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SBL Exam 2 > 2. Clinical Perspectives in Skin Changes > Flashcards

2. Clinical Perspectives in Skin Changes Flashcards

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1
Q

how does the rash present in measles

A

brick red, irregular, maculopapular

begins on face and proceeds down and outward and affect the palms and soles last (will see more concentrated on face/neck and sparse on trunk)

appears 3-4 days after onset of prodrome

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2
Q

what are symptoms beside rash that occur in measles

A

prodrome fever, cough, corzya and conjunctivitis

Koplik spots on the buccal mucosa

morbiliform eruption lasts 3-5 days

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3
Q

what are severe complications that occur with measles

A

pneumonia

post-measles encephalomyelitis

(illness will confer permanent immunity)

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4
Q

how does erythema infectiosum present?

A

(parvovirus/5th disease)- seen in children

fiery red “slapped cheek”

circumoral pallor

subsequent lacy, maculopapular, fading away rash on trunk/limbs

malaise, HA, pruritis (esp palm/soles)

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5
Q

Parvovirus is MCC of ______ in children?

(MCC = most common cause)

What else may parvovirus present with ?

How can in present in adults?

A

myocarditis

transient aplastic crisis and pure red blood cell aplasia

in adultls -can mimic autoimmune states (like lupus, systemic sclerosis, antiphospholipid syndrome or vasculitis)

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6
Q

what happens if parvovirus infection occurs in pregnancy

A

premature labor

hydrops fetalis

fetal loss

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7
Q

what presents in ehrlichiosis

A

fever, chills, HA, malaise, myalgia, nausea, vomiting, anorexia and photophobia

abd pain mimicking appendicitis (kids > adults)

conjunctival injection, palatal petechiae, edema of dorsal hands, calf pain

erythematous macules &/or papules, petechiae or diffuse erythema about 5 days after onset of systemic symptoms

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8
Q

what will labs look like in ehrlichiosis

A

leukopenia, lymphopenia, thrombocytopenia, transminitis (liver exams) and anemia

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9
Q

what respiratory symptoms occur in ehrlichiosis

A

cough, dyspnea, resp insufficiency

adult respiratory distress syndrome

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10
Q

what neurological symptoms present w/ ehrlichiosis

A

meningoencephalitis, altered mental status

cranial/peripheral MN paralysis

sudden transient deafness

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11
Q

besides respiratory and neurological symptoms, what other symptoms present w/ ehrlichiosis

A

acute renal failure

DIC

pericarditis

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12
Q

what is the first stage of lyme’s disease (aka erythema migrans)

A

early localized infection

= flat/kinda raised red lesion at the bite, 1 wk after the tick bite –> expands over several days (= bulls-eye lesion)

rash in area of tight clothing

(will develop viral-like illness- myalgia, arthlagia, HA, fatigue, fever)

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13
Q

what is stage 2 of lyme’s disease?

(in terms of skin lesion)

A

early diseminated infxn (wk - months later)

bacteremia (50-60% pts)

secondary skin lesions - w/i days-wks of original infection

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14
Q

what are symptoms that present with lyme’s disease stage 2

A

malaise, fatigue, fever, HA, neck pain generalized achiness

myopericarditis, w/ atrial/ventricualr arrhythmias and heart block (4-10%)

neurologic manifestations (10-15%)

conjunctivits, keratitis

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15
Q

how does lyme’s disease stage 3 present

A

late persistent infection (months-years later)

musculoskeletal manifestation (60%) - monarticular/oligoarticular arthritis of knee or other large wt-bearing joints & chronic arthritis (10%)

rare: neurological manifestations

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16
Q

what is acrodermatitis chronicum atrophicans

A

rare symptom in stage 3 of lyme’s disease

= cutaneous manifestation

usually bluish-red discolartion of distal extremity w/ associated swelling

-lesions = atrophic and sclerotic, resember localized scleroderma

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17
Q

how can you differentiate lyme’s disease and shingles

A

maculopapular rash similar in both

BUT lyme’s does NOT follow dermatomal distribution

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18
Q

what is the time EBV remains infectious and what is the incubation period

A

remain infectious during convalescence (for 6 months or longer after symptoms onset)

incubation period = last several weeks (30-50 days)

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19
Q

what is commonly associated with EBV

A

infectious mononucleosis

-transmit by saliva and also recovered from genital secretions

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20
Q

what are symptoms of infectious mononucleosis

-how do you diagnose

A

malaise, fever, exudate sore throat, uvular edema, tonsilitis, gingivitis, solt palatal petchiae, conjuctival hemorrhage, & sometimes maculopapular rash

Test: (+) heterophile agglutination test (monospot test) ; large atypical lymphocytes in blood smear, lymphocytosis

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21
Q

what are complications that occur with infectious mononucleosis

A

hepatitis, myocarditis, neuropathy, encephalitis, airway obstruction from adenitis, hemolytic anemia, thrombocytopenia

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22
Q

what are physical findings in infectious mononucleosis

A

LAD - discrete, nonsuppurative, slightly painful: esp along posterior cervical chain

transient bilateral upper lid edema (Hoagland sign)

Splenomegaly (in up to 50% pt, sometimes massive)

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23
Q

Syphilis:

Cause?

