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OMS II BECOM Exam 1 > Viral exanthems and other dermatologic infections/inflammations - Stillwell > Flashcards

Viral exanthems and other dermatologic infections/inflammations - Stillwell Flashcards

1
Q

exanthema

A

-widespread rash - caused by toxins, drugs, infection, autoimmune

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2
Q

enanthem

A

-rash on mucous membrane (ex. mouth, nose)

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3
Q

macule

A
  • flat lesion on the surface of skin (not raised)
  • <2cm; patch if >2cm diameter
  • ex. freckle
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4
Q

papule

A
  • small lesion raised above the skin

- <0.5 cm; nodule (0.5-5cm); tumor >5cm

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5
Q

plaque

A
  • large, flat topped raised lesion
  • > 1cm
  • ex. psoriasis or eczematous dermatitis
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6
Q

pustule (pimple)

A
  • small collection of pus in epidermis/dermis
  • may form to papule –> collection of inflammatory cells
  • small abscess
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7
Q

vesicle

A
  • small fluid filled lesion above the skin (translucent)
  • <0.5 cm
  • may be grouped
  • ex. HSV-1 - fever blister on lip
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8
Q

bulla

A
  • fluid filled lesion above the skin (translucent)
  • > 0.5 cm
  • ex. 2nd degree burn or pressure blister
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9
Q

morbilliform rash

A
  • diffuse rash sometimes showing circular or elliptical lesions
  • ex. measles, drug/allergic rxns, syphilis
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10
Q

viral exanthems/enanthems

A
  • viral syndrome includes fevers, chills, myalgias, arthralgias, fatigue (may or may not have a rash)**
  • rash may be from virus itself or immune response
  • low WBCs, platelets, sometimes anemia
  • ESR, CRP, procalcitonin usually normal
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11
Q

alpha herpes viruses**

A

HHV-1 (Herpes simplex virus-1/HSV-1) (oral>genital herpes)
HHV-2 (Herpes simplex virus-2/HSV-2) (genital>oral herpes)
HHV-3 (Varicella zoster virus- VZV) (chickenpox/shingles)
HHV-B (Herpes simiae virus- Herpes B virus) (rash/meningoencephalitis/lymphadenitis)

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12
Q

gamma herpes viruses**

A

HHV-4 (Epstein-Barr virus- EBV) (infectious mononucleosis)

HHV-8 (Kaposi’s sarcoma herpesvirus- KSHV) (Kaposi’s sarcoma)

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13
Q

beta herpes viruses**

A

HHV-5 (Cytomegalovirus- CMV) (infectious mononucleosis)
HHV-6 (Roseolovirus) (roseola)
HHV-7 (Roseolovirus) (roseola)

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14
Q

herpes group viruses

A
  • DNA viruses - DNA in capsid wrapped within a tegument with with the virion as the envelop
  • latently infect cells (LAT genes) - can reactivate
  • may live the rest of someone life
  • may or may not be symptomatic
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15
Q

HSV-1

A
  • most people carry it latently
  • can reactivate and spread when there are no symptomatic lesions** (reactivate less frequently than HSV-2)
  • usually oral** - ex. fever blisters on the lip
  • 80-90% usually orolabial, 10-20% genital
  • can occur on skin (herpes gladitorium - no dermatome)** and around fingertips (herpetic whitlow) and perianally**
  • begins with preherpetic neuralgia** (pain and tingling) –> progress to ulcers
  • primary infection worse than recurrences** –> febrile illness, lesions, ulcerative stomatitis**
  • no longer contagious once the scab crusts
  • prophylaxis can abort virus
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16
Q

HSV-2

A
  • less people carry virus latently; more common in women
  • can reactive and spread when there are no symptomatic lesions** (reactivates more frequently than HSV-1)**
  • 80-90% genital, 10-20% orolabial**
  • primary infection more severe than recurrences –> febrile, lesions, vaginitis, urethritis, urinary retention, inguinal lymphadenitis**
  • begin with preherpetic neuralgia –> vesicles –> ulcers
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17
Q

