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Clinical Med I > Derm - Viral Exanthems & Soft Tissue Tumors - Exam 1 > Flashcards

Derm - Viral Exanthems & Soft Tissue Tumors - Exam 1 Flashcards

1
Q

What is the secondary name and etiology for measles?

A

Secondary name: Rubeola

Etiology: paramyxovirus

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2
Q

How is measles contracted?

A

Infectious droplets- cough, sneeze, close breathing

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3
Q

How long does an area remain infectious after a measles infected person leaves?

A

For up to 2 hours

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4
Q

what risk factor should be considered when a patient presents with febrile rash?

A

Recent travel

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5
Q

How does the incubation period of measles present?

A

Typically asymptomatic

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6
Q

What is the prodrome of measles?

A

High fever (105+); followed by 3 C’s= cough, coryza, conjunctivitis

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7
Q

A patient presents to the clinic with a cluster of tiny bluish-white papules on buccal mucosa, described as “Grains of salt on a red background.” What is this and what disease process is it associated with?

A

Koplik spots

Associated with Measles

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8
Q

What is the clinical presentation of the rash seen in measles?

A
  • Blanching, maculopapular
  • Starts on face and spreads from head to toe
  • Typically spares palms and soles
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9
Q

How long is measles infectious before and after rash?

A

5 days before and 4 days after

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10
Q

What are Koplik spots?

A

Cluster of tiny bluish-white papules on buccal mucosa; “Grains of salt on a red background”

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11
Q

How do you diagnose measles?

A
  • Serology: measles virus specific IgM (most important)
  • Serum or throat swabs for histologic analysis
  • Urine may also contain virus
  • Measles RNA RT-PCR
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12
Q

What are the more common complications of measles?

A

Diarrhea&raquo_space; otitis media

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13
Q

Other than pneumonia and encephalitis, what is the distinguishable severe complication of measles?

A

Subacute sclerosing panencephalitis (SSPE) which presents 2-10 years later

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14
Q

What is SSPE?

A
  • Subacute sclerosing panencephalitis
  • Fatal degenerative disease of CNS (fatal within 1-3 years)
  • Behavioral and intellectual deterioration, seizures
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15
Q

What are the highest risk groups for measles?

A

Pregnant women, immunocompromised, ages: <5 or >20

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16
Q

What must you do if you suspect a case of measles?

A

Report to CDC

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17
Q

How is measles treated?

A
  • Symptomatic treatment
  • Vitamin A
  • Patient education (close contacts, avoid contact with pregnant women, prevent by immunization)
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18
Q

What is erythema infectiosum also known as?

A

Fifth disease

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19
Q

What is the etiology of erythema infectiosum?

A

Parvovirus B-19

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20
Q

What population is erythema infectiosum most commonly seen and how is it transmitted?

A

School-aged children; respiratory secretions

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21
Q

How long do the symptoms last with erythema infectiosum?

A

Weeks, months, years (rare); frequent clearing with recurrence of rash

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22
Q

What is the prodrome of erythema infectiosum?

A

Nonspecific flu-like symptoms for 2-3 days

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23
Q

What are the distinguishable features of erythema infectiosum?

A
  • “Slapped cheek” = erythematous malar face rash
  • Lacy, pink macular rash of trunk and extremities (extensor surfaces) 2-3 days later
  • Polyarthropathy: joint pain/inflammation
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24
Q

Although rare, what are the complications associated with erythema infectiosum?

A
  • Hydrops fetalis and/or possible fetal loss in pregnancy

- Transient aplastic crisis

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25
Q

What is used for management of erythema infectiosum?

A
  • Reassurance and symptomatic treatment*
  • For severe anemia, may need blood transfusion and immune globulin
  • Avoid contact with pregnant women
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26
Q

What is Rubella also known as?

A

German Measles

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27
Q

What is the etiology of Rubella?

A

Rubella virus

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28
Q

How is Rubella transmitted?

A

Inhaled, large particle aerosols

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29
Q

What is the prodrome for Rubella?

A

Low grade fever, lymphadenopathy, and cold symptoms for 1-5 days prior to rash

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30
Q

What are the characteristics of the rash caused by Rubella?

A
  • Pinpoint, pink maculopapules

- Head to toe progression

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31
Q

What other common symptom, besides the classic rash, may be seen in adults with Rubella?

