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251 Cards in this Set
- Front
- Back
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Primary health care reflects and evolves from what three things?
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Economic conditions
Sociocultural environment Political characteristics |
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Primary health care addresses the main health problems in the community providing what four things?
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Promotive
Preventive Curative And rehabilitative services |
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Primary health care includes at the very least what two things?
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Education concerning prevailing health problems
Methods of preventing and controlling health problems |
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Primary health care involves all related sections and aspects of national and community development including what 8 things?
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1. Agriculture
2. Animal husbandry 3. Food 4. Industry 5. Education 6. Housing 7. Public works 8. Communications and other sectors |
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Primary health care should be sustained by what three things?
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Integrated,
functional and mutually supportive referral systems. |
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What is the progress of a disease process in an individual over time, in the absence of intervention?
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Natural History
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What are the three outcomes of natural history?
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Recovery
Disability Death |
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What is the difference between the spectrum of disease and the natural history of disease?
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The spectrum of disease is primarily a population concept, while natural history is primarily a concept relating to individuals.
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The spectrum concept is useful for studying the ?
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Natural history of infectious and non-infectious diseases.
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What are the four stages of spectrums?
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1. Susceptibility stage (pre-disease)
2. Sub-clinical or Inapparent stage 3. Clinical Stage 4. Recovery, disability or death stages. |
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Within the stage system, when does exposure usually occur?
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Exposure usually occurs between the susceptibility stage and the subclinical disease stage.
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Within the stage system, when are pathologic changes noticed?
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During the stage of subclinical disease.
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At what stage is the onset of symptoms noticed?
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The onset of symptoms occurs between the subclinical disease stage and the stage of clinical disease.
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The usual diagnosis of a disease is made in what stage?
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Stage of clinical disease.
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In this stage the disease has not yet developed, but the groundwork has been laid with the presence of risk factors/exposure.
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Stage 1, susceptibility stage.
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This is the stage of pre-symptomatic disease. Through interaction of risk factors, pathogenic changes have started to occur but the disease does not manifest itself?
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Stage 2, subclinical or Inapparent stage.
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Stage 2, the subclinical or Inapparent stage of disease, is known as what with regards to infectious disease?
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The incubation period.
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Stage 2, the subclinical or Inapparent stage of disease, is known as what with regards to chronic disease?
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The latency period
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What is the latency period for Hepatitis A
HIV infection to AIDS Mesothelioma |
Hepatitis A about 2-6 weeks
HIV to AIDS median 9 years Mesothelioma median 35 years |
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In clinical disease, the latent period refers to what?
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Time interval from infection to infectiousness. e.g. in STD
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The incubation period (time from infection to development of symptomatic disease) parallels the induction and latent period of what?
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Subclinical disease
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Diseases with a short incubation period usually have a short course. These are known as?
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Acute disease
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Infections and toxic disorders are usually classified as what kind of diseases?
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Acute
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What is an example of an acute disease being severe and prolonged?
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Post viral syndromes
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Diseases that have long incubation periods (or latency) generally have a long clinical course and, if so, by convention they are called?
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Chronic disease
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Some chronic diseases paradoxically lead to sudden and unexpected death. What are two cardiovascular examples?
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Stroke or Heart Attack
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These attempt to identify the disease process during this (sub-clinical or inapparent stage of disease) phase of its natural history?
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Screening programs
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For most health problems there are large numbers of what three cases of disease?
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Unapparent
Undiscovered or Misdiagnosed cases of disease |
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In stage III, the clinical stage of disease, sufficient anatomic and functional changes have occurred with what two things?
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Recognizable signs
& Symptoms |
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This keeps the disease process from becoming established by eliminating causes or increasing resistance to the disease?
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Primary 1st degree Prevention
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What are the two major categories of primary 1st degree prevention?
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1. Health Promotion
2. Specific Protection |
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This is the process of enabling people to increase control over the determinants of health and thereby improve their health.
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Health promotion
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What are four examples of Primary 1st degree Prevention?
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1. Immunization/Vaccines
2. Antimicrobial drugs as prophylaxis 3. Environmental sanitation or modification 4. Protection against injuries and toxic exposures. |
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This interrupts the disease process before it becomes symptomatic?
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Secondary 2nd degree prevention
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What are the three cornerstones of secondary prevention?
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1. Early detection
2. Prompt Treatment 3. Screening Asymptomatic persons to uncover disease in early stages. |
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This limits the physical and social consequences of symptomatic diseases. The goal is to improve survival and quality of life.
