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SBL Exam 2 > Clinical Perspectives in Skin Changes (Tyler) > Flashcards

Clinical Perspectives in Skin Changes (Tyler) Flashcards

1
Q

What diseases can present with a diffuse maculopapular rash?

A 
Measles
Rubella
Erythema Infectiosum
Infectious Mononucleosis 
Lyme Disease
Ehrlichiosis
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2
Q

This disease presents with the following:

  • Exposure 7-18 days before onset of prodrome in an unvaccinated patient.
  • Rash
  • Leukopenia
A

Measles

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3
Q

The rash for Measles appears brick red, irregular, and maculopapular. It appears 3-4 days after onset of prodrome and moves in what direction?

A

Begins on face and moves “downward and outward”

Affects palms and soles last

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4
Q

T/F. Once you have Measles once, you can still get another time.

A

False. Illness confers permanent immunity.

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5
Q

What are the characteristic oral lesions that occur with the Measles on the buccal mucosa and are pathognomonic?

A

Koplik Spots

***Only occur about 30% of the time!

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6
Q

In children, this is an exanthematous illness characterized by a fiery red “slapped cheek” appearance.

A

Erythema Infectiosum (“Fifth Disease”)

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7
Q

Erythema Infectiosum occurs due to what virus?

A

Parvovirus

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8
Q

Besides the fiery red “slapped cheek” appearance, what are other characteristic symptoms of Erythema Infectiosum?

A

– Circumoral pallor

– Lacy, maculopapular, evanescent (vanishing, fading away) rash on the trunk and limbs

– Malaise, headache, and pruritus (palms and soles) with little fever

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9
Q

Parvovirus is one of the most common causes of _________ in childhood.

A

Myocarditis

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10
Q

Symptoms of __________ infection can mimic those of autoimmune states, such as lupus, systemic sclerosis, antiphospholipid syndrome, or vasculitis (the inflammatory arthritidies).

A

Parvovirus B19

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11
Q

Middle-aged people (especially women) can develop a limited symmetric _________ that mimics SLE and RA.

A

Polyarthritis

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12
Q

For Parvovirus, what symptoms are most common in adults, children, and pregnant women?

A

Adults = Arthralgias

Children = Rashes (especially facial and truncal)

Pregnancy = Premature labor, Hydrops fetalis, Fetal loss

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13
Q

This is a rickettsial infection that is common in Missouri. It can cause N/V, fever, chills, headache, myalgia, anorexia, photophobia, and malaise.

A

Ehrlichiosis

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14
Q

In Ehrlichiosis, other symptoms include abdominal pain mimicking _________ (occurs in children more than adults), conjunctival infection, ________ petechiae, edema of dorsal hands, and calf pain.

A

Appendicitis

Palatal

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15
Q

What would a blood workup show of Ehrlichiosis?

A 
Leukopenia 
Lymphopenia
Thrombocytopenia 
Transaminitis (increased liver enzymes) 
Anemia
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16
Q

How soon after the onset of systemic symptoms in Ehrlichiosis do the erythematous macules and/or papule, petechiae, or diffuse erythema show up?

A

About 5 days

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17
Q

Lyme Disease will often present with ________ ________, which is a flat or slightly raised red lesion that expands with central clearing (bulls eye).

A

Erythema migrans

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18
Q

This disease often presents with a headache or stiff neck, and will cause arthralgia, arthritis, and myalgias. Arthritis is often chronic and recurrent.

A

Lyme Disease

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19
Q

In what stage of Lyme Disease do the following things occur?

– A flat or slightly raised red lesion at tick bite site (about 1 week after the bite) = Erythema migrans

– Common in areas of tight clothing (groin, thigh, or axilla)

– Lesion expands over several days

– Classic lesion progresses with central clearing (bulls-eye)

A

Stage 1 = Early Localized Infection

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20
Q

In what stage of Lyme Disease do the following things occur?

– Bacteremia

– Secondary skin lesions (in about 50% of pts after original infection - lesions similar to primary lesions but smaller)

– Less common, but can develop myopericarditis (4-10%) and neurologic manifestations (10-15%)

A

Stage 2 = Early Disseminated Infection

***Weeks to months later!

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21
Q

In what stage of Lyme Disease do the following things occur?

– MSK manifestations (arthritis of knee or other large weight-bearing joints)

– These are rare, but neurologic manifestations and acrodermatitis chronicum atrophicans (bluish-red discoloration of distal extremity with associated swelling) can occur

A

Stage 3 = Late Persistent Infection

***Months to years later!

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22
Q

How can you distinguish Lyme Disease from Shingles?

