Rash + Red Eye Flashcards by Kelsi Taylor

SLE Sx + who does it commonly effect

Commonly in females of reproductive age
Sx:
Constitutional
Cutaneous
Alopecia
Oral ulcers
Photosensitivity rash
Malar rash
Discoid rash
Raynauds
MSK
Arthralgia
Myalgia
Cardiorespiratory
Pericarditis, myocarditis, endocarditis
Pleurisy
Pneumonitis
Neuro
Sz
Psychosis
Chorea
Transverse myelitis
Renal
Proteinuria
Nephrotic syndrome
ESRD
GI
Ascites
Liver dz
Haem
Hemolytic anemia (reticulocytes, reduced haptoglobin, raised indirect bili, raised LDH)
Leukopenia
Thrombocytopenia
Thrombosis

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Dx criteria for SLE

ACR
SLICC

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Ix for SLE

ANA
Anti-dsDNA antibody
Low complement levels
Anti-Smith
Antiphospholipid antibodies

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Rx for SLE (mild, mod, severe)

Avoid sun
Flu shot annually

Mild
Antimalarials
Methotrexate
NSAIDs
Prednisone

Moderate
Prednisone
Triamcinolone IM
Azathioprine

Severe
Methylprednisone
Mycophenolate mofetil
Cyclosporine
Tacrolimus
Rituximab

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Dx of celiac

sx, HLA-DQ2/DQ8 gene, ab in serum, duodenal histology

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RF for celiac

family history, women more common, T1DM, autoimmune thyroiditis, Downs, Turners, IgA deficiency

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Complications of celiac

Complications: anemia, growth failure, T cell lymphoma
peripheral neuropathy, arthritis, aphthous stomatitis, hyposplenism, higher risk of osteoporosis

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Sx of celiac

Sx: anorexia, constipation/ diarrhea, growth failure, abdo pain/ distension, steatorrhea, wt loss, dermatitis herpetiform (intensely pruritic papulovesicular rash on extensor surfaces)

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Ix, Rx + monitoring for celiac

Ix: Anti-tTG IgA + intestinal biopsy
Rx: gluten free diet, refer to RD, repeat serology in 6 months, screen for FDR
Monitoring: annual anti-tTG, Q2yr TSH

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Sx of chickenpox, incubation + infectivity period

Starts on face, spreads inferiorly to trunk + extremities
Papules evolve into vesicles then pustules that crust
Incubation 14-21d, infectivity 1-2d pre-rash

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Rx for Kawasaki’s

Management
IVIG + ASA 100mg/kg/d divided QID
Reduce ASA to 5mg/kg/d x 6 weeks post fever

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Lyme pathogen, sx + rx

Borrelia Burgdorferi
Reportable
Sx:
Macule or papule at tick bite site
Progresses to erythema migrans (bulls eye red patch that expands)
Rx: doxycycline 100mg BID, amox for kids

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Measles sx

Begins on face + shoulders, spread inferiorly
Macular rash
Fades in 4-6d, incubation 10-14d, infectivity 4d pre rash
URTI prodrome w/ fever, rash starts 4th day of fever
Koplik’s spots 1-2d pre rash

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Parvovirus sx + complications

Fifth disease/ slapped cheek
Sx
Bright red facial rash, progresses to lacy reticular rash
Complications
Severe aplastic anemia in pts w/ chronic hemolytic anemia

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Rocky mountain spotted fever sx

Evolves from pink macules to red papules to petechiae
Starts on wrists + ankles then spreads towards centre
Hx of tick exposure
Prodrome of fever, severe HA, myalgias
Rash starts 4d later
Associated w/ bradycardia + leukopenia

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Roseola - cause, sx

HHV 6
Fever
Diffuse macular rash, face sparing

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Rubella sx + name of specific finding (petechiae soft palate)

Pink macules + papules start on forehead then spread down to extremities within 1d

Forchheimer spots (petechiae on soft palate)

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Rosacea sx + rx

Sx
Central face w/ transient erythema, telangectasia, inflammatory papules and pustules
Flushing

Management
Avoid triggers
Photoprotection
Topical metronidazole or azelaic acid

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Scarlet fever sx + signs on exam + cause

Sandpaper rash, starts on trunk, spreads to extremities
Flushed face w/ perioral pallor
Rash fades in 4-5d, followed desquamation
Acute strep infection
Pastia’s sign (linear petechiae in antecubital + axillary folds)
White strawberry tongue then red strawberry tongue

