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Derm1 > Life threats > Flashcards

Life threats Flashcards

1
Q

Rash/intense pruritis caused by a drug is called?

A

Drug eruption

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2
Q

Drug eruption morphology types

A

Maculopapular (MC)
Urticarial
Specific Rx rxn
Skin flushing w/ pruritis

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3
Q

Drug eruption Progression

A

Slow sensitization overtime

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4
Q

MC types of Drug eruption

A

Maculopapular (exanthematous)
Urticarial
Fixed Drug eruption

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5
Q

Drug eruption Exanthems (maculopapular) indistinguishable from?

A

Viral exanthem

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6
Q

Drug eruption Exanthems (maculopapular) Morphology

A

Red macules/papules become confluent

  • symmetric, generalized often spares face
  • mucous membs (palms/soles)
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7
Q

Drug eruption Exanthems (maculopapular) Presents

A

Onset - 7-10D
May present after D/C Rx unknowingly.
Lasts 1-2wks
Clears rapidly w/ Rx d/c

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8
Q

Drug eruption Fixed drug morphology

A

Single or multiple round, sharply demarcated, dusky, red plaques
-can blister

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9
Q

Drug eruption Fixed drug Distro

A

Same location every exposure
MC - Glans Penis
Can occur anywhere tho

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10
Q

Drug eruption Fixed drug Onset?

A

Soon after Rx exposure

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11
Q

Drug eruption management

A 
D/c Rx
AH
PO-CCS C III-V
-Betamethasone
-Mometason
-TAC
Prepare for SOB/Anaphylaxis
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12
Q

Urticaria S/S

A

Uncomfortable/itchy

+- SOB, dysphagia, itchy mouth/throat

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13
Q

Urticaria morphology

A

Hives (wheal) - firm edematous plaque
Faint pink w/ central pallor
Orange peel look
-edema in dermis causes follicular accentuation

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14
Q

Urticaria Distro

A

Anywhere - gen/local

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15
Q

Urticaria Etiology

A

Mast cells release histamine - direct/immediate hypersensitive Rxn causing superficial dermis swelling

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16
Q

Physical Urticaria is?

A 
Dermatographism
Pressure (belts, jewelry)
Solar
Cold/Heat
Aquagenic (not temp)
Cholinergic
30-60m duration
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17
Q

Urticaria Classes

A

Acute <6wk

Chronic >6wk

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18
Q

Acute Urticaria attributes

A

Reproducible
Immediate rxn
Lead to Anaphylaxis
Duration - days

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19
Q

Chronic Urticaria attributes

A

Dx of exclusion
Recurrent over 6+wks
No apparent trigger
Smaller lesions

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20
Q

Acute Urticaria TXT

A

IM/PO Benadryl
(PO) steroids
Epi 1:1000 if anaphylaxis

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21
Q

Chronic Urticaria TXT

A

AH 2nd Gen (Fexofenadine, Cetirizine)
H2 Blk
PO Steroids (short course)
Restrict diet

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22
Q

Physical Urticaria TXT/PVT

A

Avoidance
Self limit
H1 agents Prph

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23
Q

Urticaria Labs

A

CBC w/Diff
UA Cx
H. Pylori Tests

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24
Q

Angioedema is?

A

Localized, dramatic rapid swelling of SQ tissue that burns and is painful

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25
Q

Important concerns of Angioedema?

A

GI/Resp involvement causes dysphagia, dyspnea, Abd pain or anaphylaxis

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26
Q

Angioedema MC affects what distro?

A

Lips, eyes, Tongue, Trunk, Genitals, Hands

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27
Q

Angioedema TXT

A

ID offending agent
IM/PO AH
PO Steroids
Prepare w/ Epi Pen and AW.

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28
Q

Leukocytoclastic Vasculitis Hypersensitivity is

A

Immune complex deposition on vessel walls, causing an inflammatory response

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29
Q

Leukocytoclastic Vasculitis is the MC?

A

small vessel necrotizing vasculitis

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30
Q

Leukocytoclastic Vasculitis prodrome?

A

Fever
Malaise
Myalgia
Arthralgia

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31
Q

Leukocytoclastic Vasculitis Morphology

A

RBC leakage causes vesicles/points of necrosis
Small > Increases in size to coalesce
Palpable purpura characteristic lesion
Lesions are painful and itch

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32
Q

Leukocytoclastic Vasculitis heals how?

A

Scarring and hyperpigmentation

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33
Q

Leukocytoclastic Vasculitis distro

A

Areas of increased hydrostatic pressure
Lower legs, arms
Back, sacrum (if bed bound)
May spread to multiple organs

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34
Q

Leukocytoclastic Vasculitis TXT

A 
Stop any offending Rx/agent
TXT UC
Top CCS (Predisone 3-6wk taper
Colchicine 
ABX PRN
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35
Q

Henoch-Schonlein Purpura is a?

