Clinical Perspectives in Skin Changes Flashcards
(74 cards)
1
Q
What are some conditions that cause a maculopapular skin rash?
A
- measles, rubella
- erythema infectiosum (Fifth Disease)
- mono
- Lyme Disease
- Ehrlichiosis
2
Q
What is the incubation period of measles?
A
7-18 days
3
Q
Describe the rash of measles.
A
- brick red, irregular, maculopapular
- appears 3-4 days after symptoms begin
- begins on face and proceeds “down and out”
4
Q
What would a CBC of a measles patient show?
A
leukopenia
5
Q
What are the symptoms of measles that show up prior to the rash? (aka prodromal symptoms)
A
- fever
- cough
- coryza
- conjunctivitis
- KOPLIK SPOTS!
6
Q
Describe the rash of erythema infectiosum (Parvovirus, aka “Fifth Disease”).
A
- fiery red “slapped cheek” rash followed by a lacy, evanescent rash on the trunk and limbs
- facial rash is uncommon in adults (truncal rash may briefly occur)
7
Q
What are the symptoms of erythema infectiosum (Parvovirus, aka “Fifth Disease”), other than rash?
A
- malaise
- headache
- pruritus (particularly palms and soles)
-additionally in adults: limited symmetric polyarthritis
8
Q
What is the most common cause of myocarditis in children?
A
parvovirus
9
Q
For an adult infected with parvovirus, what other conditions does it mimic and should be on the Ddx list based on the presenting symptoms?
A
- SLE
- RA
- Systemic Sclerosis
- APS
- Vasculitis
10
Q
What are complications of pregnancy caused by parvovirus?
A
- premature labor
- hydrops fetalis
- fetal loss
11
Q
What is a common Rickettsial infection in Missouri?
A
Ehrlichiosis, a tickborne disease
12
Q
What are some general systemic symptoms of ehrlichiosis?
A
- fever and chills
- headache
- malaise
- myalgia (particularly calf pain)
- N/V and loss of appetite
- photophobia
- abd. pain mimicking appendicitis (in kids)
- palatal petechiae
- edema of dorsal hands
- rash
13
Q
Describe the rash of ehrlichiosis.
A
- erythematous macules and/or papules
- petechiae
- diffuse erythema
-occurs 5 days after onset of symptoms
14
Q
What would bloodwork of an ehrlichiosis patient show?
A
- leukopenia
- lymphopenia
- thrombocytopenia
- anemia
- transaminitis (elevated liver enzymes)
15
Q
What are some respiratory symptoms of ehrlichiosis?
A
- cough
- dyspnea
- RDS
16
Q
What are some neurological symptoms of ehrlichiosis?
A
- meningoencephalitis
- AMS
- cranial or peripheral motor nerve paralysis
- sudden transient deafness
17
Q
What are some severe symptoms of ehrlichiosis?
A
- acute renal failure
- DIC
- pericarditis
18
Q
What type of rash is present in Lyme Disease?
A
-erythema migrans (targetoid, slightly raised expanding red lesion with a central clearing)
19
Q
What are systemic symptoms of Lyme Disease?
A
- headache or stiff neck
- sometimes fever
-myalgias, arthralgias, arthritis
(arthritis is often chronic/recurrent)
20
Q
Where are most cases of Lyme Disease?
A
-northeast US
21
Q
What are characteristics of Stage 1 (localized infection) in Lyme Disease?
A
- targetoid rash approx. 1 week after tick bite
- rash common in areas of tight clothing (groin, axilla)
22
Q
What are characteristics of Stage 2 (early disseminated infection) of Lyme Disease?
A
- occurs weeks to months later
- bacteremia in 50-60% of pts
- secondary skin lesions that are smaller targetoid
- malaise, fatigue
- headache, neck pain, generalized aches
- fever
- myopericarditis w/ A/V arrhythmias and heart block
- neurologic manifestations
- conjunctivitis
- keratitis
23
Q
What are characteristics of Stage 3 (late persistent infection) of Lyme Disease?
A
- months to years later
- MSK manifestations in 60%
- -arthritis of large weight-bearing joints
-neuro and cutaneous manifestations (rare)
24
Q
If the vesicle formation of Lyme Disease can be mistaken for shingles, how can one tell the difference?
