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532 DERM > Viral Exanthems > Flashcards

Viral Exanthems Flashcards

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Dermatology Board Prep flashcards
1
Q

Erythema multiforme with brief prodrome, widespread cutaneous and mucous membrane involvement.

A

Stephen Johnsons Syndrome

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2
Q

What viral rash is preceded by pain along the dermatome?

A

Herpes Zoster, Varicella-Zoster, VZV, shingles

Doesn’t cross the midline and only affects one dermatome.

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3
Q

T/F the Herpes Zoster rash is preceded by a prodrome.

A

True
Eruption is often preceded by a prodrome of pain, dysesthesia or pruritis in the affected dermatome.
Described as itching, aching, burning

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4
Q

What is the treatment for Herpes Zoster and VZV?

A
  1. Oral acyclovir - works best if started within 72 hrs of rash onset. Will still benefit if given later.
  2. Ibuprophen, gabapentin for nerve pain/discomfort
  3. Fever management
  4. Cool, moist compresses, calamine lotion, aluminum sulfate (Domeboro) soaks.
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5
Q

What diagnostic test can used to determine HZ?

A

Tzanck test.

Does not distinguish between VZV and HSV.

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6
Q

When is HZ no longer contagious?

A

When the vesicles crust over.

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7
Q

When is the varicella vaccine administered?

A

1st at 12 mo

2nd age 4-5

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8
Q

Which conditions presents with fever, abdominal pain, headache, vesicular rash w/ pinpoint lesions that begin on the face and spread to the trunk?

A

Varicella Zoster

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9
Q

When is oral antiviral therapy used for VZV/HZ?

A

Immunocompromised, other comorbidities and older kids.

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10
Q

What are some complications of VZV/HZ?

A

Bacterial infections, necrotizing fasciitis, osteomyelitis, septic arthritis and Guillian Barre syndrome.

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11
Q

Which condition presents with a prodrome of high fever, coryza (runny nose), cough and Koplik spots?

A

Measles

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12
Q

Which rash is a maculopapular blanching rash that initially presents in the hairline, forehead and behind the ears before spreading cephalocaudally?

A

Measles

Disappears in the order it appeared. It peels as it resolves (desquamic)

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13
Q

Which condition presents as arthritis in adults?

A

Erythema infectiosum (fifth disease)

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14
Q

This rash appears 7-10 days after prodrome. It’s bright red erythema appears abruptly over the cheeks (slap face), an erythematous morbilliform rash presents on the extremities and fades in a reticulate lacy pattern.

A

Erythema infectiosum (fifth disease)

Slap cheek appears absent in adults.
Lacy appearance can come and go when exercising or when exposed to sun.

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15
Q

Which condition has a prodrome that presents with headache, malaise, pharyngitis and itching?

A

Pityriasis rosea

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16
Q

Which rash initially presents with a herald patch followed by more eruptions one week later that morphs into a Christmas tree appearance?

A

Pityriasis rosea

17
Q

What condition is primarily seen in infants? It starts with high fever followed by abrupt onset of rash from the trunk to extremities (spares the face). May have febrile seizures and periorbital edema.

A

Roseola

18
Q

Rose pink maculopapular rash

A

Roseola

19
Q

Which prodrome presents primarily in adults with malaise, low-grade fever, coryza, mild conjunctivitis and URI sx, sub occipital and post auricular glands lymphadenopathy and Forschheimer spots?

A

Rubella (German Measles)

20
Q

Pink macules and papules on the face that spread to the trunk and extremities. Fades in the same order it appears.

A

Rubella (German Measles)

21
Q

Tear-drop vesicles, dew drop on a rose petal rash. Can present in multiple stages at the same time.

A

VZV Chickenpox

22
Q

Presents with mild low-grade fever, sore throat, malaise with submandibular and cervical lymphadenopathy. Oral lesions are the presenting sign followed by cutaneous lesions appearing within 24 hours.

A

Hand-foot-mouth disease

23
Q

Red macules turns pale, white oval vesicles with a red areola appear on the palms, soles, dorsal aspects of the fingers and toes and occasionally on the face, buttocks and legs.

