Virology Practice Questions

Q: Coxsackie virus is classified as which type of virus?

Enterovirus. ***Enterovirus*** - **Coxsackie virus** belongs to the genus *Enterovirus* within the family *Picornaviridae*. - Enteroviruses are characterized as **non-enveloped, positive-sense, single-stranded RNA viruses** and typically infect the gastrointestinal tract. *Herpes virus* - Herpes viruses are **enveloped, double-stranded DNA viruses** known for causing latent infections. - Examples include HSV-1 (oral herpes) and VZV (chickenpox), which are distinct from Coxsackie. *Pox virus* - Pox viruses are **large, enveloped, double-stranded DNA viruses** that replicate in the cytoplasm of infected cells. - Smallpox and molluscum contagiosum are caused by pox viruses, which have different genetic and structural characteristics than Coxsackie virus. *Myxovirus* - **Myxovirus** is an older classification that once included viruses now categorized into *Orthomyxoviridae* (e.g., influenza) and *Paramyxoviridae* (e.g., measles, mumps). - These are **enveloped, negative-sense, single-stranded RNA viruses**, a different viral structure and replication strategy compared to Coxsackie virus.

Q: Serological testing of patient shows HBsAg, IgM anti-HBc and HBeAg positive. The patient has -

Acute hepatitis B with high infectivity. ***Acute hepatitis B with high infectivity*** - The presence of **HBsAg** (hepatitis B surface antigen) indicates active infection, while **IgM anti-HBc** (IgM antibody to hepatitis B core antigen) is a marker of recent or acute infection [1]. - **HBeAg** (hepatitis B e-antigen) positivity signifies active viral replication and a high likelihood of infectivity [1]. *Chronic hepatitis B with low infectivity (not acute)* - **Chronic hepatitis B** is characterized by the presence of **HBsAg for more than six months**, but **IgM anti-HBc** would typically be negative; instead, **IgG anti-HBc** would be positive [1]. - **Low infectivity** would be indicated by the absence of **HBeAg**, replaced by **anti-HBe** (antibody to HBeAg) [1]. *Chronic hepatitis with high infectivity* - This diagnosis would show positive **HBsAg and HBeAg**, but the absence of **IgM anti-HBc** (presence of **IgG anti-HBc** instead) would distinguish it from acute infection [1]. - The presence of **IgM anti-HBc** is a crucial marker for an acute phase of hepatitis B rather than chronic. *Acute on chronic hepatitis* - This scenario would involve a patient with pre-existing **chronic hepatitis B** (positive HBsAg, IgG anti-HBc) experiencing a new acute flare-up, which could involve a resurgence of **HBeAg** or a new acute viral insult. - While **HBsAg** and **HBeAg** would be positive, the key differentiator would be the presence of both **IgM anti-HBc** (indicating the acute component) and **IgG anti-HBc** (indicating the chronic component), which is not fully described here to confirm acute on chronic.

Q: Which of the following statements about p24 is false?

Cannot be detected after seroconversion. ***Cannot be detected after seroconversion*** - This statement is **FALSE** and is the correct answer to this question. - **p24 antigen levels do decrease** after seroconversion due to immune complex formation with antibodies, but p24 can still be detected using modern assays. - In **advanced HIV disease** with declining CD4 counts, p24 antigen often becomes detectable again due to high viral loads. - Fourth-generation HIV tests detect both antibodies and p24 antigen throughout the infection course. *Cannot be seen in the first week* - This statement is **TRUE** (not the answer). - p24 antigen typically appears around **10-14 days** (1.5-2 weeks) after infection, which is after the first week (days 1-7). - The eclipse period (first 7-10 days) precedes p24 detection. *Can be detected after 3 weeks of infection* - This statement is **TRUE** (not the answer). - p24 antigen is consistently detectable at 3 weeks post-infection during the acute viremic phase. - Peak p24 levels occur around **2-4 weeks** after infection. *All of the above* - This is a distractor option and is incorrect since only one statement is false.

Q: Which of the following is an enveloped virus?

Dengue virus. ***Dengue virus*** - The **Dengue virus** is a member of the **Flaviviridae** family, which are known to be **enveloped viruses**. - Its outer lipid envelope, derived from the host cell, is crucial for its entry into host cells and evading the immune system. *Norwalk virus* - The **Norwalk virus**, also known as **Norovirus**, is a **non-enveloped RNA virus** belonging to the **Caliciviridae** family. - Its lack of an envelope makes it more resistant to disinfectants and environmental stresses, contributing to its high infectivity and ability to cause outbreaks of gastroenteritis. *Hep A virus* - **Hepatitis A virus (HAV)** is a **non-enveloped RNA virus** of the **Picornaviridae** family. - Its non-enveloped nature contributes to its stability in the environment and resistance to gastric acid, facilitating its fecal-oral transmission. *Adenovirus* - **Adenoviruses** are **non-enveloped DNA viruses** known for causing a variety of clinical manifestations, including respiratory infections, conjunctivitis, and gastroenteritis. - Their lack of an outer lipid envelope helps them survive in harsh environmental conditions and makes them highly stable.

