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SBL > Clinical Perspectives in Skin Changes > Flashcards

Clinical Perspectives in Skin Changes Flashcards

1
Q

What are some conditions that cause a maculopapular skin rash?

A
  • measles, rubella
  • erythema infectiosum (Fifth Disease)
  • mono
  • Lyme Disease
  • Ehrlichiosis
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2
Q

What is the incubation period of measles?

A

7-18 days

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3
Q

Describe the rash of measles.

A
  • brick red, irregular, maculopapular
  • appears 3-4 days after symptoms begin
  • begins on face and proceeds “down and out”
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4
Q

What would a CBC of a measles patient show?

A

leukopenia

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5
Q

What are the symptoms of measles that show up prior to the rash? (aka prodromal symptoms)

A
  • fever
  • cough
  • coryza
  • conjunctivitis
  • KOPLIK SPOTS!
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6
Q

Describe the rash of erythema infectiosum (Parvovirus, aka “Fifth Disease”).

A
  • fiery red “slapped cheek” rash followed by a lacy, evanescent rash on the trunk and limbs
  • facial rash is uncommon in adults (truncal rash may briefly occur)
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7
Q

What are the symptoms of erythema infectiosum (Parvovirus, aka “Fifth Disease”), other than rash?

A
  • malaise
  • headache
  • pruritus (particularly palms and soles)

-additionally in adults: limited symmetric polyarthritis

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8
Q

What is the most common cause of myocarditis in children?

A

parvovirus

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9
Q

For an adult infected with parvovirus, what other conditions does it mimic and should be on the Ddx list based on the presenting symptoms?

A
  • SLE
  • RA
  • Systemic Sclerosis
  • APS
  • Vasculitis
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10
Q

What are complications of pregnancy caused by parvovirus?

A
  • premature labor
  • hydrops fetalis
  • fetal loss
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11
Q

What is a common Rickettsial infection in Missouri?

A

Ehrlichiosis, a tickborne disease

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12
Q

What are some general systemic symptoms of ehrlichiosis?

A
  • fever and chills
  • headache
  • malaise
  • myalgia (particularly calf pain)
  • N/V and loss of appetite
  • photophobia
  • abd. pain mimicking appendicitis (in kids)
  • palatal petechiae
  • edema of dorsal hands
  • rash
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13
Q

Describe the rash of ehrlichiosis.

A
  • erythematous macules and/or papules
  • petechiae
  • diffuse erythema

-occurs 5 days after onset of symptoms

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14
Q

What would bloodwork of an ehrlichiosis patient show?

A
  • leukopenia
  • lymphopenia
  • thrombocytopenia
  • anemia
  • transaminitis (elevated liver enzymes)
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15
Q

What are some respiratory symptoms of ehrlichiosis?

A
  • cough
  • dyspnea
  • RDS
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16
Q

What are some neurological symptoms of ehrlichiosis?

A
  • meningoencephalitis
  • AMS
  • cranial or peripheral motor nerve paralysis
  • sudden transient deafness
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17
Q

What are some severe symptoms of ehrlichiosis?

A
  • acute renal failure
  • DIC
  • pericarditis
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18
Q

What type of rash is present in Lyme Disease?

A

-erythema migrans (targetoid, slightly raised expanding red lesion with a central clearing)

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19
Q

What are systemic symptoms of Lyme Disease?

A
  • headache or stiff neck
  • sometimes fever

-myalgias, arthralgias, arthritis
(arthritis is often chronic/recurrent)

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20
Q

Where are most cases of Lyme Disease?

A

-northeast US

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21
Q

What are characteristics of Stage 1 (localized infection) in Lyme Disease?

A
  • targetoid rash approx. 1 week after tick bite

- rash common in areas of tight clothing (groin, axilla)

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22
Q

What are characteristics of Stage 2 (early disseminated infection) of Lyme Disease?

A
  • occurs weeks to months later
  • bacteremia in 50-60% of pts
  • secondary skin lesions that are smaller targetoid
  • malaise, fatigue
  • headache, neck pain, generalized aches
  • fever
  • myopericarditis w/ A/V arrhythmias and heart block
  • neurologic manifestations
  • conjunctivitis
  • keratitis
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23
Q

What are characteristics of Stage 3 (late persistent infection) of Lyme Disease?

A
  • months to years later
  • MSK manifestations in 60%
  • -arthritis of large weight-bearing joints

-neuro and cutaneous manifestations (rare)

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24
Q

If the vesicle formation of Lyme Disease can be mistaken for shingles, how can one tell the difference?

