Clinical Perspectives in Skin Changes Flashcards

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1
Q

What type of rash is associated with Measles?

A

Brick red, irregular, maculopapular

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2
Q

When does a measles rash appear?

How does it progress?

A

1) 3-4 days after onset of prodrome

2) Starts on face, moves down/out, and ends in palms and soles

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3
Q

What is the key pathognomonic feature of measles?

A

Koplik spots on buccal mucosa

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4
Q

What are some severe complications of measles?

A

Pneumonia and encephalomyelitis

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5
Q

Where does the classic maculopapular rash present in an adult patient with measles?

A

Mostly on face and neck with more sparseness to trunk

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6
Q

In children, erythema infectiosum is characterized by what classic appearance?

What other facial feature do we see?

There is a subsequent lacy, maculopapular, evanescent rash most commonly where?

Where is pruritus most affecting?

How is the fever?

A

1) Red “slapped cheek” appearance
2) Pale around mouth (Circumoral pallor)
3) Trunk and limbs
4) Palms and soles
5) Mild

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7
Q

What is one of the most common causes of myocarditis in childhood?

A

Parvovirus

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8
Q

Symptoms of parvovirus B19 infection can mimic those of autoimmune states, such as?

A

1) SLE
2) Systemic sclerosis
3) Antiphospholipid syndrome
4) RA

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9
Q

What rickettsial infection causes erythematous macules, abdominal pain mimicking appendicitis, conjunctival injection, palatal petechiae, edema of dorsal hands, and calf pain?

A

Ehrlichiosis

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10
Q

Ehrlichiosis can affect what different systems?

A

1) Respiratory
2) Neurologic
3) Renal
4) Heart (pericarditis)

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11
Q

What classic finding do we see in Lyme disease?

A

Erythema migrans

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12
Q

What occurs during stage 1 of Lyme disease?

A

Erythema migrans progresses into bullseye lesion

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13
Q

Concomitant viral-like illness develops in most Lyme disease patients and is characterized by?

A

Myalgia, arthralgia, headache, fatigue

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14
Q

What occurs during stage 2 of Lyme disease?

A

1) Bacteremia

2) Secondary skin lesions that are similar to primary lesions but smaller

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15
Q

When does Lyme stage 2, the early disseminated infection stage occur?

When does stage 3 occur?

A

1) Weeks to months later

2) Months to years later

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16
Q

In about 4-10% of patients, how can Lyme disease affect the heart?

A

Myopericarditis, with atrial or ventricular arrhythmias and heart block

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17
Q

What is the classical manifestation that occurs in stage 3 of Lyme disease?

A

Arthritis of knee or other large weight-bearing joints

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18
Q

What is the common manifestation of EBV and may occur at any age?

A

Mononucleosis

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19
Q

What test is used for Mononucleosis?

A

Heterophile agglutination test (Monospot)

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20
Q

What are common physical findings of mononucleosis?

A

1) LAD especially posterior cervical chain
2) Upper lid edema (Hoagland sign)
3) Splenomegaly

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21
Q

What group of bacteria is syphilis in?

What is the specific bacteria that causes it?

A

1) Spirochete

2) Treponema pallidum

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22
Q

What are the primary lesions seen in the early (infectious) syphilis state?

A

Chancre and regional LAD

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23
Q

What cardiovascular disease do we see in the late syphilis stage?

A

Aortitis

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24
Q

What type of lesions are found on the skin and mucous membranes in secondary syphilis?

A

Condylomata lata

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25
Q

What Coxsackievirus infection causes stomatitis, vesicular rashes, and nail dystrophies and onychomadesis?

A

Hand foot mouth disease

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26
Q

What Coxsackievirus infection causes sudden onset fevers, headaches, myalgias, and petechiae on soft palate that ulcerate?

A

Herpangina

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27
Q

What is the hallmark of HFMD?

A

Development of a vesicular eruption on the palms and soles

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28
Q

In HFMD, the vesicles quickly erode and form?

A

Yellow to gray, oval erosions surrounded by an erythematous halo

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29
Q

In classic HFMD, what do nearly all patients develop that involves the tongue buccal mucosa, hard palate, and, less frequently, the oropharynx?

A

Enanthem

30
Q

What are potential complications due to Coxsackievirus infection?

A

1) Pleurodynia (Bornhold dz)
2) Aseptic meningitis
3) Acute pericarditis

31
Q

Measles, Rubella, Erythema infectiosum, Infectious mononucleosis, Lyme disease, and Ehrlichiosis all cause what type of rash?

A

Diffuse Maculopapular rash

32
Q

TSS, Scarlet fever, and Erythema multiforme all cause what type of rash?

A

Desquamative skin changes

33
Q

What is characterized by abrupt onset of fever, vomiting, watery diarrhea, and non purulent conjunctivitis?