A

Lyme Disease does NOT follow dermatomal distributions like Shingles

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23
Q

EBV is ubiquitous (infects >95% of adult population for their lifetime). ________ ________ is a common manifestation of EBV and may occur at any age. EBV is largely transmitted by saliva but can also be recovered from genital secretions.

A

Infectious Mononucleosis (“Kissing Disease”)

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24
Q

How can we test for Infectious Mononucleosis?

A

Positive heterophiles agglutination test (Monospot)

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25
Q

What type of infection is being described?

– Lymphadenopathy (slightly painful, especially along posterior cervical chain)

– Transient bilateral upper lid edema (Hoagland Sign)

– Splenomegaly (in 50%, can be massive – should avoid contact sports!)

A

Infectious Mononucleosis

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26
Q

This disease is caused by a spirochete that can infect almost any organ or tissue in the body. Its transmission occurs most frequently during sexual contact.

A

Syphilis

***Caused by Treponema Pallidum!

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27
Q

What is congenital syphilis?

A

Transplacental transmission occurs in infants of untreated or inadequately treated mothers.

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28
Q

T/F. Syphilis has two major clinical stages, which are separated by a symptom-free latent period.

A

True

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29
Q

This stage of Syphilis consists of:

– Primary lesions (chancre and lymphadenopathy)

– Secondary lesions (commonly involving skin and mucous membranes)

– Congenital lesions

A

Early (Infectious) Syphilis

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30
Q

This stage of Syphilis consists of:

– Benign (gummatous) lesions involving skin, bones, and viscera

– Cardiovascular disease (principally aortitis)

– CNS and ocular syndromes

A

Late Syphilis

***Remember that late Syphilis can cause AORTITIS! Important!

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31
Q

Secondary Syphilis can present with a rash that is diffuse (may include palms and soles), macular, papular, pustular, and combinations. There is also ________ ________ on the genitalia. There can also be ________ ________, which are painless, silvery ulcerations of mucous membranes with surrounding erythema. Lymphadenopathy also presents.

A

Condylomata lata

Mucous Patches

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32
Q

This virus causes Hand-Foot-Mouth Disease and Herpangina. It has more than 50 serotypes and 2 major subgroups: A and B. Most often occurs during summer months.

A

Coxsackie Virus

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33
Q

This disease is caused by Coxsackie Virus and presents with the following:

    • Stomatitis (swelling of mouth and lips)
    • Vesicular rash on hands and feet
    • Nail dystrophies and onychomadesis (nail shedding)
A

Hand-Foot-Mouth Disease (HFMD)

***Caused by Coxsackie Virus subtypes A and B!

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34
Q

This disease is caused by Coxsackie Virus and presents with the following:

– Sudden-onset fevers

– Headaches

– Myalgias

– Petechiae or papule on the soft palate that ulcerate in about 3 days then heal.

A

Herpangina

***Caused by Coxsackie Virus subtypes A and B3!

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35
Q

The hallmark of this disease is the development of a vesicular eruption on the palms and soles. The vesicles quickly erode and form yellow to gray, oval or “football-shaped” erosions surrounded by an erythematous halo. Patients will often develop an enanthem consisting of similarly appearing oral erosions.

A

HFMD

36
Q

What are complications of Coxsackie Virus?

A

Epidemic pleurodynia (Bornholm Disease, subtype B)

Aseptic meningitis (subtypes A and B)

Acute pericarditis (subtype B)

37
Q

This disease can be caused by multiple organisms. Most cases (>90%) were initially reported in women of childbearing age, especially common within 5 days of onset of menstrual period in women who have used tampons.

A

Toxic Shock Syndrome (TSS)

38
Q

Strains of staphylococci may produce toxins that can cause four important entities, which are…

A

– Scalded Skin Syndrome (typically in children) or Bullous Impetigo (in adults)

– Necrotizing pneumonitis in children

– TSS

– Enterotoxin food poisoning

39
Q

Toxic shock is characterized by abrupt onset of fever, vomiting, and watery diarrhea. A diffuse macular erythematous rash and non-purulent conjunctivitis are common. The patient will look like they have a ________. Desquamation, especially of the palms and soles, is typical during recovery.

A

Sunburn

***Morbilliform rash is common (looks like measles)

40
Q

This is a syndrome characterized by exudative pharyngitis, fever, and scarlatiniform rash. It is typically caused by Group A strep (pyogenes).

