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SBL > Clinical Perspectives in Skin Changes > Flashcards

Clinical Perspectives in Skin Changes Flashcards

1
Q

name the six diffuse maculopapular rashes

A
  1. measles
  2. rubella
  3. erythema infectiosum
  4. infectious mononucleosis
  5. lyme disease
  6. ehrlichiosis
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2
Q

in an unvaccinated patient, what is the time between exposure to measles and prodrome?

A

7-18 days

P STAR

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3
Q

brick red, irregular, maculopapular

appears 3-4 days after onset of prodrome

begins on the face and proceeds downward and outward

A

measles rash

predilection for face and neck, sparseness on the trunk

P STAR

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4
Q

describe the WBC in measles

A

leukopenia

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5
Q

describe the prodrome of measles

A

fever, cough, coryza, conjunctivitis

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6
Q

where are koplik spots located? for which disease are they pathognomonic?

A

buccal mucosa, measles

[koplik spots occur 30% of the time]

P STAR

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7
Q

what are the severe complications of measles?

A
  1. pneumonia

2. post-measles encephalomyelitis

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8
Q

circumoral pallor

subsequent lacy, maculopapular, evanescent rash on the trunk and limps

malaise, HA, pruritus (palms and soles) but little fever

fiery red “slapped cheek” appearance

A

erythema infectiosum (an exanthematous illness)

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9
Q

what is one of the most common causes of myocarditis in children?

A

parvovirus

  • transient, aplastic crisis and pure red blood cell aplasia may occur
  • arthralgias uncommon in children
  • rashes, esp. facial, uncommon in adults
  • during pregnancy: premature labor, hydrops fetalis, fetal loss are reported sequelae
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10
Q

symptoms of parvovirus B19 infection can mimic those of what autoimmune states?

A

lupus, systemic sclerosis, antiphospholipid syndrome, vasculitis

MARKED

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11
Q

the rash of parvovirus can sometimes mimic urticaria and eczema due to…

A

immune deposition

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12
Q

what rickettisal infection is common in missouri?

A

ehrlichiosis

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13
Q

child in missouri presents with appendicitis-like abdominal pain, conjunctival injection, palatal petechiae, edema of dorsal hands, calf pain

fever, chills, HA, malaise, myalgia, N/V, anorexia, photophobia

what is your number one on the ddx? what will labs show? how many days after onset of systemic symptoms does the patient show cutaneous changes?

A
  1. ehrlichiosis (usually presents with flu-like symptoms)
  2. leukopenia, thrombocytopenia, lymphopenia, transaminitis, anemia
  3. erythematous macules and/or papules, petechiae, or diffuse erythema ~5 days days after onset of systemic symptoms
  • *cough, dyspnea, respiratory insufficiency/adult RDS
  • *meningoencephalitis, altered mental status, cranial or peripheral motor nerve paralysis, sudden transient deafness
  • *acute renal failure, DIC, pericarditis
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14
Q

what is a severe neurological complication of ehrlichiosis?

what are three other severe complications?

A

meningoencephalitis

if prolonged: acute renal failure, DIC, pericarditis

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15
Q

name the lesion and disease:

flat or slightly raised red lesions that expands with central clearing

A

erythema migrans; lyme disease

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16
Q

describe stage 1 of lyme disease

A

early localized infection:

erythema migrans at bite site ~1 week following (can be up to one month after); common areas are groin, axilla, thigh

concomitant viral-like illness: myalgias, arthritis, HA, fatigue +/- fever

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17
Q

describe stage 2 of lyme disease

A

early disseminated infection (weeks-months later):

myopericarditis w/ atrial or ventricular arrhythmias; heart block in 4-10% of pts

conjunctivitis, keratitis; possible neurologic manifestations

bacteremia

secondary skin lesions w/in days-weeks of original infxn, similar to primary lesion but smaller

malaise, fatigue, fever, HA, neck pain, generalized achiness

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18
Q

a patient has myopericarditis w/ atrial or ventricular arrythmias, and heart block. what stage of lyme disease do you suspect?

