Desquamation Disorders

Question 1

characteristic erythematous iris-shped papules and vesicobullous lesions involving the extremities (especially the palms and soles) and the mucus membranes

Answer 1

erythema multiforme

Question 2

What are the major differences between EM minor and EM major?

Answer 2

EM minor is often due to HSV and has few systemic sx, whereas EM major is often due to meds and has systemic sx

Question 3

What do the following medications have in common: bactrim, dapsone, anti-epilectics, PCN, cephalosporins, and allopurionol?

Answer 3

frequent offenders to cause erythema multiforme

Question 4

drug induced or idiopathic rxn patterns characterized by skin tenderness and erythema followed by cutaneous and mucosal exfoliation. potentially life threatening

Answer 4

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Question 5

considered a maximal variant of Erythema Multiforme Major

Answer 5

Steven’s Johnsons

Question 6

Considered a maximal variant of Steven’s Johnsons

Answer 6

toxic epidermal necrolysis

Question 7

Most common age of presentation for SJS and TEN

Answer 7

> 40yrs

Question 8

How long after drug exposure might SJS or TEN occur?

Answer 8

1-3 weeks

Question 9

Conditions that are risk factors for SJS or TEN

Answer 9

Lupus, HIV, HLS-B12

Question 10

Treatment for SJS/TEN

Answer 10

Cessation of causative drug. ICU, fluids, IVIG (halts progression). erythromycin ointment for eye lesions

Question 11

Medication that is commonly associated with a drug rash

Answer 11

Bactrim (Septra)

Question 12

Treatment for drug rash

Answer 12

benadryl, steroids, avoid sweating

Question 13

What do the following have in common: petechiae, subungal splinter hemorrhages, Osler’s nodes, Janeway lesions, roth spots.

Answer 13

peripheral lesions of bacterial endocarditis

Question 14

exudative lesions in the retina

Answer 14

roth spots

Question 15

Small, non-blanching, reddish-brown macules on extremities, upper chest, mucus membranes. Occur in crops

Answer 15

petechial lesion

Question 16

Establish the diagnosis of bacterial endocarditis

Answer 16

blood cultures (3 sets 1hr before abx)

Question 17

Patient presents 1-2 wks after tick bite with fever > 102, chills, weakness, headache and photophobia. Indirect fluorescent antibody is positive

Answer 17

RMSF

Question 18

What day of fever does a red macular rash of RMSF that evolves to petechiae usually show up?

Answer 18

2nd-6th day

Question 19

Common areas involved in RMSF rash

Answer 19

palms and soles

Question 20

What do you need to rule out when diagnosing RMSF with blood cultures and CSF?

Answer 20

meningoccemia

Question 21

How is meningococcemia transmitted?

Answer 21

droplets

Question 22

pain in the hamstrings upon extension of the knee with the hip at a 90 degree flexion

Answer 22

Kernig sign

Question 23

flexion of the knee in response to flexion of the neck.

Answer 23

brudzinski

Question 24

Patient presents with nuchal and back rigidity, high fever, chills, HA. Kernig and Brudzinkski are positive

Answer 24

meningococcemia

Question 25

Common locations of the pink 2mm-10mm macule/papule rash of meningococcemia

Answer 25

pressure points and lower extremities

Question 26

Important complication of meningococcemia typically present in toxic patients with ecchymotic skin lesions

Answer 26

DIC

Question 27

fibrin degradation product, present when coagulation system has been activated

Answer 27

D-Dimer

Question 28

What conditions does D-Dimer aid in diagnosing?

Answer 28

DIC and DVT

Question 29

Caused by Neisseria gonorrhoeae. Early phase consists of tenosynovitis, arthralgias, dermatitis, and peripheral skin lesions.

Answer 29

Gonococcemia

Question 30

Describe the classic skin lesions of gonococcemia

Answer 30

acral hemorrhagic pustules

Question 31

Treatment for gonococcemia

Answer 31

ceftriaxone, 1 gram IV daily, until 48 hours after improvement begins then switch to cefixime for 1 wk