4: Microbiology - viral skin infections

Question 1

Which virus causes both chicken pox and shingles?

Answer 1

Varicella zoster virus

Question 2

What is chicken pox also known as?

Answer 2

Varicella

Question 3

What is shingles also known as?

Answer 3

Herpes zoster or zoster

Question 4

What kind of virus is varicella zoster?

Answer 4

Part of the herpes family

Question 5

When do patients typically get chicken pox?

Answer 5

Childhood

Question 6

What is the presentation of chicken pox?

Answer 6

Distinctive red macular > papular > vesicular rash which then scabs over without scarring

Question 7

After the first infection, varicella zoster virus becomes ___ within the body.

Answer 7

latent

Question 8

When do patients typically develop shingles?

Why?

Answer 8

Late in life / immunosuppressed

Virus reactivates and immune system cannot deal with it

Question 9

Where do varicella zoster viruses sit when they are latent?

What happens when they reactivate?

Answer 9

Dorsal sensory nerve

Same presentation as chicken pox in ONE DERMATOME only (i.e shingles)

Question 10

Chicken pox rash is centripetal. What does this mean?

Answer 10

Primarily found on the trunk

Question 11

What are other symptoms of chicken pox, apart from the rash?

Answer 11

Pruritus

Pain

Question 12

What are some complications of chicken pox?

Answer 12

Secondary infection e.g pneumonia

Haemorrhage

Scarring

Encephalopathy (spread to the brain)

Question 13

Why is shingles rash so distinctive?

Answer 13

Dermatomal, meaning it’s restricted to one or more dermatomes and is found on one side of the body usually

Question 14

Who tends to develop shingles?

Answer 14

Elderly

Immunocompromised

Question 15

What occurs in addition to the rash of shingles?

Answer 15

Tingly pain

Question 16

If pain persists four weeks after a shingles infection, what is it called?

Answer 16

Post herpetic neuralgia

Question 17

What are the three divisions of the trigeminal nerve (CN V)?

Answer 17

V1 - opthalmic division

V2 - maxillary division

V3 - mandibular division

Question 18

If a patient has shingles affecting the opthalmic division of their trigeminal nerve, where will the rash be?

Answer 18

On the face (unilaterally), affecting the forehead and eye down to the bridge of the nose

Question 19

Who should a patient with opthalmic zoster be referred to?

Answer 19

Opthalmologist

Question 20

Why could children develop shingles?

Answer 20

Mother had chicken pox in utero

Immunocompromised

Question 21

Adults tend to get herpes zoster in their ___ and ___ nerves.

Children tend to get herpes zoster in their ___ and ___ nerves.

(cervical, thoracic, lumbar, sacral)

Answer 21

thoracic , lumbar

cervical , sacral

Question 22

What is Ramsay-Hunt syndrome?

What are the possible symptoms?

Answer 22

VSV in the 7th and 8th cranial nerves

Facial palsy, deafness, tinnitus

Question 23

Which kind of vaccine is used to prevent chickenpox?

Answer 23

Live attenuated

alive, but less virulent

Question 24

How is shingles vaccinated against?

Answer 24

The same live attenuated chicken pox vaccine

Question 25

Which virus commonly causes infections in young people in the form of **primary gingivostomatitis**? What does this infection look like?

Answer 25

**Herpes simplex** **Ulceration in and around mouth**

Question 26

How long does primary gingivostomatitis last?

Answer 26

**1-2 weeks**

Question 27

When herpes simplex virus recurs it presents as ___ \_\_\_ around the mouth.

Answer 27

**cold sores**

Question 28

Dentists and anaesthetists sometimes develop lesions in their nail folds called **herpetic whitlow** - why?

Answer 28

**Their fingers are inoculated with herpes simplex virus by contact with the cold sores around people's mouths**

Question 29

If herpes simplex virus encounters the open skin of a child with eczema, what life threatening infection can occur?