Q: HIV window period indicates:

time period between infection and detection of antibodies. ***time period between infection and detection antibodies*** - The **HIV window period** refers specifically to the time frame after initial infection during which **HIV antibodies** have not yet reached detectable levels in routine serological tests. - During this period, an infected individual can still transmit the virus, even if their test results would appear **negative** for antibodies. *time period between infection and onset of first symptoms* - The onset of **first symptoms**, such as acute retroviral syndrome, can occur before or after antibodies are detectable, and is not the defining characteristic of the window period. - Symptoms are a **clinical manifestation**, whereas the window period is a **diagnostic concept** related to test detectability. *time period between infection and minimum viral load* - **Viral load** (the amount of virus in the blood) is typically **high** shortly after infection, then decreases somewhat before rising again, and its minimum point is not directly related to the antibody window period. - The window period focuses on the host's **immune response** to the virus, specifically antibody production. *time period between infection and maximum viral load* - The **maximum viral load** usually occurs during the acute (early) phase of infection, often before the development of detectable antibodies. - This represents a peak in viral replication, not the interval until the **immune system's antibody response** becomes detectable.

Q: Which viral infection is primarily associated with hemolysis?

Epstein-Barr virus. **Epstein-Barr virus** - **Epstein-Barr virus (EBV)** is strongly associated with **cold agglutinin disease**, an **autoimmune hemolytic anemia** where cold-reacting antibodies agglutinate and lyse red blood cells. [4] - Hemolysis in EBV infection can also occur due to direct viral effects on red blood cells or immune-mediated mechanisms beyond cold agglutinins. [1] *Hepatitis B virus* - Hepatitis B virus is primarily known for causing **liver inflammation** and **hepatocellular damage**, rather than direct or immune-mediated hemolysis. [2] - While chronic HBV infection can lead to complications such as cirrhosis or liver cancer, it is not a common cause of hemolytic anemia. *Hepatitis-C* - Hepatitis C virus is a common cause of **chronic liver disease**, leading to **fibrosis**, **cirrhosis**, and **hepatocellular carcinoma**. [3] - Although HCV is sometimes associated with mixed cryoglobulinemia, which can cause vasculitis and organ damage, it does not typically cause significant hemolysis. *Hepatitis A virus* - Hepatitis A virus causes **acute, self-limiting liver inflammation** and is primarily transmitted through the **fecal-oral route**. [2] - It does not typically cause sustained or severe hemolysis; any hemolytic events are rare and usually mild.

Q: Pharyngeal-conjunctival fever is caused by

Adenovirus 3 and 7. ***Adenovirus 3 and 7*** - **Adenovirus serotypes 3 and 7** are the most common causes of **pharyngoconjunctival fever**, which presents with combination of **pharyngitis**, **conjunctivitis**, and **fever**. - This syndrome often occurs in outbreaks, particularly in children, and can be spread through **respiratory droplets** or contaminated water. *Adenovirus 11, 21* - **Adenovirus 11 and 21** are primarily associated with **hemorrhagic cystitis**, an inflammation of the bladder often presenting with **hematuria**. - They are less commonly implicated in typical pharyngoconjunctival fever, though adenoviruses can cause a spectrum of respiratory symptoms. *Adenovirus 40, 41* - **Adenovirus serotypes 40 and 41** are leading causes of **infantile gastroenteritis**, characterized by **diarrhea** and **vomiting**. - They are not typically associated with respiratory or ocular manifestations like pharyngoconjunctival fever. *Adenovirus 8, 19* - **Adenovirus 8 and 19** are well-known causes of **epidemic keratoconjunctivitis**, a severe form of conjunctivitis often involving the **cornea**. - While they cause a significant eye infection, they are not the primary serotypes linked to the broader syndrome of **pharyngoconjunctival fever** which includes pharyngitis and fever.

Q: What indicates HBV replication?

HBV DNA. ***HBV DNA*** - **HBV DNA** is the **gold standard and most direct marker of active HBV replication** in modern clinical practice - **Quantitative HBV DNA (viral load)** precisely measures the level of viral replication and is essential for: - Diagnosing active infection - Monitoring disease progression - Guiding treatment decisions - Assessing treatment response - Detected by **PCR (Polymerase Chain Reaction)** or other nucleic acid amplification tests - Directly indicates the presence of replicating virus *HBeAg* - **HBeAg (Hepatitis B e-antigen)** is a marker of high viral replication in **HBeAg-positive chronic hepatitis B** - However, it has significant limitations: - **HBeAg-negative variants** can have active replication without HBeAg presence - Not present in all cases of active replication - Less direct than measuring actual viral DNA - Useful as a supplementary marker but not the primary indicator of replication *DNA polymerase* - **HBV DNA polymerase** is an enzyme essential for viral replication - While its activity correlates with replication, it is **not routinely measured** as a primary clinical marker - HBV DNA testing has replaced DNA polymerase assays in modern practice *IgM Anti-HBc* - **IgM Anti-HBc (IgM antibody to hepatitis B core antigen)** indicates **acute or recent HBV infection** - Reflects the **immune response** to infection, not viral replication itself - Can be present during acute phase even as viral replication is being controlled - Not a marker of ongoing chronic replication