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Tertiary third degree prevention
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This is a part of tertiary 3rd degree prevention:
Procedures or measures aimed at correcting the anatomic and physiologic components of disease in symptomatic persons. To halt the disease process and thus prevent or limit the impairment caused by the disease. |
Disability limitation
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This is part of tertiary 3rd degree prevention:
To mitigate the effectys of disease and to prevent it from resulting total social and functional disability. To restore a disable person to a useful and self-sufficient role in society thru psychosocial, medical and vocational services. |
Rehabilitation
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What is the primary purpose of public health and medicine?
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To influence favourably the natural history of disease.
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It is the rate of new disease events in a population during a period of time.
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Incidence rate
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It is the proportion of individuals with existing disease during a period of time.
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Prevalence rate
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This is the percentage of persons diagnosed as having a specified disease who die as a result of that illness within a given period.
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Case fatality rate
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This measures the frequency of all current events (old and new) at a given instant in time.
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Point prevalence
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This measures the frequency of all current events (old and new) for a prescribed period of time.
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Period prevalence
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This is an incidence rate calculated for a specific disease for a limited period of time during an epidemic.
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Attack rate
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When epidemiologists observe the relationships between exposures and disease outcomes in free-living populations, they are conducting?
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Observational studies
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When epidemiologists or clinicians test interventions aimed at minimizing the disease producing exposures and optimizing health promoting exposures or factors they are performing?
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Experimental studies
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This is a brief, objective report of a clinical characteristic or outcome from a single clinical subject or event.
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Case report
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This is an objective report of a clinical characteristic or outcome from a group of clinical subjects.
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Case series report
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The presence or absence of disease and other variables are determined in each member of the study population or in a representative sample at a particular time.
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Cross-sectional study
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This identifies a group of people with the disease and compares them with a suitable comparison group without the disease. It can help determine caused relationships. Very useful for studying conditions with very low incidence or prevalence of disease.
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Case-control study
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Population group is identified who has been exposed to risk factor is followed over time and compared with a group not exposed to the risk factor.
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Cohort study
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In this observational study the subjects are tracked forward in time. It can determine incidence and causal relationships. It is important to follow population long enough for incidence to appear.
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Prospective study
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In this experimental study, research that involves the administration of a test regimen to evaluate its safety and efficacy occurs.
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Clinical trial
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Experimental study, subjects who do not receive the intervention under study are used as a source of comparison to be certain that the experiment group is being affected by the intervention and not by other factors.
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Control group
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What is another name for the control group in experimental studies?
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Placebo group
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What is phase one of the FDA's three phases of clinical trials?
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Phase One: Testing safety on healthy volunteers.
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What is phase two of the FDA's three phases of clinical trials?
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Testing protocol and dose levels in small group of patient volunteers.
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What is phase three of the FDA's three phases of clinical trials?
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Testing efficacy and occurrence of side effects in larger group of patient volunteers.
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Phase three of the FDA's three phases of clinical trials is considered?
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The definitive test.
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Randomized controlled clinical trial:
This means that neither subjects nor researchers who have contact with them know whether the subjects are in the treatment or comparison group. |
Double blind
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Randomized controlled clinical trial:
Experiment in which the unit of allocation to receive a preventive or therapeutic regimen is an entire community or political subdivision. Does the treatment work in real world circumstances. |
Community trial
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Randomized controlled clinical trial:
For ethical reasons, no group involved can remain untreated. All subjects receive intervention but at different times. Assume double-blind design. |
Crossover study
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Rate of live births in a population during a time period.
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Birth rate
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Rate of live births among women of childbearing ages 15-44 in a population during a time period.
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Fertility rate
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Rate of deaths in a population during a time period.
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Mortality rate
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Yearly rate of deaths among children less than 1 year of age in relation to the number of live births during the same year.
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Infant mortality rate
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Infant deaths prior to day 28 per 1000 live births.
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Neonatal mortality rate
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Infant deaths from day 28 through 365 per 1000 live births.
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Postneonatal mortality rate
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What is the name of the neonatal mortality rate plus the postneonatal mortality rate?
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Infant mortality rate.
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What is the order of the "evidence pyramid"?
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1. Meta-Analysis
2. Systematic Review 3. Randomized Controlled Trial 4. Cohort studies 5. Case Control studies 6. Case Series/Case Reports 7. Animal research/Laboratory studies |
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This study will thoroughly examine a number of valid studies on a topic and combine the results using accepted statistical methodology as if they were from one large study.
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Meta-Analysis
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usually focus on a clinical topic and answer a specific question. An extensive literature search is conducted to identify all studies with sound methodology. The studies are reviewed, assessed, and the results summarized according to the predetermined criteria of the review question. The Cochrane Collaboration has done a lot of work in the area
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Systematic reviews
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carefully planned projects that study the effect of a therapy on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control groups (no intervention).
