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Y4: Dermatology > Infective diseases > Flashcards

Infective diseases Flashcards

(122 cards)

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1
Q

primary infection with HSV usually occurs when? what symptoms will they present with?

A

in childhood - asymptomatic or gingivostomatitis

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2
Q

herpes simplex infection occurs when there is reactivation of the HSV from a __ __ __ or __ __ __

A

dorsal root ganglion

cranial nerve ganglion

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3
Q

T/F: after initial infection with the herpes simplex virus, HSV becomes dormant and lies in the dorsal root ganglia of the spinal nerves for life

A

true

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4
Q

characteristic lesion with HSV?

A

localised painful vesicular rash preceding by tingling (esp if recurrent)

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5
Q

HSV-1 is most commonly associated with ___ lesions, whereas HSV-2 is most commonly associated with ___ lesions

A

1- oral

2- genital

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6
Q

Presentation of herpes labialis?

A

(aka coldsore)

Prodromal burning/ itching > small crop of vesicles arise on lips/ perioral > burst to leave a crust

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7
Q

Presentation of herpes genitalis?

A

Prodromal burning/ itching > small crop of acutely painful vesicles arise on the genitalia (+ rarely anal)

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8
Q

Presentation of herpetic whitlow?

A

paronychia

most common in dentists and other healthcare workers

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9
Q

diagnosis of HSV?

A

clinical diagnosis

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10
Q

management of HSV infection?

A

topical aciclovir

oral if widespread/ systemic upset

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11
Q

complications of HSV infection?

A

eczema herpeticum (pt with atopic eczema - urgent IV therapy + hospitalisation)
erythema multiforme
herpes simplex encephalitis

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12
Q

what virus causes chicken pox

A

varicella zoster virus (90% of population infected before adolescence)

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13
Q

transmissions of varicella zoster virus?

A

via airborne droplets and/ or direct contact with the lesions of an infected person

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14
Q

Varicella zoster virus:

1) Once in contact with pt, the virus travels where to replicate?
2) after several days, virus spreads to the __ and __ and continues to multiply
3) 1-2 weeks later, migrates to skin and mucous membranes causing characteristic ____ rash
4) on exposure to virus, large number of ___ are released throughout the body
5) the virus becomes dormant in the __ __ __
6) it can then reactive in later life as ____

A

1) regional lymph nodes (primary viraema)
2) spleen and liver
3) vesicular (vesicles are filled with highly contagious viral fluid)
4) Abs (providing lifelong immunity - chicken pox for 2nd time v rare)
5) dorsal root ganglia of the spine
6) shingles (herpes zoster)

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15
Q

presentation of chicken pox?

A

1) prodrome (1-2 days before cutaneous features): pyrexia, HA, malaise, abdo pain
2) widespread vesicular rash: begins on trunk, quickly spreads to the rest of the body. Extreme pruritis, vesicles burst leaving a crust.

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16
Q

diagnosis of chicken pox?

A

clinical diagnosis

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17
Q

Rx of chicken pox?

A

self-limiting. Supportive treatment (paracetamol, NSAIDs, emollients)

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18
Q

aietology of shingles?

A

reactivation of varicella zoster virus from DRG or CNG

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19
Q

shingles

1) T/F: can arise in anyone
2) more common in elderly
3) more common in patients who are _____

A

1) as long as they’ve been preivously infected with varicella zoster
2) true (unsuual in children)
3) immunocompromised

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20
Q

differentiating shingles from chickenpox?

A

shingles: arises in a single dermatome (relating to the ganglion the virus has reactivated in)

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21
Q

3 stages of shingles?

A

1) pre-eruptive: prodromal pruritis or burning for 1-2 days
2) eruptive: maculopapular rash developing in a single dermatome. Clusters of small vesicles >burst and form crust. Severe neuritic pain and allodynia.
3) chronic: post-herpetic neuralgia. Can be recurrent/ last >1 month after the rash has cleared

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22
Q

diagnosis of shingles?

A

clinical diagnosis (vesicular rash confined to single dermatome)

if uncertain > viral swab for PCR

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23
Q

Rx shingles?

A

aciclovir (early oral therapy may reduce length of illness and risk of post-herpetic neuralgia)

symptomatic: rest, paracetamol, NSAIDs
prevention: shingles vaccine. If infection = avoid contact with pregnant women and immunocompromised

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24
Q

Complications of shingles?

