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Dermatology > Viral Exanthems > Flashcards

Viral Exanthems Flashcards

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Dermatology Board Prep flashcards
1
Q

What is an exanthem?

A
  • rash that shows up abruptly
  • affects several areas of the skin simultaneously
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2
Q

What is an enanthema?

A

eruption on a mucous membrane

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3
Q

What are viral exanthemas commonly described as?

A

morbilliform

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4
Q

What is a mobilliform?

A

composed of erythematous macules and papules = looks like a measles rash

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5
Q

How can you differentiate viral exanthems from drug eruption rashes?

A

history taking

viral exanthem = common in kids (they have a rash s/p viral infection)

drug eruptions = common in adults

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6
Q

What is roseola infantum?

A

acute febrile illness with later onset of roseola rash

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7
Q

What is the timeline of fever in roseola infantum? What happens after this timeline?

A

3-7 days; rash appears afterwards

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8
Q

What is the prodrome of roseola infantum?

A
  • high fever (over 101)
  • palpebral edema
  • cervical lymphadenopathy
  • mild URI sxs
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9
Q

What is the clinical presentation of the exanthem in Roseola Infantum?

A

pink macules and papules surrounded by white halos

starts on trunk → neck + prox. extremities

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10
Q

How long does the rash in roseola infantum last for?

A

1-3 days

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11
Q

What is “exanthema subitum”?

A

“sudden rash” = exanthem rash appears suddenly as the fever subsides

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12
Q

What is Roseola Infantum also called?

A

Sixth disease

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13
Q

What is the etiology of Roseola Infantum?

A

HHV-6 (herpes virus)

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14
Q

What is the key symptoms of roseola infantum?

A

exanthema subitum

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15
Q

What is the epidemology of roseola infantum? (population it affects)

A

children 6mo-4yr

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16
Q

What is the most common exanthem to occur in children before the age of 2?

A

roseola infantum

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17
Q

How can someone become immune to roseola infantum?

A

no vaccine, infection = immunity

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18
Q

What are 2 complications that reactivation of HHV-6 has?

A

in immunocompromised → morbidity

reactivation w/ drug exposure → DIHS (drug induced hypersensitivity)

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19
Q

What are 3 things that HHV-6 infection in children results in?

A
  • subclinical infection
  • acute febrile illness w/o rash; risk of febrile seizure
  • exanthema subitum
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20
Q

What is the prognosis of roseola infantum?

A

benign; self-limited

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21
Q

What is the treatment for roseola infantum?

A

supportive = treat fever w/ antipyretics (NSAIDs)

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22
Q

What is Erythema Infectiosum also called? What is the etiology of this disease?

A

Fifth disease; Parvovirus B19

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23
Q

What is the mode of transmission for Erythema Infectiosum?

A
  • respiratory tract secretions
  • inoculation with blood products
  • vertical transmission = mom to fetus
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24
Q

What is the incubation period for Erythema Infectiosum prior to onset of rash?

A

1-2 wks

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25
Q

When are individuals sick with erythema infectiosum most infectious?

A

before onset of rash = (when they have the rash = less infectious)

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26
Q

What is the epidemiology for erythema infectiosum?

A
  • kids 4-10 y/o (can affect all ages)
  • happens w/ epidemics (ie: flu); school outbreaks in late winter-early spring
  • common secondary spread in household (kids are petri dishes)
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27
Q

What is the pattern with antibodies in erythema infectiosum?

A

increasing prevalence of antibodies with age = the older you are, the more antibodies are built against Fifth Disease

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28
Q

What are the symptoms of Erythema Infectiosum?

A
  • erythematous “slapped cheek” rash → reticular erythema on body
  • low-grade fever
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29
Q

How do you diagnose Erythema Infectiosum?

A

detection of serum Parvo-B19 specific IgM Ab is preferred = indicates infection occurred w/in last 2-4 mos.

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30
Q

What is Papular Purpuric Gloves and Socks Syndrome?

A

rare Parvo-B19 related disease

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31
Q

What are the symptoms of Papular Purpuric Gloves and Socks Syndrome?

A
  • painful, pruritic papules
  • petechiae
  • purpura on hands and feet
  • fever
  • enanthem
32
Q

How is Papular Purpuric Gloves and Socks Syndrome different from Erythema Infectiosum?

A

Gloves and Socks syndrome = viremic and contagious

33
Q

What is a general note about Parvo-B19 infections symptomatically?

A

most infections are asymptomatic and unrecognized

34
Q

What is the treatment for Parvo-B19 infections?

A

supportive care = treat the symptoms

35
Q

What is the prognosis for Parvo-B19 infections?

A

resolves after 5-10 days; can recur

36
Q

What are the triggers that can reactivate Parvo-B19?

A

sun; hot temp; exercise; bathing; stress

37
Q

What are the complications with Parvo-B19 infections?

A

immunodeficiency → chronic erythroid hypoplasia w/ severe anemia

chronic hemolytic anemias (ie: Sickle Cell patients) → transient aplastic crisis

38
Q

What is a special consideration in pregnancy when it comes to pregnant mothers infected with Parvo-B19?

A
  • hydrops fetalis (accumulation of fluid in 2 fetal compartments)
  • intrauterine growth retardation
  • pleural and pericardial effusion
  • death 2%-6.5% (lowish)
39
Q

What is the prodrome for Hand-Foot-and-Mouth disease?

