12 - Viral Infections Flashcards

1
Q

What are warts?

A

Benign epidermal neoplasms caused by HPV (small DNA viruses)

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2
Q

Causes/pathophys of warts

A

HPV (>100 types)

HPV infects keratinocytes and induces hyperplasia and hyperkeratosis

Infection can be

  • latent
  • subclinical
  • clinical
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3
Q

Which warts are associated w SCC?

A

38
41
48

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4
Q

How are warts spread?

A

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

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5
Q

Course that warts follow?

A

May resolve spontaneously in

  • weeks - months
  • Years - lifetime

Regression involves a multifactorial immune response

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6
Q

Wart removal?

A

May take several sessions
Minimal scarring

If normal skin lines return, removal was successful

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7
Q

Morphology of warts?

A

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

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8
Q

Diagnostic sign

A

Warts may become fused and produce mosaic pattern on surface

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9
Q

Comon warts are aka?

A

Verruca vulgaris

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10
Q

Describe a verruca vulgaris

A
Dome shaped
Gray-brown
Hyperkeratotic 
Papule 
Black dots on surface
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11
Q

Tx or verruca vulgaris?

A
Liquid nitrogen Q 2-4 weeks
Light electrocautery
Salicylic acid (topical)
Imiquimod (topical)
Blunt dissection
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12
Q

Describe filiform warts

A

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

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13
Q

MC site of filiform warts?

A

MC on face

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14
Q

Tx for filiform warts?

A
Curettage
Apply bilat traction 
Use 1 firm stroke
Light electrocautery
Light cryosurgery
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15
Q

Flat warts are aka?

A

Verruca plana

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16
Q

Describe verruca plana

A

Flat (lol)

Flat-topped papules
Grouped
Pink, light brown, yellow
Sites
- Forehead
- around mouth
- back of hands
- shaved areas (beard, legs)
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17
Q

Tx for veruca plana

A

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

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18
Q

Where are plantar warts found?

A

Soles of feet

points of max pressure
- metarasal heads or heels

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19
Q

How to differentiate plantar warts from corns?

A

Shave and look for black dots and lack of skin lines

- corns have skin lines

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20
Q

Plantar wart treatment?

A

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
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21
Q

Alternate plantar wart tx?

A

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

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22
Q

When treating plantar warts you should avoid?

A

Cryo

- blister on sole can be painful

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23
Q

What are subungual and periungual warts?

A

Wart next to nail

  • maybe the tip of the iceburg
  • painful

May be spread by cuticle biting

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24
Q

Subungual and periungual wart tx?

A

Resistant to chemical and surgical methods

Cryosurgery
Cantharidin (paint wait for blister, repaint, occlude x 48hrs)
Salicyclic acid
Duct tape 
Blunt dissection
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25
Q

Genital warts are aka?

A

Condyloma acuminata or veneral warts

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26
Q

Condyloma acuminata or veneral warts are associated w?

A

HPV 6, 11, 16, 18

MC viral STD

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27
Q

Describe genital warts

A

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

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28
Q

Self inoculation of genital warts?

A

Spread rapidly over moist areas

Kissing lesions on labia or rectum

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29
Q

Genital wart treatment success?

A

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

Flat and inconspicuous warts may escape txt

30
Q

High risk and low risk HPV subtypes?

A

high: 16,18

Low: 6, 11

31
Q

Genital warts txt considerations?

A

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
Q

Genital warts provider administered tx?

A
TCA - trichloracetic acid
Podophyllum resin
Cryosurgery
Scissor excision
Curettage
Electrosurgary
Carbon dioxide laser
33
Q

Genital warts Pt applied tx

A
Podofilox gel (condylox)
Imiquimod 5% (aldara)

If all else fails
- 5-fluorouracil (efudex)

34
Q

Warts DDX?

A

Genital

  • bowenoid papules
  • pearly penile papule (NOT WARTS)
35
Q

Bowenoid papules morphology?

A
Small
Brown or pink
Flat/slightly irregular
Discrete
Grouped papules

Resemble flat or genital wart

36
Q

Bowenoid papules distribution?

