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

Most cases of acute herpetic gingivostomatitis arise when?

Back 8

6 months to 5 years

Front 9

Explain why HSV is "neurotropic"?

Back 9

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

Front 10

How is diagnosis of HSV usually made?

Back 10

clinical.

Front 11

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

Back 11

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

Front 12

What is SECONDARY INFECTION of HSV?

Back 12

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

Front 13

WHat are PRODROMAL symptoms of HSV?

Back 13

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

Front 14

Where do most secondary lesions of HSV appear?

Back 14

vermillion border and surrounding skin

Front 15

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

Back 15

- recurrent herpes labialis

Front 16

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

Back 16

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

Front 17

What is HERPETIC WHITLOW?

Back 17

primary or secondary HSV infection involving the finger.

Front 18

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

Back 18

Chickenpox

Front 19

How is VZV spread?

Back 19

- direct contact
- airborne droplets

Front 20

Describe the skin lesions of VZV?

Back 20

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

Front 21

Describe the oral lesions of VZV:

Back 21

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

Front 22

How is diagnosis of VZV made?

Back 22

- history of exposure in past 3 weeks
- clinical signs

Front 23

What is the treatment for VZV?

Back 23

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

Front 24

Define Herpes zoster?

Back 24

- herpes zoster is the recurrent form of varicella infection.

Front 25

What is the laymans term for Herpes Zoster?

Back 25

- shingles

Front 26

What is the reason that VZV can recur?

Back 26

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 27

Describe oral lesions of herpes zoster?

Back 27

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

Front 28

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

Back 28

ocular involvement may lead to permanent blindness

Front 29

Infectious mononucleosis is caused by what virus?

Back 29

Epstein-Barr Virus

Front 30

How is EBV transmitted?

Back 30

Through Saliva - sharing straws or kissing in adults

Front 31

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

Back 31

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

Front 32

What are some signs of Mono?

Back 32

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

Front 33

What is the treatment for MONO?

Back 33

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

Front 34

What are the most prominent members of the PARAMYXOVIRUS FAMILY?

Back 34

Measles
Mumps

Front 35

How is MEASLES spread?

Back 35

- airborne droplets

Front 36

Define "Kopliks spots"

Back 36

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

Front 37

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

Back 37

1-2 days

Front 38

During what period is the MEASLES patient contagious?

Back 38

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

Front 39

What are some possible complications of MEASLES?

Back 39

- encephalitis
- viral pneumonia

Front 40

When is the MMR vaccine recommended?

Back 40

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

Front 41

What is HAND FOOT AND MOUTH disease?

Back 41

Highly contagious systemic infection usually caused by coxsackievirus A.

Front 42

How is HFM disease transmitted?

Back 42

inhalation of airborne droplets or by contact with saliva containing virus

Front 43

HFM disease most commonly occurs in what demographic>?

Back 43

children 1-5 years old

Front 44

Describe the oral lesions of hand foot mouth disease:

Back 44

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

Front 45

Describe the skin lesions of hand foot mouth:

Back 45

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

Front 46

What is the treatment for hand foot mouth:

Back 46

self-limiting. Resolves within 7-10 days

Front 47

Define HERPANGINA:

Back 47

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

Front 48

Describe the lesions of Herpangina:

Back 48

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

Front 49

What is ACUTE LYMPHONODULAR PHARYNGITIS?

Back 49

localized infection of coxsackievirus A

Front 50

What is ACUTE LYMPHONODULAR PHARYNGITIS characterized by?

Back 50

sore throat, fever, and mild headache

Front 51

What is the clinical features of acute lymphonodular pharyngitis?

Back 51

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

Front 52

What diseases are related to HERPES SIMPLEX VIRUS?

Back 52

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

Front 53

What diseases are related to VARICELLA ZOSTER VIRUS?

Back 53

- chickenpox
- shingles

Front 54

What disease are related to EPSTEIN BARR VIRUS?

Back 54

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

Front 55

What disease are related to HUMAN PAPILLOMAVIRUSES?

Back 55

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

Front 56

What diseases are related to COXSACKIEVIRUSES?

Back 56

- herpangina
- hand foot mouth disease
- acute lymphonodular pharyngitis

Front 57

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 57

Herpetic whitlow

Front 58

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 58

Herpetic whitlow

Front 59

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 59

Acute herpetic gingivostomatitis (Primary Herpes Simplex Infection)

Front 60

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 60

Acute herpetic gingivostomatitis (Primary Herpes Simplex Infection)

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

Back 64

Recurrent Herpes Labialis

Front 65

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 65

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 66

What is this lesion?

Back 66

Recurrent Herpes Labialis

Front 67

What is this lesion?

Back 67

Recurrent Herpes Labialis

Front 68

What virus is this child infected with?

Back 68

Varicella zoster (Chicken pox)

Front 69

What virus is this child infected with?

Back 69

Varicella zoster (Chicken pox)

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

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 72

Herpes Zoster (Shingles)

Front 73

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

Back 73

MEASLES
They precede the rash by 2 days.

Front 74

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

Back 74

0.3%

Front 75

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

Back 75

HIV PCR

Front 76

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

Back 76

Gram stain

Front 77

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 77

Molluscum contagiosum

Front 78

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

Back 78

Inhibition of REVERSE TRANSCRIPTASE and DNA CHAIN TERMINATION

Front 79

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

Back 79

Inhibition of reverse transcriptase alone

Front 80

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

Back 80

Inhibiton of protease

Front 81

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

Back 81

Inhibition of protease

Front 82

Enfuvirtide is an antiretroviral drug which works by which mechanism?

Back 82

Inhibition of HIV/target cell fusion

Front 83

Raltegravir is an antiretroviral drug which works by what mechanism?

Back 83

Inhibition of integrase

Front 84

Maraviroc is an antiretroviral drug which works by what mechanism?

Back 84

Inhibition of chemokine receptor CCR5

Front 85

When should POST EXPOSURE PROPHYLAXIS begin?

Back 85

Within 2 hours of exposure

Front 86

List the AIDS-defining illnesses:

Back 86

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