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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}} and  {{AJL}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Microbiology
|MainCategory=Microbiology
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|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Genitourinary
|SubCategory=Genitourinary
|MainCategory=Microbiology
|MainCategory=Microbiology
|MainCategory=Microbiology
|MainCategory=Microbiology
|MainCategory=Microbiology
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|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Genitourinary
|SubCategory=Genitourinary
|Prompt=A 60 year old female patient presents to her physician’s office for post-coital bleeding.   Following appropriate work-up, the pathology identified in this patient is similar to the image shown below. Which of the following characteristics appropriately describes the etiology of the patient's condition?
|Prompt=A 27-year-old sexually active woman presents to the physician’s office with post-coital bleeding. A cervical smear is performed, and the patient's pathological findings are shown in the image below. The physician then explains to the patient that her condition is most likely caused by a sexually transmitted virus. Which of the following characteristics best describes the virus responsible for this patient's condition?<br>
 
[[Image:ThinPrep Pap smear HPV.jpeg|500px]]
[[Image:ThinPrep Pap smear HPV.jpeg|350px]]
|Explanation=The patient presents with an abnormal pap-smear that displays the presence of [[koilocytes]], which are abnormal squamous epithelial cells that have undergone transformation following infection with [[human papillomavirus]] ([[HPV]]). The image illustrated above depicts a normal cervical cell on the left, and a [[koilocyte]] on the right. Characteristically, koilocytes are poorly keratinized cells that contain large, hyperchromatic, atypical nuclei with a [[perinuclear halo]] (vacuoles). HPV is a sexually transmitted, double-stranded, non-enveloped DNA virus. It is a member of the ''Papovaviridae'' family. Among the most significant HPV types include HPV types 16, 18, 31, 33, and 45, which predispose to the development of [[cervical cancer]]. In contrast, HPV types 6, 11, 42, 43, and 44 frequently result in [[genital warts]], whereas HPV types 1, 2, and 4 are associated with development of plantar warts.
|Explanation=The patient is presenting with [[genital warts]] or [[condyloma  accuminatum]] caused by [[human papilloma virus]] ([[HPV]]). The image shown above shows a normal cervical cell on the left, and a [[koilocyte]] defined as an HPV-infected cell, on the right side that is characterized by large nuclei with [[perinuclear halo]].
|AnswerA=Double-stranded, non-enveloped DNA virus
 
|AnswerAExp=The human papilloma virus (HPV) is a double-stranded, non-enveloped DNA virus.
HPV infection is a [[sexually transmitted infection]] (STI). Among the most important HPV types are HPV types 16, 18, 31, 33, and 45 which predispose to [[cervical cancer]]; and 6, 11, 42, 43, and 44 which cause [[genital warts]].
|AnswerB=Double-stranded, enveloped DNA virus
 
|AnswerBExp=Herpesviruses, adenoviruses, and poxviruses are double-stranded, enveloped DNA viruses.
Educational Objective:
|AnswerC=Single-stranded, non-enveloped DNA virus
Koilocytes, defined as enlarged nuclei with perinuclear halo, are infected cells with HPV.  HPV is a sexually transmitted virus that has at least a 100 types described, some of which predispose to cervical cancer and some cause genital warts.
|AnswerCExp=Parvoviruses are single-stranded, non-enveloped DNA viruses.
|AnswerA=Sexual activity
|AnswerD=Single-stranded, enveloped RNA virus.
|AnswerAExp=Sexual activity predisposes to HPV infection.  “Multiple sexual partners” is the most important risk factor for HPV infection that causes genital warts and cervical cancer.
|AnswerDExp=flaviviruses, togaviruses, retroviruses, coronaviruses, orthomyxoviruses, paramyxoviruses, rhabdoviruses, filoviruses, arenaviruses, bunyaviruses, and delta virus are all examples of single-stranded, enveloped RNA viruses.
|AnswerB=Smoking
|AnswerE=Double-stranded, non-enveloped RNA virus
|AnswerBExp=Smoking is an important risk factor for many cancers and chronic diseases.  It is in fact also a risk factor for cervical cancer.
|AnswerEExp=Reoviruses are double-stranded, non-enveloped RNA viruses.
|AnswerC=Polycycstic overian syndrome (PCOS)
|EducationalObjectives=[[Koilocyte]]s are squamous epithelial cells that have undergone morphological transformation following infection with HPV. Characteristically, they contain enlarged nuclei with perinuclear halos.  HPV is a sexually transmitted double-stranded, non-enveloped DNA virus that predisposes to the development of cervical cancer, genital warts, and plantar warts.
|AnswerCExp=Polycycstic overian syndrome (PCOS) is a risk factor for endometrial cancer.
|References=Burd EM. Human Papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1-17.<br>
|AnswerD=Exposure to aniline dye
First Aid 2014 page 158
|AnswerDExp=Exposure to aniline dye is a risk factor for transitional cell carcinoma.
|AnswerE=Family history
|AnswerEExp=Family history is an important risk factor for many cancers and chronic diseases.  It is in fact the most important risk factor for ovarian cancer.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=condyloma, accuminata, condyloma accuminata, HPV, human, papilloma, virus, human papilloma virus, genital, warts, genital warts, cervical, cancer, risk, factor, sexual, partner, multiple
|WBRKeyword=Koilocytes, Pap smear, Papsmear, Cervical smear, DNA virus, HPV, Papilloma virus, Papillomavirus
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 00:40, 28 October 2020
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D. and Alison Leibowitz [1])]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Microbiology
Sub Category SubCategory::Genitourinary
Prompt [[Prompt::A 27-year-old sexually active woman presents to the physician’s office with post-coital bleeding. A cervical smear is performed, and the patient's pathological findings are shown in the image below. The physician then explains to the patient that her condition is most likely caused by a sexually transmitted virus. Which of the following characteristics best describes the virus responsible for this patient's condition?

