Epidermis/Dermis Layers Flashcards
(191 cards)
1
Q
Most common agents in Tinea pedis
A
- Trichophyton mentagrophytes
- Trichophyton rubrum
- Epidermophyton floccosum
2
Q
Most common agent in Tinea manuum
A
- Trichophyton rubrum
- Trichophyton mentagrophytes
- Epidermophyton floccosum
3
Q
nails lose luster, become opaque/white, brittle, and have a crumbling consistency - commonly caused by?
A
White Superficial Onychomycosis (Leukonychia mycotica) is commonly caused by T. rubrum and T. metagrophytes
4
Q
Most common agent in Tinea cruris
A
- Epidermophyton floccosum
- Trichophyton mentagrophytes
- Trichophyton rubrum
5
Q
Most common agent in Tinea unguium
A
T. rubrum and T. metagrophytes
6
Q
Most common fungal nail infection; nail thickens and often discolors
A
Distal Subungual Onychomycosis
7
Q
Most common fungal nail infection in HIV pts; begins in nail fold
A
Proximal Subungual Onychomycosis
8
Q
Nails hardened, thickened, brownish-green discoloration, w/ striated ridges or grooves; generally w/ cuticle involvement w/ or w/o pus
A
Paronychial or Onychomycotic Candidosis: AKA onychomycosis caused by Candida albicans
9
Q
“weeping” or “scaled skin” lesion
A
Intertriginous Candidosis
10
Q
Nonspecific febrile illness followed by rash w/ “slapped cheek” appearance
A
Erythema Infectiosum/Fifth Disease caused by HPV B19
11
Q
HPV B19 - describe the genome and virus
A
ssDNA, non-enveloped virus w/ 1 serotype
12
Q
socks and gloves maculopapular rash
A
Erythema Infectiosum/Fifth Disease caused by HPV B19
13
Q
bone marrow biopsy reveals: presence of large pink or lilac colored inclusions in giant pronormoblasts
A
HPV B19 infection
14
Q
HHV-6 uses __________ as a cellular receptor
A
CD46 - found on ALL human nucleated cells
15
Q
Measles virus - describe the genome and virus
A
ssRNA, enveloped w/ 1 serotype
16
Q
Which virus causes Giant cell formation
A
Measles virus
17
Q
Complication of HPV B19
A
Aplastic Crisis
18
Q
Rash and Fever
A
Measles
19
Q
Measles rash is due to
A
immune system - T cell (HLA I and II on endothelial cells)
20
Q
Describe a “Morbilliform rash” and what disease it exists with
A
symmetrical, non-pruritic, bright red maculopapular rash; Measles
21
Q
Describe the rash appearance and disappearance with Measles
A
Begins on face and descends, ~1-2days later rash rapidly fades from top to bottom by fine briny desquamation
22
Q
Giant Cell Pneumonia
A
Measles
23
Q
Describe the genome and virus of VZV
A
Alpha herpesvirus: large, dsDNA virus, enveloped, encodes its own thymidine kinase w/ 1 serotype
24
Q
VZV travels down nerves via
A
reverse axoplasmic flow
25
Primary infection with VZV, viral replication occurs
URT -> lymph nodes -> lymphoid tissue, liver, spleen, etc
26
Exfoliatin exotoxin mechanism
glutamate specific serine proteases highly specific to the cadherin desmoglein I
27
Exfoliatin exotoxin is produced by
Staph aureus
28
Exfoliatin exotoxin may cause
Bullous impetigo, SSSS, Ritter's disease
29
dsDNA virus that replicates in the nucleus
Herpes
30
dsDNA virus that replicates in the cytoplasm
Variola major (Orthopox)
31
Candida pathogenic form
yeast, pseudohyphae, and hyphae
32
Risk Factors for Cutaneous Candidiasis
Female, young/old, diabetes, obesity (skin folds), pregnancy
33
Intertriginous Candidosis lesions
“weeping” or “scaled skin - Pruritic, erythematous w/ macerated edges
34
Paronychial or Onychomycotic Candidosis lesions
Chronic - Nails hardened, thickened, brownish-green discoloration, w/ striated ridges or grooves
35
Culture Candida on?
