Skin changes in SBL

Question 1

What is pathognomonic for measles?

Answer 1

Koplik spots on the buccal mucosa

Question 2

Parvovirus is one of the most common causes of _____ in childhood

Answer 2

myocarditis

Question 3

What can the symptoms of parvovirus B19 mimic?

Answer 3

They can mimic the symptoms of autoimmune states, such as lupus, systemic sclerosis, antiphospholipid syndrome, or vasculitis

Question 4

What is the difference between Lyme disease vesicles and shingles vesicles?

Answer 4

Lyme’s does NOT follow dermatomal distributions like shingles

Question 5

What is a common manifestation of EBV that may occur at any age?

Answer 5

infectious mononucleosis

Question 6

What is characteristic of stage 1 Lyme disease (early localized infection)

Answer 6

Erythema migrans (bullseye lesion) at the bite site ~1 week after the tick bite

Question 7

What is characteristic of stage 2 Lyme disease

Answer 7

Weeks to months later

Bacteremia
Secondary skin lesions

Question 8

What is characteristic of stage 3 Lyme disease

Answer 8

months to years later

Musculoskeletal manifestations
neurologic manifestations (rare)
acrodermatitis chromicum atrophicans (rare)

Question 9

What develops in most Lyme disease patients?

Answer 9

A concomitant viral-like illness characterized by myalgias, arthralgias, headache, fatigue, and possibly fever

Question 10

What develops in most Lyme disease patients?

Answer 10

A concomitant viral-like illness characterized by myalgias, arthralgias, headache, fatigue, and possibly fever

Question 11

What is secondary syphilis characterized by?

Answer 11

rash
condyloma lata
mucus patches
generalized lymphadenopathy
fever
malaise, anorexia
arthralgias and myalgias

Question 12

What is the hallmark of hand foot and mouth disease?

Answer 12

the development of a vesicular eruption on the palms and soles

Vesicles quickly erode and form yellow to gray, oval or football shaped erosions surrounded by an erythematous halo

Question 13

What is scarlet fever typically caused by?

Answer 13

Group A strep (pyogenes)

Question 14

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

Answer 14

Streptococcus pyogenes

Question 15

Most distinctive symptom of scarlet fever

Answer 15

strawberry tongue

Question 16

What is erythema multiforme

Answer 16

A rare cutaneous/mucocutaneous eruption characterized by TARGET LESIONS, predominantly on the face and extremities

Question 17

What are most cases of erythema multiforme related to?

Answer 17

infections (HSV) and Mycoplasma pneumoniae

Question 18

Characteristics of the lesions of Varicella (chicken pox)

Answer 18

Progress sequentially from rose-colored macules to papules, vesicles, pustules, and crusts

Lesions in all stages are usually present at the same time

Question 19

What is gonococcemia caused by?

Answer 19

bacterial infection caused by Neisseria gonorrhoeae, a gram-negative, aerobic coccus-shaped bacterium found in pairs

Question 20

What is the clinical triad of disseminated gonococcemia?

Answer 20

dermatitis
migratory polyarthritis
tenosynovitis

Question 21

What are the skin findings of gonococcemia

Answer 21

skin findings consist of small to medium sized macules or most typically, hemorrhagic vesicopastules on an erythematous base located on palms and soles

skin lesions may develop necrotic centers

Question 22

Disseminated meningococcal infection may present as…

Answer 22

meningitis alone
acute meningococcemia with or without meningitis
chronic meningococcemia

Question 23

What is a possibility in severe cases of meningococcemia

Answer 23

necrosis of the skin and underlying tissue may necessitate amputation

Question 24

Acute meningococcemia with disseminated intravascular coagulation may produce what?

Answer 24

purpura fulminans

Question 25

What is the pentad that characterizes TTP

Answer 25

microangiopathic autoimmune hemolytic anemia
thrombocytopenia
neurologic symptoms
fever
renal failure

Question 26

What is often required to initiate clinical TTP

Answer 26

an additional inflammatory trigger (such as infection, surgery, pancreatitis, or pregnancy)

Question 27

What are the non-palpable purpura (think “other” like autoimmune)

Answer 27

ITP
TTP
DIC
Other thrombocytopenia or platelet dysfunction
Clotting factor defect

Question 28

What are the palpable purpura (think infectious/inflammatory)

Answer 28

Vasculitis:

• SLE
• Sjogren’s
• Henoch-Scholein’s
• RA

Infection:
meningoccemia
gonococcenia
RMSF
Endocarditis

Question 29

What is the most common form of cutaneous cancer?

Answer 29

basal cell carcinoma of the skin

Question 30

What are the risk factors of melanoma

Answer 30

history of sunburns
blue or green eyes
blonde or red hair
fair complexion
>100 typical nevi, any atypical nevi
prior personal or family history of melanoma
p16 mutation

Question 31

How does one screen for melanoma

Answer 31

ABCDE

Asymmetry
Border
Color
Diameter
Evolution

Question 32

Characteristics of a shave biopsy

Answer 32

Most common biopsy technique
Less time consuming
Good cosmetic result
Limited downtime for the patient
Limited to processes occurring to the depth of the mid dermis

Question 33

Characteristics of a punch biopsy

Answer 33

can provide full thickness skin sample
Rapid healing
Limited by the diameter of the punch tool
May not be adequate for processes in the subq tissue due to limitations with depth

Question 34

Characteristics of an excisional biopsy

Answer 34

Sterile technique required
Advantages include an adequate sample down to the subq tissues
Margins can also be controlled and adjusted as needed

Question 35

Limitations of excisional biopsy

Answer 35

Increased duration of the procedure
Longer healing time
Greater potential for scarring
Suture removal

Question 36

What should you do if you suspect melanoma

Answer 36

AVOID BIOPSY

Refer to dermatology or appropriate surgically trained physician