A

Arthralgia/arthritis

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32
Q

What is a distinguishable complication seen with Rubella? What are characteristics associated with this complication?

A

Birth defect in pregnant women = Congenital rubella syndrome (lethal)

  • “Blueberry muffin” rash in infants*
  • Hearing loss
  • Mental retardation
  • Cardiovascular and ocular defects
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33
Q

What are other complications seen with Rubella besides congenital rubella syndrome?

A
  • Encephalitis, thrombocytopenic purpura, GI hemorrhage

- Mortality

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34
Q

How is Rubella managed?

A
  • Symptomatic treatment only
  • Avoid contact with pregnant women
  • Prevention by immunization (MMR)
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35
Q

What is the etiology of roseola infantum?

A

Most commonly caused by Herpes virus 6 (HHV-6)

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36
Q

What is the typical progression of roseola infantum that makes it distinguishable from other conditions?

A

High fever (102-105°) for 3-5 days –> fever resolves abruptly –> rash appears

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37
Q

What are the important prodrome characteristic seen with roseola infantum?

A
  • High fever (potentially > 105°) with abrupt end*

- Irritability and potential for seizures

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38
Q

How does the rash for roseola infantum present and what is distinguishable about it?

A
  • Blanching pink/ erythematous maculopapular
  • Spreads from neck/trunk initially then to face/extremities*
  • Typically nonpruritic/nontoxic appearance
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39
Q

What is the treatment for roseola infantum?

A

Supportive treatment (with antipyretics to keep fever under control)

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40
Q

Why is a UTI an important differential diagnosis of roseola infantum in a non-verbal age group?

A

UTI is a common cause of fever in infants

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41
Q

What is the etiology of hand, foot, and mouth?

A

Coxsackie A16 virus

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42
Q

What population is most commonly affected by hand, foot and mouth?

A

Children < 5 y/o

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43
Q

How is hand, foot, and mouth transmitted?

A

Oral ingestion of virus via fecal-oral or oral/respiratory secretions (vesicles)

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44
Q

Although the prodrome is typically absent in hand, foot and, what symptoms does it include when it does present?

A

Fever, fussiness, emesis, abdominal pain, diarrhea

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45
Q

What is the clinical presentation typically associated with hand, foot and mouth?

A
  • Vesicles on hands, feet, and buttocks (classic appearance)
  • Can also have sore throat, vesicles on buccal mucosa, vesicles on tongue
  • Vesicles may create ulcers
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46
Q

What are the complications of hand, foot and mouth?

A
  • Decreased oral intake, dehydration
  • Encephalitis
  • Aseptic meningitis
  • Loss of nails
  • Fetal loss, myocarditis, and conjunctival ulceration (rare)
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47
Q

How is hand, foot and mouth treated?

A

Symptomatic treatment only

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48
Q

How is hand, foot and mouth prevented?

A

Good hygiene; no vaccine currently

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49
Q

What is the etiology of molluscum contagiosum?

A

Poxvirus

50
Q

What population is typically affected by molluscum?

A

Children (sometimes seen in adults and immunocompromised)

51
Q

How does molluscum contagiosum spread?

A
  • Transmitted via direct physical contact and contact with contaminated fomites
  • Autoinoculation: self spreading by touching, scratching, shaving
52
Q

What is the distinguishable feature of the lesions that present with molluscum?

A

Umbilication (dimple at the center)*

53
Q

How does molluscum contagiosum present clinically?

A
  • Flesh colored, pearly, umbilicated papules
  • Anywhere except palms and soles
  • No associated symptoms
54
Q

What are the treatment options for molluscum contagiosum?

A
  • No treatment
  • Spontaneously resolves in 6-12 months
  • Home treatment: podophyllotoxin cream
  • Clinical office care: cryotherapy, curettage, cantharidin
55
Q

In what case is treatment of molluscum contagiosum recommended?

A

Lesions in genital region

56
Q

In what population is using Podophyllotoxin cream contraindicated?

A

Pregnant women as it causes fetal toxicity

57
Q

What are the 2 types of Human Papilloma Virus (HPV)?

A
  1. Mucosal: condyloma acuminata

2. Cutaneous: common, plantar, and flat warts

58
Q

What should be considered with respect to cutaneous HPV?

A

Play a role in oncogenesis of skin and mucosal malignancies (ex. SCC)

59
Q

What is the etiology of condyloma acuminatum?

