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SBL Exam 1 & 2 > Skin changes in skin, blood and lymph > Flashcards

Skin changes in skin, blood and lymph Flashcards

1
Q

What is erythema infectiosum also called?

A

Fifth disease

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2
Q

Physical presentation of erythema infectiosum?

A

Slapped cheek appearance, circumoral pallor, evanescent rash (rash that appears with fever) on trunk and limbs. Little fever

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3
Q

What is one of the most common causes of myocarditis?

A

Parvovirus

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4
Q

How does parvovirus present in middle-aged persons?

A

Limited symmetric polyarthritis that mimics systemic lupus and RA, which may be in some cases be a type II mixed cryoglobulinemia develops.

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5
Q

Symptoms of parvovirus B19 infection can mimic?

A

Those of autoimmune states.

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6
Q

Are arthralgias common in children with parvovirus?

A

No

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7
Q

What happens in pregnant women with parvovirus?

A

Premature labor, hydrops fetalis and fetal loss are reported sequelae.

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8
Q

How does Lyme disease present?

In which part of the United States is it commonly found?

A

Erythema migrans: A flat or slightly raised red lesion that expands with central clearing.
Headache or stiff neck
Arthralgia/myalgias/Arthritis
Common in Pacific NE USA

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9
Q

Arthritis in Lyme disease is often?

A

Chronic and recurrent

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10
Q

Stage 1 of lyme disease. When does it occur, where, progression?

A

Erythema migrans - 1-week after bite.
Common in areas of tight clothing (groin, axilla)
Expands over several days
Progresses with central clearing (bull’s eye)

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11
Q

What else happens in stage 1 of Lyme disease?

A

Viral-like illness: Myalgia, HA, fatigue, +/- fever

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12
Q

How does stage 2 of Lyme disease present?

A

Malaise, fatigue, neck pain.
Myopericarditis with atrial/ventricular arrhythmias and heart block.
Neuro manifestations (Bells Palsy)
Conjunctivitis, keratitis

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13
Q

When and how does stage 3 of Lyme disease present?

A

Late to persistent infection (months- years later)
MSK manifestations: mono/oligoarthritis of the knee or other large weight bearning joint.
Others: neuro manifestation (encephalopathy) and acrodermatitis chronicum atrophicans (both rare)

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14
Q

Difference between Lyme disease and shingles?

A

Lyme does not follow dermatomes like shingles.

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15
Q

How is EBV largely transmitted?

A

Saliva. Sometimes genital secretions.

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16
Q

In which population has EBV (infectious mono) remained high?

A

Age 12-19

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17
Q

How does infectious mono present?

A

Malaise, fever, (exudative) sore throat/pharyngitis
Palatal petechiae, lymphadenopathy, splenomegaly and occasional maculopapular rash
Transient bilateral upper lid edema
Conjunctival hemorrhage

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18
Q

Histological presentation of infectious mono?

A

Atypical lymphocytes

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19
Q

Positive test or mono?

A

Mono spot (heterophile agglutination test)

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20
Q

Complications of mono?

A

Hepatitis, myocarditis, neuropathy etc

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21
Q

In which 4 diseases do peripheral skins eruptions occur?

A

Meningococcemia
Rocky Mountain spotted fever
Secondary syphilis
Hand-Foot-mouth disease

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22
Q

What organism is rocky mountain fever caused by?

A

Rickettsia rickettsii (a parasite of ticks)

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23
Q

Where and When (time) does Rocky Mountain fever typically occur.
Incubation period?
Mortality in untreated patients?

A

North/South Carolina, Tennessee, Oklahoma, and Arkansas.
Late spring and summer.
Incubation - 2-14 days
High mortality in untreated pts.

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24
Q

Symptoms of rocky fever?

A

Fever, chills, HA, N/V.
Cough and pneumonitis occur early in the disease
Rash: faint macule -> petechiae. Begins on wrist/ankles, spreads upwards (arms/legs) and towards center of the body.
May px with splenomegaly, hepatomegaly, jaundice, myocarditis.

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25
Q

Stages in syphilis are separated by?

A

Symptom-free latent period.

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26
Q

How does the early infectious stage of syphilis present?

A

Chancre and regional lymphadenopathy

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27
Q

How does the late stage of syphilis present?

A

A gummatous lesion in skin, bones or viscera.
Cardiovascular disease (esp aortitis)
CNS and ocular syndromes

28
Q

How does secondary syphilis present?

A

Diffuse rash, condylomata lata and mucous patches (painless salivary ulceration of mucous membrane with surrounding erythema.
Generalized lymphadenopathy
Constitutional sx: fever, malaise, arthralgias

29
Q

What two diseases is the Coxsackievirus responsible for?

A

Hand -foot-mouth disease and Herpangina

30
Q

How does hand-foot-mouth disease present clinically?

A

Stomatitis (sore/inflammation of the mouth)
Vesicular rash on hands and feet
Nail dystrophies and onychomadesis (nail shedding)

31
Q

How does Herpangina present clinically?

A

Sudden onset fever
HA
Myalgias
Petechies or papules on the soft palate that ulcerate in 3 days then heal.

32
Q

What is the hallmark of HFMd?

