DERMATOLOGY

Question 1

MANAGEMENT

Answer 1

INVESTIGATIONS

CBC
Electrolytes
BUN
Creatinine
Blood Cultures
CRP
Urinalysis
Urine Culture
+/- LP

Question 2

DOCUMENTATION

Answer 2

ASK ABOUT:

Duration
Distribution
Colour
Progression / Spreading
Blisters
Bumps
Involvement of mucus membranes
Recurrence

a/w
pain
pruritis
bleeding
discharge

systemic symptoms: fever (esp > 5 days)
malaise
Fatigue
weight loss
joint pain
swelling
Confusion / Behaviour Change
Dyspnea
Headaches
Neck Stiffness
Red Eyes
URTI / LRTI
Diarrhea
Blood in Stool
Abdo Pain
Involvement of Hands / Feet

Relationship with physical agents
Drug exposures
Sick Contacts / Travel

Immunization Status

PHYSICAL EXAM

Look for:
Fever

Undress and look at mucous membranes, genetalia, hands and feet

Non Blanching (petichiae / purpura)
Blisters / Ulcers
Infected Skin
Hives
Mucosal Change
Involvement of hands / feet
Conjunctivitis

DISTRIBUTION & PATTERN:
Discrete vs. confluent
Solitary vs. multiple
Distribution: dermotomal, symmetric, asymmetric, flexor / extensor
Sun exposed skin
Circumscribed

CONFIGURATION / SHAPE:
Annular
Discoid
Reticular

COLOUR:
Hypo / Hyperpigmented
Erythema (blanching)
Purpura (non blanching)
Telangectasia

MORPHOLOGY: PRIMARY LESION
Macule
Patch
Papule: Elevated, circumscribed lesion < 5 mm

Nodule: Elevated, firm, circumscribed lesion > 5 mm

Plaque: Elevated, flat topped, circumscribed lesion > 5 mm

Vesicle: Circumscribed collection of free fluid < 5 mm

Bulla: Circumscribed collection of free fluid > 5 mm

Pustule: Circumscribed collection of free fluid and leukocytes

Furuncle
Cyst
Wheal
Tumor

MORPHOLOGY: SECONDARY LESION
Scale
Crust
Erosion
Fissure
Ulcer
Excoriation
Atrophy
Lichenification

Question 3

DDx: Dangerous Rash

Answer 3

NON-BLANCHABLE (petechiae / purpura):
-Meningococcemia
-D.I.C.
-Coagulopathy
-Thrombocytopenia
-H.S.P.
-H.U.S.

BLISTERING:
-Herpes Simplex Virus
-Varicella
-Toxic Shock Syndrome
-Staph Scalded Syndrome
-Steven Johnson Syndrome
-Toxic Epidermal Necrolysis
-Burns

INFECTION:
-Impetego
-Cellulitis
-Nectrotizing Fasciitis

HIVES:
-Anaphylaxis

MACULOPAPULAR:
-Kawasaki’s
-Multisystem Inflammatory Syndrome in Children
-Rocky Mountain Spotted Fever

Question 4

DDx: Non-Emergent

Answer 4

NON-BLANCHABLE (petechiae / purpura):
-H.S.P.

BLISTERING:
-Varicella (non complicated)
-HFM
-Scabies
-Bullous Impetigo

MACULOPAPULAR:
-Pityriasis Rosea
-Atopic Dermatitis
-Enterovirus Rash
-Erythema Infectiosum
-Roseola
-Erythema Multiforme
-Scarlet Fever