A

stage 2 - early disseminated infection

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19
Q

describe stage 3 of lyme disease

A

late persistent infection (months-years):

60% polyarthritis; 10% develop chronic arthritis

ACA - cutaneous, bluish-red discoloration of distal extremity w/ assoc. swelling; lesions atrophic and sclerotic (resemble localized scleroderma)

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20
Q

a patient w/ known history of lyme disease follows up at your office

on PE you notice cutaneous, bluish-red discoloration of distal extremity w/ assoc. swelling; lesions atrophic and sclerotic

what is the name of this?

A

acrodermatitis chronicum atrophicans / ACA

this occurs in stage 3 (late persistent infection)

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21
Q

how do you differentiate between vesicle formation in lyme disease from that of shingles?

A

lyme disease will not follow dermatomal distributions

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22
Q

pt presents w/ malaise, fever, exudative sore throat

palatal petechiae, LAD, splenomegaly, maculopapular rash

heterophile agglutination test is positive

how does the blood smear look?

A

infectious mononucleosis (+ monospot)

blood smear will have atypical, large lymphocytes; lymphocytosis

LAD – discrete, nonsuppurative, slightly painful, esp. along posterior cervical chain

note: conjunctival hemorrhage, uvular edema, tonsillitis, or gingivitis may occur

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23
Q

name a few complications of infectious mononucleosis

A

hepatitis, myocarditis, neuropathy, encephalitis, airway obstruction from adenitis, hemolytic anemia, thrombocytopenia

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24
Q

what is the hoagland sign?

A

transient bilateral upper lid edema, seen in infectious mononucleosis

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25
Q

what is the cardiovascular disease associated with the late syphilis stage?

A

aortitis

26
Q

painless, silvery ulcerations of mucous membranes with surrounding erythema

generalized LAD, lesions on palms

A

secondary syphilis ((chancres in primary))

pt will likely have diffuse macular, papular, pustular rash; condyloma lata

constitutional symptoms: low grade fever, malaise, anorexia, arthralgias, myalgias

27
Q

what causes HFMD?

A 
coxsackie virus (subtypes A and B) -- HFMD
herpangina (subtype A; B3)

enteroviruses usually occur during the summer months

28
Q

stomatitis, vesicular rash on hands and feet, nail dystrophies and onychomadesis

A

HFMD from subtypes A and B

29
Q

sudden-onset fevers, HA, myalgias, petehiae or papules on soft palate that ulcerate in about 3 days

A

herpangina from subtype A; B3

*more serious

30
Q

what is the hallmark of HFMD?

A

vesicular eruption on palms and soles

bright pink macules and papules –> vesicles w/ surrounding edema –> quickly erode, form yellow-to-grey oval or football-shaped erosions surrounded by erythematous halo

P STAR

31
Q

in classic HFMD, nearly all patients also develop…

A

enanthem consisting of similarly appearing oral lesions

(tongue buccal mucosa, hard palate, oropharynx)

P STAR

32
Q

coxsackie virus complication:

pleuritic chest pain, HA, malaise, pharyngitis

A

epidemic pleurodynia (Bornholm disease)

subtype B

P STAR

33
Q

coxsackie virus complication:

fever, HA, stiff neck, CSF lymphocytosis, encephalitis and transverse myelitis

A

aseptic meningitis

subtypes A and B

P STAR

34
Q

coxsackie virus complication:

positional, pleuritic chest pain; fevers, myalgias

A

acute pericarditis

clinical and echocardiographic signs of pericarditis

subtype B

P STAR

35
Q

name the three desquamative skin changes

A
  1. TSS
  2. scarlet fever
  3. erythema multiforme
36
Q

abrupt onset of fever, V, watery diarrhea

diffuse macular erythematous rash and non-purulent conjunctivitis

A

TSS – pt’s look sunburned

desquamation, esp. of palms and soles, occurs during recovery

37
Q

what is the most common cause of tonsillopharyngitis in children and adolescents?

A

streptococcus pyogenese (Grp A strep)

P STAR

38
Q

what is the typical cause of scarlet fever?

A

grp A strep (pyogenese)

char. by exudative pharyngitis, fever, and scarlatiniform rash

39
Q

what is the prodrome of scarlet fever?

A

1/2 - 2 days of malaise, sore throat, fever, V

P STAR

40
Q

generalized, punctate, red; prominent on neck, in axillae, groin, skin folds

circumoral pallor

fine desquamation involves hands and feet

oral findings?

