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Oral Pathology - My deck > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

What is the only natural reservoir for HHV?

A

Humans, HHV stands for human herpes virus!

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2
Q

What are the types of HHV?

A

HHV-1, HHV-2, VZV, EBV, CMV, HHV-6, HHV-7, KSHV

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3
Q

Where are lesions typically seen in HSV-1?

A

Lesions are typically above the waist, specifically, perioral lesions

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4
Q

What condition has been able to induce HHV-1 lesions experimentally?

A

UV light exposure

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5
Q

What term describes a symptomatic primary infection in younger populations?

A

Acute herpetic gingivostomatitis

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6
Q

How is HHV-2 transmitted?

A

Sexual contact

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7
Q

Are primary infections of HHV-1 and HHV-2 usually asymptomatic or symptomatic?

A

80% are usually asymptomatic

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8
Q

After initial exposure or HHV-1 and HHV-2, where is the virus transported to?

A

The virus is taken up by the sensory nerves and transported to associated sensory ganglia (latent state).

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9
Q

What is the primary site of latency for herpes?

A

Trigeminal ganglion

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10
Q

What are the terms that describe reactivation of herpes virus?

A

Secondary infection, recurrent infection or recrudescent infection

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11
Q

What is the most common site of recurrence for HHV-1?

A

Vermillion border and adjacent skin of the lips.

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12
Q

What is other names for HHV-1 when it occurs adjacent skin of the lips?

A

Herpes labialis, cold sore, fever blister

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13
Q

True or False: 40% of people in the US has a history of herpes labialis

A

True

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14
Q

Describe the prodrome of HHV-1?

A

Pain, burning, itching, tingling 6-24 hours before the lesion develops. Symptoms are most severe in the first 8 hours.

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15
Q

Describe the appearance of HHV-1/2 lesions.

A

Multiple, small, erythematous papules (fluid filled vesicles) that rupture and crust with 2 days.

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16
Q

How long does it take for HHV-1/2 to heal?

A

7-10 days

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17
Q

How many HHV-1/2 outbreaks does a majority of people experience a year?

A

2 outbreaks a year

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18
Q

How long is the HHV-1/2 virus actively replicating for?

A

2 days. Mechanical rupture of intact vesicles releases the virus and can result in spreading the lesion

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19
Q

Where do recurrent intraoral lesions usually occur?

A

Almost always on keratinized, bound mucosa (palate, attached gingiva)

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20
Q

At what age does acute herpetic gingivostomatitis usually occur?

A

Most cases occur before 5 years old

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21
Q

True or False: Both movable and attached oral mucosa can be affected by acute herpetic gingivostomatitis.

A

True, both movable and attached mucosa can be affected by acute herpetic gingivostomatitis.

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22
Q

In acute herpetic gingivostomatitis, self-inoculation of ________, _______, and _______ can occur.

A

Fingers, eyes and genitals

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23
Q

What term describes primary herpes in patients 18 years and older?

A

(Acute herpetic?) Pharyngotonsillitis

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24
Q

What are the initial symptoms of herpetic pharyngotonsillitis?

A

Sore throat, fever, headache

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25
Q

What term describes a herpes infection of the thumb or fingers?

A

Herpetic whitlow

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26
Q

What term describes a herpetic infection found in contaminated abrasions of wrestlers or rugby players?

A

Herpetic gladiatorum or scrumpox

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27
Q

What term describes a herpes infection created by shaving?

A

Herpes barbae

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28
Q

What location of HSV-1 is a concern for ocular involvement?

A

The tip of the nose (ocular involvement of herpes is actually the leading infectious cause of blindness in the US)

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29
Q

What term describes a life threatening infection caused by extensive herpetic cutaneous vesicular eruption that arises from pre-existing skin disease?

A

Eczema herpticum or Kaposi’s varicelliform eruption

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30
Q

What are the histopathologic features of HHV?

A

Multinucleation, ballooning degeneration (Acantholysis, nuclear clearing, nuclear enlargement) Tzanck cells (free floating)

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31
Q

How is HHV diagnosed?

A

Clinical presentation, cytologic smear, tissue biopsy, serologic testing(has to be 4-8 days after exposure)

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32
Q

How is HHV treated?

A

Antivirals (acyclovir)

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33
Q

What virus causes chicken pox?

A

Varicella-Zoster Virus aka HHV-3

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34
Q

How is VZV spread?

A

Through air droplets or direct contact with active lesions

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35
Q

At what age do most cases of VZV occur?

A

Between the ages of 5-10

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36
Q

After initial VZV infection, where does the virus establish latency?

