Infective Soft Tissue Lesions I - Viral Flashcards
A 40 y.o man came into the clinic to get his upper molar teeth removed as it is deeply carious. Prior to the procedure, the dentist administered one carpule of Mepivacaine to achieve local anesthesia in the region of extraction. The extraction was uneventful, and post-extraction instructions were advised to the patient, including the prescription of Ponstan as an analgesic. 2 days after the extraction, the patient experienced sensations of mild pain and itching at the site of extraction. Otherwise, the patient feels fine, with no signs of high fever, sore throat, or coughing. He thought that it was just a form of post-extraction complication and thus decided to ignore the sensations. The next day, however, he noticed that some red spots had appeared at the site of extraction.
What is the phenomenon that the patient is currently experiencing, and why did it occur?
A) The patient has localised anaphylaxis reaction (atopy) as he might be allergic to the painkiller prescribed to him. The dentist failed to take comprehensive medical history prior to the extraction procedure.
B) The patient has localised soft tissue burns as he was not compliant with the post-surgical instructions given by the dentist. It is likely that the patient takes hot soup when he is still under local anesthesia.
C) The patient has recurrent herpes simplex infection, which is triggered by the administration of local anesthetics at the site of extraction.
D) The red spots are early manifestations of herpangina. He might have contacted the virus after he has the molar extraction done.
C
A 30 year-old male patient enters the clinic and upon clinical examination, you notice multiple small round grayish-white ulcerative lesions in the oral cavity. What is the likely diagnosis and how will you advise the patient to manage it?
A) Hand-Foot-Mouth Disease. Advise patient to maintain adequate hydration with fluids.
B) Hand-Foot-Mouth Disease. Advise patient to monitor for any systemic complications.
C) Herpangina. Advise patient to take analgesics if presenting with headache.
D) Herpangina. Advise patient that a biopsy is highly recommended before surgical removal of the lesions.
C
A patient presents with multiple small ulcers at the oropharynx. Which virus is the most likely causative agent?
A) Coxsackie virus
B) Cytomegalovirus
C) HPV-16
D) Varicella zoster virus
A
What is the treatment for recurrent VZV infection?
A) Antibiotics
B) Antivirals
C) Purified VZV immunoglobulin
D) Supportive and symptomatic relief
D
Which of the following best describes the likely diagnosis for the lesion shown below?
(Picture shows reddish lesions on palate, only on one side of midline)
A) This is likely a primary infection and complications include post-herpetic neuralgia.
B) This is likely a primary infection and histopathological features include acantholysis with formation of Tzanck cells.
C) This is likely a secondary infection due to reactivation of latent virus. Clinical presentations of lesions are only limited to the intra-oral region on both keratinised and non-keratinised oral mucosa.
D) This is likely a secondary infection due to reactivation of latent virus. Supportive and symptomatic relief is the most common form of management done.
D, VZV reactivation causing herpes zoster infection
(Refer to document for image of Kaposi sarcoma)
A 45-year old female came to your clinic and said that she has been having diffuse pain on right maxilla and mandible since 4 days ago. She said it started with a tingling sensation. Now there are painful ulcers on the gums, roof of the mouth, upper lip, and tip of her nose. She reported that she has had a history of chicken pox when she was a toddler. What is the best next course of action to manage her case?
A) Advise her to apply sunblock on the extraoral lesions
B) No action required as the condition will resolve on its own
C) Prescribe antiviral medications like acyclovir, valacyclovir and famciclovir
D) Refer her to an ophthalmologist
D
A 21 year old presents with multiple small raised vesicles with redness and tingling on the vermillion border of her upper lip. Patient reports previous history of such lesions when she is under high stress from school. What is your diagnosis?
A) Hand-Foot-Mouth Disease
B) Herpangina
C) Secondary Herpes Labialis
D) Varicella
C
Which virus is the most common cause of oral viral infections?
A) Cytomegalovirus
B) Epstein Barr virus
C) Herpes simplex virus
D) Kaposi’s sarcoma herpesvirus
C
Which is a feature unique to secondary human herpes simplex virus infections in healthy patients?