Transmission?

Risk

A

1. Treponema pallidum, spirochete that can infect any organ and cause protein clinical manifestations

  1. transmitted via sexual contact or transplacenta transmission
  2. risk = 30-50% ppl w/ unprotected sex with ind w/ syphylis
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24
Q

What is the early phase of syphilis

A

=infectious

  • primary lesion (chancre & regional LAD)
  • secondary lesion (skin, mucous mem, occasionally bone, CNS and liver)
  • congenital lesions
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25
what is the late phase of syphilis
after early and latent phase =benign (gummatous) lesions involving skin, bones and viscera **CV dz** CN & Ocular Syndrome
26
what is the manifestation of secondary syphilis
**Rash**: diffuse (MAY INCLUDE palm/sole), macular, papular, pustular and combos **condylomata lata:** papular lesions on the folds of moist areas that to form flat, wartlike lesions, (_esp genitalia and anus)_ **Mucous Patches**: painless, silvery ulcerations of mucous mems w/ surrounding erythema -low grade fever, malaise, anorexia, arthalgia/myalgia
27
What is another name for Coxsackievirus infxn
hand-foot-mouth dz (HFMD) | (summer months)
28
what are the symptoms of HFMD (subtype A & B)
stomatitis, **\*vesicular rash on hands and feet:** pink macules/papules --\> 4-8 mm vesicles w/ surrounding erythema; erode and make. _yellow-green_ **football shape w/ erythematous halo** nail dystrophies and onychomadesis -_Enanthem_ similar to oral erosions on tongue bucal mucosa, _hard_ palate & less freq oropharynx
29
what is herpangina
subtype A; B3 coxsackievirus infxn =sudden onset fever, HA, myalgia -_petechia/papules **on soft palate** that ulcerate in about 3 days and then heal_
30
what are complications of coxsackievirus?
* **Epidemic pleuodynia (Bornholm Dz, subtype B)** : pleuritic chest pain, systemic symps (HA, malaise, pharyngitis) * **Aseptic meningitis (subtype A&B) -** kids/teens; HA, fever, **stiff neck**, CSF lymphocytosis, encephalitis and transverse myelitis * **Acute pericarditis (subtype B)** - positional, plueritic chest pain, fevers, myalgia, clinical/echo sign of pericarditis
31
TSS: Cause: Presenting population:
strains of staphylococci Women of childbearing age using tampons during menstrual periods
32
what are the characterisitics fo TSS
abrupt onset of fever, vomiting, & watery diarrhea _diffuse macular erythematous rash & non-purulent conjunctivitis_ desquamation, esp palm/soles, during recovery could be morbiliform, scarlatiniform or even pustular
33
what causes scarlet fever and what are the lab tests to confirm your Dx
typically Group A Strep pyogenes **\*most common cause of tonillopharyngitis in kids/teens\*** throat culture - look for strep & Anti-streptolysin O (ASO) titers increase
34
how does scarlet fever present
1/2 to 2 days of malaise, sore throat, fever and vomiting **_strawberry tongue_** generalized punctate red rash on neck, axillae, groin and skin folds circumoral pallor fine desquamation involved hands/feet
35
what are the characteristics of erythema multiforme
=rare cutaneous/mucocutaneous eruption ==\> "target" lesions on face and extremities \> in M kids and young adults benign course but freq recurrence; possible ocular complications
36
what are most cases of erythema multiform related to?
infxn: HSV and Mycoplasma pneumoniae
37
what are the symptoms that present with erythema multiforme
prodromal symptoms - mostly absent, if present = mild URI-like fever \>38.5 C (101.3 F) (33%) prior occurances (33%)
38
how does varicella present?
high contagious exanthem; mostly kids rash _begins on face and scalp_ and spreads rapidly to trunk, relatively spare the extremities scattered lesions reflect viremic spread **progress sequentially from rose colored macule to papules, vesicles, pustules and crusts** **\*\*lesions in all stages present at the same time\***
39
How is varicella eliminated
its not! remain LATENT VZV infection of sensory and autonomic neurons provide host immunity to VZV
40
what does the term pemphigus mean & what are the subtypes
=group of autoimmune blistering dz of skin & mucous membranes 1. vulgaris 2. foliaceus 3. paraneoplastic 4. IgA pemphigus
41
what are clinical manifestations of pemphigus
lesion = pruritic/painful primary lesion = flaccid blister, which may occur anywhere on the skin (EXCEPT palms/soles) blister may form in normal or erythematous skin fragile - erosions resulting from broken blisters (which can be large and spread to the periphery) exposure to UV can make it worse
