Week 6 - infectious diseases, derm, atopy, imms Flashcards
(94 cards)
1
Q
Timing of Tdap immunization in pregnancy
A
between 27-36 weeks
Health Canada recommends 27-32 weeks
2
Q
Arthrus reaction is _____ type hypersensitivity reaction
A
type 3
3
Q
ACNE
3 types of lesions
A
- comedonal
- inflammatory (pustules and papules)
- nodules and cysts
4
Q
ACNE PATIENT COUNSELLING
- Noticeable improvement of acne takes _____weeks!
- often looks worse in first _____weeks before it gets better
- If retinoids, counsel re: ______
- Benzoyl peroxide & topical retinoids - counsel re: ________
CCPPDD
A
- Noticeable improvement of acne takes 4-8 weeks!
- Acne often looks worse in first 2-4 weeks before it gets better
- Tx is non-curative
- If retinoids, counsel re: contraception
- Benzoyl peroxide & topical retinoids - counsel re: photosensitivity, irritation + drying
cleaning (soap free cleanser 1-2x/day) cosmetics (non-comedogenic) picking protection (sunscreen) diet (low glycemic) duration (long term treatment)
5
Q
ACNE TREATMENT with hormones
- duration of OCP: before improvement? max effect?
- what hormone worsens acne?
A
Duration:
- 3-4 months before improvement
- max effect at 6 months
Worse with depo provera
6
Q
ACNE TREATMENT with topical retinoids
Timing: -if used alone? -if used with benzoyl peroxide Frequency? Adverse side effects? Counselling?
A
Timing:
- best at night 20 min after washed and completely dried
- BP in AM, retinoid in PM
Frequency: start with once/week, build up
S/E: redness, peeling, stinging, dryness
Counselling: photosensitivity, teratogenic
7
Q
ACNE TREATMENT
why is spironolactone not generally used in males?
A
spiro - s/e of gynecomastia
8
Q
ACNE TREATMENT - systemic retinoids
Counselling re: contraception
Pregnancy testing
Side effects
A
contraception: need 2 reliable forms teratogenic
PREG TESTS
- twice before starting (one at discussion, one at least 11 days before starting)
- every month during
- one month after stopping
SIDE EFFECTS
- dryness (skin, mucous membranes) - worse in first 8 weeks
- avoid other topical tx d/t dryness
- photosensitivity
- initial acne flare during first 2 months
9
Q
ERYTHEMA INFECTIOSUM
- aka?
- organism?
- transmission?
A
aka Fifth’s disease
Parvovirus B19
resp secretions, percutaneous, vertical
10
Q
ERYTHEMA INFECTIOSUM
- symptoms
- characteristics of rash
- timeline
A
mild prodrome:
- fever, malaise
- slapped cheeks x 2-3 weeks
- rash: lacy reticulated macules and papules 1-4 days later, pruritic
- papular-purpuric gloves and sock syndrome
- rash 7-10 days after prodrome, resolves in 1-2 weeks
11
Q
ERYTHEMA INFECTIOSUM
-complications
A
pregnancy: fetal hydrops, growth retardation, fetal loss
adults: arthritis
aplastic crises
12
Q
ERYTHEMA INFECTIOSUM
- diagnostics
- counselling for pregnant women
A
- IgM and IgG for pregnant women if suspected
- serial US to monitor fetal hydrops if pregnant and + parvovirus
13
Q
ROSEOLA
- organism?
- transmission?
- common age?
A
-HHV 6/7
saliva
common in ages 6 months to 2 years
14
Q
ROSEOLA
- symptoms
- characteristics of rash
A
prodrome high fever x 3-5 days, URTI
rash: blanchable pink macules/papules with halo, not itchy, to trunk
**fever disappears with onset of rash
15
Q
ROSEOLA
- complications
- diagnostics
- treatment
A
self limiting
febrile seizures 15%
no Ix
supportive management
16
Q
IMPETIGO
- organism
- transmission
- common age
A
Staph aureus 80%
GAS 10%
broken skin, self-inoculation
common in ages 2-5 years old
17
Q
IMPETIGO
-characteristics of:
nonbullous
bullous
ecthyma
A
NONBULLOUS
-papules –> vesicles –> pustules, golden crusts
usually face and extremities
BULLOUS
-flaccid bullae, clear yellow –> rupture –> thin brown crust
usually on trunk
ECTHYMA
-ulcers deep into dermis
“punched out” ulcers with yellow crust
18
Q
IMPETIGO
counselling
- return to school?
