Viral Skin Infections - Wright

Question 1

HSV-1: where does it cause lesions?

Answer 1

perioral, lips, oral cavity

Question 2

HSV-2: where does it cause lesions?

Answer 2

genital area

It takes two to get an STD

Question 3

How is HSV transmitted?

Answer 3

Direct contact

Question 4

History of primary HSV infection?

Answer 4

Pain, burning, and tingling in the area. Possible fever, malaise, LAD

Question 5

What happens symptomatically as HSV recurs?

Answer 5

The symptoms tend to get milder

Question 6

Appearance of HSV infection?

Answer 6

clusters of monomorphous vesicles with an erythematous base; “punched out” lesions and crusted papules

Question 7

What petry dish technique is used to dx HSV?

Answer 7

Tzanck smear, you will see multinucleate giant cells

Question 8

Should you culture/PCR HSV?

Answer 8

Yes

Question 9

What is herpes zoster commonly known as?

Answer 9

Shingles

Question 10

What increases your chances of VZV reactivation?

Answer 10

Age over 60, immunosuppression

Question 11

Where does VZV lay dormant?

Answer 11

Dorsal root ganglia

Question 12

What are some triggers for VZV reactivation?

Answer 12

Trauma, stress, fever, radiation, immunosuppression

Question 13

Clinical appearance of VZV?

Answer 13

grouped vesicles following a DERMATOME; most commonly on the trunk

Question 14

What is positive Hutchinson’s sign? What does this mean (THIS IS ON THE TEST)?

Answer 14

Vesicles at the tip/side of the nose; indicates the nasociliary branch of V1 is involved

Question 15

Why is a positive Hutchinson’s sign a bad thing?

Answer 15

It increases the patient’s risk of blindness

Question 16

What is a common complication of VZV after it resolves?

Answer 16

Postherpetic neuralgia (continued nerve pain) in 5-20% of patients, typically over 40

Question 17

Differentiating between HSV and VZV on history and physical alone?

Answer 17

HSV is not as painful, doesn’t follow a dermatome

Question 18

Is there a vaccine for VZV? Who should get it?

Answer 18

Yes, Zostavax; those 60 and older

Question 19

What is molluscum contagiosum?

Answer 19

Cutaneous infection caused by the pox virus

Question 20

What is the course of molluscum contagiosum? What will it leave behind?

Answer 20

Resolves spontaneously in months to years; can leave behind a depressed scar

Question 21

Clinical manifestation of mollscum contagiosum?

Answer 21

pink to skin-colored, 2-10 mm, dome-shaped, waxy papules, commonly with CENTRAL UMBILICATION

Question 22

Where does molluscum contagiosum commonly present?

Answer 22

Face, upper chest, extremities

Question 23

Treatment of molluscum contagiosum?

Answer 23

No clear evidence to support any one therapy.

She did talk about a drug called Cantharidin. MOA is to essentially cause blister of molluscum, dries up then falls of

Question 24

What causes warts (verrucae)

Answer 24

HPV

Question 25

What are the oncogenic strains of HPV? (she said to know this)

Answer 25

16, 18, 31, 33

Question 26

What do common warts look like? Where are they most common?

Answer 26

Single/multiple skin-colored, hyperkeratotic papules or plaques, might have black dots; most common on the HANDS (but can be anywhere)

Question 27

What are the “black dots” you see in warts?

Answer 27

Thrombosed capillaries

Question 28

What are filliform warts?

Answer 28

Warts that look like fingers; commonly around the eye or mouth

Question 29

Describe flat warts. Where are they most common?

Answer 29

Smooth, skin-colored to slightly tan/pink flat-topped thin papules (3-5mm); legs (most common), face, arms, neck

Question 30

What facilitates the spread of flat warts?

Answer 30

Shaving

Question 31

Where are plantar warts found?

Answer 31

Plantar foot, toes

Question 32

What is commonly seen in the plantar wart?

Answer 32

The black dots

Question 33

What is characteristic of the appearance of anogenital warts?

Answer 33

Can form large masses resembling cauliflower

Question 34

What is the best treatment for warts? Patients don’t like this answer

Answer 34

Over the counter therapies

Question 35

What are the 2 HPV vaccines?

Answer 35

Gardasil (16, 18, 6, 11) and Cervarix (16 and 18)