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545 > Week 6 - infectious diseases, derm, atopy, imms > Flashcards

Week 6 - infectious diseases, derm, atopy, imms Flashcards

1
Q

Timing of Tdap immunization in pregnancy

A

between 27-36 weeks

Health Canada recommends 27-32 weeks

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2
Q

Arthrus reaction is _____ type hypersensitivity reaction

A

type 3

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3
Q

ACNE

3 types of lesions

A
  • comedonal
  • inflammatory (pustules and papules)
  • nodules and cysts
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4
Q

ACNE PATIENT COUNSELLING

  • Noticeable improvement of acne takes _____weeks!
  • often looks worse in first _____weeks before it gets better
  • If retinoids, counsel re: ______
  • Benzoyl peroxide & topical retinoids - counsel re: ________

CCPPDD

A
  • Noticeable improvement of acne takes 4-8 weeks!
  • Acne often looks worse in first 2-4 weeks before it gets better
  • Tx is non-curative
  • If retinoids, counsel re: contraception
  • Benzoyl peroxide & topical retinoids - counsel re: photosensitivity, irritation + drying
cleaning (soap free cleanser 1-2x/day)
cosmetics (non-comedogenic)
picking
protection (sunscreen)
diet (low glycemic)
duration (long term treatment)
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5
Q

ACNE TREATMENT with hormones

  • duration of OCP: before improvement? max effect?
  • what hormone worsens acne?
A

Duration:

  • 3-4 months before improvement
  • max effect at 6 months

Worse with depo provera

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6
Q

ACNE TREATMENT with topical retinoids

Timing: 
-if used alone?
-if used with benzoyl peroxide
Frequency?
Adverse side effects?
Counselling?
A

Timing:

  • best at night 20 min after washed and completely dried
  • BP in AM, retinoid in PM

Frequency: start with once/week, build up
S/E: redness, peeling, stinging, dryness
Counselling: photosensitivity, teratogenic

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7
Q

ACNE TREATMENT

why is spironolactone not generally used in males?

A

spiro - s/e of gynecomastia

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8
Q

ACNE TREATMENT - systemic retinoids

Counselling re: contraception

Pregnancy testing

Side effects

A

contraception: need 2 reliable forms teratogenic

PREG TESTS

  • twice before starting (one at discussion, one at least 11 days before starting)
  • every month during
  • one month after stopping

SIDE EFFECTS

  • dryness (skin, mucous membranes) - worse in first 8 weeks
  • avoid other topical tx d/t dryness
  • photosensitivity
  • initial acne flare during first 2 months
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9
Q

ERYTHEMA INFECTIOSUM

  • aka?
  • organism?
  • transmission?
A

aka Fifth’s disease

Parvovirus B19

resp secretions, percutaneous, vertical

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10
Q

ERYTHEMA INFECTIOSUM

  • symptoms
  • characteristics of rash
  • timeline
A

mild prodrome:

  • fever, malaise
  • slapped cheeks x 2-3 weeks
  • rash: lacy reticulated macules and papules 1-4 days later, pruritic
  • papular-purpuric gloves and sock syndrome
  • rash 7-10 days after prodrome, resolves in 1-2 weeks
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11
Q

ERYTHEMA INFECTIOSUM

-complications

A

pregnancy: fetal hydrops, growth retardation, fetal loss

adults: arthritis
aplastic crises

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12
Q

ERYTHEMA INFECTIOSUM

  • diagnostics
  • counselling for pregnant women
A
  • IgM and IgG for pregnant women if suspected

- serial US to monitor fetal hydrops if pregnant and + parvovirus

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13
Q

ROSEOLA

  • organism?
  • transmission?
  • common age?
A

-HHV 6/7

saliva

common in ages 6 months to 2 years

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14
Q

ROSEOLA

  • symptoms
  • characteristics of rash
A

prodrome high fever x 3-5 days, URTI

rash: blanchable pink macules/papules with halo, not itchy, to trunk

**fever disappears with onset of rash

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15
Q

ROSEOLA

  • complications
  • diagnostics
  • treatment
A

self limiting
febrile seizures 15%

no Ix

supportive management

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16
Q

IMPETIGO

  • organism
  • transmission
  • common age
A

Staph aureus 80%
GAS 10%

broken skin, self-inoculation

common in ages 2-5 years old

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17
Q

IMPETIGO

-characteristics of:

nonbullous
bullous
ecthyma

A

NONBULLOUS
-papules –> vesicles –> pustules, golden crusts
usually face and extremities

