Derma - urticaria, bacterial skin infxns Flashcards
0
Q
Urticaria/angioedema
Edema extends to deep dermis and /or subcutaneous and submucosal layers
A
Angioedema
1
Q
Urticaria/angioedema
Circumscribed, raised, erythematous, evanescent areas involving the superficial dermis
A
Urticaria
2
Q
Pathogenesis of urticaria and angioedema
A
Mast cells, basophils, eosinophils releases histamine and cytokines
Results to vascular permeability
Then extravasation of fluids and proteins
Causing edema
3
Q
Acute urticaria recurs for how many days
A
<30d
4
Q
Chronic urticaria recurs for how many days
A
> 30d
5
Q
Wheals of acute urticaria.
A
Large wheals, associated with angioedema
6
Q
Wheals of chronic urticaria.
A
Small and large wheals
7
Q
Acute/chronic urticaria
IgE-dependent (with atopic background)
A
Acute urticaria.
8
Q
Acute/chronic urticaria
Due to anti-FcR autoantibodies
A
Chronic urticaria
9
Q
Acute/chronic urticaria
Related to alimentary agents, parasites and penicillins
A
ACute urticaria
10
Q
Acute/chronic urticaria
Intolerance to salicylates and benzoates
A
Chronic urticaria
11
Q
Chronic urticaria cannot tolerate
A
Salicylates and benzoates
12
Q
Acute/chronic urticaria
Complement mediated in serum sickness-like reaction (whole blood, ig, penicillin)
A
Acute urticaria
13
Q
Chronic urticaria common in children/adult, M/F
A
Adult, F
14
Q
Acute/chronic urticaria
May persist for 10yrs
A
Chronic urticaria
15
Q
Acute/chronic urticaria
Rarely persists for >24hrs
A
Acute urticaria
16
Q
Localized urticarias
A
Solar
Pressure
Vibration
Cold urticaria
17
Q
Immunologic urticarias
A
IgE-mediated urticaria
Complement-mediated urticaria
Immunologic contact urticaria
Autoimmune urticaria
18
Q
Immunologic urticaria due to type 1 HPS with atopic background. Common Ag are food, drug and helminths
A
IgE mediated urticaria
19
Q
IgE mediated urticaria HPS type
A
Type 1 HPS
20
Q
Acute immunologic urticarias
A
IgE mediated
Complement mediated
Immunologic contact
21
Q
Immunologic urticaria which releases anaphylotoxin causing mast cells degradation. Common in serum sickness, ig and admin of whole blood
A
Complement mediated urticaria
22
Q
Chronic immunologic urticaria
A
Autoimmune urticaria
23
Q
Immunologic urticaria common in children with atopic dermatitis sensitized to environmental allergens and individuals sensitized to latex rubber gloves. Accompanied by anaphylaxis.
A
Immunologic contact urticaria
24
Autoimmune urticaria is positive in what test
Autologous serum skin test
25
The remission of disease activity of autoimmune urticaria is due to
Plasmapheresis
IVIg
Cyclosporin
26
Physical urticaria with positive linear lesion after storming or scratching skin
Dermographism
27
Demographics fades in ...
30min
28
Physical urticari confined to sites exposed to cold
Cold urticaria
29
Diagnosis of cold urticaria
Ice cube test
30
How to do ice cube test
Application of ice for 10min
| Wheal appears within 5min
31
Diagnostic test for solar urticaria
Test with UVB, UVA and visible light
32
How to test solar urticaria
260-690nm uv expo for 30-120s
| Wheal appears within 30min
33
Wheezing for <1hr is seen in what Physical urticaria
Solar urticaria
34
Mediator of solar urticaria
Histamine
35
Wheezing physical urticaria
Solar
| Cholinergic urticaria
36
Physical urticaria which appears with exercise and sweating
Cholinergic urticaria
37
Physical urticaria in which the intracutaneous of ACH and mecholyl will produce micropapular whealing
Cholinergic urticaria
38
Very rare phys urticaria with water of any temperature
Aquagenic urticaria
39
Aquagenic urticaria lesion is same with
Cholinergic urticaria
40
Sites of predilection of pressure urticaria
Soles
Palms
Waist
41
Applications of p perpendicular to skin in pressure urticaria will produce WHEAL after..
