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ANDREWS’ Diseases Of The Skin 13 Ed. > CHAPTER 19: VIRAL DISEASES > Flashcards

CHAPTER 19: VIRAL DISEASES Flashcards

1
Q

part of the virus that etermines serologic specificity, protects the nucleic acid from enzymatic degrada- tion in biologic environments, controls host specificity, and increases the efficiency of infection.

A

protein coat ( capsid)

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2
Q

few eroded follicular papules (resembling acne excoriée) to extensive lesions involving the whole beard area in men

caused by HSV -1 infection

A

Herpetic sycosis

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3
Q

Infection with HSV-1 is highly contagious to susceptible persons who wrestle with an infected individual with an active lesion.

A

Herpes gladiatorum

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4
Q

occur on the fingers or periungually
Lesions begin with tenderness and erythema, usually of the lateral nailfold or on the palm.

Deep-seated blisters develop 24–48 h after symptoms begin

A

Herpetic whitlow

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5
Q

causative agent of orolabial herpes?

A

HSV 1

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6
Q

causative agent of genital herpes?

A

HSV 2

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7
Q

MOT of genital herpes

A

Genital herpes is spread by skin-to-skin contact, usually during sexual activity.

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8
Q

describe the lesions of genital herpes

A

lesions are classic, grouped blisters on an erythematous base

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9
Q

tx for neonatal herpes

A

IV acyclovir for 14 days for SEM ( skin, eyes and/or mouth infection);
21 days for CNS and dessiminated dse

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10
Q

management for pregnant women with genital herpetic leisons or prodromal sx?

A

acyclovir 400 mg TID PO x 10 days ( except in the first month of gestation).

Caesarian section ( scalp electrode and vacuum assisted delivery is CI )

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11
Q

Infection with herpesvirus in patients with atopic dermatitis (AD) may result in spread of herpes simplex throughout the eczematous areas, called

A

eczema herpeticum (EH) or Kaposi varicelliform eruption (KVE).

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12
Q

3 clinical hallmarks of HSV infection

A
  1. pain
  2. active vesicular border
  3. scalloped periphery
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13
Q

what is the standard treatment for acyclovir-resistant herpes simplex

A

IV foscarnet

IV Cidofovir for Foscarnet resistant herpes simplex

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14
Q

most characteristic feature of HSV infection histologically

A

**multinucleated giant cells, ** molding together, forming a crude **jigsaw puzzle appearance. **

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15
Q

incubation period of VZV

A

10-21 days

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16
Q

MOT of VZV

A

respiratory route and less often by direct contact w/ the lesion

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17
Q

treatment of genital herpes

A

oral acyclovir, 200 mg five times or 400 mg three times daily; famciclovir, 250 mg three times daily; or valacyclovir, 1000 mg twice daily, all for 7–10 days.

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17
Q

when is Varicella most infetious?

A

infectious from 5 days BEFORE the eruption appears and are most infectious 1–2 days BEFORE the rash appears.

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18
Q

when does varicella ceases its infectivity?

A

Infectivity usually ceases 5–6 days after the erup- tion appears.

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19
Q

“teardrop” vesicles on an erythematous base

A

Varicella

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20
Q

most common neurologic com- plications of varicella

A

Cerebellar ataxia and encephalitis

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21
Q

what drug is commonly CI in varicella?

A

aspirin and other salicylates

risk of reye syndrome

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22
Q

treatment of varicella

A

acyclovir 20 mg/kg, maximum 800 mg per dose, four times daily for 5 days.

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23
Q

neonatal varicella can occur if the mother develops varicella when?

A

If the mother develops varicella between 5 days BEFORE and 2 days AFTER delivery

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24
Q

management of varicella in pregnant women

A

oral acyclovir, 800 mg five times daily for 7 days, except perhaps during the first month.

> /= 35 weeks of gestation or with increased risk of premature labor: admission and IV acyclovir, 10 mg/kg three times daily

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25
Q

VZIG is recommended in pregnant women when?