A

Acute Leukocytoclastic Vasculitis occuring in children 2-10yo (MC 0 systemic vasculaitis in PEDs)

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36
Q

HSP is characterized by?

A

NON-thrombocyopenic hypersensitivity Rxn w/ Palpable purpura over legs/ass and is ass/w arthralgias and abd pain

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37
Q

HSP prodrome

A

fever

anorexia

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38
Q

HSP S/S

A

Malaise
Arthralgia
Abd pain
N/V/D - microscopic hematuria, GI bleed, nephritis

39
Q

HSP increased labs

A

ESR
Complement
IgA

40
Q

HSP morphology

A

Starts as hives > then classic Leukocytoclastic Vasculitis lesions w/in 48h.
2-10mm in diameter
Crops coalesce w/ eccymosis
Pinpont petechiae
Fades in several days to leave brown macules

41
Q

HSP can be preceded by?

A

Illness 1-3wks prior

URI (strep w/ IgA depositis)

42
Q

HSP management

A

Self limiting
Watch for GI bld, blood loss
NSAIDs or PO steroids
Occ. Dapsone or plasmophoresis

43
Q

Name all hypersensitivity syndromes

A 
EM - Erythema Multiforme
SJS - Stevens-Johnson Syndrome
TEN - Toxic Epidermal Necrolysis
EN - Eryhema Nodosum
SS - Sweet Syndrome
44
Q

hypersensitivity syndromes have what in common?

A

Acute Fever
Neutrophilic dermatosis
Response to Infections, Rx, Malig, Autoimmune D/O, and preg

45
Q

Erythema Multiforme affects what pop?

A

20-40yo

46
Q

Erythema Multiforme pts complain of?

A

Fever
Malaise
Lesions that burn

47
Q

What precedes Erythema Multiforme?

A

URI or HSV infection

Or mycoplasma pneumoniae

48
Q

Erythema Multiforme morphology

A 
Urticarial papules
Target lesion (iris lesion) or vesicles/bullae(mucous membrane)
Red macule has central color change
Coalesce into large areas
49
Q

Erythema Multiforme Atypical morphology and causes

A

Rx - Allopurinol, Dilantin
Red macules or papules/plaques
Persistent urticarial plaqus w/ diff colors

50
Q

Erythema Multiforme distro

A

Back of hands - palm/soles
extensor limbs
Gemeralized
Mucous membranes

51
Q

Erythema Multiforme is?

A

Immune complex Dz that damages vasculature and causes tissue necrosis

52
Q

Erythema Multiforme management?

A 
S/S relief
Mild = no Txt
Prednisone 1-3wk taper
HSV induced - Acyclovir or vacylclovir
D/C Rx if suspected
53
Q

SJS is a

A

vesiculobullous dz of skin, mouth, eyes, genitals

54
Q

SJS presents

A

Any age (MC children or young adults)
Very sick and in pain
Preceded by URI w/ high fever or malaise

55
Q

MC offending agents for SJS are?

A

Seizures Rx
Abx
Gout Rx

56
Q

SJS prodrome prior to cutaneous S/S

A

Fever Stinging eyes, painful swallowing

57
Q

SJS morphology

A

Flat, atypical targets or purpuric macules widespread
1st - trunks (+- Palm/soles)
Then - Neck, Face, and Prox UE
Bullous lesions
Mucosal lesions - conjunctiva, nasal, oral, genitals
-ulcerate w/ hemorrhagic crusts
Ocular - corneal Ulcerations - Blindness

58
Q

SJS etiology

A

Direct toxic effect from -
Rx - (MC- Phenytoin, Phenobarbital, PCNs, Sulfas)
Viral URI
Mycoplasma pneumonia

59
Q

SJS management

A 
S/S itch/pain
IVF
Ophthalmology refer - ocular
ABX - Prn
Severe - admit to burn unit
Severe throat pain - NG feed
Severe dysuria - Foley cath
60
Q

SJS complications

A

Sloughing of upper/lower respiratory tract

Blindness due to corneal lesions

61
Q

Toxic Epidermal Necrolysis is?

A

detachment of epidermis at dermoepidermal Jx (Sub-epidermal)
Full thickness necrosis
(high M/M due to sepsis)

62
Q

Toxic Epidermal Necrolysis prodrome?

A

Rash 1-2wks prior
MC - Fever
HA
Sore throat

63
Q

Toxic Epidermal Necrolysis sudden onset of?

A

Red tender skin

64
Q

Toxic Epidermal Necrolysis is ass/w what other condition?

A

URI

65
Q

Toxic Epidermal Necrolysis morphology

A

Begins localised or morbilliform and coalesce
Generalized red macular sunburn appearance
Diffuse hot erythema (painful in hours)
Vesicles or large bullae may appear
Scalp and non erythematous skin is spared

66
Q

Toxic Epidermal Necrolysis - Nikolsky sign

A

Slight thumb pressure = skin wrinkles and seperates from dermis

67
Q

Toxic Epidermal Necrolysis Mucous membrane morphology?

