week 1 Flashcards
Why is it called primary GINGIVOSTOMATITIS?
Due to the site of lesions on the gingiva
AND/OR on ANY: oral mucosa
secondary HSV
- age
- systemic
- oral 1 (3 locations)
Age: Usually puberty and after…
Systemic: none
Oral: Vesicles->ulcers
located: 1. Gingiva 2. Hard palate 3. Lips
Differential diagnosis HSV primary (3)
Streptococcal Pharyngitis
Erythema multiforme
ANUG
Differential HSV primary (3) reasons it is not each
- SP (1)
- EM (4)
- AN (3)
Strep- Pharyngeal (posterior lesions) palate/post mouth
Erythema Multi- requires a sensitivity (usually very immediate timing. Target lesion. LARGE crusty lesions on LIP/Buccal mucosa NOT ON GINGIVA!!!!
ANUG-STENCH, [Bleeding gums w/o brushing], commonly has stress or immunocompromised host]
Treatment for Diff diagnosis HSV
(3)
SP EM ANUG
Strep- Streptococcal antibiotics
Erythema Multi- Steroids for type 3/2 hypersens.
ANUG- Oral hygeine and ANUG specific Antibiotics
Differential Diagnosis for HSV secondary
- disease
- Reason it is not (3)
Aphthous ulcers
- No tingling prodromal phase
- Non-keratinized tissue ONLY!!!!
- Never has a vesicle or bulla prior to the ulcers
What is a cause for secondary HSV lesions to not be restricted to Ging, Hard palate, or lips? (2)
Immunocompromised - AIDS etc
Chemotherapy
What are 4 ways to determine HSV diagnosis if the clinical signs are insufficient?
- Biopsy (painful and invasive)
- Fluorescent antibody test (via smear) can be inconclusive with other similar viral DNA (Herpetic family etc)
- Insitu hybridization (expensive)
- Culture (1-3 days)
Pro / con of Biopsy vs smear cytology
Biopsy is invasive/painful
Smear will not show tissue architecture (may be inconclusive or lack specificity)
Tzanck (z-(t)ank) Tank but starts with a z sound…
-indicates it could be what possible diseases? (4)
HSV VZV Cytomegalovirus or Pemphigus vulgaris (common pemphigus)
Describe a Tzanck cell (2)
-what cells are they initially?*
Balloon and glassy
-initially prickle cells of epithelium (obviously of Keratinized tissue)
What is the primary systemic concern for prescribing valtrex for a viral infection?
Kidney function
Supportive care for Primary HSV infection: non-immunocompromised (4) and if fever 1 more (children vs adults)
- Rest
- Fluids
- Soft food
- Xylocaine 2%
* Fever
5c. Tylenol (often children so no aspirin)
6a. Aspirin (adults)
What timing window must be met before giving medication for any HSV?
48 hrs of onset of prodromal symptoms (tingling)
Can we treat a patient for a TOOTH problem if they have an active secondary HSV infection?
-Why might you not treat?
CAREFULLY and only if they have an emergent issue.
- otherwise reschedule them
- -We do not want to spread the involved tissues to another area of the patients face or mouth
Can you premed a patient that has NO signs of a secondary HSV infection (not even tingling)?
-What are they? (3)
Yes
- Lysine (consistent preventative)
- Valcyclovir (expensive but bid)
- Acyclovir (cheap but 5x a day)
Mode of infection VZV
Droplets
People infected with chicken pox
usually children
Adults are either old or immunocompromised
Zoster (shingles)
- who
- Where (2)
- PAIN?
- Lesions? (2)
Age- old / immunocompromised
Where- Follows dermatomes AND UNILATERAL!!!
Pain is severe
Lesions- MACULES and papules (maculo-papular lesions)
Ramsay hunt syndrome is related to ______ specifically in the ______ ganglion?
VZV (zoster) in the Geniculate ganglion (facial nerve)
***VZV still means it is unilateral!!!!
4 general complications of zoster?
Infection of maculo-papule lesions -> ulcers
Neuralgia
Motor paralysis
Ocular inflammation
differential for VZV (2)
why is it not each
HSV-shorter term less pain
Hand foot and mouth disease-lesions on hands and feet…
HSV scenario
- age
- systemic symptoms 5
- Oral symptoms 4
Age: young
Systemic: Fever, malaise, lymphadenopathy, ARTHRALGIA, ANOREXIA
Oral: TINGLING, red, swollen, bleeding gums
Traits of VZV
- Virus type
- Age(s) involved
- Route of infection
- Lesions (describe location, secondary problems, symptom(s))
DNA virus
young, or OLD/immunocompromised
Droplet infection (pneumonia like symptoms for varicella)
Lesions: trunk,head/neck
-often get bacterial infections in lesions
-intense pruritus
Days knocked off of HSV infection by use of prompt (w/in 48 hrs)
At best 2 days… more like 1.5
Theapies for Zoster infections
- Supportive
- Immunocompromised(3)
Supportive Acyclovir: 800mg 5xa-day 7-10 days
Immuno: Systemic antiviral
vidarabine
human leukocyte interferon
Hand foot and mouth disease description
- Virus nucleic acids and type and family
- GROUP infection class
- Route of infection
- Age
- RNA of piconavirus/Coxsackie Group
- Endemic/epidemic
- Airborne OR fecal-oral
- Usually under age 5
Hand foot and mouth description cont
- Incubation time
- Symptoms (4)
Incubation time: Short (fast onset)
Sypmtoms:
123 Low fever, Malaise, Lymphadenopathy
4 SORE MOUTH
Hand foot and mouth cont again…description
- Disease progression?
- Treatments (2)
The disease usually does not progress (self-limiting AND spontaneous resolution)
Treatment: 1 WARM sodium bicarb mouth wash AND 2 tylenol
Herpangina description
- age
- Time of year
- Route of infection
kids
summer
fecal oral
herpangina cont symptoms -Location (3) OF VESICLES -vesicles manifest as \_\_\_\_\_\_ -Non-lesion sypmtoms (4) -Self limiting?
Vesicle location: Soft palate, faucial pillars and tonsils
They manifest in crops (like VZV)
Fever and malaise AND sore throat/dysphagia
IS self limiting
Measles A.K.A.
- Virus type and Nucleic acids
- Spread via
- Age/time of year
- Prodromal symptoms (3)
- paramyxovirus RNA A.K.A: Rubeola
- Airborne droplets
- Kids in WINTER
- Prodromal: fever and lesion tingling! (like HSV)
- –Oral lesions!
Measles: Rubeola
classic oral symptom:
-specific location
-describe oral alteration (3)
Koplik’s Spots
- Found on BUCCAL mucosa
- Red MACULE
- Necrotic center
Measles: Rubeola
-Histo path– cell name, location and description
Histopathology: Warthin-Finkeldey Giant cells
- found in: Lymph tissues
- Desc: Multinucleated Macrophages
-4 dangerous complications of measles
Encephalitis Throbocytopenic purpura -Secondary infections: ---Otitis media ---Pneumonia
Treatment of Measles/Rubeola
Treat the symptoms
- Fever (NSAIDS)
- Fluids
- (etc….)
German measles A.k.A and Family
- Spread via?
- Similar to _______ but more MILD or SEVERE?
Aka Rubella of the TOGA family
Spread via: “contagious” i would assume aerosols
Similar to Measles (rubeola) but more MILD
