Questions
Trichodysplasia spinulosa polyomavirus: Questions
Study questions about Trichodysplasia spinulosa polyomavirus: multiple-choice, clinical scenarios, short-answer and exam-style.
Mock Exam mode
Sit this set one question at a time. Multiple-choice questions mark themselves; written questions reveal a tickable mark scheme so you can score your own answer. You get a combined score at the end.
5 questions: 5 MCQ, 0 written.
- MCQ
The main principle of managing trichodysplasia spinulosa is to:
- A. Give lifelong systemic cytotoxic chemotherapy
- B. Perform wide surgical excision with sentinel node biopsy
- C. Start high-dose systemic corticosteroids
- D. Deliver radiotherapy to all affected facial skin
- E. Reduce immunosuppression to restore immune control
Show answer
Correct answer: E
Why E
As with the other polyomaviruses, control depends on cellular immunity, so the central measure is to reduce immunosuppression where the underlying condition allows, supported by topical antivirals such as cidofovir. Chemotherapy, excision and radiotherapy are treatments for cancer, not for this benign follicular disease, and corticosteroids would deepen the immunosuppression that drives it.
- MCQ
Trichodysplasia spinulosa characteristically presents with:
- A. Painful vesicles in a dermatomal band
- B. A solitary rapidly growing violet nodule
- C. Facial keratin spicules with loss of the eyebrows and eyelashes
- D. Widespread flaccid bullae and erosions
- E. Annular scaly plaques with central clearing and an advancing raised edge
Show answer
Correct answer: C
Why C
Trichodysplasia spinulosa produces follicular papules each bearing a fine keratin spicule on the central face, with loss of the eyebrows and eyelashes and sometimes a leonine appearance. Dermatomal vesicles suggest zoster, a violet nodule Merkel cell carcinoma, flaccid bullae pemphigus, and annular scaly plaques dermatophyte infection.
- MCQ
Trichodysplasia spinulosa develops when:
- A. Immunosuppression allows productive viral replication in hair follicles
- B. A healthy adult is infected with the virus for the first time
- C. The virus integrates into and transforms follicular cells
- D. The virus reactivates within the dorsal root ganglia
- E. Ultraviolet light progressively mutates the genome of the follicular cells
Show answer
Correct answer: A
Why A
The disease occurs almost only in immunosuppressed patients, in whom loss of T-cell control permits productive replication of the virus in hair follicle cells. It is not a disease of primary infection, does not involve integration and transformation (that is Merkel cell polyomavirus), and has nothing to do with ganglionic latency or ultraviolet mutagenesis.
- MCQ
Which skin-biopsy finding supports a diagnosis of trichodysplasia spinulosa?
- A. Small round blue cells with a dot-like paranuclear cytokeratin 20 pattern
- B. Koilocytes throughout the epidermis
- C. Caseating granulomas in the dermis
- D. Distended hair follicles with trichohyalin-rich inner root sheath cells
- E. A subepidermal blister filled with eosinophils
Show answer
Correct answer: D
Why D
The biopsy shows greatly distended hair follicles with an expanded population of inner root sheath cells rich in eosinophilic trichohyalin, the histological hallmark of trichodysplasia spinulosa. Dot-like cytokeratin 20 indicates Merkel cell carcinoma, koilocytes HPV, caseating granulomas tuberculosis, and an eosinophil-rich subepidermal blister bullous pemphigoid.
- MCQ
Trichodysplasia spinulosa polyomavirus is best classified as:
- A. An enveloped herpesvirus that becomes latent in the skin and nerves
- B. A non-enveloped polyomavirus of the genus Alphapolyomavirus
- C. A single-stranded RNA virus of the skin
- D. A cutaneous papillomavirus
- E. A poxvirus of the skin surface
Show answer
Correct answer: B
Why B
It is a non-enveloped double-stranded DNA polyomavirus, species Alphapolyomavirus octihominis, in the same genus as Merkel cell polyomavirus. It is not a herpesvirus, an RNA virus, a papillomavirus or a poxvirus.