CIS: Skin changes in blood and lymph Flashcards
What are causes of a Diffuse Maculopapular Rash?
- Measles
- Rubella
- Erythema Infectiosum
- Infectious mononucleosis
- Lyme disease
Describe Measles
- Exposure: day 1
- 7-18 days later: prodrome in an unvaccinated patient (fever, cough, coryza, conjunctivis)
- 3-4 days after prodrome: brick red maculopapular rash “morbiliform rash” that begins on the face and proceeds “downward and outward” => palms and soles LAST. Lasts 3-5 days
- Koplik spots on buccal mucosa = pathognomonic
What is pathognomic for measles
Koplik spots = but only occur
What are complications of measles?
- Pneumonia
- Post-measles encephalitis
How is the presentation of Rubella different from Measles?
“3 day measles”
Short prodrome and rash only lasts 2-3 days.
What is fifth disease and who does it occur in?
- Fifth disease => erythema infectionisum => due to parvovirus B19
- Produces a slapped cheek appearance
- White around mouth (circumoral pallor)
- Lacy, maculopapular rash on TRUNK and LIMBS
- Itchy palms and soles
- Little fever
What is the presentation of erythema infectiosum?
- Child + red “slapped cheek appearce”
- White around mouth “circumoral pallor”
- Lacy maculopapular rash on the trunk and limbs
- Pruritis in palms and soles
- Rarely fever

Parvovirus is one the most common causes of _____ in children.
What else can it cause?
Myocarditis
=> aplastic crisis and pure RBC aplasia
How does parvovirus affect middle aged people (especially women)?
Mimics SLE and RA => looks like an inflammatory arthritis

What lesion does Lymes Disease produce?
Erythema migrans: flat or slightly raised expanding lesion where tick bit => progresses to a bulls-eye lesion (becomes pale in the middle)

What are the stages of Lymes Disease?
Where is it MC?
NE, Mid-Atlantic, Upper Midwest, Pacific coast
- Stage 1 (early localized infection): Erythema migrans “bulls eye lesion” + myalgias + HA/fatigue
-
Stage 2: Early disseminated infections (weeks - months later)
- Bacteremia
- Secondary lesions (similar to 1st but smaller)
- Stage 3: Late persistant infections (months - years): MSK infections => monoarticular, oligoarticular arthritis of knee or weight bearing joints

How is the maculopapular rash + vesicle formation seen in Lymes different than shingles?
Does NOT follow a dermatomal distrubution

Infectious mononucleosis if the MC manifestation of EBV.
- How is it transmitted?
- What is the incubation period?
- MC at what ages?
Infectious mononucleosis if the MC manifestation of EBV.
- How is it transmitted?
- What is the incubation period?
- MC at what ages?
- Saliva
- 30-50 days
- 12-19 YO
Other symptoms of infectious mononucleosis
Diagnose how?
- Fever + malaise
- Exudative sore throat: pharyngitis, uvular edema, tonsilittis, gingivitis
- Posterior cervical lymphandenopathy
Dx = (+) heterophile aggluttination test (monospot)
What are common illnesses that manifest with manifest with peripheral skin eruptions?
- Meningococcemia
- Rocky Mountain Spotted Fever
- Secondary syphilis
- Hand/Foot/Mouth disease
Rocky Moutain Spotted Fever
- MC caused by
- When does it occur
- Complication?
- Rickettsia rickettssi, a parasite of tick, caused by ticks
- Late spring - summer
- If untreated= 70% chance of mortality
Descibe the rash and presentattion of RMSF
- Cough + pneumonitis
- Rash = begins as a faint macule that progresses to large maculopapules/petchiae; begins on wrist and ankles (can involve palms and soles) => spreads to arms, legs and trunk
What causes Syphilis?
Treponema pallidum, a spirochete, via sexual contact
2 major clinical stages of syphilis
1. Early (infectious stage)
2. Late syphilis
What is this?

