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KChan Saves the World > KC Immunology > Flashcards

KC Immunology Flashcards

1
Q

*Ddx fever and arthralgias (5)

A

Lyme disease
Acute rheumatic fever
Viral arthralgias
Reactive arthritis
Rubella
Disseminated gonococcal infection

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2
Q

*Treatment for disseminated gonococcal infection

A

IV ceftriaxone 1 g every 24 hours plus a single dose of oral azithromycin 1g, step down to oral after 48h.

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3
Q

*5 risk factors for DGI

A

Female
Pregnancy
Menstruation
Complement deficiency
Immunocompromise
High risk sexual behaviours

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4
Q

*Arthritis guy 34 male joint pain and muscle pain 1 month. previously healthy. Four things on differential

A

Lyme disease
Acute rheumatic fever
Viral arthralgias (HIV, Hep B/C, Rubella, Parvo b19)
Reactive arthritis
Disseminated gonococcal infection

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5
Q

*Arthritis guy 34 male joint pain and muscle pain 1 month. previously healthy. 3 investigations other than arthrocentesis results that could help confirm or make the diagnosis

A

ESR/CRP
Serology
Blood Cx

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6
Q

*Old lady with 2 days knee pain XR with cloudy knee. Likely Dx and most specific finding on tap?

A

Pseudogout/CPPD, crystals on tap

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7
Q

*5 causes of acute mono-arthritis.

A
  • Septic arthritis
  • Viral arthritis (e.g. HIV, rubella, parvovirus, hepatitis)
  • Gout
  • Pseudogout
  • Osteoarthritis
  • Soft tissue injury/trauma
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8
Q

*What is the classic triad of reactive arthritis

A
  • Arthritis
  • Conjunctivitis
  • Urethritis

Can’t see can’t pee and you have a sore knee = reactive arthritis

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9
Q

*2 bugs in each patient group/risk factor type (bacterial septic joint)
○ Neonate (0-1year)
○ Children
○ Adolescent
○ >65
○ Sickle cell disease:
○ IVDU

A

○ Neonate (0-1year) -GBS, Staph A, GNR
○ Children – SA, H flu
○ Adolescent – SA, GC, NG
○ >65 - Staph A, GNR
○ Sickle cell disease: Salmonella, MRSA
○ IVDU – Pseudom, Staph A, GNR , MRSA

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10
Q

*What are five bugs that cause reactive arthritis.

A

CCYSS
1. Campylobacter
2. Chlamydia
3. Yersinia
4. Shigella
5. Salmonella

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11
Q

List 10 systemic symptoms associated with arthritis

A

Airway: TMJ dysfunction, atlanto-axial instability
Breathing: pulmonary hypertension, pulmonary fibrosis (RA)
Cardiac: arrhythmias (RA), pericarditis (RA, rheumatic fever), aortic root abnormalities (RA, ank spond)
Neurologic: cauda equina (ank spond), conjunctivitis (reactive arthritis), uveitis (spondyloarthropathies)
Renal: acute kidney failure (scleroderma), genital lesions (reactive arthritis, gonococcal arthritis)
Heme: aplastic anemia, anemia of chronic disease
Derm: plaques (psoriasis), sclerodactyly (scleroderma), erythema migrans (lyme), tophi (gout), erythema marginatum (rheumatic fever), nodules (rheumatoid arthritis)

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12
Q

Compare the clinical presentation of osteoarthritis vs rheumatoid arthritis

A

Osteo: joint pain worsens with activities and improves with rest, worse later in the day, systemically well, DIP involvement (Heberden)
Rheumatoid: joint pain improves with activity, morning stiffness, systemic symptoms, PIP involvement (Swan neck, Boutonniere’s)

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13
Q

List 4 seropositive and 4 seronegative inflammatory arthropathies

A

Positive: rheumatoid, lupus, scleroderma, dermatomyositis
Negative: ank spond, psoriatic, reactive, enteropathic (IBD related), PMR

PPRAN(enk)

