Viral Infections- Part II- Exam 2

Question 1

What pt population is Rubeola most common in? What is it caused by?

Answer 1

Most common in children <5

Caused by Rubeola virus

Question 2

What is the incubation period of rubeola? How is it transmitted? How long do they need to stay away from people?

Answer 2

7-14 days after infection

spread airborne through infected droplets or when people touch the droplets on surfaces- VERY contagious

need to stay away from people for 4 days after the rash appears but contagious for 8, (4 days before rash appears and 4 days after rash)

Question 3

Low Grade Fever (can be 104-105)
Dry Cough
Coryza (Runny nose)
Conjunctivitis
Sore throat
Koplik’s spots on the buccal mucosas
Red, blotchy skin rash
s/s may last for 2-3 days

What am I?

Answer 3

Rubeola

Question 4

What are Koplik’s spots? What dz is it associated with?

Answer 4

Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek

Rubeola

Question 5

Describe the skin rash in a pt with rubeola? What are common places for it to present?

Answer 5

Small red spots, some slightly raised, in tight clusters giving the skin a blotchy red appearance

Face (behind the ears and along the hairline) → arms and trunk → thighs, lower legs, and feet-> then it gradually recedes first from the face then thighs then feet

Question 6

If a pt is exposed to rubeola who has not been vaccinated, what is the protocol? In what timeframe?

Answer 6

Non immunized people, including infants, may be given the measles vaccination within 72 hours of exposure to provide protection against the disease.

If measles still develops, the illness usually has milder symptoms and lasts for a shorter time

Question 7

What is the supportive care for rubeola?

Answer 7

Increased fluid intake
Acetaminophen for fever (No ASA)
Antibiotics for complications of bacterial infection

Question 8

What are some common rubeola complications? Which one is the most common?

Answer 8

OM- MC
Bronchitis
Pneumonia
Preg complications
Encephalitis
Thrombocytopenia

aka the pt is at risk for secondary bacterial infections

Question 9

What is the vaccine dosing schedule for measles, mumps, rubella? (MMR)

Answer 9

1st dose: 12-15 months

2nd dose: 4-6 yrs

can give both doses at least 4 weeks apart as long as the patient is 12 months and older and no older than 12 years

Question 10

_____ is caused by the mumps virus. What is the incubation? How is it transmitted?

Answer 10

12-15 days after infection

Airborn
Contact w/ saliva
Contaminated surfaces

Question 11

____ is the isolation/communicable period for mumps?

Answer 11

isolation of mumps patients for 5 days after their glands begin to swell

Question 12

Fever
Headache
Muscle aches
Tiredness
Loss of appetite
parotitis

What am I?
What is the treatment?

Answer 12

Mumps

no specific treatment, supportive care

Question 13

What is parotitis?

Answer 13

swollen and tender salivary glands under the ears or jaw on one or both sides of the face

Question 14

What are common mumps complications?

Answer 14

orchitis
encephalitis
oophoritis/mastitis
deafness

Question 15

What is orchitis?

Answer 15

inflammation of one or both testicles, which can cause pain, swelling, and frequent infection

Question 16

What is the difference between measles (rubeola) and rubella (German measles)?

Answer 16

Measles (rubeola) is more severe and more contagious than rubella

Question 17

What is the incubation period for rubella? How is it transmitted? What is the communicable period?

Answer 17

2-3 weeks

airborne
direct contact (mucus or saliva)
bloodstream of pregnant women

10 days b4 rash and 1-2 weeks after rash dissappears

Question 18

Mild fever
Headache
Stuffy or runny nose
Inflamed, red eyes
Symmetrical postauricular and occipital tender lymphadenopathy
A fine, pink rash that begins on the face and quickly → trunk → arms and legs, before disappearing in the same sequence
Arthralgias, especially in young women.

What am I?
How long does it last?

Answer 18

Rubella

2-3 days

sometimes s/s are difficult to notice, only 50% become symptomatic

Question 19

What are the complications of rubella?

