CMV infection** is very common and a frequent opportunistic infection in **immunosuppressed solid organ transplant recipients**, especially within the first few months post-transplant [1]. - **CMV pneumonitis**, characterized by diffuse interstitial pneumonia and fever, is a classic presentation of CMV disease in this patient population [1]. *Varicella zoster virus* - While VZV can cause serious infections in immunosuppressed individuals, **pneumonia due to VZV** is typically part of a disseminated disease and less common than CMV pneumonitis in transplant recipients. - **Cutaneous vesicular lesions** would usually precede or accompany VZV pneumonia, which are not mentioned here. *Herpes simplex virus* - HSV can cause severe mucocutaneous infections in immunocompromised patients, but **HSV pneumonia** is rare and usually manifests as tracheobronchitis or a focal necrotizing pneumonia, not typically diffuse interstitial. - **Esophagitis or encephalitis** are more common serious manifestations of HSV in this population than primary pneumonitis. *Epstein-barr virus* - EBV is primarily associated with **post-transplant lymphoproliferative disorder (PTLD)** in transplant recipients, which can involve the lungs. - While PTLD can manifest with fever and pulmonary infiltrates, **diffuse interstitial pneumonia** solely due to primary EBV infection is less characteristic than for CMV.
Question 9: Genital warts are caused by which virus?
- A. Herpes simplex
- B. Cytomegalovirus
- C. Varicella zoster
- D. Human Papillomavirus (Correct Answer)
Explanation: ***Human Papillomavirus*** - **HPV types 6 and 11** are the most common causes of **genital warts (condyloma acuminata)**. - HPV is a **DNA virus** that infects epithelial cells and can cause benign proliferative lesions. *Herpes simplex* - **Herpes simplex virus (HSV)** causes **genital herpes**, characterized by painful vesicles and ulcers, not warts. - HSV is a **DNA virus** that primarily infects mucocutaneous sites and establishes latency in sensory ganglia. *Cytomegalovirus* - **Cytomegalovirus (CMV)** is a **beta-herpesvirus** that causes a wide range of clinical syndromes, especially in immunocompromised individuals, but does not cause genital warts. - CMV infection can manifest as mononucleosis-like syndrome, retinitis, colitis, or pneumonitis. *Varicella zoster* - **Varicella zoster virus (VZV)** causes **chickenpox** (varicella) and **shingles** (herpes zoster), characterized by vesicular rashes, not genital warts. - VZV is an **alpha-herpesvirus** that remains latent in dorsal root ganglia after primary infection.
Question 10: Congenital varicella infection causes all except:
- A. Macrocephaly (Correct Answer)
- B. Cortical atrophy
- C. Cicatrix
- D. Limb hypoplasia
Explanation: ***Macrocephaly*** - **Macrocephaly** is generally not a direct consequence of congenital varicella infection; rather, **microcephaly** due to brain damage is more commonly observed. - Congenital varicella typically causes destructive lesions leading to tissue loss, not increased head circumference. *Cortical atrophy* - **Cortical atrophy** results from the destructive effects of the virus on the developing brain, leading to **neuronal loss** and reduced brain volume. - This can manifest as **microcephaly**, an indirect but common finding associated with congenital varicella. *Cicatrix* - **Cicatrix** (zig-zag scarring) is a classic dermatological manifestation of congenital varicella, resulting from the virus's impact on developing skin. - These characteristic **skin lesions** are one of the most identifiable features of the syndrome. *Limb hypoplasia* - **Limb hypoplasia**, involving underdeveloped limbs, is a hallmark feature of congenital varicella, often due to **viral damage** to limb buds and associated neural structures. - This can lead to **bone shortening** and muscle atrophy in affected limbs.
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