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14
Q

List 4 x ray findings of arthritis

A

Joint space narrowing, subchondral sclerosis, subchondral cyst, osteophytes

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15
Q

What is the clinical and x ray finding of ankylosing spondylitis

A

Inflammatory arthritis involving the sacroiliac joints, vertebrae and enthesitis (where ligament attaches to bone). Typically younger patients. Sx improve with exercise. May be associated with uveitis, aortic root disease
X ray shows sacroiliitis and bamboo spine (squaring of VB margins)

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16
Q

List 5 clinical findings is psoriatic arthritis

A

Arthritis (often asymmetric) + Psoriasis (silvery plaques, nail involvement) +/- conjunctivitis, aortic insufficiency, dactylitis, nail pitting

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17
Q

List 5 tests that you would order on synovial fluid

A

gram stain, culture, cell count (WBC count), crystals, glucose, protein, lactate

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18
Q

How would you diagnose a septic joint on synovial fluid analysis

A

Bacterial culture
Gram stain only 30-60% positive
WBC >50,000 suggests septic arthritis but a lower value cannot rule it out

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19
Q

Describe how you would landmark an arthrocentesis for: wrist, elbow, shoulder, hip, knee, ankle

A

see photo

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20
Q

List 5 ddx for monoarticular sore joint

A

Osteoarthritis, rheumatoid arthritis
Gout, septic joint, pseudogout (calcium crystals)
Lyme, reactive arthritis, viral arthritis
Trauma

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21
Q

List 5 risk factors for septic arthritis

A

age >80, diabetes, chronic arthritis, recent intra articular corticosteroid inject, prosthetic implants

low SES, injection drug use, alcoholism, HIV, skin infection

Two main categories - older with fake hip and young with a drug problem

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22
Q

What is reactive arthritis

A

sterile secondary inflammation of a joint with no infecting microorganisms in the synovial fluid

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23
Q

List the bacterial associated with septic arthritis in each of the following age groups: infant, children, adolescents, older adults, sickle cell anemia, IVDU

A

see photo

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24
Q

What is the Kocher criteria

A

fever, non weight bearing, ESR >40, WBC >12

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25
Q

What joint is most commonly affected by septic arthritis

A

Knee 50%, hip 25%, shoulder 15%

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26
Q

List 5 complications of septic arthritis

A

cartilage destruction, arthritis, growth impairment in children, sinus tracts, avascular necrosis, sepsis, bacteremia

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27
Q

List 10 risk factors for the development of gout

A

Metabolic: HTN, DM, obesity
Dietary: EtOH, meat/seafood, legumes, soft drinks; dairy/coffee protective
Meds:thiazide diuretic, cyclosporine, radiocontrast exposure, lead
Stressor: illness, trauma, surgery

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28
Q

What is the appearance of gout crystal on synovial fluid

A

needle shape and blue
MoNosidum urate crystals = gout; Needle shape, normal gout

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29
Q

What is the appearance of pseudogout crystal on synovial fluid

A

calcium crystals will be yellow and rhomboid
Calcium pyrophosphate crystals = Pseudogout

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30
Q

List 3 medications for the treatment of gout. What one treatment should be avoided

A

NSAIDs
Colchicine
Steroids
Avoid allopurinol

Why avoid allopurinol? A purine analog that inhibits xanthine oxidase, resulting in a decrease in synthesis of uric acid - takes several weeks to achieve steady state and reduce attacks - dont give it in acute process can cause smaller crystals to percipitate out and cause an attack

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31
Q

What X ray finding is associated with calcium crystals/pseudogout

A

Chondrocalcinosis: linear densities within the articular cartilage or joint capsules

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32
Q

List 5 asymmetric and 5 symmetric etiologies for polyarticular joint pains

A

Asymmetric = infectious; symmetric = inflammatory
- Asymmetric: reactive arthritis, Lyme disease, gonococcal, rheumatic fever, viral arthritis
- Symmetric: inflammatory (rheumatoid, psoriatic, polymyalgia rheumatic, ankylosing spondylitis), drug-induced