A

-shingles follows a dermatomal pattern while a Lyme Disease rash doesn’t

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25
Q

What is the incubation periods for EBV?

A

-30 to 50 days

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26
Q

How long does saliva remain infectious for EBV?

A

-6 months or longer after symptoms

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27
Q

What age groups is typically associated with EBV?

A

ages 12-19

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28
Q

What is the common clinical disease associated with EBV?

A

infectious mononucleosis

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29
Q

What are the symptoms of mono?

A
  • malaise, myalgia
  • fever
  • exudative sore throat
  • tonsillitis, uvular edema, gingivitis
  • loss of appetite
  • palatal petechiae, conjunctival hemorrhage
  • lymphadenopathy (particularly posterior cervical chain)
  • splenomegaly (sometimes massive)
  • transient B/L upper eyelid edema (Hoagland Sign)
  • maculopapular rash (occasionally)
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30
Q

What type of lab test would confirm a diagnosis of infectious mononucleosis?

A

+ Monospot

31
Q

What would appear on a blood smear of a mono patient?

A
  • atypical large lymphocytes

- lymphocytosis

32
Q

What are some complications of mono?

A
  • hepatitis
  • myocarditis
  • neuropathy
  • encephalitis
  • airway obstruction from adenitis
  • hemolytic anemia
  • thrombocytopenia
33
Q

What is the infectious organism of syphilis?

A
  • Treponema pallidum, a spirochete

- spread by sexual contact (transmission during unprotected sex w/ an infected partner is 30-50%)

34
Q

What is the simple disease progression of syphilis?

A
  • early stage
  • latent period
  • late stage
35
Q

What are characteristics of early (infectious syphilis)?

A
  • chancres
  • lymphadenopathy
  • occasionally bone, liver, or CNS lesions
36
Q

What are the characteristics of late syphilis?

A
  • -gummatous lesions of skin, bones, and viscera
  • -cardiovascular disease (particularly aortitis)
  • -low-grade fever
  • -malaise, myalgias, arthralgias
  • -loss of appetite
  • -CNS symptoms
  • -occular symptoms
37
Q

Describe the rash of secondary syphilis.

A
  • diffuse macular, papular, and pustular combo
  • -rash may affect palms and soles
  • condyloma lata (genital wart-like lesions)
  • painless silvery ulcers of mucous membranes
38
Q

What virus causes Hand-Foot-Mouth Disease?

A
  • Cocksackievirus A and B

- more common in summer

39
Q

What are the symptoms of Hand-Foot-Mouth Disease?

A
  • stomatitis
  • vesicular rash on palms and soles
  • nail dystrophies
  • -onychomadesis (nail shedding)
40
Q

Describe the rash of Hand-Foot-Mouth Disease.

A
  • begin as bright pink macules that progress to vesicles with surrounding erythema (4-8 mm)
  • vesicles erode to form yellow/grey football-shape erosions surrounded by erythematous “halo”
  • similar erosions on tongue, buccal mucosa, hard palate and oropharynx
41
Q

What virus causes herpangina?

A

Cocksackie A and B3

42
Q

What are the symptoms of herpangina?

A
  • sudden fever
  • HA
  • myalgia
  • petechiae/papules on soft palate that ulcerate after 3 days and then heal
43
Q

What are some complications of Cocksackievirus?

A
  • epidemic pleurodynia
  • -pleuritic CP, HA, malaise, pharyngitis
  • aseptic meningitis
  • -fever, HA, stiff neck, CSF lymphocytosis, encephalitis
  • acute pericarditis
  • -positional pleuritic CP, fever, myalgia
44
Q

What are the symptoms of Toxic Shock Syndrome?

A
  • -abrupt onset fever, diarrhea, vomiting
  • -diffuse macular erythematous rash
  • -non-purulent conjunctivitis
  • -desquamation of palms and soles during recovery
45
Q

What are the symptoms of Scarlet Fever?

A
  • exudative pharyngitis and tonsillitis, sore throat
  • fever
  • malaise
  • vomiting
  • “strawberry tongue”
  • scarlatiniform rash
46
Q

What pathogen causes Scarlet Fever?

A

typically Streptococcus pyogenes

47
Q

What is the most common cause of tonsillopharyngitis in kids and adolescents?

A

Streptococcus pyogenes

48
Q

Describe the rash of Scarlet Fever.

A
  • generalized red punctae on neck, axilla, groin, and skin folds
  • desquamation of hands and feet
49
Q

What are lab tests that can detect strep?

A

–presence of Group A beta-hemolytic streptococci in throat cultures

–anti-streptolysin O titer rise

50
Q

What causes most cases of Erythema multiforme?

