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KCSU17 Derm > Systemic Derm Dz > Flashcards

Systemic Derm Dz Flashcards

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1
Q

Transmission of syphilis

A

Treponema palladium (spirochete)

Sexual contact (microabrasions of uninfected come in contact with infected lesions)

Vertical transmission

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2
Q

4 stages of syphilis

A
  1. Primary
  2. Secondary
  3. Latent (early, late)
  4. Tertiary
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3
Q

Primary syphilis

A

Chancre develops w/in days to 3 months of exposure

Very infectious

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4
Q

Chancre

A

Painless , indurated papule with ruled edges and ulcerated base

Top layer of skin is gone, fat exposed

Primary syphilis

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5
Q

Secondary syphilis

A

Occurs 4-10 weeks after untreated chancre

Spirochete spread thru lymphatic system

Involves skin, mucous membrane, eyes and lymphatic

Rashes and lesions occur

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6
Q

Lesions of secondary syphilis

A

Dermatitis (muscle membranes, palms, soles)

Reddish-brown, macular, <5mm and discrete

All of these lesions contain T. Palladium

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7
Q

Patients with secondary syphilis may also develop

A

Condyloma lata (painless, gray/white papules in mouse area or mucous membrane – VERY infectious)

Alopecia (patchy hair loss of scalp and face)

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8
Q

Systemic secondary syphilis

A

Malaise

Fever

Anorexia, weight loss

Myalgia and arthralgia

Painless adenopathy

Organ inflammation

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9
Q

Neurosyphilis EARLY

A

First 6 months of infection

Meningitis (high lymphocyte CBC) and meningovascular syphilis (young patient strokes out w/o symptoms)

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10
Q

Latent syphilis

A

Resolution of symptoms and patient is non infectious unless blood transfusion or pregnancy

Some have periodic relapses

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11
Q

Tertiary syphilis

Symptoms

A
  1. Gumma’s
  2. Cardiovascular
  3. Neurosyphilis
  4. Ocular Syphilis
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12
Q

Gummas

A

Granulomas that ulcerate

Classically seen on liver, bones and testes

Very rare, tertiary syphilis

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13
Q

Cardio syphilis

A

Tertiary syphilis (occurs 10 years after primary infection)

Ascending aortic aneurysms +/- aortic valvular disease due to description of vast vasorum (aortic blood supply)

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14
Q

Neurosyphilis Tertiary

A

Takes doralsis (destruction of posterior spinal cord columns, impaired vibration, proprioception)

General paresis (memory alteration)

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15
Q

Ocular syphilis

A

Tertiary or secondary

Patients can have destruction of optic cells that cause photophobia and dimming of vision

Argyll-Robertson pupil

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16
Q

Argyll-Robertson pupil

A

Prostitute’s pupil

Accommodates but doesnt react

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17
Q

Initial syphilis test

A
  1. VDRL
  2. RPR

Tests serum reactivity fo cardiolipin cholesterol antigen

Measured in titers, can get false positive (pregnancy, connective tissue disorders, IVDA) or negatives (HIV)

Non-treponema so need a confirmatory tests

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18
Q

Confirmatory tests of syphilis

A
  1. TP-EIA
  2. FTA-ABS

Confirms if RPR/VRDL are positive

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19
Q

Treatment of syphilis

A

IM PCN (if neuro it is IV PCN)

Primary = 1 shot in butt 
Secondary= 1 shot in butt for 3 weeks

Health department notification and repeat screening

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20
Q

Rocky Mountain Spotted Fever

Geographical region

A

Tick Bourne

Occurs in late spring/early summer in southeastern US

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21
Q

Parasite that causes Rocky Mountain Spotted Fever

Study These Flashcards
A

Rickettsia rickettsial

Animal -> tick -> human

22
Q

Rocky Mountain Spotted Fever

Symptoms

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A

Typically 2-14 days after bite (5-7)

Fever, severe HA, myalgia/arthralgia, N/v, dyspnea and cough

23
Q

Following systemic symptoms…

Rocky Mountain Spotted Fever

Study These Flashcards
A

2-4 days alter, erythematous macular rash on wrists and ankles that spreads distally AND proximally