Answer 29

**Eczema herpeticum** (Dermatitis herpetiformis is associated with CROHN'S DISEASE)

Question 30

Herpes simplex virus can be divided into Type _ and Type \_.

Answer 30

**1 , 2**

Question 31

If herpes simplex virus spreads to the brain, what sign will the patient show?

Answer 31

**Encephalopathy**

Question 32

Which herpes virus is the main cause of oral lesions?

Answer 32

**Herpes simplex type I**

Question 33

Which drug can be used to treat VZV and HSV?

Answer 33

**Aciclovir**

Question 34

Does aciclovir treat latent infection?

Answer 34

**No**

Question 35

How can viral infection be confirmed?

Answer 35

**Take a swab**

Question 36

Which skin condition is associated with **herpes simplex virus** (as well as some drug reactions) and presents as a **bullseye rash**?

Answer 36

**Erythema multiforme**

Question 37

What is a common infection in children which presents as **fleshy, firm, umbilicated** nodules?

Answer 37

**Molluscum contagiosum**

Question 38

What type of infection is molluscum contagiosum?

Answer 38

**Viral infection**

Question 39

Which virus causes **warts**?

Answer 39

**Human papilloma virus**

Question 40

What are warts called if they appear on the feet?

Answer 40

**Verrucas** because they're squashed flat

Question 41

What are some other diseases caused by human papilloma virus?

Answer 41

**Genital warts** **Cervical cancer**

Question 42

What is **herpangina**?

Answer 42

**Blistering rash at the back of the mouth**

Question 43

Which family of viruses cause **herpangina**?

Answer 43

**Enteroviruses** | (coxsackie virus)

Question 44

What member of the enterovirus family causes **herpangina** and **hand, foot and mouth disease**?

Answer 44

**Coxsackie virus**

Question 45

Which infection is also known as **slapped cheek disease** because it presents as a raised red rash on a child's cheek?

Answer 45

**Erythema infectiosum**

Question 46

Which virus causes **erythema infectiosum (slapped cheek disease)**?

Answer 46

**Parvovirus**

Question 47

Where children develop erythema infectiosum, what do adults present with when they are infected with parvovirus?

Answer 47

**Acute arthritis**

Question 48

How is suspected parvovirus infection investigated?

Answer 48

**Blood IgM test** (NOT a swab)

Question 49

Which virus causes **scabby mouth** in sheep and appears as **firm, fleshy nodules** on the hands of farmers?

Answer 49

**Orf**

Question 50

Which **bacteria** has a primary infection phase, then disseminates to cause secondary symptoms all over the body?

Answer 50

**Syphilis**

Question 51

What is a **chancre**?

Answer 51

**Painless ulcer** found at the site of syphilis infection

Question 52

What happens in the **secondary phase** of syphilis infection?

Answer 52

**Red rash all over the body** soles of feet, palms, mucous membranes

Question 53

What happens in the tertiary phase of syphilis?

Answer 53

**Life threatening systemic presentation** - CNS, cardio etc.

Question 54

Which bacteria causes syphilis?

Answer 54

***Treponema pallidum***

Question 55

How is syphilis diagnosed?

Answer 55

**Swab** at chancre site OR **Blood test**

Question 56

How is **syphilis** treated?

Answer 56

**Benzylpenicillin**

Question 57

What kind of ulcers, found in the mouth, are consistent with syphilis?

Answer 57

**Snail track ulcers**

Question 58

What is a bacterial infection which is spread by **ticks**?

Answer 58

**Lyme disease**

Question 59

What is the bacteria responsible for **Lyme disease**?

Answer 59

**Borrellia burgdorferi**

Question 60

What is the pathognomonic skin sign of Lyme disease? What does it look like?

Answer 60

**Erythema migrans** **Bullseye rash**

Question 61

How is Lyme disease treated?

Answer 61

**Doxycycline** or **amoxicillin**

Question 62

How can a **late** diagnosis of Lyme disease be diagnosed?

Answer 62

**Blood test**