A
  • HSV
  • Mycoplasma pneumoniae

-medications are NOT a common cause

51
Q

Describe the rash of Varicella (chicken pox).

A
  • begins on face/scalp and spreads rapidly to trunk, with relative sparing of extremities
  • lesions are scattered, not clustered and present in all stages of healing simultaneously
52
Q

What is the progression of the chicken pox rash?

A

rose-colored macules to vesicles to pustules to crusts

53
Q

True or False: blisters of pemphigus vulgaris are fragile

A

True - the most common lesions observed are actually erosions that resulted from broken blisters

–erosions are often quite large and tend to spread at their periphery

54
Q

What pathogen causes gonococcemia?

A

Neisseria gonorrhoeae, a gram-negative aerobic diplococci

-usually seen located within PMN leukocytes

55
Q

What is the classic triad in gonococcemia?

A
  • dermatitis
  • migratory polyarthritis
  • tenosynovitis

-cutaneous lesions present in 40-70% of cases

56
Q

Describe the lesions of disseminated gonococcemia.

A

–small- to medium-sized hemorrhagic vesicopustules on an erythematous base located on palms and soles

–lesions may develop necrotic centers (“gun metal gray”)

57
Q

What pathogen causes meningococcemia?

A

Neisseria meningitidis

58
Q

What are the ways that disseminated meningococcal infection may present?

A
  • meningitis alone
  • acute meningococcemia (w/ or w/o meningitis)
  • chronic meningococcemia
59
Q

Describe the rash of acute meningococcemia.

A
  • petechial rash on the extremities

- in severe cases, necrosis of the skin and underlying tissue (purpura fulminans d/t DIC) may necessitate amputation

60
Q

Describe the rash of chronic meningococcemia.

A

–rose-colored macules and papules

61
Q

What is the pentad of Thrombotic Thrombocytopenic Purpura (TTP)?

A
  • thrombocytopenia
  • neurologic symptoms
  • fever
  • renal failure
  • microangiopathic autoimmune hemolytic anemia
62
Q

What is a common initiation factor of TTP?

A

-an additional inflammatory trigger such as infection, surgery, pancreatitis, or pregnancy)

  • median age of onset is 40
  • 9x higher incidence in blacks
63
Q

What is deficient in the classic form (idiopathic form) of Thrombotic Thrombocytopenic Purpura?

A

ADAMTS13 (severe deficiency)

64
Q

Palpable purpura should make you think of what type of etiology?

A

infectious or inflammatory

  • -vasculitis (SLE, Sjogrens, RA, Henoch-Scholein’s)
  • -infection (meningococcemia, RMSF, endocarditis)
65
Q

Non-palpable purpura should make you think of what type of etiology?

A

auto-immune

–ITP, TTP, DIC, platelet dysfunction, clotting factor defect

66
Q

What is the most common form of cutaneous cancer?

A

Basal Cell Carcinoma

67
Q

Describe the appearance of basal cell carcinoma.

A
  • pearly/translucent/waxy papule, erythematous path >6mm, or nonhealing ulcer in sun-exposed area
  • telangectatic vessels visible
68
Q

Describe the appearance of Squamous Cell Carcinoma.

A
  • nonhealing ulcer or warty nodule
  • -red, conical, hard, occasional ulceration

-may arise from actinic keratosis

69
Q

What are some risk factors for melanoma?

A
  • Hx of sunburn
  • blue/green eyes; blond/red hair; fair complexion
  • 100+ typical nevi or any atypical nevus
  • prior Hx or family Hx of melanoma
  • p16 mutation
70
Q

What are the most common locations for melanomas?

A
  • men: back

- women: lower extremities and trunk

71
Q

What are the ABCDE’s of melanoma and which is the most important?

A 
Asymmetry
Border (irregular, notched, ragged)
COLOR (varying shades ... black, blue, white)
Diameter greater than 5-6 mm
Evolution
72
Q

What are some characteristics of a Shave Biopsy?

A
  • most common
  • less time consuming
  • good cosmetic result
  • limited downtime for the patient

-limited to processes that occur down to the mid-dermis

73
Q

What are some characteristics of a Punch Biopsy?

A
  • full thickness sample
  • rapid healing
  • limited by diameter of the punch tool
  • depth limitations for processes in subcutaneous tissue
74
Q

What are some characteristics of an Excisional Biopsy?

A
  • more advanced procedure
  • sterile technique req’d
  • adequate sample down to subcutaneous tissue
  • controlled margins
  • increased procedure duration
  • longer healing time
  • greater potential for scarring
  • suture removal

SBL (4 decks)

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