2: Viral Infections

Question 1

What does VZV cause

Answer 1

Children: chickenpox
Adults: shingles

Question 2

How is VZV transmitted

Answer 2

Respiratory droplets

Question 3

How does chickenpox present

Answer 3

Fever and prodrome for 1-2d, then pruritic erythematous rash with crusts

Question 4

How does shingles present

Answer 4

Maculopapular rash in singre dermatome

Question 5

What is herpes zoster opthalmicus

Answer 5

Herpes zoster affecting the ophthalmic division of the trigeminal nerve

Question 6

how does herpes zoster opthalmicus present

Answer 6

• Vesicular rash in distribution of opthalmic branch that may or may not involve the eye

Question 7

what sign strongly indicates ocular involvement

Answer 7

Hutchinson sign = rash on tip of the nose

Question 8

why does hutchinson sign strongly indicate ocular involvement

Answer 8

Hutchinson sign indicates nasociliary involvement which is a strong predictor of ophthalmic involvement

Question 9

how is herpes zoster opthalmicus managed

Answer 9

PO acyclovir

Question 10

how soon should anti-virals for herpes zoster be started

Answer 10

72h

Question 11

when is IV anti-virals given in herpes opthalmicus

Answer 11

Immunocompromised patient or severe infection

Question 12

Aside from acyclovir, what is given in herpes opthalmicus

Answer 12

Topical Steroids - to reduce infection

Question 13

If an individual has hutchinson sign what do they required and why

Answer 13

• Urgent ophthalmological review - as they likely have involvement of ocular nerve

Question 14

What is herpes zoster oticus also known as

Answer 14

Ramsay Hunt Syndrome

Question 15

what causes herpes zoster oticus

Answer 15

Re-activation Herpex soter virus in the geniculate nucleus of the seventh cranial nerve

Question 16

what is the first clinical feature of Ramsay-hunt

Answer 16

ocular pain

Question 17

how else does Ramsay-hunt present clinically

Answer 17

• vesicular rash inside the ear
• facial nerve palsy
• vertigo and tinnitus

Question 18

how is Ramsay hunt syndrome managed

Answer 18

oral acyclovir and corticosteroids

Question 19

how is VZV managed

Answer 19

oral acyclovir in 48h of symptom onset

Question 20

who is VZV vaccine offered to

Answer 20

elderly people over-70

Question 21

what is a complication of VZV

Answer 21

post-hepatic neuralgia = pain in region rash previously was

Question 22

what is EBV also known as

Answer 22

HHV4

Question 23

What two things can EBV cause

Answer 23

infectious mononucleosis

hairy leukoplakia

Question 24

in which patients does infectious mononucleosis tend to occur in

Answer 24

adolescents

Question 25

what is the triad of symptoms in EBV

Answer 25

• Sore throat
• Lymphadenopathy
• Pyrexia

Question 26

what are other symptoms of EBV infection

Answer 26

• Splenomegaly
• Petechial rash
• Hepatitis
• Haemolytic anaemia secondary to cold agglutinins

Question 27

how does hepatitis present

Answer 27

• Raised ALT

Question 28

what will amoxicillin in 99% of people with EBV cause

Answer 28

maculo-papular rash

Question 29

how is EBV diagnosed

Answer 29

• Hetrophil antibody test (Infectious monospot)

Question 30

what will be seen on FBC

Answer 30

Leucocytosis

Question 31

how is EBV managed

Answer 31

Rest
Fluid
Avoid alcohol
Analgesia

Question 32

what should patients with EBV avoid doing and why

Answer 32

Contact sports for 8W due to risk of splenic rupture

Question 33

what does EBV increase risk of

Answer 33

• Hodgkin lymphoma
• Burkitt lymphoma
• Nasopharyngeal cancer
• B cell lymphoma
• Gastric cancer
• Post transplantation lymphoma

Question 34

what does HHV6 cause

Answer 34

Roseola infantum

Question 35

what does HHV8 cause

Answer 35

Kaposi sarcoma

Primary effusion lymphoma