3: Derm 1 Flashcards
1
Q
What causes hand foot and mouth dz?
A
Coxsackievirus A16
Enterovirus 70
2
Q
What are the complications of early stage lyme dz?
A
Fever, fatigue, malaise, headache, neck/joint stiffness (myalgias/arthralgias), lyme meningitis
3
Q
Subclass of cellulitis that is superficial with sharp, defined borders caused by GABHS.
A
Erysipelas
4
Q
What is treatment for measles?
A
Supportive
Avoid ASA
5
Q
What is the treatment for neurologic lyme dz (2)?
A
- Ceftriaxone 2 g once daily IV x 14 days (range 10-28 days)
- Doxy 200-400 mg/day in 2 divided doses PO x 10-28 days if intolerant to beta-lactam ABX
6
Q
What are the complications of early disseminated lyme dz?
A
Multiple erythema migrans (3–5 weeks after bite), facial palsy, aseptic meningitis, cardiac involvement (AV block and myocarditis), musculoskeletal pain
7
Q
What can fifth’s dz cause in a pregnant woman?
A
Hydrops fetalis
8
Q
Organism that causes Lyme disease.
A
Borrelia burgdorferi spirochete
9
Q
What diameter is the target rash in lyme dz?
A
5-15 cm
10
Q
When is vaccination for meningococcemia done?
A
Age 11 and before starting college.
Ages 2-5 for certain high-risk children.
11
Q
Erythematous papule/pustule around a hair follicle.
A
Folliculitis
12
Q
T/F Scarlet fever requires rapid strep test or throat culture.
A
True (caused by same organism)
13
Q
DDx of shingles?
A
HSV
Impetigo
14
Q
A mild illness also known as German measles.
A
Rubella
15
Q
Where does staph scalded skin syndrome usually start?
A
Respiratory site such as nose or mouth
16
Q
Reactivation of latent varicella infection that is more common after a mild case of chickenpox.
A
Shingles
17
Q
What are transmission routes for hand foot and mouth?
A
Fecal
Oral
Respiratory
18
Q
Manifests as a subcorneal pustule with erosions and honey-colored crusts
A
Impetigo
19
Q
How is rubella acquired?
A
Respiratory secretions. Invades respiratory epithelium.
20
Q
What is the treatment for hand foot and mouth?
A
Symptomatic. May require tylenol or benadryl/maalox solution for oral lesions (can use non-salicylate antacid if concerned for salicylates).
21
Q
What animals/rodents carry the lyme spirochete?
A
Deer
Rodents (white tailed mouse)
Ticks
22
Q
When does varicella occur?
A
Late autumn, spring, and winter
23
Q
What is staph scalded skin syndrome called in neonates?
A
Ritter’s disease
24
Q
What is the medication treatment for impetigo (6)?
A
- Beta lactamase-resistant penicillin or cephalosporin for 5–10 days
- Oral if sick. Topical if not sick.
- Mupirocin (Bactroban) TID for 5–10 days
- Altabax (retapamulin)
- Bleach baths
- Penicillin alternatives: erythromycin and clarithromycin
25
May follow a break in the skin caused by nail biting or tearing a hangnail.
Acute paronychia
26
Clinical manifestions: low-grade fever, HA, chills, followed by erythematous facial rash, and lacy, maculopapular rash
Fifth's dz
27
What is the prevention for rubella?
May give IG for pregnant, nonimmunized, exposed women.
MMR vaccine at 12 months and 4 years old.
Vaccine for postpartum women if not immune during pregnancy.
28
Localized skin infection, involving dermis and subcutaneous tissue with obstruction of local lymphatics.
Cellulitis
29
Chronic paronychia causes inflammation and edema without _____.
Pain
30
T/F Cellulitis can be associated with fever, chills, and malaise.
True
31
Rubbing erythematous skin sideways causes superficial epidermis to slough off.
Nikolsky's sign (staph scalded skin syndrome)
32
In meningococcemia, leakage of the endotoxin in the bacterial cell walls can cause what (3)?
DIC
Irreverisible shock
Multisystem failure
33
Treatment for chronic paronychia (2).
1. Antifungals
| 2. Antibiotics
34
What is the treatment for staph scalded skin syndrome?
1. ICU
| 2. Systemic antistaph ABX
35
What is the treatment for rubella?
Supportive
36
Name 3 sequelae of scarlet fever.
1. Rheumatic fever
2. Heart problems
3. Acute glomerulonephritis
37
Treatment for cellulitis.
1. Outpatient oral antibiotics (Keflex [cephalexin], Augmentin [amoxicillin/clavulanate]) for early onset cellulitis
2. Consider coverage for MRSA
3. Follow up closely to watch for sepsis
38
Upper respiratory prodrome followed by high fever, chills, headache, toxicity, and hypotension.
Meningococcemia
39
Caused by circulating staph toxin which can exfoliate the skin.
Staph scalded skin syndrome
40
Staph scalded skin syndrome can be related to _____ if no peeling.
nonstrep scarlet fever
41
What is a complication of fifth's dz?