1-4hrs
42
Pressure urticaria is delayed for (time)
30min-12hrs
43
Physical urticaria which is painful and interferes with quality of life. No lab abnormalities. Associated with fever
Pressure angioedema
44
Familial, autosomal dominant physical urticaria
Vibratory angioedema
45
Distinct angioedema syndrome
Hereditary angioedema HAE
| Angioedema-urticaria-eosinophilia syndrome AUES
46
Major mediator of chronic idiopathic urticaria
Histamine.
47
Eicosanoids and neuropeptides
Urticaria due to mast cells releasing agents and pseudo allergens and chronic idiopathic urticaria
48
Urticaria due to mast cells releasing agents and pseudo allergens and chronic idiopathic urticaria AGENTS
```
FAARS
Food preservatives
Ace inhibitors
Additive azo dyes
Radio contrast media
Salicylate
```
49
Due to direct effects of exogenous urticants penetrating into skin and blood vessels
Non immune contact urticaria
50
Urticaria associated with vascular/connective tissue autoimmune disease
SLE
| Sjögren's syndrome
51
Urticaria vasculitis lesion persists for
>12-24hrs
52
Urticaria associated w vascular or connective tissue autoimmune disease has SLOW/RAPID changes in size and config
Slow
53
Urticaria associated w vascular or connective tissue autoimmune disease may or may not have residual pigmentation due to
Hemosiderin
54
Urticaria often with hypocomplementemia and renal disease
Urticaria associated w vascular or connective tissue autoimmune disease
55
HAE is autosomal dominant/recessive
Dominant
56
T or F: Uritacaria usually occurs in HAE
Does not usually occur
57
Lab abnormalities in HAE
Decreased C1-esterase inhibitor
| Low C4
58
May follow trauma (phys/emotional)
AE of face and ext, laryngeal edema, acute abd pain (presents as surgical emergency)
With bradykinin formation
Can be life threatening
HAE
59
Treatment for HAE
Danazol (long term)
| Whole fresh plasma
60
With severe AE with pruritic urticaria of face, neck, trunk and ext
AUES
61
AUES lasts for how many days
7-10d
62
Lab abnormalities of AUES
Leukocytosis
| Eosinophilia
63
HAE/AUES:
No family history
Fever
Marked increase in wt
AUES
64
Treatment for AUES
Prednisone
65
HAE/AUES: good prognosis
AUES
66
Lab in urticarial vasculitis
Increased ESR
| Hypocomplementemia
67
Flushing. Burning. Wheezing.
Cholinergic urticaria
68
Fever.
Serum sickness
| AUES
69
Hoarseness. Stridor. Dyspnea.
AE
70
Arthralgia.
Serum sickness
| Urticarial vasculitis
71
Abdominal colicky pain.
HAE
72
Medications.
Penicillin
Aspirin
NSAIDs
Ace inhibitors
73
Treatment when severe urticaria is associated with anxiety and depression
Doxepin
74
Treatment for urticaria with AE
Prednisone
75
Treatment for AUES
Prednisone
76
Treatment for acute attack of HAE
Whole fresh plasma or
| C1-esterase inhibitor
77
H2 antihistamine
Cimetidine
Famotidine
Ranitidine
78
3rd gen H1 antihistamine
Piperadine - desloratadine, fexofenadine
| Piperazine - levocetirizine
79
2nd gen H1 antihistamine
Piperadine - loratadine, terfenadine
| Piperazine - cetirizine
80
1st gen H1 antihistamine
Alkylamine - chlorpheniramine maleate, dimethindene maleate
Aminoalkyl ether (ethinolamine)- clemastine fumarate, diphenhydramine
Ethylenediamine- antazoline
Phenothiazine- mequitazine, phomethazine
Piperidine- azatadine maleate, cyproheptadine
Piperazine- hydroxyzine
81
Age of onset: eryhtrasma
Adult
82
Age of onset: impetigo and ecthyma
Primary - children
Secondary- any age
Bullous- children/young adult
83
Age of onset: abscess, furuncle, carbuncle
Children up to young adult (boys)
84
Age of onset: erysipelas and cellulitis
Any age
85
Age of onset: staph-scalded-skin syndrome (Ritter's dse)
Neonate up to <5y/o
86
Commonly called as Ritter's disease
Staph-scalded-skin syndrome
87
Etiology: eryhtrasma
C. Minutissimum
88
Etiology: impetigo and ecthyma
Staph aureus-most common
| GAS
89
Etiology: abscess, furuncle, carbuncle
MSSA, MRSA
90
Etiology: erysipelas and cellulitis
Adult- S.aureus, GAS
| Children- HiB, S.aureus, GAS
91
Etiology: Ritter's disease
S.aureus grp2
92
Site of predilection: eryhtrasma
```
Toe web spaces >groin folds > axilla
Interiginous areas (intra gluteal, infra mammary)
```
93
Site of predilection: abscess, furuncle, carbuncle
Hair follicles
| Break of integrity of skin
94
Macules, sharply marginated, red-brown, scaling at sites not continuously occluded.