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Randomized controlled clinical trials
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Studies that show the efficacy of a diagnostic test are called ?
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prospective, blind comparison to a gold standard study
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What is the best study for these questions?
Type of Question 1. Therapy 2. Diagnosis 3. Etiology/Harm 4. Prognosis 5. Prevention 6. Clinical Exam 7. Cost |
1. RCT>cohort > case control > case series
2. prospective, blind comparison to a gold standard 3. RCT > cohort > case control > case series 4. cohort study > case control > case series 5. RCT>cohort study > case control > case series 6. prospective, blind comparison to gold standard 7. economic analysis |
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What are the two aims of chemoprophylaxis?
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Aimed at preventing infection or relapse.
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What are the two basic principles of chemoprophylaxis?
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Use as narrow a spectrum as possible
Use as short a treatment as possible |
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IgG - Immediate protection - no memory - is an example of ?
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Passive immunization
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The standard Igs (human, animals) from pooled plasma from donors, the Igs can be used vs. many common viruses. These are described as what?
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Non-specific
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Human hyperimmune serum (high titre) come from donor c. high titre antibodies to specific virus, and is useful against a specific single virus. These are described as what?
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Specific
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What is one of the main reasons to use passive immunization?
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Because there is no effective vaccine or the time needed for the existing vaccine is too short.
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1. When do infants begin to produce active immunization "antibodies"?
2. When do you normally stat immunizations in children? |
1. In the first year.
2. Usually at 2 months |
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What three things are a part of the chain of transmission?
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Source (infected) - - to - - Index Case - - to - - Secondary
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What is the function of immunizations/vaccinations based off of?
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The existence of prolonged and protective secondary immune response.
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High affinity in a vaccine means what?
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A stronger immune response
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Active immunization involves administration of all or part of a microorganism or a modified product. What are the three types of products in an active immunization?
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Toxoid
Purified antigen Antigen produced by genetic engineering |
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This vaccine multiplies inside human host and provides strong antigenic stimulation. This leads to prolonged immunity (yrs to life, often with a single dose.
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Active vaccine: Live attenuated pathogens
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In what situations are live attenuated pathogens: active vaccines: contraindicated?
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Pregnancy and immunocompromised individuals.
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What type of vaccine does not multiply in human host, provides little cell mediated immunity, and requires multiple doses of vaccine with subsequent booster doses?
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Active vaccine: Killed micro-organism
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These vaccines are extracted molecules from pathogens, from acellular filtrate of culture medium in which organisms grow, or from recombinant DNA techniques?
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Active vaccine: Microbial extracts
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When are active microbial extract vaccines prepared with toxoids used?
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When a pathogenicity of an organism is due to secreted toxin, e.g. tetanus, diphtheria
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These vaccines have covalent bonding (conjugation) of an antigenic polysaccharide to a protein, used in children under two years old?
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Active vaccine: Conjugated vaccines
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What vaccines are usually the safest and produce the most robust immune response?
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Active vaccine: Conjugated vaccines
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What vaccines are derivatives of bacterial exotoxins, rendered non toxic but remain immunogenic. They are administered IM, SC?
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Active vaccine: Toxoids
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What is an example of a active vaccine: Toxoids?
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Tetanus, Diphtheria
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Which vaccines are IgG, IgA cell mediated?
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Living vaccines
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What vaccines are mainly IgG, and they have little or no cell mediation?
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Non living vaccines
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Immunization can result in the activation of what five things?
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Antitoxin
Anti-Adherence Anti-Invasive Neutralizing Or other types of protective humoral or cellular response from the recipient. |
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What are the three responsibilities of health care providers when administering vaccinations?
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Follow vaccine directives
Maintain records Report adverse events |
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Providers are expected to use vaccine information statements available from the CDC for what 5 vaccines?
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MMR
Polio Pertussis Tetanus Diphtheria |
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In what disease, which can be avoided with screening and immunizations, do 90% of infants with perinatal infection develop chronic infection?
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Hepatitis B
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When is the hepatitis B vaccination first administered?
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At birth
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When can a hepatitis B vaccination at birth be delayed?
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If the mother is Hep B negative and in rare cases a provider orders a copy of the mother's negative HBsAg lab report in the infant's medical record.
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When are the second and third dose of Hepatitis B vaccine administered?
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2nd dose - 1-2 months
3rd dose - no earlier than 24 weeks |
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Infants born to HBsAG positive mothers should be tested for HBsAG and antibody to HBsAG after completion of at least how many doses and at what age?
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3 doses
9-18 months |
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What three instances would you use HBV postexposure prophylaxis?
