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SBL (Skin, Blood, Lymph) Exam 1 and 2 > Lecture 18: Skin Changes in SBL (Exam 2) > Flashcards

Lecture 18: Skin Changes in SBL (Exam 2) Flashcards

1
Q

What 6 organisms cause Maculopapular Rash? (MEILER)

A

Measles, Erythema infectiosum, Infectious Mono, Lyme Disease, Ehrlichiosis, Rubella

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2
Q

When does a measles rash appear? What does it look like and what direction does it spread?

A
  • prodrome occurs 7-18 days after infection, with rash appearing 3-4 days after
  • brick red and irregular; begins on face and moves “DOWN AND OUT” (palms and soles LAST)
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3
Q

What is the prodrome of Measles? (FCCC)

What finding is pathognomonic and what does illness confer?

A

P: Fever, cough, coryza, conjunctivitis

Koplik spots on cheek mucosa are PATH

  • illness confers permanent immunity
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4
Q

What does the rash caused by Erythema Infectiosum look like? Where does it typically occur?

A
  • “slapped cheek” appearance

- lacy, maculopapular fading rash on TRUNK and LIMBs (pruritis on PALMS and SOLES)

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5
Q

What is Parovirus a common cause of and what does it mimic in middle-aged patients, especially women?

A

CC of MYOCARDITIS

  • mimics SLE and RA (limited symmetric polyarthritis) as well as other autoimmune states
  • also mimics urticaria and eczema
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6
Q

What Parovirus symptom is uncommon in children and which is one is uncommon in adults?

A

Children: usually NO arthralgias

Adult: usually NO rashes. especially facial

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7
Q

What is Erlichiosis and when does its rash occur? What is a common symptom found in children infected with it?

A

rickettsial infection with erythematous macules/papules approximately 5 days after systemic symptoms

  • children experience ABDOMINAL PAIN mimicking APPENDICITIS
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8
Q

What kind of neurologic problems occur due to Ehrlichiosis? (ME/D)

A

meningoencephalitis, altered mental state, motor nerve paralysis, sudden deafness

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9
Q

What kind of rash is caused by Lyme Disease?

A

Erythema Migrans (flat/slightly raised red lesion with central clearing)

  • also headache/stiff neck, arthralgias (chronic)
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10
Q

Lymes Disease Staging:

Stage 1
Stage 2
Stage 3

A

S1: early localized erythema migrans (flat/slight raise)

  • 1 wk after bite (groin, thigh, axilla)
  • “bulls-eye” lesion

S2: early disseminated infections (wks-mths)
- bacteremia and 2nd skin lesions (smaller than first)

S3: late persistent infection (mths-yrs)

  • MSK (polyarthralgia) and neuro problems
  • Acrodermatitis Chronicum Atrophicans
    • bluish-red discoloration of distal extremity
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11
Q

What disease can Lyme’s Disease be mistaken for?

A

SHINGLES

  • Lyme does NOT follow dermatomal distribution
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12
Q

What is Infectious Mononucleosis a common manifestation of and how is it transmitted?

A

CM of Epstein Barr Virus (occurs at any age)

  • infects 95% of adult population via saliva (or genital secretions)
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13
Q

Infectious Mononucleosis

What test is positive for EBV, what does a peripheral blood smear show, and what are 3 physical findings it can present with? (L/H/S)

A

(+) - Monospot Test (heterophile agglutination test)

PBS: atypical large lymphocytes (lymphocytosis)

PF: LAD, Hoagland Sign (upper lip edema), Splenomegaly

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14
Q

What are 4 possible complications of Infectious Mononucleosis infection? (HMHT)

A

hepatitis, myocarditis, hemolytic anemia, thrombocytopenia

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15
Q

What kind of Skin problems does Meningococcemia, Secondary Syphilis, and HFM Disease present as?

A

PERIPHERAL SKIN ERUPTIONS

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16
Q

What is Syphilis and how is it spread?

A
  • caused by Treponema pallidum (spirochete) transmitted by sexual contact
  • can infect almost any organ or tissue in the body
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17
Q

What is the difference between Early and Late Syphilis?

A

E: chancre and regional LAD, secondary lesions

L: gummatous lesions (skin, bones, viscera), CNS/ocular syndromes, and AORTITIS

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18
Q

What is a pretty classical cardiovascular complication of Late Syphilis?

A

AORTITIS

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19
Q

How does Secondary Syphilis rash usually present and where? (2)

A
  • diffuse macular/papular/pustular combinations on PALMS and SOLES
  • also Condylomata lata on genitals
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20
Q

What are 3 common clinical findings of Hand-Foot-Mouth Disease? How does Herpangina rash differ from HFM?

A
  • stomatitis, vesicular (hand/feet) rash, nail dystrophies

Herpangina: petechiae/papules on soft palate that ulcerate in about 3 days and heal

21
Q

What is the hallmark of Hand-Foot-Mouth Disease and what does its rash look like?

What 3 locations does the enanthem occur at? (HOT)

A

HM: vesicular eruption on PALMS and SOLES (bright pink macules/papules –> small vesicles w/erythema)

  • erode –> yellow/gray “football” shaped erosion
  • erythematous halo present

Enathem: oral erosion of tongue, hard palate, oropharynx

22
Q

What Hand-Foot-Mouth Disease manifestations occur in both subtypes and ONLY subtype B?

A

Both: ASEPTIC MENINGITIS (usually kids)

Subtype B: Acute Pericarditis

23
Q

What 3 diseases cause Desquamative Skin Changes? (TSE)

A

Toxic Shock Syndrome, Scarlet Fever, Erythema multiforme

24
Q

What is Toxic Shock Syndrome characterized by and what does it rash look like?