Post-inflammatory Hyperpigmentation
Associated with dermatophytoses and candidiasis
Eryhtrasma
95
Woods lamp of erythrasma
Coral-red fluorescence
96
Heavy growth of corynebacterium
Erythrasma
97
T or F: eryhtrasma may relapse if predisposing causes are not corrected
True
98
Prophylaxis for erythrasma
Benzoyl peroxide
Medicated powders
Topical antiseptics- isopropyl, ethanol
99
Topical therapy for erythrasma
Benzoyl peroxide
Eythromycin, clindamycin
Mupirocin
Antifungals
100
Nonspecific inflammation of opposed skin and between redundant skin.
Common among obese.
Intertriginous infection and intertrigo
101
Management for intertrigo
Wt reduction
Moist dressing/ castellani's paint
Zinc oxide ointment- reduce friction
Pimecrolimus, tacrolimus
102
Etiology of pyoderma
Coagulase neg staph
| S.aureus, GAS
103
Portal of entry of primary impetigo
Minor breaks in skin
104
Portal of entry of secondary impetigo
Traumatic breaks
105
Duration of lesion of impetigo
Days to wks
106
Duration of lesion of ecthyma
Wks to mos
107
Impetigo/ecthyma: variable pruritus (associated w/ AD)
Impetigo
108
Impetigo/ecthyma:
pain and tenderness (indurated)
Induration with thick adherent crust
Ecthyma
109
Site of predilection of ecthyma
Distal ext
110
T or F: mimoetigo is associated with lymphangitis or LA
True
111
Bullous/nonbollous;
| Golden yellow crusts
Nonbullous
112
Bullous/nonbollous; clear yellow, brown crusts with shallow moist erosion
Bullous
113
Bullous/nonbollous; with normal appearing skin
Bullous
114
Bullous/nonbollous; scattered discrete with satellite lesions by auto inoculation
Nonbollous
115
Distribution of nonbollous
More in intertriginous areas
116
What happens to an untreated impetigo
leads to ecthyma resulting to healing with scar
117
T or F: with MRSA infection, impetigo and ecthyma is associated with high morbidity and mortality
True
118
Topical treatment for impetigo and ecthyma
Mupirocin 3x/d for 7-10d
119
Systemic treatment for impetigo and ecthyma
Pen G or V
| Cephalosporin, vancomycin etc
120
Prevention of impetigo and ecthyma
Daily bath
Benzoyl peroxide
Check family member
Ethanol or isopropyl for hands
121
It occurs as a foreign body response to splinter, ruptured inclusion cyst and injection sites
Sterile abscess
122
Represents as a continuum of severity of staph aureus infection
Folliculitis
Carbuncle
Furuncles
123
site of predilection of abscess, furuncle, carbuncle
Hair follicle
| Break on intergrity of skin
124
Synonym for abscess, carbuncle, furuncle
Boil
125
Acute /chronic localized infection with collection of pus and tissue destruction. Arise from dermis, subQ fat and ms or deeper
Abscess
126
SOP of abscess
Any cutaneous sites, sites of trauma
127
Acute, deep seated from staph folliculitis. Firm tende nodule with central necrotic plug with central pustule with or without surrounding cellulitis.
Furuncle
128
SOP of furuncle
Any hair-bearing region
129
Deeper infection with interconnecting abscess with similar evolution to furuncle.
Multiple adjacent coalescing furuncle.
Carbuncle
130
SOP of. Carbuncle
Several contiguous hair follicle.