A

Human papillomavirus (HPV)

60
Q

What is condyloma acuminatum, who does it commonly affect, and how is it transmitted?

A

Genital warts; homosexual males (most commonly); sexual contact

61
Q

What is the clinical presentation of condyloma acuminatum?

A

Classic cauliflower-like lesions: perianal growth, mild pruritus

62
Q

How are condyloma acuminatum treated?

A

Topical (podophyllin), immunotherapeutic, surgical

63
Q

What are verruca vulgaris also known as and what is their etiology?

A

Common warts; HPV

64
Q

What are the common characteristics for verruca vulgaris, including the population affected and how they are transmitted?

A
  • More common in children/ young adults
  • Transmission: skin to skin contact
  • Spontaneous resolution in 1-2 years
  • Recurrence is common
65
Q

What is the clinical presentation of verruca vulgaris?

A
  • Lesions are raised, rough-surfaced, with tiny, pigmented thrombosed capillaries (“seeds”)*
  • Common on hands and feet (plantar)
66
Q

How is verruca vulgaris treated?

A
  • Nothing (spontaneous resolution may occur)
  • Salicylic acid (at home or in clinic)
  • Cryotherapy
  • Electrodessication
  • Snip/shave biopsy (filiform warts)
  • lesion should be pared/shaved down prior to treatment
67
Q

What is varicella also known as?

A

Chicken pox

68
Q

What is the etiology of varicella?

A

Varicella-zoster virus (VZV), a herpes virus

69
Q

How is varicella transmitted?

A

Aerosolized droplets or direct contact with skin lesions (highly contagious and can recur)

70
Q

What is the clinical presentation of the rash associated with varicella?

A
  • Generalized vesicular rash
  • Pruritic
  • Lesions occur at different stages*
71
Q

What is the distinguishable characteristic of varicella and how does this help with diagnosis?

A

Visualizing lesions in all three stages at the same time

72
Q

Other than visualizing the rash, what is another technique used to diagnose varicella and what does it show?

A

Tzanck smear which shows multinucleated giant cells

73
Q

What complications can be seen with varicella?

A
  • Group A strep
  • Encephalitis and Reye syndrome (uncommon)
  • Largest complications seen in immunocompromised patients
74
Q

How is varicella treated?

A
  • Symptomatic treatment and patient education
  • Contagious until all lesions are crusted
  • Avoid pregnant females
  • Acyclovir used in immunosuppressed patients
  • Vaccination
75
Q

What is the etiology of herpes zoster?

A

Varicella zoster virus (VZV), a herpes virus

76
Q

What is herpes zoster also known as?

A

Shingles

77
Q

What population does herpes zoster most commonly appear in?

A

Elderly and immunocompromised patients

78
Q

If shingles is caused by the same virus as varicella, describe how shingles occurs.

A

The varicella virus is dormant in the sensory ganglia. Immunity to this virus decreases with age, stress, trauma, or being immunocompromised. The virus begins to replicate, travel along a sensory nerve, and skin lesions will begin to appear.

79
Q

What kind of pattern does herpes zoster follow?

A

It follows a dermatomal pattern. The lesions will be unilateral for this reason

80
Q

What is the prodrome of herpes zoster?

A

Acute neurotic pain that precedes the eruption of lesions by 3-5 days.

May also have pruritis, fever, headache, and allodynia

81
Q

Describe the herpes zoster rash.

A

Grouped vesicles on an erythematous base that follow a dermatomal distribution and are unilateral. Thoracic distribution is most common.

82
Q

What is post herpeticum neuralgia (PHN)?

A

A chronic complication of herpes zoster, results in lancinating pain which can last months-years after resolution of lesions. Occurs 10-15 % of the time.

83
Q

What is herpes zoster ophthalmicus (HZO)?

A

A chronic complication of herpes zoster which occurs when the lesions are around the eyes. This has a high risk for vision loss.

84
Q

What is Hutchinson’s sign?

A

When herpes zoster vesicles are on the nose. Causes concern for herpes zoster ophthalmicus and vision loss.

85
Q

What is the main treatment for herpes zoster?

A

To start treatment early (within 72 hours) with antivirals

  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)
  • Acyclovir (Zovirax)
86
Q

What patient education should be given to someone with herpes zoster?

A

Stay hydrated, keep skin clean and dry, and cover the lesions

87
Q

What pain medications are given for acute herpes zoster?