A

Ramsay hunt syndrome

Herpes zoster opthalmicus

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25
what is ramsay hunt syndrome?
aka herpes zoster oticus virus reactivates in geniculate gangloin, causing it to migrate down CNVII and VIII Rash/ vesicles develop in the auditory canal and throat. Facial palsy, deafness, vertigo, tinnitus.
26
what is herpes zoster opthalmicus
virus reactivates in the ophthalmic division of the trigeminal nerve (CN V1). +ve Hutchinson sign: indicates involvement of the nasociliary branch + potential ocular complications - keratitis, uveitis, conjuncitivis, iritis, optic neuritis
27
what is impetigo
contagious bacterial infection common in childhood (2-5) can occur later in life if pts are immunocompromised
28
most commonly develops during what sort of weather?
hot and humid
29
most common pathogens in impetigo
most often s. aureus. Less commonly strep pyogenes or MRSA
30
2 types of impetigo?
impetigo (non-bullous) | bullous impetigo
31
how does impetigo form
small breaks in skin/ minor abrasions allow bacteria to enter skin from another infected individual
32
presentation of impetigo
most often the face (esp around mouth+ nose) erythematous macules > small crop of vesicles/ pustules > rupture releasing exudate > dries forming golden yellow/ brown crust (honey comb)
33
impetigo infection lasts how long?
2-3 weeks
34
diagnosis of impetigo?
clinical diagnosis | swab if uncertain
35
Rx of impegito?
wound care: regular cleaning, topical antiseptic or Abx Oral fluclox if infection extensive Measures to reduce spread (not sharing towels etc)
36
what is this describing: a pyogenic infection of the s/c fat and lower dermis
cellulitis
37
causative pathogen in cellulitis?
``` step pyogenes (2/3) staph aureus (1/3) ```
38
risk factors for cellulitis?
``` prev cellulitis venous stasis lymphodema obesity elderly IVDU alcoholism inflammatory dermatoses insect bites pregnancy immunosupression ```
39
how does cellulitis form?
bacteria penetrate the skin through disruptions to the normal barrier they make their way to the deep dermal and s/c layers where they proliferate
40
presentation of cellulitis?
often unilateral, affecting a limb localised, painful, erythematous and swollen systemic features (fever, rigors, malaise)
41
diagnosis of cellulitis
clinical diagnosis | confirm with: raised WCC, raised CRP, swab and culture causative organism
42
Rx of cellulitis?
analgesia (WHO ladder) | fluclox 1st line Abx
43
what is molluscum contagiosum
viral skin infection that presents as cluster of papules (mollucsa)
44
who gets molluscum contagiosum?
almost exclusively childhood infection (1-4)
45
what causes molluscum contagiosum?
infection with Poxvirus methods of transmission: direct skin-skin contact, indirect (fomite), autoinucolation (scratching, shaving), sexual transmission
46
presentation of molluscum contagiosum?
clusters of small, shiny, round, umbilcated papules most often on limbs usually flesh coloured (can be white, pink or pigmented)
47
diagnosis of molluscum contagiosum?
clinical (skin biopsy if unusual presentation - rare)
48
Rx of molluscum contagiosum?
no treatment to eradicte the virus self limiting mostly, not actively treatment (often lasts 12-18 months) To speed up disappearance of each papule: squeeze out the soft, white core of the papule, cryothereapy, gentle curettage, antiseptics, wart paints/ salicylic acid
49
what is pityriasis versicolor?
a common cutaneous yeast infection
50
pityriasis versicolor more common in what climate?
hot/ humid
51
what causes pityriasis versicolor?
infection with the fungus Malassezia (makes up part of normal cutaneous flora) > changes from its usual form to a pathological form that proliferates and causes infection
52
pityriasis versicolor presentation: 1) most commonly presents on the ___ initially 2) describe the lesions 3) are the lesions symptomatic?
1) trunk 2) multiple hypopigmented macules with a fine scale 4) may be slightly pruritic
53
diagnosis of pityriasis versicolor?
clinical | if uncertain: wood's lamp (yellow/ green fluorescence). Skin scraping for microscopy.
54
Rx of pityriasis versicolor?
topical anti-yeast e.g. clotrimazole or ketoconazole
55
what is this describing: Also known as slapped cheek/ fifths disease. A common infective paediatric condition.
erythema infectiosum
56
erythema infectiosum - most common in who? and when?
children | winter months
57
what causes erythema infectiosum?
infection with parovirus B19/ erythrovirus | - spread via respiratory droplets
58
presentation of erythema infectiosum?