A

there is significant exposures within the first 72–96 h

(VZIG) should not be given once the pregnant woman has developed varicella.

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26
Q

Children immunized with live attenuated varicella vaccine may develop varicella of reduced severity on exposure to natural varicella. This has been called

A

modified varicella-like syndrome (MVLS)

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27
Q

VZV remains latent in ___

A

sensory dorsal root ganglion cells.

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28
Q

the dermatomes most frequently affected of VZV are:

A

the thoracic (55%), cranial (20%, with the trigeminal nerve being the most common single nerve involved), lumbar (15%), and sacral (5%).

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29
Q

what nerve is involve in herpes zoster ophthalmicus?

A

ophthalmic division of the fifth cranial nerve

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30
Q

Thoracic zoster may be associated with motor neuropathy of the abdominal muscles resulting in a bulge on the flank or abdomen, called a ____

A

“postherpetic pseudotumor.”

31
Q

Ramsay Hunt syndrome results from involvement of the ______

A

facial and auditory nerves by VZV.

32
Q

tx of herpes zoster

A

Valacyclovir, 1000 mg, and famciclovir, 500 mg, may be given three times daily.acyclovir, 800 mg five times daily

33
Q

Three classes of medication are used as standard therapies to manage ZAP ( zoster-associated Pain) and PHN ( Postherpetic Neuralgia):

A
  1. tricyclic antidepressants (TCAs)
    *Gabapentin and pregabalin
  2. antiseizure medications
  • phenylhydantoin, carbamaze- pine, and valproate;
  1. long-acting opiates
34
Q

zostavax is a live attenuated vaccine for the prevention of Herpes Zoster. when should we stop taking antiviral meds?

A

Since it is a live virus vaccine, persons taking antiviral medications must stop them 24 hours before immunization and not take them for 14 days after immuniza- tion.

35
Q

MOT of infectious mononucleosis

A

The virus is shed into the saliva, so contact with oral secretions is the most common route of transmission.

36
Q

causative agent of Infectious mononucleosis

A

Epstein-Barr virus (EBV) / HHV 4

37
Q

caused by HHV 4

fever (up to 40°C), headache, lymphadenopathy, splenomegaly, and pharyngitis (sore throat)

pinhead-sized petechiae, at the junction of the soft and hard palate (Forchheimer spots)

oral hairy leukoplakia

lab fx: absolute lymphocytosis of greater than 50% and monocytosis with abnormally large, “atypical” lymphocytes.

A

Epstein-Barr virus (EBV)

37
Q

causative agent of Infectious mononucleosis

A

EBV /HHV4

37
Q

caused by HHV 4

fever (up to 40°C), headache, lymphadenopathy, splenomegaly, and pharyngitis (sore throat)

pinhead-sized petechiae, at the junction of the soft and hard palate (Forchheimer spots)

oral hairy leukoplakia

lab fx: absolute lymphocytosis of greater than 50% and monocytosis with abnormally large, “atypical” lymphocytes.

A

Epstein-Barr virus (EBV)

38
Q

causative agent of cytomegalovirus

A

HHV 5

39
Q

Clinical manifestations in infants may include jaundice, hepatosplenomegaly, cerebral calci- fications, chorioretinitis, microcephaly, mental retardation, and deafness.

Purpuric lesions, showing extramedullary hematopoeisis called “blueberry muffin baby.”

An urticarial or morbilliform eruption or erythema nodosum in immunocompetent adults

A

Congenital cytomegalovirus (CMV)

40
Q

tx of CMV

A

valganciclovir, foscarnet, or cidofovir

41
Q

common cause of sudden, unexplained high fever in young children between 6 and 36 months of age.

may be accompanied by convulsions and lymphadenopathy.

at 4th day, fever drops then a morbilliform erythema of discrete, rose-colored macules appears

mucous membranes are spared

A

Roseola infantum

42
Q

also called as 6th disease

A

Roseola infantum (exanthem subitum)

43
Q

causative agent of Kaposi sarcoma

A

HHV 8

44
Q

what is the most common cause of Gianotti-Crosti syndrome (GCS) worldwide?