A

Hand-foot-mouth disease

24
Q

Transmitted by fecal-oral route. Possibly respiratory

A

Hand-foot-mouth disease

25
Q

Transmitted by respiratory droplets

A 
Measles
Erythema infectiosum (fifths disease)
Roseola
Rubella (German measles)
Chickenpox
26
Q

Rubeola virus

A

Measles

27
Q

Parvovirus B19

A

Erythema infectiosum (fifths disease)

28
Q

HSV-6 and HHV-7

A

Roseola

29
Q

Coxsackie A16 and enterovirus 71

A

Hand-foot-mouth disease

30
Q

What oral lesions look like grains of sand and only last 12-72hrs?

A

Koplik spots

31
Q

What is the pharmacological treatment for viral exanthms?

A
  1. Acetaminophen/NSAIDS
  2. Vitamin A - measles risk factor
  3. Abx for secondary infections
32
Q

A patient who has had a previous herpes zoster outbreak experiences a second outbreak and asks the provider about treatment to reduce the duration and severity of symptoms. What will the provider recommend?

a. Acyclovir
b. Lidocaine patch
c. Oral corticosteroids
d. Topical corticosteroids

A

ANS: A
Acyclovir, given within 72 hours of onset of rash, has been shown to reduce the duration and severity of the rash and pain and to reduce the risk for PHN and disseminated disease. Lidocaine patches help with pain, but do not reduce the duration of the symptoms. Corticosteroids have not been shown to prevent development of PHN, but have shown modest reduction in duration and severity.

33
Q

An older patient experiences a herpes zoster outbreak and asks the provider if she is contagious because she is going to be around her grandchild who is too young to be immunized for varicella. What will the provider tell her?

a. An antiviral medication will prevent transmission to others.
b. As long as her lesions are covered, there is no risk of transmission.
c. Contagion is possible until all of her lesions are crusted.
d. Varicella zoster and herpes zoster are different infections.

A

ANS: C
Herpes zoster lesions contain high concentrations of virus that can be spread by contact and by air; although they are less contagious than primary infections, contagion is possible until all lesions are crusted. Antiviral medications shorten the course, but do not reduce transmission. Covering the lesions does not prevent transmission. Herpes zoster and varicella zoster are the same.

34
Q

A patient has a unilateral vesicular eruption which is described as burning and stabbing in intensity. To differentiate between herpes simplex and herpes zoster, which test will the provider order?

a. Polymerase chain reaction analysis
b. Serum immunoglobulins
c. Tzanck test
d. Viral culture

A

ANS: A
The PCR is a rapid and sensitive test that can differentiate between the two. Serum Ig levels are not diagnostic. The Tzanck test identifies the presence of a herpes virus, but does not differentiate between the two types. Viral culture will differentiate, but is not rapid. REF: Diagnostics

35
Q

An adolescent female has grouped vesicles on her oral mucosa. To determine whether these are caused by HSV­1 or HSV­2, the primary care pediatric nurse
practitioner will order which test?

A. Direct fluorescent antibody test
B. Enzyme­ linked immunosorbent assay
C. Tzanck smear
D. Viral culture

A

ANS: D

36
Q

A 4­ year ­old child has clusters of small, clear, tense vesicles with an erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment?

A. Mupirocin ointment applied to lesions 3 times daily
B. Oral acyclovir 20 to 40 mg/kg/dose for 7 to 10 days
C. Topical acyclovir applied to lesions 4 times daily
D. Topical diphenhydramine and magnesium hydroxide

A

ANS: D

37
Q

A previously healthy school ­age child develops herpes zoster on the lower back. What will the primary care pediatric nurse practitioner do to manage this condition?

A. Order Burow solution and warm soothing baths as comfort measures.
B. Prescribe oral acyclovir 30 mg/kg/day in 4 doses/day for 5 days.
C. Recommend topical antihistamines to control itching.
D. Stress the need to remain home from school until the lesions are gone.

A

ANS: A

38
Q

A school­ age child has a rash without fever or preceding symptoms. Physical examination reveals a 3­cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a “Christmas tree” pattern on the child’s back. What is the initial action?

A. Obtain a KOH preparation of a skin scraping to verify the diagnosis.
B. Prescribe topical steroid creams to shorten the course of the disease.
C. Reassure the child’s parents that the rash is benign and self­ limited.
D. Recommend topical antihistamines and emollients to control the spread

A

ANS: C

532 DERM (8 decks)

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