A

Dorsal spinal ganglia

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37
Q

What are some predisposing factors for reactivation of VZV?

A

Immunosuppression, radiation, malignancies, increasing age, alcohol abuse, emotional or physical stress

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38
Q

What is the syndrome associated with VZV?

A

Ramsay Hunt Syndrome

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39
Q

Describe Ramsay Hunt Syndrome.

A

Cutaneous lesions of the external auditory canal, facial paralysis, hearing deficits, vertigo

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40
Q

What virus causes infectious mononucleosis?

A

Epstein Barr virus aka HHV 4

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41
Q

What are some other lesions which demonstrate EBV?

A

Oral hairy leukoplakia, lymphomas (African’s Burkitt lymphoma), Nasopharyngeal carcinoma

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42
Q

Approximately how many adults are infected with EBV?

A

Up to 95% of adults

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43
Q

How is infectious mononucleosis diagnosed?

A

Presence of Paul Bunnel heterophil antibodies

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44
Q

What are the signs of infectious mononucleosis?

A

Prodrome 2 week before, fatigue, malaise, anorexia, fever, lymphadenopathy, oral lesions (petechiae on hard palate, NUG)

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45
Q

What virus can reside in salivary glands, endothelium, macrophages and lymphocytes?

A

Cytomegalovirus aka HHV 5

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46
Q

Approximately, what percentage of CMV infections are asymptomatic?

A

Almost 90%

47
Q

What are the common symptoms of CMV infection?

A

Fever, joint and muscle pain, shivering, chronic mucosal ulcerations

48
Q

In what population is CMV common?

A

AIDS patients

49
Q

What are the classifications of enteroviruses?

A

Echoviruses, Caxsackievirus, Poliovirus

50
Q

What are the 3 disease caused by the coxsackievirus that are important to oral health care professionals?

A

Herpangina, hand/foot/mouth disease, acute lymphonodular pharyngitis

51
Q

How are enteroviruses spread?

A

Crowding and poor hygiene, fecal-oral route; during acute phase, it can be transmitted through saliva or respiratory droplets

52
Q

True or False: infection with one strain of enteroviruses confers immunity

A

True, infection with one strain of enteroviruses confers immunity

53
Q

What age group(s) are commonly affected by enteroviruses?

A

Nearly half of reported cases occur in infants younger than 1, 85% occur in patients younger than 20

54
Q

Describe herpangina

A

Skin rash, 2-6 oral lesions in the posterior mouth, along with sore throat, fever and dysphagia

55
Q

Describe the ulcerations seen in herpangina

A

Begin as red macules that form fragile vesicles that rapidly ulcerate; ulcerations are 3mm in diameter

56
Q

Describe hand-foot-and-mouth disease

A

Skin rash and oral lesions associated with flu like symptoms

57
Q

Describe the oral lesions seen in hand-foot-and-mouth disease

A

Resemble ulcerations of herpangina, but larger (up to 1 cm), and more numberous (up to 30); buccal mucosa, labial mucosa, and tongue

58
Q

True or False: Lesions seen in hand-foot-and-mouth disease heal without crusting

A

True, lesions seen in hand-foot-and-mouth disease heal without crusting

59
Q

Describe acute lymphonodular pharyngitis

A

Sore throat, fever, mild headache, with 1-5 yellow to dark pink nodules in the posterior mouth that represent hyperplastic lymphoid aggregates

60
Q

How are infections caused by enteroviruses diagnosed?

A

Diagnosis can be made from clinical manifestations, infection is self limiting

61
Q

What is another name for measles?

A

Rubeola is another name for measles

62
Q

What virus causes measles/rubeola?

A

Paramyxovirus

63
Q

When do most cases of measles arise?

A

In winter

64
Q

How is measles spread?

A

Through respiratory droplets

65
Q

What is the incubation period for the paramyxovirus?

A

10-12 days

66
Q

How long are measles infectious?

A

Infectious from 2 days before symptoms and 4 days after rash appears

67
Q

In measles, what is responsible for the rash formation?

A

Vasculitis

68
Q

How long does measles last?

A

Nine-day measles, 3 stages with 3 days

69
Q

What is the 1st stage of measles?

A

3 C’s + fever

Coryza, cough, conjunctivitis

70
Q

What term describes multiple areas of mucosal erythema with numerous, small, blue-white macules (grains of slat on a red background) and is associated with the 1st stage of measles?

A

Koplik’s spots (pathognomic for measles)

71
Q

What do Koplik’s spots represent?

