Viral infection

Question 1

Viral warts are caused by what family of virus?

Answer 1

Human papillomavirus

Question 2

HPV subtypes:

a) common warts
b) plane warts
c) genital warts

Answer 2

a) 1, 2 and 4
b) 2
c) 6, 11, 16 and 18

Question 3

What is spontaneous resolution of a viral wart often preceded by?

Answer 3

Blackening within the wart due to capillary thrombosis

Question 4

Infection with which HPV serotypes predisposes to cervical cancer?

Answer 4

16 and 18

Question 5

Treatment options for viral warts (5)

Answer 5

12 weeks daily application of salicylic acid "wart paint"
Cryotherapy
Curettage and cautery
Podophyllotoxin
Immunomodulation e.g. imiquimod

Question 6

Natural course of varicella

Answer 6

Malaise
Papules –> clear vesicles on a pink base
Vesicles become pustules
Lesions crust then clear, leaving white depressed scars

Question 7

Management of varicella (2)

Answer 7

Active Rx rarely required- topical calamine lotion is usful

Antivirals should be reserved for severe attacks and immunocompromised people (prophylactically if exposed)

Question 8

Pathophysiology of herpes zoster

Answer 8

Reactivation of dormant herpes varicella-zoster virus in the dorsal (sensory) root ganglion since an earlier episode of chickenpox

Question 9

Presentation of herpes zoster (2)

Answer 9

Neuralgic pain and vesicles in a dermatomal pattern

Initial pain is sometimes taken for an emergency e.g. MI, acute appendicitis

Question 10

Complications of herpes zoster (3)

Answer 10

Secondary bacterial infection
Opthalmic zoster can cause corneal ulcers (involvement of tip of nose indicates this)
Post-herpetic neuralgia

Question 11

Treatment of herpes zoster (2)

Answer 11

If diagnosed early, antivirals are of benefit

Vaccination with live attenuated vaccine reduces incidence of zoster and post-herpetic neuralgia

Question 12

What are the two types of herpes simplex virus and where do they generally cause lesions?

Answer 12

HSV I- usually extragenital

HSV II- usually genital lesions

Question 13

How does primary herpes simplex virus manifest in children?

Answer 13

Acute gingivostomatitis with malaise, fever, lethargy, cervical lymphadenopathy

Question 14

What is herpetic whitlow?

Answer 14

Direct inoculation of herpes simplex virus onto finger causing fluid filled blister

Question 15

How does primary herpes simplex virus II infection manifest?

Answer 15

Painful anogenital blisters which rapidly ulcerate

Question 16

examples of triggers for reactivation of herpes simplex? (5)

Answer 16

Menstruation
stress
illness
UV radiation

Question 17

Complications of herpes simplex (5)

Answer 17

Disseminated herpes simplex (causing severe systemic illness)
Herpes encephalitis or meningitis
Eczema herpeticum
Dendritic ulcers
Erythema multiforme

Question 18

Treatment of herpes simplex

Answer 18

Topical or oral aciclovir

Question 19

Pearly umbilicated papules caused by infection with a common pox virus

Answer 19

Molluscum contagiosum

Question 20

Management options: molluscum contagiosum (4)

Answer 20

Cryotherapy, C + C, salicylic acid wart paint, topical imiquimod

Question 21

Most common HIV-associated malignancy, caused by herpesvirus 8

Answer 21

Kaposi sarcoma

Question 22

Appearance of Kaposi sarcoma?

Answer 22

Multiple purplish patches/nodules

Question 23

Other skin changes in AIDS (5)

Answer 23

Seborrhoeic eczema
Florid, unusually extensive or atypical common infections e.g. candida, tinea, herpes simplex, scabies, warts
Hairy leucoplacia
Dry skin, pruritus
Drug eruptions

Question 24

Causative viruses:

a) herpangina
b) hand foot and mouth disease
c) erythema infectiousum

Answer 24

a) group A coxsackie viruses
b) coxsackie A16
c) parvovirus B19

Question 25

Child with fever, severe sore throat covered in many vesicles/ulcers?

Answer 25

Herpangina

Question 26

Slapped cheek erythema indicates?

Answer 26

Erythema infectiosum