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Life threats Flashcards

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1
Q

Rash/intense pruritis caused by a drug is called?

A

Drug eruption

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2
Q

Drug eruption morphology types

A

Maculopapular (MC)
Urticarial
Specific Rx rxn
Skin flushing w/ pruritis

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3
Q

Drug eruption Progression

A

Slow sensitization overtime

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4
Q

MC types of Drug eruption

A

Maculopapular (exanthematous)
Urticarial
Fixed Drug eruption

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5
Q

Drug eruption Exanthems (maculopapular) indistinguishable from?

A

Viral exanthem

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6
Q

Drug eruption Exanthems (maculopapular) Morphology

A

Red macules/papules become confluent

  • symmetric, generalized often spares face
  • mucous membs (palms/soles)
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7
Q

Drug eruption Exanthems (maculopapular) Presents

A

Onset - 7-10D
May present after D/C Rx unknowingly.
Lasts 1-2wks
Clears rapidly w/ Rx d/c

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8
Q

Drug eruption Fixed drug morphology

A

Single or multiple round, sharply demarcated, dusky, red plaques
-can blister

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9
Q

Drug eruption Fixed drug Distro

A

Same location every exposure
MC - Glans Penis
Can occur anywhere tho

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10
Q

Drug eruption Fixed drug Onset?

A

Soon after Rx exposure

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11
Q

Drug eruption management

A 
D/c Rx
AH
PO-CCS C III-V
-Betamethasone
-Mometason
-TAC
Prepare for SOB/Anaphylaxis
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12
Q

Urticaria S/S

A

Uncomfortable/itchy

+- SOB, dysphagia, itchy mouth/throat

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13
Q

Urticaria morphology

A

Hives (wheal) - firm edematous plaque
Faint pink w/ central pallor
Orange peel look
-edema in dermis causes follicular accentuation

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14
Q

Urticaria Distro

A

Anywhere - gen/local

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15
Q

Urticaria Etiology

A

Mast cells release histamine - direct/immediate hypersensitive Rxn causing superficial dermis swelling

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16
Q

Physical Urticaria is?

A 
Dermatographism
Pressure (belts, jewelry)
Solar
Cold/Heat
Aquagenic (not temp)
Cholinergic
30-60m duration
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17
Q

Urticaria Classes

A

Acute <6wk

Chronic >6wk

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18
Q

Acute Urticaria attributes

A

Reproducible
Immediate rxn
Lead to Anaphylaxis
Duration - days

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19
Q

Chronic Urticaria attributes

A

Dx of exclusion
Recurrent over 6+wks
No apparent trigger
Smaller lesions

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20
Q

Acute Urticaria TXT

A

IM/PO Benadryl
(PO) steroids
Epi 1:1000 if anaphylaxis

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21
Q

Chronic Urticaria TXT

A

AH 2nd Gen (Fexofenadine, Cetirizine)
H2 Blk
PO Steroids (short course)
Restrict diet

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22
Q

Physical Urticaria TXT/PVT

A

Avoidance
Self limit
H1 agents Prph

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23
Q

Urticaria Labs

A

CBC w/Diff
UA Cx
H. Pylori Tests

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24
Q

Angioedema is?