A

Toxic shock syndrome

34
Q

What is typical during recovery of TSS?

A

Desquamation especially of palms and soles

35
Q

What are some physical findings associated with TSS?

A

1) Sunburnt appearance

2) Maculopapular rash

36
Q

Scarlet fever is typically caused by?

A

Group A strep (pyogenes)

37
Q

What is the most common cause of tonsillopharyngitis in children and adolescents?

A

Streptococcus pyogenes

38
Q

What are some characteristics of the rash seen in scarlet fever?

A

1) Prominent on neck, axilla, groin
2) Circumoral pallor
3) Desquamation involves hands and feet

39
Q

What key clinical feature is seen with scarlet fever?

A

Strawberry tongue

40
Q

What is a rare cutaneous or mucocutaneous eruption characterized by “target” lesions, predominantly on the face and extremities?

A

Erythema multiforme

41
Q

Most cases of Erythema multiforme are related to what infections?

A

1) HSV

2) Mycoplasma pneumoniae

42
Q

What highly contagious exanthem usually begins on the face and scalp and spreads rapidly to the trunk, with relative sparing of the extremities?

A

Varicella

43
Q

How do the lesions of Varicella progress?

When does each occur?

A

1) Rose-colored macules to papules, vesicles, pustules, and crusts
2) At the same time

44
Q

What immunoglobulin is involved with pemphigus?

A

IgA

45
Q

What may exacerbate the painful skin lesions of pemphigus?

A

Exposure to UV radiation

46
Q

Because pemphigus vulgaris blisters are fragile, the most common skin lesions observed in patients are?

A

Erosions resulting from broken blisters

47
Q

Gonococcemia is caused by bacterial infection from what organism?

What the distinct characteristics of this bacteria?

A

1) Neisseria gonorrhoeae

2) Gram-negative, aerobic diplococci

48
Q

Disseminated gonococcal infection results in a classic triad of?

A

1) Dermatitis
2) Migratory polyarthritis
3) Tenosynovitis

49
Q

What skin findings do we see with gonococcemia?

A

1) Small macules

2) Hemorrhagic vesiculopustular on an erythematous base located on palms and soles

50
Q

What may the skin lesions develop in gonococcemia?

A

Necrotic centers

51
Q

Meningococcemia is caused by what bacterial infection?

A

Neisseria meningitidis

52
Q

In severe cases of meningococcemia, necrosis of the skin and underlying tissue may necessitate?

A

Amputation

53
Q

In acute meningococcemia, what type of rash is most common?

A

Petechial rash on extremities

54
Q

Acute meningococcemia with disseminated intravascular coagulation may produce?

A

Purpura fulminans

55
Q

Traditionally, Thrombotic Thrombocytopenic Purpura is characterized by the pentad which consists of?

A

1) Microangiopathic Autoimmune Hemolytic Anemia
2) Thrombocytopenia
3) Neurologic symptoms
4) Fever
5) Renal failure

56
Q

The classic form of TTP is idiopathic TTP, which is the result of a severe deficiency in?

A

ADAMTS13

57
Q

What is the most common form of cutaneous cancer?

A

Basal cell carcinoma

58
Q

What is the common physical presentation for basal cell carcinoma?

A

Umbilicated and bleeding

59
Q

What is a nonhealing ulcer or a small red, conical, hard nodule?

A

Squamous Cell Carcinoma

60
Q

What is the common physical presentation for Squamous Cell Carcinoma?

A

Keratinization

61
Q

What mutation is a risk factor for melanoma?

A

p16 mutation

62
Q

The back is the most common location for melanoma for which sex?

The lower extremities followed by trunk is common for which sex?

A

1) Men

2) Women

63
Q

Which criteria of melanoma screening carries the greatest sensitivity and specificity at predicting the metastatic potential of a lesion?

A

Color

64
Q

Palpable purpura is caused by?

Non-palpable purpura is caused by?

A

1) Vasculitis and infection

2) Autoimmune

65
Q

What is the most common biopsy technique that is less time consuming, has good cosmetic result but is limited to processes occurring to the depth of the mid
dermis?

A

Shave biopsy

66
Q

What technique is able to provide full thickness skin sample but may not be adequate for processes in the subcutaneous tissue due to limitations with depth?

A

Punch Biopsy

67
Q

What technique can produce adequate sample down to the subcutaneous tissues but has longer healing time and greater potential for scarring?

A

Excisional Biopsy

68
Q

What procedures may be used for vesiculobullous diseases for routine histology or immunofluorescence studies?

A

Punch or shave

69
Q

What procedures may be used for lesions that are suspected to be of melanocytic origin?

A

Excision or punch biopsy (for small lesions)

70
Q

What procedure may be used for suspected melanoma?

A

Avoid biopsy and refer to derm

71
Q

What type of skin rash may occur from contact dermatitis?

A

Desquamative