Pathology #12 - Viral Infections

Front 1

What type of virus is HSV?

Back 1

- herpes simplex virus
- DNA virus
- herpesvirus family

Front 2

What are the two forms of HSV?

Back 2

HSV 1 - spread predominantly through oral (above waist)
HSV 2 - predominantly through sexual contact (lesions below waist)

Front 3

How does spread of HSV to an uninfected host occur?

Back 3

- during periods of asymptomatic viral shedding
- symptomatic active lesions

Front 4

What is the usual incubation period of HSV?

Back 4

3 - 9 days

Front 5

Define PRIMARY INFECTION of HSV?

Back 5

- initial exposure of an individual who has not been previously exposed to the disease

Front 6

Most primary infections of HSV occur when?

Back 6

childhood - subclinical - few result in clinical disease

Front 7

What is the most common form of symptomatic primary HSV?

Back 7

acute herpetic gingivostomatitis

Front 8

acute herpetic gingivostomatitis - Most common pattern of ________HSV infection; most cases occur between ages of ________; _____ onset with anterior ____________, fever (103 to 105°F), anorexia, irritability, and sore mouth lesions; mild to severely debilitating and may last from _____ up to _____.

Back 8

1. symptomatic Primary

2. 6 mos and 5 years

3. abrupt

4.cervical lymphadenopathy

5. 5-7 days up to 2 WEEKS

Front 9

Most cases of acute herpetic gingivostomatitis arise when?

Back 9

6 months to 5 years

Front 10

Explain why HSV is "neurotropic"?

Back 10

it is transported via nerves to sensory ganglia, the TRIGEMINAL GANGLION to reside in a latent form

Front 11

How is diagnosis of HSV usually made?

Back 11

clinical.

Front 12

Which treatment mode is good for HSV and in which time frame?

Back 12

If identified within 2-3 days then ACYCLOVIR is helpful.

Front 13

What is SECONDARY INFECTION of HSV?

Back 13

reactivation of the latent virus, causing vesiculo-ulcerative eruption on infected epithelial surface

Front 14

WHat are PRODROMAL symptoms of HSV?

Back 14

- tingling
- burning
- itching
- pain in site where lesions will appear

Front 15

Where do most secondary lesions of HSV appear?

Back 15

vermillion border and surrounding skin

Front 16

What is the name for the most common form of secondary infection of HSV?

Back 16

- recurrent herpes labialis

Front 17

Intraoral recurrence of HSV are almost always restricted to what types of surfaces?

Back 17

keratinized mucosa that is bound to bone
- attached gingiva
- hard palate

Front 18

Acute herpetic gingivostomatitis Oral lesions:

Affected mucosa initially has __________ -----> rapidly collapse to numerous, ______ ------> enlarge slightly with central _______ covered by _____ -------> adjacent ulcerations _______ ------> larger, shallow, irregular ulcerations. Occurs on ______mucosa. number of lesions variable. In all cases gingiva is enlarged, painful, and extremely erythematous and often has distinctive _______ along mid-facial _______. Involvement of the labial mucosa may spread beyond the wet line to include adjacent vermilion border of the lips. May also have ________ of the perioral skin.

Back 18

1. pinhead vesicles

2. small red lesions

3. central ulceration

4. Yellow Fibrin

5. Coalesce

6.both movable and nonmovable (attached) mucosa

7. punched-out erosions

8. free gingival margins

9. satellite vesicles

Front 19

What is HERPETIC WHITLOW?

Back 19

primary or secondary HSV infection involving the finger.

Front 20

What is the more common layman's term for VARICELLA?

Back 20

Chickenpox

Front 21

How is VZV spread?

Back 21

- direct contact
- airborne droplets

Front 22

Describe the skin lesions of VZV?

Back 22

intensely pruritic vesicles
- "dew-drops on rose petals"

Front 23

Describe the oral lesions of VZV:

Back 23

- few 1-2 mm shallow oral ulcers, generally not as symptomatic as cutaneous lesions

Front 24

How is diagnosis of VZV made?