A
-shingles follows a dermatomal pattern while a Lyme Disease rash doesn’t
25
What is the incubation periods for EBV?
-30 to 50 days
26
How long does saliva remain infectious for EBV?
-6 months or longer after symptoms
27
What age groups is typically associated with EBV?
ages 12-19
28
What is the common clinical disease associated with EBV?
infectious mononucleosis
29
What are the symptoms of mono?
- malaise, myalgia
- fever
- exudative sore throat
- tonsillitis, uvular edema, gingivitis
- loss of appetite
- palatal petechiae, conjunctival hemorrhage
- lymphadenopathy (particularly posterior cervical chain)
- splenomegaly (sometimes massive)
- transient B/L upper eyelid edema (Hoagland Sign)
- maculopapular rash (occasionally)
30
What type of lab test would confirm a diagnosis of infectious mononucleosis?
+ Monospot
31
What would appear on a blood smear of a mono patient?
- atypical large lymphocytes
| - lymphocytosis
32
What are some complications of mono?
- hepatitis
- myocarditis
- neuropathy
- encephalitis
- airway obstruction from adenitis
- hemolytic anemia
- thrombocytopenia
33
What is the infectious organism of syphilis?
- Treponema pallidum, a spirochete
| - spread by sexual contact (transmission during unprotected sex w/ an infected partner is 30-50%)
34
What is the simple disease progression of syphilis?
- early stage
- latent period
- late stage
35
What are characteristics of early (infectious syphilis)?
- chancres
- lymphadenopathy
- occasionally bone, liver, or CNS lesions
36
What are the characteristics of late syphilis?
- -gummatous lesions of skin, bones, and viscera
- -cardiovascular disease (particularly aortitis)
- -low-grade fever
- -malaise, myalgias, arthralgias
- -loss of appetite
- -CNS symptoms
- -occular symptoms
37
Describe the rash of secondary syphilis.
- diffuse macular, papular, and pustular combo
- -rash may affect palms and soles
- condyloma lata (genital wart-like lesions)
- painless silvery ulcers of mucous membranes
38
What virus causes Hand-Foot-Mouth Disease?
- Cocksackievirus A and B
| - more common in summer
39
What are the symptoms of Hand-Foot-Mouth Disease?
- stomatitis
- vesicular rash on palms and soles
- nail dystrophies
- -onychomadesis (nail shedding)
40
Describe the rash of Hand-Foot-Mouth Disease.
- begin as bright pink macules that progress to vesicles with surrounding erythema (4-8 mm)
- vesicles erode to form yellow/grey football-shape erosions surrounded by erythematous "halo"
- similar erosions on tongue, buccal mucosa, hard palate and oropharynx
41
What virus causes herpangina?
Cocksackie A and B3
42
What are the symptoms of herpangina?
- sudden fever
- HA
- myalgia
- petechiae/papules on soft palate that ulcerate after 3 days and then heal
43
What are some complications of Cocksackievirus?
- epidemic pleurodynia
- -pleuritic CP, HA, malaise, pharyngitis
- aseptic meningitis
- -fever, HA, stiff neck, CSF lymphocytosis, encephalitis
- acute pericarditis
- -positional pleuritic CP, fever, myalgia
44
What are the symptoms of Toxic Shock Syndrome?
- -abrupt onset fever, diarrhea, vomiting
- -diffuse macular erythematous rash
- -non-purulent conjunctivitis
- -desquamation of palms and soles during recovery
45
What are the symptoms of Scarlet Fever?
- exudative pharyngitis and tonsillitis, sore throat
- fever
- malaise
- vomiting
- "strawberry tongue"
- scarlatiniform rash
46
What pathogen causes Scarlet Fever?
typically Streptococcus pyogenes
47
What is the most common cause of tonsillopharyngitis in kids and adolescents?
Streptococcus pyogenes
48
Describe the rash of Scarlet Fever.
- generalized red punctae on neck, axilla, groin, and skin folds
- desquamation of hands and feet
49
What are lab tests that can detect strep?
--presence of Group A beta-hemolytic streptococci in throat cultures
--anti-streptolysin O titer rise
50
What causes most cases of Erythema multiforme?