A

EBV

45
Q

affects children 6 months to 14 years of age

Proposed diagnostic criteria involve the following positive clinical fea- tures:

  1. Monomorphous, flat-topped, pink-brown papules or papulovesicles of 1–10 mm in diameter (Figs. 19-25 and 19-26)
  2. Any three or all four sites involved—face, buttocks, forearms, and extensor legs
  3. Symmetry
  4. Duration of at least 10 days

Negative clinical features include:
1. Extensive truncal lesions
2. Scaly lesions

A

Gianotti-Crosti syndrome (GCS)

46
Q

main vector for monkeypox?

hosts for monkeypox?

A

vector: wild African rodents and monkeys.

accidental host: humans

47
Q

MOT of monkeypox?

A

Direct contact with an infected animal or person appears to be required to acquire the infection,

48
Q

are smooth-surfaced, firm, dome-shaped,
pearly papules, averaging 3–5 mm in diameter ;

central umbilication of the dome- shaped lesion.

in atopic children, it is a mild, eczematous eruption surrounding the individual lesions.

Henderson- Paterson bodies.

A

Molluscum contagiosum

49
Q

tx of Molluscum contagiosum

A

Spontaneous resolution

Topical cantharidin, applied for 4–6 h

alternatives:
nicking the lesions with a blade to express the core (with or without comedo extractor), squeez- ing the lesion with a tissue forceps, light cryotherapy, applica- tion of trichloroacetic acid (TCA, 35–100%)

50
Q

causative agent of Hand-foot-and-mouth disease (HFMD)?

A

coxsackievirus A16

51
Q

tx for HFMD

A

Treatment is supportive,
in an enterovirus outbreak. Pediatrics 2013; 132:3149.
with oral or topical anesthetics.

note: use of oral glucocorticoids
associated with worse outcomes.

52
Q

Also known as rubeola and morbilli

spread by respiratory droplets and has an incuba- tion period of 9–12 days.

A

Measles

53
Q

fever, malaise, conjunctivitis, and prominent upper respiratory symptoms (nasal congestion, sneezing, coryza, cough). After 1–7 days, the exanthem appears, usually as macular or morbilliform lesions on the anterior scalp line and behind the ears.

Koplik spots

Lymphopenia, with a decreased WBC count.

A

Measles

54
Q

commonly known as German measles, is caused by a togavirus and probably spreads by respiratory secretions. The incubation period is 12–23 days (usually 15–21).

A

Rubella

55
Q

prodrome of 1–5 days consisting of fever, malaise, sore throat, painful LATERAL and UPWARD eye movement, headache, red eyes, runny nose, and adenopathy.

cephalocaudad axanthem apperance within 24 hrs and resolves on the 3rd day

Forchheimer’s sign

Posterior cervical, suboccipital, and postauricular lymphadenitis

blueberry muffin disease

A

Rubella or German measles

56
Q

aka 5th disease

A

Erythema infectiosum

57
Q

also known as phlebotomus fever and pappataci fever.

vector: Phlebotomus papatasii, is found in the Mediterranean area (Sicil

A

Sandfly fever

58
Q

begins 2–15 days after the infectious mosquito bite.

high fevers accompanied by myalgias, head- ache, retro-orbital pain, and severe backache (breakbone fever)

elevated LFTs, thrombocytopenia, leukopenia.

eruption at 3-5 days of illness as fever defervesces

“islands of white in a sea of red”

A

dengue fever

59
Q

how to do a tourniquet test?

A

taking BP, leaving the cuff inflated for 5 min. , waiting 2 min and counting petechiae.