A) Bilateral presence of small vesicles
B) Diffuse erythematous, mildly enlarged gingiva
C) Multiple enlarged, tender lymph nodes palpated in cervical and submandibular regions
D) Sudden onset of oral lesions on attached mucosa
D
A 58 year old man presents with persistent burning pain, together with oral lesions extending to the midline. His eyes have also been affected. How would you diagnose the patient?
A) Herpes Zoster
B) Varicella
C) Hand foot mouth disease
D) Oral HSV infection
A
Which of the following viral infections primarily manifests with oral lesions and is associated with an increased risk of oral cancer?
A) Epstein-Barr virus (EBV)
B) Herpes zoster
C) Human papillomavirus (HPV)
D) Varicella-zoster virus (VZV)
C
Which of the following statements is most likely to be true regarding primary orofacial HSV infections?
A) Majority of primary infections are found in teenagers
B) Oral lesions are only found on attached oral mucosa
C) Tzanck cells can be observed histopathologically
D) Usually diagnosed via PCR tests
C
Which of the following is the most common clinical test for diagnosis of orofacial HSV?
A) Biopsy
B) Serology
C) Polymerase Chain Reaction (PCR) of viral DNA
D) Direct fluorescent assay for HSV antigen
B
Systemic signs of VZV include the following EXCEPT…
A) Fever
B) Malaise
C) Pharyngitis
D) Cold sores
D
What is false of primary orofacial Herpes Simplex Virus?
A) Lesions are found only on attached oral mucosa
B) Oral lesions usually resolve after 10 days
C) Results in significant pain
D) Results in sudden onset of ulcers
A
An 8 year old child presents with multiple small ulcers in the oral cavity. She reports that along with the ulcers, she has been having a sore throat and swallowing difficulties. Upon examination, you note that the ulcers are confined to the oropharyngeal region and you do not notice any skin lesions on her fingers or toes. What would be the most appropriate differential diagnosis for this case?
A) Verruca vulgaris
B) Hand, foot and mouth disease
C) Herpetic stomatitis
D) Herpangina
D
Which of the following statements about the Varicella Zoster virus is true?
A) Acyclovir should be prescribed in all individuals with a primary infection
B) The virus remains latent in the motor nerve ganglion
C) The VZV vaccine contains live attenuated virus.
D) There is acanthosis with Tzanck cells formation
C
Your 6 year old patient comes in with prodromal flu-like symptoms and multiple small ulcers, especially at the anterior oral cavity. The patient’s mother informs you that she also has these lesions around her fingers, toes and heel margins. What would be the most appropriate differential diagnosis for this case?
A) Cytomegalovirus
B) Hand Foot Mouth Disease
C) Herpangina
D) Herpes Simplex Virus
B
A 8 year old male comes for a checkup, and complains of painful ulcers. You examine him intraorally and note the presence of ulcers on his labial and buccal mucosa, gingiva, and hard and soft palates. His gums are also diffusely erythematous. What is most likely your next step of management?
A) Biopsy to confirm your diagnosis
B) Prescribe amoxicillin
C) Prescribe analgesics for his pain relief
D) Scaling and polishing
C
A 20 year old female complains of a tingling sensation on the vermillion border of her lips. She reported having no relevant medical history and that she frequently feels the tingling sensation in times of stress or after UV exposure. What is the possible diagnosis?
A) Epstein Barr Virus
B) Herpes Zoster
C) Kaposi Sarcoma
D) Secondary Herpes Labialis
D
A 6 year old girl presents with multiple small (2-3mm) ulcers in the posterior oral cavity like those shown in the image below.
(Image shows multiple small, grayish-white lesions on posterior palate and oropharyngeal region)
She has been having fever and headaches the past day. Which of the following viruses is most likely to have caused this?
A) Coxsackie Virus
B) Epstein Barr Virus
C) Herpes Simplex Virus
D) Human Papilloma Virus
A
Which is not part of the classic triad of Congenital Rubella Syndrome (CRS)?
A) Deafness
B) Kidney failure
C) Deafness
D) Cataract
B
Under which of the following scenarios should we be most concerned of possible blindness if the nose is involved in a viral lesion?
A) Coxsackie
B) Herpes Zoster (Shingles)
C) HIV
D) Varicella
B