Sabouraud-Glucose agar
36
Definitive diagnosis for Candida?
Germ Tube Test
37
Cutaneous Candidosis Treatment
1% Crystal Violet
38
Paronychial Candidosis Treatment
Nystatin, Amphotericin B, Ketoconazole
39
HPV B19 has a predilection for
bone marrow and erythrocyte precursors
40
Is HPV B19 present in the rash?
No - immune-mediated
41
Biphasic course of HPV B19 is
-initial phase/prodrome caused by viremia at day8
FEVER BREAKS...
- Immune-mediated Rash (face->limbs/trunk->palms/soles)
42
Rash of Erythema Infectiosum is due to
Type III HSN rxn
43
Prodrome of Erythema Infectiosum begins on Day __ and lasts _____
Day 8 and lasts 2-3 days
44
Describe the course of the rash with Erythema Infectiosum
FEVER BREAKS....initially on the face as “slapped cheek” appearance w/ relative circumoral (around the mouth) sparing. Maculopapular rash may appear later on limbs, trunk, palms and soles (socks and gloves)... lasts 2-3 days
45
Does anything make the rash of Erythema Infectiosum worse?
exacerbated by exercise, emotion, hot baths, sunlight
46
Typical pt w/ Erythema Infectiosum
Late winter, early spring, endemic in 4-15 y/o, school or daycare outbreak
47
Erythema Infectiosum In Seronegative Adults causes
Prodrome: flu-like symptoms lasting 3-4 days
| symmetric polyarthralgia of the hands and wrists, occasionally ankles and knees for 2-3 weeks
48
Erythema Infectiosum exposure in Pregnant female...
Treat w/ IVIG to prevent abortion
49
Complication of Erythema Infectiosum
Aplastic crisis (esp in anemic pts) for 7-10d
50
Immunity in Erythema Infectiosum
Humoral - Type III HSN
51
For Erythema Infectiosum, Bone marrow biopsy would reveal
large pink or lilac colored inclusions in giant pronormoblasts and absence of erythroid progenitor cells
52
Treatment for Erythema Infectiosum
Supportive – antipyretics, analgesics, NSAIDs
| IVIG for immunocompromised/pregnant females
53
How does HHV-6 enter cells?
uses CD46 as a cellular receptor, glycoprotein expressed on the surface of all human nucleated cells
54
Clinically important serotype of HHV in Exanthem Subitum?
HHV-6B
55
HHV-6 - Life-long, active infection in
Salivary glands
56
HHV-6 - Persistent, latent infection in
macrophages and monocytes
57
Exanthem Subitum is biphasic, describe
Initial prodrome w/ HIGH fever
FEVER BREAKS...
Immune-mediated rash
58
Typical Patient w/ Exanthem Subitum
6mo - 3yrs
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The prodrome of Exanthem Subitum begins ____ and lasts _____
4-7 days after exposure; lasts 4-6 days; characterized by HIGH fever
60
Exanthem Subitum Sx In Adults
Mononucleosis-like Sx: Fever, pharyngitis, cervical lymphadenopathy
61
Diagnosis of Exanthem Subitum
EIA IgM, but it cross-reacts w/ CMV
62
Treatment for Exanthem Subitum
Supportive
63
Measles virus initially replicates in
URT and draining lymph nodes
64
Measles in primarily controlled by what type of immunity
CMI
65
Is the rash of Measles infectious?
Yes
66
How does Measles cause malnutrition?
Desquamation of epithelium - GIT -> bloody diarrhea
67
Communicability of Measles?
Begins at prodrome and lasts until 4-5 after rash onset
68
Typical patient with Measles?