(+) >10 petechiae per sq inch

60
Q

phases of 5th dse (Erythema infectiosum)

A

three phases:

1st phase: slapped cheek appearance

2nd phase: After 1–4 days, erythematous macules and papules on the proximal extremities and later the trunk ( reticulate or lacy pattern)

3rd phase: recurring stage
reduced eruptions, only to recur after heat exposure

61
Q

caused by Aedes mosquito

incubation period is 2–7 days

abrupt onset of high fever, joint pain and swelling for wks to months

Lymphopenia, thrombocytopenia, and elevated LFTs can be observed in the first week of the illness.

morbilliform exanthem

post-inflammatory hyperpigmentation

managed similar to burn patients

A

chikungunya virus infection

62
Q

vector of Zika virus

A

Aedes aegypti and Aedes albopiticus

63
Q

fever, rash joint pains, conjucnctivitis

petechiae on palate, gingival bleeding, diffuse papular eruption cephalocaudally

can be sexually transmitted ( persists in semen after months of infection)

causing birth defects : microcephaly and brain damage

A

zika virus

64
Q

causative agent of external genital warts ?

anogenital dysplasia?

A

external genital warts:
HPV-6/11

anogenital dysplasia:
HPV-16/18.

65
Q

elevated, rounded papules with a rough, grayish surface

tiny black dots may be visible, representing thrombosed, dilated capil- laries.

do not have dermatoglyphics (fingerprint folds)

A

verruca vulgaris or wart

66
Q

caused by HPV types 3, 10, 28, and 41

common on swimmers and on the sun-exposed surfaces of the face and lower legs.

2–4 mm, flat-topped papules that are slightly ery- thematous or brown on pale skin and hyperpigmented on darker skin.

koebnerization, forming linear, slightly raised, papular lesions.

tx: topical retinoids

A

Flat warts (verruca plana)

67
Q

lobulated papules that average 2–5 mm in size,

Cauliflower-like masses in perianal skin, vulva, and inguinal folds.

STD

A

Condylomata acuminata

68
Q

also called HSIL (high-grade squamous intraepithelial lesion).

characterized by flat, often hyperpig- mented papules a few millimeters to several centimeters in diameter.

single or multiple lesions on penis, near the vulva, or perianally

caused by HPV-16, HPV-18

hx: Pigmentation of the epithelium and numerous mitoses, especially in meta- phase, are characteristic but not diagnostic of HPV-induced HSIL on the external genitalia.

may progress to squamous cell carcinoma (SCC).

A

bowenoid papulosis

69
Q

rare, aggressive, wartlike growth that is a verrucous carcinoma.

caused by HPV-6.

MC on the glans or prepuce of an uncircumcised male;

regional lymphatic metastasis

tx: complete surgical excision

A

Giant condyloma acuminatum
(Buschke-Lowenstein tumor)

70
Q

management of genital warts

A
  1. Podophyllin: warts on occluded or moist surfaces (mucosa or under the prepuce)
  2. Purified podophyllotoxin 0.5% solution or gel BID x 3 days
  3. Imiquimod
  4. Bichloracetic acid or TCA 35–85%
  5. Cryotherapy with liquid nitrogen
  6. Electrofulguration or electrocauterization
  7. CO2 laser
  8. 5-Fluorouracil 5% cream BID
71
Q

uses the GLUT glucose transporter to enter cells

assoc with T-cell leukemia-lymphoma.

the most common skin conditions are dermatophytosis (30%), seborrheic dermatitis (25%), and xerosis/acquired ichthyosis (up to 80%).

A

Human T-lymphotropic virus

72
Q

the patient is defined as having AIDS, when the Th cell counts is ___

A

Th cell </= 200

73
Q

the patient is defined as having advanced AIDS, when the Th cell counts is ___

A

Th cell </= 50

74
Q

some con- ditions may initially appear or be exacerbated by the sudden improvement of the immune status that occurs with eradica- tion of HIV viremia and with increase in Th-cell counts. This complex of manifestations is called _____

A

immune reconstitution inflammatory syndrome (IRIS)

IRIS occurs in 15–25% of HIV- infected persons started on HAART.

ANDREWS’ Diseases Of The Skin 13 Ed. (20 decks)

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