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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
diagnosis of rubella
* clinical presentation * Rubella IgM antibody
26
What are the complications associated with rubella
* encephalitis (1:6000); thrombocytopenic purpura; GI hemorrhage * birth defects in pregnant women **congenital rubella syndrome**
27
what can congential rubella syndrome cause in fetus
* hearing loss * mental retardation * cardiovascular and ocular defects * LETHAL * associated with Rubella
28
Management of Rubella
* symptomatic treatment * avoid contact with pregnant women
29
This disease is most commonly caused by Herpes Virus 6
Roseola Infantum
30
what age range is most commonly affected with Roseola Infantum
infants and young children (peaks 7-13 months)
31
What is the clinical presentation (timeline of events) that allows for diagnosis of Roseola Infantum
* high fever (\>102) 3-5 days -\> resolves abruptly -\> rash appears
32
Describe rash and its progression of distribution in Roseola Infantum
* blanching pink/erythematous maculopapular * typically nonpuritic * spreads from neck/trunk initially then to face face/extremities
33
diagnosis of Roseola Infantum
clinical presentation
34
treatment options for Roseola Infantum
* supportive treatment: antipyretics
35
Which viral exanthems disease is characterized by polyarthropathy
fifth disease
36
which viral exanthems disease is characterized by generalized lymphadenopathy and polyarthralgias
rubella
37
What disease is attributed to coxsackie A16 virus
hand, foot, and mouth
38
Who is most commonly affected by hand, foot, and mouth disease? How is the disease transmitted?
* mostly affects children \<5 yrs old * transmission: oral ingestion of virus: fecal-oral or oral/respiratory secretions
39
Prodrome for hand, foot, and mouth disease
* typically absent * fever, fussiness, emesis, abd pain, diarrhea *
40
Describe rash seen with hand, foot, and mouth disease
* vesicles on buccal mucosa, tongue * vesicles on hands, feet and buttock * may create ulcers
41
complications with hand, foot, and mouth disease
* decreased oral intake, dehydration * encephalitis * aseptic meningitis * loss of nails * fetal loss, myocarditis, and conjunctival ulceration is rare
42
treatment for hand, foot, and mouth
* symptomatic treatment only * lidocaine gel for oral discomfort: use in adults * prevention with good hygiene
43
Etiology of molluscum contagiosum
poxvirus
44
molluscum contagiosum is commonly seen in what age group? How is it transmitted?
* common in children * transmission: direct physical contact and contact with contaminated fomites (clothing; towels; linens) * autoinoculation: self-spreading * VERY CONTAGIOUS
45
clinical presentation of molluscum contagiosum
* flesh colored, pearly, papules with **umbilication** (dimple at center) * 2-5mm * located anywhere **except palms and soles**
46
associated symptoms with molluscum contagiosum
NONE
47
treatment for molluscum contagiosum
* treatment recommended in genital region * home treatment: podophyllotoxin cream (contraindicated in pregnant women) * clinical office care: cryotherapy (adults); cantharidin (children)
48
what is condyloma acuminata? What is it caused by?
* Mucosal: genital warts * HPV
49
HPV infection can present on cutaneous surface as what?
common, plantar, and flat warts
50
HPV forms benign warts but what is concerning?
* play a role in oncogenesis of skin and mucosal malignancies (ex. SCC) * induce epidermal proliferation -\> viral induced tumors
51
what is the most common anorectal infection affecting homosexual males?
condyloma acuminatum (genital warts)
52
how is condyloma acuminatum (genital warts) spread
transmission: most common is sexual contact
53
clinical presentation of condyloma acuminatum
* classic cauliflower-like lesions:perianal growth, mild pruritus
54
treatment for condyloma acuminatum (genital warts)
* topical: podophyllin * surgical (cryotherapy, excision)
55
What is verruca vulgaris? What virus causes it?
