Viral Infections (Hepatitis, Herpes, etc.) — MCQs
A 2 month old baby presented with acute icteric viral hepatitis. The mother is a known hepatitis B carrier. Mother's hepatitis B virus serological profile is MOST likely to be:
What does a Tzanck smear in varicella-zoster virus infection typically show?
A child presents with a fever and a rash. Urine examination showed cells with owl's eye appearance. What is the most likely diagnosis?
A patient presents with painful blisters around the angle of the mouth. What is the most likely pathogen responsible for this condition?
Which of the following statements regarding dengue fever is false?
Which of the following statements regarding classical Dengue fever is FALSE?
An elderly man who had been in several military conflicts during the early 1980s and received blood transfusions for injuries recently consulted his physician for a diagnosis of cryoglobulinemia and glomerulonephritis. Additional testing revealed that he was infected with a virus transmitted through blood. Which virus was involved in this infection?
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?
Chronic viral hepatitis is seen with all of the following viruses, except?
In HIV patients, Kaposi's sarcoma is most likely caused by which of the following?
Viral Infections (Hepatitis, Herpes, etc.) Indian Medical PG Practice Questions and MCQs
Question 1: A 2 month old baby presented with acute icteric viral hepatitis. The mother is a known hepatitis B carrier. Mother's hepatitis B virus serological profile is MOST likely to be:
- A. HBsAg and HBeAg positive (Correct Answer)
- B. HBsAg and HBe antibody positive
- C. HBsAg positive only
- D. HBV DNA positive
Explanation: ***HBsAg and HBeAg positive*** - A mother who is **HBsAg and HBeAg positive** has a high viral load and is highly infectious, making vertical transmission to her infant very likely, leading to acute icteric viral hepatitis in the newborn [1]. - **HBeAg positivity** indicates active viral replication, a key factor in efficient perinatal transmission of HBV [1]. *HBsAg and HBe antibody positive* - **HBe antibody positivity** indicates a lower viral load and less active viral replication, suggesting a lower risk of perinatal transmission than if HBeAg were positive [1]. - While the mother is a carrier (HBsAg positive), the presence of HBe antibody usually means the infection is in a less active, potentially chronic persistent phase, with reduced infectivity [1]. *HBsAg positive only* - A mother being **HBsAg positive only** (without HBeAg or antibody information) is insufficient to definitively determine the infectivity status or the likelihood of acute icteric hepatitis in the infant. - **HBsAg positivity** confirms carrier status but doesn't specify the level of viral replication or infectivity as precisely as HBeAg status [1]. *HBV DNA positive* - **HBV DNA positive** indicates the presence of viral genetic material, confirming active infection or replication, but it's a quantitative measure and doesn't replace the serological markers for assessing infectivity in the context of perinatal transmission [1]. - While strongly indicative of active infection, **HBV DNA positive** usually correlates with HBeAg positivity in highly infectious carriers, and HBeAg is the more specific serological marker for this high infectivity state [1].
Question 2: What does a Tzanck smear in varicella-zoster virus infection typically show?
- A. Acantholytic cells
- B. Epidermal spongiosis
- C. Multinucleated giant cells (Correct Answer)
- D. Necrotic cells
Explanation: ***Multinucleated giant cells*** - A Tzanck smear identifies **multinucleated giant cells** with intranuclear inclusions, which are characteristic **cytopathic effects** of herpesviruses like VZV [1]. - These cells result from the fusion of infected keratinocytes, a hallmark finding in **herpes simplex** and **varicella-zoster infections** [1]. *Acantholytic cells* - Acantholytic cells are seen in conditions like **pemphigus vulgaris**, where there is loss of cell-to-cell adhesion between keratinocytes, leading to intraepidermal blistering. - While VZV can cause blistering, the primary cytological finding on Tzanck smear is not acantholysis but rather the presence of multinucleated cells. *Epidermal spongiosis* - Spongiosis refers to **intercellular edema** of epidermal cells, leading to widening of the intercellular spaces, typically seen in **eczematous dermatoses** [1]. - This finding is not specific to viral infections and does not represent the characteristic cytopathic effect of VZV on a Tzanck smear. *Necrotic cells* - Necrotic cells, or dead cells, are a general finding in many inflammatory and infectious processes where tissue damage occurs. - While VZV infection can lead to cell necrosis, the presence of isolated necrotic cells is not the specific, diagnostic feature for VZV on a Tzanck smear. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 366-367.
Question 3: A child presents with a fever and a rash. Urine examination showed cells with owl's eye appearance. What is the most likely diagnosis?
