RTI I: Skin Manifestations Flashcards
1
Q
- What is first disease known as?
- What is the etiology of this?
A
- Measles (rubeola)
- Measles virus
2
Q
- What is second disease known as?
- What is the etiology of this?
A
- scarlet fever
- streptococcus pyogenes
3
Q
- What is third disease known as?
- What is the etiology of this?
A
- rubella
- rubella virus
4
Q
- What is fourth disease known as?
- What is the etiology of this?
A
- Filatov Duke’s disease
- exotoxin-producing staphylococcus aureus
5
Q
- What is fifth disease known as?
- What is the etiology of this?
A
- erythema infectiosum
- parvovirus B19
6
Q
- What is sixth disease known as?
- What is the etiology of this?
A
- roseola infantum
- HHV-6 and HHV-7
7
Q
- What is a discolored spot of on the skin; freckle?
- What is a localized, elevation of the skin that is often accompanied by itching; urticaria?
- What is a solid, circumscribed elevated area on the skin; pimple?
- What is a larger papule; acne vulgaris?
- What is a small fluid filled sac; blister?
A
- macule
- wheal
- papule
- nodule
- vesicle
8
Q
- What is a small, elevated, circumscribed lesion of the skin that is filled with pus; a whitehead?
- What is an eating or gnawing away of tissue; decubitus ulcer?
- What is a dry, serous or seropurulent, brown, yellow, red, or green exudate that is seen secondary to lesions; eczema?
- What is a thin, dry flake of cornified epithelial cells such as psoriasis?
- What is a crack-like sore or slit that extends through the epidermis into the dermis; athletes foot?
A
- pustule
- erosis
- crust
- scale
- fistula
9
Q
- What is erythema infectiosum caused by?
- Which individuals is this more common in?
- What seasons is there higher rates of erythema infectiosum?
- How is this transmitted?
- What is the incubation period?
A
- infection with parvovirus B19
- ages 5-15 more common than adults
- spring and summer months
- respiratory droplets, contact with secretions
- 5 days
10
Q
What are the initial symptoms of Erythema infectiosum?
A
- fevers
- rhinorrhea
- headache
- sore throat
- N/D
- arthralgias
11
Q
When will a malar rash associated with erythema infectiosum appear?
A
2-5 days after initial symptom onset
12
Q
What is this describing:
- slapped cheek appearance
- lacy maculopapular rash
- spare nasal, circumoral and periorbital regions of the face
- may spread to trunk/limbs
- may be pruritic
A
malar (cheek) rash
13
Q
Once a malar rash appears with an pt with erythema infectiosum, it is no longer (…)
A
contagious
14
Q
What may the malar rash look like in adults?
A
lupus
15
Q
The malar rash in erythema infectiosum spares what regions?
A
circumoral, perinasal, and periorbital regions of the face
16
Q
A
16
Q
- Adults (especially females) are more likely to develop (…) from infection with parvovirus B19 (erythema infectiosum)
- This will be in (…) and will also be (…)
- How is this treated?
A
- arthritis
- small joints; symmetric
- NSAIDs (ibuprofen)
(typically resolves w/ treatment, but can recur in some)
17
Q
- Parvovirus can cause (…)
- What does this cause a destruction of?
- Which type of patients are especially affected by this?
- What does treatment require?
A
- aplastic crisis
- erythrocyte progenitor cells
- sickle cell patients
- RBC transfusion and supplemental oxygen
18
Q
How is Erythema infectiosum diagnosed?
A
- clinical suspicion (recognition of signs/symptoms only; diagnostic testing unnecessary)
- can test for IgM if unsure (rare)
19
Q
What is the treatment for erythema infectiosum?
A
supportive measures only unless complications develop (self-limiting virus)
20
Q
Is there a vaccine for erythema infectiosum?
A
no
21
Q
What are the different types measles?
A
- rubella (german - ella)
- rubeola (america - ruby)
22
Q
- What is Rubeola caused by?
- What is the incubation period of rubeola?
- How is rubeola transmitted?
A
- Measles virus
- 11-12 days
- droplets, secretions, saliva that remain infectious for 2 hours
23
Q
- Prior to MMR vaccine, how many people died annually from rubeola?
- What is the MMR vaccine series (how many shots)?
- This vaccine gives what % immunity, usually for life?
- Rubeola infection can occur at any age, but is primarily in what individuals?
A
- 2 million
- 2 shots
- 99%
- unvaccinated individuals
24
- Once a person is infected with rubeola, how long are they infectious for (what is the time frame)?
