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Clinical Medicine > derm: viral exanthems > Flashcards

derm: viral exanthems Flashcards

1
Q

paramyxovirus causes what disease

A

measels (rubeola)

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2
Q

How is measels transmitted?

A

infectious droplets; highly contagious; area remains infectious for up to 2 hrs after infected person leaves

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3
Q

prodrome for measels

A

high fever (often 105F) followed by 3 C’s: cough, coryza; conjunctivitis

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4
Q

What typically develops in patients with measels 48 hours prior to rash?

A

Koplik spots: “grains of salt on a red background”

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5
Q

Describe the typical rash associated with measels including spreading pattern

A
  • blanching, maculopapular
  • starts on face and spreads from head to toe
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6
Q

when is a person with measels infectious

A

5 days before rash and 4 days after

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7
Q

How is the diagnosis of measels confirmed

A
  • serum and throat swabs
  • serology: measles virus specific IgM
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8
Q

common complications associated with measels

A

diarrhea and otitis media

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9
Q

severe complications associated with measles

A
  • pneumonia (6%)
  • Encephalitis (1/1000)
  • subacute sclerosing panencephalitis
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10
Q

what is subacute sclerosing panencephalitis (SSPE)

A

complication resulting from measels in which a person gets fatal degenerative disease of CNS (behavioral and intellectual deterioration, sz) 7-10 yrs after measles

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11
Q

treatment for measels

A
  • report to CDC
  • symptomatic treatment
  • vitamin A
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12
Q

what is fifth disease

A

erythema infectiosum

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13
Q

parvovirus B19 has been linked to what disease

A

erythema Infectiosum (fifth disease)

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14
Q

what age group is most commonly affected by erythema Infectiosum (fifth disease)? How is this disease transmitted?

A
  • most commonly occurs in school-aged children
  • respiratory secretions
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15
Q

symptoms of erythema Infectiosum (fifth disease) can last for weeks, months, or rarely years. The disease frequently clears with recurrence of the rash following what?

A

nonspecific stimuli: stress, sunlight, exercise, hot bath

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16
Q

prodrome of erythema Infectiosum (fifth disease)

A

nonspecific flu-like symptoms x 2-3 days

  • mild low grade fever, coryza, HA, nausea, diarrhea, sore throat
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17
Q

what disease is associated with a facial rash “slapped cheek” and a body rash “lacy” that follows facial rash 2-3 d later. Where is the body rash located?

A

erythema Infectiosum (fifth disease)

  • body rash is found on trunk and extensor surfaces of extremities
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18
Q

how is erythema Infectiosum (fifth disease) diagnosed

A
  • clinical presentation
  • parvovirus B19 IgM antibodies
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19
Q

If a pregnant women gets this disease, her fetus could develop Hydrops fetalis

A

erythema Infectiosum (fifth disease)

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20
Q

transient aplastic crisis is a rare complication of which disease

A

erythema Infectiosum (fifth disease)

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21
Q

treatment of erythema Infectiosum (fifth disease)

A

reassurance and symptomatic treatment

  • for severe anemia, may need blood transfusion
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22
Q

How is rubella transmitted

A

inhaled large particle aerosols

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23
Q

what is the prodrome with rubella

A
  • may be concurrent with rash or appear 1-5 days prior
  • minimal symptoms: low grade fever. lymphadenopathy, cold symptoms in older kids or adults
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24
Q

Describe the rash and its progression on body associated with rubella

A
  • 3 day measles
  • pinpoint, pink maculopapules
  • head to toe progession
  • *arthralgias may accompany rash
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25
Q

diagnosis of rubella

A
  • clinical presentation
  • Rubella IgM antibody
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26
Q

What are the complications associated with rubella

A
  • encephalitis (1:6000); thrombocytopenic purpura; GI hemorrhage
  • birth defects in pregnant women congenital rubella syndrome
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27
Q

what can congential rubella syndrome cause in fetus

A
  • hearing loss
  • mental retardation
  • cardiovascular and ocular defects
  • LETHAL
  • associated with Rubella
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28
Q

Management of Rubella

A
  • symptomatic treatment
  • avoid contact with pregnant women
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29
Q

This disease is most commonly caused by Herpes Virus 6

A

Roseola Infantum

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30
Q

what age range is most commonly affected with Roseola Infantum

A

infants and young children (peaks 7-13 months)

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31
Q

What is the clinical presentation (timeline of events) that allows for diagnosis of Roseola Infantum

A
  • high fever (>102) 3-5 days -> resolves abruptly -> rash appears
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32
Q

Describe rash and its progression of distribution in Roseola Infantum

A
  • blanching pink/erythematous maculopapular
  • typically nonpuritic
  • spreads from neck/trunk initially then to face face/extremities
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33
Q

diagnosis of Roseola Infantum

A

clinical presentation

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34
Q

treatment options for Roseola Infantum

A
  • supportive treatment: antipyretics
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35
Q

Which viral exanthems disease is characterized by polyarthropathy

A

fifth disease

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36
Q

which viral exanthems disease is characterized by generalized lymphadenopathy and polyarthralgias

A

rubella

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37
Q

What disease is attributed to coxsackie A16 virus

A

hand, foot, and mouth

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38
Q

Who is most commonly affected by hand, foot, and mouth disease? How is the disease transmitted?