non-specific prodrome (HA, malaise, fever) biphasic rash - erythema over cheeks, sparing nasal bridge and periorbital region. 1-4 days. - pink, lace-like rash trunk and limbs. 5-9 days. Can recur in the following months following trigger e.g. sunlight, stress etc
59
when are pts with erythema Infectiosum no longer infectious?
when erythematous rash over cheeks forms
60
complications of erythema Infectiosum?
small joint polyarthropathy spontaneous abortion (hydrops foetalis) aplastic crisis chronic anaemia
61
diagnosis of erythema Infectiosum?
clinical | if uncertain -Ab testing (paravirus B19 IgM)
62
rx of erythema infectiosum?
self-limiting | supportive Rx
63
hand, foot and mouth disease occurs following infection with what?
cocksackie virus A16, cocksackie virus A10, enterovirus 71 (usually more severe)
64
transmission of hand, foot and mouth disease?
often faecal-oral route
65
presentation of hand, foot and mouth disease?
non-specific prodrome: HA, malaise, fever painful oral lesions (vesicles and ulcers) vesicles on palms of hands, soles of feet and in between fingers (grey in colour, have tendency to ulcerate/ crust. Typically resolve in 10 days. May be painful
66
complications of hand, foot and mouth disease?
neuro involvement/ meningitis risk - usually when enterovirus 71 is the causative virus
67
Rx of hand, foot and mouth disease?
self-limiting | supportive treatment as required
68
what is Pitted Keratolysis?
a bacterial skin infection mainly affecting the feet
69
Pitted Keratolysis 1) more common in what weather? 2) high incidence in what occupations?
1) hot and humid | 2) farmers, athletes, industrial/ construction workers
70
causative organism in Pitted Keratolysis?
Corynebacterium infection.
71
Pitted Keratolysis risk factors?
- hot, humid weather (bacteria proliferative) - poorly breathable footwear - excessive perspiration - poor hygeine - immunosupression
72
Pitted Keratolysis pathophysiology 1) bacteria rapidly proliferative in optimum conditions 2) they produce protease enzymes that work to destroy the __ __ 3) ____ compounds released by the bacteria cause a potent malodour
2) stratum corneum (>characteristic pitted appearance) | 3) sulfur
73
Pitted Keratolysis almost always affects where?
plantar aspect of foot (+ rarely the hands)
74
how does Pitted Keratolysis present?
extremely unpleasant, malodorous feet multiple small pits covering the feet. Usually asymptomatic, may rarely cause pain or itching. May coalesce to form a large crater-like lesion
75
diagnosis of Pitted Keratolysi?
clinical | skin scraping to rule out fungal infection
76
Rx of Pitted Keratolysi?
encourage breathable, light footwear and foot hygeine topical fusidic acid oral Abx therapy if severe erythromycin)
77
lice are obligate ____ found living on the human body how are they spread?
ectoparasites spread via human contact
78
what are the names for 1) head louse 2) body louse 3) pubid louse
1) Pediculus capitis 2) Pediculus corporis (aka Vagabond's disease when chronic) 3) Phthirus pubis
79
presentation of lice
intense pruritis | often visible lice and eggs
80
diagnosis of lice?
clinical
81
Rx of lice?
malothion lotion of other insecitide hygeine to avoid spread/ reinfection
82
what is tinea?
a fungal infection with a dermatophyte | aka ringworm of the skin
83
subtypes of tinea?
``` Tinea capitis = Scalp. Tinea barbae = Beard. Tinea corporis = Body. Tinea manuum = Hands. Tinea unguium = Nails. Tinea cruris = Groin. Tinea pedis = Feet. ```
84
how is tinea spread?
can be human contact (most common) animal contact, soil contact
85
organism responsible for tinea?
trichophyton rubrum (>70%) and Trichophyton mentagraphytes (>20%) spread by human contact Microsporum canis spread through animal contact (cats and dogs)
86
presentation of tinea?
expanding lesions with central clearing and red scaly serpignous edge, thickened and crumbling nail
87
diagnosis of tinea?
clinical | skin scraping/ nail clippings for microscopy and culture
88
Rx of tinea?
small and localised infection: clotrimazole cream extensive/ stubborn infection: oral terbinafine or intraconazole affecting nails: oral terbinafine
89
what is the most common fungal infections affecting the skin?
candida skin infection | most common type of yeast infection
90
candida infection of the skin is most often with candida _____
albicans
91
risk factors for candida infection?
``` extremes of life warm, humid climate immunodeficient broad-spec Abx certain underlying skin conditions Fe deficiency COCP use/ pregnancy ```
92