BULLOUS
-flaccid bullae, clear yellow –> rupture –> thin brown crust
usually on trunk

ECTHYMA
-ulcers deep into dermis
“punched out” ulcers with yellow crust

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18
Q

IMPETIGO

counselling

  • return to school?
  • hygiene
A

return to school 24 hours after starting abx

-hand hygiene

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19
Q

IMPETIGO

treatment

A

localized:
-fucidin or mupirocin x 7 days

-po abx (keflex or cloxacillin) if no response to topical abx after 24-48 hours

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20
Q

MEASLES

  • transmission
  • incubation
  • most infectious?
A

airborne and resp droplets
nose/throat secretions

incubation 8-12 days
-most infectious 1-2 days before prodrome, 4 days after rash

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21
Q

MEASLES

  • symptoms
  • characteristics of rash
A

prodrome:
fever and 3 C’s
-conjunctivitis, coryza, cough
-koplik’s spots

Rash: maculopapular erythema behind ears and hairline –> generalized, then desquamates

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22
Q

MEASLES

complications
treatment

A
  • OM/pneumonia
  • encephalitis
  • death from resp/neuro complications

Vaccine within 72 hours of exposure
IG if MMR contraindicated

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23
Q

RUBELLA

transmission
incubation

A

infected nose/throat secretions

incubation 2-3 weeks

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24
Q

RUBELLA

symptoms
characteristics of rash

A

prodrome: fever, headache, URTI, conjunctivitis

maculopapular rash –> confluent
face–> trunk
postauricular/suboccipital LN

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25
Q

RUBELLA

complications

A

congenital rubella syndrome: birth abnormalities
miscarriage, stillbirth
arthralgia

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26
Q

KAWASAKI

symptoms
characteristics of rash

A

high fever x 5 days

CREAM

  • conjunctivitis
  • rash (not vesicular)
  • extremities: palmar/plantar erythema and/or edema
  • adenopathy (cervical , unilateral)
  • mucosa: strawberry tongue, cracked lips

Rash: morbilliform, urticarial, scarlatiniform, erythema

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27
Q

KAWASAKI

complications

treatment

A

20% coronary artery damage, MI
higher risk in males

  • IVIG most effective between day 5-10
  • ASA
  • serial echo, refer to cardio
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28
Q

SCARLET FEVER

organism
transmission

A

group A strep

resp secretions

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29
Q

SCARLET FEVER

symptoms
characteristics of rash

A

fever, headache, sore throat

  • pastia lines (axilla, ACF, inguinal folds)
  • strawberry tongue

rash to neck, chest, axillae
sandpaper fine red papules

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30
Q

SCARLET FEVER

complications

treatment

A

acute rheumatic fever

penicillin within 9 days of symptom onset

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31
Q

ROCKY MOUNTAIN SPOTTED FEVER

organism

transmission

A

rickettsia

tick bites

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32
Q

ROCKY MOUNTAIN SPOTTED FEVER

symptoms
characteristics of rash

A

fever, headache, malaise, n/v/d

rash: pink macules/papules
become petechiae/purpura

ankles and wrists –> palms and soles –> limbs –> trunk
-always involves palms and soles

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33
Q

ROCKY MOUNTAIN SPOTTED FEVER

complications

treatment

A

CNS involvement - seizures, blindness, deafness, coma
Multiorgan involvement
Rash can cause severe necrosis, gangrene (rare)
Fatality 1-4%

Doxycycline including those under age 9 since this is life threatening

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34
Q

DRUG RELATED RASHES

  • common culprits
  • characteristics of rash
  • timing
A

sulfa, PCN, cephalosporins, anticonvulsants

erythematous macules and papules to trunk –> symmetrical spread

1-2 weeks after starting rx, can take 1-2 weeks to resolve after stopping med

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35
Q

MUMPS

transmission
timeline

A

airborne droplet
direct contact saliva/resp secretions

Incubation 16-18 days, max infectious 2 days before and 5 days after onset of parotid swelling

