Dermatologic Disorders and Communicable Diseases

Question 1

Coxsackie Virus

Answer 1

Hand-Foot-Mouth Disease:
highly contagious viral illness resulting in ulceration and inflammation of the soft palate and exanthema on hands and feet

Question 2

S/Sx of coxsackie virus

Answer 2

fever
malaise
vomiting
drooling
papulovesicular rash

Question 3

What is the management of coxsackie virus?

Answer 3

acetaminophen

possible topical applications

Question 4

Rubeola AKA

Answer 4

ordinary measles or red measles that can occur at any age

Question 5

Rubeola s/sx

Answer 5

VIRUS that leads to fever:
fever
runny nose 
cough
red eyes
spreading skin rash
koplik's spots

Question 6

What are koplik’s spots?

Answer 6

small, white, granular spots surrounded by red rings found inside the mouth–particularly on the inside of the cheek opposite the first and second molars

Question 7

Rubella AKA

Answer 7

3 day measles or german measles that can occur at any age

Question 8

Rubella s/sx

Answer 8

erythematous maculopapular rash
starts on face and spreads to extremities and trunk
gone in 72 hours
associated malaise
joint pain
postauricular and suboccipital lymphadenopathy

Question 9

What is one consideration to remember with rubella?

Answer 9

it is teratogenicity

Question 10

Roseola Infantum AKA

Answer 10

sixth disease in 6 months to 2 year olds (rare after 4 years)

Question 11

What causes roseola infants?

Answer 11

Herpesvirus 6

Question 12

What are the s/sx of roseola infantum?

Answer 12

URI symptoms
small pink, flat to raised bumps that start on trunk then move to extremities
High fever for 8 days with an abrupt end when rash develops
possible seizures associated with fever

Question 13

Erythema Infectiosum AKA

Answer 13

fifth disease in 5-14 years olds

Question 14

What causes erythema infectiosum?

Answer 14

human parvovirus B19

Question 15

What are the s/sx of erythema infectiosum?

Answer 15

slapped cheek appearance
lacy reticular exanthem
face then arms, legs, trunk and dorsum of hands/feet
rash can last up to 40 days–average of 1.5 weeks
can cause fatal aplastic crisis and arthralgias

Question 16

What are the laboratory tests to check for erythema infectiosum?

Answer 16

Parvovirus B19 IgM, IgG

Question 17

What are special considerations of erythema infectiosum?

Answer 17

patient education–intrauterine infection can produce fatal anemia
If a pregnant woman is exposed, may need immunoglobulin
Infectiosum erythema is not contagious once the fever breaks

Question 18

What is lyme disease?

Answer 18

Most common vector-borne disease in the US–mice and deer ticks are the major animal reservoirs, but birds may also be a source

Birrelia burgdorferi (spirochete)
Ticks must feed for more than 24 to 26 hours to transmit infecting organism

Question 19

What is stage 1 of lyme disease?

Answer 19

erythema migrants: a flat or slightly raised red lesion that expands over several days but has central clearing–most commonly appears in areas of tight clothing–looks like a target, concentric circles
50% of pts have flu like symptoms

Question 20

What is stage 2 of lyme disease?

Answer 20

Headache, stiff joints
migratory pains
cardiac symptoms--dysrhythmias, heart block
aseptic meningitis
bell's palsy 
peripheral neuropathy

Question 21

What is stage 3 of lyme disease?

Answer 21

joint and periarticular pain
subacute encephalopathy
acrodermatitis chronicum atrophicans: bluish red discoloration of the distal extremity with edema–localized DIC coagulation problem

Question 22

How do you screen/dx lyme disease?

Answer 22

detection of antibody to b. burgdorferi via ELISA screening
western blot assay is confirmatory
elevated ESR

Question 23

What are the diagnostic criteria of lyme disease?

Answer 23

Exposure to tick habitat within the last 30 days with:
erythema migrans or:
one late manifestation and:
laboratory confirmation

Question 24

How to manage lyme disease?

Answer 24

7 yrs old: doxycycline
refer for stage 2 and 3
let health dept know

Question 25

What is scabies?

Answer 25

skin infestation caused by a parasitic mite that burrows in startup corneum requiring spread through the direct or indirect contact with personal items

Question 26

Signs and symptoms of scabies

Answer 26

intense itching irritability in infants linear or curved burrows (snake like) infants: red-brown vesiculopapular lesions on head, neck, palms, or soles older children: red papillose on skin folds, umbilicus or abdomen may see regional adenopahty

Question 27

What is the management of scabies?