Candida makes up part of the normal flora of the human ___ ___ and ____.
digestive tract | vagina
93
T/F: candida is a commensal of the skin
not typically, but can colonise areas temporarily
94
Candida skin infection presentation?
typically affects the folds of the skin (groin, under breasts, abdo skin folds etc - candida intertrigo) Skin in red, can look shiny in skin folds and there are often spotty 'satellites' around the edges Also commonly affects the oral cavity (white plaques on buccal mucosa/ tongue)
95
diagnosis?
clinical | if uncertain skin swabs and scrapings for microscopy and culture
96
Rx of candida skin infection?
clotrimazole cream | oral fluconazole
97
what causes scabies
infection with a parasitic mite Sarcoptes scabiei, variety hominis
98
transmission of scabies?
skin-skin contact between individuals
99
scabies: Mite burrows through the epidermis and lies in the ___ ____ Here, it lays 2-4 eggs each day. The symptoms experienced by infected individuals are due to what?
stratum corneum | the host immune response
100
presentation of scabies?
extreme pruritus (worse at night, often distrurbing sleep) affects whole body, almost always scalp-sparing burrows: irregular tracks, usually grey. Most often in webspaces. Also around waist, axillae and groin. Erythematous papules, vesicles and excoriations
101
diagnosis of scabies?
clinical | microscopic examination of scabies burrow
102
Rx of scabies?
``` permethrin cream (malothion as alternative) antihistamines, crotamiton cream and hydrocortisone cream to reduce pruritis avoid contact with others ```
103
what is necrotising fasciitis?
acutely life-threatning infection of one of more of the deep soft tissue compartments (dermis, adipose tissue, fascia, muscle)
104
T/F: necrotising fasciitis has a high mortality rate
true | risk of serious complications
105
type 1 vs type 2 nec fascitis?
1) polymicrobial infection. Both anaerobic and aerobic bacteria. Most common in patients who are immunocomprimised/ chronically ill 2) infection with strep pyogenes (GAS)
106
how does nec fas form?
Bacteria enter skin through sites of trauma (small puncture wounds, surgical incisions...etc). Often the primary site is not identified. The infection spreads along the fascial plane to infect the deep soft tissues.
107
presentation of necrotising Fasciitis?
severe pain out of proportion to what is seen erythema with well-defined edge oedema skin surface may appear relatively normal (while underlying tissue is extremely necrotic) systemic upset
108
what signs/ symptoms would suggest necrotising Fasciitis with streptococcal infection?
ulceration, haemorrhagic bullae, lymphangitis
109
what signs/ symptoms would suggest necrotising Fasciitis with anaerobe infection?
foul smelling wound
110
diagnosis of necrotising Fasciitis?
'dishwater fluid' on wound washout bloods: FBC, CRP, U&E, CK, lactate blood and wound cultures surgical exploration ASAP
111
treatment of necrotising Fasciitis?
urgent surgical debridement broad spec abx admission to ICU
112
what is Orf
a viral skin infection transferring to humans from sheep and goats relatively common in sheep/ goat farmers
113
Orf causative pathogen?
parapox virus: contracted through direct contact with infected sheep/ goats
114
Orf presentation?
development of a single lesion at the site of inoculation - mutiple lesions rare - most often on hands/ forearm - lesion arises as small, firm papule which is initially very tender and irritating - the lesion enlarges to become a flat-topped pustule/ blister with a white centre and red periphery
115
Orf diagnosis?
clinical
116
Orf treatment?
self-limiting (6 weeks)
117
What is lyme disease
rare bacterial infection contracted from ticks
118
lyme disease is most common in what region?
temperate - scottish highlands most common in UK | peak incidence in summer
119
what causes lyme disease?
infection with bacteria, Borrelia (spirochete bacterium) | Ixodes ticks act as a vector for the bacteria
120
presentation of lyme disease?
erythema migrans - 1-2 weeks post bite - 'bulls eye' - usually painful - possible associated malaise, myalgia, pyrexia - resolves within 3-4 weeks disseminated disease, days-weeks post bite - arthritis, cardiac complications, nerve palsies, rheum complications chronic lyme disease - chronic arthritis/ pain
121
diagnosis?
high clinical suspicion required | blood sample for ELISA testing
122
Rx of lyme disease?
oral antibiotic therapy (amox/ doxy) | cure rate decreases as treatment delayed

Y4: Dermatology (3 decks)

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