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36
Q

MUMPS

symptoms

diagnosis

A

fever, malaise, parotitis

dx: oral buccal swab and urine

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37
Q

MUMPS

complications

A 
10% aseptic meningitis --> hearing loss
Mumps meningitis
Permanent deafness in <5 in 100,000
Miscarriage if early pregnancy
No link to birth defects
Orchitis --> can result in sterility
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38
Q

FLU

transmission

timeline

A

droplet

Infectious one day before five days after symptoms begin
***kids can spread up to 21 days after onset of symptoms
Symptoms 1-4 days after exposure

39
Q

MRSA

treatment

  • uncomplicated
  • deeper/severe
  • kids
A

uncomplicated abscess: I+D, no abx

Deeper/severe:
-septra, clinda, doxy, linezolid
Topical: mupirocin

kids: avoid tetracycline in kids <8 (tooth discolouration)

40
Q

FEBRILE SEIZURES

simple vs complex

  • clonic movement
  • duration
  • # per 24 hours
  • neuro development
  • family hx
A

SIMPLE

  • generalized
  • <15 minutes
  • 1 per 24 hours
  • normal neuro devt
  • positive FHx

COMPLEX

-focal
->15 minutes
>1 in 24 hours
-abnormal neuro devt
-neg family hx

41
Q

FEBRILE SEIZURES

ask about immunizations
-which organisms of concern?

A

Hib and strep pneumoniae

42
Q

FEBRILE SEIZURES

investigations

A

none needed if simple seizure and normal neuro exam

43
Q

viral meningitis

most common cause
transmission

A

enterovirus most common (85%)

initially mucosa (resp, GI) –> spread to CNS

44
Q

PERTUSSIS

3 stages

A
  1. catarrhal stage
    - URTI
    - fever UNCOMMON
    - 1 to 2 weeks
  2. Paroxysmal stage
    - worsening paroxysmal cough
    - watery rhinorrhea
    - lasts 2-8 weeks
    - sweating in between
  3. Convalescent
    weeks to months for cough to improve
45
Q

PERTUSSIS

3 characteristics of cough associated with pertussis

A 
cough lasting > 2 weeks
OR
-paroxysmal cough ANY duration
-inspiratory whoop
-associated with vomiting or apnea
46
Q

PERTUSSIS

high risk contacts need chemoprophylaxis

A
  • babies <1 year old
  • pregnant women in 3rd trimester
  • all household or daycare contacts if baby <1 year OR pregnant woman in 3rd trimester
47
Q

MONO

organism
transmission
timeline

A

epstein barr virus

salivary transmission

oral shedding 6-18 months!
incubation 4-6 weeks

48
Q

MONO

symptoms
characteristics of rash

A 
tonsils with exudate
fever malaise etc
petechiae to palate
-posterior lymphadenopathy
-enlarged liver and spleen

RASH
-generalized maculopapular
trunk and arms –> face and forearms
-morbilliform, papular, scarletina, vesicular, purpuric, copper

49
Q

MONO

complications

A
  • splenic rupture
  • glomerulonephritis
  • arthritis
  • hepatosplenomegaly
  • meningitis
50
Q

MONO

diagnosis

return to sports?

A

monospot 25% false neg in 1st week
-can be detected 2-9 weeks after exposure so often early false neg

avoid contact sports for 3 weeks (minimum 21 days)

51
Q

DIAPER DERMATITIS

main organisms

A

candida albicans

staph aureus

52
Q

DIAPER DERMATITIS

characteristic and distribution of rash:

  • candida:
  • irritant:
  • streptococcal
A

candida: scaly erythematous papules and plaques to FOLDS
irritant: BEEFY RED plaques with SATELLITE papules and pustules, CONVEX, spares intertriginous folds
strep: well demarcated bright red tender PERIANAL patch

53
Q

DIAPER DERMATITIS

nonpharm counselling

A 
• Skin care
• Clean and dry diaper area
• Change diaper frequently --> avoid cloth!
• Barrier creams
HYGIENE
54
Q

DIAPER DERMATITIS

treatment

A

candida:
• Nystatin, miconazole, ketoconazole with every diaper change
Low potency corticosteroids (0.5-1% hydrocortisone)

secondary bacterial infection:

  • mupirocin if local/mild
  • keflex if worse
55
Q

PITYRIASIS ROSEA

organism
common age group

A

herpesvirus 6/7

teens and young adults

56
Q

PITYRIASIS ROSEA

onset of herald patch:
duration:

A

onset: herald patch 1-20 days before generalized rash
duration: 6-12 weeks

57
Q

PITYRIASIS ROSEA

herald patch description

generalized rash description

A

oval pink or red plaque 2–5 cm in diameter, with a scale trailing just inside the edge of the lesion like a collaret.

generalized:
-SCALY circular or oval patch or plaques to chest or back in christmas tree pattern, itchy 25%

58
Q

PITYRIASIS ROSEA

counselling

A

self-limiting
resolves in 1-2 months
moisturize dry skin

59
Q

SCABIES

organism and lifespan
transmission

A
  • female scabies mite burrows, lays 2-3 eggs/day, die after 4-6 weeks
  • eggs hatch in 10-14 days

transmission: prolonged skin to skin contact

60
Q

SCABIES

incubation

  • primary episode
  • subsequent
A

primary: 3-6 weeks after contact with infected person

if prior sensitization: within 1-3 days

61
Q

SCABIES

symptoms
characteristics of rash

location

A

intense pruritis, worse at night

burrows, excoriated papules/pustules/vesicles

interdigital web spaces, flexor surfaces, axillae, genitals

babies: whole body including face, palms, soles

62
Q

SCABIES

diagnostic tests

A

skin scraping not required (may have low number of mites)

63
Q

SCABIES

nonpharm counselling

A
  • all family members need to be treated
  • wash towels, clothing etc in hot water
  • tumble in hot dryer x 20 min
  • if not able to wash: plastic bag x 1 week
64
Q

SCABIES

pharm treatment

  • dose
  • contraindications
  • peds consideration
A

permethrin 5%
-massage into skin from neck to soles of feet, leave on for 8-14 hours and shower off

contraindications: allergy to chrysanthemum/ragweed

Pediatric considerations: safe for infants as young as 2 months, need special application to scalp, temple, forehead, hands, feet. Babies: apply head to toe

REPEAT TREATMENT IN ONE WEEK

65
Q

GUTTATE PSORIASIS

organism

timeline

A

beta-hemolytic strep

1-2 weeks after strep infection (tonsillitis or perianal dermatitis)
SUDDEN onset
resolves in 6-12 months

66
Q

GUTTATE PSORIASIS

symptoms

A

SUDDEN onset

small oval red papules and plaques on torso and extremities

67
Q

SEBORRHEIC DERMATITIS

risk factors

A
  • oily skin
  • immunosuppression: transplant recipients, HIV infection, lymphoma
  • neurological disorders (Parkinson’s, CVA, epilepsy)
  • lack of sleep and stress
68
Q

SEBORRHEIC DERMATITIS

organism

A

malassezia furfur

69
Q

SEBORRHEIC DERMATITIS

characteristics of rash
location

A

yellow greasy adherent scale, minimally red
salmon pink patches or waxy
not itchy

scalp, armpit, groin, neck
folds

70
Q

SEBORRHEIC DERMATITIS

nonpharm counselling

A

removal of scales:

  • apply mineral/olive oil
  • gently wash hours later
  • do not vigorously remove hair –> permanent hair loss
71
Q

name the atopy triad

A

atopic dermatitis
asthma
allergic rhinitis

72
Q

IRRITANT DERMATITIS

-most common form?

ALLERGIC CONTACT DERMATITIS
-most common triggers

ATOPIC DERMATITIS
-most common triggers

A

IRRITANT
-diaper dermatitis

allergic triggers:
-poison ivy, nickel, fragrance

atopic triggers:
extreme temperatures, sweating, clothing with rough textures
exposure to skin irritants, topical medications, stress
Dust mites common aeroallergen

FOOD IS NOT COMMON

73
Q

allergic dermatitis is what type of hypersensitivity?