A
  • abrupt fever, vomiting, watery diarrhea –> staph related
  • diffuse macular erythematous rash and conjunctivitis with desquamation occurring in recovery (PALMS and SOLES)

looks like MASSIVE SUNBURN = RED FACE AND EYES

25
Q

What is Scarlet Fever caused by and what are 3 findings of its syndrome?

A
  • caused by Group A Strep (pyrogenes)

- exudative pharyngitis, fever, scarlatiniform rash

26
Q

What is Streptococcus pyrogenes the most common cause of in children and adolescents?

A

TONSILLOPHARYNGITIS

27
Q

What does Scarlet Fever rash look like, what is a common condition it causes, and what test is it positive for?

A
  • generalized on neck, axilla, groin, skin folds and desquamation on HANDS and FEET
  • causes STRAWBERRY TONGUE
  • anti-streptolysin O (ASO) titer rise
28
Q

Where do Erythema Multiforme rashes occur at and what are the two most common causes?

A
  • target lesions on face and extremities
  • caused by Herpes Simplex Virus (HSV) and Mycoplasma pneumoniae

prodromal symptoms are absent in most cases but look at preceding 3 wks for HSV symptoms and respiratory infection/flu-like illness

29
Q

What causes Vesicular and Bullous lesions? (VP)

A

varicella and pemphigus

30
Q

What does the Varicella rash look like and how does it spread?

A

occurs in childhood

  • begins on face/scalp and spreads to trunk but SPARES EXTREMITIES (SCATTERED LESIONS)
31
Q

What are 3 common findings of Varicella rash?

A
  • scattered lesions
  • progress from rose-colored macules –> papules/vesicles/pustules/crusts
  • lesions in ALL STAGES are present AT THE SAME TIME
32
Q

What is Pemphigus and what does it look like?

A
  • autoimmune blistering disease of skin/mucous that is exacerbated by UV radiation
  • pruritic/painful that typically SPARES the PALMS and SOLES
  • most common lesions are erosions from broken blisters that can spread at their periphery
33
Q

What are 3 common causes of Petechial and Purpuric lesions? (GMT)

A

gonococcemia, menigococcemia, thrombotic thrombocytopenic purpura

34
Q

What is Gonococcemia and what is the classical triad seen in disseminated infection? (D/MP/T)

A
  • bacterial Neisseria gonorrhea (Gram -) aerobic cocci-shaped bacterium found in pairs
  • STD from oral/anal/vaginal intercourse; can be trans. vertically to child (ophthalamia neonatorum)

TRIAD: dermatitis, migratory polyarthritis, tenosynovitis

35
Q

What do Gonococcemia rashes look like? Where do they typically occur?

A
  • small-medium macules or hemorrhagic vesicopustules on erythematous base on PALMS and SOLES
  • can develop necrotic centers with “gun metal gray” lesions
  • disappear after appropriate treatment
36
Q

What is Meningococcemia and what do acute vs chronic rashes look like?

A
  • Neisseria meningitidis that appears as meningitis, acute meningococcemia w or w/o meningitidis, or chronic meningococcemia
    acute: petechial rash on extremities that can cause necrosis of skin/tissue in SEVERE cases
    chronic: rose-colored macules/papules (wax and wane w/periodic fever)
37
Q

What does Acute Meningococcemia with DIC produce?

A

PURPURA FULMINANS

  • has a lacy look to it
38
Q

What is the pentad of TTP? (MAHA/T/N/F/R)

A

microangiopathic autoimmune hemolytic anemia

thrombocytopenia, neuro problems, fever, renal failure

39
Q

What is TTP caused by, when is it usually seen, and who is it seen in?

A
  • severe ADAMSTS13 deficiency usually requiring additional inflammatory trigger to initiate
  • median age: 40 yo with 9x higher incidence among blacks
40
Q

What should you think of if purpura is palpable vs non-palapable?

A

Palpable - Vasculitis and Infection

Non-Palpable - Autoimmune

41
Q

Basal Cell Carcinoma

A
  • most common form of cutaneous cancer
  • waxy, pearly appearance (diagnostic) with telangiectatic vessels or shiny, scaly reddish plaques (back/chest/legs)
  • usually see umbilicated, bleeding lesions
42
Q

Squamous Cell Carcinoma

A
  • nonhealing ulcer or warty nodule (small, red, conical, hard nodules) –> KERATINIZED LESION appearing crusty
  • can arise from actinic keratosis
43
Q

What are common risk factors of Melanoma? (Lifestyle, physical, genetics)

A
  • sun exposure history
  • blue/green eyes, blonde/red hair, fair complexion
  • prior history of melanoma, p16 mutation, > 100 typical nevi
44
Q

Where does melanoma typically occur in men and women?

A

Men: back
Women: lower legs, then trunk

can occur anywhere on skin surface

45
Q

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

What diameter is usually concerning when using ABCDE screening for melanoma?

A

COLOR

diameter > 5 (6) mm is usually concerning

46
Q

What is a Shave Biopsy?

A
  • most common biopsy technique with good cosmetic result and occurs at depth of MID-DERMIS
  • use a Dermablade Scalpel to get whole lesion
47
Q

What is a Punch Biopsy?

A
  • used for FULL THICKNESS skin sample

- rapidly heals but has limited diameter (may not be adequate for SubQ tissue)

48
Q

What is an Excisional Biopsy?

A
  • requires sterile technique; margins can be controlled/adjusted as needed
  • can get down to SUBQ TISSUE
  • limits: inc. produce time, longer healing time, greater scarring, SUTURES

SBL (Skin, Blood, Lymph) Exam 1 and 2 (22 decks)

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