- A. Herpes simplex virus infection
- B. Toxoplasmosis caused by Toxoplasma gondii
- C. Cytomegalovirus (CMV) infection (Correct Answer)
- D. Infectious mononucleosis caused by Epstein-Barr virus
Explanation: ***Cytomegalovirus (CMV) infection*** - The presence of cells with an **owl's eye appearance** in urine sediment is a classic histological hallmark of **CMV infection**. - CMV can cause a variety of symptoms in children, including **fever and rash**, making this the most likely diagnosis. *Herpes simplex virus infection* - HSV causes characteristic **vesicular lesions** on mucocutaneous surfaces, often associated with fever. - While HSV can cause systemic illness, it does not typically present with **owl's eye inclusions** in urine cells. *Toxoplasmosis caused by Toxoplasma gondii* - **Toxoplasmosis** can cause fever and rash, especially in congenital infections or immunocompromised individuals. - However, it does not lead to **owl's eye inclusions** in urinary cells, which are pathognomonic for CMV. *Infectious mononucleosis caused by Epstein-Barr virus* - **Infectious mononucleosis** commonly presents with fever, fatigue, and lymphadenopathy, sometimes with a rash. - **Epstein-Barr virus (EBV)** infection does not produce cells with an **owl's eye appearance** in the urine; that is specific to CMV.
Question 4: A patient presents with painful blisters around the angle of the mouth. What is the most likely pathogen responsible for this condition?
- A. Herpes Simplex Virus (Correct Answer)
- B. Coxsackievirus
- C. Varicella-Zoster Virus
- D. Epstein-Barr Virus
Explanation: ***Herpes Simplex Virus*** - The image shows a cluster of **small, painful vesicles** on an erythematous base around the mouth, characteristic of **herpes labialis** or cold sores. - HSV-1 is the primary cause of oral herpes, which typically presents with these recurrent painful blister outbreaks. *Coxsackievirus* - Coxsackievirus typically causes **Hand, Foot, and Mouth Disease**, characterized by oral lesions (herpangina) and a rash on the hands and feet. - The painful blisters are usually in the **posterior oral cavity** (soft palate, tonsillar pillars) and are not typically perioral in the depicted clustered vesicular pattern. *Varicella-Zoster Virus* - VZV causes **chickenpox** (widespread vesicular rash) and **shingles** (painful, dermatomal vesicular rash). - While it causes vesicles, they would present as either widespread and generalized or in a unilateral, **dermatomal distribution**, which is not consistent with the perioral presentation shown. *Epstein-Barr Virus* - EBV is primarily known for causing **infectious mononucleosis**, which can lead to fatigue, fever, and lymphadenopathy, and sometimes oral manifestations like palatal petechiae or oral hairy leukoplakia. - It does not typically cause the **painful vesicular lesions** around the mouth as depicted.
Question 5: Which of the following statements regarding dengue fever is false?
- A. Common in south Asian region
- B. Transmitted by Aedes aegypti
- C. Thrombocytopenia
- D. Subclinical cases never occur (Correct Answer)
Explanation: **Subclinical cases never occur** - This statement is false because **subclinical** or **asymptomatic infections** are common in dengue fever, meaning many infected individuals do not develop noticeable symptoms but can still transmit the virus. - Studies indicate that the ratio of asymptomatic to symptomatic cases can be as high as 4:1, playing a significant role in **virus transmission** and **herd immunity**. *Common in south Asian region* - This statement is true; **dengue fever** is highly **endemic** in South Asian regions, including countries like India, Bangladesh, and Pakistan, due to suitable climatic conditions for the **Aedes mosquito** and high population density. - The region experiences annual outbreaks, particularly during **monsoon seasons**, leading to a substantial public health burden. *Transmitted by Aedes aegypti* - This statement is true. Dengue fever is primarily transmitted to humans through the bite of infected female **Aedes aegypti mosquitoes**. - **Aedes albopictus** can also act as a vector, but **Aedes aegypti** is considered the main vector in most urban areas. *Thrombocytopenia* - This statement is true. **Thrombocytopenia** (low platelet count) is a hallmark of dengue fever, often correlating with disease severity and risk of **hemorrhage**. - As platelet counts drop, patients are at higher risk of **bleeding complications**, especially in **severe dengue**.
Question 6: Which of the following statements regarding classical Dengue fever is FALSE?
- A. Positive tourniquet test (Correct Answer)
- B. Low case fatality rate
- C. Self limiting disease
- D. Transmitted by Aedes aegypti
Explanation: **CRITICAL ISSUE:** This question as currently written is problematic because **all four statements are TRUE** about classical dengue fever, making it impossible to identify a FALSE statement. ***Analysis of Each Statement:*** **Positive tourniquet test** (Currently marked as answer) - This is actually a **TRUE statement** about classical dengue fever - The tourniquet test is **positive in classical dengue fever** and is used as a diagnostic criterion by WHO - A positive tourniquet test indicates capillary fragility and is seen in both classical dengue and DHF - **This should NOT be the answer** to a FALSE question **Low case fatality rate** - TRUE statement: Classical dengue fever has a very low case fatality rate (<1%) with proper supportive care - Mortality is primarily associated with severe dengue/DHF/DSS **Self limiting disease** - TRUE statement: Classical dengue is typically self-limiting, resolving within 7-10 days with symptomatic treatment - Characterized by fever, headache, retro-orbital pain, myalgia, and rash **Transmitted by Aedes aegypti** - TRUE statement: **Aedes aegypti** is the primary vector for dengue transmission - Also transmitted by Aedes albopictus in some regions - Day-biting mosquitoes found in urban/semi-urban areas **RECOMMENDATION:** This question needs revision as it currently has no correct answer. All options are true statements about classical dengue fever.
