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KCSU17 Derm > Systemic Derm Dz > Flashcards

Systemic Derm Dz Flashcards

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Dermatology Board Prep flashcards
1
Q

Transmission of syphilis

A

Treponema palladium (spirochete)

Sexual contact (microabrasions of uninfected come in contact with infected lesions)

Vertical transmission

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2
Q

4 stages of syphilis

A
  1. Primary
  2. Secondary
  3. Latent (early, late)
  4. Tertiary
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3
Q

Primary syphilis

A

Chancre develops w/in days to 3 months of exposure

Very infectious

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4
Q

Chancre

A

Painless , indurated papule with ruled edges and ulcerated base

Top layer of skin is gone, fat exposed

Primary syphilis

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5
Q

Secondary syphilis

A

Occurs 4-10 weeks after untreated chancre

Spirochete spread thru lymphatic system

Involves skin, mucous membrane, eyes and lymphatic

Rashes and lesions occur

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6
Q

Lesions of secondary syphilis

A

Dermatitis (muscle membranes, palms, soles)

Reddish-brown, macular, <5mm and discrete

All of these lesions contain T. Palladium

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7
Q

Patients with secondary syphilis may also develop

A

Condyloma lata (painless, gray/white papules in mouse area or mucous membrane – VERY infectious)

Alopecia (patchy hair loss of scalp and face)

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8
Q

Systemic secondary syphilis

A

Malaise

Fever

Anorexia, weight loss

Myalgia and arthralgia

Painless adenopathy

Organ inflammation

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9
Q

Neurosyphilis EARLY

A

First 6 months of infection

Meningitis (high lymphocyte CBC) and meningovascular syphilis (young patient strokes out w/o symptoms)

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10
Q

Latent syphilis

A

Resolution of symptoms and patient is non infectious unless blood transfusion or pregnancy

Some have periodic relapses

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11
Q

Tertiary syphilis

Symptoms

A
  1. Gumma’s
  2. Cardiovascular
  3. Neurosyphilis
  4. Ocular Syphilis
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12
Q

Gummas

A

Granulomas that ulcerate

Classically seen on liver, bones and testes

Very rare, tertiary syphilis

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13
Q

Cardio syphilis

A

Tertiary syphilis (occurs 10 years after primary infection)

Ascending aortic aneurysms +/- aortic valvular disease due to description of vast vasorum (aortic blood supply)

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14
Q

Neurosyphilis Tertiary

A

Takes doralsis (destruction of posterior spinal cord columns, impaired vibration, proprioception)

General paresis (memory alteration)

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15
Q

Ocular syphilis

A

Tertiary or secondary

Patients can have destruction of optic cells that cause photophobia and dimming of vision

Argyll-Robertson pupil

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16
Q

Argyll-Robertson pupil

A

Prostitute’s pupil

Accommodates but doesnt react

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17
Q

Initial syphilis test

A
  1. VDRL
  2. RPR

Tests serum reactivity fo cardiolipin cholesterol antigen

Measured in titers, can get false positive (pregnancy, connective tissue disorders, IVDA) or negatives (HIV)

Non-treponema so need a confirmatory tests

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18
Q

Confirmatory tests of syphilis

A
  1. TP-EIA
  2. FTA-ABS

Confirms if RPR/VRDL are positive

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19
Q

Treatment of syphilis

A

IM PCN (if neuro it is IV PCN)

Primary = 1 shot in butt 
Secondary= 1 shot in butt for 3 weeks

Health department notification and repeat screening

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20
Q

Rocky Mountain Spotted Fever

Geographical region

A

Tick Bourne

Occurs in late spring/early summer in southeastern US

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21
Q

Parasite that causes Rocky Mountain Spotted Fever

A

Rickettsia rickettsial

Animal -> tick -> human

22
Q

Rocky Mountain Spotted Fever

Symptoms

A

Typically 2-14 days after bite (5-7)

Fever, severe HA, myalgia/arthralgia, N/v, dyspnea and cough

23
Q

Following systemic symptoms…

Rocky Mountain Spotted Fever

A

2-4 days alter, erythematous macular rash on wrists and ankles that spreads distally AND proximally

No puritis

24
Q

Rocky Mountain Spotted Fever

Diagnosed

A

Clinical grounds bc no serological test is fast enough

25
Q

Rocky Mountain Spotted Fever

Treatment

A

Doxy IV or oral if suspected

26
Q

Lyme disease

Geography

A

Tick-borne (borrelia burgdorferi)