A

Foci of epithelial necrosis

72
Q

What is the 2nd stage of measles?

A

Fever continues + maculopapular, erythematous (morbilliform) rash

73
Q

How does the rash first begin and spread in the 2nd stage of measles?

A

Face first, then a downward spread from trunk to extremities

74
Q

What is the 3rd stage of measles?

A

Fever ends + rash fades, replaced by brown pigmentary staining

75
Q

What is another name for rubella?

A

German measles is another name for rubella

76
Q

What virus causes rubella?

A

Togavirus

77
Q

What is the greatest importance to remember about Rubella?

A

It has the capacity to induce birth defects (congenital rubella syndrome)

78
Q

What is the incubation time of the togavirus?

A

2-3 weeks

79
Q

When are patients with rubella contagious?

A

1 week before rash to 5 days after its development

80
Q

How long does rubella last?

A

3 day measles

81
Q

What is the most common complaint seen in rubella?

A

Arthritis, other symptoms are mild

82
Q

What term describes small, discrete, dark-red papules on the palate in some cases of rubella?

A

Forchheimer’s sign

83
Q

What is congenital rubella syndrome?

A

Deafness, heart disease, cataracts

84
Q

What is another name for mumps?

A

Epidemic parotitis

85
Q

What is mumps?

A

Mumps is a disease of the exocrine glands

86
Q

What is the best known site of involvement in cases of mumps?

A

Salivary glands

87
Q

What do glands exhibit in cases of mumps?

A

Edema and lymphocytic infiltration

88
Q

What is the incubation period for mumps?

A

2-4 weeks

89
Q

When are patients with mumps contagious?

A

Contagious from 1 day before clinical appearance to 2 weeks after resolution

90
Q

What might 25% or postpubertal males experience during mumps infection?

A

Epididymorchitis

91
Q

What might 25% or first trimester women experiency during mumps infection?

A

Spontaneous abortions

92
Q

How is mumps treated?

A

Palliative treatment

93
Q

How effective is the MMR vaccine?

A

Very! 95%

94
Q

What does HIV and AIDS stand for?

A

Human immunodeficiency virus, and acquired immunodeficiency syndrome

95
Q

Where is the HIV found?

A

In bodily fluids

96
Q

How is HIV spread?

A

Through sexual contact, parenteral exposure to blood, transmission from mother to fetus

97
Q

What cell does HIV target?

A

CD4+ helper T lymphocyte

98
Q

What are the 3 stages of HIV/AIDS?

A

Acute self limited viral syndrome; asymptomatic period; final symptomatic period

99
Q

What are the 5 oral manifestations most strongly associated with HIV infection?

A

Candidiasis, Oral hairy leukoplakia, Kaposi’s sarcoma, Non-Hodgkin’s lymphoma, periodontal diseases

100
Q

How many HIV and AIDS patients present with candidiasis?

A

1/3 of HIV patients and 90% of AIDS patients

101
Q

Oral hairy leukoplakia is a sign of severe _____ ______ and ______ _____ in HIV and AIDS patients.

A

Severe immune depression and advanced disease

102
Q

What is the most common EBV related lesion in AIDS patients?

A

Oral hairy leukoplakia

103
Q

Describe oral hairy leukoplakia

A

White mucosal plaque that does not rub off, usually occurs bilaterally, on the lateral border of the tongue

104
Q

What term describes a multifocal neoplasm of vascular endothelial cell origin?

A

Kaposi’s sarcoma

105
Q

What virus causes Kaposi’s sarcoma?

A

HHV-8

106
Q

What percentage of patients with Kaposi’s sarcoma have oral lesions?

A

70%, in 20% of patients the oral cavity is the primary site of involvement

107
Q

What locations are commonly affected by Kaposi’s sarcoma?

A

Hard palate, gingiva and tongue

108
Q

In Kaposi’s sarcoma, is a biopsy required?

A

Yes

109
Q

Describe a few characteristics associated with Non-Hodgkin’s Lymphoma

A

Up to 5% of HIV infected patients, presents as a high grade/aggressive disease = widespread involvement and short survival times

110
Q

What are the 3 atypical patterns of periodontal disease associated with HIV?

A

Linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulceratice periodontitis

111
Q

What is linear gingival erythema?

A

Gingivitis that doesn’t respond to improved plaque control and has a greater degree of erythema

112
Q

How is linear gingival erythema treated in HIV patients?

A

Systemic antifungals

113
Q

How is NUG and NUP treated? in HIV patients

A

Debridement, antimicrobials, immediate follow up and long term maintenance

Oral Pathology - My deck (22 decks)

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