A

The development of a vesicular eruption on the palms and soles.

33
Q

How do the lesions in HFMd progress?

A

bright pink macules -> small vesicles -> erosion of vesicles surrounded by an erythematous halo.
Some may develop similar oral erosions that involve the tongue, buccal mucosa, hard palate.

34
Q

Complications of coxsackie virus?

A

Epidemic pleurodynia (pleuritic chest pain & systemic symptoms)
Aseptic meningitis,
Acute pericarditis.

35
Q

Diseases that present with desquamative skin changes?

A

Toxic Shock Syndrome
Scarlet fever
Erythema multiforme

36
Q

Strains of staphylococci may produce toxins that cause four important entities. What are they?

A

Scalded skin syndrome (children). Bullous impetigo (adults)
Necrotizing pneumonitis (children)
Toxic Shock syndrome
Enterotoxin food poisoning

37
Q

How does TSS present clinically?

A

Abrupt onset of fever, vomiting and watery diarrhea.
Diffuse macular erythematous rash
Nonpurulent conjunctivitis
Desquamation of palms and soles during recovery

38
Q

How is scarlet fever characterized?

A

Exudative pharyngitis, fever & scarlatiniform rash

39
Q

How does scarlet fever present clinically?

A

Prodrome: 1/2 -2 days of malaise
Rash: Generalized, red, prominent on neck & skin folds Circumoral pallor
Desquamation of hands & feets
Others: Strawberry tongue, exudative tonsillitis

40
Q

How is erythema multiforme characterized?

A

Target lesions on the face and extremities.

Male children & young adults

41
Q

Most cases of erythema multiforme are related to?

A

Infections (herpes simplex and Mycoplasma pneumoniae)

42
Q

Is prodrome typically present in erythema multiforme?

A

No. If they are, they are usually mild and suggestion of a URI.

43
Q

In many cases of erythema multiforme, pay special attention to?

A

The previous occurrence of disease

44
Q

Erythema multiforme Majus form can typically present differently. How?

A

Mucosal lesions mostly in the oral cavity

Hard palate is typically spared

45
Q

How does Erythema multiforme Majus present in children?

A

In children- lip and oral mucosal are severely affected by M. Pneumoniae.

46
Q

Which disease present with vesicular and bullous lesions?

A

Varicella and pemphigus

47
Q

How does varicella present clinically?

A

Rash that begins on the face and scalp > trunk. Relatively spares the extremities

48
Q

How are the lesions organized in varicella?

A

Scattered (reflecting viremic spread to the skin)
Rose-colored macules -> papules -> vesicles -> pustules ->crusts
Lesions in all stages are usually present at the same time.

49
Q

Which population does varicella mostly affect?

A

immunocompromised of any age

50
Q

What does varicella lead to?

A

Lifelong latent VZD infection of sensory and autonomic neurons.

51
Q

How does pemphigus Vulgaris present?

A

Blisters that typically appear on normal-looking skin (not typically hands and soles)
Fragile so -> large erosions from broken blisters

52
Q

Which skin conditions present with petechial and purpuric lesions?

A

Gonococcemia
Meningococcemia
TTP

53
Q

In which cells can N. meningitides be visualized?

A

Polymorphonuclear leukocytes

54
Q

What is the classic triad of gonoccemia?

A

Dermatitis
Migratory polyarthritis
Tenosynovitis

55
Q

How does dermatitis present in gonoccemia?

A

small to medium-sized macule or hemorrhagic vesicopustules on an erythematous base located on palms and soles.

56
Q

The word “gunmetal grey” describes what?

A

The concurrence of hemorrhage and necrosis that occurs in cutaneous lesions of gonoccemia.

57
Q

How does the rash of acute meningococcemia present?

A

Petechial rash most common in extremities.

In severe cases: necrosis of skin and underlying tissue

58
Q

How does the rash of chronic meningococcemia present?

A

Rose-colored macules and papules. The rash may wax and wane with fevers.

59
Q

What is the pentad of TTP?

A 
Microangiopathic autoimmune hemolytic anemia
Thrombocytopenia
Neuro symptoms 
Fever
Renal failure
60
Q

In which population would you commonly see TTP?

A

Blacks

61
Q

What type of purpura would you see in TTP?

A

Non-palpable purpura. Also seen with other thrombocytopenic purpura & platelet defects

62
Q

Palpable purpura can be seen in which conditions?

A

Vasculitis due to autoimmune disease and blood infection (meningococcemia).

63
Q

How does basal cell carcinoma present?

A

Pearly papule, erythematous patch (esp >6mm) or nonhealing ulcers sun-exposed areas (face, trunk, lower legs).

64
Q

A patient with basal cell carcinoma will also often present with a history of?

A

Bleeding

65
Q

How does squamous cell carcinoma of the skin present?

A

Non-healing ulcer or warty nodule. Small, red conical, hard nodules that occasionally ulcerate.

66
Q

The most common location for melanoma? Men? Women/

A

Men: back
Women: Lower extremities followed by trunk

67
Q

What feature of ABCDE (melanoma screening) caries the greatest sensitivity and specificity at predicting the metastatic potential of a lesion

A

Color

SBL Exam 1 & 2 (3 decks)

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