Answer 19

arthritis (mostly in women, fingers, wrists, knees can last up to 1 month)
OM/Encephalitis
Congenital rubella syndrome

Question 20

_____ up to 90% of infants born to mothers who had rubella during the first 11 weeks of pregnancy develop this. What is the classic triad?

Answer 20

Congenital rubella syndrome

Microcephaly
Cataracts
Cardiac defects

Question 21

If a patient contracts rubella while pregnant and wishes to continue with the pregnancy, she may be given _______ to fight off the infection and reduce symptoms – it does not necessarily eliminate the possibility of the baby developing congenital rubella syndrome

Answer 21

hyperimmune globulin

Question 22

you can order ____ to confirm the dx of rubella. What is the treatment?

Answer 22

IgM antibody titers

supportive care

Question 23

T/F: You can get the MMR vaccine while pregnant

Answer 23

FALSE! because MMR is a live attenuated vaccine

Question 24

_____ is a common childhood exanthematous illness caused by Parvovirus B19 (the only parvovirus linked directly to disease in humans)

Answer 24

Erythema Infectiosum

Question 25

What is the incubation period for Erythema Infectiosum? (5th disease) Transmission? Communicable period? What season is it most common in?

Answer 25

1-2 weeks respiratory secretions (saliva, sputum, nasal mucus) blood or blood products pregnant women can pass to baby MS in the spring

Question 26

Unlike other exanthems, patients with ______ are most contagious before they get a rash or joint pain and swelling. After the rash appears, patients are generally not contagious so it is safe to go back to school or work

Answer 26

5ths disease

Question 27

What pt population is 5th disease MC in?

Answer 27

5-7 y/o

Question 28

Fever rhinitis HA fiery-red facial erythema “slapped cheeks” lacy (reticular) macular exanthem mainly over the proximal extremities What am I? What is the timeline for s/s?

Answer 28

5th disease: Erythema infectiosum First: mild fever, rhinitis, HA 1-2 weeks: slapped cheeks facial redness 1-4 days after slapped cheeks, lacy rash over proximal extremities rash can reoccur intermittently

Question 29

______ is common in adults with 5th disease, can last 1-3 weeks (sometimes longer)

Answer 29

Polyarthropathy syndrome

Question 30

What is the dx for 5th disease?

Answer 30

Diagnosis is usually clinical based on the appearance of the “slapped cheeks” or lacy rash A blood test can also be performed to detect IgM-specific antibodies to parvovirus B19

Question 31

What is the treatment for 5th disease? Immunocompromised pts/RBC disorders?

Answer 31

usually mild- goes away by itself symptomatic relief IV immune globulin for immunocompromised patients and those with RBC disorders

Question 32

What are the complications with 5th disease?

Answer 32

can suppress RBC production, causing transient aplastic crisis, chronic red cell aplasia, hydrops fetalis or congenital anemia. even more likely in patients that already have RBC illnesses: iron-deficiency anemia, HIV, sickle cell disease, thalassemia and spherocytosis

Question 33

What is the prevention for 5th disease?

Answer 33

NO vaccine!! after infection you have immunity that protects from parvovirus B19 infections in the future educate on the importance of handwashing, cough etiquette etc etc

Question 34

_____ is caused by Human Herpesvirus (HHV) types 6 and 7. Also known as _____

Answer 34

Roseola infantum 6th disease

Question 35

What is the incubation for 6th disease? tranmission? What time of year is it MC?

Answer 35

5-15 days airborne spring and fall

Question 36

Both HHV-6 and -7 are highly prevalent in the healthy population and affect almost all children between ___ and ___ of age. What age range is RARELY seen in?

Answer 36

6 mos and 3 yrs younger than 2 and older than 4

Question 37

High fevers lasting 3-5 days few clinical findings observed early in the course after loss of fever, rash appears: blanchable, rosy pink, nonpruritis macular rash on the neck and trunk feel sick only while they have the fever, once rash appears kids tend to feel fine What am I? What is the treatment? When will it usually resolve?