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Sexual contact
Infant younger than 12 months for whom the case is a primary caregiver Persons who have had identifiable percutaneous or perimucosal exposure to the blood of the case. |
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This has an incubation period of 1-3 days, vomiting often precedes the onset of diarrhea, severe dehydrating infection occurs primarily among children 3 to 35 months of age, generally resolves in 3-7 days.
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Rotavirus
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How is the rotavirus transmitted?
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It is transmitted via the fecal/oral route. It is shed in high concentrations in the stool.
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What is the minimum age to give the rotavirus vaccine?
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Administer the first dose at age 6-12 weeks.
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You can't start the rotavirus vaccine later than how many weeks?
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12 weeks.
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When must you administer the final dose of the rotavirus vaccine?
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32 weeks. You can't administer any dose later than age 32 weeks. This vaccine is very specific for infants.
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When are the first three doses of DTaP administered?
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2, 4 and 6 months. First dose can be given as early as 6 weeks.
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The fourth dose of DTaP may be administered as early as ? Provided?
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12 months provided 6 months have elapsed since the third dose.
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When age do you administer the final dose of DTaP?
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4-6 years of age.
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What are four examples of when passive immunization are used?
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1. Needlestick injury c. Hep B
2. Aleviate symptoms of ongoing disease – VZV- used to prevent dissemination in immunosuppressed. 3. Protect immunosuppressed patients (VZV) 4. Block action of bacterial toxins & prevent diseases they cause (ie Rx of Rabies) |
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What is an a possible adverse effect from using a passive immunization?
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Recipient can mount adverse response to antigenic determinants of foreign AB – systemic anaphylaxis- -esp when Igs derived from non-human source (eg horse)
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Attenuated = avirulent – limited in ability to cause disease. Useful for protection vs infections caused by?
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enveloped viruses, which need T-cell immune responses for resolution of infection.
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What are examples of live attenuated pathogens that are used as vaccines?
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Typhoid fever
BCG (Salmonella) Measles Mumps Rubella Chickenpox Polio (Sabin) Yellow-fever |
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Efficacy of this vaccine depends on whether the ag in the vaccine is present in all strains of the org
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Active - Microbial extracts
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Examples of microbrial extracts used as vaccines?
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B. Pertussis Ag
*Hib Diphtheria (Tox) *Meningococcal *Pneumococcal Tetanus (TOX) Hep B |
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Vaccines can produce humoral immunity through?
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B cell proliferation leading to antibody production – may / may not involve helper T cells.
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What is the leading cause of bacterial meningitis?
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Haemophilus influenzae type b (Hib)
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At what age do you give the Haemophilus influenza type b conjugae vaccine?
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Minimum age 6 weeks.
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What are the two types of Haemophilus influenza type b vaccinations?
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PRP-OMP
TriHIBit |
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If this Hib vaccine is used at ages 2 and 4 months, a dose at age 6 months is not required.
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PRP-OMP
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This is a DTaP/Hib combination product that should not be used for primary immunization of Hib, but can be used as boosters following any Hib vaccine in children age __ months or older.
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1. TriHIBit
2. 12 months |
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Children with
Functional or anatomic asplenia Sickle Cell disease HIV Out of home group child care Certain racial and ethnic groups are at increased risk for what? |
Invasive pneumococcal disease.
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This is the most common cause of bacterial meningitis in the US?
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Invasive pneumococcal disease
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What is the minimum age to give the pneumococcal conjugate vaccine PCV?
the pneumococcal polysaccharide vaccine PPV? |
1. 6 weeks
2. 2 years |
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if a child is 24-59 months old and has an incomplete schedule of pneumococcal vaccine, what do you administer?
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PCV pneumococcal conjugate vaccine
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Which pneumococcal vaccine do you administer to a child aged 2 years or older who has underlying medical conditions?
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PPV pneumococcal polysaccharaide vaccine.
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What vaccine side effects must be reported?
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Anaphylaxis or anaphylactic shock within 7 days of any vaccine
Encephalopathy, encephalitis, or seizures Any sequelae of reportable events Any other serious or unusual event Vaccine side effects that are listed as contraindications to future vaccination in the package insert |
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Vaccine specific reportable events include:
Measles: |
Thrombocytopenic purpura within 7 to 30 days; vaccine-strain measles infection in an immunodeficient recipient within six months of measles vaccination
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Vaccine specific reportable events include: Rubella:
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Chronic arthritis within 6 weeks
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Vaccine specific reportable events include: Measles, mumps, and or rubella:
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Encephalopathy or encephalitis within 15 days
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Vaccine specific reportable events include: Pertussis:
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Encephalopathy or encephalitis within 7 days
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Vaccine specific reportable events include: Tetanus:
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Brachial neuritis within 28 days
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What is the first clinical manifestation with Fifth's disease?