A
  • mostly affects children <5 yrs old
  • transmission: oral ingestion of virus: fecal-oral or oral/respiratory secretions
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39
Q

Prodrome for hand, foot, and mouth disease

A
  • typically absent
  • fever, fussiness, emesis, abd pain, diarrhea
    *
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40
Q

Describe rash seen with hand, foot, and mouth disease

A
  • vesicles on buccal mucosa, tongue
  • vesicles on hands, feet and buttock
  • may create ulcers
41
Q

complications with hand, foot, and mouth disease

A
  • decreased oral intake, dehydration
  • encephalitis
  • aseptic meningitis
  • loss of nails
  • fetal loss, myocarditis, and conjunctival ulceration is rare
42
Q

treatment for hand, foot, and mouth

A
  • symptomatic treatment only
  • lidocaine gel for oral discomfort: use in adults
  • prevention with good hygiene
43
Q

Etiology of molluscum contagiosum

A

poxvirus

44
Q

molluscum contagiosum is commonly seen in what age group? How is it transmitted?

A
  • common in children
  • transmission: direct physical contact and contact with contaminated fomites (clothing; towels; linens)
  • autoinoculation: self-spreading
  • VERY CONTAGIOUS
45
Q

clinical presentation of molluscum contagiosum

A
  • flesh colored, pearly, papules with umbilication (dimple at center)
  • 2-5mm
  • located anywhere except palms and soles
46
Q

associated symptoms with molluscum contagiosum

A

NONE

47
Q

treatment for molluscum contagiosum

A
  • treatment recommended in genital region
  • home treatment: podophyllotoxin cream (contraindicated in pregnant women)
  • clinical office care: cryotherapy (adults); cantharidin (children)
48
Q

what is condyloma acuminata? What is it caused by?

A
  • Mucosal: genital warts
  • HPV
49
Q

HPV infection can present on cutaneous surface as what?

A

common, plantar, and flat warts

50
Q

HPV forms benign warts but what is concerning?

A
  • play a role in oncogenesis of skin and mucosal malignancies (ex. SCC)
  • induce epidermal proliferation -> viral induced tumors
51
Q

what is the most common anorectal infection affecting homosexual males?

A

condyloma acuminatum (genital warts)

52
Q

how is condyloma acuminatum (genital warts) spread

A

transmission: most common is sexual contact

53
Q

clinical presentation of condyloma acuminatum

A
  • classic cauliflower-like lesions:perianal growth, mild pruritus
54
Q

treatment for condyloma acuminatum (genital warts)

A
  • topical: podophyllin
  • surgical (cryotherapy, excision)
55
Q

What is verruca vulgaris? What virus causes it?

A

common warts; HPV

56
Q

verruca vulgaris is most common in what age group? How is it transmitted

A
  • more common in children or young adults
  • transmission: skin to skin contact
57
Q

When do verruca vulgaris go away? What is a possible complication

A
  • spontaneous resolution in 1-2 years
  • recurrence is common
58
Q

Clinical presentation of verruca vulgaris. How do you confirm diagnosis

A
  • raised, rough-surfaced lesions with tiny, pigmented thrombosed capillaries (“seeds”)
  • diagnosis: 15 blade scape off hyperkeratotic portion and thrombed capillaries can be visualized
59
Q

Name for verruca vulgaris on hands and feet

A

plantar

60
Q

treatment for verruca vulgaris

A
  • nothing: spontaneous resolution may occur
  • salicylic acid (home treatment)
  • cryotherapy: use #15 blade to shave down callous prior to treatment
  • duct tape: silver
61
Q

a type of HPV wart commonly seen on face

A

filiform wart

62
Q

etiology of varicella

A

varicella-zoster virus (VZV), a herpes virus

63
Q

transmission of varicella

A
  • aerosolized droplets or direct contact with skin lesions
  • highly contagious
  • recurrence occurs
64
Q

prodrome for varicella

A
  • fever, malaise, pharyngitis, anorexia
65
Q

describe rash associated with varicella

A
  • pruritic
  • rash: generalized vesicular rash; lesions occur at different stages over 4 days and are typically crusted over in 6 days
66
Q

diagnostic for varicella

A
  • visualizing lesions in all three stages at the same time
  • Tzanck smear shows multinucleated giant cells
67
Q

complications associated with varicella

A
  • Group A strep with associated complication
  • encephalitis and reye syndrome (swelling in liver and brain): uncommon
68
Q

why should a person infected with varicella stay away from pregnant females

A

congenital varicella syndrome

69
Q

what medication can be used to treat immunosuppressed children and adults with varicella

A

acyclovir

70
Q

etiology of herpes zoster (Shingles)

A

varicella zoster virus (VZV)

71
Q

what patient population is commonly affected with herpes zoster (Shingles)

A

elderly and immunocompromised patients

72
Q

list steps for pathogenesis of herpes zoster (Shingles)