Back 24

- history of exposure in past 3 weeks
- clinical signs

Front 25

What is the treatment for VZV?

Back 25

- supportive care
- acyclovir for adults, neonates, immunocompromised, and patients with progressive illness

Front 26

Define Herpes zoster?

Back 26

- herpes zoster is the recurrent form of varicella infection.

Front 27

What is the laymans term for Herpes Zoster?

Back 27

- shingles

Front 28

What is the reason that VZV can recur?

Back 28

after initial infection with VZV the virus is transported up the sensory nerves where it resides in a latent form in the DORSAL SPINAL GANGLIA.

Front 29

Describe oral lesions of herpes zoster?

Back 29

Oral lesions occur with trigeminal nerve involvement and are sharply and distinctively unilateral along nerve distribution - STOP AT MIDLINE

Front 30

What can be a cause of significant morbidity with herpes zoster?

Back 30

ocular involvement may lead to permanent blindness

Front 31

Infectious mononucleosis is caused by what virus?

Back 31

Epstein-Barr Virus

Front 32

How is EBV transmitted?

Back 32

Through Saliva - sharing straws or kissing in adults

Front 33

What is the difference between getting EBV in childhood vs adolescent / adult?

Back 33

Childhood - usually asymptomatic
Adol/Adult - develops into infectious mononucleosis

Front 34

What are some signs of Mono?

Back 34

- lymphadenopathy
- oropharyngeal tonsillar enlargement
- oral lesions: lymphoid enlargement, NUG, petechiae on palate

Front 35

What is the treatment for MONO?

Back 35

- IM resolves within 4-6 weeks. No specific treatment other than bed rest.

Front 36

What are the most prominent members of the PARAMYXOVIRUS FAMILY?

Back 36

Measles
Mumps

Front 37

How is MEASLES spread?

Back 37

- airborne droplets

Front 38

Define "Kopliks spots"

Back 38

in Measles, small erythematous macules with white necrotic centers appearing on buccal mucosa

Front 39

Koplik's spots in Measles generally precede skin rash by how long?

Back 39

1-2 days

Front 40

During what period is the MEASLES patient contagious?

Back 40

- 2 days prior to becoming symptomatic
- 4 days after rash develops

Front 41

What are some possible complications of MEASLES?

Back 41

- encephalitis
- viral pneumonia

Front 42

When is the MMR vaccine recommended?

Back 42

- 12-15 months first dose
- 1 months second dosse

Front 43

What is HAND FOOT AND MOUTH disease?

Back 43

Highly contagious systemic infection usually caused by coxsackievirus A.

Front 44

How is HFM disease transmitted?

Back 44

inhalation of airborne droplets or by contact with saliva containing virus

Front 45

HFM disease most commonly occurs in what demographic>?

Back 45

children 1-5 years old

Front 46

Describe the oral lesions of hand foot mouth disease:

Back 46

shallow ulcers 2-7 mm in diameter (1-30) on buccal mucosa, labial mucosa and tongue

Front 47

Describe the skin lesions of hand foot mouth:

Back 47

1-3 mm erythematous macules that may develop a central vesicle

Front 48

What is the treatment for hand foot mouth:

Back 48

self-limiting. Resolves within 7-10 days

Front 49

Define HERPANGINA:

Back 49

enterovirus infection caused by any one of several strains of coxsackievirus A or B or echovirus

Front 50

Describe the lesions of Herpangina:

Back 50

acute onset of sore throat, fever, 1-2mm shallow oral ulcers (2-6) localized to posterior soft palate/tonsillar pillar region

Front 51

What is ACUTE LYMPHONODULAR PHARYNGITIS?

Back 51

localized infection of coxsackievirus A

Front 52

What is ACUTE LYMPHONODULAR PHARYNGITIS characterized by?