A

Scarlet Fever

41
Q

This is the most common cause of tonsillopharyngitis in children and adolescents.

A

Streptococcus pyogenes

42
Q

For Scarlet Fever, prodrome is 1/2 to 2 days of malaise, sore throat, fever, and vomiting. Next the rash will appear, which is generalized, punctate, red, and prominent on the neck, in axillae, groin, and skin folds. There is circumoral pallor and fine desquamation on hands and feet. A major characteristic is the ________ ________, and exudative tonsillitis.

A

Strawberry Tongue

43
Q

This is a rare cutaneous or mucocutaneous eruption characterized by “target” lesions, predominantly on the face and extremities. Highest incidence found male children and young adults.

A

Erythema Multiforme

44
Q

Most cases of Erythema Multiforme are related to what infections?

A

Herpes Simplex Virus (HSV)

Mycoplasma pneumoniae

45
Q

This is a highly contagious exanthem that occurs most often in childhood. Rash usually begins on the face and scalp and spreads rapidly to the trunk, with relative sparing of the extremities. Lesions are scattered, rather than clustered.

A

Varicella (Chicken Pox)

46
Q

Describe the lesions of Varicella and their stages.

A

They progress from rose-colored macules to papules, vesicles, pustules, and crusts. These lesions in all stages are usually present at the same time!

47
Q

In who is Varicella more likely to be severe and associated with life-threatening complications?

A 
Adults
Immunocompromised people (any age)
48
Q

The term Pemphigus refers to a group of autoimmune blistering diseases of skin and mucous membranes. Pemphigus can be divided into 4 major types, which are…

A

Vulgaris
Foliaceus
Paraneoplastic
IgA Pemphigus

49
Q

The skin lesions in Pemphigus Vulgaris (PV) can be pruritic or painful. Exposure to ________ may exacerbate disease activity.

A

UV (Sun)

50
Q

What type of Pemphigus is being described?

– Primary lesions is flaccid blister, can occur anywhere on skin (not palms or soles).

– Blisters are very fragile, most common skin lesions observed in patients are erosions resulting from broken blisters.

– Erosions often quite large.

A

Pemphigus Vulgaris (PV)

51
Q

This type of Pemphigus presents with scaly, crusted lesions. There is a desquamation (exfoliative) character.

A

Pemphigus foliaceus

52
Q

This is a bacterial infection caused by Neisseria gonorrhoeae, a gram-negative aerobic diplococci. It is an STD, and can also be transmitted vertically from mother to child during vaginal birth.

A

Gonococcemia (Gonorrhea)

53
Q

If gonorrhea is transmitted from mother to child during vaginal birth, it manifests as an inflammatory eye infection called…

A

Ophthalmia Neonatorum

54
Q

This is the term for a disseminated gonococcal infection (gonococcemia). The spread of infection from the primary site of inoculation to other parts of the body through the bloodstream.

A

Gonoccemia

***Very rare - 0.5% to 3% of cases!

55
Q

What is the classic triad of Gonoccemia?

A
    • Dermatitis
    • Migratory polyarthritis
    • Tenosynovitis

***Affects tendons, joints, and joint lining!

56
Q

Cutaneous lesions often occur in gonoccemia (40-70%). Skin findings consist of small- to medium-sized macules, or most typically, ________ ________ on an erythematous based located on palms and soles. The lesions may also develop ________ centers.

A

Hemorrhagic vesicopustules

Necrotic

57
Q

The concurrence of some degree of hemorrhage and necrosis led to the term ______ ______ ______ to describe the cutaneous lesions of DGI (disseminated gonococcal infection).

A

“Gun Metal Gray”

58
Q

Worldwide, ________ ________ is responsible for 1.2 million cases of infection and 135,000 deaths annually.

A

Neisseria meningitidis

59
Q

What can disseminated meningococcal infection present as?

A
    • Meningitis alone
    • Acute meningococcemia with or without meningitis
    • Chronic meningococcemia
60
Q

In (ACUTE/CHRONIC) meningococcemia, a classic petechial rash present in 60% of patients will be on the extremities. In severe cases, necrosis of the skin and underlying tissue may necessitate amputation!

A

Acute

61
Q

The rash of (ACUTE/CHRONIC) meningococcemia more commonly consists of rose-colored macules and papule, although petechiae, nodules, vesicles, and pustules may be present. Rash may wax and wane with periodic fevers.

A

Chronic

62
Q

Acute meningococcemia with disseminated intravascular coagulation (DIC) may produce ________ ________. This is characterized by retiform purpura and necrosis of the skin. Can progress to gangrene of the digits and distal extremities.

