VIRAL SKIN INFECTIONS Flashcards
(227 cards)
1
Q
Viruses are facultative intracellular micro org (T/F)?
A
False
They are obligate intracellular!
2
Q
What are the structural components of a virion particle?
A
central core of nucleic acid; DNA or RNA,ss or ds
A protein coat (capsid)
Envelope (in some viruses)
3
Q
What are the two main groups of viruses?
A
DNA viruses
RNA viruses
4
Q
Viral infections causing skin pathology which can either be ?
A
exanthematic
non-exanthematic (enanthematic)
5
Q
What does an exanthema mean?
A
Involving only skin eruptions accompanied by systemic illnesses such as malaise and fever
6
Q
Outline 3 examples of exanthematic viral infections?
A
Chicken pox
Roseola infantum
Ptyriasis rosea
7
Q
What does an enanthema mean?
A
involves mucosal eruptions especially in association with skin.
8
Q
Outline 3 examples of enanthematous viral infections?
A
herpes
warts
Kaposi sarcoma
9
Q
Outline the major groups of virus families?
A
Herpesviridae Human papilloma virus Paramyxoviridae Enteroviruses Retroviruses
10
Q
Latent, lytic and recurrent infections are typical of the herpes viruses (T/F)?
A
True
11
Q
Herpes viruses refers to a large group of RNA viruses capable of infecting animals and humans with about 25 known to infect humans (T/F)?
A
False
They are DNA viruses
Only about 8 are known to infect humans out of 100
12
Q
Itemize the 3 subfamilies of the herpes viruses family?
A
Alphahepesvirinae
Betaherpesvirinae
Gammaherpesvirinae
13
Q
Outline the 9 herpes viruses known to infect man?
A
HSV-1------HHV1 HSV-2------ HHV2 VZV----------HHV-3 EBV ---------HHV-4 CMV--------HHV-5 HHV-6A and HHV-6B HHV-7 Kaposi's sarcoma ------ HHV-8
14
Q
What viruses make up the alphaherpesvirinae?
A
herpes simplex virus 1 and 2
varicella-zoster virus
15
Q
Itemize 4 essential features of the alphaherpesvirinae
A
extremely short reproductive cycle (hours) prompt destruction of the host cell
they have a wide host range
establish latent infection in sensory nerve ganglia.
16
Q
Itemize 4 essential features of the betaherpesvirinae
A
They have a restricted host range
Their reproductive life cycle is long (days) with infection progressing slowly in cell culture systems.
their ability to form enlarged cells
These viruses can establish latent infection in secretory glands, cells of the reticuloendothelial system, and the kidneys.
17
Q
What viruses make up the betaherpesvirinae ?
A
human cytomegalovirus
HHV-6 and HHV-7
18
Q
Itemize 4 essential features of the gammaherpesvirinae
A
They infect and become latent in lymphoid cells. their associations with cancer and cellular proliferation
19
Q
What viruses make up the gammaherpesvirinae?
A
EBV (HHV-4)
HHV -8
20
Q
What are the 2 main types of herpes simplex virus?
A
HSV-1 (oro-facial)
HSV-2 (genital)
21
Q
How is HSV transmitted?
A
DIRECT CONTACT of a susceptible person with droplets from infected secretions
22
Q
What facilitates transmission of HSV?
A
Trauma?
23
Q
What is the usual route of spread of HSV-1?
A
spread by respiratory droplets or by direct contact with infected saliva
24
Q
What is the usual route of transmission of HSV-2?
A
usually transmitted by genital routes; sexual route, virus shed on toilet seats
25
What category of people are at risk of HSV-1 infection?
nail biters. CHILDREN!
thumb suckers
nipples of breastfeeding mother
dentists
26
Infection with HSV-1 may confer immunity against HSV-2 (T/F)?
False
| Infection with either confers no immunity against the other.
27
Oropharyngeal HSV-1 infections result in latent infections in the sacral ganglia (T/F)?
False
| Trigeminal ganglia!
28
Genital HSV-2 infections lead to latently infected trigeminal ganglia (T/F)?
False
| Sacral ganglia
29
Lesions seen in primary HSV infections are usually less numerous than recurrent infections (T/F)?
False
| The are more
30
Systemic diseases commonly accompany primary HSV infections (T/F)?
False
| Only rarely does systemic disease develop.
31
Primary HSV infections are usually subclinical with most being asymptomatic (T/F)?
