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OMOPOR > Viral Infections > Flashcards

Viral Infections Flashcards

1
Q

Clinical Features

  1. Prodromal symptoms 12-24h before
  2. Abrupt onset
  3. Pinhead vesicles rapidly collapse → Multiple small erythematous lesions → Enlarge → Develop central ulceration covered by yellow fibrin
  4. Enlarged, painful, erythematous gingiva
  5. Resolves in 5-7 days (Mild) to 2 weeks (Severe)
A

Primary Herpetic Gingivostomatitis

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2
Q

HSV remains latent in the?

A

Trigeminal ganglion

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3
Q

Clinical Features

  1. Prodromal signs: Pain, burning, itching 6-24 hours before
  2. Multiple small, erythematous papules develop → Form a cluster of fluid-filled vesicles -> Rupture and crust within 2 days
  3. Heals within 7-10 days
A

Herpes Labialis

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4
Q

Clinical Features

  1. 1-3mm vesicles rapidly collapse to form a cluster of erythematous macules with central yellowish ulceration
  2. 7-10 days to heal
A

Recurrent HSV (Immunocompetent)

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5
Q

Investigation for HSV

A
  1. Viral isolation from tissue culture inoculated with fluid of intact vesicles
  2. Cytological smear
  3. Perilesional tissue biopsy
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6
Q

Management of HSV in healthy patients

A

Supportive care and symptomatic management
- Warm salt water sinse
- Lidocaine 2% topical
- Oral analgesics (NSAIDs, opioids)
- Adequate nutrition and fluids replacement

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7
Q

Management of HSV in immunocompromised patients

A

Systemic therapy
- Acyclovir 200mg 5times a day over 7-10 days
- Valacyclovir 1000mg/8hr over 7 days

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8
Q

VZV is latent in the?

A

Sensory nerve ganglia

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9
Q

What is Varicella?

A

Benign self-limiting illness in immunocompetent children

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10
Q

Risk factors of Herpes Zoster (Shingles)

A

1 HIV infection, Radiation, Immunosuppressive agents

  1. Malignancies
  2. Old age
  3. Stress and alcohol
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11
Q

Complications of Herpes Zoster

A
  1. Ramsay Hunt Syndrome
  2. Post herpetic neuralgia
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12
Q

Clinical Features

  1. Systemic signs: Fever, malaise, pharyngitis, rhinitis
  2. Dermatologic findings
    - Initial pruritic rash (exanthema)
    - Erythema → Vesicle → Pustule → Crusting
  3. Oral Findings
    - Small aphthae-like ulcers on palate and buccal mucosa
    - Painless lesions
    - Vesicles rupture → 1-3mm ulcers x30
    - Last for 5-10 days
A

Varicella (HHV-3)

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13
Q

Clinical Features

  1. Prodromal signs: Tingling, burning, itching, flu-like symptoms
  2. Acute
    - Clusters of fluid-filled vesicles on erythematous base → Ulcers
    - Crusting occurs
  3. Chronic
    - Persistent pain longer than 3 months
  4. Extends to midline and occur in conjunction with involvement of overlying skin
  5. Ocular involvement
A

Herpes Zoster (Shingles)

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14
Q

Investigation for VZV

A
  1. Cytological smears
  2. Histology of tissue
  3. Viral culture, immunofluorescence stains for VZV antibodies
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15
Q

Management of Varicella in healthy patients

A

Supportive care

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16
Q

Management of Varicella in immunocompromised patients

A

Purified VZV Ig

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17
Q

Prevention of VZV

A
  1. VZV vaccine (live attenuated virus)
  2. Recommended in those >60 years old
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18
Q

Management of Herpes Zoster

A
  1. Supportive care and symptomatic relief: Anti-pyretics and anti-pruritics
  2. Early use of anti-viral medications
    - Acyclovir 800mg 5 times a day, over 7-10 days
    - Valacyclovir 1000mg/ 8 hours over 7 days
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19
Q

Management of post-herpetic neuralgia

A
  1. Systemic steroids
  2. Early use of systemic antivirals
  3. Anti-depressants and anti-convulsants: Neurontin
  4. Symptomatic relief with Lidoderm patches
20
Q

Clinical Findings

  1. Children: Asymptomatic
  2. Young adults: Fever. lymphadenopathy, pharyngitis and tonsillitis
  3. Adults >40 years old: Fever and pharyngitis
A

Epstein Barr Virus infection (HHV-4)

21
Q

Conditions associated with Epstein Barr Virus

A
  1. Infectious mononucleosis
  2. Oral hairy leukoplakia
  3. Burkitt lymphoma
  4. Nasopharyngeal Carcinoma
22
Q

Management of EBV

A
  1. Infectious mononucleosis resolves within 4-6 weeks
  2. NSAIDs can be used to minimize most common symptoms
23
Q

CMV is latent in?