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Facial rash
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What does the facial rash look like in Fifth's disease?
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Large, erythematous patches on both cheeks (slapped cheek appearance), can also be on forehead and chin, circumoral region is spared, lasts 1-4 days.
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When dose the body rash occur in fifth's disease?
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within 1-2 days of the facial rash.
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This is a symmetrical, maculopapular, lacy, erythematous rash predominately on the extensor surfaces then flexor surfaces, buttocks and trunk, palms and soles are spared.
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The body rash in Fifth's disease
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How long does it take the body rash to resolve in fifth's disease?
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3-7 days, but may last up to 20 days.
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What is a clinical manifestation of fifth's disease in adolescents and adults?
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Associated with symmetrical joint pain and swelling of hands, knees and feet.
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What causes the symmetrical joint pain in adolescents and adults with Fifth's disease?
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Formation of antibody complex in joint spaces.
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What is the treatment of fifth's disease for healthy children?
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It is typically a benign infection for healthy children, you manage the symptoms only by giving motrin etc.
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What patients may need treatment for aplastic crisis?
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Sickle Cell patients with Fifth's disease
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Fifth's disease is not associated with congenital abnormalities, but what may occur?
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Fetal death
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Roseola Infantum (Exanthem Subitum) is caused by what?
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Human Herpes virus 6 and 7
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Who is primarily affected by Roseola infantum, and at what time of year?
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Children 6 months to 3 years of age
Peak season: Late fall, early spring |
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What usually brings children with Roseola infantum into the ER?
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They are running a 102-105 fever.
Despite this fever the kids usually appear non-toxic. |
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What other clinical manifestations are usually associated with Roseola infantum, besides abrupt fever?
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Anorexia, irritability, lymphadenopathy, bulging anterior fontanelle. Last 3-8 days.
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When does the rash appear in Roseola infantum?
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Once the fever has subsided, so you probably won't see this in the ER considering the kids are presenting in the ER for fever.
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This rash is a erythematous, maculopapular blanching exanthem. Discrete, pink macules and or papules 2-3 mm. It begins on the trunk, spreads to the neck, face and extremities. It is nonpruritic and tends to coalesce. It lasts 1-2 days.
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Rash associated with Roseola infantum
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What diagnostic tests do you order when working up Roseola infantum?
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CBC to check for leukocytes
UA to check for urinary tract infection CXR to rule out pneumonia Possibly a Lumbar Puncture |
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How do you manage roseola infantum?
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Use antipyretics, tylenol or ibuprofen. You are trying to avoid the complications of febrile seizures by keeping temp at a baseline.
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How is Varicella transmitted?
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via nasopharyngeal secretions, or direct contact with vesicle fluid.
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How long is varicella infectious?
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1-2 days before rash until all lesions have crusted.
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What age range is most affected by varicella?
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Children aged 5-9 years old.
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What is the hallmark sign for varicella?
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You have lesions in stages. The lesions are vesicular type lesions caused by a DNA herpes type virus.
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What is the prodrome for varicella?
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Low grade fever
Upper respiratory symptoms - usually a small unproductive cough Lymphadenopathy Malaise |
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Apart from the body, where else are varicella lesions found?
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Mouth, conjunctiva, vaginal area, anal area. If this doesn't itch, then it probably isn't Chicken Pox
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What is the distribution of the varicella rash?
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Trunk, scalp and then spreads peripherally.
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What are the stages of lesions seen in Varicella?
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Initial lesions are papules that evolve into vesicles (dewdrops on rose petals)
Vesicles become pustular and rupture forming a crust |
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When do scabs from varicella usually disappear?
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10-14 days, typically not leaving a scar.
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What laboratory diagnostics do you use for varicella?
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Viral cultures, PCR and immunofluorescence testing of vesicular fluids. Also varicella titer test for immunity
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What is the management for Varicella?
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Supportive:
Low grade fever - antipyretics, acetaminophen, ibuprofen Pruritus - Calamine lotion, oatmeal and aveeno baths, oral antihistamines: Benadryl Cool showers, not hot. |
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What is indicated for immunocompromised children, to reduce the risk of dissemination and complications with varicella?
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Acyclovir.
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What complications can occur from having Varicella?
6 of them |
1. Secondary bacterial infection
2. Hepatitis 3. Encephalitis, Aseptic meningitis 4. Congenital Varicella syndrome 5. Reye Syndrome 6. Zoster infection later in life - shingles |
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When is the MMRV vaccine for healthy children meant to be administered?
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12 months to 12 years of age.
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What is a post exposure prophylaxis for varicella?
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Varicella zoster immune globulin (VZIG)
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When is Varicella zoster immune globulin administered to adults?