Question 7: An elderly man who had been in several military conflicts during the early 1980s and received blood transfusions for injuries recently consulted his physician for a diagnosis of cryoglobulinemia and glomerulonephritis. Additional testing revealed that he was infected with a virus transmitted through blood. Which virus was involved in this infection?
- A. Hepatitis A Virus (HAV)
- B. Hepatitis B Virus (HBV)
- C. Hepatitis C Virus (HCV) (Correct Answer)
- D. Hepatitis D Virus (HDV)
Explanation: ***Hepatitis C Virus (HCV)*** - HCV infection is a common cause of **mixed cryoglobulinemia** and can lead to **glomerulonephritis**, particularly membranoproliferative glomerulonephritis. - Before widespread screening of the blood supply, HCV was a significant risk from **blood transfusions**, especially for individuals who received them in the early 1980s [1]. *Hepatitis A Virus (HAV)* - HAV is primarily transmitted via the **fecal-oral route** and does not typically cause chronic infection or lead to cryoglobulinemia or glomerulonephritis. - It causes **acute, self-limiting hepatitis** and is not associated with blood transfusions in the context described. *Hepatitis B Virus (HBV)* - While HBV can be transmitted through blood and can cause glomerulonephritis (e.g., membranous nephropathy), it is less commonly associated with **cryoglobulinemia** in comparison to HCV. - The constellation of cryoglobulinemia and glomerulonephritis, especially with a history of transfusions in the 1980s, points more strongly to HCV. *Hepatitis D Virus (HDV)* - HDV is a **defective virus** that requires co-infection with HBV to replicate. - While it can cause severe liver disease, it is not primarily associated with **cryoglobulinemia** or glomerulonephritis as a direct cause, but rather exacerbates HBV-related complications.
Question 8: 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 9: Chronic viral hepatitis is seen with all of the following viruses, except?
- A. HEV (Correct Answer)
- B. HCV
- C. HBV
- D. HDV
Explanation: ***HEV*** - While HEV can cause acute hepatitis, it **rarely progresses to chronic infection** in immunocompetent individuals. - Chronic HEV infection is primarily seen in **immunocompromised patients**, such as organ transplant recipients. *HCV* - **Hepatitis C virus** is well-known for its high propensity to establish chronic infection, with about 75-85% of acutely infected individuals developing **chronic hepatitis** [1]. - Chronic HCV infection can lead to **cirrhosis**, liver failure, and hepatocellular carcinoma [1]. *HBV* - **Hepatitis B virus** is a major cause of chronic hepatitis worldwide, especially when acquired perinatally or in early childhood [1]. - Approximately 5-10% of immunocompetent adults who acquire acute HBV infection progress to **chronic hepatitis** [1]. *HDV* - **Hepatitis D virus** is a defective virus that requires co-infection with HBV to replicate; therefore, chronic HDV infection only occurs in individuals with chronic HBV. - Co-infection or superinfection with HDV often **accelerates the progression of liver disease** to cirrhosis and liver failure.
Question 10: In HIV patients, Kaposi's sarcoma is most likely caused by which of the following?
- A. Bacteria
- B. Parasite
- C. Fungus
- D. Virus (Correct Answer)
Explanation: ***Virus*** - The image likely depicts **Kaposi's sarcoma**, a common lesion in HIV patients, which is caused by **Human Herpesvirus 8 (HHV-8)**. - Other viral infections like **Herpes Simplex Virus (HSV)** can also cause mucocutaneous lesions in immunocompromised individuals. *Bacteria* - While HIV patients are susceptible to bacterial infections (e.g., **Staphylococcus aureus** causing skin abscesses), the described lesion type is not characteristic of common bacterial skin infections. - Bacterial lesions often present as pustules, cellulitis, or ulcers with purulent discharge, which differ from typical Kaposi's sarcoma. *Parasite* - Parasitic infections can occur in HIV patients (e.g., **scabies** or **leishmaniasis**), but these typically present with different dermatological features like intensely itchy papules or nodular ulcerative lesions. - Lesions caused by parasites do not usually manifest as the violaceous, nodular, or plaque-like appearances seen in Kaposi's sarcoma. *Fungus* - Fungal infections in HIV patients can cause skin lesions (e.g., **candidiasis** with oral thrush or esophagitis, or **cryptococcosis** with molluscum-like lesions). - However, the morphology of these fungal lesions generally differs from the classic appearance of Kaposi's sarcoma or other common viral lesions in HIV.
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