A

rash of scarlet fever

strawberry tongue!!! and exudative tonsillitis

throat culture: group A b-hemolytic streptococci
ASO titre rise

P STAR

41
Q

where are the lesions of erythema multiforme predominant?

A

face and extremities, char. by target lesions

MARKED

42
Q

erythema multiforme is most common in male children and young adults, and most cases are related to…

A

infections!!!!

HSV and mycoplasma pneumoniae!!!!!

P STAR

43
Q

what are the prodromal symptoms of erythema multiforme?

A

absent in most cases; usually mild though, suggesting URI

detailed history is important here, up to 3 weeks prior to look for HSV, URI, or flu-like symptoms

44
Q

what are the two vesicular and bullous lesions?

A
  1. varicella

2. pemphigus

45
Q

rash begins on the face and scalp, spreads rapidly to trunk w/ relative sparing of extremities

rose colored macules –> papules, vesicles, pustules, and crusts

A

varicella (chicken pox)

lesions in all stages present at the same time!

MARKED

46
Q

name the three petechial and purpuric lesions

A
  1. gonococcemia
  2. meningococcemia
  3. thrombotic thrombocytopenia purpura
47
Q

what is the classic triad of disseminated gonococcal infection?

A

dermatitis
migratory polyarthritis
tenosynovitis

P STAR

48
Q

hemorrhagic vesicopustules on an erythematous base, on palms and soles

some necrotic centers – “gun metal grey”

A

DGI (disseminated gonococcal infection)

lesions tender on palms and soles, otherwise painless and nonpruritic elsewhere

do not confuse w/ coxsackie

49
Q

describe the presentation of disseminated meningococcal infection

A

meningitis alone
acute meningococcemia +/- meningitis
chronic meningococcemia

P STAR

50
Q

describe the classic rash seen in acute meiningococcemia…

what happens in severe cases?

A

petechial rash, typically on extremities (~60% cases)

in severe cases: necrosis of the skin and underlying tissue necessitate amputation

P STAR

51
Q

describe the rash of chronic meningococcemia…

A

rose-colored macules and papules

petechiae, nodules, vesicles, and pustules may be present; rash may wax and wane w/ periodic fevers

52
Q

acute meningococcemia w/ DIC may produce…

A

purpura fulminans

char. by retiform purpura and necrosis of the skin
may progress to gangrene of the digits and distal extremities

P STAR

53
Q

describe the pentad of TTP

A
  1. microangiopathic autoimmune hemolytic anemia (MAHA)
  2. thrombocytopenia
  3. neurologic symptoms
  4. fever
  5. renal failure

P STARSLOTS OF THEM

54
Q

what is often required to initiate clinical TTP?

A

additional inflammatory trigger… infection, surgery, pancreatitis, pregnancy

median age: 40 yrs
blacks&raquo_space;> non-blacks

classic form of TTP is idiopathic – severe deficiency of ADAMST13

55
Q

palpable purpura means…

A

infectious/inflammatory

vasculitis

  • SLE
  • Sjrogrens
  • Henoch-Scholein’s
  • RA

infection

  • meningococcemia
  • gonococcemia
  • RMSF
  • endocarditis
56
Q

non-palpable purpura means…

A

“other” such as autoimmune

ITP, TTP, DIC
clotting factor defect
other thrombocytopenia or platelet dysfxn

57
Q

what is the most common form of cutaneous skin cancer?

A

BCC

58
Q

waxy, pearly papule; erythematous patch or non-healing ulcer in sun-exposed areas; telangiectatic vessels

umbilicated / bleeding

A

BCC

on back, chest and lower legs: reddish, somewhat shiny, scaly plaques

history of bleeding from the lesion is possible (not w/ SCC)

59
Q

small red, conical, hard nodules that occasionally ulcerate

non-healing ulcer or warty nodule

A

SCC

may arise from actinic keratosis
may occur in pts who are immunosuppressed or s/p organ transplant

60
Q

name the risk factors for melanoma

A

LOL THIS IS YOU

  • hx of sunburns / heavy sun exposure
  • blue or green eyes
  • blonde or red hair
  • fair complexion
  • > 100 typical nevi, any atypical nevi
  • prior personal or family history of melanoma
  • p16 mutation

mean age: 63 yrs

P STAR

SBL (4 decks)

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