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Dermatology - Chapters > Ch. 14 - Generalized Erythema > Flashcards

Ch. 14 - Generalized Erythema Flashcards

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1
Q

What must a PA primarily focus on in order to correctly diagnose generalized erythema?

A

a complete history and physical with special attention to sites of skin involvement

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2
Q

What are the two most common eruptions for drug reactions?

A
  1. hives

2. mobilliform (more common than hives)

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3
Q

What appears as a generalized eruption of erythematous macules and papules, often confluent in large areas?

A

mobilliform

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4
Q

Which antibiotics are common offenders in drug eruptions?

A
  1. beta-lactams (penicillins, cephalosporins)

2. sulfonamides-trimethoprim-sulfamethoxazole

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5
Q

Which diuretics are common offenders in drug eruptions?

A
  1. furosemide
  2. hydrochlorothiazide
    - both contain a sulfonamide
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6
Q

Approximately ___% of all medical inpatients experience drug-induced skin reactions.

A

2%

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7
Q

T/F: The onset of a drug-induced morbilliform eruption is immediate upon initiation of the drug.

A

FALSE (onset begins within several days to as long as a week after initiation)

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8
Q

What are the factors that a PA should consider when a patient that is on several medications presents with a drug eruption?

A

you should suspect drugs that are:

  1. new (started within 1 wk of the rash)
  2. frequent offenders
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9
Q

How can you differentiate between a viral exanthem and a drug eruption?

A

a drug eruption is much more erythematous, more confluent, and more pruritic

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10
Q

How can you differentiate between a toxic erythema and a drug eruption?

A

toxic erythemas have:

  1. ‘sandpaper-like’ texture
  2. mucous membrane involvement
  3. the presence of fever
  4. a focus of infection or presence of lymphadenopathy
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11
Q

What is the difference between a generalized erythema (drug eruption) & a chronic exfoliative erythroderma?

A

chronic exfoliative erythroderma has prominent desquamation

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12
Q

The presence of what in the infiltrate is an important clue suggesting a drug-related cause of generalized erythema?

A

eosinophils

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13
Q

What is the time required for total clearing of a drug eruption?

A

usually 1-2 weeks

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14
Q

What is a potential consequence of continuing the offending drug?

A

worsening of the rash

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15
Q

What is a form of generalized erythema that is caused by hematogenous dissemination of virus to the skin, in which a vascular response is elicited?

A

viral exanthem

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16
Q

What are the major viruses that are most often associated with exanthems?

A
  1. Rubeola (Measles)
  2. Rubella (German Measles)
  3. Herpesviruse type 6 (Roseola)
  4. Parovirus B19 (erythema infectiosum)
  5. Enteroviruses (ECHO & coxsackievirus)
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17
Q

What is the most common viral exanthem in children aged less than 2 years?

A

Roseola

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18
Q

Which viral exanthem occurs in young school-aged children, often in epidemics?

A

‘fifth’ disease (erythema infectiosum)

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19
Q

What is the prodrome of measles characterized by?

A

THE 3 C’S:

  1. Cough
  2. Coryza (cold symptoms)
  3. conjunctivitis
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20
Q

T/F: In patients with infectious mononucleosis, ampicillin increases the likelihood of rash from 3% to nearly 100%.

A

TRUE

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21
Q

How does the rash present typically in measles & German measles?

A

Begins on the head (behind the ears in measles) and proceeds to involve the trunk & extremities.
- in measles, individual lesions tend to become confluent on the face & trunk but remain discrete on the extremities.

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22
Q

How does roseola present clinically?

A

rose-red macules and papules develop primarily on the trunk & proximal extremities.

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23
Q

Which viral exanthem characteristically begins with red cheeks that have a ‘slapped’ appearance followed by a net-like erythema on the trunk & proximal extremities?

A

erythema infectiosum

24
Q

What is characteristic of measles and often precede the rash?

A

koplik’s spots

25
Q

What are found on the buccal mucosa and appear as tiny gray-white papules on an erythematous base?

A

koplik’s spots

26
Q

In which viral exanthem does fever subside just before the rash appears?

A

Roseola

27
Q

How is viral exanthem differentiated from Rocky Mountain spotted fever?

A

Rocky Mountain spotted fever starts distally (hands & feet) & becomes more purpuric as it progresses

28
Q

What is the most serious complication that can arise from measles?

