viruses and bacteria

Question 1

how does syphilis present? (3)

Answer 1

• primary = painless ulcer (chancre) at inoculation site + enlarged LNs
• secondary = snail track ulcer, widespread red/brown rash, generally unwell
• tertiary (10-30yrs later) = gumma, nasal speech, Holmes Adie pupil, leukoplakia

Question 2

s/s of primary syphilis (2)

Answer 2

• painless ulcer (chancre) at inoculation site (self-limiting)
• enlarged LNs

Question 3

s/s of secondary syphilis (3)

Answer 3

• snail track ulcer
• widespread red/brown rash
• generally unwell

Question 4

s/s of tertiary syphilis (4)

Answer 4

10-30yrs later:
- gumma
- nasal speech
- Holmes Adie pupil
- leukoplakia

Question 5

describe syphilitic gumma (4)

Answer 5

• feature of tertiary syphilis
• highly destructive, deep, subcutaneous nodule that grows and adheres to the skin
• central site ulcerates
• releases viscous, gum-like pus

Question 6

which bacteria causes tuberculosis

Answer 6

Mycobacterium tuberculosis

Question 7

s/s of tuberculosis (9)

Answer 7

• malaise
• reduced appetite
• weight loss
• fever
• night sweats
• cough with purulent/rusty red sputum
• deep oral ulcers with punched out centre and red margin
• hilar lymphadenopathy
• caseating granulomas

Question 8

common sites for tuberculosis-related oral ulcers (3)

Answer 8

BM
hard palate
tongue

Question 9

describe Staphylococcus aureus scalded skin syndrome (age, presentation, tx)

Answer 9

• <6yo
• peeling skin with background erythema
• SPARES mucous membranes
• tx with IV antibiotics if needed

Question 10

which virus is HHV1?

Answer 10

herpes simplex (primary and recurrent)

Question 11

which virus is HHV2

Answer 11

herpes simplex (predominantly genital)

Question 12

which virus is HHV3?

Answer 12

varicella zoster virus

Question 13

which virus is HHV4?

Answer 13

Epstein Barr virus

Question 14

which virus is HHV5?

Answer 14

cytomegalovirus

Question 15

what condition is HHV6 linked to?

Answer 15

multiple sclerosis

Question 16

what condition is HHV8 related to?

Answer 16

Kaposi’s sarcoma

Question 17

describe primary herpetic gingivostomatitis (what, age, s/s)

Answer 17

• manifestation of HSV1
• <5yo
• fever, submandibular lymphadenopathy, headache
• coalescing ulcers, red gingiva, ooze and serous exudate
• affecting keratinised areas, pharynx, perioral region and lips

Question 18

primary herpetic gingivostomatitis age

Answer 18

<5yo

Question 19

s/s of primary herpetic gingivostomatitis (4)

Answer 19

• fever
• coalescing ulcers
• red gingiva
• ooze and serous exudate

Question 20

primary herpetic gingivostomatitis management (5)

Answer 20

• immunocompetent = resolves spontaneously within 14 days
• rest, soft diet (cold, bland)
• adequate fluid intake
• analgesics
• antivirals (within 48 hours of starting) +/- systemic treatments if severe or immunocompromised

Question 21

describe herpes labialis (4)

Answer 21

• recurrent form of HSV1 infection
• triggered by stress, coinfection, hormones, immunosuppression
• small blisters on the lips, gums, throat
• ulcers with crusting

Question 22

HSV infection histology (3)

Answer 22

• acantholysis
• enlarged herpes-infected cells (multinucleated, ground glass appearance)
• immunohistochemistry = brown nuclei in keratinocytes

Question 23

what does HHV3 cause? (virus, infections with descriptions)

Answer 23

• Varicella Zoster virus
• varicella = primary infection “chickenpox”; highly infective but self-limiting, pruritus, scarring, secondary infections
• zoster = reactivated form “shingles”, in extremes of age, unilateral vesicles/ulcers with crusting, pyrexia, malaise

Question 24

describe chickenpox (virus, presentation)

Answer 24

• Varicella Zoster virus
• primary infection
• highly infective but self-limiting
• pruritus, scarring, secondary infections
• pyrexia, malaise, pharyngitis

Question 25

management of chickenpox

Answer 25

- antipyretic/analgesia - adequate hydration, soft diet - oral antiviral if risk of complications (eg immunocompromised)

Question 26

describe shingles (virus, presentation)

Answer 26

- Varicella Zoster virus - reactivated form, in extremes of age - unilateral vesicles/ulcers with crusting - pyrexia, malaise

Question 27

what is HHV4 associated with? (4)

Answer 27

- Epstein Barr virus - infectious mononucleosis/glandular fever - oral hairy leukoplakia - Burkitt's lymphoma - nasopharyngeal carcinoma

Question 28

describe infectious mononucleosis (cause, age, symptoms)

Answer 28

- Epstein Barr virus - teens and young adults - sore throat, malaise, pyrexia

Question 29

describe oral hairy leukoplakia (cause, demographic, presentation)

Answer 29

- recurrent form of Epstein Barr virus - immunocompromised pts - vertical linear corrugated white patches on lateral tongue

Question 30

oral hairy leukoplakia histology (4)

Answer 30

- hair-like projections with hyperkeratosis - linear band of vacuolated (clear) cells in prickle cell layer - often fungal hyphae colonisation without inflammation - in situ hybridisation - blue nuclei in prickle keratinocytes

Question 31

what is HHV5 associated with? (3)

Answer 31

- cytomegalovirus - illness similar to infectious mononucleosis - CMV sialadenitis (mimics mumps) - oral ulceration in immunocompromised pts (deep, indurated or flat and irregular)

Question 32

what does cutaneous Kaposi's sarcoma look like?

Answer 32

diffuse, small, like a bruise, may be multiple

Question 33

what does oral Kaposi's sarcoma look like?

Answer 33

macular, nodular - like a bruise or proliferative may be multiple

Question 34

describe Kaposi's sarcoma (what, association, histology)

Answer 34

- form of angiosarcoma related to HHV8 - associated with thrombocytopaenia - lamina propria replaced by tumour with vasodilation and many extravasated RBCs - immunohistochemistry shows brown nuclei

Question 35

describe hand-foot-mouth disease (cause, oral presentation)

Answer 35

- coxsackie viruses - self-limiting, very infectious - multiple sore small vesicles on soft palate with large areas of erythema

Question 36

give some topical treatments for viral diseases (3)

Answer 36

- acyclovir 5% cream - 5x/day, 3-4 hours intervals - penciclovir 1% cream - every 2 hours - idoxyuridine in dimethyl sulfoxide (traditional) - QDS

Question 37

why do systemic viral treatments tend to have low compliance?

Answer 37

high frequency of pills

Question 38

give some systemic viral treatments (4)

Answer 38

- acyclocir 200mg 5x/day for 5/7 - valcyclovir 1g TDS for 7 days (VZV) or 500mg BD for 5 days (HSV) - famiciclovir 1500mg single dose (HSV, USA) - CMV = IV gancyclovir, cidofovir, foscarnet

Question 39

how are most primary viral infections managed in healthy patients? (3)

Answer 39

- bed rest - fluids - simple analgesics (self-limiting, supportive)

Question 40

what are Koplik's spots? (3)

Answer 40

- bright red spots with white or bluish-white centres - buccal mucosa - diagnostic/pathognomic feature of measles in the pre-eruptive stage