- Infection with rubeola occurs in (...)% of the susceptible that are exposed
- What is the R-naught value of rubeola?
- 4 days prior to symptoms until 4 days after rash appears
- 90%
- 11-18 (1 person infects 11-18 people)
25
What is the clinical presentation of a patient with rubeola in the prodromal phase?
- fever
- cough
- coryza (profuse clear nasal drainage)
- conjunctivitis
- koplik spots
26
What is a pathognomonic presentation for rubeola?
koplik spots
27
When a patient, especially a child, presents with an unknown rash, be sure to check the (...) for any changes
oral cavity
28
What is this describing:
- small, white spots on the buccal mucosa
- appears like "grains of sand/rice"
- appears 2-3 days before rash
koplik spots
29
What are the clinical manifestations of rubeola in the eruptive phase?
- maculopapular rash that is typically non-pruritic
- macules blanch and progress to papules with coalesce
30
With rubeola, how does the maculopapular rash spread through body?
begins behing the **hairline**, and spreads to the **face**, then the **trunk**, and then the **extremities**
31
What happens in the convalescent phase of rubeola? (clinical manifestations)
rash begins to disappear in the same order it arrived and fever resolves
| (hairline to face to trunk to extremities)
32
How does the location(s) of the rash associated with Rubeola differ compared to erythema infectiosum?
rash in rubeola doesn't spare around mouth/eyes and there isn't a "slapped cheek" appearance
33
- Complications of measles affect what % of those who get measles?
- Which individuals will have the worst outcomes?
- How many individuals will develop pneumonia after measles?
- 1 in 1000 individuals will develop (...); what does this lead to?
- How many people will die from measles (out of those infected)?
- 30%
- young children
- 1 in 20 infected individuals
- encephalitis; hearing loss, intellectual disability
- 3 in 1000
34
What are some complications associated with a rubeola infection?
- fetal demise
- otitis media
- diarrhea
- pneumonia
- keratoconjunctivitis
- encephalitis
35
- Fetal demise is a worrisome rubeola complication especially when it is contracted by the mother in the (...)
- Otitis media is a rubeola complication consisting of an infection of the (...) and is a (...) complication of measles
- How is diarrhea presented when it is a measles complication and what does it increase?
- 1st trimester (organ formation)
- tympanic membrane; common complication
- water, severe; increases mortality d/t dehydration
36
When deaths occur from measles, what is typically the cause?
pneumonia
37
- What types of pneumonia are considered rubeola complications?
- What bacteria typically cause the secondary infection?
- primary measles infection or secondary bacterial pneumonia
- Streptococcus pneumoniae or Hamophilus influenzae
38
- Keratoconjuctivitis is a rubeola complication that is an infection of the (...)
- If this is not found and treated early, what can it lead to?
- cornea
- corneal damage and blindness
39
- Measles can cause swelling of the (...)
- What is this known as?
- What will the patient present with?
- brain parenchyma
- encephalitis
- fever, HA, changes in consciousness/altered mentation
- neurological deficit
40
How is measles (rubeola) diagnosed?
| (diagnostic testing)
- measles (rubeola) IgM - less sensitive in first 3 days of rash
- *possible to send viral cultures of various specimens (blood/throat)*
41
If a patient presents with a fever, cough, coryza, conjuctivitis, and a rash, what should be in your differential?
measles (rubeola)
42
If a patient comes in with measles (rubeola), what should you ask them (about risk factors)?
- immunization status
- international travel
- exposure to known case
43
What is the general treatment of rubeola?
- supportive: increase fluids orally/IV; acetaminophen to reduce fever
- Vitamin A supplement in all children w/ measles
- vaccination
44
- Low levels of what vitamin can worsen measles complications?
- You should supplement all (...) who have measles
- You should treat for (...) in each case
- vitamin A
- children
- 2 days
45
What is the dose vitamin A supplementation for these individuals:
- infants < 6 months
- infants 6-11 months
- children > 12 months
- 50,000 IU daily
- 100,000 IU daily
- 200,000 IU x 2 daily
46
- Patients who non-immune who are exposed to a case of measles should be vaccinated within (...)
- In some cases, immune globulin can be given to which individuals for measles protection?
- 72 hours
- children under 1, pregnant women, immunocompromised persons
47
- If a patient develops a complication such as pneumonia or otitis media from measles, what can be given to them?
- What is an antiviral medication that can be used in some cases for rubeola?
- How is rubeola prevented?
