Viral infections of the skin

Question 1

Which virus causes chicken pox (varicella) and shingles?

Answer 1

Varicella (herpes) zoster

Question 2

What kind of lesions are characteristic of chicken pox?

Answer 2

Macules to papules to vesicles to scabs (itchy)

Question 3

How are the lesions in chicken pox typically distributed?

Answer 3

Usually centripetal (tend to be located on trunk)

Question 4

Name four possible complications of varicella.

Answer 4

Bacterial infection Pneumonitis Haemorrhagic rash (purpura) Scarring Encephalitis

Question 5

What are two severity predictors in chicken pox?

Answer 5

Extremes of age Impaired cell-mediated immunity

Question 6

Which subset of patients tend to be affected by the rare complication of varicella pneumonia?

Answer 6

Teens, adults

Question 7

How is neonatal varicella caused? How can this be prevented?

Answer 7

Infection of mother in late pregancy VZ immune globulin in susceptible women

Question 8

How does shingles manifest?

Answer 8

Lesions in a particular dermatome

Question 9

In what circumstances could opthalmic zoster occur in children?

Answer 9

Immunocompromised; if they had varicella in utero

Question 10

What is Ramsay-Hunt syndrome? What are the possible symptoms and complications?

Answer 10

Reactivation in the facial nerve Vesicles and pain in the auditory canal/throat Facial palsy Irritate the 8th (vestibulocochlear) nerve causing deafness, tinnitus, vertigo

Question 11

What kind of vaccine is used for varicella? When is this used in the UK?

Answer 11

Live attenuated Not routinely used in children, can be used in eldery to reduce impact of shingles and post-herpetic neuralgia

Question 12

How does herpes simplex virus infection usually manifest in children?

Answer 12

Primary gingivostomatitis

Question 13

What name is given to the recurrence of HSV, and what are the possible complications of this?

Answer 13

Cold sore Herpetic whitlow Eczema herpeticum (can be life threatening)

Question 14

Which serotype of HSV is mainly responsible for oral lesions?

Answer 14

HSV-1

Question 15

If a patient with herpes began to display signs/symptoms such as fever, fit, odd behaviour, hemiparesis and dysphasia, which diagnosis would be suspected?

Answer 15

Herpetic encephalitis

Question 16

How does aciclovir work?

Answer 16

Guanosine analogue, incorporated into DNA

Question 17

How can viral diagnoses be confirmed?

Answer 17

Viral swab (red-top vacutainer) Antibody tests (where infection site is inaccessible or as adjunct to viral swab)

Question 18

Which virus is responsible for warts?

Answer 18

Human papillomavirus

Question 19

Which serotypes of HPV are responsible for: a) warts b) genital warts c) cervical cancer

Answer 19

a) 1-4 b) 6 & 11 c) 16 & 18

Question 20

Which serotypes of HPV does the Gardasil vaccine give protection against?

Answer 20

6, 16 & 18

Question 21

Which disease does this picture show? How are these lesions described?

Answer 21

Molloscum contagiosum

Fleshy, firm, unbilicated, pearly nodules

Question 22

“Target lesions” are the characteristic feature of which skin condition? What is it caused by?

Answer 22

Erythema multiforme

Many triggers- drug reactions, herpes simplex, mycoplasma pneumonia

Question 23

What is herpangina and what are the causative organisms?

Answer 23

Blistering rash at back of mouth

Enteroviruses

Question 24

Which viruses cause hand foot and mouth?

Answer 24

Enteroviruses, particularly Coxsackie virus

Question 25

What are the symptoms of hand foot and mouth?

Answer 25

Flu-like illness, vesicular rash, mouth ulcers

Question 26

What name is given to parvovirus B19 infection? (when it affects the skin)

Answer 26

Erythema infectiosum (slapped cheek disease)

Question 27

What are the features of parvovirus B19 infection?

Answer 27

Facial rash which disappears after around 2-4 days, followed by development of rash on the extremities, mainly the extensor surfaces

May also cause arthritis- especially in wrists, and more promiment in adults

Question 28

What are the possible complications of parvovirus infection?

Answer 28

Spontaneous abortion (preceded by foetal hydrops)

Aplastic crisis (seen in patients with reduced red cell life span)

Chronic anaemia

Question 29

How is a diagnosis of parvovirus confirmed?

Answer 29

Parvovirus IgM

Question 30

Which virus is associated with sheep farmers?

Answer 30

Orf

Question 31

What is the causative organism in syphilis?

Answer 31

Treponema pallidum

Question 32

How does syphilis manifest primarily, secondary and tertiary?

Answer 32

Painless ulcers at site of entry

Widespread erythema (esp. on palms and soles)

CNS, cardiovascular complications