True!
32
In what group of patients would widespread organ involvement occur in primary HSV infection?
Immunocompromised patients
33
reactivations will still occur spontaneously in spite of HSV-specific humoral and cellular immunity in the host. (T/F)
True!
34
Most recurrences are very symptomatic, reflected by viral shedding in secretions (T/F)?
False
| Many recurrences are asymptomatic, reflected only by viral shedding in secretions, thanks at least to our immune system.
35
Recurrences occur without triggers in HSV-1 infections (T/F)?
False
| In HSV-2
36
HSV recurrent infections are less extensive and less severe in Immunocompromised patients (T/F)?
False.
| In immunocompetent ptx
37
Itemize 5 trigger factors of HSV-1 infection?
```
febrile illnesses
fatigue
emotional stress
premenstrually
exposure to sunlight
dental surgery
```
38
HSV Recurrence is often preceeded by what?
A prodrome of itching and burning!
39
Outline the natural history of recurrence of HSV infections?
Recurrence is often preceeded by a prodrome of itching and burning
Within 24h, red papules appear at the site progress to blisters over 24h
form erosions over the next 24h – 36h
and heal in another 2 to 3 days
40
What is the total duration of a typical outbreak of genital herpes?
7 days
41
How would you differentiate recurrent from primary genital herpes infection?
lesions usually occur in grouped blisters.
Vesicles are smaller
unlike initial infection they tend to occur in the same anatomic region, but not always on identical sites.
42
In what situation would recurrent herpetic infections be increased in incidence and severity, running a prolonged and atypical course ?
Situation of reduced immunity!
43
What term is used to describe the acquisition of HSV at a new site in an individual previously infected ?
"non-primary, first episode" infection
44
Orolabial herpes typically lasts for about 6days (T/F)?
False
| Lasts for abt 2 weeks
45
What is the most striking and common lesion seen in orolabial herpes?
Gingivitis (swollen, tender gums)
46
Primary infections of orolabial herpes in adults commonly cause what?
pharyngitis
tonsillitis
Localized lymphadenopathy
47
Recurrent disease in orolabial herpes may be precipitated by what?
respiratory tract infections (cold sores) ultraviolet radiation
menstruation
stress
48
The cluster of vesicles seen In orolabial herpes is most commonly localized where?
at the border of the lip
49
Intense pain associated with orolabial herpes is usually constant throughout the illness (T/F)?
False
| occurs at the outset but fades over 4–5 days
50
Lesions seen in orolabial herpes usually heal with minimal scarring (T/F)?
False
| Lesions heal without scarring!
51
Outline the natural history of orolabial herpes illness?
Lesions progress through the pustular and crusting stages, and healing without scarring is usually complete in 8–10 days
52
Mention 4 complications of orolabial herpes?
```
Maurice syndrome
Recurrent lymphocytic meningitis
Encephalitis
Keratoconjunctivitis
Recurrent postherpetic erythema multiforme (HLA DQw3)
```
53
Primary genital herpes is usually mild lasting for any 1week (T/F)?
False
It can be severe
Lasting about 3 weeks
54
How would you describe the characteristic lesions seen in primary genital herpes infection?
VESICULOULCERATIVE lesions of the penis of the male or of the cervix, vulva, vagina, and perineum of the female.
55
Lesions in primary genital herpes may be painless (T/F)?
False
| It's painful!
56
Itemize 4 associated symptoms seen in primary genital herpes infection?
fever
malaise
dysuria
inguinal lymphadenopathy
57
Viral excretion in primary genital herpes persists for how long?
about 3 weeks
58
Recurrences of genital herpetic infections are less common but tend to be severe when they occur (T/F)?
False
| Recurrences of genital herpetic infections are common and tend to be mild.
59
How would you differentiate recurrent from primary genital herpes infection clinically?
A limited number of vesicles appear and heal in about 10 days.
60
symptomatic recurrence of genital herpes infection usually indicate a person shedding virus can transmit the infection to sexual partners. (T/F)?
False
Whether a recurrence is symptomatic or asymptomatic, a person shedding virus can transmit the infection to sexual partners.
61
Recurrent genital herpes lesions are always painful (T/F)?
False
| Some recurrences are asymptomatic!
62
How would you differentiate genital herpeticum lesion from the chance seen in syphyllis clinically?