A

Salivary glands, macrophages, lymphocytes and endothelial cells

24
Q

Clinical Findings

  1. Neonates
    - Ill within few days
    - Hepatosplenomegaly
    - Tooth defects
  2. Immunocompromised adults
    - Fever, malaise, myalgia, abnormal liver function tests, atypical peripheral leukocytes
    - 1/3 has pharyngitis, lymphadenopathy
A

Cytomegalovirus (HHV-5)

25
Q

Management of CMV infection

A

Resolve spontaneously in healthy patients

Therapy required in immunocompromised patients: Ganciclovir/Valganciclovir

26
Q

Investigations for Viruses

A
  1. Cytological smears
  2. Histology of tissue
  3. Others: Viral culture, PCR, Serology testing
27
Q

Location of Primary Herpetic Gingivostomatitis

A

Non-keratinised and keratinised gingiva

28
Q

Location of Recurrent HSV (Immunocompromised)

A

Non-keratinised mucosa

28
Q

Location of Recurrent HSV (immunocompetent)

A

Keratinised mucosa bound to bone (Attached gingiva and hard palate)

29
Q

HFMD is caused by?

A

Coxsackie A16, enterovirus 17

29
Q

Clinical Features

  1. Flu-like symptoms
  2. Macules → 1-5mm vesicles → Oral ulcers
  3. Heal within 1 week
A

Oral lesions of HFMD

30
Q

HFMD occurs in the?

A

Labial and buccal mucosa, tongue

31
Q

Herpangina is caused by?

A

Coxsackie A1-6, A8, A10, A22

31
Q

Location of Recurrent VZV infection (Herpes Zoster/Shingles)

A

Non-keratinised and keratinised mucosa

32
Q

Clinical Features

  1. Systemic symptoms: Sore-throat, dysphagia, fever, malaise
  2. Red macules → Fragile vesicles → Multiple small 2-3mm ulcers
  3. Lesions heal in 7-10 days
A

Herpangina

33
Q

Location of Herpangina

A

Soft palate or oropharynx

33
Q

Management of Herpangina

A
  1. Self-limiting
  2. Supportive: Fluid intake and adequate nutrition, topical anesthetics, analgesics, anti-pyretic
34
Q

Management of HFMD

A
  1. Self-limiting
  2. Supportive: Fluid intake and adequate nutrition, topical anesthetics, analgesics, anti-pyretic
35
Q

Oral manifestations of HIV

A
  1. Candidiasis
  2. Oral hairy leukoplakia
  3. Karposi sarcoma
  4. ANUG
36
Q

Human Papilloma Virus is latent in?

A

Epithelial cells

37
Q

Clinical Features

  1. White papule/nodule
  2. Papillary projections
  3. Painless, pedunculated/sessile
  4. Keratin horn
  5. Children
A

Verruca Vulgaris (HPV 2,4)

38
Q

Clinical Features

  1. Well-demarcated, exophytic mass
  2. Short, blunted surface projections
  3. Painless, sessile, pink
  4. Teenagers and young adults
A

Condyloma Acuminatum (HPV 6,11)

38
Q

Clinical Features

  1. Solitary, exophytic nodule
  2. Finger-like projections
    ‘Cauliflower’ appearance
  3. Painless, pedunculated, soft
  4. White/red/normal in colour
  5. Adults
A

Squamous papilloma (HPV 6,11)

39
Q

Management of Squamous Papilloma

A

Conservative surgical excision including base of lesion

39
Q

Management of Verucca Vulgaris

A

Excised surgically or laser, cryotherapy or electrosurgery

41
Q

Histopathological Features of HPV

A

Proliferation of keratinised squamous epithelium arranged in finger-like projections with fibrovascular CT cores

  1. Koliocytes (Viral-altered epithelial cells) in spinous cell layer
42
Q

Differential Diagnosis of HPV lesions

A
  1. CA larger lesions than SP
  2. CA has more blunt and broad cores

OMOPOR (7 decks)

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