A

1-2 days = fever, sore throat, malaise

40
Q

What are the symptoms after a prodrome in Hand-Foot-and-Mouth disease?

A
  • enanthem & exanthems
  • rash starts at mouth → hands and feet (sometimes w/ buttocks and elbow involvement)
41
Q

What is the characteristic of the exanthem in Hand-Foot-and-Mouth disease?

A

bright pink macules and papules → painful vesicles w/ erythematous halos; erosions w/ surrounding erythema

42
Q

What is characteristic of the enanthem in Hand-Foot-and-Mouth disease?

A

resembles aphthae (canker sores)

43
Q

What is the etiology of Hand-Foot-and-Mouth disease?

A

Coxsackievirus

44
Q

What is the epidemiology of Hand-Foot-and-Mouth disease?

A

commonly children
- during late summer, early fall

45
Q

What is the incubation period of Coxsackievirus with Hand-Foot-and-Mouth disease?

A

4-6 days

46
Q

What is the prognosis of Hand-Foot-and-Mouth disease?

A

benign, self-limited, resolves w/in 10 days

very contagious

47
Q

What is the treatment for Hand-Foot-and-Mouth disease?

A

supportive = treat sxs (ie: fever)

48
Q

What will be the majority of the exanthems that we will encounter?

A

nonspecific viral exanthems = nonspecific and difficult to categorize = this is their category lol

49
Q

What is the prodrome for Nonspecific Viral Exanthems?

A
  • no indicative symptom complex
  • Nonspecific associated sxs:
    fever; headache; fatigue; myalgias; respiratory or GI complaints
50
Q

What is noteable about the exanthems in Nonspecific Viral Exanthems?

A

no unique lesion morphology or distribution

51
Q

What is the prognosis for Nonspecific Viral Exanthems?

A

resolve over 1wk w/o treatment

52
Q

What is the etiology for Nonspecific Viral Exanthems?

A
  • nonPolio enteroviruses = common in summer
  • Respiratory viruses (ie: adeno, rhino, etc) = common in winter
53
Q

What must you do when you diagnose Measles or Rubella via serology?

A

cases must be reported to local or state health departments

54
Q

Which Classical Viral Exanthems are uncommon in the USA and why?

A

Measles and Rubella because of routine vaccinations

55
Q

What are the symptoms for Measles?

A

Prodrome:
- 4D’s + 3C’s = 4 days Cough, Coryza (head cold), Conjunctivitis
- fever
- malaise

Other sxs:
- exanthema and enanthema

56
Q

What is the characteristic of the exanthema of Measles?

A
  • erythematous macules and papules
  • starts at face
  • head to toe distribution
57
Q

What is the characteristic of the enanthema of Measles?

A

Koplik spots = blue/white dots on mucosa

58
Q

What is the recovery period for Measles?

A

starts 2 days after rash onset; 6-7 days for full recovery

59
Q

What is another name for Measles?

A

Rubeola

60
Q

What is the mode of transmission for Measles?

A

respiratory droplets

61
Q

What is the incubation period for Measles?

A

8-12 days from exposure to onset of symptoms

62
Q

When are patients infected with Measles contagious?

A

1-2 days before onset of sxs (3-5 days before onset of rash)

*Immunocomp pts. contagious throughout

63
Q

Epidemiology for Measles?

A
  • unvaccinated
  • foreign-born
  • immunocomp
  • pediatrics (common)
64
Q

How is Measles diagnosed?

A

clinically; confirm w/ serology

65
Q

What are the 2 testing options for Measles?

A

Serology anti-measles IgM and IgG; isolation of virus or identification of measles RNA

Histological eval skin lesions or respiratory secretions = syncytial keratinocytic giant cells

66
Q

What is the prognosis of Measles?

A

self-limiting; 10-12 days

67
Q

What is the treatment of Measles?

A

supportive = treat the symptoms

68
Q

What risk factors can worsen the prognosis of Measles?

A
  • malnutrition
  • immunosuppression
  • poor health
  • inadequate supportive care
    = can lead to infant death
69
Q

Which supplement has been shown to help treat Measles?

A

Vitamin A

70
Q

What are the common complications of a Measles infection?

A
  • otitis media
  • Croup (laryngotracheobronchitis)
  • diarrhea
  • pneumonia
71
Q

What are the less common but notable complications of Measles?

A
  • Hepatitis
  • thrombocytopenia
  • encephalitis
72
Q

What is the most common fatal complication with Measles infection?

A

pneumonia

73
Q

What is the clinical presentation of Rubella?

A
  • LOW-grade fever
  • headache, sore throat, rhinorrhea, cough
  • conjunctivitis
  • lymphadenopathy
  • exanthema and enanthema
74
Q

What is the exanthema characteristic in Rubella?

A
  • pruritic
  • pink/red macules and papules
  • starts on face → neck, trunk, extremities w/in 24hrs
75
Q

What is the enanthema characteristic in Rubella?

A

petechial lesions on soft palate and uvula = Forchheimer’s sign

76
Q

What is the treatment for Rubella?

A

supportive = treat symptoms

77
Q

What is the complication with Rubella infections?

A

infected pregnant women → miscarriage, fetal death, congenital rubella syndrome

Dermatology (5 decks)

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