A

encephalitis

29
Q

What is the most important complication of rubella?

A

congenital rubella syndrome

30
Q

How does the virus gain entry to the body in all the viral exanthems?

A

through the upper respiratory tract (rubella & rubeola) or GI tract (enteroviruses)

31
Q

What is an autoimmune disorder in which virtually any kind of skin lesion can occur, including macules, papules, plaques, bullae, purpura, subcutaneous nodules, and ulcers?

A

systemic lupus erythematous (SLE)

32
Q

How does SLE present clinically?

A

an erythematous rash often with a violaceous hue; a malar rash with a “butterfly” appearance

33
Q

The American Rheumatism Association states that a pt. is diagnosed with SLE if they have 4 or more criteria. What are the criteria?

A
  1. Malar rash 7. renal disorder
  2. Discoid rash 8. neurologic disorder
  3. photosensitivity 9. hematologic disorder
  4. oral ulcers 10. immunologic disorder
  5. arthritis 11. antinuclear disorder
  6. serositis
34
Q

How is SLE differentiated from dermatomyositis?

A

Periungual erythema with telangiectasia is virtually diagnostic of dermatomyositis

35
Q

If a butterfly rash is present how can a PA differentiate between SLE & seborrheic dermatitis?

A

Seborrheic dermatitis has fine yellowish scale, involvement of the nasolabial folds, and coexistence of a scaling rash on the scalp, behind the ears, on the eyebrows, & presternal area

36
Q

What are the lab screening tests for SLE?

A

CBC, platelet count, UA, & ANA

37
Q

What is a generalized erythema that is a cutaneous response to a circulating toxin?

A

toxic erythema

38
Q

What are 4 types of toxic erythema?

A
  1. scarlet fever
  2. staphylococcal scalded skin syndrome (SSSS)
  3. toxic shock syndrome
  4. kawasaki syndrome
39
Q

Who is at highest risk for SSSS?

A

neonates (because of decreased toxin clearance by kidneys & lack of antibody to to the toxin)

40
Q

Except for toxic shock syndrome, toxic erythemas occur most often in _____.

A

children

41
Q

What are the characteristics of toxic erythema seen on physical examination?

A
  1. sandpaper-like erythema
  2. accentuated in flexural folds
  3. followed by desquamation
42
Q

Mucous membrane involvement accompanies all toxic erythemas except ____.

A

SSSS (staph. scalded skin syndrome)

43
Q

How is toxic erythema differentiated from toxic epidermal necrolysis?

A

toxic epidermal necrolysis has blistering that is subepidermal rather than intraepidermal

44
Q

What organism is found in pts. with scarlet fever?

A

Group A streptococci

45
Q

Striking mucous membrane involvement & lymphadenopathy in a child who appears seriously ill are key features of what toxic erythema?

A

Kawasaki syndrome

46
Q

In pts. with toxic erythema, cultures should be obtained from what potential bacterial reservoris?

A
  1. throat
  2. skin
  3. vagina
  4. blood
47
Q

What is the course of scarlet fever?

A

complete recovery within 5-10 days

48
Q

T/F: In all toxic erythema disorders, post-inflammatory desquamation usually occurs in 1-2 wks.

A

TRUE

49
Q

the toxins involved in toxic erythema act as ____ that directly activate T cells.

A

superantigens

50
Q

T cell activation in toxic erythema causes the release of massive amounts of which cytokines?

A
  1. TNF-alpha
  2. IL-1
  3. IL-6
51
Q

T/F: Scarlet fever can recur if repeated streptococcal infections occur.

A

FALSE (scarlet fever DOES NOT recur because of specific antitoxin Abs that are formed from the 1st episode)

52
Q

What is SSSS caused by?

A

a toxin produced by phage group II S. aureus

53
Q

What is known as a generalized, inflammatory skin condition involving more than 90% of the skin surface area?

A

erythroderma

54
Q

What are the causes of erythroderma?

A
  1. primary skin dz
  2. med. rxn
  3. rxn. to underlying malignancy
  4. idiopathic
55
Q

Which generalized erythematous skin disorder is a exfoliative erythroderma with palpable lymphadenopathy?

A

Sezary Syndrome

Dermatology - Chapters (18 decks)

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