Viral Infections

Question 1

What are Warts “Verucca Vulgaris” caused by?

Answer 1

Human Papilloma Virus (HPV)

Question 2

Who is m/c affected by warts?
How is it spread?

Answer 2

• M/C in kids 12-16, immunosuppressed
• Spread via direct contact

Question 3

Clinical features of Warts?

Answer 3

• Disrupts normal skin lines
  -Thrombosed capillaries (tiny black dots)
• May be painful
• Occur at site of trauma
• Recurring

Question 4

What are the different types of Warts?

Answer 4

Common: m/c hands, knees, periungual, sharply demarcated rough surfaced firm papules 2-10 mm in diameter, light gray/yellow/brown/gray-black

Plantar: white-skin colored rough papules, may be flat, thrombosed capillaries

Flat: m/c in kids and females secondary to shaving, on face, neck, hands, forearms flesh-colored

Genital “Condyloma”: STD, m/c in young adults 15-25, pink-brown kerototic papules or nodules, cauliflower-like

Question 5

How do you treat Warts?

Answer 5

• 1st line = Cryotherapy
• Salicylic acid
• Cantharidin (do test spot, don’t use on face, better for kids than liquid N)

Question 6

T/F: Warts that don’t respond to treatment should be biopsied

Answer 6

True

Question 7

Which HPV types are high risk for cancer?

Answer 7

6, 11, 18, 31, 35

Question 8

What’s the causative agent for Molluscum Contagiosum?
How’s it transmitted?

Answer 8

• Pox virus (flourishes in patches of eczema)
• Direct contact -contagious!

Question 9

How do you treat Molluscum Contagiosum?

Answer 9

• Cantharone
• Cryotherapy
• ED&C

Question 10

What is Herpes Zoster “Shingles”?

Answer 10

Acute reactivation of Varicella-Zoster virus (meaning pt’s had chicken pox before)

Question 11

Clumps of painful vesicles in a dermatomal distribution that’s unilateral

Answer 11

Herpes Zoster

Question 12

What are the 3 stages of Herpes Zoster?

Answer 12

1. Prodrome - burning, pain, tingling, flu-like sx
2. Acute - vesicles, pruritis
3. Chronic - Post herpetic neuralgia (PHN)

Question 13

RF for Herpes Zoster?

Answer 13

• > 55 y/o
• Immunosuppressed

Question 14

If pt c/o eye pain, H/A, swollen gland and you suspect shingles, what should you do?

Answer 14

Refer to optho! (Herpes Zoster opthalmicus)

Question 15

Hutchinson sign

Answer 15

Lesions at tip of nose (indicative of Shingles)

Question 16

Pt edu: What is important to tell a Shingles pt?

Answer 16

Avoid contact with pregnant women & anyone who has not been vaccinated against chicken pox

Question 17

How do you treat Herpes Zoster “Shingles”?

Answer 17

Acyclovir w/i 72 hrs

Question 18

How is Herpes Simplex Virus (HSV) transmitted?
Where does it often occur?

Answer 18

• Direct contact (beware of Asymptomatic shedding: period where virus is replicating w/o visual lesions)
• Mouth, Lips, Genital

Question 19

What’re S&S of HSV?

Answer 19

• H/A, Fever, Myalgias
• Irritability, Pain
• Burning/Tingling
• Itching
• Dysuria
• Vaginaal discharge
• LAD

Question 20

What does an HSV rash look like?

Answer 20

• Grouped vesicles on erythematous base
• Lesions may scar

Question 21

RF for HSV?

Answer 21

• Broken skin
• UV light/sunburn
• Immunosuppression
• Stress
• Menstruation

Question 22

How is HSV diagnosed?
What tests should be ordered?

Answer 22

• Usu. clinical, may confirm with labs
• Viral cx
• HSV Type 1/2 titers (blood test)

Question 23

How do you treat HSV?

Answer 23

• Acyclovir, Valacyclovir
• Abreeva