A

Inflammation, blistering, Erosions
-Esp the Oropharynx, GI tract
Vagina - epithelium blisters/erodes

68
Q

Toxic Epidermal Necrolysis Eye morphology

A

Severe eyes involvement - purulent conjuctivitis, ulceration, erosions, adehesions - blindness

69
Q

Toxic Epidermal Necrolysis Respiratory tract morphology

A

Suspect is S/S dyspnea, hypersecretion, hypoxemia.

70
Q

Toxic Epidermal Necrolysis MC cause

A

Rx -
ABX (Sulfa - aminoPCN’s)
Anticonvulsant(Phenytoin, Phenobarbital, Valproic acid)
NSAIDs/analgesics (CCS, Allopurinol)

71
Q

Toxic Epidermal Necrolysis mangement

A 
Admit - burn unit
Cyclosporine A, Cyclophosphamide
Plasma Exchange
IVIG
PVT Infection (MC - Death)
72
Q

CI Rx of Toxic Epidermal Necrolysis

A

CCS

73
Q

Toxic Epidermal Necrolysis MC cause of death?

A

Infection

74
Q

Classification of SJS and TEN

A

<10% epidermal detachment - SJS
>30% epidermal detachment - TEN
inbetween = overlap

75
Q

Staph scalded Skin Syndrome etiology?

A

2/2 Coag positive S. Aureus toxin

Same organism to cause bullous impetigo

76
Q

Staph scalded Skin Syndrome concern w/. PEDs?

A

Incomplete immunity cant clear toxin from kidney

77
Q

Staph scalded Skin Syndrome causes a?

A

Split in skin high in epidermis (granular layer)

78
Q

Staph scalded Skin Syndrome management?

A

Anti-Staph meds - Diclox/cephalexin

NO CCS

79
Q

How to differ SSSS from TEN?

A

Frozen section

80
Q

Kawasaki’s is?

A

Mucocutaneous Lymph node syndrome

81
Q

Kawasaki’s patient presents?

A

Infant -12yo (Avg 2-3yo)
101-104 fever unresponsive to antipyretics
Cervical LAD
Rash, Oral/Mucous membrane changes

82
Q

Kawasaki’s Acute phase?

A 
Fever 7-14D > resolves
Conjunctival injection
Strawberry tongue/oral mucous chances
Tender Edema on Palm/soles (Peels in 10D)
Diffuse maculopapular rash
83
Q

Kawasaki’s Subacute phase?

A

End of fever - 25D
Desquamation of fingers/toes
Arthralgias
Thrombocytosis

84
Q

Kawasaki’s Convalescent phase?

A

Timeframe = (6-8wks after onset)

S/S disappear to ESR normalization

85
Q

Kawasaki’s distro?

A

Conjunctiva - injection
Tongue - hypertrophic papillae = strawberry tongue
Palm/soles - red/swollen, tender
Skin diffusely - urticarial and/or deep red diffuse maculopapular eruption (desquam in 5-7D)
Diaper dermatitis is common
Cervical LAD

86
Q

Kawasaki’s Management

A

Monitor for cardiac ABNL (Major cause heart Dz PEDs)
-EKG, Echo (Coronary aneurysms)
IVIG high dose over 10-12hrs
ASA - 4x/D = req afebrile 3-7D > 1x/D 4-6wks

87
Q

Kawasaki’s labs

A

WBC >20k

^ESR/CRP, PLTs (thrombosis)

88
Q

Toxic Shock Syndrome ass/w causes

A

Post partum (post c-section)
Nasal packing (staph carrier)
Use diaphragm
Super absorbent tampons

89
Q

Toxic Shock Syndrome morphology

A 
Diffuse scarlet fever-like rash
Macular
Erythematous
Looks like sunburn
Desquam on Palms/soles
90
Q

Toxic Shock Syndrome S/S

A

Vaginal hyperemia and TTP
Conjunctival Injection
Strawberry tongue

91
Q

Toxic Shock Syndrome distro

A

Diffuse Rash
Mucous membrane involved (Conjunct, oral, vaginal)
Multisystem Dz

92
Q

Toxic Shock Syndrome Dx criteria

A

> 102 fever
Rash - diffuse, red, macular (sunburn look)
Mucous membrane involvement (Vag, Oral, Conj)
HOTN <90SBP
Multisys involvement

93
Q

Toxic Shock Syndrome etiology?

A

Coag Positive Staph w/ TSS toxin-1

Local infection w/ systemic spread

94
Q

Toxic Shock Syndrome management?

A 
Betalactamase resistant ABX
-Oxacillin
-Nafcillin
-Cefoxitin
-Vancomycin/clinamycin (IV) 3-5d > (PO) x2Wks
I&amp;D abscesses
Remove tampon
Maintain BP (IVF/Hydration - Vasopressors)
Manage-multisys invovlement

Derm1 (7 decks)

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