No puritis

24
Q

Rocky Mountain Spotted Fever

Diagnosed

Study These Flashcards
A

Clinical grounds bc no serological test is fast enough

25
Rocky Mountain Spotted Fever Treatment
Doxy IV or oral if suspected
26
Lyme disease Geography
Tick-borne (borrelia burgdorferi) Thruout US but mostly northern areas (northeast, mid Atlantic, upper Midwest and pacific northwest)
27
Lyme disease Localized disease
3-21 days after the bite Erythema chronicum migrans rash (ECM) (bullseye) Lymphadenopathy Fever, headache, stiff neck, severe myalgia/arthralgia
28
ECM
Painless expanding multi-ringged bright red macule rash Central clearing at site of tick bite Followed by secondary regions Pathognomonic for Lyme disease
29
Disseminated Lyme disease systems
1. Cardiac (arrthymias, AV block, pericarditis) 2. Neurologic (aseptic meningitis, CN palsies) 3. Joints (severe arthralgia/myalgia)
30
Diagnosis Lyme disease Clinical
Clinical diagnosis Finding ECM or disseminated disease problems OR lab
31
Lab diagnosis of Lyme disease
1. Ab detection to confirm exposure (EIA/ELISA) | 2. If positive, Western Blot to confirm
32
Prevention of Lyme disease
Long sleeves, hats, light colored clothing Prophylactic treatment with Doxy X1 so that tick bite will not become infectious
33
Treatment of Lyme disease
Doxy 100 mg 2xday for 2-3 weeks (localized Dz) Systemic dz: advanced Abx, infectious disease specialist
34
Chronic Lyme disease
Patients with Lyme disease who have been treated but continue to show symptoms Nonspecific symptoms No treatment available
35
Primary VZV infection
Chicken pox Contagious benign febrile illness of childhood that then stores viral particles in dorsal root ganglia where they are dormant (reactivate if stressed, ill, immunosuppressive)
36
Reactivated VZV infection
Shingles Less contagious but significant disease Neuron inflammation and rash on dermatome doesnt cross mid line
37
Shingles
Caused by reactivation of VZV 1 million/year 95% of adults are susceptible
38
Risk factors for shingles
Immunosuppressed Older age No sex predominance
39
Manifestations of shingles
1. Pre-eruptive prodrome (parenthesis of affected dermatome/48-72hrs) 2. Acute eruptive phase (vascular lesions, lasts at least 10 days, vesicles burst and crust over) 3. Chronic phase/PHN (burning or aching pain, 30+ post infection)
40
Herpes zoster opthalmicus
10-15% CNV affected by reactivation In addition to inflammation typical with shingles, they can infect the eye and lead to blindness This is detected by vesicles on the face or noe se
41
Herpes zoster Oticus
Ramsey Hunt syndrome CN VII affected Ear, face, and vestibular issues
42
Disseminated herpes zoster
Shingles that affects more than one dermatome Indistinguishable from varicella
43
Zoster sine herpete
Uncommon Pain and weakness of dermatome without signs of cutaneous vesicles
44
complications of shingles
PHN Secondary sepsis/cellulitis
45
PHN
Untreated shingles that wont go away Commmon in the elderly Best way to prevent is to detect and treat shingles early
46
Diagnosis of shingles
Lab testing is futile Diagnosis is made clinically DFA used in immunocompromised (Tzanck smear)
47
Management of shingles
Episodes are self limiting so treat if serous Conservative treatment Glucocorticoids Pain control Antivirals
48
Prevention of shingles
Varivax (chicken pox vaccine, given to children or adults w/o varicella exposure) Zostavax (higher potentcy live attenuated VZV vaccine, given to adults 50+)
49
SJS
Infection of the skin and mucous membranes Less than 10% of the body is covered Can be on spectrum of TEN
50
SJS increased risk
1. Slow acylators 2. Immunocompromised patients 3. Patients with brain tumors who undergo radiotherapy with anti-epileptics 4. Patients with SLE
51
SJS etiologies
1. Medications 2. Infection 3. Genetics 4. Idiopathic

KCSU17 Derm (12 decks)

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