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within five days of exposure.
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When is Varicella zoster immune globulin administered to neonates?
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Neonates whose mothers develop chickenpox within 5 days before up to 2 days after delivery.
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What disease is caused by the coxsackievirus group A16?
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Hand-Foot and Mouth disease
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How is Hand-Foot and Mouth disease transmitted?
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Through oral and respiratory secretions, fecal contamination.
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What is the peak incidence for Hand-Foot and Mouth disease? Also, who is this most common in?
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Summer to Early Fall
Most common in children under five years old. |
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How long dose Hand-Foot and Mouth disease last?
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Approximately one week.
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What is the prodrome for Hand-Foot and Mouth disease?
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Low grade fever
Malaise Sore throat Anorexia |
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What are the two clinical manifestations of Hand-Foot and Mouth disease?
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Oral and Skin lesions
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What is characteristic of the Oral lesions in Hand-Foot and Mouth disease?
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Shallow, yellowish ulcers surrounded by red halos, found on the buccal mucosa, gingivae, tongue, soft palate, uvula, anterior tonsillar pillars
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These are erythematous macules or papules 2-8 mm that evolve into vesicles on an erythematous base, located on the palms and fingers, plantar surfaces of feet and toes, interdigital spaces and buttocks (and genitals)
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characteristics of the Skin lesions in Hand-Foot and Mouth disease
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What is a common reason why children are brought into the doctor for Hand-Foot and Mouth?
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The Skin lesions on the sole of the foot cause so much pain that the child isn't walking anymore.
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What are the laboratory diagnostics for Hand-Foot and Mouth?
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They are typically not needed due to the characteristic nature of the disease.
BUT, Viral cultures can be taken from oral ulcers, cutaneous vesicles and stool. |
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What is the management plan for Hand-Foot and Mouth?
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It is Supportive:
Acetaminophen, fluids to prevent dehydration. |
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What are rare complications associated with Hand-Foot and Mouth?
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Myocarditis, aseptic meningitis
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How does hand foot and mouth resolve?
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It is a typically self limited illness. Educate about frequent hand washing, especially after changing a diaper.
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This is a multisystem illness characterized by vasculitis of the small and medium sized blood vessels.
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Kawasaki Disease
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What population is most affected by Kawasaki disease?
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Occurs more frequently in boys, 18 months to 2 years old. It is more common in Asian populations. It is usually self limited, but the kids are very sick.
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What are the diagnostic criteria for Kawaski disease?
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Fever of 5 or more days and a presence of four of the following:
1. Bilateral conjunctival injection 2. Oropharynx mucus membrane changes or lesions 3. Peripheral extremity changes 4. Rash 5. Cervical Lymphadenopathy |
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What oropharynx symptom is a hallmark sign of Kawasaki disease?
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Strawberry tongue
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The rash in Kawasaki disease can appear like what?
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Measles, and it can be very scarlatiniform = like sand paper, It is nonvesicular, pruritic and found mainly on the trunk.
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What can you see in the peripheral extremities of Kawasaki disease?
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Edema of hands and feet, erythema, and desquamation.
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Suspicion of this disease leads to hospitalization and observation, a cardiology consult, and watching for coronary aneurysms
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Kawasaki disease
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What do you see in the acute, 7-14 day, stage of Kawasaki disease?
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High Fever
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What do you see in the subacute, 10-25 days, stage of Kawasaki disease?
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Peeling of skin, a gradual improvement of symptoms, but there is a chance for the development of coronary aneurysms and thrombocytosis.
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What do you see in the convalescent, 21-60 days, of Kawasaki disease?
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Resolution of remaining symptoms, lab values return to normal, and in the fingernail's Beau lines.
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What are the diagnostic tests used to diagnose Kawasaki disease?
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CBC, UA, EKG, Echo, CXR, Elevated ESR, C-Reactive protein
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What is the treatment for Kawasaki disease?
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Admit, Cardiology consult, IV immune Globulin within 10 days of onset to prevent cardiac complications, High dose aspirin therapy.
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When is the one time that you actually use high dose aspirin therapy in children?
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In Kawasaki disease, anti-inflammatory and anti-thrombotic
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What are two Tx's that you might have to consider if Kawasaki is very severe?
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Anti-platelet and anti-thrombotic treatment.
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What herpes types are neurotropic and replicate in the epithelial cells?
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HSV1, 2 and VZV
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What herpes virus is secreted in saliva of ~all children and in lymphoproliferative diseases of adults?
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HHV-6
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What herpes viruses are lymphotrophic? There are three of them.
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EBV, CMV, HHV-6
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Severe complications that may be associated with herpes simplex occur in?