Erosions or ulcerations from genital herpes are usually VERY TENDER and NOT INDURATED as opposed to the chancre of primary syphilis
63
Recurrent genital herpes usually heals without scarring unless the lesion is secondarily infected (T/F)?
True
64
The favored site for recurrent genital herpes particularly in women is? and why is this so?
The buttocks
| may be due to post-coital inoculation!
65
What is the most common non-specific test used in the diagnosis of HSV infection? and what is seen?
TZANCK SMEAR
| Multinucleated giant cells
66
Itemize the specific diagnostic methods used in suspected HSV infection?
Viral culture of blister fluid
Direct fluorescent antibody
Polymerase chain reaction
Skin biopsy; viropathic changes
67
What are the treatment options for HSV infection?
Recurrent herpetic lesion is self-limiting and dries up in about a week if uncomplicated by bacterial infection
LIPS
--zinc oxide ointment and castor oil (soothes and protects from sunlight)
-- 5% IDOXURIDINE in dimethyl sulphoxide should be applied to affected area 2hourly for 2 days.
-- 0.1% IDOXURIDINE in water solution is useful in treatment of the eye.
TOPICAL ANTISEPTIC or ANTIBIOTIC
GENTAMYCIN or OXYTETRACYCLINE ointment 3 times daily for bacterial superinfection.
GENITAL HERPES
BETADINE or POTASSIUM PERMANGANATE solution sit baths 3 times daily.
ZINC OXIDE and CASTOR OIL to soothe, or SULPHUR 5% in zinc oxide.
Alternatively BETADINE ointment or OXYTETRACYCLINE ointment 3 times daily.
SEVERE INFECTIONS or INFECTIONS in IMMUNODEFICIENT patients
if available give ACYCLOVIR 200-400 mg
5 times daily for 5-10 days.
68
Zoster is a mild, highly contagious disease, chiefly of children (T/F)?
False
| Varicella (chickenpox)
69
Varicella is a sporadic, incapacitating disease of children resulting from the reactivation of the residual latent virus in a partially immune person. (T/F)?
False
Zoster (shingles)
It's seen in adults not children
70
Varicella is usually mild in adults and the Immunocompromised (T/F)?
False
| It's more severe!
71
Both Varicella and zoster are caused by the same organism (T/F)?
True
72
How would you differentiate Varicella from zoster?
VARICELLA is the acute disease that follows primary contact with the virus
whereas ZOSTER is the response of the partially immune host to reactivation of varicella virus present in latent form in neurons in sensory ganglia
73
Varicella has a worldwide distribution as opposed to shingles (T/F)?
False
| They both occur worldwide!
74
A killed vaccine is available for the VZV (T/F)?
False
| live attenuated vaccine
75
Varicella is also known as what?
Chicken pox
76
How do you get chicken pox?
spread by the respiratory route
| direct contact with lesions.
77
What is the incubation period for Varicella?
about 14 days [10-21 days]
78
Viral replication of HSV occurs first where?
at the site of infection.
79
Viral replication of VZV occurs first where?
Regional lymph nodes
80
replication of VZV in liver,spleen, lungs associated with secondary viremia (T/F)?
False
| It's primary viremia
81
Infection of mononuclear cells by VZV and development of typical rash is associated with primary viremia (T/F)?
False
| It's secondary viremia
82
Skin Lesions in chicken pox are described as what?
"teardrop” vesicles on an erythematous base
83
Outline the natural history of Varicella infection?
Slight malaise is followed by the development of papules, which turn rapidly into clear vesicles, (lesions appear in crops and are often itchy) the contents of which soon become pustular.
Over the next few days the lesions crust and then clear, sometimes leaving white depressed scars.
84
Which area of the body are more and less affected in chicken pox?
Lesions are most profuse on the TRUNK and least profuse on the periphery of the LIMBS .
85
Lifelong immunity usually follows chicken pocks infection (T/F)?
True!
86
Second episodes of chicken pox would indicate what?
immunosuppression
| another viral infection
87
Itemize 5 possible complications of Varicella infection?
secondary bacterial infection with S.aureus or streptococcal organisms
Pneumonia
Cerebellar ataxia and encephalitis
Reye syndrome (acute hepatitis + encephalopathy due to use of aspirin)
Maternal infection during the first 20weeks may result in congenital malformations or spontaneous abortions.
Neonatal varicella.
88
What are the contraindications of administering VZV vaccine?
patients with immunodeficiencies or blood dyscrasias
89
What are the treatment options for chicken pox?
