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SDNP exam > Urticaria, photosensitivities, hypersensitivity, vasculitis > Flashcards

Urticaria, photosensitivities, hypersensitivity, vasculitis Flashcards

1
Q

IgE mediated type 1 hypersensitivity

A

urticaria

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2
Q

Mast cell is the primary mediator which causes inflammation of mast cells, histamine causes cell contraction with leaking through the cells leading to edema and vasodilation causes erythema

A

urticaria pathophysiology

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3
Q

Wheals, edematous plaques, with white halos, general distribution, migrate and regess and last <24 hours

A

urticaria

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4
Q

How to manage acute urticaria?

A

H1 blockers- cetirizine, levocetirizine, loratidine, then diphenhydramine, hydroxyzine
H2 blockers- famotidine, cimetidine
doxepin- for pruritus
avoid heat, spicy foods, use hypoallergenic products, otc gels for pruritus placed in regrigerator, apply to skin cold, cool bedroom, cool bath, avoid nsaids and alcohol

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5
Q

overheating especially with exercise, itching and burning

A

cholinergic urticaria

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6
Q

hives after water exposure

A

aquagenic urticaria

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7
Q

Labwork for urticaria

A

thyroid
throat culture
punch with DIF

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8
Q

igE immediate hypersensitivity

A

angioedema

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9
Q

management of patients with non-anaphylaxis angioedema

A

h1 antihistamines certirizine (high dose) 20mg BID
glucocorticoid; prednisone 20-40mg daily for 7 days

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10
Q

Darier signs

A

mastocytosis

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11
Q

ingestion or activities that cause mast cell degranulation

nsaid, alcohol ingestion, anticholinergic, anesthetics, narcotics, polymyxin B sulfate

heat & friction

A

mastocytosis

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12
Q

UVA/UVB mediated
CD4 + T lymphocytes
occurs early in season or with winter tropical vacays

occurs on sun exposed areas primarily the arms, v of chest, back of neck, SPARES THE FACE

papulovesicular, same distribution every time

A

PMLE

polymorphous light eruption

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13
Q

how to dx and treat PMLE

A

punch biopsy

prevention with good sunblock and clothing, topical steroids, antihistamine, severe case may need oral steroids

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14
Q

photosensitivity triggered by UV exposure
strong associated wth hep C, liver disease, and hemochromatosis

A

porphyria cutanea tarda

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15
Q

patient complains of fragility especially hands with ulcers, scarring and milia, hypertrichosis, mottled brown pigment around the eye

A

PCT

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16
Q

How to dx and manage pct

A

biopsy w/ DIF
CBC, porphyrins, hepatitis panel
24 HR URINE FOR PORPHYRINS

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17
Q

WOOD LAMP FINDINGS FOR PORPHYRIA CUTANEA TARDA

A

BRIGHT PINK OR CORAL COLORED URINE

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18
Q

What plants contain psoralen compounds that cause phytophotodermatitis

A

meadow grass, parsnip, limes, wild angelica, cow parsley, carrot, fig,sweet orance, bishop’s weed, hogweed, rue, and celery

19
Q

You should always suspect a Fixed Drug Reaction when you see….

A

well-demarcated hyperpigmented macules on the face (especially around the mouth) hand/fingers, genital

20
Q

If the patient has been on a medication for _______ it is unlikely the cause of DRESS

A

more than 3 months

21
Q

hypersensitivity reaction
often from IV vancomycin

cipro, amphotericin B & rifampin

A

usually occurs during infusion but may be delayed, extreme flushing and pruritus, angioedema, anaphylaxis

22
Q

inflammation of blood vessels resulting in narrowed or occluded vessels, severity

A

vasculitis

23
Q

non palpable purpura w/ Cayenne pepper appearance (leaky capillaries) Schamburg’s disease

A

capillaritis or pigmented purpura

24
Q

Palpable purpura, lesions can coalesce to cover large areas, at times can seem urticarial but lasts > 24 hours, lower extremities and buttocks

A

leukocytoclastic vasculitis

25
Q

what should you do if you suspect leukocytoclastic vasculitis

A

1st- skin biopsy which will reveal- inflammatory infiltrates composed of neutrophils w/ fibrinoid necrosis