A

Localized, dramatic rapid swelling of SQ tissue that burns and is painful

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25
Important concerns of Angioedema?
GI/Resp involvement causes dysphagia, dyspnea, Abd pain or anaphylaxis
26
Angioedema MC affects what distro?
Lips, eyes, Tongue, Trunk, Genitals, Hands
27
Angioedema TXT
ID offending agent IM/PO AH PO Steroids Prepare w/ Epi Pen and AW.
28
Leukocytoclastic Vasculitis Hypersensitivity is
Immune complex deposition on vessel walls, causing an inflammatory response
29
Leukocytoclastic Vasculitis is the MC?
small vessel necrotizing vasculitis
30
Leukocytoclastic Vasculitis prodrome?
Fever Malaise Myalgia Arthralgia
31
Leukocytoclastic Vasculitis Morphology
RBC leakage causes vesicles/points of necrosis Small > Increases in size to coalesce Palpable purpura characteristic lesion Lesions are painful and itch
32
Leukocytoclastic Vasculitis heals how?
Scarring and hyperpigmentation
33
Leukocytoclastic Vasculitis distro
Areas of increased hydrostatic pressure Lower legs, arms Back, sacrum (if bed bound) May spread to multiple organs
34
Leukocytoclastic Vasculitis TXT
``` Stop any offending Rx/agent TXT UC Top CCS (Predisone 3-6wk taper Colchicine ABX PRN ```
35
Henoch-Schonlein Purpura is a?
Acute Leukocytoclastic Vasculitis occuring in children 2-10yo (MC 0 systemic vasculaitis in PEDs)
36
HSP is characterized by?
NON-thrombocyopenic hypersensitivity Rxn w/ Palpable purpura over legs/ass and is ass/w arthralgias and abd pain
37
HSP prodrome
fever | anorexia
38
HSP S/S
Malaise Arthralgia Abd pain N/V/D - microscopic hematuria, GI bleed, nephritis
39
HSP increased labs
ESR Complement IgA
40
HSP morphology
Starts as hives > then classic Leukocytoclastic Vasculitis lesions w/in 48h. 2-10mm in diameter Crops coalesce w/ eccymosis Pinpont petechiae Fades in several days to leave brown macules
41
HSP can be preceded by?
Illness 1-3wks prior | URI (strep w/ IgA depositis)
42
HSP management
Self limiting Watch for GI bld, blood loss NSAIDs or PO steroids Occ. Dapsone or plasmophoresis
43
Name all hypersensitivity syndromes
``` EM - Erythema Multiforme SJS - Stevens-Johnson Syndrome TEN - Toxic Epidermal Necrolysis EN - Eryhema Nodosum SS - Sweet Syndrome ```
44
hypersensitivity syndromes have what in common?
Acute Fever Neutrophilic dermatosis Response to Infections, Rx, Malig, Autoimmune D/O, and preg
45
Erythema Multiforme affects what pop?
20-40yo
46
Erythema Multiforme pts complain of?
Fever Malaise Lesions that burn
47
What precedes Erythema Multiforme?
URI or HSV infection | Or mycoplasma pneumoniae
48
Erythema Multiforme morphology
``` Urticarial papules Target lesion (iris lesion) or vesicles/bullae(mucous membrane) Red macule has central color change Coalesce into large areas ```
49
Erythema Multiforme Atypical morphology and causes
Rx - Allopurinol, Dilantin Red macules or papules/plaques Persistent urticarial plaqus w/ diff colors
50
Erythema Multiforme distro
Back of hands - palm/soles extensor limbs Gemeralized Mucous membranes
51
Erythema Multiforme is?
Immune complex Dz that damages vasculature and causes tissue necrosis
52
Erythema Multiforme management?
``` S/S relief Mild = no Txt Prednisone 1-3wk taper HSV induced - Acyclovir or vacylclovir D/C Rx if suspected ```
53
SJS is a
vesiculobullous dz of skin, mouth, eyes, genitals
54
SJS presents
Any age (MC children or young adults) Very sick and in pain Preceded by URI w/ high fever or malaise
55
MC offending agents for SJS are?
Seizures Rx Abx Gout Rx
56
SJS prodrome prior to cutaneous S/S
Fever Stinging eyes, painful swallowing
57
SJS morphology
Flat, atypical targets or purpuric macules widespread 1st - trunks (+- Palm/soles) Then - Neck, Face, and Prox UE Bullous lesions Mucosal lesions - conjunctiva, nasal, oral, genitals -ulcerate w/ hemorrhagic crusts Ocular - corneal Ulcerations - Blindness
58
SJS etiology
Direct toxic effect from - Rx - (MC- Phenytoin, Phenobarbital, PCNs, Sulfas) Viral URI Mycoplasma pneumonia
59
SJS management
``` S/S itch/pain IVF Ophthalmology refer - ocular ABX - Prn Severe - admit to burn unit Severe throat pain - NG feed Severe dysuria - Foley cath ```
60
SJS complications
Sloughing of upper/lower respiratory tract | Blindness due to corneal lesions
