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Flashcards in 12 - Viral Infections Deck (70):
1

What are warts?

Benign epidermal neoplasms caused by HPV (small DNA viruses)

2

Causes/pathophys of warts

HPV (>100 types)

HPV infects keratinocytes and induces hyperplasia and hyperkeratosis

Infection can be
- latent
- subclinical
- clinical

3

Which warts are associated w SCC?

38
41
48

4

How are warts spread?

Touch
- adjacent toes
Moist surfaces (pools)
Sites of trauma

5

Course that warts follow?

May resolve spontaneously in
- weeks - months
- Years - lifetime

Regression involves a multifactorial immune response

6

Wart removal?

May take several sessions
Minimal scarring

If normal skin lines return, removal was successful

7

Morphology of warts?

Verrucous papule 1-5mm in size
Cylindrical projections
Thromboseses vessels become trapped in projections and seen as black dots on surface of warts

8

Diagnostic sign

Warts may become fused and produce mosaic pattern on surface

9

Comon warts are aka?

Verruca vulgaris

10

Describe a verruca vulgaris

Dome shaped
Gray-brown
Hyperkeratotic
Papule
Black dots on surface

11

Tx or verruca vulgaris?

Liquid nitrogen Q 2-4 weeks
Light electrocautery
Salicylic acid (topical)
Imiquimod (topical)
Blunt dissection

12

Describe filiform warts

Finger like
Flesh-colored projections
Very superficial
- easiest to treat

13

MC site of filiform warts?

MC on face

14

Tx for filiform warts?

Curettage
Apply bilat traction
Use 1 firm stroke
Light electrocautery
Light cryosurgery

15

Flat warts are aka?

Verruca plana

16

Describe verruca plana

Flat (lol)

Flat-topped papules
Grouped
Pink, light brown, yellow
Sites
- Forehead
- around mouth
- back of hands
- shaved areas (beard, legs)

17

Tx for veruca plana

Imiquimod 5% cream (aldara)
Cryosurgery/electrosurgery
5-fluorouracel cream (efudex)
Tretinoin cream (retin-a)

18

Where are plantar warts found?

Soles of feet

points of max pressure
- metarasal heads or heels

19

How to differentiate plantar warts from corns?

Shave and look for black dots and lack of skin lines
- corns have skin lines

20

Plantar wart treatment?

Not required if painless
- will regress over time

But if youre feeling froggy:

Debride (pare) and warm water soak prior to tx
- salicyclic acid w occlusion
- 40% salicylic acid plaster
- imiquimod (aldara) w occlusion
- cantharidin w occlusion
Blunt dissection

21

Alternate plantar wart tx?

Laser
E D and C
Chemotherapy (bichloracetic acid)
Intralesional bleomycin sulfate ($$)

22

When treating plantar warts you should avoid?

Cryo
- blister on sole can be painful

23

What are subungual and periungual warts?

Wart next to nail
- maybe the tip of the iceburg
- painful

May be spread by cuticle biting

24

Subungual and periungual wart tx?

Resistant to chemical and surgical methods

Cryosurgery
Cantharidin (paint wait for blister, repaint, occlude x 48hrs)
Salicyclic acid
Duct tape
Blunt dissection

25

Genital warts are aka?

Condyloma acuminata or veneral warts

26

Condyloma acuminata or veneral warts are associated w?

HPV 6, 11, 16, 18

MC viral STD

27

Describe genital warts

Pale pink w numerous discrete narrow-to-wide projections on a broad base

Surface is smooth, velvety, moist and lacks hyperkeratosis of warts found elsewhere

May coalesce to form large, cauliflower-like mass

28

Self inoculation of genital warts?

Spread rapidly over moist areas
Kissing lesions on labia or rectum

29

Genital wart treatment success?

Frequently recur
- latent virus extends beyond txt ares in clinically normal skin

Flat and inconspicuous warts may escape txt

30

High risk and low risk HPV subtypes?

high: 16,18

Low: 6, 11

31

Genital warts txt considerations?

HPV cannot completely be eliminated
- surrounding subclinical infection

HPV infx may persist -> pts lifetime
- intermittent infection

Contagious spread from subclinical HPV pts vs exophytic wart is unclear

Check partner

32

Genital warts provider administered tx?

TCA - trichloracetic acid
Podophyllum resin
Cryosurgery
Scissor excision
Curettage
Electrosurgary
Carbon dioxide laser

33

Genital warts Pt applied tx

Podofilox gel (condylox)
Imiquimod 5% (aldara)

If all else fails
- 5-fluorouracil (efudex)

34

Warts DDX?

Genital
- bowenoid papules
- pearly penile papule (NOT WARTS)

35

Bowenoid papules morphology?

Small
Brown or pink
Flat/slightly irregular
Discrete
Grouped papules

Resemble flat or genital wart

36

Bowenoid papules distribution?