- antibiotics
- ribavirin
- vaccination, 2 doses
48
When is ribavirin given to patients with measles (rubeola)?
- infants under 12 mos
- immunosuppressed
- pts needing ventilation
49
How is ribavirin given for those being treated with it for rubeola?
- 15-20 mg/kg/day in 2 divided doses (IV or oral)
- no studied duration (5 days to 3 weeks)
50
- When is the MMR vaccine given?
- What % effectiveness does it provide after 2 doses?
- 12-15 months and 4-6 years
- 97%
51
How is rubella transmitted?
- respiratory droplets
- direct contact with secretions
52
How contagious is rubella compared to rubeola?
less contagious
53
Pertaining to rubella:
- less than (...) people infected each year in the US
- between (...)% of infected patients are asymptomatic
- 10 people
- 20-50%
54
- What is the incubation period for rubella?
- What typically appears with a rubella infection?
- When does this occur and how long does it last for?
- 8-9 days
- pink, maculopapular rash
- 16-18 days after exposure, lasts for 1-3 days
55
What are some other symptoms associated with rubella?
- low-grade fever
- coryza
- conjunctivitis
- lymphadenopathy (cervical, occiptal, postauricle)
- forchheimer spots
56
What are forchheimer spots?
petechiae on the palate
57
- What is the path of the maculopapular rash in rubeola?
- This rash is occasionally (...)
- This rash lasts for (...) days and then disappears in the same direction is appeared
- face, trunk, extremities
- pruritic
- 3 days
58
What is the major complication of rubella?
when it is acquired in pregnancy:
congenital rubella syndrome (CRS)
59
What are other complications of rubella?
- arthralgia and arthritis
- orchitis (testicular inflammation)
- rare hemorrhages (brain, GI, renal)
60
Complications of Rubella rarely cause long-lasting illness except (...)
CRS
| (congenital rubella syndrome)
61
What is used for the diagnosis of rubella?
rubella IgM antibodies
62
All pregnant women will be tested for (...) in pregnancy due to this being one of the TORCH infections
rubella IgG
63
What is the treatment for rubella?
- no specific treatment
- supportive care (hydration, antipyretics)
- self-limiting in most cases
64
- When does roseola peak?
- How is it spread?
- What is the typical affected age?
- spring and fall
- respiratory droplets or contact with saliva
- predominantly prior to age 2; after 2, 90% are seropositive
65
Remember "Rosie" is an infant usually under age (...)
2
66
Roseola can have a similar appearance to (...) but the prevalence is (...) and there are a few distinguishing characteristics
- measles
- much higher
67
What is the cause of 10-45% of fevers in infants?
roseola
68
Going from most common to diagnosis to least common to diagnose, put these in order:
- rubella, rubeola, erythema infectiosum, roseola
- erythema infectiosum
- roseola
- measles (rubeola)
- rubella
69
What is the roseola timeline?
- high fever for 3-5 days, coryza and conjunctivitis, irritability and fatigue
- defervescence (fever disappears)
- rash appears within 48 hours of fever resolution
70
How does the roseola rash begin and spread?
- trunk
- neck
- extremities
- face
71
Describe the rash of roseola
- appears as 3 to 5 small macules or papules
- rose colored lesions (starts as)
- may have surrounding halo
- rash in blanching
- non-pruritic
72
How long does a roseola rash last for?
up to 48 hours and then resolves
73
What are some clinical manifestations of roseola?
- respiratory tract symptoms (cough/congestion)
- lymphadenopathy (cervica/occipital)
- diarrhea
- febrile seizures
- nagayama spots
74
What are nagayama spots associated with?
| (red papules on soft palate/uvula; seen in 2/3 of pts)
roseola
75
What are some complications of roseola?
- pneumonia
- meningitis
- hepatitis (uncommon)
- rhabdomyolysis
- guillain-barre syndrome (symmetric paralysis)
76
- Which individuals may have a reactivation of roseola?
- What can this result in?
- immunosuppressed patients
- bone marrow failure, meningitis/encephalitis, pneumonia, myocarditis, hepatitis
77
malar rash; EI
78
malar rash; EI
79
malar rash, EI
80
koplick spots; rubeola
81
koplick spots; rubeola
82
koplick spots; rubeola
83
maculopapular rash; rubeola, rubella, roseola
84
maculopapular rash; rubeola, rubella, roseola
85
maculopapular rash; rubeola, rubella, roseola
86
forchheimer spots; rubella
87
forchheimer spots; rubella
88
forchheimer spots; rubella
89
nagayama spots