common warts; HPV
56
verruca vulgaris is most common in what age group? How is it transmitted
* more common in children or young adults * transmission: skin to skin contact
57
When do verruca vulgaris go away? What is a possible complication
* spontaneous resolution in 1-2 years * recurrence is common
58
Clinical presentation of verruca vulgaris. How do you confirm diagnosis
* raised, rough-surfaced lesions with tiny, pigmented thrombosed capillaries ("seeds") * diagnosis: 15 blade scape off hyperkeratotic portion and thrombed capillaries can be visualized
59
Name for verruca vulgaris on hands and feet
plantar
60
treatment for verruca vulgaris
* nothing: spontaneous resolution may occur * salicylic acid (home treatment) * cryotherapy: use #15 blade to shave down callous prior to treatment * duct tape: silver
61
a type of HPV wart commonly seen on face
filiform wart
62
etiology of varicella
varicella-zoster virus (VZV), a herpes virus
63
transmission of varicella
* aerosolized droplets or direct contact with skin lesions * highly contagious * recurrence occurs
64
prodrome for varicella
* fever, malaise, pharyngitis, anorexia
65
describe rash associated with varicella
* pruritic * rash: generalized vesicular rash; lesions occur at different stages over 4 days and are typically crusted over in 6 days
66
diagnostic for varicella
* visualizing lesions in all three stages at the same time * Tzanck smear shows multinucleated giant cells
67
complications associated with varicella
* Group A strep with associated complication * encephalitis and reye syndrome (swelling in liver and brain): uncommon
68
why should a person infected with varicella stay away from pregnant females
congenital varicella syndrome
69
what medication can be used to treat immunosuppressed children and adults with varicella
acyclovir
70
etiology of herpes zoster (Shingles)
varicella zoster virus (VZV)
71
what patient population is commonly affected with herpes zoster (Shingles)
elderly and immunocompromised patients
72
list steps for pathogenesis of herpes zoster (Shingles)
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
prodrome of herpes zoster (Shingles)
* acute neuritic pain precedes eruption by 3-5 days * throbbing, stabbing, burning sensation * pruritus, fever, HA, allodynia
74
describe rash associated with herpes zoster (Shingles)
* development of grouped vesicles on an erythematous base * eruption follows dermatomal distribution * unilateral * thoracic distribution most common
75
what is post herpetic neuralgia (PHN)
lancinating pain which can last months-years after resolution of lesions (10-15%)
76
what is herpes zoster opthalmicus (HZO)? What sign can alert provider to this?
* sight-threatening linked to trigeminal ganglion activation * Hutchinson's sign: vesicles on nose
77
treatment for herpes zoster (Shingles)
* **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
when does herpes zoster (Shingles) usually resolve
2-6 weeks
79
a patient with herpes zoster (Shingles) can transmit what to seronegative patients? What disease will manifest?
* varicella * chickenpox
80
what preventative option is available for herpes zoster (Shingles)
zostavax in adults \>60 yrs
81
herpes simplex virus (HSV) comes in two types: What does HSV-I commonly cause? How is it spread?
* most commonly oral: herpes labialis * "cold sores" * transmitted by direct contact during viral shedding
82
herpes simplex virus (HSV) comes in two types: What does HSV-II commonly cause? How is it spread
* most commonly genital: herpes genitalis * transmitted sexually
83
Worldwide, how many adults have serologic evidence of HSV-1? Why? How many of these individuals have a history of herpes labialis
* 90% * commonly acquired asymptomatically in childhood * 20-25%
84
What is the problem with primary presentation of HSV-1
* can be severe! * gingivostomatitis (infection of mouth and gums) * pharyngitis * severe mouth pain and fever
85
what percent of the US population has serologic evidence of HSV-II? What accounts for 40% of newly acquired genital herpes?
* 15-20% * 70% of cases transmitted during viral shedding * 40% of newly acquired cases of genital herpes due to HSV-I
86
pathogenesis of HSV
* 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
prodrome of HSV. Why is this significant in terms of treatment
* prodrome: burning, tingling or pruritus * valacyclovir (valtrex), Famciclovir (Famvir) or Ayclovir (Zovirax)
88
clinical presentation of HSV
grouped vesicles on an erythematous base * crusting at later stages
89
diagnosis of HSV
* 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
treatment option for chronic episodes of herpes labialis
antivirals: valacyclovir (valtrex): consider discontinuing medication after 1 year to determine recurrence rate
91
* 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?
* acanthosis nigricans * concern is associated conditions: Obesity, Diabetes
92
What is the treatment for acanthosis nigricans
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
* sharply demarcated brown patches on the forehead and malar prominences
melasma
94
what is the etiology of melasma? What population is most commonly affected?
* acquired hyperpigmentation * melanocytes produce a large amount of pigment when stimulated by UV light or increase in hormones (pregnancy) * darker skinned individuals susceptible
95
"Mask of pregnancy" is associated with which skin condition
melasma
96
treatment for melasma
* sunscreen * hydroquinone, tretinoin
97
what is a lipoma
common subcutaneous soft-tissue tumor composed of adipose tissue
98
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?
epithelial inclusion cyst * cyst can become infected and very painful
99
treatment for epithelial inclusion cyst
* uninfected: kenalog injection, I&D, excision * infected: I&D; oral Abx

Clinical Medicine (6 decks)

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