Exam 3 part 2 acute skin infections

Question 1

What are the hallmarks of urticaria?

Answer 1

transient wheals, pruritic, type 1 hypersensitivity (IgE). HIVES

Question 2

What are the hallmarks of angioedema?

Answer 2

swelling of lips, burning pain, emergency

Question 3

What are the hallmarks of Steven Johnson syndrome?

Answer 3

2+ Mucous membranes,

Question 4

What causes Steven Johnson syndrome?

Answer 4

Hypersensitivity to sulfa drugs (often a treatment for UTIs)

Question 5

What are the hallmarks of erythema multiforme

Answer 5

Target lesions on palm, 1 mucous membrane

Question 6

What are the hallmarks of Toxic Epidermal Necrolysis

Answer 6

2+ mucous membranes, 30+% skin sloughing

Question 7

What are the hallmarks of fixed drug reaction

Answer 7

1 spot of hyper pigmentation, start demarcated lines

Question 8

What are the hallmarks of erythema nodosum

Answer 8

Anterior leg nodules

Question 9

What are the hallmarks of Erythema induratum

Answer 9

posterior leg nodules

Question 10

Whats the difference between erythema nodosum and induratum?

Answer 10

EN is the anterior leg nodules, EI is the posterior leg nodules

Question 11

What layer of skin does urticaria affect?

Answer 11

Dermis

Question 12

What layer of skin does Erythema multiforme affect?

Answer 12

Epidermis and Dermis

Question 13

What layer of the skin does Steven Johnson Syndrome and Toxic epidermal necrolysis affect?

Answer 13

Epidermis and Dermis

Question 14

What layer of the skin does fixed drug eruption affect?

Answer 14

Epidermis

Question 15

What layer of the skin does panniculitis (Erythema nudism and erythema induratum) affect?

Answer 15

Subcutaneous

Question 16

What layer of the skin does angioedema affect?

Answer 16

Deep dermis and subcutaneous

Question 17

What needs to be done when seeing a patient with urticaria or angioedema?

Answer 17

Thorough history (travel, recent infection, occupational exposure, meds, foods) Careful family history for pre-existing allergies, Look at total body (joints, skin surfaces, mucosal membranes)

Question 18

How often are angioedema and urticaria acute reactions?

Answer 18

Over 2/3rds of all these reactions are acute

Question 19

Immune causes of urticaria and angioedema?

Answer 19

Type 1 IgE mediated (allergies), auto-immune (SLE, hashimoto’s immune thyroiditis, infectious agent (viral, bacterial, etc)

Question 20

Non-immune causes of urticaria and angioedema?

Answer 20

Physical urticarias (ice, sun, friction, pressure), direct mast-cell degranulation (narcotics, aspirin, NSAIDs), foods containing high levels of histamines (strawberries, tomatoes, shrimp)

Question 21

Different lab exams to evaluate urticaria and angioedema

Answer 21

CBC, ESR, TSH, basica chem panel, anti-thyroid antibodiy and FANA in female patients, punch biopsy to exclude vasculitis if lesion persists for 48 hrs

Question 22

What is the therapy for angioedema and urticaria?

Answer 22

Avoid allergen, avoid extremes in heat and cold, exercise, alcohol. Acute: antihistamines non-sedating H1 blockers

Question 23

name First choice antihistamines for treatment of urticaria and angioedema?

Answer 23

Second generation, non-sedating H1 blockers: Cetirizene (10-20mg/day), Fexofenadine (180mg/day), Desloratadine (5mg/day) , Loratidine (10mg/day)

Question 24

What is the last resort for antihistamines

Answer 24

Oral corticosteroids (prednisone, tapered over 10-14 days), EpiPen for type 1 IgE mediated

Question 25

What would you diagnose someone who comes into the clinic with bulls-eye lesions on their extremities (palms and soles) with?

Answer 25

Erythema multiforme

Question 26

What can cause erythema multiforme?

Answer 26

50% is idiopathic, drugs: sulfonamides, phytoin, barbituruates, phenylbutazone, penicillin, allopurinol. Infection: HSV, Mycoplasma

Question 27

What are the two forms of Erythema Multiforme?

Answer 27

EM minor (1 mucosal site, usually post-HSV infection), EM Major (SJS, usually due to drugs

Question 28

What usually causes erythema multiforme minor?

Answer 28

Post herpes simplex infection, EM rash at day 10

Question 29

What usually causes EM major?

Answer 29

Due to drugs (sulfa, PCN, dilantin, tegretol), and after mycoplasma pneumonia infection

Question 30

What is the therapy for erythema multiforme?

Answer 30

Prevention of HSV outbreaks, glucocorticoids for severe systemic illness

Question 31

T/F: SJS and TEN can be life threatening?

Answer 31

Yes

Question 32

How do you differentiate between EM and SJS and TEN?

Answer 32

EM (1 membrane)>SJS ( TEN (30% of epidermal detachment, 2 membranes)

Question 33

What are risk factors for SJS and TEN?

Answer 33

systemic lupus, HLA-B12, HIV disease

Question 34

What is the leading causative factor of SJS and TEN?

Answer 34

SJS: 50% associated with drugs, TEN: 80% associated with drugs

Question 35

How long does it take for SJS and TEN to develop after first drug exposure?

Answer 35

1-3 weeks, detachment is equivalent to a 2nd degree burn

Question 36

Treatment of SJS and TEN?

Answer 36

early diagnosis and withdrawal from drug, ICU, management of IV fluids, early glucocorticoids, high dose of Ig for TEN, debride only frankly necrotic skin, treat complications

Question 37

What are complications of SJS and TEN?

Answer 37

sepsis, GI hemorrhage and fluid/electrolyte imbalance

Question 38

Where do fixed drug eruptions happen?

Answer 38

face and genitals most common

Question 39

How do you treat fixed drug eruptions?

Answer 39

remove offending drug

Question 40

What are the two forms of panniculitis?

Answer 40

Erythema nodosum, erythema induratum

Question 41

How do you accurately diagnose panniculitis?

Answer 41

skin biopsy

Question 42

What triggers erythema nodosum?

Answer 42

Infection (strep, TB, infection) Meds (OCP, sulfa, NSAIDs), autoimmune (BD, sarcoid)

Question 43

What is erythema induratum usually associated with?

Answer 43

TB

Question 44

How do you treat panniculitis?

Answer 44

rest, ice, pain control