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females who are pregnant
individuals with immunosuppression |
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The most common complication of primary HSV-2 genital infection is ?
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Bacterial Superinfection
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This virus can enhance the Urogenitary tract for transmission of HIV?
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Herpes
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The primary infection of herpes presents in what way in children?
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Gingivostomatitis
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The primary infection of herpes presents in what way in adults?
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pharyngotonsillitis
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When is the time of HSV spread most prevalent?
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During the HSV prodrome stage.
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At what age is acute herpetic gingivostomatitis most prevalent?
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2-3 years old
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In this prodrome you see anterior cervical lymphadenopathy, chills and fever (104), numerous vesicles that collapse and form small red lesions, ulcerations covered with fibrin, edematous gingiva, self inoculation to other areas can occur and it usually resolves within 5-7 days.
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Acute herpetic gingivostomatitis HSV primary infection.
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How long does acute herpetic gingivostomatitis last, and when do the symptoms subside?
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Lasts 5-7 days, and the symptoms subside in 2 weeks.
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What laboratory tests can you use to diagnose acute herpetic gingivostomatitis HSV?
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HSV culture
Tzank stain - Acantholysis Multinucleated epithelial cells |
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What drugs are used to treat HSV, acute gingivostomatitis?
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Acyclovir
Valacyclovir Famciclovir |
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What type of pain control should be used with HSV acute herpetic gingivostomatitis?
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Lidocaine topical
Acetaminophen Ibuprofen |
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This is a reaction triggered by emotional stress, trauma, cold, sunlight, gastric upset, fever, mentrual cycle, and other factors suppressing the immune system. The incubation can be 1-26 days. There is an altered sensation, vesicle formation and shedding of virus without clinical disease.
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Secondary HSV infection
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What types of HSV secondary infections are there?
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• Herpes labialis
• Recurrent intraoral herpes |
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What is the prodrome for HSV secondary infections?
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Prodromal symptoms and signs
Pain, burning, itching, tingling Small vesicles |
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These clinical presentations are associated with?
• Herpetic whitlow • Herpes gladiatorum (scrumbox) • Areas of chronic skin disease (pemphigus, eczema) • Immunocompromised patients • So-called geometric glossitis |
Secondary HSV infection
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What is one of the clinical hallmarks for Herpes Zoster?
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It is always on one side of the body, following a dermatome
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Reactivation of the varicella zoster virus is associated with what four things?
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aging
immunosuppression intrauterine exposure varicella at <18 month of age |
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Acute, localized infection of the Varicella-Zoster virus, which causes a painful blistering, pruritic rash.
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Herpes Zoster
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Pain that persists for more than 1 month after the onset of Herpes zoster
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Post-Herpetic Neuralgia
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Prodrome symptoms may include chills, fever, malaise, G.I. disturbance and parasthesia or neuralgia along the affected dermatome.
Red papules usually appear along the affected dermatome within 3 days.( usually last for <day) The eruption of vesicles closely follows the maculopapular rash. Vesicles are fluid filled and can transmit the virus, usually dry up in an average of 7 days. Scarring may occur at the site. |
Herpes Zoster Prodrome
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What are the treatment options for Herpes Zoster?
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1) Promote healing, reduce inflammation and pruritis of the rash
Domboro solution-OTC- most effective. Calamine lotion-OTC Oatmeal soak-OTC 2) Reduce viral shedding/DNA replication of the virus Acyclovir-less costly, equal outcome to others, more studies performed. 5xs a day dosing can be problem Famvir.-more costly but less dosing Valtrex-most expensive, less dosing required. |
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In Herpes Zoster these shorten the duration of viral shedding, stop the formation of new lesions, and reduce pain severity. They should be started within 48-72 hours of rash onset and administered for 7 days (up to 10 days in patients with eye manifestations).
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Antivirals:
acyclovir famciclovir valacyclovir |
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What is the primary option, and secondary options, for treating pain in Herpes Zoster?
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Primary Options
oxycodone : 5 mg orally (immediate-release) every 4 hours when required Secondary Options oxycodone : 5 mg orally (immediate-release) every 4 hours when required and lidocaine topical : (2-5%) apply to the affected area(s) every 3-4 hours when required or calamine lotion: apply to the affected area(s) up to four times daily when required |
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The goal of therapy for (postherpetic neuralgia) is to reduce morbidity through the use of (6-7 things)
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tricyclic antidepressants
anticonvulsants anesthetics analgesics corticosteroids antiviral agents A recently approved vaccine is also effective for preventing herpes zoster (HZ) outbreaks and PHN |
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If there is eye involvement, Herpes Zoster virus on the trigeminal nerve, what must you do?