HSV-1,2

A
  1. treatment: acy/penci/famci/valacyclovir**
  2. prophylaxis: condoms, oral meds –> lowers reactivation risk and makes it less severe
  3. diagnosis: usually clinical, antibodies ineffective bc would cross react
    - Tzanck smear from ulcer –> multinucleated giant cells*
    - best is PCR test of swab of lesion    *
  4. immunity: cell mediated immunity** - not much problem if antibodies are low, but problem with low T cells (immunosuppressed people)
18
Q

varicella zoster - HHV-3

A
  1. epidemiology: acquire through inhalation
    - will normally get it if not immune (vaccinated)
    - primary infection (chickenpox aka varicella) –> lead to pneumonia and meningitis/encephalitis**; secondary bacterial infections in child
    - remains dormant in CN5 and dorsal root ganglia and reactivates into shingles (herpes zoster) - risk increases with age
  2. clinic: vesiculated lesions that come in crops*
    - reactivation to shingles follows single dermatome
    - reactivation can develop postherpetic neuralgia (chronic pain) with shingles**
    - if reactivated in trigeminal nerve –> cornea is at risk**
  3. treat: acy/famci/valacyclovir or VZV Igs
  4. prophylaxis:
    - viravax (live) for children
    - zostavax (live) given to adults –> decreases risk of reactivation and post herpetic neuralgia
    - shingrix (recombinant) given to elderly –> go to treatment
  5. diagnosis: clinic or PCR
19
Q

chickenpox vs smallpox**

A
  1. chickenpox - lesions are crops over time, easily crusts, mild illness before rash, spares palms/soles**
  2. smallpox - lesions all at once, takes days to crust, sever illness before rash, affects palms/soles**
20
Q

HHV-6, HHV-7 (roseola) aka exanthem subitum

A
  1. epidemiology: spread through saliva or mother to baby, frequent in children
  2. clinic: high fevers and febrile seizures, rash starts on trunk and moves peripherally
    - similar to measles, but does not look as sick in roseola
  3. treat: supportive
  4. prophylaxis: no vaccine
21
Q

HHV-8 (kaposi’s sarcoma)

A
  1. epidemiology: seroprevalence increases with age/sex partners
    - pass from mother to child, body fluids (sexual contact)
  2. clinic: associated with kaposi’s sarcoma tumor in immunocompromised (ex. AIDS - low CD4)**
    - associated with multicentric Castleman’s disease
    - purplish-violet lesions on MOUTH and NOSE**
  3. treat: boost immune system with HAART
  4. prophylaxis: safe sex; no vaccine
22
Q

Herpes B virus (Herpes simiae)

A
  1. epidemiology: virus in macaque/rhesus monkeys**
    - acquire from bite or secretions
  2. clinic: lesions similar to HSV (gladiatorum)
    - also pharyngitis, lymphadenitis, meningoencephalitis –> death
  3. treat: acyclovir immediately
  4. prophylaxis: no vaccine
23
Q

hand, foot, and mouth disease (coxsackie virus A16 - sometimes enterovirus-17)**

A
  1. epidemiology: highly contagious
    - transmitted by nasopharyngeal, fecal-oral, air droplets, direct contact
    - usually in children under 10
    - polio like illness in adults
  2. clinic: papules, vesicles, ulcers on hands, feet, mouth
    - nonpruritic rash involving the palms/soles**
    - grey-white lesions with ulcers in the back of mouth
  3. treat: none
  4. prophylaxis: no vaccine in US, is vaccine in China
24
Q

herpangina (coxsackie virus A and B, enterovirus 71, sometimes echovirus)**

A
  1. epidemiology: spread in summer in respiratory droplets or fecal-oral, children under 10
  2. clinic: within couple days, grayish lumps develop into vesicle in the in mouth and pharynx (often soft palate and tonsils) and get bigger
    - looks like herpes stomatitis or hand-foot-mouth disease
  3. treat: none
  4. prophylaxis: no vaccine
25
Q

for boards** - not on test

A
  1. First disease- Measles (Rubeola)
  2. Second disease- Scarlet fever/Scarletina (secondary to Group A Strep producing an exotoxin)
  3. Third disease- German measles (Rubella)
  4. Fourth disease- Staphylococcal Scalded Skin Syndrome (Ritter’s disease caused by exfoliative exotoxin producing Staphylococcus aureus)
  5. Fifth disease- Erythema infectiosum (Parvovirus B 19/Slapped Cheek Syndrome)
  6. Sixth disease- Exanthem subitum (Roseola)
26
Q