A live attenuated vaccine is now available, and being more widely used
IN MILD ATTACKS
CALAMINE LOTION topically can be used.
SEVERE ATTACKS and for IMMUNOCOMPROMISED patients
Acyclovir, famciclovir and valaciclovir should be reserved
for the latter, prophylactic aciclovir if given within a day or two of exposure
90
The skin lesions of zoster are histopathologically distinct from those of varicella (T/F)?
False
| They are identical
91
an acute inflammation of the sensory nerves and ganglia is a common finding in chicken pocks (T/F)?
False
| It's zoster!
92
What is the single most important risk factor in the development of herpes zoster?
waning immunity!
| Virus travels down the nerve to the skin and induces vesicle formation.
93
The clinical manifestations of herpes zoster are caused by a newly acquired virus (T/F)?
False
| It's due to virus acquired in the past!
94
Describe the natural history of herpes zoster?
Attacks usually start with a burning pain, soon followed by erythema and grouped, sometimes bloodfilled, vesicles scattered over a dermatome.
The clear vesicles quickly become purulent, and over the space of a few days burst and crust.
95
Occasions when pain is not followed by the eruption in herpes zoster is known as?
zoster sine eruption
96
Keloids is a known complication of zoster scars (T/F)?
True
97
Zoster is characteristically bilateral (T/F)?
False
| It's unilateral
98
Zoster may affect more than one adjacent dermatome (T/F)?
True!
99
patients with zoster cannot transmit the virus to others (T/F)?
False
| They can transmit the virus to others in whom it will cause chickenpox.
100
The thoracic segments and the ophthalmic division of the trigeminal nerve are often involved disproportionately in zoster (T/F)?
True!
101
Persistent herpetic neuralgia is most common in what group of patients?
Elderly
102
What are the components of Ramsay hunt syndrome?
facial palsy
ear pain
associated vesicles
103
Itemize 5 complications of herpes zoster?
SECONDARY BACTERIAL INFECTION
Zoster of the ophthalmic division of the trigeminal nerve can lead to corneal ulcers and scarring. (HUTCHINSON SIGN which indicates involvement of the nasociliary nerve)
PERSISTENT HERPETIC NEURALGIA
MOTOR PALSY (uncommon) but has led to paralysis of ocular muscles, the facial muscles, the diaphragm and the bladder.
DISSEMINATED HERPES ZOSTER
HERPES ZOSTER OTICUS
CNVIII involvement may result in vertigo, dizziness and hearing loss
104
How is herpes zoster diagnosed?
TZANCK SMEAR show multinucleated giant cells and a ballooning degeneration of keratinocytes, indicative of a herpes infection.
CULTURE
105
What are the treatment options for herpes zoster?
EARLY STAGE of diagnosis of the disease
--It is essential that systemic treatment should start within the first 5 days of an attack!
ACICLOVIR; 800mg every 4hrs for 7-10 days FAMCICLOVIR ; 500mg evry 8hrs for 7 days VALACICLOVIR; 1000mg every 8hrs for7 days
Administration of GABAPENTIN in conjuction with antivirals during the acute phase may protect against POST HERPETIC NEURALGIA
LATE DIAGNOSIS
treatment should be SUPPORTIVE with REST, ANALGESICS and bland applications such as CALAMINE.
Secondary bacterial infection should be treated appropriately.
106
What is the treatment of post HERPETIC neuralgia?
```
gabapentin
pregabalin
lidocaine patch 5%
opioid analgesics
TCA
```
107
Roseola infantum is also known as what?
Exanthem subitum or 6th Disease
108
What age group are commonly affected by Roseola infantum?
infants aged under two years
109
What's the incubation period for Roseola infantum?
10-15 days
110
Outline the natural history of the 6th disease?
Begins with Prodromal symptoms: There is fever for a 2 or 3 days which suddenly drops on the fourth accompanied by the rose coloured rash
The Initial rash is A rose pink maculopapular eruption which appears on the neck and trunk,buttocks,sometimes face and extremities
The rash may affect the face and limbs before clearing over one to two days
111
The mucous membrane are rarely spared in Roseola infantum (T/F)?
False
| They are spared!
112
How is Roseola infantum diagnosed?
diagnosed from its clinical features!
113
What is a very important complication of the 6th disease?
febrile convulsions.
