Skin Changes in Skin, Blood, and Lymph

Question 1

Five illnesses that manifest with a diffuse maculopapular rash

Answer 1

1) measles
2) rubella
3) erythema infectiosum
4) infectious mononucleosis
5) lyme disease

Question 2

Prodrome of measles (4)

Answer 2

1) fever
2) cough
3) coryza
4) conjunctivitis

Question 3

Describe rash of measles

Answer 3

• brick red, irregular maculopapular
• appears 3-4 days after onset of prodrome
• begins on the face and proceeds “downward and outward”, affecting palms and soles last
• lasts 3 - 5 days

Question 4

What PEx finding is pathgnomonic with measles?

Answer 4

koplik spots

Question 5

Symptoms of rubella

Answer 5

• enlargement of cerival, suboccipital, and postauricular glands
• rash of 2 - 3 days duration

Question 6

Rash associated with rubella

Answer 6

• erythematous macules and papules appearing initially on the face and speading to the trunk, arms, and legs within 24 hours
• rash lasts 2 - 3 days
• desquamation may follow resolution of rash

Question 7

Disease association erythema infectiosum

Answer 7

Parvovirus B19 infection, “fifith disease”

Question 8

Describe rash of “fifth disease”

Answer 8

• fiery red “slapped cheek” appearance
• circumoral pallor
• subsequent lacy, maculopapular, evanescent rash on the trunk and limbs

Question 9

Sx besides rash in fifth disease (3)

Answer 9

• malaise
• headache
• pruritus
• (little fever)

Question 10

common cause of myocarditis in childhood

Answer 10

parvovirus B19

Question 11

What can parvovirus B19 mimic?

Answer 11

autoimmune states

(lupus, systemic sclerosis, antiphospholipid syndrome, vasculitis)

Question 12

Sx Parvovirus infection in adults (3)

Answer 12

• eczema-like rash
• inflammatory arthritis
• premature labor/hydrops/fetal loss in pregnancy

Question 13

Rash associated with Lyme disease

Answer 13

erythema migrans,

a flat or slightly raised red lesion that expands with central clearing

Question 14

Stage 1 of Lyme Disease

Answer 14

Early localized infection

Erythema migrans

(flat or slightly raised red lesion at the bite site ~1 week after tick bite)

common in areas of tight clothing (groin, thigh, axilla)

Question 15

Lyme disease stage 2

Answer 15

Early disseminated infection

Bacteremia

• malaise, fever, fatigue, headache, neck pain
• secondary skin lesions (similar to primary lesion but smaller)
• myopericardiditis, neuro manifestations, conjunctivitis

Question 16

Lyme disease stage 3

Answer 16

Late persistent infection (months to years later)

• arthritis
• neurologic manifestations
• acrodermatitis chronicum atrophicans (resembles scleroderma_

Question 17

Cause of infectious mononucleosis

Answer 17

Epstein Barr virus

Question 18

How is EBV transmitted?

Answer 18

By saliva, but also genital secretions

Question 19

Symptoms of infectious mononucleosis

Answer 19

• malaise, fever, (exudative) sore throat
• palatal petechiae, lymphadenopathy, splenomegaly
• occasionally a maculopapular rash

Question 20

Lab testing for mono

Answer 20

+ heterophile agglutination test (Monospot)

atypical large lymphocytes in blood smear

Question 21

What is Hoagland sign and when is it seen?

Answer 21

transient bilateral upper lid edema;

Mononucleosis

Question 22

Infections that cause peripheral skin eruptions (4)

Answer 22

1) meningococcemia
2) rocky mountain spotted fever
3) secondary syphilis
4) hand/foot/mouth disease

Question 23

Cause of Rocky mountain spotted fever &

route of transmission

Answer 23

Rickettsia rickettsii

Parasite of ticks, transmitted by tick bites

Question 24

Describe rash associated with Rocky mountain spotted fever

Answer 24

Begins as faint macule that progresses to large maculopapules & petechiae

Rash starts of wrists & ankles, characteristically involves palms & soles

spreads to arms, legs, & trunk

Question 25

Desribe rash of secondary syphillis

Answer 25

**Rash: diffuse** (may include palms & soles) macular, papular, pustular, and combinations **Condyloma lata** **Mucous patches**: painless, silvery ulcerations**`**

