Rash + Red Eye Flashcards
SLE Sx + who does it commonly effect
Commonly in females of reproductive age
Sx:
Constitutional
Cutaneous
Alopecia
Oral ulcers
Photosensitivity rash
Malar rash
Discoid rash
Raynauds
MSK
Arthralgia
Myalgia
Cardiorespiratory
Pericarditis, myocarditis, endocarditis
Pleurisy
Pneumonitis
Neuro
Sz
Psychosis
Chorea
Transverse myelitis
Renal
Proteinuria
Nephrotic syndrome
ESRD
GI
Ascites
Liver dz
Haem
Hemolytic anemia (reticulocytes, reduced haptoglobin, raised indirect bili, raised LDH)
Leukopenia
Thrombocytopenia
Thrombosis
Dx criteria for SLE
ACR
SLICC
Ix for SLE
ANA
Anti-dsDNA antibody
Low complement levels
Anti-Smith
Antiphospholipid antibodies
Rx for SLE (mild, mod, severe)
Avoid sun
Flu shot annually
Mild
Antimalarials
Methotrexate
NSAIDs
Prednisone
Moderate
Prednisone
Triamcinolone IM
Azathioprine
Severe
Methylprednisone
Mycophenolate mofetil
Cyclosporine
Tacrolimus
Rituximab
Dx of celiac
sx, HLA-DQ2/DQ8 gene, ab in serum, duodenal histology
RF for celiac
family history, women more common, T1DM, autoimmune thyroiditis, Downs, Turners, IgA deficiency
Complications of celiac
Complications: anemia, growth failure, T cell lymphoma
peripheral neuropathy, arthritis, aphthous stomatitis, hyposplenism, higher risk of osteoporosis
Sx of celiac
Sx: anorexia, constipation/ diarrhea, growth failure, abdo pain/ distension, steatorrhea, wt loss, dermatitis herpetiform (intensely pruritic papulovesicular rash on extensor surfaces)
Ix, Rx + monitoring for celiac
Ix: Anti-tTG IgA + intestinal biopsy
Rx: gluten free diet, refer to RD, repeat serology in 6 months, screen for FDR
Monitoring: annual anti-tTG, Q2yr TSH
Sx of chickenpox, incubation + infectivity period
Starts on face, spreads inferiorly to trunk + extremities
Papules evolve into vesicles then pustules that crust
Incubation 14-21d, infectivity 1-2d pre-rash
Rx for Kawasaki’s
Management
IVIG + ASA 100mg/kg/d divided QID
Reduce ASA to 5mg/kg/d x 6 weeks post fever
Lyme pathogen, sx + rx
Borrelia Burgdorferi
Reportable
Sx:
Macule or papule at tick bite site
Progresses to erythema migrans (bulls eye red patch that expands)
Rx: doxycycline 100mg BID, amox for kids
Measles sx
Begins on face + shoulders, spread inferiorly
Macular rash
Fades in 4-6d, incubation 10-14d, infectivity 4d pre rash
URTI prodrome w/ fever, rash starts 4th day of fever
Koplik’s spots 1-2d pre rash
Parvovirus sx + complications
Fifth disease/ slapped cheek
Sx
Bright red facial rash, progresses to lacy reticular rash
Complications
Severe aplastic anemia in pts w/ chronic hemolytic anemia
Rocky mountain spotted fever sx
Evolves from pink macules to red papules to petechiae
Starts on wrists + ankles then spreads towards centre
Hx of tick exposure
Prodrome of fever, severe HA, myalgias
Rash starts 4d later
Associated w/ bradycardia + leukopenia
Roseola - cause, sx
HHV 6
Fever
Diffuse macular rash, face sparing
Rubella sx + name of specific finding (petechiae soft palate)
Pink macules + papules start on forehead then spread down to extremities within 1d
Forchheimer spots (petechiae on soft palate)
Rosacea sx + rx
Sx
Central face w/ transient erythema, telangectasia, inflammatory papules and pustules
Flushing
Management
Avoid triggers
Photoprotection
Topical metronidazole or azelaic acid
Scarlet fever sx + signs on exam + cause
Sandpaper rash, starts on trunk, spreads to extremities
Flushed face w/ perioral pallor
Rash fades in 4-5d, followed desquamation
Acute strep infection
Pastia’s sign (linear petechiae in antecubital + axillary folds)
White strawberry tongue then red strawberry tongue
Ix for persistent rash
Ix - scraping, culture, biopsy, labs
Painless causes of red eye (diffuse vs localised)
Diffuse:
Eyelid abnormality (blepharitis, ectropion, entropion, trichiasis, eyelid lesion [eg. stye, tumour])
Localized redness:
Pterygium, corneal foreign body, ocular trauma, subconjunctival hemorrhage
Painful causes of red eye (reduced visual acuity vs normal)
Normal acuity:
Chalazion/Stye
Acute blepharitis
herpes zoster ophthalmicus
Viral/allergic/bacterial conjunctivitis
Herpes simplex keratitis
corneal ulcer
marginal keratitis
Reduced acuity:
Scleritis
corneal abrasion
acute glaucoma
Acute anterior uveitis (iritis)
hypopyon
hyphema
Ix for optic neuritis vs orbital cellulitis vs retinal detachment
MRI for optic neuritis
CT for orbital cellulitis
US for retinal detachment
Sx + rx of optic neuritis
Painful loss of vision, positive RAPD
Rx: steroids
Rx for Acute angle-closure glaucoma
Topical BB (timolol)
Pilocarpine (miotics)
Topical clonidine (alpha adrenergic agonist)
Topical prednisone
Acetazolamide (carbonic anhydrase inhibitors) IV
Mannitol (diuretic) IV
Complications of uveitis
Glaucoma
Posterior Synechiae
Cataracts
Dark curtain over vision?