Thruout US but mostly northern areas (northeast, mid Atlantic, upper Midwest and pacific northwest)

27
Q

Lyme disease

Localized disease

A

3-21 days after the bite

Erythema chronicum migrans rash (ECM) (bullseye)

Lymphadenopathy

Fever, headache, stiff neck, severe myalgia/arthralgia

28
Q

ECM

A

Painless expanding multi-ringged bright red macule rash

Central clearing at site of tick bite

Followed by secondary regions

Pathognomonic for Lyme disease

29
Q

Disseminated Lyme disease systems

A
  1. Cardiac (arrthymias, AV block, pericarditis)
  2. Neurologic (aseptic meningitis, CN palsies)
  3. Joints (severe arthralgia/myalgia)
30
Q

Diagnosis Lyme disease

Clinical

A

Clinical diagnosis

Finding ECM or disseminated disease problems

OR lab

31
Q

Lab diagnosis of Lyme disease

A
  1. Ab detection to confirm exposure (EIA/ELISA)

2. If positive, Western Blot to confirm

32
Q

Prevention of Lyme disease

A

Long sleeves, hats, light colored clothing

Prophylactic treatment with Doxy X1 so that tick bite will not become infectious

33
Q

Treatment of Lyme disease

A

Doxy 100 mg 2xday for 2-3 weeks (localized Dz)

Systemic dz: advanced Abx, infectious disease specialist

34
Q

Chronic Lyme disease

A

Patients with Lyme disease who have been treated but continue to show symptoms

Nonspecific symptoms

No treatment available

35
Q

Primary VZV infection

A

Chicken pox

Contagious benign febrile illness of childhood that then stores viral particles in dorsal root ganglia where they are dormant (reactivate if stressed, ill, immunosuppressive)

36
Q

Reactivated VZV infection

A

Shingles

Less contagious but significant disease

Neuron inflammation and rash on dermatome doesnt cross mid line

37
Q

Shingles

A

Caused by reactivation of VZV

1 million/year

95% of adults are susceptible

38
Q

Risk factors for shingles

A

Immunosuppressed

Older age

No sex predominance

39
Q

Manifestations of shingles

A
  1. Pre-eruptive prodrome (parenthesis of affected dermatome/48-72hrs)
  2. Acute eruptive phase (vascular lesions, lasts at least 10 days, vesicles burst and crust over)
  3. Chronic phase/PHN (burning or aching pain, 30+ post infection)
40
Q

Herpes zoster opthalmicus

A

10-15%

CNV affected by reactivation

In addition to inflammation typical with shingles, they can infect the eye and lead to blindness

This is detected by vesicles on the face or noe se

41
Q

Herpes zoster Oticus

A

Ramsey Hunt syndrome

CN VII affected

Ear, face, and vestibular issues

42
Q

Disseminated herpes zoster

A

Shingles that affects more than one dermatome

Indistinguishable from varicella

43
Q

Zoster sine herpete

A

Uncommon

Pain and weakness of dermatome without signs of cutaneous vesicles

44
Q

complications of shingles

A

PHN

Secondary sepsis/cellulitis

45
Q

PHN

A

Untreated shingles that wont go away

Commmon in the elderly

Best way to prevent is to detect and treat shingles early

46
Q

Diagnosis of shingles

A

Lab testing is futile

Diagnosis is made clinically

DFA used in immunocompromised (Tzanck smear)

47
Q

Management of shingles

A

Episodes are self limiting so treat if serous

Conservative treatment
Glucocorticoids
Pain control
Antivirals

48
Q

Prevention of shingles

A

Varivax (chicken pox vaccine, given to children or adults w/o varicella exposure)

Zostavax (higher potentcy live attenuated VZV vaccine, given to adults 50+)

49
Q

SJS

A

Infection of the skin and mucous membranes

Less than 10% of the body is covered

Can be on spectrum of TEN

50
Q

SJS increased risk

A
  1. Slow acylators
  2. Immunocompromised patients
  3. Patients with brain tumors who undergo radiotherapy with anti-epileptics
  4. Patients with SLE
51
Q

SJS etiologies

A
  1. Medications
  2. Infection
  3. Genetics
  4. Idiopathic

KCSU17 Derm (12 decks)

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