IV. Viral Infections

Question 1

A condition characterized by high grade fever, conjunctivitis, colds, and rash appearing at the height of the fever with branny desquamation. Fever abates as rashes appears on the hands and feet

Answer 1

Measles (Incubation: 10-12d, POC: 4 days before and 4 days after the onset of rash), Tx: Vitamin A 100,000 IU single dose

Question 2

Grayish white dots with red border opposite the lower molars appearing before the prodrome in Measles

Answer 2

Koplik spots

Question 3

Chronic complication of measles with a delayed onset due to persistent infection with an altered virus that is harbored intracellularly in the CNS

Answer 3

Subacute sclerosing panencephalitis (SSPE)

Question 4

Stages in SSPE: irritable, temper outbursts, reduced attention span

Answer 4

Stage 1

Question 5

Stages in SSPE: myoclonus due to inflammation in the basal ganglia but consciousness is maintained

Answer 5

Stage 2

Question 6

Stages in SSPE: involuntary movements disappear and replace by choreoathetosis, immobility, dystonia, lead pipe rigidity with deterioration in sensorium

Answer 6

Stage 3

Question 7

Stages in SSPE: loss of critical centers for breathing, HR and BP, death

Answer 7

Stage 4

Question 8

From the RNA family Togaviridae transmitted via oral droplet or transplacentally to the fetus characterized by retroauricular, posterior, cervical, and postoccipital lymphadenopathy. Rashes begins on the face and spreads cephalocaudally

Answer 8

German measles/Rubella/ 3 day measles (Incubation: 14-21d, POC: 7 days before and 7 days after the onset of rash)

Question 9

Discrete rose spots on the soft palate seen in Rubella

Answer 9

Forscheimer spots

Question 10

A syndrome of IUGR, cataracts, microcephaly, PDA, blueberry skin muffin lesions, congenital profound SNHL, motor and mental retardation

Answer 10

Congenital Rubella

Question 11

From the RNA family paramyxoviridae transmitted via direct contact, airborne droplets, fomites contaminated by saliva, characterized by painful enlargement of the parotid glands.

Answer 11

Mumps (Incub: 16-18 days, POC: 1-2 days before the onset of parotid swelling until 5 days after the onset of swelling)

Question 12

Caused by Human Herpes virus type 6 (can suppress all cellular lineages) characterized by fever for 3-5d with fussiness, rash appearing with 12-24 hours, ulcers in the uvulopalatoglossal junction (Nagayama spots) in Asians

Answer 12

Roseola

Question 13

Caused by neurotropic human herpes virus via direct contact or airborne spread characterized by fever, malaise anorexia, headache 1-2d before the rash, rash starting on the trunk spreading to other parts appearing on all stages

Answer 13

Varicella (Incub: 10-21d POC: 1-2d before the onset of rash until 3-7d after the onset of rash and all the lesions have crusted)

Question 14

Congenital Varicella: AOG when infection causes maximal interruption with limb development, short and malformed limbs covered cicatrix (skin lesion with zigzag scarring associated with atrophy of the affected limb)

Answer 14

6-12 weeks AOG

Question 15

Congenital Varicella: AOG when infection causes eye and brain involvement

Answer 15

16-20 weeks AOG

Question 16

Condition characterized by ulcerative intraoral lesions in the tongue, buccal mucosa, tender vesicular lesions in the hands and feet

Answer 16

Hand, Foot, and Mouth Disease (Incub: 4-6d)

Question 17

Organism responsible for Hand, Foot, and Mouth Disease

Answer 17

Coxsackie virus A16

Question 18

Small vesicles and ulcers with a red ring mainly on the anterior tonsillar pillars, may be seen on the soft palate, uvula, and pharyngeal wall

Answer 18

Herpangina/ Coxsackie virus A

Question 19

Also called the 5th disease characterized by slapped cheek appearance, rash with central clearing of macular erythema and lacy reticulated appearance esp on the extensors, palms and soles are spared, rash resolves without desquamation

Answer 19

Erythema Infectiosum (Incub: 16-17 days) caused by Parvovirus B19

Question 20

Presents as shallow indurated ulcers which may be covered by a yellow-gray membrane, thin walled skin vesicles on a red base usually at the mucocutaneous junction and gumline, pain in the mouth, drooling, refusal to eat or drink, fever affecting children 6 months-5 years old

Answer 20

Herpetic Gingivostomatitis/HSV Type 1 (Incub: 2-21 days)

Question 21

Presents with anosmia, memory loss, peculiar behavior, expressive aphasia, hallucinations and focal seizures.