Winter/spring, nonvaccinated, 5-9
69
INcubation period of Measles
10-12 days
70
Prodromal Sx of Measles
High fever, coryza, conjunctivitis, brassy cough, cervical LAD, Koplik spots (secondary viremia)
71
Describe the rash of Measles
Fever and prodrome continue w/ rash appearance
| “Morbilliform rash” symmetrical, non-pruritic, bright red maculopapular rash on face, confluent and descends to LE
72
Measles Rash clears by
desquamation from head --> toe
73
Atypical Measles patient population
people vaccinated b/w 1963-1967 w/ killed vaccine - vesicular and purpuric and starts on limbs
74
Complications of Measles
Otitis Media, Primary Viral Giant Cell Pneumonia, Diarrhea, encephalitis, Subacute Sclerosing Panencephalitis
75
Subacute Sclerosing Panencephalitis is caused by
defective measles virus
76
Subacute Sclerosing Panencephalitis is a condition where
fatal, slowly progressive, inflammatory, demyelinating disease of the CNS
77
Congenital Measles results in
stillbirth or fetal malformation
78
Lab diagnosis of Measles
giant cell formation, FAT
79
Treatment for Measles
Supportive, Vitamin A, Gamma globulin (IgG) for immunocompromised or unvaccinated pts w/in 6 days of exposure
80
MMR live attenuated vaccine is administered
o Dose 1: 15-18 mo
| o Dose 2: 4-6 years or 11-13 years
81
lymph node enlargement (postauricular, suboccipital, and cervical) indicates
Rubella, German Measles, 3-day Measles
82
Forschheimer Spots
enanthem, small red spots on soft palate associated w/ Rubella
83
Incubation period for Rubella
14-21 days
84
Communicability of Rubella begins and lasts?
Begins 5 days before rash and 5 days after appearance of rash
85
Typical Rubella patient
Unvaccinated, older child/adolescent, winter/spring
86
Describe the prodrome of Rubella
Minimal or Absent (low fever, lymph node enlargement)
87
Describe the rash of Rubella
Discrete pink-red maculopapular rash lasting 3-5 days, initially on face -> trunk -> extremities; Forschheimer spots on soft palate
88
Congenital Rubella Syndrome
first trimester -> teratogenic effects -> abortion
| If survival -> isolate due to prolonged shedding, PDA, cataracts, hearing loss, CNS; recommend abortion
89
Diagnosis for Congenital Rubella Syndrome is made by
STORCH - IgM in cord blood
90
Treatment for Rubella
Supportive
91
Post-exposre prophylaxis for pregnant female refusing abortion
IG w/in 72hr of exposure
92
Scarlet fever is caused by
S. pyogenes, beta-hemolytic, lysogenized w/ a phage producing exotoxin, catalase negative
93
Scarlet fever is mediated by S. pyogenes
SPE exotoxin - superantigen
94
Virulence factors of S. progenes of Scarlet fever
M protein - antiphagocytic
| SPE exotoxin
95
Scarlet fever is preceded by
pharyngitis or impetigo
96
Scarlet fever Sx
o Enanthem: hyperemia of the entire pharynx w/ petechial lesions; white strawberry -> red strawberry -> raspberry tongue
o Exanthem: diffuse macular erythroderma -> blanching scarlitiniform rash: fine, red, punctate, “sandpaper” like rash spreads from trunk -> periphery
97
Pastia Lines
Scarlet Fever - petechiae in skin folds
98
Scarlet Fever rash resolves by
desquamation 1-2 weeks after onset
99
Fever and rash in summer/fall
Non-polio enterovirus
100
Kaposi Sarcoma agent
HHV-8
101
Site of latency for HHV-8
B cells
102
Risk Factors for Kaposi Sarcoma
>60, Male, Mediterranean and Middle Eastern descent, AIDS
103
Kaposi Sarcoma lesions
Bluish-red or purple bumps (tumors) on the skin
104
Treatment for Kaposi Sarcoma
Surgical excision, Radiation, Chemotherapy
105
Describe the VZV genome
dsDNA virus, enveloped, encodes its own thymidine kinase w/ 1 serotype
106
Latency of VZV occurs in
DRG or CN (CNV ganglia) after primary infection