- Primary chancre of the tongue + penis seen in early( infectious) stage of syphilis
- Seen with regional lymphadenopathy
What are the 2 clinical stages of syphilis and what lesions do you find?
1. Early (infectious) stage = chancres + regional lymphadenapathy
2. Late syphilis = benign gumma lesions on skin, bones and viscera

What do you see in Secondary Syphilus?
- Diffuse maculopapular pustular rash (can be on palms and soles)
- Condylomata lata
- Mucous patches: painless, silvery ulcers on the mucous membranes + surrounding erythema

Describe this lesion and what causes it

- Hand-foot-mouth disease due to Coxsackievirus A6 or enterovirus infection
-
Lesion:
-
Football- vesicular rash on palms and soles, surrounded by a red halo
- also on butt and external genitalia
-
Football- vesicular rash on palms and soles, surrounded by a red halo
Hallmark of HFMD = football vesicular rash on the palms and soles of feet.
What other findings do we see?
- Stomatitis
- Nail dystrophies + onychomadesis (nail shedding)
- Oral erosions of tongue buccal mucosa

What are 3 complications of Coxsackievirus?
- Epidemia pleurodynia: pleuritis chest pain
- Aseptic meningitis
- Acute pericarditis
Causes of Desquamative Skin Changes
- Toxic Shock Syndrome
- Scarlet Fever
- Erythema Multiforme
Strains of Staph. can produce toxins that cause what?
- Scalded skin syndrome (esp in children) or bullous impetigo (in adults)
- Necrotizing pneumotitis = children
- Toxic shock syndrome
- Enterotoxin food poisinging
Most cases (≥ 90%) of TSS were initially reported in who?
Women of childbearing age, especially common within 5 days of the onset of a menstrual period in women who have used tampon
Describe Toxic shock syndrme
- Abrupt onset of Fever/V/D (watery)
- Diffuse maculopapular (morbilliform) rash = desquamation (esp in palms and soles) is typical
- NON-PURELENT CONJUNCTIVITIS

Scarlet Fever is characterized by what?
Due to?
Group A Strep Pyogenes
- Exudative pharyngitis (sore throat): strawberry tongue, exudative tonsillitis
- Fever
- Scarlet rash: bright red rash MC on neck, axilla, groin, skin folds. Desquamation occurs on hands + feet

What do you see on labs in scarlet fever?
- Group A beta-hemolytic strep on culture
- Anti-streptolysin O titer rise
what is this

Erythema Multiforme “target lesion” MC due to Herpes Simplex (HSV) and Mycoplasma pneumonia
- Skin and mucus membranes: on face and extremities
- MC in male kids and yound adults
Describe the onset of Erythema Multiforme
- No prodome. If sx ==> URI
- REVIEW the past 3 weeks to ID cause: HSV, respiratory symptoms, or influenza illness
Erythema Multiforme majus that are NON-cutaneous occur where and often due to ________
Mucosal lesions MCC by M. pneumoniae, most often in oral cavity: Lips, hard palate is spared.

What causes Vesicular and Bullous lesions
1. Varicella
2. Pemphigus
What is this?

Varicella chicken pox
- Highly contagious rash that begins on face/scalp => trunks (SPARES extremities)
- Scattered
- Progresses from: rose colored macules => papules, vesicles, pustules + crusts
- Lesions seen at all different stages
*
What is this

Varicella chicken pox: remember they becomes papules, vesicles, pustules and crust
what is this?
what makes these lesions worse

- Pemphigus vulgaris: PRURITIC + PAINFUL fragile large bulla that have a tendency to spread at periphery
- UV radiation
What causes Petechial and Purpuric Lesions
- Gonococcemia
- Meningococcemia
- Thrombotic thrombocytopenic purpura
bullous pemphigus have a ____ origin
AI
What is gonoccemia?
Disseminated gonococcal infection (spread from primary sites => other parts of body via blood stream)
Classic triad of gonoccemia
- Dermatitis (small - medium sized macules or vesicopustules with red base on PALMS and SOLES. May develop a necrotic center and hemorrage, forming a “gun metal grey lesion”. if on palms and soles => tender. if not, painless)
- Migratory polyarthritis
- Tenosynovitis
what is this?

what is this?

Acute meniingococemia with DIC => pupura fulminans: retiform purpura + necrosis of skin that can cause gangrene of digits and distal extremeities => may need amputation

Pentad of TTP
- MIHA
- Thrombocytopenia
- Neurologic symptoms
- Fever
- Renal failure
TTP is MC at what age and MC in who?
40YO
Blacks
what is this

purpura
BCC is MC where?
- Back
- Chest
- Lower legs
Bleeds

SCC presents as what?
- Red, warty nodule that can ulcerate (nonhealing)
- Keratinization.
- Common on hand

What is the most sensitive at predicting the metastatic potentia of a melnoma?
COLOR
- Black = necrotic
- Blue = deeper
- White = ischemia, fibrosis, deeper invasion