Q: All are true regarding mumps, EXCEPT:

Spreads through Stensen's duct to parotid gland. ***Spreads through Stensen's duct to parotid gland*** - Mumps virus does NOT primarily enter the parotid gland via **Stensen's duct**; rather, it reaches the parotid glands via **hematogenous spread** after initial replication in the upper respiratory tract and regional lymph nodes. - Stensen's duct is the **excretory duct** for saliva drainage from the parotid gland, not a viral entry route. - This is the **false statement** in this EXCEPT question. *Incubation period is 18-21 days* - The typical incubation period for mumps is **16-18 days** (range 12-25 days), so 18-21 days falls within the acceptable range. - This relatively long incubation period allows for potential asymptomatic transmission before symptom onset. *Can cause aseptic meningitis* - Mumps is a well-known cause of **aseptic (viral) meningitis**, occurring in approximately **10-15%** of mumps cases. - CNS involvement can also include encephalitis, though this is less common. - Most cases of mumps meningitis resolve without permanent neurological sequelae. *Multiplies in respiratory epithelium* - Mumps virus is transmitted via **respiratory droplets** and initially replicates in the **nasopharyngeal mucosa and respiratory epithelial cells**. - This initial replication site leads to local viral shedding and subsequent viremia with systemic spread to glandular tissues (parotid, pancreas, testes, ovaries).

Q: Reverse transcriptase is a RNA-dependent DNA polymerase. Which of the following uses it?

Hepatitis B virus. ***Hepatitis B virus*** - Hepatitis B virus (HBV) is a **DNA virus** that replicates via an **RNA intermediate** using **reverse transcriptase**. - Its genome is a partially double-stranded circular DNA, and the enzyme is crucial for synthesizing the DNA genome from a pregenomic RNA template. *Hepatitis A virus* - Hepatitis A virus (HAV) is a **single-stranded RNA virus** (positive-sense) that replicates without a reverse transcriptase step. - Its replication involves direct translation of its RNA genome into viral proteins and replication via an RNA-dependent RNA polymerase. *Hepatitis E virus* - Hepatitis E virus (HEV) is a **single-stranded RNA virus** (positive-sense) that, like HAV, does not utilize reverse transcriptase for its replication. - It replicates in the cytoplasm of host cells using an **RNA-dependent RNA polymerase**. *Hepatitis C virus* - Hepatitis C virus (HCV) is a **single-stranded RNA virus** (positive-sense) belonging to the Flaviviridae family. - It replicates its RNA genome directly using an **RNA-dependent RNA polymerase** and does not involve a DNA intermediate or reverse transcription.

Question 1

Coxsackie virus is classified as which type of virus?

Accepted Answer

Enterovirus

Answer

Pox virus

Answer

Myxovirus

Answer

Herpes virus

Question 2

Serological testing of patient shows HBsAg, IgM anti-HBc and HBeAg positive. The patient has -

Accepted Answer

Acute hepatitis B with high infectivity

Answer

Chronic hepatitis with high infectivity

Answer

Acute on chronic hepatitis

Answer

Chronic hepatitis B with low infectivity (not acute)

Question 3

Which of the following statements about p24 is false?

Accepted Answer

Cannot be detected after seroconversion

Answer

Cannot be seen in the first week

Answer

All of the above

Answer

Can be detected after 3 weeks of infection

Question 4

Which of the following is an enveloped virus?

Accepted Answer

Dengue virus

Answer

Norwalk virus

Answer

Hep A virus

Answer

Adenovirus

Question 5

HIV window period indicates:

Accepted Answer

time period between infection and detection of antibodies

Answer

time period between infection and onset of first symptoms

Answer

time period between infection and minimum viral load

Answer

time period between infection and maximum viral load

Question 6

Which viral infection is primarily associated with hemolysis?

Accepted Answer

Epstein-Barr virus

Answer

Hepatitis-C

Answer

Hepatitis A virus

Answer

Hepatitis B virus

Question 7

Pharyngeal-conjunctival fever is caused by

Accepted Answer

Adenovirus 3 and 7

Answer

Adenovirus 11, 21

Answer

Adenovirus 40, 41

Answer

Adenovirus 8, 19

Question 8

What indicates HBV replication?

Accepted Answer

HBV DNA

Answer

DNA polymerase

Answer

HBeAg

Answer

IgM Anti-HBc

Question 9

All are true regarding mumps, EXCEPT:

Accepted Answer

Spreads through Stensen's duct to parotid gland

Answer

Incubation period is 18-21 days

Answer

Multiplies in respiratory epithelium

Answer

Can cause aseptic meningitis

Question 10

Reverse transcriptase is a RNA-dependent DNA polymerase. Which of the following uses it?

Accepted Answer

Hepatitis B virus

Answer

Hepatitis A virus

Answer

Hepatitis E virus

Answer

Hepatitis C virus

Virology — MCQs

Virology — MCQs

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