retinal detachment
Most common type of macular degeneration?
dry
Sx of Posterior Vitreous Detachment
Flashes/ floaters
Most common eye cancer in kids
retinoblastoma
How to assess vision + eyes
Snellen chart, slit lamp, fluorescein, tonometry
Rx for viral conjunctivitis
Supportive, cold compresses, ocular decongestants, artificial tears
Strict hand washing/hygiene, avoid work if healthcare worker until eye discharge ceases
Common bacterial pathogens causing conjunctivitis in adults + kids
Staph aureus in adults
Strep pneumoniae, H influenzae in children
Who to give abx to for bacterial conjunctivitis
Antibiotic therapy in healthcare workers, immunocompromised, comorbidity, contact lens wearers, unreliable
Rx for bacterial conjunctivitis
Fucidin 1% ophthalmic 1 drop BID x 7 days
Erythromycin ointment 1.25cm QID x 5-7 days
If severe or contact lens, cover for pseudomonas
Ciprofloxacin 0.3% (or oflaxacin) QID x 5-7 day
Rx for allergic conjunctivitis
Avoid exposure, artifical tear, topical antihistamine H1 antagonist
Olopotadine (Pataday) 0.2% 1 drop daily x 2w
RF for dry eyes
Risk: Age, female, medications (anticholinergic)
Rx for corneal abrasion
Topical NSAIDs (diclofenac 0.1% [Voltaren], ketorolac 0.4% [Acular LS] 1 drop QID x 2 days maximum)
Topical Antibiotic (erythromycin 0.5% opht oint, polymyxin B/trimethoprim (Polytrim) opht solution, and sulfacetamide 10% opht oint QID x 5d or until asymptomatic x 24h)
If contact lens wearer, cover for pseudomonas (Ciprofloxacin, Gentamicin, Ofloxacin)
Differences between episcleritis + scleritis
Phenylephrine (2.5%) eye drops leads to swift, transient resolution of episcleral redness in episcleritis
Non-tender on palpation in episcleritis (tender in scleritis)
Pink-red in episcleritis (blue-purple hue in scleritis)
Radial pattern of sclera maintained in episcleritis (loss of radial pattern of sclera in scleritis)
Sx of glaucoma
Blurred vision
HA, N/V
Uni or bilateral
Hazy cornea
Mild dilated oval pupil
Sx + rx of uveitis
Photophobia
Blurred vision
Circumcorneal congestion
Rx: Topical steroids
Sx of scleritis
Blurred vision
Globe pain w/ palpation
Generalised injection
What is Bells phenomenon?
upward gaze with inability to close eye lid on affected side
Rx for Bell’s palsy
Bells Palsy rx: corticosteroids
Red flags for red eye
pain on palpation, decreased acuity, anisocoria
Bugs causing conjunctivitis in contact lens wearers
acanthomoeba
Perilimbal haze causes
iritis, keratitis
Fixed, hazy cornea = what?
raised intraocular pressure
Fixed, hazy cornea + pain = what?
acute angle glaucoma
Risks of eye steroids
worsening herpes simplex keratitis, globe rupture, corneal ulcerations, glaucoma
How to prevent pink eye
goggles, wash hands, condoms