Paper and gravol

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33
Q

What is the Jones criteria for rheumatic fever

A

Jones criteria (two major or one major and two minor) + prior Group A strep
Major: JONES criteria: joint arthralgias, O carditis (murmur, CHF, pericarditis), nodules, erythema marginatum, Sydenham chorea
Minor: arthralgia, fever, elevated CRP, long PR
Strep infection: +ve culture, +ve rapid strep antigen, elevated ASO titre (rise 1-3 weeks after infection, falls after 6 months)

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34
Q

What are physical exam techniques to differentiate tendinitis and bursitis from arthritis

A

o Location of pain
o Pain throughout all ranges of motion
o Tendinitis: localized, no uniform swelling, certain movements cause pain with contraction or passive movement.
o Bursitis: Passive ROM not pain except for when bursa is compressed in extreme flexion,
o Diminished joint ROM- concern for septic arthritis

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35
Q

List 3 provocative test that can suggest impingement syndrome

A

Neer, Hawkins Kennedy, empty can

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36
Q

List 5 potential sites for tendinopathy

A

rotator cuff, bicipital tendinopathy, tennis elbow (extensor tendons), de Quervain’s (extensor pollicus brevis and abductor pollicis longus), wrist (flexor carpi ulnaris), Achilles tendon

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37
Q

List 5 common sites of bursitis

A

olecranon, femur, prepatellar, subacromial, trochanteric, ischiogluteal, iliopsoas, pes anserine

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38
Q

List 5 etiologies of nonpeptic arthritis

A

Idiopathic
Overuse injury, traumatic Rheumatologic: gout, pseudogout, ankylosing spondylitis, rheumatoid arthritis

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39
Q

List 4 findings on synovial fluid aspiration that suggest septic bursitis

A

Septic if: purulent fluid, fluid to serum glucose ratio <50%, +ve gram stain, +ve culture, WBC >5000 from aspirate

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40
Q

*What are 4 exam findings in GCA?

A

Fever
Jaw claudication
Tender temporal artery
Monocular vision loss
“The presence of tenderness, prominence, or beading of the superficial temporal artery on physical examination is associated with GCA”

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41
Q

*What are 2 large vessel vasculitides?

A

GCA
Takayasu

Giant in the name, G and T

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42
Q

*What are 3 different modalities used to assess for GCA?

A

CRP
Temporal artery biopsy
Doppler US *controversial
MRI

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43
Q

*What medication and STARTING dose do you give to treat GCA?

A

oral prednisone 60 to 100 mg daily
Switch to IV if visual symptoms

toci recently been approved

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44
Q

*What are 4 clinical findings of Behçet’s Disease?

A

The triad of recurrent oral aphthous ulcers, genital ulcers, and uveitis in young adults is highly suggestive of Behçet’s disease.
Erythema nodosum
Pyoderma gangrenosum
Iritis
Optic neuritis
Neuro-Behcet’s
Increased ICP
Inflammatory oligoarthritis

Can not have sex

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45
Q

*What are 4 non-pharmacologic causes of cutaneous vasculitis?

A

Erythema Nodosum
HSP
Polyarteritis Nodosa
Behcet’s

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46
Q

What is the diagnostic criteria for lupus

A

Clinical: cutaneous (ex. Malar, discoid rash), oral ulcers, non-scarring alopecia, synovitis, serositis, renal disorders, neurologic disorders, hemolytic anemia and thrombocytopenia, lupus enteritis
immunologic: ANA +ve, Anti-dsnDNA +ve, Anti-Sm, anti-Ro +ve, antiphospholipid antibody reduced C3 and C4

4 criteria has to be met from the above, at least 1 clinical and 1 immunological

SOAP BRAIN BD: Serositis, oral ulcers, arthritis, photosensitivity and pulmonary fibrosis, blood cells (pancytopenia), renal/Raynaud’s, ANA+, immunologic (anti Sm, anti dsDNA), neuropsych, malar rash, discoid rash