Next- if histology confirms- chest xray with lab work

26
Q

panniculitis
bilateral symmetrical tender pink nodules which can be bruise like, typically on the lower extremities, usually transient but may last 2 years, may have fever and joint pain, occurs with crohns/UC, most common in patient’s with sarcoidosis

A

erythema nodosum

27
Q

how to dx erythema nodosum

A

punch biopsy, must include subcutaeneous fat, CBC, throat culture

28
Q

how to treat erythema nodosum

A

1st line- nsaids, indomethacin, naproxen, postassium iodide
2nd line systemic or ILK

compression stockings and elevation

29
Q

High risk bites

A

cat bites
bites to hand/foot
puncture/crush injury
immunosuppresion
delayed presentation
proximity to vascular graft/prosthetic joint

30
Q

how to care for bite wounds:

A

C/S
then irrigate and debride wound, do not close puncture wounds, do not close a high risk wound

31
Q

primary closure for a bite only if

A

bite on the face with concern for cosmesis, antibiotic prophylaxis, f/u in 24-48 hours for wound check, never use tissue adhesive to close wound.

32
Q

antibiotic choices for bites

A

prophylaxis 3-5 days
empiric 5-14 days

33
Q

Treat animal bites with

A

mupirocin ointment TID
Augmentin 875/125mg BID for 5-14 days

Alternative- PCN & metro, docy and metro, bactrim and metro

update tetanus
assess for need for rabies prophylaxis

34
Q

how soon should you begin antibiotic therapy after an animal bite

A

within 8-12 hours of incident

35
Q

small papules in a cluster or linear pattern, usually found on legs & ankles, children experience urticaria

A

flea bites

36
Q

how to treat flea bites?

A

vacuum regularly, professional exterminator, tcs, burrows solution, antihistamine

37
Q

20 minutes to 2 hours after painless to sharp sting
Mild redness, urticaria, cyanosis
halo lesion with pale round area surrounded by a ring of erythema, patient may complain of ha, parathesias, n/v, htn, spasms

A

black widow bite

analgesics, muscle relaxants, antiemetics
tetanus prophylaxis
antivenom safe (risk for anaphylaxis)

intermittent ice application and elevation

38
Q

min to hours after a painless bite, a central blister, mottled blanched halo with surrounding redness/swelling, becomes necrotic 3-4 days later, severe pruritus and burning pain at bite site w/in 2-6 hours, expanding ulcerative necrosis

A

brown recluse

tetanus

intermittent ice application and elevation

antibiotic if secondarily infected.

39
Q

30min to 36 hours after painless bite, a firm nodule with blisters/pus, sloughing may appear, patient will complain of memory impairment, ha, nausea, and fatigue

A

HOBO

abx if needed
tetanus prophylaxis
intermittent application of ice and elevation

40
Q

Bee/wasp sting management

A

cold compress, remove stinger, tcs and antihistamine

41
Q

Avoid moveing/rubbing limb, fresh water, cold, ice, urination on area, alcohol on site, lemon juice, meat tenderizer if …..

A

marine sting

42
Q

what should you do if you acquire a marine sting

A

remove tentacle, vinegar/seawater/hotwater
antivenom-box jelly

tcs
antihistamine

43
Q

1st 30 days: flu like symptoms, erythema migrans (bulls eye)

dx and treat

A

LYME DISEASE

If elisa +- <30 days of symptoms igM and IgG western blot
If elisa -: >30 days just IgG

prophylaxis- doxy 200mg PO, single dose w/in 72 hours of bite

localized doxy 100mg PO BID x 10 days
Amoxicillin 500mg TID x 14days

44
Q

generalized, intense pruritus, worse at night, erythematous papules, excoriations, burrows/threadlike, fine linear pattern, favors wrists, interdigital spaces, waist, genitalia, areolae and umbilicus, spares head and face.

A

Scabies

TX with
topical permetrin 5% for infants >2 months and pregnanc

ivermectin 200mcg/kg PO single dose repeat in 1-2 weeks

seal everything in bag for 3 days
treat all household members, itching will persist weeks after treatment

SDNP exam (14 decks)

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