Viral Infections

Question 1

Name the four viruses of importance?

Answer 1

Herpes
Coxsackie
Paramyxovirus
Human papilloma

Question 2

What is the herpes virus?

Answer 2

Double stranded DNA - icosahedral capsid surrounding dsDNA

Question 3

What gives herpes virus specificity?

Answer 3

Glycoproteins

Question 4

What is life cycle of herpes?

Answer 4

Virus binds specific cell surface receptor
Docking allows uncoating of virus and entry
DNA inserted into cell as protein uncoated
dsDNA moves into nucleus and interact host cell protein
Polymerase transcribes viral proteins = mRNA
mRNA translated into viral proteins
Viral DNA inserted into capsid
Cell becomes full and bursts = release viral particles

Question 5

What is difference between herpes type 1 and 2

Answer 5

Type 1 - skin and oral mucous membranes

2 - genital mucosa

Question 6

Where does virus live in type I simplex?

Answer 6

Virus enter trigeminal sensory neurones and migrate to ganglion

Question 7

How is simplex type I reactivated?

Answer 7

Reactivation caused by UV, stress, illness, immunosuppression

Virus migrates to peripheral nerve endings and it shed

Question 8

Why are infants at increased risk of primary infection?

Answer 8

Have passive immunity from maternal antibodies - these deplete very quickly

Question 9

Are primary HSV symptomatic?

Answer 9

No 90% are asymptomatic

Question 10

Who do you seen primary herpetic gingivostomatitis in?

Answer 10

Children and young adults

Question 11

What is incubation period of PHG?

Answer 11

5 days

Heal 10-14 days

Question 12

What is issue with treating patient with primary herpetic gingivostomatisis?

Answer 12

Risk of herpetic whitlow

Question 13

Signs and symptoms of primary herpetic gingivostomatisis?

Answer 13

Malaise and fever
Vesicles which rupture
Erythematous gingivitis
Crusting lesions

Question 14

Pathogenesis of primary herpetic gingivostomatisis?

Answer 14

Herpes virus replicates epithelial cells

Epithelial destruction and ballooning cells = intra-epithelial vesicles

Question 15

Management of primary herpetic gingivostomatisis?

Answer 15

Supportive = fluids, analgesics, soft diet, chlorhexidine 
Medication = acyclovir 5 days

Question 16

When should acyclovir be given in primary herpetic gingivostomatisis?

Answer 16

Early infections

Immunosupressed pt

Question 17

What is herpes labials often referred as

Answer 17

Cold sores

Question 18

What are clinical features of a cold sore?

Answer 18

Prodromal tingling before vesicles
Vesicles at mucocutaneous junction - ulcerate and crust
Last 7-10 days

Question 19

Treatment of herpes labials?

Answer 19

Acyclovir - only effective prodromal stages

Question 20

What can herpes labials be confused with?

Answer 20

Erythema multiforme

Question 21

What is type 3 HSV?

Answer 21

Varicella zoster virus?

Question 22

Difference between primary and secondary varicella zoster virus?

Answer 22

Primary = chicken pox

Secondary (herpes zoster) = shingles

Question 23

Where does shingles affect?

Answer 23

One of division of trigeminal nerve?

Question 24

3 phases of varicella zoster virus?

Answer 24

Pre-herpetc - pain in affected division
Rash phase
Post-herpetic neuralgia - burning pain

Question 25

What see is rash phase of VZV?

Answer 25

Unilateral vesicles - follow trigeminal division

Question 26

Management of shingles?

Answer 26

Tx w/ anti-viral - acyclovir/ valaciclovir Supportive measure Ophthalmology if eye involvement

Question 27

How manage post-herpetic neuralgia in shingles?

Answer 27

Neuropathic pain drugs - gabapentin/ antidepressants

Question 28

What is HSV4?

Answer 28

Epstein barr virus

Question 29

What see in Epstein Barr virus?

Answer 29

Infectious mononucleosis - glandular fever | Petechiae soft palate/ tonsils

Question 30

What other things are related to epstien-barr virus?

Answer 30

Burkitts lymphoma Nasopharyngeal carcinoma Hairy leukoplakia

Question 31

How does oral hairy leukoplakia present?

Answer 31

White patchs bilateral on lateral border of tongue

Question 32

What pt often present with oral hairy leukoplakia?

Answer 32

HIV

Question 33

What are the 5 different types HSV?

Answer 33

``` I -skin and oral II - gential III- varicella zoster IV - epstein barr V - cytomegalovirus ```

Question 34

What is HSV 5?

Answer 34

Cytomegalovirus

Question 35

Where does HSV5 lay dormant?

Answer 35

Dormant in lymphocytes

Question 36

Issue w/ HSV5?

Answer 36

Rarely cause problem healthy indiviudals | Issue if immunocompromised/ new-born

Question 37

How does cytomegalovirus present immuno-suppreswed?

Answer 37

Salivary gland swellings

Question 38

What virus do you see herpangina in?

Answer 38

Coxsackie - type 4

Question 39

What see in herpangina?

Answer 39

Vesicles and ulcers on soft palate - last a few day

Question 40

What causes hand, foot and mouth?

Answer 40

Coxsackie virus - type 16

Question 41

What see in hand, foot and mouth

Answer 41

Mild systemic upset Rash/ vesicles palms of hands and sole of feet Intra-oral vesicles

Question 42

What causes mumps/meaasles?

Answer 42

Paramyxovirus - negative strand mRNA virus

Question 43

What see is measles?

Answer 43

Systemic upset | Koplik's spots - papule buccal and palatal mucosa

Question 44

What are kopliks spots seen in measles?

Answer 44

In prodromal phase

Question 45

What is HPV?

Answer 45

Circular dsDNA

Question 46

What cancer can HPV be related to?

Answer 46

HPV16 and 18 oncogenic HP16 = oropharyngeal HPV18 = cervical

Question 47

What to HPV 6 and 11 cause?

Answer 47

warts

Question 48

What does HPV infect?

Answer 48

Basal keratinocytes - can't penetrate intact mucosa needs epithelial damage

Question 49

How can HPV present orally?

Answer 49

Squamous cell papilloma Verucca vulgaris Focal epithelial hyperplasia