A

delayed type (type IV)

74
Q

ATOPIC DERMATITIS

location in infancy:
location in childhood
location in adults:

A

Distribution changes by age:
• Infancy: face, scalp, EXTENSOR surfaces. Diaper area spared
• Childhood and adult: FLEXURAL surfaces: neck, antecubital and popliteal fossae
Adults: greater extremity, head, neck involvement

75
Q

PITYRIASIS ALBA

symptoms
description of rash

A

minimal or absent itch

hypopigmented patch to face with fine scale

76
Q

PITYRIASIS ALBA

treatment
counselling

A

no treatment if asymptomatic

  • moisturize if dry
  • clears after one year
77
Q

ATOPIC DERMATITIS

nonpharm counselling

A
  • avoid triggers
  • air purifier
  • NO food restriction needed
  • limit baths and hot water
  • emollients
  • wet wraps
78
Q

LICHEN PLANUS

  • appearance
  • location
  • etiology
  • prognosis
A

• Appearance:
○ Pruritic, polygonal, pink-purple flat-topped papules
○ Sometimes overlying delicate white lines (Wickham striae)
Pinpoint to >1 cm
• Location
○ Flexor surfaces
○ Rare in kids to involve mucous membranes and nails (50% of adults have oral lichen planus, 10% nails)
• Etiology
○ Unknown, ?virus ?medication
○ DermNet: T-cell mediated autoimmune disorder
• Prognosis
○ Resolves within 1-2 years, can have grey-brown post-inflammatory macules that will eventually fade

79
Q

LICHEN STRIATUS

  • appearance
  • location
  • etiology
A

appearance:

  • flat topped papules, slightly hyperpigmented
  • confluent red scaly linear bands

location
-blaschko lines

etiology unknown

80
Q

LICE

organism and patho
transmission

A

allergic reaction to lice saliva during feeding

onset of itching delayed for 4-6 weeks

lifespan of louse is one month
-can survive 55 hours without host

transmission:
direct contact with head of infested patient

81
Q

LICE

pharm counselling

A
  • do not use conditioner before treatment
  • rinse over sink instead of bath/shower
  • rinse with warm water (instead of hot)
  • keep treatment on for 10 minutes before rinsing
  • REPEAT TREATMENT on day 9
82
Q

Description of lesion morphology

SCALDA

A 
size
colour
arrangement
lesion morphology
distribution
always check hair, nails, mucus membranes, between fingers and toes
83
Q

MEASLES recovery

cough can persist for ____ weeks
fever beyond day ____ of rash suggests measles-related complication

two most common complications

A

cough can persist for 1-2 weeks

fever beyond day 3-4 of rash suggests complication

most common complication diarrhea and otitis media

84
Q

MEASLES testing

A

NP swab: up to 8 days after rash onset
urine: up to 14 days after rash onset

IgM and IgG within 7 days of rash onset, repeat 10-14 days after first sample to determine if seroconversion

85
Q

MEASLES

nonpharm counselling

A
  • airborne for up to 2 hours
  • isolation for 4 days after start of rash
  • avoid pregnant, unvaccinated or immunocompromised people
86
Q

MEASLES

when should contacts should receive vaccine?

A

incompletely immunized contacts:

-within 72 hours of last exposure to infected person

87
Q

VARICELLA ZOSTER

symptoms
characteristics of rash

A

fever and malaise x 2-3 days
generalized pruritic rash to torso, face, extremities
VESICULAR
various stages of resolution: macule –> papules –> vesicle

88
Q

VARICELLA ZOSTER

complications

A

if in pregnancy: congenital varicella syndrome

  • fetal demise
  • secondary infection with staph
89
Q

MONO

monospot detects _____ antibodies
______ weeks after infection

A

heterophil antibodies

detected 2-9 weeks after infection

90
Q

MONO

splenic rupture symptoms

A

abdo pain
falling hematocrit
usually 14 days after symptom onset

91
Q

complications of varicella

A
  • superinfection
  • pneumonia
  • CNS involvement
  • Reye syndrome
  • glomerulonephritis
  • arthritis
  • congenital varicella syndrome (limb atrophy, CNS malformation, low birth weight, cataracts, learning disabilities)
  • fetal demise
92
Q

complications of HSV

A

conjunctivitis

  • keratitis
  • encephalitis
  • secondary infection
93
Q

varicella

symptoms

A

generalized pruritic rash
-torso, face, extremities with fever and malaise x 2-3 days

100s of vesicles in various changes
-rapidly changes from macular –> papular –> vesicle –> crusted

94
Q

Hand foot mouth disease

  • organism
  • location of rash
A

-coxsackievirus

-vesicles and ulcers in buccal mucosa, tongue, palate, hands and feet
high fever

common in kids <5

545 (6 decks)

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