Question 26

Skin infections related to Coxsackie infection

Answer 26

1) hand-foot-mouth disease 2) herpangina

Question 27

Describe rash of Hand-foot-mouth

Answer 27

**Stomatitis** **Vesicular rash on hands & feet** vesicles erode and form "football-shaped" eroisions surrounded by erythematous halo

Question 28

Infections that cause desquamative skin changes (3)

Answer 28

1) toxic shock syndrome 2) scarlet fever 3) erythema multiforme

Question 29

Organism that causes of Toxic Shock syndrome

Answer 29

Strains of staphylococci

Question 30

Describe rash of toxic shock syndrome

Answer 30

**Diffuse macular erythematous rash** (w/ nonpurlulent conjunctivitis) **Desquamation** of palms and soles is typical with recovery

Question 31

Rash associated with Scarlet fever

Answer 31

**Generalized, punctate, red**: prominent on neck, in axillae, groin, and skin folds **circumoral pallor** **Fine desquamation** involves hands & feet

Question 32

Infections related to erythema multiforme (2)

Answer 32

1) Herpes simplex virus 2) Mycoplasma pneumoniae

Question 33

Describe erythema multiforme rash

Answer 33

Rare cutaneous or mucocutaneous eruption characterized by "target" lesions predominantly on the face & extremities

Question 34

Non-cutaneous lesions associated with erythema multiforme

Answer 34

mucosal lesions are present in up to 70%, usually in **oral cavity** predilection for the **lips**

Question 35

Describe the rash of varicella

Answer 35

Highly contagious exanthem, most often occurs in **childhood** Usually begins on **face and scalp**, spreads rapidly to the **trunk** Relative **sparing of extremities** vesicles, pustules, and crusts \*\*\*Lesions in **all stages of healing** present at the same time\*\*

Question 36

Cause of pemphigus

Answer 36

autoimmune disease

Question 37

Describe lesions of pemphigus

Answer 37

can be pruritic or painful exposure to UV radiation may excacerbate disease Primary lesion is a flaccid blister which may occur anywhere, but typically not the palms and soles

Question 38

Infections that cause petechial & purpuric lesions (3)

Answer 38

1) gonococcemia 2) meningococcemia 3) thrombotic thrombocytopenic purpura

Question 39

Classic triad of gonoccemia

Answer 39

1) dermatitis 2) migratory polyarthritis 3) tenosynovitis

Question 40

Cutaneous lesions associated with gonoccemia

Answer 40

Hemmorrhagic vesicopustules on an erythematous base located on the palms and soles Lesions may develop necrotic centers ("gun metal gray")

Question 41

Rash associated with **acute** meningococcemia

Answer 41

classic petechial rash (in severe cases, with **DIC**, necrosis of skin and underlying tissue may necessitate amputation --\> *purpura fulminans*)

Question 42

Describe rash of **chronic** meningococcemia

Answer 42

rose-colored macules and papules \*rash may wax and wane with periodic fevers

Question 43

Pentad associated with Thrombotic Thrombocytopenic Purpura

Answer 43

1) microangiopathic autoimmune hemolytic anemia 2) thrombocytopenia (**petechial lesions**) 3) neurologic symptoms 4) fever 5) renal failure

Question 44

Palpable vs. Nonpalpable Purpuric disorders

Answer 44

Question 45

Most common form of skin cancer

Answer 45

basal cell carcinoma

Question 46

Describe **appearance** basal cell carcinoma and typical **location**

Answer 46

Waxy, "pearly" appearance, with telangiectatic vessels easily visible Usually on the back, chest, and lower legs

Question 47

Describe appearance squamous cell carcinoma of the skin

Answer 47

nonhealing ulcer or warty nodule appear as small, red, conical, hard nodules that occasionally ulcerate

Question 48

Precursor lesion to SCC

Answer 48

actinic keratosis

Question 49

Mutation associated with melanoma

Answer 49

p16

Question 50

Most common locations of melanoma

Answer 50

**Back** for men **Lower extremities** followed by trunk for women

Question 51

Screening tool for melanoma

Answer 51

**A** - asymmetry **B** - border **C** - color (black, blue, white) **D** - diameter ( \>5mm) **E** - evolution \*color carries the greatest sensitivity and specificity for metastatic potential