107
Communicability of VZV
Person is infectious 1-2d before rash and 4-5d after; once scabbed over, pt is no longer infectious
108
Incubation period of VZV
14-16days
109
Describe the prodrome of VZV
absent in young, 1-2days before rash in older
110
Describe rash of VZV varicella
mild-high fever, fatigue, anorexia, HA, n/v, rash, centripetal pattern: more severe on head/trunk, thin-walled vesicle on a maculopapular base
111
Describe the stages of VZV varicella
All stages seen bc new lesions appear each time the fever spikes 3-6d: vesicular, pustular, crusted, and scab
112
Adult varicella infection typically has 1 or more:
Interstitial pneumonia, hepatitis, meningoencephalitis, thrombocytopenia
113
Neonatal Varicella lesion
hemorrhagic lesion -> fatal
114
Zoster Sx
Initially, tingling or pin-prick sensation
| Followed by severe pain in dermatome
115
Complications of Zoster
Opthalmic zoster or zoster oticus (Emerg)
| Postherpetic Neuralgia, Facial palsy, Ramsey-Hunt Syndrome
116
Lab Findings of VZV
Multinucleated giant cells w/ Cowdry type A
117
Treatment of VZV
Supportive
118
Treatment of VZV in Immunocompromised/Pregnant:
VZIG w/in 3-4 days
119
Anergy occurs with
Measles and MMR vaccine
120
Child vaccine for VZV
Varivax
121
Adult vaccine for VZV Zoster
Zostavax
122
Treatment for Zoster
acyclovir, famciclovir, valacyclovir given w/in 3 days of onset of rash
123
Treatment for Postherpetic Neuralgia
Nortiptyline, Lidocain, Gabapentin, Opioid, Acyclovir
124
Exfoliatin Exotoxin is produced by
S. aureus + phage
125
Exfoliatin Exotoxin causes which diseases
Bullous impetigo, SSSS, Ritter's Disease
126
Exfoliatin Exotoxin mechanism
glutamate specific serine proteases highly specific to the cadherin desmoglein I: adhesion protein is the desmosomes of the stratum granulosum
127
Clefts form in which layers in bullous impetigo
cleft formation b/w the stratum corneum and spinosum
128
Bullous impetigo lesions
flaccid, paper-thin, white, serous fluid-filled sacks that rupture -> painful, moist, denuded erythematous lesions that dry in 1-2d the thin ”varnish-like” light-brown crusted lesions
129
Is organism present in Bullous impetigo lesions?
Yes
130
SSSS
Single, focal infection -> hematogenous dissemination of EXOTOXIN -> fever and sterile bullae
131
SSSS lesions
Widespread, diffuse (scarlitiniform rash) that progresses in 1-3 days to extensive size, w/ spontaneous exfoliation of skin; w/in 5 days desquamation of total body
132
Nikolsy Sign is positive in
SSSS
133
Diagnosis of bullous impetigo and SSSS
CIE or gel diffusion assay for elevated anti-teichoic acid Ab’s
134
Treatment for bullous impetigo
Mupirocin
135
Treatment for SSSS
Cephalosporin
136
Black piedra agent
piedra hortai
137
White piedra agent
Trichosporon beigelii
138
White piedra Sx
white nodules on the hair shaft
139
Black piedra Sx
brown/black collar around the hair shaft; decreases hair luster and shine
140
Treatment for White or Black Piedra
Cut/Shave hair, oral azole antifungals
141
Tinea capitis etiologic agents
1. Microsporum
| 2. Trichophyton
142
Microsporum
Ectothrix
143
Trichophyton
Endothrix
144
In the US, Tinea capitis is caused primarily by
Microsporum audouinii and M. canis
145
Tinea capitis due to Microsporum Sx
itchy, scaly, papules on scalp
| Hair becomes dull and brittle breaking off 3-4mm above the scalp
146
Tinea capitis due to Trichophyton Sx
Hair breaks off at scalp "black dot"
147
Tinea capitis common Sx
scalp scaling, scalp pruritis, occipital LAD, patchy or diffuse alopecia
148
Diagnosis of Tinea Capitis
Wood’s Lamp: Microsporum – ectothrix fluorescence
149
P. acnes
GPR, non-motile, obligate anaerobic, diptheroid/pleomorphic rod (lacks catalase)