114
What are the treatment options for exanthema subitum?
CONTROL FEVER
Fever can be controlled with wet dressings or tepid water sponge baths, supplemental fluids and antipyretics
HHV-6 is insensitive to current antiviral agents, but in immunocompromised children with severe disease some authorities recommend treatment with GANCICLOVIR
115
an acute, self healing exanthem xterised by oval erythemato-squamous lesions of the trunk and limbs is the correct description for what?
Ptyriasis rosea!
116
What viral agents have been implicated in causing Ptyriasis rosea?
HHV-6
| HHV-7
117
What age groups are commonly affected by Ptyriasis rosea?
affects children and young adults[10-35yrs]
118
Second attacks of Ptyriasis rosea are very common after initial resolution (T/F)?
False
| Second attacks are rare!
119
What body regions are usually spared in Ptyriasis rosea?
face
scalp
palms
soles
120
Ptyriasis rosea is a highly contagious infection (T/F)?
False
| It seems not to be contagious!
121
an oval pink or red plaque 2-5cm in diameter, with a finely scaling borders which marks the beginning of Ptyriasis rosea infection is called what?
HERALD or MOTHER PATCH
122
Describe the natural history of Ptyriasis rosea infection?
Typical Ptyriasis rosea begins with a solitary patch called herald patch or mother patch.
It enlarges progressively to abt >= 3cm
Soon after, many smaller oval lesions with scale at their borders appear on the trunk and (upper) arms.
Typically the lesions take on the direction of the langer’s cleavage lines forming a "Christmas tree pattern" on the back and disappear spontaneously within 2 months.
123
Ptyriasis rosea lesions are typically itchy and painful (T/F)?
False
| They usually cause no pain or itch
124
A majority of patients have associated systemic symptoms such as aching and tiredness in Ptyriasis rosea infection (T/F)?
False
| It's a minority!
125
How long do Ptyriasis rosea eruptions last before they resolve?
eruption lasts between 2 and 10 weeks
126
Spontaneous resolution of Ptyriasis rosea lesions sometimes occur leaving hyperpigmented patches that fade away more slowly (T/F)?
False
| It's hypopigmented patches
127
How would you differentiate between pityriasis rosea and secondary syphilis?
It is difficult
However unlike Ptyriasis rosea, Secondary syphilis involves palms and soles with generalized lymphadenopathy!
serological tests for syphilis should be performed!
128
What important investigation must always be carried out in a case of Ptyriasis rosea?
Serological test for syphyllis!
129
Mention 5 differentials of Ptyriasis rosea?
Secondary syphilis; except it involves palms and soles with generalized lymphadenopathy
Seborrhoiec dermatitis; but here it's profuse in presternal and infrasternal areas with scalp involvement
Nummular eczema; except it's pruritic or vesicular.
Lichen planus; diff in histopathology
Pityriasis lichenoides chronica; no herald patch, histopathology
130
What are the treatment options for pityriasis rosea?
No treatment is curative, and active treatment is seldom needed!
A moderately potent topical steroid or calamine lotion will help the itching if present
One per cent salicylic acid in soft white paraffin or emulsifying ointment reduces scaling.
Sunlight or artificial UVB often relieves pruritus and may hasten resolution
131
a vascular neoplasm that affects skin and mucosa, and less commonly involves other organs like lymph nodes, lungs and GI tract describes what?
Kaposi sarcoma!
132
What viruses has been linked to Kaposi sarcoma?
HHV-8
133
What are the variants of Kaposi sarcoma?
classical
endemic
epidemic/ HIV-related
134
purple-black papules and rounded nodules usually on one leg which progress very slowly or remain stationary, patient can survive for over a decade. This describes what variant of KS?
Classical KS
135
Patients with classical KS rarely survive up to 2 years (T/F)?
False
| Patient can survive for over a decade!
136
The most aggressive variant of KS is known as?
Epidemic/ HIV-related KS
137
The epidemic variant of KS has 4 variants (T/F)?
False
| It's the endemic variant!
138
Itemize the 4 types of endemic KS?
benign nodular
aggressive
florid
lymphadenopathic
139
The florid endemic KS variant progresses much faster than any other variant of KS (T/F)?
False
| It's the epidemic/ HIV-related variant
140
What body regions are commonly affected by KS?
the face
the trunk
the genitalia
the proximal limbs especially the thighs
141
What complications may arise from KS lesions?