Answer 21

HSV encephalitis

Question 22

Transmitted via oral secretions or sexual intercourse characterized by fatigue, pharyngitiswith marked tonsillar enlargement with petechiae at the junction of the hard and soft palate, generalized lymphadenopathy, splenomegaly, hepatomegaly

Answer 22

Infectious Mononucleosis/EBV

Question 23

Antibodies used to confirm infectious mononucleosis

Answer 23

Heterophil antibody (Paul-Bunnell antibodies) or specific EBV antibodies

Question 24

Associated with IM characterized by symmetrical rash on the cheeks, multiple erythematous papules which may coalesce into plaques that look like atopic dermatitis involving the extremities and buttocks

Answer 24

Gianotti-Crosti Syndrome

Question 25

Most common congenital infection which causes hepatosplenomegaly, jaundice, petechiae, purpura, microcephaly, hearing loss or learning disability, IUGR, jaundice, purpura, intracerebral calcifications, and chorioretinitis

Answer 25

Cytomegalovirus

Question 26

Strkingly enlarged epithelial or mesenchymal cells with large intranuclear inclusions

Answer 26

CMV

Question 27

Prophylaxis and treatment for influenza virus type A outbreaks

Answer 27

Amantadine and Rimantadine (Oseltamivir taken within 48 hours may decrease severity and duration)

Question 28

A generalized maculopapular rash appearing 1-2 days after defervescence sparing the palms and soles, disappearing in 1-5 days with desquamation

Answer 28

Hermann’s rash

Question 29

Diagnostic test which may be used in dengue illness in Day 1-4 of illness

Answer 29

NS-1 antigen test

Question 30

Dengue: detected in 80% of patients by day 5 and 99% by day 10, peaks 2 weeks after onset of symptoms and decline in 2-3 months

Answer 30

IgM (Dengue blot test)

Question 31

Neurologic phase in rabies infection characterized by excessive restlessness, uncontrollable excitement, agitation, confusion, hallucination, combativeness, focal paralysis, hydrophobia, aerophobia

Answer 31

Furious type

Question 32

Neurologic phase in rabies infection characterized by ascending symmetric paralysis with flaccidity, and decreased DTRs, respiratory paralysis and coma

Answer 32

Paralytic phase

Question 33

Category of bites: licking, nibbling of intact skin

Answer 33

Category I

Question 34

Category of bites: superficial abrasions without bleeding

Answer 34

Category II

Question 35

Category of bites: lacerations, transdermal bites, puncture wounds with bleeding, all wounds in the head and neck with or without bleeding

Answer 35

Category III

Question 36

Pediatric HIV classification, at least 2 of the ff: lymphadenopathy, patoritis, hepatosplenomegaly, dermatitis, persistent or recurrent sinusitis or otitis media

Answer 36

Category A (Mild symptoms)

Question 37

Pediatric HIV classification, any of the ff: oropharyngeal thrush persisting greater than 2 months, recurrent or chronic diarrhea, persistent fever for more than 1 month, hepatitis, recurrent herpetic gingivostomatitis, pneumonits, disseminated varicella, with visceral involvement, cardiomegaly

Answer 37

Category B (Moderate symptoms)

Question 38

Pediatric HIV classification, 2 serious bacterial infections: sepsis, meningitis, pneumonia in a 2 yr period, lower RT candidiasis, cryptococcosis, encephalopathy, malignancies, disseminated mycobacterial infection, pneumocystis carinii pneumonia, severe weight loss

Answer 38

Category C (severe symptoms)