Penis
Vulva
Anus

37

Bowenoid papules etiology?

Sex
- HPV - oncogenic type
- quasi-premalignant

38

Bowenoid papules prognosis?

Resolve spontaneously in months-years

Direct progression to SCC has not been observed

39

Bowenoid papules txt?

Cryo
Electrosurgery
Excision
CO2 laser
Imiquimod 5% (aldara)
5-FU (efudex)
Abstinence
Condom use

Check sex partner

40

Bowenoid papules DDX

Genital warts
Bowen disease
Psoriasis
Lichen planus

41

Mulluscum contaginosum is MC found in?

Kids

42

How is molluscum contagiosum spread?

Kids
- Touching
- Self-inoculation
- arms and face

Adults
- sex
- groin, pubis, thighs
- wrestlers/wrasslers
- masseurs

43

Molluscum contagiosum morphology

Small discrete 2-5mm flesh colored
- central umbilicaiton
- large lesions (1cm) (inflamed and crusted)

44

Molluscum contagiosum etiology

DNA poxvirus
Virion colony encased in protective sac
- prevents triggering host immune response

45

Molluscum contagiosum management?

Self limiting
Pruritic
Problems of contagion

46

Molluscum contagiosum txt?

Babies/small kids
- apply tretinoin
- lesion irritated - rub off w cloth
- wash area to prevent spread

Older kids/adults
few lesions
— durette
— LN2
multiple lesions
— retinA or TCA

47

Herpes names?

Oral - herpes labialis
Genital - herpes genitalis

Serotypes
- HSV-1 - oral
- HSV-2 - genital

48

HSV-2 spread is often?

From undiagnosed pts
- mild or unrecognized sxs but still sheds virus

Asymptomatic viral shedding is primary mode of herpes virus transmission

49

Herpes simplex first presentation?

First time is the worst time

Vesicles appear 6 days after contact
Last 14 days
Shedding last 15-16 days

50

Why is herpes the gift that keeps on giving?

Ascends peripheral sensory nerves and establishes latency in nerve root ganglia

51

Recurrent HSV “flare-ups”

Less severe than primary
Prodrome
- Itching burning, pain
Virus cultured x 5 days
Shed virus between flareups

Tends to get less freq over time

52

HSV morphology?

Grouped vesicles on an erythematous base
Superficial lesion
Slight central umbilication in 2-3 days then erode
Crust form then heal w/o scarring in 2 weeks

53

Clinical presentation of HSV?

Discharge
Dysuria
Inguinal LAD
Fever
Myalgia
Lethargy
Photophobia

All more common in women

54

Types of Herpes simplex?

Herpes gladitorium
Ocular herpes
Herpetic whitlow
HSV of buttock (women usually)
HSV of trunk

55

Diagnosis of HSV?

PCR - gold standard
Viral culture (during shedding)
Tzanck prep
- multinucleated giant cells
Serology differentiates 1 and 2

56

HSV management

Acyclovir
Valcyclovir
Famciclovir

penciclovir or abrevia (labialis)

57

Which HSV med is the best?
- per ms booker

Valcyclovir (valtrex)

58

Presentation of varicella?

Prodrome
- fever
- malaise
- HA

Croups of lesion in various stages
- Trunk-> extremeties
- Puritic in vesicle phase
- Scarring

59

Stages of varicella?

Papule-vesicle-erosion-crust

60

Etiology of varicella?

DNA poxvirus
Respiratory transmission
Spring (more common)
Lifelong immunity
- except reactivation

61

Varicella txt?

Cool bathes (aveeno)
Antihistamine PRN
Tylenol (no ASA)
Acyclovir

62

Acyclovir indication (varicella)

Start w/in 24hrs
Non-pregnant over age 13
Chronic skin disease
Children on steroids or immunocompromised

63

What is herpes zoster?

Reactivated varicella virus
- dorsal root ganglion

64

Herpes zoster presentation?

Prodrome
- pain, itching, burning
- constitutional sxs

Red swollen papules/plaques of varying size

Vesicles appear as clusters on the erythematous base

Clear and change to cloudy and prulent then erode/ruptureto form cursts (2 weeks)

65

dx of herpes zoster?

Clinical
+ tzanck prep

66

Herpes zoster txt

Acyclovir
Valcyclovir
Famciclovir

Prednisone (over 50 yrs)
Analgesics
- opiate pain meds prn
Capsaicin cream
Soaks

67

If herpes zoster is on ophthalmic branch of trigeminal nerve

Ophthalmologist consult

68

Prevention of herpes zoster?

Zostavax
- Single dose
- Sub Q
- Live attenuated vaccine

Pts 60yrs +

69

Zostavax is not?

Substitute for varivax
Txt for zoster or PHN

70

Why do fish live in salt water?

Because pepper makes them sneeze