Lesions may be warty, tumorous, may ULCERATE and they may cause GROSS OEDEMA, especially in the face, penis and scrotum
142
KS often presents with generalised lymph node enlargement or pleural lesion (T/F)?
True!
143
KS lesions usually affect the lower extremities bilaterally (T/F)?
False
| It's unilateral
144
What important examination must always be carried out in a suspected KS patient?
Always examine the mouth!
| Plaques, nodules and tumours in the mouth, especially on the hard palate and tonsils are very common
145
What investigations are carried out in the diagnosis of KS?
```
PCR ASSAYS
Viral DNA can be detected in patient specimens
(Direct virus culture is difficult)
SEROLOGICAL ASSAYS are available to measure persistent antibody to KSHV, using
*indirect immunofluorescence
*Western blot
*ELISA formats.
SKIN BIOPSY
CHEST X-RAY
UPPER & LOWER GI ENDOSCOPY.
```
146
Treatment for KS is mostly palliative (T/F)?
True!
147
What are the treatment options for KS?
Treatment options depend on
* extent of tumor and growth rate
* HIV viral load
* general condition of the patient.
LIMITED SKIN DISEASE
may be treated with
*CRYOTHERAPY
*INTRALESIONAL VINBLASTINE / VINCRISTINE *RADIATION THERAPY
148
Most people will have a wart at some time in their lives (T/F)?
True
149
Their prevalence is highest in adolescents (T/F)?
False
| Childhood!
150
What viral agents is implicated in causing warts?
Human papilloma virus(HPV)
151
Itemize the well recognized types of viral warts and what they cause?
HPV 1,2,4 ---COMMON WARTS
HPV 6,11 ---- ANOGENITAL WARTS
HPV 16,18---GENITAL DYSPLASIA/CERVICAL CA
152
How do you get viral warts?
close contact; direct or indirect!
| Viral particles are released from the surface of papillomatous lesion
153
Why do we have different kinds of warts?
Papillomaviruses cause infections at cutaneous and mucosal sites, sometimes leading to the development of different kinds of wart
154
What is the pathogenesis of viral warts?
It is likely that microlesions allow infection of proliferating basal layer cells at other sites or within different hosts.
155
HPV Genital warts are usually acquired through?
sexually transmitted
156
Mention the HPV types implicated in common warts?
HPV 1, 2, 4, 27, 57 and 63
157
Common warts are most commonly seen in what group of individuals?
Teenagers!
158
How is common wart spread?
By contact
| Auto-innoculation
159
What is usually the first sign of common wart infection?
smooth skin-coloured papule.
160
Common warts can occur at any age (T/F)?
True
161
Describe the typical history of common wart infection?
The first sign is a smooth skin-coloured papule which enlarges into an irregular hyperkeratotic surface giving it the classic ‘warty’ appearance
162
What HPV types are implicated in plantar warts?
HPV 1, 2, 4, 27, and 57
163
Common warts can be painful urging the patient to seek treatment (T/F)?
False
| It's plantar warts!
164
How can plantar warts be differentiated from corns?
Presence of bleeding capillary loops allows plantar warts to be distinguished from corns
165
Common warts are associated with presence of bleeding capillary loops (T/F)
False
| It's plantar warts!
166
This kind of warts has a rough surface, which protrudes only slightly from the skin and is surrounded by a horny collar. This describes what?
Plantar warts!
167
What are the treatment options for palmoplantar warts?
KERATOLYTIC THERAPY
SALICYLIC ACID 25% ointment twice daily. followed by CUTTING or SCRAPING the warts with a pumice stone, callus file or a knife twice a week.
Preparations of SALICYLIC ACID 5-20% and LACTIC ACID 5-20% in COLLODION are easier to use.
Light ELECTRO DISSECTION and CURETTAGE.
FREEZE with LIQUID NITROGEN when available
168
Warts resolve spontaneously in the healthy as the immune response overcomes the infection (T/F)?
True
169
Warts resolve spontaneously within 2 weeks without treatment (T/F)?
False
| 6 mnths to 2yrs
170
Plane warts most commonly affects which area of the body?
the face and brow
| the backs of the hands.
171
smooth flat-topped papules usually skin-coloured or light brown that become inflamed as a result of an immunological reaction, just before they resolve spontaneously correctly describes what?
Plane warts!
172
What kinda warts exhibit positive koebners phenomena?