47
Q

List 10 signs and symptoms of lupus

A

Nephritis: can cause either a nephrotic or nephritic syndrome; low threshold to screen
Neuropsychiatric: headache, seizures, confusion, sinus thrombosis (lupus often associated with APS)
Cardiac
- Pericardial disease: effusions can be treated with high dose glucocorticoids (1-2mg/kg of methylprednisone)
- CAD: higher incidence in SLE patients - 52x increases in women
- Mitral valve insufficiency: due to non infectious vegetations (Libman-Sacks)
Resp
- PE: higher incidence in SLE patients- 6x, especially those with APS
- Pleuritis: most common resp issue, pleuritic pain ± effusion
- Pneumonia from immunosuppression
CAD: higher incidence in SLE patients - 52x increases in women
Mitral valve insufficiency: due to non infectious vegetations (Libman-Sacks)
Rash: butterfly malar rash must spare the nasolabial fold, discoid rash that have circular, scaly rashes that often destroy cartilage on the scalp, ears
Arthritis: symmetric and nonerosive (unlike RA) and may involve multiple joints
GI: lupus enteritis, oral ulcerations

48
Q

List 5 drugs that can cause drug induced lupus

A

hydralazine, procainamide, methyldopa, chlorpromazine, isoniazid, quinidine, minocycline

CHIMP Z not C

HPI ZM

49
Q

List 5 presentations associated with antiphospholipid antibody syndrome

A

PE, ischemia, venous thrombosis, arterial thrombosis (stroke), ACS, avascular necrosis of the bone, miscarriages, livedo reticularis, thrombocytopenia

50
Q

List 5 abnormal lab findings associated with antiphospholipid syndrome

A

Prolonged aPTT (with normal INR and PT), falsely positive VDRL
Positive screen for anti-cardiolipin Ab, lupus anticoagulant Ab, IgG, IgM

51
Q

List 2 ANCA associated vasculitis

A

granulomatosis with polyangiitis Wegener’s , eosinophilic-granulomatosis with polyangiitis ex. Chug-Strauss, microscopic polyangiitis

52
Q

List 3 medium sized vasculitides

A

Polyarteritis nodosa, Burger’s disease, Kawasaki disease

53
Q

List 4 small sized vasculitides

A

Goodpasture’s, granulomatosis with polyangiitis, (Wegener), microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss disease), Behcet’s disease, HSP

54
Q

What is the clinical presentation of microscopic polyangiitis

A

Pulmonary/renal syndrome with rapidly progressing renal failure and pulmonary hemorrhage
Similar to Wegner’s

55
Q

What is the clinical presentation of granulomatosis with polyangiitis (Wegener’s)

A

Renal + pulmonary involvement esp. with ENT disease (otitis media, heading loss, sinusitis, epistaxis etc)
Risk of difficult airway due to subglottic stenosis and pulmonary hemorrhage

56
Q

What is the clinical presentation of Goodpasture’s syndrome

A

Glomerular nephritis, pulmonary hemorrhage and GBM antibodies

57
Q

What is the clinical presentation of Goodpasture’s syndrome

A

Vasculitis with asthma and high eosinophils

58
Q

What is the clinical presentation of Bechet’s

A

Aphthous ulcers + 2 of: genital lesions, cutaneous lesion, neurological, oral or rheum manifestation, uveitis/iritis

59
Q

List 3 vasculitides with cutaneous manifestations

A

Erythema nodosum, HSP, polyarteritis nodosa, Behcet’s disease,

60
Q

What is the clinical presentation of polyarteritis nodosa

A

Cutaneous lesion + new onset HTN
- Livedo reticularis (mottled rash), erythema nodosum (tender nodules on the knees), Raynaud’s, digital infarcts, ulcers, palpable purpura, splinter hemorrhages

61
Q

What is the clinical presentation of Buerger’s disease

A

1) history of smoking 2) onset before age of 50 3) infrapopliteal arterial occlusive lesions 4) upper limb involvement 5) absence of other atherosclerotic risk factors
Sx include claudication, painful nodules, and gangrene esp. in young asian males who smoke

62
Q

What is the diagnostic criteria for GCA

A

Age >50
ESR >50 (CRP >10)
At least one of cranial sx (HA, scalp tenderness, jaw claudication, vision loss) or signs of PMR (shoulder, hip, or girdle pain; associated with PMR in 50% of cases)
- RAPD increases likelihood of GCA
At least one of biopsy of GCA, evidence of large vessel vasculitis by MRA or CTA, or PET