150
Virulence Factors of P. acnes
Extracellular Lipase
151
Inflammatory acne due to P. acnes infection
Inflammatory mediators: fatty acids resulting from microbial lipase breakdown of sebaceous gland products
152
Treatment for Inflammatory acne due to P. acnes infection
Salicyclic Acid, Retinoid Acid, Azelaic Acid: antikeratinizing and decreased sebum production; Antibiotics, Benzoyl Peroxide
153
Impetigo etiologic agents
S. aureus and S. pyogenes
154
Impetigo lesions
Thickened honey-colored adhesive crust, purulent discharge on top of lesions resolves in a couple weeks w/o scarring
155
Impetigo Treatment
Retapamulin: topical abx for MRSA
Mupirocin: topical abx
156
Tinea favosa etiologic agent
Trichophyton schoenleinii
157
Tinea favosa lesions
Formation of yellow crusts w/in the hair follicles (scutula) and cicatricial alopecia and scarring, w/ Mousey or cheesy odor present
158
Tinea favosa
Chronic mycotic infection of the scalp or glaborous skin
159
Tinea favosa Treatment
Oral antifungals
160
Hot tub folliculitis agent
P. aeruginosa
161
Refractory folliculitis agent
Malassezia furfur
162
Folliculitis agent
S. aureus
163
Tinea barbae agents
T. rubrum (anthropophilic)
T. mentagrophytes (zoophilic)
T. verrucosum (zoophilic)
164
Hair removal is ___________ in tinea barbae, but _________ in bacterial infections
painless; painful
165
Foruncle and carbuncle agent
S. aureus
166
Foruncle lesion
boil/deep folliculitis are firm, painful, tender, discrete, red nodules
167
Carbuncle lesion
several hair follicles, lesion is larger, deeper, indurated, erythematous, edematous, painful + SYSTEMIC SIGNS
168
Treatment of Foruncle and carbuncle
Moist heat, incision/drainage
169
Ecthyma common etiologic agent
S. pyogenes
170
Ecthyma
nonbullous impetigo extending into dermis
171
Ecthyma lesions
“punched out” ulcers w/ greenish-yellow crust and violaceous margin; scarring
172
largest, dsDNA, replicates in cytoplasm of infected cell
Smallpox
173
Smallpox incubation period
7-17days
174
Prodrome of Smallpox Sx include
high fever (104 F) w/ chills, severe HA, back pain, delirium, prostration for 2-4 day
175
Rash of Smallpox
Enanthem -> Exanthem on face -> extremities
| Macules -> Papules -> Vesicles -> Pustules (umbilicate) -> Scabs (SAME SATGE)
176
Smallpox Rash lasts
8 – 13 days before scabbing occurs
177
Guarnieri bodies:
Smallpox - eosinophilic intracytoplasmic inclusions on smears or biopsies
178
Diagnosis of Smallpox
CALL CDC
179
Treatment of Smallpox
Cidofovir: nucleoside phosphonate - DNA polymerase inhibitor
180
Smallpox lesions are located in what layer
deep dermis
181
Normal reaction to Dryvax Vaccinia for Smallpox
pustular lesion at the injection site leaving a depigmented scar, flu-like Sx, regional LAD, satellite lesions
182
Erysipelas agent
S. pyogenes
183
Ersipelas location of infection
extremities (leg, feet) and face (cheeks, bridge of nose “butterfly” distribution)
184
Recurrent erysipelas due to
lymphatic obstruction
185
Ersipelas lesion
Burning, itching at site of infection w/ rapid spread (minutes/hours) -> bright red erythema
SHARPLY DEMARCATED
186
Erysipelas
Involves the upper dermis and superficial lymphatics - lymphatic tracking
187
Cellulitis lesion
Systemic S/S: fever, chills, malaise, leukocytosis
| Inflammation: pain, erythema, edema, warmth, Rapidly advancing edge +/- elevation, Diffuse, NOT sharply demarcated
188
Subcutaneous tissues palpation in Cellulitis
can be palpated
189
Diagnosis of cellulitis
Xray, CT, MRI for gas presence
190
Treatment for cellulitis
Cefazolin-probenecid, Nafcillin, Ceftriaxone, Clindamycin
| MRSA: Vancomycin, Linezolid, Daptomycin
191
Treatment for complicated cellulitis
Levofloxacin