A

Narcotics and NSAIDs

88
Q

What pain medications are given for chronic herpes zoster?

A

Tricyclic antidepressants, gabapentin, and pregabalin

89
Q

What is the treatment if someone has herpes zoster with ocular involvement?

A

Emergent ophthalmology consult

90
Q

Can someone with Shingles transmit shingles to another person?

A

No. But they can transmit varicella since it is the same virus.

91
Q

How can Herpes Zoster be prevented?

A

Zosravax injection (single dose) or Shingrix injection (2 doses, but more effective)

Only approved for patients older than 50.

92
Q

What is HSV-1 most common presentation?

A

Herpes labialis - Cold sores

93
Q

How is HSV transmitted?

A

Direct contact during viral shedding

94
Q

What is HSV-II most common presentation?

A

Genital herpes

95
Q

How is HSV-II transmitted?

A

Transmitted sexually

96
Q

What happens to the Herpes simplex virus after primary infection?

A

It remains latent in nerve root ganglion and can be reactivated by changes in immune status –> stress, infection, menses, fatigue, sun exposure, etc

97
Q

Describe the clinical presentation of the lesions from herpes simplex virus.

A

Grouped vesicles on an erythematous base with crusting of lesions at later stages.

98
Q

What is the prodrome of herpes simplex virus?

A

Burning, tingling, or pruritis

99
Q

How is herpes simplex virus diagnosed?

A

Clinical presentation, viral culture, direct microscopy via Tzanck smear, and serology.

100
Q

What is a Tzanck smear?

A

When fluid is scraped from a vesicle and stained with Wrights stain. It is positive if there are giant multinucleated cells.

101
Q

What are the complications of herpes simplex virus?

A
  • Erythema multiforme
  • Eczema herpaticum
  • Recurrent aseptic meningitis
102
Q

What is the recommended treatment for herpes simplex virus?

A
  • Start treatment early (<72 hours preferred)

- Treatment of initial outbreak and subsequent outbreaks is valacyclovir, Famciclovir, or Acyclovir

103
Q

When are antivirals used for chronic suppression of HSV?

A

If there are 4 or more outbreaks of herpes labialis in one year, or there are HSV recurrences with serious complications

104
Q

What is the most common cutaneous cyst?

A

Epidermal inclusion cyst aka epidermoid cyst

105
Q

What is the clinical presentation of an epidermal inclusion cyst?

A

A soft, mobile nodule that is fluctuate and often with a central punctum

106
Q

What is the treatment of an uninfected epidermal inclusion cyst?

A
  • Nothing
  • Kenalog injections
  • Incision and drainage
107
Q

What is the treatment of an infected epidermal inclusion cyst?

A

Incision and drainage and possibly oral antibiotics

108
Q

What is a lipoma?

A

The most common subcutaneous soft tissue tumor that is composed of adipose tissue

109
Q

What is the clinical presentation of a lipoma?

A

Soft, mobile, and typically non-tender mass.

110
Q

What is the treatment of a lipoma?

A

Surgical removal

111
Q

What can lipomas mimic the look of?

A

Sarcomas

112
Q

What is a sarcoma?

A

A rare malignant tumor that is comprised of 80% soft tissue

113
Q

What is the clinical presentation of a sarcoma?

A
  • An enlarging, painless mass, most commonly to extremities or trunk.
  • Pain, edema, and paresthesias may present due to compression
114
Q

How are sarcomas managed?

A
  • Imaging of the primary lesion with MRI or CT
  • Core needle biopsy and surgical resection
  • Chest CT to rule out metastasis (or MRI for brain metastasis)
  • Multidisciplinary sarcoma team referral
115
Q

What is the incubation period for erythema infectiosum?

A

7-14 days

116
Q

What is the incubation period of Rubella?

A

12-23 days

117
Q

What is the incubation period of hand, foot and mouth?

A

3-5 days

118
Q

What is the incubation period of varicella?

A

10-21 days

119
Q

What is the incubation period of roseola infantum?

A

9-10 days

120
Q

What populations should an individual infected with Herpes Zoster avoid?

A
  • Pregnant women
  • Infants
  • Immunocompromised
128
Q

How does measles most commonly result in death in children?

A

Pneumonia

129
Q

What is the histology of molluscum contagiosum?

A

Eosinophilic cytoplasmic inclusion bodies

Clinical Med I (24 decks)

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