63
Q

What is the clinical presentation for Takayasu

A

Claudication, reduced or absent pulse, bruit, hypertension, asymmetric BPs
Chronic vasculitis in young women esp. Asians

64
Q

List 5 triggers for erythema nodosum

A

Infectious: viral URTI, strep infections, TB, sarcoidosis
Drugs: penicillins, sulfa, OCPs, phenytoin
Autoimmune: IBD, SLE

65
Q

List 4 triggers for serum sickness

A

Foreign protein (ex. blood), penicillins, sulfa drugs, NSAIDs, phenytoin

66
Q

What is the difference between serum sickness and hypersensitivity vasculitis

A

Serum sickness manifestation include skin + joint + heart + kidney
Hypersensitivity vasculitis is ONLY SKIN

67
Q

*Stem is guy who presents with sepsis, intubated, gets abx, has anaphylaxis. 3 first steps:

A

Stop medications
IM epinephrine
Fluid resuscitation

68
Q

*Table with epi effects – 2 effects of alpha, 2 of beta 1 and 2 of beta 2

A

Alpha 1 -adrenergic stimulation increases vasoconstriction, increases peripheral vascular resistance, and decreases mucosal edema.
Through beta 1 -adrenergic stimulation, inotropic and chronotropic cardiac activity is enhanced.
Beta 2 -adrenergic stimulation also provides stabilization of mast cells and basophils, and it induces bronchodilation.

69
Q

*What beta lactam can you give in pen allergy, what is % cross reactivity

A

Cephalosporins share the β-lactam ring structure and side chains of the penicillins, but allergic cross-reactivity appears to be low, somewhere between 1% to 8% of patients.

70
Q

*3 other medications to give in anaphylaxis, besides IM epi

A

Benadryl
Ranitidine
Ventolin
Atrovent
Methylprednisolone
IV epinephrine
Glucagon plus d5W if on BB

71
Q

*Name four historical or clinical patient risk factors for severe anaphylaxis

A

• Extremes of age: Very-young (under-recognition), elderly
• Comorbid conditions: Cardiovascular disease (heart failure, ischemic heart disease, hypertension), pulmonary disease ( asthma, COPD)
• Others: Concurrent use of anti-hypertensive agents, specifically beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, concurrent use of cognition-impairing drugs (e.g. alcohol, recreational drugs, sedatives, tranquilizers), recent anaphylaxis episode

72
Q

*What is mechanism of NSAID-induced anaphylaxis

A
  • Interruption of arachidonic acid metabolism,
  • a non-IgE (non- immunologic) mediated process
73
Q

*What blood test do you send to confirm the diagnosis for NSAID-induced anaphylaxis?

A
  • Serum histamine
  • Tryptase
74
Q

*Name three clinical situations in which you should be concerned about potential adverse effects of epinephrine in anaphylaxis

A
  • CAD/MI
  • Dysrhythmias
  • TIA/stroke
  • Elderly
75
Q

*Your patient has had multiple rounds of epi and fluids and remains hypotensive. What are two therapeutic interventions you can use?

A
  • IV epinephrine
  • IV vasopressor in addition to epinephrine (e.g. norepinephrine, vasopressin)
  • Glucagon if on beta-blocker
76
Q

*List four components of a discharge plan for patient with anaphylaxis

A
  • Education on allergy/anaphylaxis
  • Return to ER if worsening symptoms
  • Prescription for EpiPen
  • Follow-up with family physician/allergist
77
Q

*3 causes angioedema

A

BRADYKININ EXCESS
1. Hereditary angioedema (HAE)
2. Acquired C1 esterase inhibitor deficiency (ACID)
3. ACE inhibitor (ACEI)
ALLERGIC
4. Hypersensitivity reaction/allergy - will have urticaria as well

78
Q

*List 3 medications to treat angioedema

A
  • C1 esterase inhibitor protein replacement (Icatibant)
    • FFP (has C1 esterase inhibitor in it)
    • anti-H1/H2, epinephrine & steroids
79
Q