131
Possible HEMATOGENOUS seeding of abscess, furuncle and carbuncle
```
Heart valves
Joints
Spine
Long bones
Viscera
```
132
Abscess/carbuncle/furuncle: accompanied with fever and malaise
Carbuncle
133
Management for abscess furuncle carbuncle
I and D plus systemic antimicrobial
134
Adjunctive therapy for absces, Furuncle, carbuncle
Application of heat (promotes localization or consolidation and aids early spontaneous drainage)
135
Aka soft tissue infection
Cellulitides
136
An acute, diffus, spreading, edematous, suppurative inflammation of dermis and subQ tissues.
Often with malaise, fever and Chills
Soft tissue infection a
137
History of human bite
Erysipelas and cellulitis
138
Spread on infection in soft tissue infection is due to
Hyaluronidase - polysaccharide ground subs
Fibrinolysin - fibrin barriers
Lecithinase - cell mem
139
Soft tissue infection is more on a reaction to..
Cytokine and bacterial superantigens
140
SOP of erysipelas in adult
Low leg
141
SOP of erysipelas in young male
Arm
142
SOP of erysipelas in female
Post mastectomy
143
SOP of erysipelas ff rhinitis and conjunctivitis
Face
144
SOP of erysipelas in operative wound site
Trunks
145
SOP of erysipelas in children
Head and neck - HiB
| Ext - staph aureus, GASP
146
Unlike other types of cellulitis, that which is cause by ___ usually ff a primat enteritis with bacteremia and dissemination
V. Vulnificus
147
Management for erysipelas and cellulitis: primary with pneumococcus
Benzoyl peroxide plus immunize those at risk
148
Management for erysipelas and cellulitis: primary with HiB
Benzoyl peroxide plus chemo prophylaxis for household contacts of <4y/o
149
Management for erysipelas and cellulitis: primary with vibrio
Benzoyl peroxide plus avoid eating uncooked seafood
150
Antimicrobial treatment for erysipelas and cellulitis
S. Aureus and beta lactam antibiotics
151
Staph aureus phage grp 2 in Ritter's dse produces what toxin
Exfoliating toxin A and B
152
Site of ET production
```
Purulent conjunctivitis
Otitis media
Omphilitis
Occult nasopharyngeal
Bullous impetigo
```
153
Pathogenesis of Ritter's disease.
| Colonize. ET production. Transport by blood to skin. _________ = __________
Acantholysis and intraepidermal cleavage within stratum granulosus = local Bullous imopetigo or mild scarlatiniform rash
154
Ritter's disease spont heals in
5-7d
155
Macular scarlatiniform rash or diffuse ill defined erythema.
Fine stippled sandpaper apparance.
SSS syndrome or Ritter's disease
156
Ritter's disease spreads within
24-48hr
157
(+) nikolsky sign
Ritter's dse
158
Ddx for Ritter's disease
TEN
TSs
Kawasaki syndrome
159
T or F: In Ritter's disease, staph aureus is seen at site of infection, NOT from sites of sloughing skin or bullae
True
160
T or F: In Ritter's disease, gram(+) cocci only at colonized site
True
161
Ritter's disease spont heals with adeq antibiotic treatment in
3-5d
162
T or f: Ritter's disease lesion produces scarring
False
163
Psedudomonas aeroginosa prefers dry/moist environment
Moist environment
164
Pseudomonas aeroginosa colonized what part of the body
```
Skin
External ear
URT
Large bowel
(In those who are compromised )
```
165
Entry sites of pseudomonas infection
Breaks in MC barrier
Aspiration
Decubitus or skin ulcers
Thermal burns
166
3 stages of infection of pseudomonas
Bacterial attachemt and colonization
Local invasion and damage of tissue
Disseminated systemic disease
167
T or F: psedomonas infection may stop at any stage
True
168
Clinical syndrome of pseudomonas infection
```
Nail colonization
Folliculitis
Toe web infection
1and2 pyoderma
Ext. otitis
```
169
Nail colonization of pseudomonas infection is seen undersurface of oncholytic nails. What is the discoloration
Green
170
Hot tub folliculitis of pseudomonas infection infects multiple hair follicle. Is it self limited?
True
171
Color of exudate and odor ofPyoderma of pseudomonas infection
Blue green exudates and fruity odor
172
Is external otitis in pseudomonas infection self limited?
True
173
Invasive infection of pseudomonas
Ecthyma gangrenosum
174
Erythematous macule which leads to hemarhagic bluish infarction to black in central necrosis with erythematous halo
Ecthyma gangrenosum
175
SOP of ecthyma gangrenosum
Axilla
Groin
Perianal
Everywhere
