Clinical Perspectives in Skin Changes (Tyler) Flashcards
(85 cards)
What diseases can present with a diffuse maculopapular rash?
Measles Rubella Erythema Infectiosum Infectious Mononucleosis Lyme Disease Ehrlichiosis
This disease presents with the following:
- Exposure 7-18 days before onset of prodrome in an unvaccinated patient.
- Rash
- Leukopenia
Measles
The rash for Measles appears brick red, irregular, and maculopapular. It appears 3-4 days after onset of prodrome and moves in what direction?
Begins on face and moves “downward and outward”
Affects palms and soles last
T/F. Once you have Measles once, you can still get another time.
False. Illness confers permanent immunity.
What are the characteristic oral lesions that occur with the Measles on the buccal mucosa and are pathognomonic?
Koplik Spots
***Only occur about 30% of the time!
In children, this is an exanthematous illness characterized by a fiery red “slapped cheek” appearance.
Erythema Infectiosum (“Fifth Disease”)
Erythema Infectiosum occurs due to what virus?
Parvovirus
Besides the fiery red “slapped cheek” appearance, what are other characteristic symptoms of Erythema Infectiosum?
– Circumoral pallor
– Lacy, maculopapular, evanescent (vanishing, fading away) rash on the trunk and limbs
– Malaise, headache, and pruritus (palms and soles) with little fever
Parvovirus is one of the most common causes of _________ in childhood.
Myocarditis
Symptoms of __________ infection can mimic those of autoimmune states, such as lupus, systemic sclerosis, antiphospholipid syndrome, or vasculitis (the inflammatory arthritidies).
Parvovirus B19
Middle-aged people (especially women) can develop a limited symmetric _________ that mimics SLE and RA.
Polyarthritis
For Parvovirus, what symptoms are most common in adults, children, and pregnant women?
Adults = Arthralgias
Children = Rashes (especially facial and truncal)
Pregnancy = Premature labor, Hydrops fetalis, Fetal loss
This is a rickettsial infection that is common in Missouri. It can cause N/V, fever, chills, headache, myalgia, anorexia, photophobia, and malaise.
Ehrlichiosis
In Ehrlichiosis, other symptoms include abdominal pain mimicking _________ (occurs in children more than adults), conjunctival infection, ________ petechiae, edema of dorsal hands, and calf pain.
Appendicitis
Palatal
What would a blood workup show of Ehrlichiosis?
Leukopenia Lymphopenia Thrombocytopenia Transaminitis (increased liver enzymes) Anemia
How soon after the onset of systemic symptoms in Ehrlichiosis do the erythematous macules and/or papule, petechiae, or diffuse erythema show up?
About 5 days
Lyme Disease will often present with ________ ________, which is a flat or slightly raised red lesion that expands with central clearing (bulls eye).
Erythema migrans
This disease often presents with a headache or stiff neck, and will cause arthralgia, arthritis, and myalgias. Arthritis is often chronic and recurrent.
Lyme Disease
In what stage of Lyme Disease do the following things occur?
– A flat or slightly raised red lesion at tick bite site (about 1 week after the bite) = Erythema migrans
– Common in areas of tight clothing (groin, thigh, or axilla)
– Lesion expands over several days
– Classic lesion progresses with central clearing (bulls-eye)
Stage 1 = Early Localized Infection
In what stage of Lyme Disease do the following things occur?
– Bacteremia
– Secondary skin lesions (in about 50% of pts after original infection - lesions similar to primary lesions but smaller)
– Less common, but can develop myopericarditis (4-10%) and neurologic manifestations (10-15%)
Stage 2 = Early Disseminated Infection
***Weeks to months later!
In what stage of Lyme Disease do the following things occur?
– MSK manifestations (arthritis of knee or other large weight-bearing joints)
– These are rare, but neurologic manifestations and acrodermatitis chronicum atrophicans (bluish-red discoloration of distal extremity with associated swelling) can occur
Stage 3 = Late Persistent Infection
***Months to years later!
How can you distinguish Lyme Disease from Shingles?
Lyme Disease does NOT follow dermatomal distributions like Shingles
EBV is ubiquitous (infects >95% of adult population for their lifetime). ________ ________ is a common manifestation of EBV and may occur at any age. EBV is largely transmitted by saliva but can also be recovered from genital secretions.
Infectious Mononucleosis (“Kissing Disease”)
How can we test for Infectious Mononucleosis?
Positive heterophiles agglutination test (Monospot)