What is the definition of anaphylaxis

A

Acute illness onset + 2 system involvement OR hypotensionKnown allergen exposure + hypotension

80
Q

What are the 4 types of immune reactions

A

ACID
- Acute IgE - allergic reaction causes degranulation of mast cells ex. anaphylaxis
- Cell cytotoxic - IgM and Igg antigens leading to cytotoxic and cell lysis ex. blood transfusion
- Immune complex - IgM and IgG form immune complexes which are dropped in vessel walls creating a local inflammatory reaction ex. lupus
- Delayed - no antibodies, sensitized lymphocytes start the inflammatory reaction ex. EM, TENS

81
Q

*Recognize tinea corporis (on the hand, therefore tinea manuum if you’re being fancy)

A

picture

82
Q

*Tx for tinea corporis

A

Topical antifungal like ketoconazole

83
Q

*What pathology is this rash associated with

A

Heliotrope rash associated with dermatomyositis

84
Q

*With dermatomyositis, what’s the rash expected on the hands?

A

Gottron’s papules on the hands

85
Q

*What is this rash, pathonomic finding, and organisms

A

Scabies, Burrows, Sarcoptes scabiei-var hominins

86
Q

*One medication Tx for scabies, and for the itch

A

Permethrin 5% cream or ivermectin PO, both the patient and family members

87
Q

*What advice do you give the family with a scabies outbreak (2 things)?

A

All members of family/close contacts to be treated
Decontaminate of clothing bed linens towels etc (washing machine + dryer or airtight container for 72hours)

88
Q

(Causes for treatment failure of permethrin

A

Not treating whole family, not cleaning linens, not completing course, reinfestation

89
Q

*Fill in the table for EM minor, SJS, and SSSS
- Age group
- Cause
- Distribution of rash
- Description of rash
- MM involvement
- Eye involvement

A

see photo

90
Q

*Cutaneous manifestations for disseminated gonococcal infection

A

The lesions are often multiple and have a predilection for periarticular regions of the distal extremities. The lesions begin as erythematous or hemorrhagic papules that evolve into pustules and vesicles with an erythematous halo ( Fig. 110.13 ). They may be tender and may have a gray necrotic or hemorrhagic center. Healing with crust formation usually occurs within 4 or 5 days, although recurrent crops of lesions may appear even after antibiotics have been started.

91
Q

*5 ways to test for disseminated gonococcal infection

A
  • Cultured from cutaneous lesions
  • Immunofluorescent antibody staining of direct smears from pustules
  • Gram stain from cutaneous lesions
  • Synovial fluid PCR
  • Cultures from all mucosal orifices
  • Synovial culture
92
Q

*5 clinical or historical features of TEN ( toxic epidermal necrolysis)?

A
  • > 30% total body surface area involvement
  • Use of medication known to cause TEN (e.g. sulfa drugs, NSAIDs, penicillin, .etc)
  • Recent infection (e.g. prodrome of fever, rhinitis, sore throat, myalgia)
  • Malignancy
  • Macular rash with target lesions that become confluent with dermal
  • epidermal dissociation (positive Nikolsky sign)
  • Mucous membrane involvement
  • Cornea/conjunctival involvement
  • Hematuria
  • Diarrhea
  • Bronchitis/pneumonia
93
Q

*4 treatments of TEN

A
  • Discontinue offending agent In consultation with specialist(Derm consult)
  • Corticosteroids
  • IVIG
  • Plasmapheresis
  • Supportive care:
  • IV fluid resuscitation
  • Prevention of secondary infection
  • Expert wound management
94
Q

*2 antibiotics classes associated with TEN

A
  • Sulfa
  • Penicillin
95
Q

*3 other drugs causing TEN? (other than abx)

A
  • NSAIDs
  • Aspirin
  • Barbiturates
  • Phenytoin
  • Carbamazepine
  • Allopurinol

ABCNAP

96
Q

*What is Nikolsky sign?

