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Senior - Derm 3 > 12 - Viral Infections > Flashcards

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
Genital warts are aka?
Condyloma acuminata or veneral warts
26
Condyloma acuminata or veneral warts are associated w?
HPV 6, 11, 16, 18 MC viral STD
27
Describe genital warts
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
28
Self inoculation of genital warts?
Spread rapidly over moist areas | Kissing lesions on labia or rectum
29
Genital wart treatment success?
Frequently recur - latent virus extends beyond txt ares in clinically normal skin Flat and inconspicuous warts may escape txt
30
High risk and low risk HPV subtypes?
high: 16,18 Low: 6, 11
31
Genital warts txt considerations?
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
Genital warts provider administered tx?
``` TCA - trichloracetic acid Podophyllum resin Cryosurgery Scissor excision Curettage Electrosurgary Carbon dioxide laser ```
33
Genital warts Pt applied tx
``` Podofilox gel (condylox) Imiquimod 5% (aldara) ``` If all else fails - 5-fluorouracil (efudex)
34
Warts DDX?
Genital - bowenoid papules - pearly penile papule (NOT WARTS)
35
Bowenoid papules morphology?
``` Small Brown or pink Flat/slightly irregular Discrete Grouped papules ``` Resemble flat or genital wart
36
Bowenoid papules distribution?
Penis Vulva Anus
37
Bowenoid papules etiology?
Sex - HPV - oncogenic type - quasi-premalignant
38
Bowenoid papules prognosis?
Resolve spontaneously in months-years Direct progression to SCC has not been observed
39
Bowenoid papules txt?
``` Cryo Electrosurgery Excision CO2 laser Imiquimod 5% (aldara) 5-FU (efudex) Abstinence Condom use ``` Check sex partner
40
Bowenoid papules DDX
Genital warts Bowen disease Psoriasis Lichen planus
41
Mulluscum contaginosum is MC found in?
Kids
42
How is molluscum contagiosum spread?
Kids - Touching - Self-inoculation - arms and face Adults - sex - groin, pubis, thighs - wrestlers/wrasslers - masseurs
43
Molluscum contagiosum morphology
Small discrete 2-5mm flesh colored - central umbilicaiton - large lesions (1cm) (inflamed and crusted)
44
Molluscum contagiosum etiology
DNA poxvirus Virion colony encased in protective sac - prevents triggering host immune response
45
Molluscum contagiosum management?
Self limiting Pruritic Problems of contagion
46
Molluscum contagiosum txt?
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
Herpes names?
Oral - herpes labialis Genital - herpes genitalis Serotypes - HSV-1 - oral - HSV-2 - genital
48
HSV-2 spread is often?
From undiagnosed pts - mild or unrecognized sxs but still sheds virus Asymptomatic viral shedding is primary mode of herpes virus transmission
49
Herpes simplex first presentation?
First time is the worst time Vesicles appear 6 days after contact Last 14 days Shedding last 15-16 days
50
Why is herpes the gift that keeps on giving?
Ascends peripheral sensory nerves and establishes latency in nerve root ganglia
51
Recurrent HSV “flare-ups”
``` 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
HSV morphology?
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
Clinical presentation of HSV?
``` Discharge Dysuria Inguinal LAD Fever Myalgia Lethargy Photophobia ``` All more common in women
54
Types of Herpes simplex?
``` Herpes gladitorium Ocular herpes Herpetic whitlow HSV of buttock (women usually) HSV of trunk ```
55
Diagnosis of HSV?
``` PCR - gold standard Viral culture (during shedding) Tzanck prep - multinucleated giant cells Serology differentiates 1 and 2 ```
56
HSV management
Acyclovir Valcyclovir Famciclovir penciclovir or abrevia (labialis)
57
Which HSV med is the best? | - per ms booker
Valcyclovir (valtrex)
58
Presentation of varicella?
Prodrome - fever - malaise - HA Croups of lesion in various stages - Trunk-> extremeties - Puritic in vesicle phase - Scarring
59
Stages of varicella?
Papule-vesicle-erosion-crust
60
Etiology of varicella?
``` DNA poxvirus Respiratory transmission Spring (more common) Lifelong immunity - except reactivation ```
61
Varicella txt?
Cool bathes (aveeno) Antihistamine PRN Tylenol (no ASA) Acyclovir
62
Acyclovir indication (varicella)
Start w/in 24hrs Non-pregnant over age 13 Chronic skin disease Children on steroids or immunocompromised
63
What is herpes zoster?
Reactivated varicella virus | - dorsal root ganglion
64
Herpes zoster presentation?
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
dx of herpes zoster?
Clinical | + tzanck prep
66
Herpes zoster txt
Acyclovir Valcyclovir Famciclovir ``` Prednisone (over 50 yrs) Analgesics - opiate pain meds prn Capsaicin cream Soaks ```
67
If herpes zoster is on ophthalmic branch of trigeminal nerve
Ophthalmologist consult
68
Prevention of herpes zoster?
Zostavax - Single dose - Sub Q - Live attenuated vaccine Pts 60yrs +
69
Zostavax is not?
Substitute for varivax | Txt for zoster or PHN
70
Why do fish live in salt water?
Because pepper makes them sneeze

Senior - Derm 3 (7 decks)

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