Blisters

Question 1

contrast bulla and vesicle

Answer 1

diameter- bulla greater than 1 cm

both blisters

Question 2

what is crust on blister

Answer 2

dried transudate

Question 3

acral lesions

Answer 3

on distal extremities, hands and feet

Question 4

arcuate lesions

Answer 4

arc or curve

Question 5

intertriginous lesions

Answer 5

in body folds

Question 6

describe herpes zoster pres

Answer 6

dermatomal

grouped vesicles on erythematous base (typical of herpes family, including VZV)

preceded by pain or burning

usually only occurs once unlike HSV which recurs

Question 7

tx of VZV/ shingles

Answer 7

aycyclovir/ valacyclovir decrease length of eruption and post herpetic neuralgia

Question 8

disease from herpes simplex

Answer 8

painful, grouped vesicles on erythematous base

vesicles appear pustular, tend to recur

Question 9

HSV 1 vs 2

Answer 9

1 favors mouth and nose

2 favors gentiala, buttocks, thighs

Question 10

suspicion w/ perianal erosions or ulcerations in immunosuppressed pts

Answer 10

HSV

recurrent ulcers on buttocks or genitals are HSV until proven otherwise

Question 11

herpetic whitlow

Answer 11

classically on the finger, often happens to dentists

Question 12

testing for herpes viruses (5)

Answer 12

tzanck prep- bedside scraping w/ microscope exam (cant diff b/w VZV and HSV)

viral culture- needs fluid, takes 1-3 weeks

direct fluorescent antibody- can differentiate well, takes 48 hrs

serological - determines past exposrue, not directly clinical

fluid swab (most common)- for PCR diffs b/w HSV1, 2 and VZV

Question 13

HSV tx options

Answer 13

acyclovir- safe cheap and reliable, fine in pregnancy (IV for immunocompromised)

famciclovir and valacyclovir more expensive but easier dosing

Question 14

presentation of dyshidrotic eczema

Answer 14

aka pompholyx

pruritic vesiculopapules on palms, soles, sides of fingers

fluid compared to tapioca pudding, leave behind mahogony mark (hyperpigmentation)

Question 15

hx details for dyshidrotic eczema

Answer 15

usually hx of atopic dermatits, coexisting tinea pedis (fungal foot infection)

Question 16

tx for dyshidrotic eczema

Answer 16

potent topical steroid

Question 17

4 location clues for foot vesicles

Answer 17

dorsal- contact dermatitis, insect bites

sides and toes- dyshidrotic eczema

soles- tinea pedis

balls, heels- friction

Question 18

pain often precedes..

Answer 18

HSV or VZV

Question 19

itch precedes…

Answer 19

contact dermatitis, dyshidrotic eczema, VZV

Question 20

trauma precedes…

Answer 20

friction blister, pressure ulcer, cryotherapy

Question 21

recurrent blisters likely…

Answer 21

HSV

Question 22

pres of chicken pox

Answer 22

primary VZV infection- diffuse vesicles on erythematous base w/ various stages of healing

more extensive and severe in adults

can be identical to disseminated reactivated zoster (rare)

Question 23

etiology of pemphigus vulgaris

Answer 23

autoab to desmogleins 1 and 3 b/w keratinocytes, cuases superficial bulae and erosions

usually w/ elderly

Question 24

dx of pemphigus vulgaris

Answer 24

direct immunofluorescence

Question 25

bullous pemphigoid etiology

Answer 25

autoab to hemidesmosomes causing deep, tense bullae on pruritic urticarial base

split b/w basement membrane and basal layer

usually elderly

Question 26

dx of bullous pemphigoid

Answer 26

BPAG2 antibodies found w/ direct immunofluorescence

Question 27

dx of bullous impetigo

Answer 27

“honey crusting” typical

dx w/ bacterial culture, not typically recurrent