Common warts
| Plane warts
173
Plain warts are usually multiple and painful (T/F)?
False
| They are multiple and painless!
174
What are the treatment options for plane warts?
SALICYLIC ACID 2-5% ointment twice daily for 4-8 weeks.
LIMITED NUMBER OF LESIONS
CURETTAGE with a SHARP CURETTE.
ELECTROSURGERY may be carefully tried but may leave hypopigmented scars.
CAUSTIC PENCIL (=silver nitrate pencil) daily.
If lesions are WIDESPREAD and salicylic acid 2-5% ointment is not successful, it is BEST to LEAVE!!
175
What is the risk of electrosurgery therapy in TX of plane warts?
May leave hypopigmented scars!
176
Low-risk genital HPV types are implicated in anogenital warts (T/F)?
True
| HPV 6 & 11
177
most HPV induced genital dysplasias are caused by HPV 6 and 18 (T/F)?
False!
| It's HPV 16 & 18
178
What are the various routes of transmission of condyloma acuminata?
by DIRECT CONTACT
usually through SEXUAL INTERCOURSE,
sometimes by INFECTED HANDS
from MOTHER TO CHILD during CHILDBIRTH.
179
The lesion seen in anogenital warts can be described as?
Papillomatous cauliflower-like lesions, with a moist macerated vascular surface which may coalesce to form huge lesions causing discomfort and irritation.
180
The vaginal and anorectal mucosae may be affected in condyloma acuminata (T/F)?
True!
181
What agent is used in the treatment of anogenital warts in pregnant women?
Trichlorocacetic acid 50-88% solution
182
What are the treatment options for anogenital warts?
*Women with anogenital warts, or who are the partners of men with anogenital warts, should have their cervical cytology checked regularly*
PODOPHYLLOTOXIN (0.5% solution or 0.15% cream)
IMIQUIMOD (5% cream).
**Both are irritants and should be used carefully
**Apply podophyllin carefully to the warts with the back of a matchstick. Leave it on for 4 to 6 hours then wash off with water and soap. Repeat weekly until cleared.**
TRICHLOROACETIC ACID (50-88%) solution, applied in the clinic, may be used in pregnancy.
CRYOSURGERY with LIQUID NITROGEN .
CAUTERISATION of large and/or refractive genital warts. *This can be a very useful procedure but is controversial*
Topical 5% 5-FU cream (EFUDIX) may be used once daily to once weekly for up to 6 months after any of these treatments to prevent recurrences!
183
What viruses is implicated in Molluscum contagiosum?
Pox virus!
184
How is Molluscum contagiosum spread?
spread by DIRECT CONTACT;
SEXUALLY
SHARING A TOWEL at the swimming bath
185
What group of individuals are commonly affected by Molluscum contagiosum?
Children!
186
Molluscum contagiosum lesions are commonly present on what body regions?
Face
eyelids
occasionally on the limbs and trunk
187
Whatbis the incubation period for Molluscum contagiosum?
ranges from 2 to 6 weeks?
188
Several members of the family are often affected by Molluscum contagiosum (T/F)?
True!
189
A typical description of Molluscum contagiosum lesions will include?
Individual lesions are shiny, white or pink, and hemispherical with central punctum, which may contain a cheesy core, giving the lesions their characteristic umbilicated look.
190
Distribution of Molluscum contagiosum lesions depends on what?
The mode of infection
191
Multiple lesions are rarely seen in Molluscum contagiosum infection (T/F)?
False
| Multiple lesions are commonly seen
192
What group of individuals are prone to extensive lesions in Molluscum contagiosum infection?
Atopic individuals
immunocompromised
spread by scratching
use of topical steroids
193
Untreated lesions In Molluscum contagiosum usually clear in 2 months (T/F)?
False
| 6-9 months
194
Individual lesions rarely persist for more than 6-9 months in Molluscum contagiosum infection (T/F)?
False
| 2 months
195
Lesions in Molluscum contagiosum infection are usually accompanied by a brief local inflammation before complete resolution (T/F)?
True!
196
Mention 2 complications seen in Molluscum contagiosum infection ?
Large solitary lesions may take longer.
Some leave depressed scars
Traumatized or overtreated lesions may become secondarily infected
197
Diagnosis in Molluscum contagiosum is by?
PCR can detect viral DNA sequences
| ELECTRON MICROSCOPY can detect poxvirus particles.