A

Penis
Vulva
Anus

37
Q

Bowenoid papules etiology?

A

Sex

  • HPV - oncogenic type
  • quasi-premalignant
38
Q

Bowenoid papules prognosis?

A

Resolve spontaneously in months-years

Direct progression to SCC has not been observed

39
Q

Bowenoid papules txt?

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

Check sex partner

40
Q

Bowenoid papules DDX

A

Genital warts
Bowen disease
Psoriasis
Lichen planus

41
Q

Mulluscum contaginosum is MC found in?

A

Kids

42
Q

How is molluscum contagiosum spread?

A

Kids

  • Touching
  • Self-inoculation
  • arms and face

Adults

  • sex
  • groin, pubis, thighs
  • wrestlers/wrasslers
  • masseurs
43
Q

Molluscum contagiosum morphology

A

Small discrete 2-5mm flesh colored

  • central umbilicaiton
  • large lesions (1cm) (inflamed and crusted)
44
Q

Molluscum contagiosum etiology

A

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

45
Q

Molluscum contagiosum management?

A

Self limiting
Pruritic
Problems of contagion

46
Q

Molluscum contagiosum txt?

A

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
Q

Herpes names?

A

Oral - herpes labialis
Genital - herpes genitalis

Serotypes

  • HSV-1 - oral
  • HSV-2 - genital
48
Q

HSV-2 spread is often?

A

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

Asymptomatic viral shedding is primary mode of herpes virus transmission

49
Q

Herpes simplex first presentation?

A

First time is the worst time

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

50
Q

Why is herpes the gift that keeps on giving?

A

Ascends peripheral sensory nerves and establishes latency in nerve root ganglia

51
Q

Recurrent HSV “flare-ups”

A
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
Q

HSV morphology?

A

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
Q

Clinical presentation of HSV?

A
Discharge
Dysuria
Inguinal LAD
Fever
Myalgia
Lethargy
Photophobia

All more common in women

54
Q

Types of Herpes simplex?

A
Herpes gladitorium 
Ocular herpes
Herpetic whitlow
HSV of buttock (women usually)
HSV of trunk
55
Q

Diagnosis of HSV?

A
PCR - gold standard
Viral culture (during shedding)
Tzanck prep
- multinucleated giant cells
Serology differentiates 1 and 2
56
Q

HSV management

A

Acyclovir
Valcyclovir
Famciclovir

penciclovir or abrevia (labialis)

57
Q

Which HSV med is the best?

- per ms booker

A

Valcyclovir (valtrex)

58
Q

Presentation of varicella?

A

Prodrome

  • fever
  • malaise
  • HA

Croups of lesion in various stages

  • Trunk-> extremeties
  • Puritic in vesicle phase
  • Scarring
59
Q

Stages of varicella?

A

Papule-vesicle-erosion-crust

60
Q

Etiology of varicella?

A
DNA poxvirus
Respiratory transmission
Spring (more common)
Lifelong immunity 
- except reactivation
61
Q

Varicella txt?

A

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

62
Q

Acyclovir indication (varicella)

A

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

63
Q

What is herpes zoster?

A

Reactivated varicella virus

- dorsal root ganglion

64
Q

Herpes zoster presentation?

A

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
Q

dx of herpes zoster?

A

Clinical

+ tzanck prep

66
Q

Herpes zoster txt

A

Acyclovir
Valcyclovir
Famciclovir

Prednisone (over 50 yrs)
Analgesics 
- opiate pain meds prn
Capsaicin cream
Soaks
67
Q

If herpes zoster is on ophthalmic branch of trigeminal nerve

A

Ophthalmologist consult

68
Q

Prevention of herpes zoster?

A

Zostavax

  • Single dose
  • Sub Q
  • Live attenuated vaccine

Pts 60yrs +

69
Q

Zostavax is not?

A

Substitute for varivax

Txt for zoster or PHN

70
Q

Why do fish live in salt water?

A

Because pepper makes them sneeze