A

Purpura fulminans

63
Q

Thrombotic Thrombocytopenic Purpura (TTP) is characterized by the pentad of what?

A
    • Microangiopathic Autoimmune Hemolytic Anemia
    • Thrombocytopenia
    • Neurologic symptoms
    • Fever
    • Renal failure
64
Q

Often, an additional _________ trigger (such as infection, surgery, pancreatitis, or pregnancy) is required to initiate clinical TTP.

A

Inflammatory

65
Q

T/F. TTP is a very mild, and treatable disease. Most patients symptoms will resolve on their own.

A

False. If untreated, TTP has a mortality rate exceeding 90%.

66
Q

The classic form of TTP is idiopathic TTP, which is the result of a severe deficiency in…

A

ADAMTS13

67
Q

If we see palpable purpura, what should we think of?

A

Think infectious/inflammatory

68
Q

What are diseases we would see that involves palpable purpura and vasculitis?

A

SLE
Sjogren’s
Henoch-Scholein’s
RA

69
Q

What are diseases we would see that involves palpable purpura and infection?

A

Meningococcemia
Gonoccemia
RMSF
Endocarditis

70
Q

If we see non-palpable purpura, what should we think of?

A

“Other” like autoimmune

71
Q

This is the most common form of cutaneous cancer. There is usually a waxy, “pearly” appearance, with telangiectatic vessels easily visible. Can also appear umbilicated and bleeding.

A

Basal Cell Carcinoma (of skin)

72
Q

What often causes BCC?

A

Common in fair-skinned people with a lot of sun exposure (often intense).

73
Q

This type of cancer presents as a non healing ulcer or warty nodule. The lesions appear as small red, conical, hard nodules that occasionally ulcerate. Caused by skin damage due to long-term sun exposure.

A

Squamous Cell Carcinoma (of skin)

74
Q

SCC of the skin has a 15% chance of malignancy when developing from…

A

Actinic Keratosis

75
Q

Melanoma has a rising incidence worldwide. What are the main risk factors for developing melanoma?

A
    • History of sunburns and/or heavy sun exposure
    • Blue or green eyes
    • Blonde or red hair
    • Fair complexion
    • > 100 typical nevi, any atypical nevi
    • Prior personal or family hx of melanoma
    • p16 mutation
76
Q

What are the most common locations for melanoma in men and women?

A

Back for men
LE followed by trunk for women

***ANYWHERE on the skin!

77
Q

T/F. Melanoma is surgically curable if caught early, but potentially lethal with increased risk when diagnosed and treated late.

A

True

78
Q

How do we screen for melanoma?

A

Using ABCDE!

A = Asymmetry

B = Border (irregular)

C = Color (black - necrotic; blue - deeper depth of invasion; white - ischemic, fibrosis, deeper invasion)

D = Diameter (greater than 5-6 mm)

E = Evolution (lesion changes over time)

79
Q

What component of the ABCDE screening for melanoma carries the greatest sensitivity and specificity for predicting the metastatic potential of a lesion?

A

Color

80
Q

What type of skin biopsy technique is being described?

    • Most common biopsy technique
    • Less time consuming
    • Good cosmetic result
    • Limited downtime for patient
    • Limited to process occurring to depth of mid dermis
A

Shave Biopsy

***Band-aid and on their way!

81
Q

This is a tool used to perform a shave biopsy. It’s useful because you can bend it to affect your margins.

A

Dermablade Scalpel

82
Q

What type of skin biopsy technique is being described?

    • Able to provide full thickness skin sample
    • Rapid healing
    • Limited by diameter of the tool used
    • May not be adequate for processes in SubQ tissue (due to limitations with depth)
A

Punch Biopsy

83
Q

What type of skin biopsy technique is being described?

– More advanced procedures

– Sterile technique required

– Advantages include adequate sample down to SubQ tissues

– Margins can be controlled and adjusted as needed

– Limitations include: Increased procedure duration, longer healing time, possible scarring, suture removal.

A

Excisional Biopsy

84
Q

Where should the injections be done for an excisional biopsy?

A

1st injection at apex of one end of site. 2nd and 3rd injections in mid aspect of area directed toward the opposite apex (this covers whole excision area!)

85
Q

What biopsy should be performed if we suspect melanoma?

A

AVOID biopsy!

***Refer to dermatology or appropriate surgically trained physician!

SBL Exam 2 (7 decks)

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