Answer 27

permethrin (nix) 5% rinse (1st treatment leave on for 8-14 hours), repeat in one week, OR: ivermectin (not used if mother is pregnant, lactating or for children under 15 kg) can give antihistamines for pruritus

Question 28

What is impetigo?

Answer 28

a bacterial infection of the skin typically caused by gram positive strep or staph (staph aureus) involves the face mostly, but can occur anywhere occurs most often in summer--very contagious

Question 29

S/sx of impetigo

Answer 29

signs of inflammation pain, swelling, warmth regional lymphadenopaty HONEY, CRUSTING LESIONS

Question 30

Treatment of impetigo

Answer 30

topical antimicrobials for minor infections (bacitracin, bactroban) Use the oral lactase resistant antibiotics when oral route is preferred: dicloxacillin, cephalexin, erythromycin (will treat staph and strep) severe cellulitis: IV antibiotics--vanco, nafcillin, doxycycline abstain from school and community until 48 hrs after treatment apply burrow's solution to clean lesions

Question 31

Psoraisis

Answer 31

inflammatory skin disorder based on genetic predisposition in which the epidermal turnover is reduced from 14 days to 2 days. Normal maturation of skin cells cannot take place, and keratinization is faulty and epidermis is thickened

Question 32

Signs and symptoms of psoraisis

Answer 32

can be asymptomatic itching possible lesions are red, sharply defined plaques with silvery scales scalp, elbows, knees, palms, soles, and nails are common sites fine pitting of the nails is strongly suggestive of psoriasis--as is separation of nail plate from bed pink or red line in intergluteal fold auspitz's sign

Question 33

What is auspitz's sign?

Answer 33

drops of blood appear when scales are removed in someone with psoraisis

Question 34

What is the treatment for psoriasis?

Answer 34

topicals for scalp: tar/salicyclic acid shampoo, topical steroid oil Topical steroids for skin: 2x/day for 2-3 weeks, resume with calcipotriene, a synthetic vit B3 derivative, betamethasone or triamcinolone Use UVB light and coal tar exposure if more than 30% of body surface is involved moisturizer

Question 35

What is pityriasis rosea?

Answer 35

mild, acute inflammatory disorder, which is self-limiting and can last 3-8 weeks more common in spring/fall and pts typically have a URI prior more common in females

Question 36

Signs and symptoms of pityriasis rosea?

Answer 36

possibly asymptomatic initial lesion (herald patch) is 2-10 cm--usually macular, oval, and fawn color with a crinkled appearance and collarette scale **if on palms of hand, genitals, or mouth--think syphilis pruritic rash in a christmas tree pattern may be found on turn and proximal extremities within 1-2 weeks--follows ripples on back

Question 37

Management of pityriasis rosea?

Answer 37

possibly check for syphillis if itching: ataraxic, oral antihistamines, topical antipuritic, cool compresses, topical steroids (triamcinolone) daily sunlight exposure will hasten healing--UVB x1 week oral erythromycin x2week is very effective

Question 38

Irritant dermatitis

Answer 38

diaper rash--peaks at 9-12 months

Question 39

Allergic contact dermatitis s/sx

Answer 39

redness, pruritus, scabbing tiny vesicles and weepy, encrusted lesions in acute phases scaling, erythema and thickened skin in chronic phase location will suggest cause affected areas hot and swollen history of exposure

Question 40

If severe allergic contact dermatitis what is the treatment

Answer 40

prednisone starting at 60 mg daily and tapering over 14 days

Question 41

Atopic dermatitis

Answer 41

Eczema--sensitive to low humidity and worse in winter when air is dry

Question 42

Signs and symptoms of atopic dermatitis

Answer 42

intense pruritis along face, neck, trunk, wrists, hands, antecubital, and popliteal folds dray scaly skin

Question 43

Diagnostics for eczema

Answer 43

RAST test--or skin tests whence may suggest dust mite allergy serum IgE eosinophilia may be present

Question 44

Management of eczema

Answer 44

hallmark treatment: moisturizing lotion immediately after bathing--must blot dry topical steroids applied 2-4x daily and rubbed in well systemic steroids in severe cases: prednisone 40 mg daily, taper over 5-7 days In acute weeping: use saline or aluminum sub acetate solution and colloidal oatmeal baths

Question 45

Molluscum Contagiosum

Answer 45

pink to flesh-colored discrete papules, which become umbilicated papillose with a cheesy core