- HSV
- Mycoplasma pneumoniae
-medications are NOT a common cause
51
Describe the rash of Varicella (chicken pox).
- begins on face/scalp and spreads rapidly to trunk, with relative sparing of extremities
- lesions are scattered, not clustered and present in all stages of healing simultaneously
52
What is the progression of the chicken pox rash?
rose-colored macules to vesicles to pustules to crusts
53
True or False: blisters of pemphigus vulgaris are fragile
True - the most common lesions observed are actually erosions that resulted from broken blisters
--erosions are often quite large and tend to spread at their periphery
54
What pathogen causes gonococcemia?
Neisseria gonorrhoeae, a gram-negative aerobic diplococci
-usually seen located within PMN leukocytes
55
What is the classic triad in gonococcemia?
- dermatitis
- migratory polyarthritis
- tenosynovitis
-cutaneous lesions present in 40-70% of cases
56
Describe the lesions of disseminated gonococcemia.
--small- to medium-sized hemorrhagic vesicopustules on an erythematous base located on palms and soles
--lesions may develop necrotic centers ("gun metal gray")
57
What pathogen causes meningococcemia?
Neisseria meningitidis
58
What are the ways that disseminated meningococcal infection may present?
- meningitis alone
- acute meningococcemia (w/ or w/o meningitis)
- chronic meningococcemia
59
Describe the rash of acute meningococcemia.
- petechial rash on the extremities
| - in severe cases, necrosis of the skin and underlying tissue (purpura fulminans d/t DIC) may necessitate amputation
60
Describe the rash of chronic meningococcemia.
--rose-colored macules and papules
61
What is the pentad of Thrombotic Thrombocytopenic Purpura (TTP)?
- thrombocytopenia
- neurologic symptoms
- fever
- renal failure
- microangiopathic autoimmune hemolytic anemia
62
What is a common initiation factor of TTP?
-an additional inflammatory trigger such as infection, surgery, pancreatitis, or pregnancy)
- median age of onset is 40
- 9x higher incidence in blacks
63
What is deficient in the classic form (idiopathic form) of Thrombotic Thrombocytopenic Purpura?
ADAMTS13 (severe deficiency)
64
Palpable purpura should make you think of what type of etiology?
infectious or inflammatory
- -vasculitis (SLE, Sjogrens, RA, Henoch-Scholein's)
- -infection (meningococcemia, RMSF, endocarditis)
65
Non-palpable purpura should make you think of what type of etiology?
auto-immune
--ITP, TTP, DIC, platelet dysfunction, clotting factor defect
66
What is the most common form of cutaneous cancer?
Basal Cell Carcinoma
67
Describe the appearance of basal cell carcinoma.
- pearly/translucent/waxy papule, erythematous path >6mm, or nonhealing ulcer in sun-exposed area
- telangectatic vessels visible
68
Describe the appearance of Squamous Cell Carcinoma.
- nonhealing ulcer or warty nodule
- -red, conical, hard, occasional ulceration
-may arise from actinic keratosis
69
What are some risk factors for melanoma?
- Hx of sunburn
- blue/green eyes; blond/red hair; fair complexion
- 100+ typical nevi or any atypical nevus
- prior Hx or family Hx of melanoma
- p16 mutation
70
What are the most common locations for melanomas?
- men: back
| - women: lower extremities and trunk
71
What are the ABCDE's of melanoma and which is the most important?
```
Asymmetry
Border (irregular, notched, ragged)
COLOR (varying shades ... black, blue, white)
Diameter greater than 5-6 mm
Evolution
```
72
What are some characteristics of a Shave Biopsy?
- most common
- less time consuming
- good cosmetic result
- limited downtime for the patient
-limited to processes that occur down to the mid-dermis
73
What are some characteristics of a Punch Biopsy?
- full thickness sample
- rapid healing
- limited by diameter of the punch tool
- depth limitations for processes in subcutaneous tissue
74
What are some characteristics of an Excisional Biopsy?
- more advanced procedure
- sterile technique req'd
- adequate sample down to subcutaneous tissue
- controlled margins
- increased procedure duration
- longer healing time
- greater potential for scarring
- suture removal