A

Rubbing of the skin results in exfoliation of its outermost layer

97
Q

3 diseases with positive Nikolsky?

A

TEN
SJS
SSSS
Pemphigus vulgaris

98
Q

*4 risk factors for the development of community acquired MRSA

A

-IVDU
-Incarcerated
-Homeless
-Nursing home
-Contact sports
-Close contact with person with risk factors
-Native Canadians
-Men who have sex with men

99
Q

*5 oral medications that can be used to tx CA-MRSA

A

-Clinda
-Septra
-Doxycyline
-Linezolid
- Levofloxacin
-Minocycline

100
Q

*4 infections caused by community acquired MRSA

A

-Cutaneous abscess
-Cellulitis
-Pneumonia
-Infective endocarditis
-Septic Arthritis

101
Q

List 5 rashes that can occur on the hands and soles

A

Hand/foot/mouth, scabies
Kawasaki, endocarditis
RMSF, syphilis
SJS, TTP

102
Q

List 5 rashes that can cause purpura

A

Palpable: inflammatory, infection
- Vasculitis (palpable): Wegener’s, Chug-strayss, HSP
- Infections: Meningitis, meningococcemia, Hepatitis, Rocky Mountain spotted fever, endocarditis, typhoid fever, toxic shock syndrome, dengue fever
- Purpura fulminans: thrombosis of blood vessels, often a complication of meningitis
- Autoimmune: Lupus
- If petechiae only above the nipple line these are generally well c/o coughing, valsalva, venipuncture, blood pressure cuff etc
Non-Palpable: low platelets
- Heme: ITP, TTP, HUS, coagulopathies, DIC

103
Q

List 5 rashes that can cause vesicles

A

Herpetic infection (shingles, herpes gladiatorum aka mat herpes), impetigo, dermatitis (poison ivy), burn, TENs, bulls pemphigoid, chicken pox,bilious impetigo, hand foot and mouth

104
Q

Briefly describe the clinical presentation and causative organisms associated with each of the following:
1. Roseola
2. Fifth disease
3. Rubella
4. Measles

A
  1. High fever that resolves followed by a maculopapular rash on the trunk. Well appearing. Herpes 6
  2. ‘Slapped’ check with lacy rash and arthralgias. Risk of hydrops in pregnant females. Parovirus B19
  3. Viral prodrome with maculopapular rash that starts on the face and moves down. Risk of congenital rubella syndrome in pregnant females. Rubella virus.
  4. 3Cs cough, conjunctivitis, coryza. Maculopapular rash that starts at head and spreads down with Kolpik spots. Extremely contagious Measles virus.
105
Q

List one agent that can be used in the treatment of tinea infections

A

Terbinafine, topical if minor oral if persistent

106
Q

What is this rash

A

Erythema marginatum; associated with rheumatic fever

107
Q

What is this rash

A

Erythema multiforme
3 zones of colour with central clearing, erythematous macules/papules and target lesions

108
Q

Well infant. What is this rash

A

Erythema toxicum

109
Q

List one mild, middle, and high strength potency steroids

A

Strong: Clobetasol 0.05% cream or ointment
Middle: Betamethasone 0.05% lotion
Mild: Hydrocortisone 1 or 1.5% cream. Not strong enough to penetrate the palms and soles

110
Q

Differentiate between SJS and TENs

A

Both Nikolsky +ve with painful vesicles and bullae
SJS: 10-30% body surface areas
TEN: >30% body surface area

111
Q

List 5 medications that can trigger SJS

A

sulfa, NSAIDs, allopurinol, penicillins, anticonvulsants

112
Q

What is erythema multiforme? List 5 causes

A

Hypersensitivity reaction causing an acute inflammatory skin reaction
Etiologies include drug reactions, infection (viral, hepatitis, influenza), fungal (histoplasmosis), bacterial (strep, TB), collagen disorders (lupus, dermatomyositis)
Rx w steroids

113
Q

What is the presentation of serum sickness

A

Type 3 hypersensitivity reaction
Rash looks like urticaria, lesions are fixed
Rash + fever + joint pain associated with an offending agent

KChan Saves the World (24 decks)

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