Parvovirus B19 (Fifth disease/Erythema Infectiosum/Slapped Cheek Syndrome)*****

A
  1. epidemiology: spread through respiratory, blood, mother to child (highly contagious)
    - worldwide outbreaks every 3-4 years
    - only infects humans**
    - usually in children, rare in adults
  2. clinic: brief viral prodrome with fever, headache, nausea, diarrhea**
    - kids: spare nasolabial folds, forehead, and mouth; rash on trunk and extremities
    - adults: polyarthralgias/arthritis, bone marrow suppression
    - utero: hydrops fetalis/miscarriage/stillbirth
  3. treat: none
  4. prophylaxis: no vaccine
  5. diagnosis: clinically, parvovirus IgM antibody, or PCR
27
Q

measles - rubeola aka red measles

A
  1. epidemiology: highly contagious, spread through airborne, respiratory droplets, secretions
    - many deaths even though there is vaccine
    - seen less over time with increasing vaccination
  2. clinic: prolonged episode (kids look SICK)
    - cough, conjunctivitis    , coryza** (stuffy/runny nose)
    - Koplik spots*** inside cheeks next to molars or soft palate
    - rash on back of ears –> head/neck –> trunk –> extremities
  3. complications: subacute sclerosing panencephalitis (SSPE)** –> brain inflammation, neurologic problems, personality changes, occurs years after measles**
    - also pregnancy, vit. A deficient, malnutrition
  4. atypical measles**: patients immunized with killed vaccine b/w 1963-1967 (no full protection) –> high fevers, headaches, rash, pneumonia, hepatitis, vasculitis
  5. treat: sometimes vit. A supplementation
  6. prophylaxis: live attenuated vaccine, give 2 doses, MMR/MMRV
  7. diagnosis: clinic, serology for IgM antibodies, or PCR
  8. path/histo: F protein causes cell to cell fusion forming giant cell syncytium***
28
Q

Mumps - mumps virus

A
  1. epidemiology: spread airborne or saliva
  2. clinic: parotitis or aseptic meningitis* (meningitis that does not grow bacteria)
    - parotid gland inflamed/enlarged
    - post-pubertal males –> mumps orchitis*** (some sterile)
    - females can get oophoritis (rare and not associated with sterility)
    - rash may/may not be present
  3. treat: none
  4. prophylaxis: live attenuated vaccine, 2 doses, 3 if needed
  5. diagnosis: clinic, IgM serology
29
Q

rubella (German measles)

A
  1. epidemiology: virus in humans and non-human primates, spreads through respiratory droplets
    - was problem before MMR vaccine
  2. clinical illness in child: mild illness** when acquired postnatally or in children
    - posterior cervical/auricular and suboccipital lymphadenopathy** and a rash due to immune rxn (starts on face spreads to trunk/extremities; spreads faster than regular measles)
    - enanthem and forshheimer spots*** (aka petechia) on soft palate
  3. clinical illness in teen/adult: more severe, harsher prodrome
    - arthralgias and polyarthritis**
    - exanthem similar to children**
  4. congenital rubella infection (CRI): intrauterine infection –> stillbirth, miscarriage
  5. congenital rubella syndrome (CRS): fetal infection and many birth defects along with ischemia in organs
  6. treat: none
  7. prophylaxis: rubella vaccine, MMR/MMRV
  8. diagnosis: clinic, rubella IgM antibody
30
Q

acute HIV***

A
  1. epidemiology: CD4 count becomes low soon after you acquire it
  2. clinic: primary HIV infection days/weeks after exposure
    - mono-like syndrome** with fever, lymphadenopathy, pharyngitis, malaise, myalgia
    - enanthem (oral or vaginal) and exanthem
  3. treat: HAART immediately
  4. prophylaxis: safe sex, avoid needles, no vaccine
  5. diagnosis: combo test for HIV1/2 and HIV RNA PCR
31
Q

difference between mono and acute HIV??**

A
  • acute HIV will have mono like symptoms but also a rash associated with it (mostly on upper body)**
  • mono from EBV,CMV does not have a rash**
32
Q