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Ix for persistent rash

Ix - scraping, culture, biopsy, labs

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Painless causes of red eye (diffuse vs localised)

Diffuse:
Eyelid abnormality (blepharitis, ectropion, entropion, trichiasis, eyelid lesion [eg. stye, tumour])

Localized redness:
Pterygium, corneal foreign body, ocular trauma, subconjunctival hemorrhage

Painful causes of red eye (reduced visual acuity vs normal)

Normal acuity:
Chalazion/Stye
Acute blepharitis
herpes zoster ophthalmicus
Viral/allergic/bacterial conjunctivitis
Herpes simplex keratitis
corneal ulcer
marginal keratitis

Reduced acuity:
Scleritis
corneal abrasion
acute glaucoma
Acute anterior uveitis (iritis)
hypopyon
hyphema

Ix for optic neuritis vs orbital cellulitis vs retinal detachment

MRI for optic neuritis
CT for orbital cellulitis
US for retinal detachment

Sx + rx of optic neuritis

Painful loss of vision, positive RAPD
Rx: steroids

Rx for Acute angle-closure glaucoma

Topical BB (timolol) Pilocarpine (miotics) Topical clonidine (alpha adrenergic agonist) Topical prednisone Acetazolamide (carbonic anhydrase inhibitors) IV Mannitol (diuretic) IV

Complications of uveitis

Glaucoma Posterior Synechiae Cataracts

Dark curtain over vision?

retinal detachment

Most common type of macular degeneration?

dry

Sx of Posterior Vitreous Detachment

Flashes/ floaters

Most common eye cancer in kids

retinoblastoma

How to assess vision + eyes

Snellen chart, slit lamp, fluorescein, tonometry

Rx for viral conjunctivitis

Supportive, cold compresses, ocular decongestants, artificial tears Strict hand washing/hygiene, avoid work if healthcare worker until eye discharge ceases

Common bacterial pathogens causing conjunctivitis in adults + kids

Staph aureus in adults Strep pneumoniae, H influenzae in children

Who to give abx to for bacterial conjunctivitis

Antibiotic therapy in healthcare workers, immunocompromised, comorbidity, contact lens wearers, unreliable

Rx for bacterial conjunctivitis

Fucidin 1% ophthalmic 1 drop BID x 7 days Erythromycin ointment 1.25cm QID x 5-7 days If severe or contact lens, cover for pseudomonas Ciprofloxacin 0.3% (or oflaxacin) QID x 5-7 day

Rx for allergic conjunctivitis

Avoid exposure, artifical tear, topical antihistamine H1 antagonist Olopotadine (Pataday) 0.2% 1 drop daily x 2w

RF for dry eyes

Risk: Age, female, medications (anticholinergic)

Rx for corneal abrasion

Topical NSAIDs (diclofenac 0.1% [Voltaren], ketorolac 0.4% [Acular LS] 1 drop QID x 2 days maximum) Topical Antibiotic (erythromycin 0.5% opht oint, polymyxin B/trimethoprim (Polytrim) opht solution, and sulfacetamide 10% opht oint QID x 5d or until asymptomatic x 24h) If contact lens wearer, cover for pseudomonas (Ciprofloxacin, Gentamicin, Ofloxacin)

Differences between episcleritis + scleritis

Phenylephrine (2.5%) eye drops leads to swift, transient resolution of episcleral redness in episcleritis Non-tender on palpation in episcleritis (tender in scleritis) Pink-red in episcleritis (blue-purple hue in scleritis) Radial pattern of sclera maintained in episcleritis (loss of radial pattern of sclera in scleritis)

Sx of glaucoma

Blurred vision HA, N/V Uni or bilateral Hazy cornea Mild dilated oval pupil

Sx + rx of uveitis

Photophobia Blurred vision Circumcorneal congestion Rx: Topical steroids

Sx of scleritis

Blurred vision Globe pain w/ palpation Generalised injection

What is Bells phenomenon?

upward gaze with inability to close eye lid on affected side

Rx for Bell's palsy

Bells Palsy rx: corticosteroids

Red flags for red eye

pain on palpation, decreased acuity, anisocoria

Bugs causing conjunctivitis in contact lens wearers

acanthomoeba

Perilimbal haze causes

iritis, keratitis

Fixed, hazy cornea = what?

raised intraocular pressure

Fixed, hazy cornea + pain = what?

acute angle glaucoma

Risks of eye steroids

worsening herpes simplex keratitis, globe rupture, corneal ulcerations, glaucoma

How to prevent pink eye

goggles, wash hands, condoms