Aplastic anemia (esp for those with sickle cell or pregnant women)
42
What are long term complications of lyme dz?
Chronic arthritis
| Neurological sequelae
43
How is rubella diagnosed?
Viral isolates from nasopharyngeal secretions
44
10 complications of impetigo.
1. Sepsis
2. Arthritis
3. Pneumonia
4. Lymphadentitis
5. Toxic shock
6. Osteomylitis
7. Endocarditis
8. Cellulitis
9. Staph scalded skin syndrome
10. APSGN (Acute poststreptococcal glomerulonephritis)
45
What is incubation period for varicella?
10-21 days (mean 14 days)
46
What is the prophylaxis for lyme dz?
Tests not necessary.
| Single dose of doxy (200 mg for adults, 4 mg/kg for children >8 with max of 200)
47
Ill, miserable child with dusky red maculopapular rash on face that spreads to trunk. Rash lasts 7-10 days, but brown macules can last u to 3 weeks.
Measles
48
Organism that causes meningococcemia.
Neisseria meningitidis
49
What is the treatment for meningococcemia?
High dose penicillin G q 4-6 hours
| Alternatives are cefotaxime, ceftriasone, and chloramphernicol
50
Describe the 2 phases of staph scalded skin syndrome.
1. Prodromal phase - Bright erythema around mouth, fever, irritability
2. Exfoliative phase - Tender, inflamed peeling skin. Red oral mucosa. Peeling on trunk.
51
T/F Rubella has a periodic occurrence of wintertime epidemics.
False. Springtime.
52
Resembles impetigo but extends through to dermis.
Ecthyma
53
Most common ages and times for fifth's disease?
School-age children
| Late winter or spring
54
T/F N. meningitidis is a gram-negative bacteria that contains endotoxin in the cell walls.
True
55
What causes fifth's dz?
Parvovirus B19
56
Recurrent varicella infection.
Herpes zoster (Shingles)
57
What organism causes scarlet fever?
GABHS
58
Superficial bacterial infection of the epidermis that can be bullous or nonbullous.
Impetigo
59
What causes varicella?
Herpes virus varicellae
60
In impetigo, bullae result from toxin-producing strains of _____.
Staph aureus
61
What is the incubation period of hand foot and mouth/
3-6 days after exposure
62
Most common bacteria in acute paronychia (2)?
1. Staph
| 2. Strep
63
Is N. meningitidis gram positive or negative?
Gram negative
64
Upper respiratorycatarrhal prodromal phase that can include Koplik's spots on buccal mucosa and conjunctivitis, rhinitis, and otitis media.
Measles
65
When is varicella contagious?
48 hours before onset of rash to 6-7 days after (until all lesions have crusted).
66
Often related to GABHS (Group A Beta Hemolytic Streptococcal) infection.
Perianal streptococcal dermatitis
67
Prodrome of low fever, URI symptoms that leads to maculopapular crop lesions. Diffuse vesicles and erythema in varying stages. Poor appetite, malaise, pruritis.
Varicella
68
T/F Chronic paronychia can cause secondary nail dystrophy.
True
69
What causes rubella?
Single-stranded positive-sense RNA virus with glucolipid envelope.
Member of the togavirus family.
70
Clinical manifestations: lymphadenopathy, erythematous macular papular discrete rash, mild pharyngitis, conjunctivitis, anorexia, HA, malaise, low-grade fever (LGF).
Rubella
71
T/F Meningococcemia contacts do not require chemoprophylaxis.
False
72
Non medication treatment for impetigo (2)?
1. Handwashing, cleanliness, exclusion from day care/school for 24–48 hours after start of antibiotic
2. Cool compresses to debride crusts
73
What is the treatment for herpes zoster (shingles)?
Supportive.
| Urgent referral to ophthalmology if lesions on face.
74
T/F Scarlet fever rash is nonblanchable.
False. Scarlet fever rash blanches. Late stage rocky mountain spotted fever does not.
75
Occurrence between 6 months and 3 years of age. Abrupt onset of illness with high fever. Possible URI symptoms, otitis media. Diffuse erythema of posterior pharynx and soft palate. GI manifestation. Macular erythematous rash during febrile phase or after fever resolves.
Roseola
76
Fulminant purpural, urticarial, maculopapular, and petechial eruptions over trunk and extremities.
Meningococcemia
77
Most common bugs in chronic paronychia (2)?
1. Candida albicans (yeast)
| 2. Mixed bacterial flora
78
Meningococcemia has symptoms similar to _____ and _____ which can cause a delay in diagnosis.
Flu
| Strep
79
Meningococcemia is most often caused by serogroups _____ and _____.
B and C
80
What is prevention of measles?
MMR at 12 months and 4 years.
81
Linear petechiae in flexural creases that can appear in scarlet fever.
Pastia's lines
82
_____ is teratogenic in pregnant women, while _____ in children can cause pneumonia.
Rubella
| Measles
83
Which rashes are caused by viruses?
```
Measles
Mumps
Rubella
Varicella
Fifth's Dz (erythema infectiosum)
Hand foot and mouth
Shingles
```
84
What causes roseola?
