HPV

Question 1

Describe HPV ?

Answer 1

Ds DNA
Non enveloped icosahedral capsid

Question 2

HPV target ?

Answer 2

Basal keratinocytes

Question 3

Mention HPV GENES ?

Answer 3

1- L1-L2 (late)
2- E1-E7 (early)

Question 4

What HPV genes are responsible for DNA replication and what are the first to be expressed??

Answer 4

E1-7

E1 & E2

Question 5

What is responsible for cytokeratin disruption (koilocytosis)?

Answer 5

E4

Question 6

What controles transcription and replication of viral DNA ?

Answer 6

E1 E2

Question 7

What allows viral replication over s.basale (amplification) ?

Answer 7

E5,6,7

Question 8

What decreases host immunity response? And through what?

Answer 8

E6, E7
Decrease TLR-9 and IL-8

Question 9

What are the oncoproteins ?

Answer 9

E6 E7

Question 10

What are fxns of E6 and E7 ?

Answer 10

E6: ubiquitin mediated p53 destruction
E7: binds to RB= increase of E2F transcription

Question 11

More superficial epidermis has higher levels of ??

Answer 11

L1 L2

Question 12

In which layer you see the complete virus ??

Answer 12

S. Granulosum

Question 13

Which genus is responsible for EV ??

Answer 13

Beta and the other cutaneous conditions by alpha

Question 14

Treatment of most warts ?

Answer 14

Resolve spontaneously in 1-2 years

Question 15

Types of warts ??

Answer 15

5
(Common, palmoplantar, flat, ridged, butchers)

Question 16

What are the black dots of common warts ?

Answer 16

Thrombosed capillaries

Question 17

What causes 10 nail dystrophy ??

Answer 17

HPV -57

Question 18

What causes common warts ?

Answer 18

HPV1,2,4,27,57

Question 19

What causes palmoplantar warts ?

Answer 19

HPV1,2,4,27,57

Question 20

Myrmecia ??

Answer 20

Palmoplantar wart with anthill appearance

Question 21

Types of palmoplantar warts appearance??

Answer 21

Mytmecia
Mosaic

Question 22

What is mosaic palmplantar wart ??

Answer 22

Coalescence of several warts

Question 23

Histology of palmoantar wart ??

Answer 23

Church spires paplillomatosis
Hyperkeratosis, acanthodis with elongated rete ridges, hypergranulosis, koilocytosis and increased dermal vessels.

Question 24

What causes flat warts ??

Answer 24

HPV3,10,28,29

Question 25

Histology of flat warts ??

Answer 25

Birds eyes ( koilocytosis of granular layer), alternating ortho/parakeratosis, mild papillomatosis, hypergranulosis, acanthosis

Question 26

What causes butchers warts ??

Answer 26

HPV 2,7

Question 27

What causes ridged warts ?? And what are its varients ??

Answer 27

HPV-60 Pigmented variants in Japanese

Question 28

What causes EV ??

Answer 28

HPV 5,8

Question 29

Mode of inheritance in EV ?

Answer 29

Autosomal recessive inheritance and acquired in HIV

Question 30

What are the mutations in EV?

Answer 30

Ever 1,2 (TMC6,8)

Question 31

What is affected in EV ??

Answer 31

Transmembrane proteins in endoplasmic reticulum that interacts with zinc transporter,leading to decrease of intracellular zinc

Question 32

Histology of EV?

Answer 32

Flat wart like architecture plus large cells with Peri nuclear halos and blue gray granular cytoplasm.

Question 33

WHIM syndrome? Mode of inheritance? Mutation? Symptoms?

Answer 33

AD, cxcr4 Wart+ hypogammaglobulinemia+ infections (bacteria) + myelokathexis (neutropenia)

Question 34

What is myelokathexia ?

Answer 34

bone marrow sequestration of mature neutrophils

Question 35

WILD syndrome? Mode of inheritance? Mutation? Symptoms?

Answer 35

Sporadic (variant of EV- AR) Wart, immunodeficiency (CD4 lymphopenia), lymphedema, defect(anogenital)

Question 36

Tt of warts and EV:

Answer 36

1- destructive (cryo, electrodissecation, shave/scissors removal) 2- topicals (salicylic acids 17%, codofovir gel, 5-fu) 3- intralesional (mmr, candida, bleomycin) 4- laser (co2, pdl)

Question 37

Types of genital warts ::

Answer 37

1- condylomata acuminata 2- condylomata plana (seen with acetic acid)

Question 38

HPV subtypes of genital warts ?

Answer 38

6,11,16,18,31,33,45

Question 39

Treatment of genital warts ?

Answer 39

1- destructive (cryo, high concentration of TCA, electrosurgery, shave removal ) 2- topical (imiquimod, podophyllotoxin, cidofovir gel) 3- intralesional cidofovir 4- laser (co2, PDT)

Question 40

Types of HPV Vaccines? At which age FDA approved

Answer 40

Bivalent (gardasil) Quadrivalent (cervarix) 9-valent (gardasil) After 9 years up to 45 It’s killed vaccine

Question 41

HPV vaccine caontains which viral proteins??

Answer 41

L1

Question 42

Contraindications of HPV vaccine )

Answer 42

Yeast allergy Pregnancy (but not breastfeeding)

Question 43

What is bowenoid papulosis ??

Answer 43

high-grade squamous intraepithelial lesion (HSIL) or SCC in situ

Question 44

Describe bowenoid papulosis ??

Answer 44

pigmented genital papules on anogenital area

Question 45

Erythroplasia if queyrat ?

Answer 45

Red smooth sharply defined plaque on glabrous penis/vulva Its either HSIL OR SCC

Question 46

Risk factors of erythrplasia of queryat ?

Answer 46

-Lack of circumcision -Chronic irritation, -infection: herpes simplex viral infection, bacteria, heat, friction, trauma -Zoon balanitis -(HPV) types 8 and 16 -Immunosuppression -UV light -Phimosis -Multiple sexual partners -Smoking -Chronic underlying diseases (lichen sclerosis, lichen planus)

Question 47

Buscke lowenstein tumor variants ? And what HPV subtypes?

Answer 47

1- oral florid papillomatosis (akerman tumor) over expression of cyclin B1 2- epithelioma caniculatum 3- papillomatosis cutis carcinoides 6,11

Question 48

Subtypes causing erythroplasia of qyerat ??

Answer 48

Premalignant subtypes

Question 49

Describe epithelioma cuniculatum And what subtypes HPV ??

Answer 49

solitary, slow growing, warty, papillomatous plaque. It usually develops on the foot, oral cavity, nails, or genitals. 2,11,16

Question 50

Histology of buscke lowenstein tumor?

Answer 50

Papillomatous acanthotic epidermis with bulbous downward extending rete ridges

Question 51

Tt of buscke lowenstein tumor ??

Answer 51

Excision with clear margins

Question 52

Variant of oral wart ??

Answer 52

Focal epithelial hyperplasia (hecks disease)

Question 53

Hecks disease HPV subtypes??

Answer 53

13,32

Question 54

Recurrent respiratory papillomatosis HPV subtypes??

Answer 54

6,11

Question 55

#1 benign laryngeal tumor??

Answer 55

Recurring respiratory papillomatosis

Question 56

Triad of Recurring respiratory papillomatosis

Answer 56

Stridor + hoarseness + respiratory distress