Question 46

Varicella Zoster Virus

Answer 46

Chickenpox caused by herpes virus and transmitted by direct contact with lesions or airborne infected individuals are contagious for 48 hours before outbreak and until lesions have crusted over most common in ages 5-10

Question 47

S/sx of varicella zoster

Answer 47

``` erythematous merciless papules develop over merciless vesicles erupt--usually distributes initially on trunk, then scalp, then face intense pruritus low grade fever generalized lymphadenopathy ```

Question 48

Treatment for varicella zoster

Answer 48

calamine/caladryl lotion antihistamine acetaminophen Oral acyclovir 20 mg/kg x 5 days--given in first 24 hours can reduce the magnitude and duration

Question 49

Tinea capitus

Answer 49

fungal infection of scalp

Question 50

Tinea cruris

Answer 50

jock itch

Question 51

Tinea corporis

Answer 51

body ringworm

Question 52

Tinea manumm and tinea pedis

Answer 52

athlete's foot

Question 53

Tine versicolor

Answer 53

hypo/hyperpigmentation macules on limbs

Question 54

Fungal infection under a microscope

Answer 54

spaghetti and meatballs hyphae microscopically when treated with KOH

Question 55

Treatment of fungal infections

Answer 55

primary treatment: griseofulvin 20 mg/kg/day x 6 weeks topical typically work for tinea carpers For tinea versicolor: use selenium sulfide shampoo for 5-15 minutes daily x7 days; 200 mg itraconazle every day by mouth as an alternative

Question 56

What do you need to be worried about with antifungals?

Answer 56

liver function

Question 57

First degree burn

Answer 57

dry, red, no blisters involves epidermis only

Question 58

2nd degree burn

Answer 58

partial thickness, moist, blisters, extends beyond dermis

Question 59

3rd degree burn

Answer 59

full thickness--dry leathery, black, pearly, waxy, extends from epidermis to dermis to underlying tissues, fat, muscles, and or bone

Question 60

Rule of 9s for adult and child:

Answer 60

Adult: head, each arm: 9% genitals: 1% each leg, front, back: 18% Child: Head, front, back: 18% each arm: 9% each leg: 14%

Question 61

Macule

Answer 61

a flat discoloration

Question 62

Patch

Answer 62

a flat discoloration that looks as though it is a collection of multiple, tiny pigment changes; may be some subtle surface change

Question 63

Papule

Answer 63

a small (

Question 64

Nodule

Answer 64

an elevated, firm lesion >1 cm (big papule)

Question 65

Tumor

Answer 65

a firm, elevated lump

Question 66

Wheal

Answer 66

a lesion raised above the surface and extending a bit below the epidermis; many times an allergic reaction (either contact or systemic)

Question 67

Plague

Answer 67

a scaly, elevated lesion--classic lesion of psoriasis

Question 68

vesicle

Answer 68

a small (

Question 69

bulla

Answer 69

serous fluid-filled vesicles >1 cm

Question 70

pustule

Answer 70

a small (

Question 71

abscess

Answer 71

a pus-filled lesion (>1 cm)

Question 72

cyst

Answer 72

large, raised lesions filled with serous fluid, blood and pus

Question 73

solitary or discrete configuration

Answer 73

individual or distinct lesions that remain separate

Question 74

grouped configuration

Answer 74

linear cluster

Question 75

confluent configuration

Answer 75

lesions that run together

Question 76

linear configuration

Answer 76

scratch, streak, line or stripe

Question 77

annular configuration

Answer 77

circular, beginning in the center and spreading to the periphery

Question 78

polycyclic configuration

Answer 78

annular lesions merge

Question 79

Open comdeone

Answer 79

blackheads; opening in the skin capped with blackened mass of skin debris

Question 80

Closed comdeone

Answer 80

whiteheads; obstructed opening which may rupture, casing low-grade local inflammatory recation

Question 81

Pharmacologic mild acne treatment

Answer 81

topical treatment with benzoyl peroxide, if not responsive--retinoic acid cream (pregnancy category C) retinoin (only applied at night and not used concomitantly with benzoyl) salicylic acid preparations topical antibiotics (erythromycin or clindamycin)

Question 82

Pharmacologic treatment for moderate acne

Answer 82

systemic along with topical treatments: doxycycline (100 mg 2x daily) erythromycin (1 gram in 2 to 3 divided doses) minocycline (50-100 mg twice daily) **tetracycline: can damage enamel of teeth, so don't give before age 12)