INF2 - A. OTC ANTIVIRALS-COVERED

Question 1

what virus causes chickenpox in babies, children, young adults (primary)

Answer 1

varicella zoster

Question 2

what virus causes shingles in adults (secondary)

Answer 2

herpes zoster

Question 3

symptoms of chickenpox

Answer 3

• flu-like symptoms
• fever
• itchy rash of red itchy spots that turn into fluid-filled blisters which crust over to form scabs which drop off
• can appear anywhere on body
• immune system produces a more severe reaction in adults

Question 4

how can chickenpox be life-threatening

Answer 4

causes secondary pneumonia in immunocompromised

Question 5

what happens after primary infection

Answer 5

• virus dormant in nerves in everyone
• VSV can reactivate in nerves when stressed, immunocompromised = shingles

Question 6

treatment of chickenpox

Answer 6

• intentional infection of children = pox party so children become immune (1-5 years old)
• neonates (1st month) = parenteral antiviral
• 1month - 12 years = paracetamol, calamine lotion on spots, stop scratching
• NOT ibuprofen (NSAIDS) as they can make symptoms worse
• adolescents/adults = antiviral Aciclovir within 24 hours (500mg 5x a day for 5/7 days)

Question 7

how long are you infectious for with chickenpox

Answer 7

• from 3-4 days before blisters appear to after scabs form

Question 8

what is the vaccine for chickenpox (can be given on PGD)

Answer 8

varivax: injection either IM or deep SC
varilrix: deep SC injection in deltoid region or anterolateral thigh
- private vaccine in UK for most
- boots do for £200

Question 9

what are some differential diagnosis’ for chickenpox

Answer 9

• molluscum contagious: location similar to chickenpox but blisters aren’t fluid-filled
• impetigo: crusty bacterial infection around mouth/nose
• scarlet fever: red flat rash
• hand, foot, mouth

Question 10

who should be given pre-exposure vaccination

Answer 10

• sero-negative HC worker at risk
• lab staff
• contacts of immunocompromised patients

Question 11

who should be given post-exposure vaccination

Answer 11

• unvaccinated HC workers

Question 12

what is shingles

Answer 12

• infection of a nerve and the area of skin around it
• occurs at end of nerves ie - trigeminal nerve
• specific line of rash along nerve
• no fluid-filled blisters just red rash
• caused by dormant VZV in nervous tissue
• shingles can re-occur
• can catch chickenpox from someone with shingles

Question 13

what can cause reactivation

Answer 13

• old age: risk and severity increases with age
• immunosuppressant therapy
• HIV infection
• stress
• if had colds and flu

Question 14

symptoms of shingles

Answer 14

• last 2-4 weeks, prodrome then pain followed by rash
• localised pain, tender skin, lasts after rash gone

Question 15

what is post-herpetic neuralgia

Answer 15

1 in 5 have
- constant or intermittent burning
- aching, throbbing, stabbing, shooting pain
- Amitriptyline if not pregnant

Question 16

what is ophthalmic shingles

Answer 16

• virus reactivated in trigeminal nerve (ophthalmic nerve is first division of trigeminal nerve)

Question 17

what is Ramsay-hunt syndrome

Answer 17

• occurs when shingles affects facial nerve near one of the ears

Question 18

management of herpes zoster

Answer 18

• self care: rash clean, dry, loose clothing, cool compress, don’t share towels, cover painful red with cling film
• antivirals: Aciclovir 800mg 5x day for 7-10 days
• analgesia: paracetamol, NSAIDs, opioids, tricyclic antidepressants, gabapentin, pregabalin - anticonvulsants/antiepileptics (prevent nerve pain)

Question 19

who is the shingles vaccine for

Answer 19

• 65-79 year olds
• > 50 year old with compromised immune system
• can be given on PGD

Question 20

which vaccine is now recommended

Answer 20

• shingrix: recombinant vaccine

Question 21

what HSV causes coldsores

Answer 21

HSV-1: small blisters
highly contagious

Question 22

symptoms of cold-sores

Answer 22

• tingling, itching or burning sensation around mouth
• small fluid-filled sores then appear
• remains dormant unless triggered
• clears on own in 7-10 days

Question 23

treatment for coldsores

Answer 23

• antiviral cream - Zovirax 2g for 5-7 days (P) reduces symptoms and length of symptoms
• severe, oral Aciclovir prescribed by GP
• apply as soon as tingling begins

Question 24

rare complications of coldsores

Answer 24

• dehydration, Whitlows, keratoconjunctivitis, skin infections, encephalitis

Question 25

where can warts occur

Answer 25

- anywhere on body: raised bumpy work - dark centre - like watery areas as skin softens and virus penetrates in

Question 26

where can verrucae occur

Answer 26

- only on sole of foot: inverted (not raised) due to pressure - dark centre - like watery areas as skin softens and virus penetrates in

Question 27

what causes warts and verrucae

Answer 27

HPV

Question 28

symptoms of warts and verrucas

Answer 28

- itching, pain, discomfort

Question 29

treatment for warts and verrucae

Answer 29

- gels/paints (most contain salicylic acid 5/10%) eg - Bazuka - plasters (salicylic acid, up to 40%) eg - Wartie - freeze spray (Wartner cryo) - cryotherapy - see GP - treatment can take months - caution: diabetics as side effect of diabetes is peripheral neuropathy so need to make sure its not an ulcer caused by neuropathy - flip-flops - avoid sharing towels, shoes etc

Question 30

what type of infection is headlice, scabies, threadworms

Answer 30

parasitic

Question 31

diagnosis of headlice

Answer 31

combing hair with fine-toothed comb to find live lice of their eggs - nits (white dots)

Question 32

treatment of headlice

Answer 32

lotions and sprays - dimeticone 4% eg - hedrin - malathion 0.5% eg - derbac M apply to whole scalp and leave for 8 hours and repeat in few weeks as eggs may still hatch *children >6 months (if < GP for prescription) and avoid formulations with alcohol if asthmatic

Question 33

what is the wet combing method

Answer 33

- wash hair with ordinary shampoo - apply lots of conditioner - comb whole head of hair from roots to ends - takes 10-30 minutes - do on days 1,5,9,13 to catch any newly hatched head lice - check again on day 17

Question 34

what mite causes scabies

Answer 34

sarcoptes scabiei

Question 35

how do scabies lay their eggs

Answer 35

feed using mouths and front legs to burrow into outer layer of skin and lay eggs so very itchy after 3-4 days, baby mites (larvae) hatch and move to surface of skin where they mature into adults

Question 36

where do scabies like

Answer 36

warm places - skin folds (in between fingers), bedsheets

Question 37

treatment of scabies

Answer 37

permethrin 5% cream malathion 0.5% lotion need to use on whole body - apply and leave to dry for 24 hours repeat 1 week layer to kill eggs that have hatched

Question 38

what causes pinworms/threadworms

Answer 38

enterobius vermicularis

Question 39

symptoms of threadworms

Answer 39

- intense anal itching as eggs are here - long term infestation

Question 40

treatment of threadworms

Answer 40

- scrupulous hygiene, hand washing, short nails, not sharing towels - mebendazole 100mg chewable tablet/suspension single dose - whole family needs treatment (>2 years = P, 6 months - 2 years = POM)