]]

Answer A AnswerA::Double-stranded, non-enveloped DNA virus
Answer A Explanation AnswerAExp::The human papilloma virus (HPV) is a double-stranded, non-enveloped DNA virus.
Answer B AnswerB::Double-stranded, enveloped DNA virus
Answer B Explanation AnswerBExp::Herpesviruses, adenoviruses, and poxviruses are double-stranded, enveloped DNA viruses.
Answer C AnswerC::Single-stranded, non-enveloped DNA virus
Answer C Explanation AnswerCExp::Parvoviruses are single-stranded, non-enveloped DNA viruses.
Answer D AnswerD::Single-stranded, enveloped RNA virus.
Answer D Explanation AnswerDExp::flaviviruses, togaviruses, retroviruses, coronaviruses, orthomyxoviruses, paramyxoviruses, rhabdoviruses, filoviruses, arenaviruses, bunyaviruses, and delta virus are all examples of single-stranded, enveloped RNA viruses.
Answer E AnswerE::Double-stranded, non-enveloped RNA virus
Answer E Explanation AnswerEExp::Reoviruses are double-stranded, non-enveloped RNA viruses.
Right Answer RightAnswer::A
Explanation [[Explanation::The patient presents with an abnormal pap-smear that displays the presence of koilocytes, which are abnormal squamous epithelial cells that have undergone transformation following infection with human papillomavirus (HPV). The image illustrated above depicts a normal cervical cell on the left, and a koilocyte on the right. Characteristically, koilocytes are poorly keratinized cells that contain large, hyperchromatic, atypical nuclei with a perinuclear halo (vacuoles). HPV is a sexually transmitted, double-stranded, non-enveloped DNA virus. It is a member of the Papovaviridae family. Among the most significant HPV types include HPV types 16, 18, 31, 33, and 45, which predispose to the development of cervical cancer. In contrast, HPV types 6, 11, 42, 43, and 44 frequently result in genital warts, whereas HPV types 1, 2, and 4 are associated with development of plantar warts.

Educational Objective: Koilocytes are squamous epithelial cells that have undergone morphological transformation following infection with HPV. Characteristically, they contain enlarged nuclei with perinuclear halos. HPV is a sexually transmitted double-stranded, non-enveloped DNA virus that predisposes to the development of cervical cancer, genital warts, and plantar warts.
References: Burd EM. Human Papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1-17.
First Aid 2014 page 158]]

Approved Approved::Yes
Keyword WBRKeyword::Koilocytes, WBRKeyword::Pap smear, WBRKeyword::Papsmear, WBRKeyword::Cervical smear, WBRKeyword::DNA virus, WBRKeyword::HPV, WBRKeyword::Papilloma virus, WBRKeyword::Papillomavirus
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Order in Linked Questions LinkedOrder::
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