L21- BW (viral skin)

Question 1

what is zostavax

Answer 1

shingles vaccine that is live attenuated, higher potency than Varivax

Question 2

what are the prerequisites for shingles

Answer 2

a prior case of chickenpox or vaccination against chickenpox

Question 3

VZV vaccines protect against

Answer 3

chickenpox, NOT shingles

Question 4

why is it recommended to get 2 doses of Vavirax

Answer 4

breakthrough cases (mild chickenpox after exposure) is well documented

Question 5

names of the VZV vaccines and what type

Answer 5

Vavirax and MMRV, live attenuated

Question 6

where does VZV live in latency

Answer 6

in neural tissues until a shingles recrudescence of prior VZV chickenpox

Question 7

slapped cheek with circumoral sparing manifestation

Answer 7

parovirus B19 aka fifth disease aka erythema infectiosum

Question 8

VZV prodrome

Answer 8

fever, malaise, HA, myalgia, anorexia (only in older kids and adults)

Question 9

what does zoster refer to

Answer 9

a belt or stripe

Question 10

Measles presentation has 3 Cs

Answer 10

Coryza, Cough, Conjunctivitis

Question 11

what time of year does parovirus B19 occur

Answer 11

in epidemics in late winter and spring

Question 12

what is the rule of thumb for HSV latency

Answer 12

the probability of recrudescence is greater in individuals with larger and more extensive initial outbreaks

Question 13

shingles vaccines

Answer 13

zostavax and shingrix

Question 14

how do adult pts with parovirus B19 present

Answer 14

arthritis or arthralgias without preceding or concurrent sxs

Question 15

what is shingrix

Answer 15

shingles vaccine that is a nonviable adjuvanted virus subunit preparation, superior protection

Question 16

who is zostavax for

Answer 16

NOT people without a hx of prior chickenpox infection (such as vaccinated)

Question 17

MMR is not appropriate for what population and why

Answer 17

preggos, those who plan to become pregnant w/in 3 months of vacc, and immunosuppressed- because its live attenuated

Question 18

painful lesions with a unilateral dermatomal distribution (sharp limits) that do not cross the center line

Answer 18

shingles

Question 19

how can you prophylactically prevent measles in unvaccinated or immunocompromised pts and for how long after exposure

Answer 19

immune globulin (BayGram) up to 6 days after exposure

Question 20

what populations experience the prodrome with VZV

Answer 20

older children and adults, younger children don’t have it

Question 21

3 Cs

Answer 21

Measles

Question 22

what two unique HSV properties influence disease

Answer 22

(1) capacity to invade and replicate in CNS, and (2) ability to establish latent disease

Question 23

what fraction of HSV sheddings are asymptomatic

Answer 23

2/3

Question 24

recrudescence

Answer 24

quasi stable state of latency that is subject to reactivation (seen in HSV and VZV)

Question 25

how many doses of shingrix

Answer 25

2

Question 26

who is shingrix for

Answer 26

good for people who have been previously vaccinated with zostavax

Question 27

where does HSV live during latency

Answer 27

it is retrograde transported through sensory neurons and ultimately infects the dorsal root ganglia

Question 28

HSV phases

Answer 28

(1) primary (maybe asymptomatic) infection that resolves (2) quasi stable state of latency subject to reactivation (recrudescence)

Question 29

what is critical to the outcome of critical rubella syndrome

Answer 29

the timing of infection- early in pregnancy is worst

Question 30

PRURITIC lesions with neuralgia, fever, malaise, HA

Answer 30

VZV

Question 31

when was measles declared eradicated in the US

Answer 31

2000

Question 32

what skin virus is very prevalent and totally unrecognized without cx

Answer 32

HHV- 6 (humans herpes virus-6)

Question 33

VZV causes

Answer 33

BOTH chickenpox and shingles

Question 34

MMR has how many doses

Answer 34

2 plus a BOOSTER third dose

Question 35

HSV treatments are ___ but \_\_\_\_

Answer 35

highly effective but not curative

Question 36

what can be used for high risk persons exposed to VZV

Answer 36

VariZIG human immunoglobulin

Question 37

VZV is a potential \_\_\_

Answer 37

TERATOGEN when infections occur in utero

Question 38

when does most HSV transmission occur

Answer 38

during asymptomatic shedding (which is frequent) or from persons who never knew they were infected

Question 39

how much reduction of measles in the US due to vaccine

Answer 39

99%

Question 40

principle problem linked to rubella

Answer 40

congenital rubella syndrome

Question 41

what tx is NOT recommended with VZV and why

Answer 41

ASA- risk of Reyes syndrome

Question 42

HSV is spread by

Answer 42

direct contact with vesicular fluid, saliva, and secretions, asymptomatic shedding

Question 43

when was the largest US measles outbreaks since it was declared eradicated

Answer 43

2014-2015

Question 44

measles is controlled by vaccination in the West but

Answer 44

still present in the remainder of the world

Question 45

what lead to the principal problem linked to rubella

Answer 45

children escaping infection (congenital rubella syndrome is principal problem)

Question 46

Kopliks spots

Answer 46

Measles- large spots on buccal mucosa

Question 47

congenital rubella syndrome

Answer 47

when infection occurs in women during the first trimester of pregnancy, leading to a SUBSTANTIAL RISK TO FETUS

Question 48

how long is HSV latency

Answer 48

lifelong