Back 52

sore throat, fever, and mild headache

Front 53

What is the clinical features of acute lymphonodular pharyngitis?

Back 53

low numbers (1-5 ) of yellow to dark pink papules develop on soft palate or tonsillar pillars

Front 54

What diseases are related to HERPES SIMPLEX VIRUS?

Back 54

- primary herpes gingivostomatitis
- secondary herpes infections (recurrent herpes labialis)
- genital herpes

Front 55

What diseases are related to VARICELLA ZOSTER VIRUS?

Back 55

- chickenpox
- shingles

Front 56

What disease are related to EPSTEIN BARR VIRUS?

Back 56

- mononucleosis (mono)
- Burkitt's lymphoma
- Nasopharyngeal carcinoma
- hairy leukoplakia

Front 57

What disease are related to HUMAN PAPILLOMAVIRUSES?

Back 57

- oral papilloma / warts
- condyloma acuminatum
- focal epithelial hyperplasia

Front 58

What diseases are related to COXSACKIEVIRUSES?

Back 58

- herpangina
- hand foot mouth disease
- acute lymphonodular pharyngitis

Front 59

This patient has a history of cold sores appearing often on the lips. They present to your office with this condition. What is your diagnosis?

Back 59

Herpetic whitlow

Front 60

This patient has a history of cold sores appearing often on the lips. They present to your office with this condition. What is your diagnosis?

Back 60

Herpetic whitlow

Front 61

This child present to you with ulcerations on the oral mucosa and surrounding areas. They are very painful and some of the blisters have already ruptured. What is your diagnosis?

Back 61

Acute herpetic gingivostomatitis (Primary Herpes Simplex Infection)

Front 62

This child present to you with ulcerations on the oral mucosa and surrounding areas. They are very painful and some of the blisters have already ruptured. What is your diagnosis?

Back 62

Acute herpetic gingivostomatitis (Primary Herpes Simplex Infection)

Front 63

This child present to you with ulcerations on the oral mucosa and surrounding areas. They are very painful and some of the blisters have already ruptured. What is your diagnosis?

Back 63

Acute herpetic gingivostomatitis (Primary Herpes Simplex Infection)

Front 64

This child present to you with ulcerations on the oral mucosa and surrounding areas. They are very painful and some of the blisters have already ruptured. What is your diagnosis?

Back 64

Acute herpetic gingivostomatitis (Primary Herpes Simplex Infection)

Front 65

This child present to you with ulcerations on the oral mucosa and surrounding areas. They are very painful and some of the blisters have already ruptured. What is your diagnosis?

Back 65

Acute herpetic gingivostomatitis (Primary Herpes Simplex Infection)

Front 66

This adult presents with a "cold sore" on the lip. They say that this happens once or twice a year. What is your diagnosis?

Back 66

Recurrent Herpes Labialis

Front 67

This adult presents with a "cold sore" on the lip. They say that this happens once or twice a year. What do you tell the patient?

Back 67

That the lesion should go away within 7-10 days. Can prescribe analgesics for the pain. Acyclovir if the lesion has only been for 2-3 days active.

Front 68

What is this lesion?

Back 68

Recurrent Herpes Labialis

Front 69

What is this lesion?

Back 69

Recurrent Herpes Labialis

Front 70

What virus is this child infected with?

Back 70

Varicella zoster (Chicken pox)

Front 71

What virus is this child infected with?

Back 71

Varicella zoster (Chicken pox)

Front 72

What virus is this child infected with?

Back 72

Varicella zoster (Chicken pox)

Front 73

What virus is this child infected with?

Back 73

Varicella zoster (Chicken pox)

Front 74

This elderly man has a positive history for chickenpox in his childhood. He presents with this severe condition strangely following unilateral trigeminal distribution. What is your diagnosis?

Back 74

Herpes Zoster (Shingles)

Front 75

These are known as "Koplik's Spots". Which condition are they associated with? Why are they significant?

Back 75

MEASLES
They precede the rash by 2 days.

