Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Review Question - QID 106563

In scope icon M 6 C
QID 106563 (Type "106563" in App Search)
A 5-year-old male is brought to the pediatrician with complaints of a painful mouth/gums, and vesicular lesions on the lips and buccal mucosa for the past 4 days. The patient has not been able to eat or drink due to the pain and has been irritable. The patient also reports muscle aches. His vital signs are as follows: T 39.1, HR 110, BP 90/62, RR 18, SpO2 99%. Physical examination is significant for vesicular lesions noted on the tongue, gingiva, and lips, with some vesicles having ruptured and ulcerated, as well as palpable cervical and submandibular lymphadenopathy. Which of the following is the most likely causative organism in this patient's presentation?

CMV

0%

0/9

EBV

11%

1/9

HIV

0%

0/9

HSV-1

89%

8/9

HSV-2

0%

0/9

Select Answer to see Preferred Response

bookmode logo Review TC In New Tab

This patient is presenting with acute herpetic gingivostomatitis caused by herpes simplex virus type 1 (HSV-1).

Acute primary herpes simplex type 1 virus infection often manifests in children ages 6 months to 5 years. The orolabial lesions may last for 10-14 days, but viral shedding can occur as long as 20+ days after initial presentation. The initial presentation can also include fever, malaise, myalgias, and cervical lymphadenopathy. Many initial acute HSV-1 infections are asymptomatic, with evidence of infection only evident at viral reactivation later in life.

Usatine et al. discuss nongenital herpes simplex virus type 1 infections. It is usually transmitted during childhood by nonsexual contact. The diagnosis can often be made by observation of the classic vesicular lesions on exam; however, the diagnosis can also be confirmed by culture, PCR, serology, fluorescent antibody testing, or Tzanck smear.

Nasser et al. conducted a Cochrane systematic review on the efficacy of acyclovir for treating primary herpetic gingivostomatitis. Only 2 trials with a total of 92 patients were included in this review. There is weak evidence that acyclovir reduces oral lesions, prevents new lesions, decreases difficulty with eating and drinking, and reduces hospital admission.

Illustration A shows a patient with acute herpetic gingivostomatitis.

Incorrect Answers:
Answer 1: Cytomegalovirus (CMV) may cause mononucleosis in immunocompetent patinets; the virus also causes numerous potential infections in immunocompromised patients, including hepatitis, retinitis, colitis, and pneumonia. It is also a TORCH infection that may lead to congenital abnormalities when transmitted perinatally.
Answer 2: Epstein-Barr virus (EBV) is the most common causative organism in infectious mononucleosis.
Answer 3: This patient's presentation of orolabial vesicular lesions, adenopathy, and fever of acute onset at 5 years of age is not consistent with acute HIV infection.
Answer 5: HSV-2 more commonly manifests with genital infection; the majority of orolabial infections are caused by HSV-1.

ILLUSTRATIONS:
REFERENCES (2)
Authors
Rating
Please Rate Question Quality

5.0

  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon

(1)

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options