Human herpes virus (6 or 7)
85
Rash that begins as red macules or papules and expands to a large, annular, erythematous rash with a pale center within 1 week.
Lyme dz (really, it can occur from 1 day to 1 month after bite, but asynch stages 1 week)
86
Causes circumoral pallor.
Scarlet fever
87
What is the treatment for roseola?
Symptomatic
88
Complications of varicella (5).
```
Impetigo
Necrotizing fasciitis (severe) from group A strep
Pneumonia
Meningitis
Encephalitis
```
89
Manifests as erythematous, warm, and tender plaques with local swelling and proximal lymphadenopathy.
Cellulitis
90
When does hand foot and mouth usually occur?
Summer, early fall
91
2 most common bacteria in impetigo.
1. Strep
| 2. Staph
92
If acute paronychia does not respond to conservative treatment, what is the next step?
I and D
93
What is the incubation period for lyme dz?
7-14 days
94
Thrives in abrasions, lacerations, arthropod bites, burns, chicken pox, and dermatitis.
Impetigo
95
What is the treatment for lyme dz (2)?
14-21 days of ABX therapy:
1. Doxycycline 100 mg (8+ yo)
2. Amoxicillin 25-50 mg/kg TID or cefuroxime or ceftriaxone
96
What are complications of roseola (2)?
Seizures
Dehydration
Rule out sepsis and meningitis
97
How is lyme dz diagnosed?
Serology for borrelia burgdorferi
98
What is the epidemiology of measles?
Prodrome 1-2 days before rash. Incubation 8-12 days from exposure to onset of symptoms.
99
Other than face and neck, where does the scarlet fever rash appear (4)?
```
Groin
Axillae
Abdomen
Trunk
Spares palms and soles
```
100
Both measles and scarlet fever have a maculopapular rash. What are the differences?
```
Scarlet fever
- Rash day 1
- Rash spares palms and soles
- Sandpaper like appearance
- Strawberry tongue
Measles
- Koplik's spots
- Rash 3-5 days after symptoms
- Rash starts on face and spreads down
```
101
Impetigo can be diagnosed by _____ and _____.
Culture
| Gram stain
102
Most common cause of folliculitis?
Staph aureus
103
When does the rash appear in scarlet fever?
After 24 hours
104
Underlying punch-out ulcer with exudate.
Ecthyma
105
What is the incubation period of meningococcemia?
1-10 days
106
Causes of cellulitis (4).
1. GABHS
2. Staph
3. Strep pneumoniae
4. H. inlfuenzae
107
What is treatment for varicella?
Symptomatic (Aveeno baths, baking soda baths, calamine lotion).
In select cases, acyclovir can be used.
Hospitalize immunocompromised and possibly give immunoglobulin.
108
Treatment for acute paronychia.
Treated with warm soaks, topical antibiotics, and systemic antibiotics (clindamycin or Augmentin).
109
When does a scarlet fever rash desquamate?
1-3 weeks
110
Clinical presentation: one week of burning, tingling, and stinging. Rash follows dermatomes but do not cross midline.
Shingles
111
DDx for scarlet fever (5)?
1. Rubella
2. Drug reactions
3. Viral exanthems
4. Staph scalded skin syndrome
5. Kawasaki dz
112
Scarlet fever rash starts on _____ and then spreads in _____ days.
Face and neck
| 1-2 days
113
What is the infectious period for rubella?
7 days before through 5-7 days after the rash.
114
How do you diagnose staph scalded skin syndrome?
Nikolsky's sign
115
Red, roughened, diffuse, sandpaper-like rash.
Scarlet fever
116
Present in axillae and groin.
Folliculitis
117
What treatment for meningococcemia would a person who is G6PD sensitive receive?
Chloramphenicol
118
Clinical presentation: vesicles or red papules found on tongue, buccal mucous membranes, hands, and feet (rash often appears when fever abates)
Hand foot and mouth disease
119
Manifests with redness, warmth, swelling, and tenderness of the proximal nail folds.
Acute paronychia
120
What are routes of transmission for varicella?
Direct contact
Airborne
Droplet
121
Causes white or strawberry tongue.
Scarlet fever
122
Often occurs in people with a history of prolonged or frequent immersion of hands in water, and in children who suck on fingers/thumbs.
Chronic paronychia
123
What is the incubation for rubella?
14-21 days
124
If fever and chills are present with cellulitis, what may be needed for diagnosis?
CBC and blood culture
125
T/F When those vaccinated for varricella get it, it does not look like varicella.
True
126
How is fifth's dz spread?
Respiratory route
127
T/F Fifth'd dz is not contagious once the rash appears.
True
128
Subclass of cellulitis that is caused by Group A strep and requires immediate hospitalization.
Necrotizing fasciitis
129
Portals of entry can include tinea, eczema, burns, abrasions, lacerations, etc.
Cellulitis
130
What bacteria cause ecthyma (3)?
1. Strep
2. Staph
3. Pseudomonas
131
Common among young children and in warm weather.
Impetigo