Answer 37

Roseola Supportive care: fluids and Tylenol. 4-6 days

Question 38

How do you dx roseola? If _____ happens need to investigate further, it happens in ____% of cases

Answer 38

dx is clinically because the rash appears after the fever, aka the kid has already begun to recover from the virus febrile seizure (10%), further workup may be indicated

Question 39

What are roseola complications?

Answer 39

meningitis, encephalitis, leukopenia, thrombocytopenia, hepatitis

Question 40

Like other viruses in this family, _____ can reactivate after the first infection and cause illness, but this happens primarily in people who have ????

Answer 40

HHV6 and HHV7 a weakened immune system

Question 41

What three viruses are included under varicella?

Answer 41

Chicken Pox Varicella Zoster Virus (VZV) Human Herpes Virus

Question 42

What is the incubation for varicella?

Answer 42

10-21 days after exposure to chickenpox or shingles

Question 43

What is the transmission for varicella? Can it be spread by a person with shingles?

Answer 43

Very contagious Does NOT require skin-to-skin contact but can be spread by touching or breathing in the virus particles that come from chickenpox blisters more commonly transmitted by respiratory secretions CAN be spread by someone who has shingles to those who have never had chickenpox or been vaccinated

Question 44

What is the communicable period for varicella?

Answer 44

1-2 days before the rash appears until time all blisters have scabbed over

Question 45

Fever Malaise Loss of appetite Headache Rash: itchy, fluid-filled blisters that eventually turn into scabs dewdrop on a rosepetal What am I? Where does the rash tend to show up first? How long does the kid have to stay out of school?

Answer 45

Chicken pox: Varicella The rash may first show up on the face and trunk → 250-500 itchy blisters Children usually miss 10 -14 days of school or childcare, takes about 1-2 weeks for all the blisters to become scabs

Question 46

What is the lab way to dx chicken pox?

Answer 46

PCR swab of the lesion IgM titers

Question 47

What is the supportive treatment for chicken pox? What is the rx?

Answer 47

Calamine lotion / oatmeal baths Trim nails Acetaminophen Acyclovir / valacyclovir: needs to be started within 24 hours and treat for 5 days

Question 48

_____ is given for post-exposure prophylaxis for chicken pox for high risk indiviuals

Answer 48

Varicella immunoglobulin

Question 49

What is the chicken pox vaccination schedule? How effective are they?

Answer 49

CDC recommends 2 doses, once at an age of 12–15 months and again at 4–6 years. 2 doses are 98% effective in prevention

Question 50

T/F: It is possible to get chicken pox even if you have had the vaccine

Answer 50

TRUE! Some people who are vaccinated may still get the disease but it is usually more mild with fewer blisters and little or no fever

Question 51

_____ is a mild, highly contagious viral infection most commonly caused by Coxsackievirus. It is most common in ____

Answer 51

Hand, Foot, and Mouth Disease young children

Question 52

What is the incubation for HFMD? Transmission? What seasons are MC? Communicable period?

Answer 52

3-7 days Highly contagious Nasal secretions, saliva, stool, blisters, resp droplets Summer and Fall Most contagious first week of illness, but can transmit until all blisters resolved

Question 53

Fever and lymphadenopathy Sore throat Malaise Irritability in infants and toddlers Loss of appetite A red non-pruritic rash, often with blistering (vesicles), on the palmar and plantar skin The vesicles are often arranged parallel to the dermatoglyphs, and may have a surrounding red halo Painful, red, blister-like lesions on the tongue, gums, hard palate, and buccal mucosa What am I? What is the treatment? When does symptoms usually resolve?

Answer 53

HFMD supportive care: topical oral anesthetic may help relieve the pain of mouth sores OTC pain medications to relieve general discomfort 7-10 days

Question 54

How can you distinguish HFMD from other viral infections?

Answer 54

The age of the affected person The pattern of signs and symptoms The appearance of the rash or sores

Question 55

What are the complications from HFMD?

Answer 55

Dehydration: sore in the mouth/throat can be swallowing difficult/painful Enchephalitis