61
Toxic Epidermal Necrolysis is?
detachment of epidermis at dermoepidermal Jx (Sub-epidermal) Full thickness necrosis (high M/M due to sepsis)
62
Toxic Epidermal Necrolysis prodrome?
Rash 1-2wks prior MC - Fever HA Sore throat
63
Toxic Epidermal Necrolysis sudden onset of?
Red tender skin
64
Toxic Epidermal Necrolysis is ass/w what other condition?
URI
65
Toxic Epidermal Necrolysis morphology
Begins localised or morbilliform and coalesce Generalized red macular sunburn appearance Diffuse hot erythema (painful in hours) Vesicles or large bullae may appear Scalp and non erythematous skin is spared
66
Toxic Epidermal Necrolysis - Nikolsky sign
Slight thumb pressure = skin wrinkles and seperates from dermis
67
Toxic Epidermal Necrolysis Mucous membrane morphology?
Inflammation, blistering, Erosions -Esp the Oropharynx, GI tract Vagina - epithelium blisters/erodes
68
Toxic Epidermal Necrolysis Eye morphology
Severe eyes involvement - purulent conjuctivitis, ulceration, erosions, adehesions - blindness
69
Toxic Epidermal Necrolysis Respiratory tract morphology
Suspect is S/S dyspnea, hypersecretion, hypoxemia.
70
Toxic Epidermal Necrolysis MC cause
Rx - ABX (Sulfa - aminoPCN's) Anticonvulsant(Phenytoin, Phenobarbital, Valproic acid) NSAIDs/analgesics (CCS, Allopurinol)
71
Toxic Epidermal Necrolysis mangement
``` Admit - burn unit Cyclosporine A, Cyclophosphamide Plasma Exchange IVIG PVT Infection (MC - Death) ```
72
CI Rx of Toxic Epidermal Necrolysis
CCS
73
Toxic Epidermal Necrolysis MC cause of death?
Infection
74
Classification of SJS and TEN
<10% epidermal detachment - SJS >30% epidermal detachment - TEN inbetween = overlap
75
Staph scalded Skin Syndrome etiology?
2/2 Coag positive S. Aureus toxin | Same organism to cause bullous impetigo
76
Staph scalded Skin Syndrome concern w/. PEDs?
Incomplete immunity cant clear toxin from kidney
77
Staph scalded Skin Syndrome causes a?
Split in skin high in epidermis (granular layer)
78
Staph scalded Skin Syndrome management?
Anti-Staph meds - Diclox/cephalexin | NO CCS
79
How to differ SSSS from TEN?
Frozen section
80
Kawasaki's is?
Mucocutaneous Lymph node syndrome
81
Kawasaki's patient presents?
Infant -12yo (Avg 2-3yo) 101-104 fever unresponsive to antipyretics Cervical LAD Rash, Oral/Mucous membrane changes
82
Kawasaki's Acute phase?
``` Fever 7-14D > resolves Conjunctival injection Strawberry tongue/oral mucous chances Tender Edema on Palm/soles (Peels in 10D) Diffuse maculopapular rash ```
83
Kawasaki's Subacute phase?
End of fever - 25D Desquamation of fingers/toes Arthralgias Thrombocytosis
84
Kawasaki's Convalescent phase?
Timeframe = (6-8wks after onset) | S/S disappear to ESR normalization
85
Kawasaki's distro?
Conjunctiva - injection Tongue - hypertrophic papillae = strawberry tongue Palm/soles - red/swollen, tender Skin diffusely - urticarial and/or deep red diffuse maculopapular eruption (desquam in 5-7D) Diaper dermatitis is common Cervical LAD
86
Kawasaki's Management
Monitor for cardiac ABNL (Major cause heart Dz PEDs) -EKG, Echo (Coronary aneurysms) IVIG high dose over 10-12hrs ASA - 4x/D = req afebrile 3-7D > 1x/D 4-6wks
87
Kawasaki's labs
WBC >20k | ^ESR/CRP, PLTs (thrombosis)
88
Toxic Shock Syndrome ass/w causes
Post partum (post c-section) Nasal packing (staph carrier) Use diaphragm Super absorbent tampons
89
Toxic Shock Syndrome morphology
``` Diffuse scarlet fever-like rash Macular Erythematous Looks like sunburn Desquam on Palms/soles ```
90
Toxic Shock Syndrome S/S
Vaginal hyperemia and TTP Conjunctival Injection Strawberry tongue
91
Toxic Shock Syndrome distro
Diffuse Rash Mucous membrane involved (Conjunct, oral, vaginal) Multisystem Dz
92
Toxic Shock Syndrome Dx criteria
>102 fever Rash - diffuse, red, macular (sunburn look) Mucous membrane involvement (Vag, Oral, Conj) HOTN <90SBP Multisys involvement
93
Toxic Shock Syndrome etiology?
Coag Positive Staph w/ TSS toxin-1 | Local infection w/ systemic spread
94
Toxic Shock Syndrome management?
``` Betalactamase resistant ABX -Oxacillin -Nafcillin -Cefoxitin -Vancomycin/clinamycin (IV) 3-5d > (PO) x2Wks I&D abscesses Remove tampon Maintain BP (IVF/Hydration - Vasopressors) Manage-multisys invovlement ```

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