42
what causes gonococcemia how is it transmitted and spread
**Neisseria gonorrhoeae** (gram neg), aerobic coccus-shaped bacterium visualized intracellularly & located w/i polymorphonuclear leukocytes = STD can also be transmitted vertically from mom to child during birth = manifest as inflam eye infection (opthalmia neomatorum) disseminated infxn from primary site of inoculation to other parts by _blood stream_
43
what is the classic triad of gonoccemia
dermatitis migratory polyarthritis tenosynovitis
44
what do the gonococcemia lesions look like
cutaneous lesions 40-70% of disseminated dx **small-med macules or hemorrhagic vesicopustules on an erythematous base located on palms and soles** **may develop necrotic centers** - lead to gun metal gray palm/sole lesions may be tender and others tend to be nonpruritic and painless -disappear after treatment
45
what is the cause of meningococcemia how does it present
**Neisseria meningtidis** **Disseminated meningococcal infxn present as** : 1. meningitis alone, 2. acute meningococcemia w/ or w/o meningitis: classic petechial rash on extremeties (_severe cases - necrosis of skin/ tissue --\>may need amputation)_ 3. chonic meningococcemia: rose colored macules & papules, wax/wane w/ periodic fevers
46
what is the pentad that characterizes TTP
1. thrombocytopenia 2. neurologic problems 3. microangiopathic autoimmune hemolytic anemia 4. fever 5. renal failure
47
TTP: population? mutation?
40 y/o, 9x more in blacks than in non-blacks def in ADAMTS13 (idiopathic/classic version)
48
what happens in TTP is untreated
mortality rate exceeds 90% even w/ modern therapy - 20% pt die w/i 1st month from complications of microvascular thrombosis
49
what is the classic form of TTP
idiopathic -due to severe deficiency in ADAMTS13
50
Compare the causes of palpable purpura vs non-palpable purpura
51
what is the most common cause of skin cancer? how does it present?
BCC =**pearly** papule w/ tenlangiectatic vessels, erythematous patch (esp \>6 mm), nonhealing ulcer on sun-exposed areas usually (face, trunk, lower legs) on back, chest and lower leg = reddish, kinda shiny and scaly plaques
52
How do squamous cell carcinomas of the skin present/look
nonhealing ulcer/warty nodule =small red, conical, hard nodules that occasionally ulcerate may arise from an actinic keratosis (15% chance malignancy)
53
what are risk factors for SCC of the skin
long term sun exposure fair skin organ transplant recipients other immunosuppressed pts
54
what are risk factors for melanoma
hx of sunburn/heavy sun exposure blue/green eyes red/blond hair fair complexion \>100 typical nevi, any atypical nevi prior personal/Fhx melanoma p16 mutation
55
who is most likely to be diagnosed w/ melanoma
mean age = 63 15% younger than 45 yo
56
what is the most common location for melanoma
back for men LE and trunk for women but can occur anywhere on skin
57
are melanomas curable?
yes, if removed and treated early but late --\> potentially lethal
58
what are the ABCDE's of melanoma
**Asymmetry** **Border:** irregular, notched, scalloped, ragged, poorly defined **Color:** varying shades; black (necrotic), blue (deeper depth invasion), white (ischemic, fibrosis, deeper invasion) **Diameter:** \> 5 or 6 mm **Evolution**
59
what is the most sensitive induication of metastatic potential for melanoma
color! greatest sensitivity and selectivity
60
what are things to think about before performing a skin biopsy
established/confirmed dx? appropriate procedure/ training? cosmetic concern? safety? (informed consent, wound healing, infxn risk) treatment & management along w/ dx?
61
what is the benefit/limits of shave biopsies
less time consuming good cosmetic result little downtime limited to process occuring to dept of mid dermis
62
what are the benefits/limits of punch biopsy
provide full thickness skin sample rapid healing limited by diameter of punch tool; may not be adequate for processes in SQ tissue
63
what are the benefits/limits of excisional biopsy?
adequate sample down to the subQ tissue margins can be controlled and adjusted as needed limitations ; increase time of procedure and healing, increased chance to scar, require suture removal
64
how do you perform an excisional biopsy

SBL Exam 2 (8 decks)

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