A
  1. varicella infected; virus dormant in sensory ganglia
  2. stress/trauma/immunocompromised/increasing age -> immunity diminishes
  3. viral replication -> virus travels along sensory nerve
  4. skin lesions appear
73
Q

prodrome of herpes zoster (Shingles)

A
  • acute neuritic pain precedes eruption by 3-5 days
  • throbbing, stabbing, burning sensation
  • pruritus, fever, HA, allodynia
74
Q

describe rash associated with herpes zoster (Shingles)

A
  • development of grouped vesicles on an erythematous base
  • eruption follows dermatomal distribution
  • unilateral
  • thoracic distribution most common
75
Q

what is post herpetic neuralgia (PHN)

A

lancinating pain which can last months-years after resolution of lesions (10-15%)

76
Q

what is herpes zoster opthalmicus (HZO)? What sign can alert provider to this?

A
  • sight-threatening linked to trigeminal ganglion activation
  • Hutchinson’s sign: vesicles on nose
77
Q

treatment for herpes zoster (Shingles)

A
  • start treatment early (within 72 hrs)
  • accelerates healing, decreased the duration of pain and may reduce incidence of PHN
  • antiviral
  • most common used: Valacyclovir (Valtrex)
78
Q

when does herpes zoster (Shingles) usually resolve

A

2-6 weeks

79
Q

a patient with herpes zoster (Shingles) can transmit what to seronegative patients? What disease will manifest?

A
  • varicella
  • chickenpox
80
Q

what preventative option is available for herpes zoster (Shingles)

A

zostavax in adults >60 yrs

81
Q

herpes simplex virus (HSV) comes in two types: What does HSV-I commonly cause? How is it spread?

A
  • most commonly oral: herpes labialis
  • “cold sores”
  • transmitted by direct contact during viral shedding
82
Q

herpes simplex virus (HSV) comes in two types: What does HSV-II commonly cause? How is it spread

A
  • most commonly genital: herpes genitalis
  • transmitted sexually
83
Q

Worldwide, how many adults have serologic evidence of HSV-1? Why? How many of these individuals have a history of herpes labialis

A
  • 90%
  • commonly acquired asymptomatically in childhood
  • 20-25%
84
Q

What is the problem with primary presentation of HSV-1

A
  • can be severe!
  • gingivostomatitis (infection of mouth and gums)
  • pharyngitis
  • severe mouth pain and fever
85
Q

what percent of the US population has serologic evidence of HSV-II? What accounts for 40% of newly acquired genital herpes?

A
  • 15-20%
  • 70% of cases transmitted during viral shedding
  • 40% of newly acquired cases of genital herpes due to HSV-I
86
Q

pathogenesis of HSV

A
  • spread through direct contact with active lesions, saliva, semen, cervical secretions (particularly during viral shedding period)
  • patient may be asymptomatic
  • virus remains latent in nerve root ganglion
  • reactivated by change in immune status
87
Q

prodrome of HSV. Why is this significant in terms of treatment

A
  • prodrome: burning, tingling or pruritus
  • valacyclovir (valtrex), Famciclovir (Famvir) or Ayclovir (Zovirax)
88
Q

clinical presentation of HSV

A

grouped vesicles on an erythematous base

  • crusting at later stages
89
Q

diagnosis of HSV

A
  • clinical presentation
  • viral culture (from vesicle)
  • direct microscopy via tzanck smear: giant multinucleated cells indicates herpes (not specific to type)
  • serology: antibodies to HSV-1 and II
90
Q

treatment option for chronic episodes of herpes labialis

A

antivirals: valacyclovir (valtrex): consider discontinuing medication after 1 year to determine recurrence rate

91
Q
  • velvety plaques that are grayish, black, or brown
  • commonly found on neck, skin folds
  • most commonly affects native american, african american, hispanic
  • Identify. What is the concern?
A
  • acanthosis nigricans
  • concern is associated conditions: Obesity, Diabetes
92
Q

What is the treatment for acanthosis nigricans

A

treat underlying condition

  • fasting plasma insulin and glucose, weight loss counseling
  • topical therapy for cosmetic purposes: lactic acid cream, urea cream, retinoids, salicyclic acid
93
Q
  • sharply demarcated brown patches on the forehead and malar prominences
A

melasma

94
Q

what is the etiology of melasma? What population is most commonly affected?

A
  • acquired hyperpigmentation
  • melanocytes produce a large amount of pigment when stimulated by UV light or increase in hormones (pregnancy)
  • darker skinned individuals susceptible
95
Q

“Mask of pregnancy” is associated with which skin condition

A

melasma

96
Q

treatment for melasma

A
  • sunscreen
  • hydroquinone, tretinoin
97
Q

what is a lipoma

A

common subcutaneous soft-tissue tumor composed of adipose tissue

98
Q

the most common cutaneous cyst is a soft, mobile nodule that is fluctuant often with a central punctum. What is this? What is a possible complication?

A

epithelial inclusion cyst

  • cyst can become infected and very painful
99
Q

treatment for epithelial inclusion cyst

A
  • uninfected: kenalog injection, I&D, excision
  • infected: I&D; oral Abx

Clinical Medicine (6 decks)

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