HPV - human papilloma virus

A
  1. epidemiology: most common STI*
    - precancerous lesions or warts
    - most cervical and oropharyngeal cancers due to HPV16,18***
  2. clinic:
    - skin warts** –> do not develop into cancer
    - genital/anal warts** (Condylomata accuminatum) –> HPV6,7; usually cleared by immune system
    - oral/pharyngeal papillomas** –> HPV16 (high risk of malignancy); white lesions on tongue
  3. treat: topical therapy, surgical removal
  4. prophylaxis: safe sex and vaccines; Gardasil 9 in US
33
Q

smallpox (variola virus)

A
  1. epidemiology: spread by respiratory droplets and oral secretions
  2. clinic: fever/headache/myalgia –> enanthem –> rash
    - macules/papules/vesicles on palms/soles unlike chickenpox*
    - one crop of lesions    *
  3. treat: Tecovirimat/Tpoxx
  4. prophylaxis: initially cowpox vaccine, now vaccinia vaccine
34
Q

cowpox (cowpox virus)

A
  1. epidemiology: skin contact with animals (cattle, rodents, cats)
    - “milk maids hands”***
  2. clinic: macules –> papules –> vesicles –> ulcers
    - black eschar that falls off***
  3. treat: none
  4. prophylaxis: use gloves
  5. diagnose: clinic or biopsy
35
Q

monkeypox (monkeypox virus)

A
  1. epidemiology: contact with macaque monkeys (“bush meat”), prairie dogs, squirrels, rats
  2. clinic: viral prodrome –> rash on trunk (can spread to extremities)
  3. treat: none
  4. prophylaxis: smallpox vaccine
  5. diagnosis: clinic or biopsy
36
Q

orf (orf virus) aka Thistle disease, Ecthyma contagiosum

A
  1. epidemiology: poxvirus that is zoonotic and get from sheep, goats, and fomites***
    - animals get lesions on muzzle, mouth/eyes –> clear it better than humans
  2. clinic: non healing lesions on face, hands, arms
  3. treat: none
  4. prophylaxis: wear gloves, vaccine for animals
  5. diagnosis: clinic and PCR
37
Q

Molluscum Contagiosum/Water Warts (Molluscum Contagiosum virus

A
  1. epidemiology: direct/sexual contact, auto inoculation, and fomites
  2. clinic: papules that umbilicate in center (very superficial, only epidermis)
    - everywhere in children
    - face/genitals in adults
  3. treat: topicals, cryosurgery, laser
  4. prophylaxis: avoid contact with lesions and fomites
  5. diagnosis: clinic or biopsy
38
Q

zika fever (zika virus)

A
  1. epidemiology: Flavivirus spread via Aedes mosquito bites, transfusions and sexual contact
  2. clinic: usually no symptoms**
    - if symptoms –> conjuctivitis, myalgia, headache, rash
    - petechial enanthem
    - microcephaly in fetus and Guillain-Barre syndrome
  3. treat: none
  4. prophylaxis: safe sex, avoid mosquitos
  5. diagnosis: blood or amniotic fluid for IgM or PCR
39
Q

Dengue Fever (Dengue fever virus infection/ Breakbone fever)

A
  1. epidemiology: bites from aedes mosquitos, transfusions
  2. clinic: retro-orbital headache, GI, sever myalgia/arthralgia (breakbone fever)*
    - biphasic/saddleback fever - returns
    - “islands of white in a sea of red”
    - hemorrhagic fever –> dehydrates, multi-organ failure, bleeding*
    - pulse-temp dissociation    * (low pulse)
  3. treat: none
  4. prophylaxis: avoid mosquitos, vaccine not in US
  5. diagnosis: serology IgM or PCR
40
Q

Chikungunya Fever (Chikungunya virus)

A
  1. epidemiology: aedes mosquitos and transfusions
  2. clinic: high/biphasic fever, joint pain, rash, headache GI, conjunctivitis
    - polyarthritis
    - hyperpigmented rash with mouth ulcers
  3. treat: none
  4. prophylaxis: avoid mosquitos
  5. diagnosis: serology IgM, PCR

OMS II BECOM Exam 1 (30 decks)

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