198
What is an effective therapy for Molluscum contagiosum in children?
Cantharidin!
199
Why may treatment of Molluscum contagiosum be difficult?
because of the closeness of lesions to the eyes!
200
Outline treatment options for Molluscum contagiosum infection?
* Can be FROZEN with ETHYL- CHLORIDE SPRAY and CURETTED.
* Spiking the umbilicated centres with a sharp-pointed tooth pick stick which has been dipped in strong IODINE SOLUTION.
* CAUSTIC PENCIL (silver nitrate pencil) for small molluscum.
* Caustic treatment with 80% PHENOL or 50-88% TRICHLOROACETIC ACID.
* CANTHARIDIN is an effective therapy in children.
201
Measles infection confers lifelong immunity (T/F)?
True
202
Measles is a chronic infection (T/F)?
False
| It's an acute infection
203
acute, highly infectious disease characterized by fever, respiratory symptoms, and maculopapular rash correctly describes what infection?
Measles infection!
204
Measles virus is highly contagious with multiple serotype and has no animal reservoir (T/F)?
False
| It has a single serotype
205
Inapparent infections are rare in measles (T/F)?
True
206
How is measles transmitted?
predominantly via the respiratory route (by inhalation of large droplets of infected secretions).
207
What is the incubation period for measles virus?
9-12 days
208
Measles is an epidemic throughout the world (T/F)?
False
| It's an endemic
209
In general, epidemics of measles recur regularly every 5–6years (T/F)
False
| Every 2-3 years
210
What determines the severity of measles infection in any community?
A population's state of immunity is the determining factor.
| The disease will flare up when there's accumulation of susceptible children
211
Not all ages will develop clinical measles (T/F)
False
| All ages!
212
Where does the measles virus undergo replication?
Reticuloendothelial cells!
213
Secondary viremia is typically associated with replication of measles virus in the reticuloendothelial system (T/F)?
False
| It's Primary viremia
214
Primary viremia is typically associated with seeding of epithelial surfaces of the body, including the skin, respiratory tract, and conjunctiva (T/F)
False
| It's secondary viremia
215
Focal replication of measles virus typically occurs where?
Epithelial surfaces
216
What is typically seen in lymphoid tissues throughout the body (lymph nodes, tonsils, appendix) in measles infection?
Multinucleated giant cells with intranuclear inclusions
217
Describe the typical natural history of measles illness?
1) An incubation period of 9-12 days
2) Its typically a 7- to 11-day illness (with a prodromal phase of 2–4 days followed by an eruptive phase of 5–8 days).
3) The fever and cough persist until the rash appears and then subside within 1–2 days
4) The rash, which starts on the head and then spreads progressively to the chest, the trunk, and down the limbs, appears as light pink, discrete maculopapules that coalesce to form blotches, becoming brownish in 5–10 days.
5)The fading rash resolves with desquamation.
Symptoms are most marked when the rash is at its peak but subside rapidly thereafter.
218
When does the maculopapular rash of measles appear?
The characteristic maculopapular rash appears about day 14 after exposure.
219
The maculopapular rash of measles appears just as circulating antibodies become detectable thus the viremia disappears and the fever falls T/F)?
True!
220
The prodromal phase of measles is characterized by what?
```
fever
malaise
sneezing
coughing
running nose
conjunctivitis
Koplik's spots
```
221
The cough and coryza of measles reflect what?
reflect an intense inflammatory reaction involving the mucosa of the respiratory tract
222
What are koplik spots and what do they contain?
They are small, bluish-white ulcerations on the buccal mucosa opposite the lower molars pathognomonic for measles
These spots contain giant cells and viral antigens
223
When do the koplik spots of measles appear?
appear about 2 days before the rash.
224
Mention 5 complications of measles infection?
Giant cell pneumonia, more common in adults
Otitis media
Post-measles encephalitis
Subacute sclerosing panencephalitis (SSPE)
Thrombocytopenic purpura
Fetal death in pregnancy
225
Measles pneumonia is more common In children (T/F)?
False
| In adults
226
How is the diagnosis of measles made?
```
CLINICALLY
Characteristic fever
koplik spots
conjunctivitis
respiratory symptoms
typical exanthema.
```
Antigen detection from epithelial cells in respiratory secretions and urine
SEROLOGY--- ELISA
227
What are the treatment options for measles?
Ribavirin
Vitamin A
Prevention is with live attenuated measles vaccine