Front 76

What is the percentage of patients sustaining a needle stick from a documented HIV-positive person become infected with HIV?

Back 76

0.3%

Front 77

Which ONE of the following is the most appropriate test for diagnosing acute HIV infection during acute retroviral syndrome?

Back 77

HIV PCR

Front 78

Diagnosis of ORAL CANDIDIASIS is most appropriately made by visual appearance plus which ONE of the following confirmatory lab tests?

Back 78

Gram stain

Front 79

A 27 year old male IDU (Injection Drug USer) presents with multiple smooth, papular, facial lesions, 2-4mm in diameter with a central umbilicus. What is the diagnosis?

Back 79

Molluscum contagiosum

Front 80

AZT and 3YC are antiretroviral drugs which work by which ONE of the following mechanisms?

Back 80

Inhibition of REVERSE TRANSCRIPTASE and DNA CHAIN TERMINATION

Front 81

Efavirenz and Nevirapine are antiretroviral drugs which work by which mechanism?

Back 81

Inhibition of reverse transcriptase alone

Front 82

Nelfinavir and Lopinavir are antiretroviral drugs which work by which mechanism?

Back 82

Inhibiton of protease

Front 83

Saquinavir and Atazanavir are antiretroviral drugs which work by which mechanism?

Back 83

Inhibition of protease

Front 84

Enfuvirtide is an antiretroviral drug which works by which mechanism?

Back 84

Inhibition of HIV/target cell fusion

Front 85

Raltegravir is an antiretroviral drug which works by what mechanism?

Back 85

Inhibition of integrase

Front 86

Maraviroc is an antiretroviral drug which works by what mechanism?

Back 86

Inhibition of chemokine receptor CCR5

Front 87

When should POST EXPOSURE PROPHYLAXIS begin?

Back 87

Within 2 hours of exposure

Front 88

List the AIDS-defining illnesses:

Back 88

- esophageal candidiasis
- oral kaposi's sarcoma
- pneumocystis pneumonia
- extrapulmonary TB

Front 89

regarding HSV infections Children with initial exposure tend to exhibit ________while adults demonstrate more often a ______. HSV-2 exposure correlates directly with ______.

Back 89

1. acute herpetic gingivostomatitis

2. Pharyngotonsillitis

3. sexual activity

Front 90

pharyngotonsillitis - sore throat, fever, malaise, and headache with numerous _______ on tonsils, posterior pharynx. Vesicle rupture ----------> numerous shallow coalescing ulcerations with an overlying diffuse _______. Ninety percent of this type of adult primary infection remains________ to ________

Back 90

1. small vesicles

2. gray-yellow exudate

3. posterior

4. Waldeyer’s ring.

Front 91

Most common site of recurrence for HSV-1 is ______ of the adjacent skin of the lips and is called________ ("cold sore”, "fever blister”) -

_____ of U.S. population believed to have a history of herpes labialis. Most common triggering factors: _______ & ______

Back 91

1. vermilion border

2. herpes labialis

3. 15-45%

4. ultraviolet light and trauma

Front 92

Herpes Labialis Recurrences also seen less often on skin of nose, chin, or cheek. Recurrences also affect oral mucosa almost always limited to the ________mucosa ; lesions more _____; 1-3 mm vesicles ------> collapse, cluster of erythematous macules, enlarge or coalesce -----> _______ ulceration -------> healing within ________

Back 92

1. keratanized (bound to bone - attached gingiva, hard palate)

2. subtle

3. central yellow

4. 7-10 days

Front 93

HSV recurrence in _______ significant and different - persist and spread on the skin until antiviral therapy, immune status improves, or die; oral mucosa also can be involved and may spread to ________; involved sites begin as _______ epithelium ------> spread_______ -------> zone of superficial _____ with circinate, raised, _____ border.

Back 93

1. immunocompromised hosts

2. unbound mucosa

3. brown, raised necrotic

4. laterally

5. erosion

6. yellow