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how herpes is transmitted
person to person, highly contagious
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does there have to be lesions to transmit herpes?
no. most transmissions occur during shedding without the presence of lesions
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herpes virus inactivated at what temperature?
room temp
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HSV I is nongenital, but 10-20% of genital lesions
are HSV I
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HSV II during childbirth
C-section if lesions present
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herpes oral appearance
small multiple papules/vesicles coalesce into large ulcerative lesion
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herpes oral gums
may be red and swollen
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herpes oral other symptoms
cervical lymphadenopathy, malaise, sore throat, headache
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2 ways to diagnose herpes
history, culture
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HSV I treatment
valcyclovir (valtrex)
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herpes genital appearance
women: vulvovaginitis, edema. multiple vesicles, erosions, ulcers, tenderness
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treatment for herpes is this, not that
treatment for herpes is antivirals (like valtrex). do not use abx on herpes.
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herpes recurrent lesions appearance
grouped vesicles on erythematous base...usually occurs at same site
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herpes prodrome
tingling or burning beforehand
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herpetic whitlow
HSV infection of finger, can give an infant if the mother has it
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lab tests for herpes (3)
- culture of vesicular fluid
- tzanck smear
- serum antibodies
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herpes treatment
ANTIVIRALS! begin at first sign of symptoms.
- topical: penciclovir cream
- oral: acyclovir, valcyclovir, famcyclovir
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herpes zoster
shingles, reactivation of latent varicella in sensory neurons
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zoster is triggered by lots of things
impaired immune system, radiation, trauma, surgery, spinal tumors, stress, lymphoma, fatigue, age
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zoster most common over age
50
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zoster spread by direct contact?
very very rarely
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zostavax
shingles vaccine for 60+ yrs old
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zoster appearance
grouped vesicles on a tender erythematous base. unilateral, along a dermatome. crusted. thoracic.
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unilateral vs bilateral
bilateral is never herpes
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unilateral on trunk
could be herpes
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disseminated herpes zoster
means more than 25 vesicles away from dermatome
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postherpetic neuralgia
pain 4 weeks or more after herpes lesions resolve. more common with older. itch burn sharp shooting pain
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zoster treatment
symptomatic treatments only (burow's, tylenol, prednisone, maybe oral valtrex)
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varicella zoster virus
chicken pox
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chicken pox and immunity
results in lifetime immunity
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chicken pox contagious from
2 days before rash erupting
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varicella appearance
starts on trunk, spreads to face and extremities, usually seen in different stages
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"dew drop on a rose petal"
varicella, chicken pox.
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varicella prevention
varicella vaccine
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HPV - 60 viral types of warts; 4 categories
- common (verruca vulgaris)
- flat (verruca plana)
- plantar
- genital (condyloma acuminata)
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verruca vulgaris
common warts. most common on hands. kissing lesions, start out smooth flesh, evolve into domed growths with black dots
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periungal warts are hard to treat
please don't bite them, you'll get warts in your mouth
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treatment for verruca vulgaris
- salicylic acid OTC
- liquid nitrogen
- light electrocautery
- canthacur
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verruca plana--flat warts
pink, light brown or light yellow. slightly elevated flat topped papules, numerous on forehead, mouth, backs of hands, shaved parts
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verruca plana flat warts treatments
- topical retinoid (tretinoin RetinA)
- efudex
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plantar warts diagnosis (trim before treating)
if bleeding in the middle, it's a wart. if a core in the middle, it's a corn
also, warts hurt with lateral pinching
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plantar wart treatment
only if causing pain. remove callous periodically. salicylic acid, canthacur, cryo, pulsed dye laser
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HPV genital--sexually and nonsexually transmitted, usually asymptomatic, aka
condyloma acuminata
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HPV appearance
skin colored pinhead papules to caulifower masses
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HPV after application of acetic acid
you can see it now, white patches
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HPV treatments (they will clear spontaneously 20-30% of patients)
- liquid N
- podophyllin
- trichloroacetic acid
- electrodessication/electrocautery/laser
- Aladara (imiquimod) x 16 weeks
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HPV prevention (2)
- 2 vaccines: cervarix and gardasil
- boys can get gardasil too
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molluscum contagiosum
- umbilicated flesh colored dome papules, waxy
- spread by scratching or touching
- seen in eczema kids
- adults can be sexually transmitted
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molluscum contagiosum treatments
- (most clear spont in 6-9 months)
- canthacur, cryo, silver nitrate paste
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non-specific viral rash
most viruses cause similar appearing rashes, so they are considered one thing
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non-specific viral rash most common in who?
children
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viruses that can cause non-specific viral rash
enterovirus, echovirus, coxsackie virus, EBV, HHV-6, HHV-7, parvovirus B-19, rhinovirus, adenovirus, RSV, influenza, parainfluenza
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exanthem
rash because of an infection
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roseola infantum
6 months-3years, high fever abrupt rash as fever resolves
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roseola infantum symptoms
appears well except high fever, watch for febrile seizures. almond shaped pale pink rash. rash is everywhere. kid feels fine.
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erythema infectiosum aka
- fifth's disease
- slapped cheek
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erythema infectiosum aka 5ths dz, slapped cheek:
- bright red cheeks, lacy erythema on arms
- 5-14 yrs
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what area does erythema infectiosum NOT affect
nasolabial fold
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lacy reticular "fish net" rash happens with
erythema infectiosum
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hand foot and mouth disease appearance
oral erosions and cloudy vesicular eruptions with red halos along mouth, hands, feet. kids under 5
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if a kid has hand foot and mouth disease you should do this
isolate them 3-7 days
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herpangina
viral. kind of like hand foot mouth disease but only in the mouth
high fever can be 106
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rubella aka
- german measles, 3 day measles:
- 1. forehead to face trunk extremities
- 2. rash disappears
- day 3: rash fades completely
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defining feature of measles
Koplik's spots
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measles 4th day of fever what happens
erythematous macules and papules erupt
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kawasaki disease
- acute multisystem vasculitis
- infants, young kids
- japan
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need 5 of 6 kawasaki criteria
- FUO 5+ days
- bilateral conjunctiva infex
- changes in lip, oral
- cervical lymphadenopathy
- polymorphous exanthem with vesicles/crusts
- changes in peripheral extremities
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kawasaki kids are
REALLY sick. not just normal pink eye
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