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Ophthalmology consult
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The condition affects children, with incidence rates in tropical climates approaching 20% of children aged 2 to 11 years.
Adults may also be infected via sexual transmission. There is no sex or ethnic trend in the incidence of molluscum. |
Molluscum Contagiosum
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This poxvirus disease has lesions that are cutaneous (less commonly mucosal). They appear as pearl-like, smooth papules, which are umbilicated.
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Molluscum Contagiosum
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Key Diagnostic Factors
Key risk factors include close or sexual contact, HIV infection and tropical climate. Common presentation: pruritus facial or groin distribution of lesions atopic dermatitis Presence or absence of coexistent dermatitis, including atopic dermatitis, is important for deciding therapy. |
Molluscum Contagiosum
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What is the TX for Molluscum Contagiosum?
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Curretage
Cryotherapy Podophyllin topical Podofilox topical Also, use lidocaine/prilocaine topical for the anesthetic, and apply it 15-30 minutes early |
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Common warts, also known as verrucae vulgaris, are caused by ?
They are most common in children and young adults. |
HPV
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Water immersion, occupations involving handling of meat or fish, nail biting behavior, young age (less than 35 years) and an immunocompromised state
put you at risk for what? |
Verrucae vulgaris
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What are the main common presentation of common warts?
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Fingers or nail fold lesions
Common warts frequently affect the hands, fingers, and periungual areas. Filiform warts commonly affect facial skin |
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What are three other signs and symptoms associated with common warts?
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Fissuring
Warts may fissure, bleed and cause pain. Hyperkeratosis common grayish-white or light brown color Filiform papule with sharp spikes Appears to emerge from the skin from a stalk. |
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What is the first line tx for warts?
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First-line treatments include salicylic acid (with or without duct tape occlusion) and cryotherapy.
Salicylic acid and Debridement or Debridement and Cryotherapy |
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What happens if you use too much cryotherapy?
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Dyschromia and scarring often result if cryotherapy is not administered judiciously.
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What are the three primary options for treating a wart, these are not the initial tx?
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Candida antigen
imiquimod topical fluorouracil topical |
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What treatment do you use for warts in the last case?
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Fluorouracil topical
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Very common STI.
Caused by HPV infection, most commonly HPV types 6 and 11. Peak incidence of genital HPV infection occurs in 16- to 25-year-olds. Diagnosis is made based on clinical presentation. Generally has a benign course and is not often associated with oncogenic potential. Treatment can be challenging, as there is no cure and recurrences are common |
Condyloma Accuminata
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An estimated 30% to 50% of sexually active adults in the U.S. are infected with ?
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HPV
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Risk Factors
Intercourse at an early age Increasing number of lifetime sexual partners Increasing number of partner's sexual partners Immunocompromise |
Condyloma Accuminata
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Differential Diagnosis
Condyloma lata Molluscum contagiosum Pearly Penile Papules Hidradenoma papilliferum Seborrheic keratosis Carcinoma in situ Bowenoid papulosis/erythroplasia of Queyrat Skin tags |
Condyloma Accuminata
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Smooth dermal or SC nodule, usually 1 cm or less in diameter.
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Hidradenoma papilliferum
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can appear as red-brown papules that may coalesce to form a plaque. These can often closely resemble benign condylomata
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Bowenoid papulosis
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Erythroplasia of Queyrat typically appears as a ?
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erythematous, well-defined, velvety plaque of the glans or vulva
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What are the tests for Condyloma accuminata?
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Screen for other STI’s!
RPR Female: Pap of cervix Male or Female with hx. of anal intercourse: Pap of anus Biopsy (rarely done if external, often done if on cervix or in the anal mucosa Consider gonorrhea, chlamydia and HIV screening |
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Treatment Options for Condyloma Acuminata
Ablative therapy: 4 things |
Cryotherapy : Use an open spray or cotton-tipped applicator for 10-15 seconds and repeat as needed.
Cryotherapy is safe for use during pregnancy. Electrodesiccation (smoke plume may be infective) Curettage /Surgical excision : Excision has the highest success rate and lowest recurrence rate. Initial cure rates are 63-91%. Carbon dioxide laser treatment: This treatment is used for extensive or recurrent genital warts. The procedure requires local, regional, or general anesthesia. (A eutectic mixture of local anesthetics [EMLA] cream may be used as an alternative anesthetic.) |
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Clinician administered treatments include acid applications (bichloroacetic acid or trichloroacetic acid) and interferon injections with antiviral mechanisms.
Medications for home use include imiquimod 5% cream, podofilox gel or solution, and antiproliferative compounds (5-fluorouracil) HPV vaccines |
Immune-based therapy for Condylomata accuminata
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