- hygiene
A
return to school 24 hours after starting abx
-hand hygiene
19
Q
IMPETIGO
treatment
A
localized:
-fucidin or mupirocin x 7 days
-po abx (keflex or cloxacillin) if no response to topical abx after 24-48 hours
20
Q
MEASLES
- transmission
- incubation
- most infectious?
A
airborne and resp droplets
nose/throat secretions
incubation 8-12 days
-most infectious 1-2 days before prodrome, 4 days after rash
21
Q
MEASLES
- symptoms
- characteristics of rash
A
prodrome:
fever and 3 C’s
-conjunctivitis, coryza, cough
-koplik’s spots
Rash: maculopapular erythema behind ears and hairline –> generalized, then desquamates
22
Q
MEASLES
complications
treatment
A
- OM/pneumonia
- encephalitis
- death from resp/neuro complications
Vaccine within 72 hours of exposure
IG if MMR contraindicated
23
Q
RUBELLA
transmission
incubation
A
infected nose/throat secretions
incubation 2-3 weeks
24
Q
RUBELLA
symptoms
characteristics of rash
A
prodrome: fever, headache, URTI, conjunctivitis
maculopapular rash –> confluent
face–> trunk
postauricular/suboccipital LN
25
RUBELLA
complications
congenital rubella syndrome: birth abnormalities
miscarriage, stillbirth
arthralgia
26
KAWASAKI
symptoms
characteristics of rash
high fever x 5 days
CREAM
- conjunctivitis
- rash (not vesicular)
- extremities: palmar/plantar erythema and/or edema
- adenopathy (cervical , unilateral)
- mucosa: strawberry tongue, cracked lips
Rash: morbilliform, urticarial, scarlatiniform, erythema
27
KAWASAKI
complications
treatment
20% coronary artery damage, MI
higher risk in males
- IVIG most effective between day 5-10
- ASA
- serial echo, refer to cardio
28
SCARLET FEVER
organism
transmission
group A strep
resp secretions
29
SCARLET FEVER
symptoms
characteristics of rash
fever, headache, sore throat
- pastia lines (axilla, ACF, inguinal folds)
- strawberry tongue
rash to neck, chest, axillae
sandpaper fine red papules
30
SCARLET FEVER
complications
treatment
acute rheumatic fever
penicillin within 9 days of symptom onset
31
ROCKY MOUNTAIN SPOTTED FEVER
organism
transmission
rickettsia
tick bites
32
ROCKY MOUNTAIN SPOTTED FEVER
symptoms
characteristics of rash
fever, headache, malaise, n/v/d
rash: pink macules/papules
become petechiae/purpura
ankles and wrists --> palms and soles --> limbs --> trunk
-always involves palms and soles
33
ROCKY MOUNTAIN SPOTTED FEVER
complications
treatment
CNS involvement - seizures, blindness, deafness, coma
Multiorgan involvement
Rash can cause severe necrosis, gangrene (rare)
Fatality 1-4%
Doxycycline including those under age 9 since this is life threatening
34
DRUG RELATED RASHES
- common culprits
- characteristics of rash
- timing
sulfa, PCN, cephalosporins, anticonvulsants
erythematous macules and papules to trunk --> symmetrical spread
1-2 weeks after starting rx, can take 1-2 weeks to resolve after stopping med
35
MUMPS
transmission
timeline
airborne droplet
direct contact saliva/resp secretions
Incubation 16-18 days, max infectious 2 days before and 5 days after onset of parotid swelling
36
MUMPS
symptoms
diagnosis
fever, malaise, parotitis
dx: oral buccal swab and urine
37
MUMPS
complications
```
10% aseptic meningitis --> hearing loss
Mumps meningitis
Permanent deafness in <5 in 100,000
Miscarriage if early pregnancy
No link to birth defects
Orchitis --> can result in sterility
```
38
FLU
transmission
timeline
droplet
Infectious one day before five days after symptoms begin
***kids can spread up to 21 days after onset of symptoms
Symptoms 1-4 days after exposure
39
MRSA
treatment
- uncomplicated
- deeper/severe
- kids
uncomplicated abscess: I+D, no abx
Deeper/severe:
-septra, clinda, doxy, linezolid
Topical: mupirocin
kids: avoid tetracycline in kids <8 (tooth discolouration)
40
FEBRILE SEIZURES
simple vs complex
- clonic movement
- duration
- # per 24 hours
- neuro development
- family hx
SIMPLE
- generalized
- <15 minutes
- 1 per 24 hours
- normal neuro devt
- positive FHx
COMPLEX
-focal
->15 minutes
>1 in 24 hours
-abnormal neuro devt
-neg family hx
41
FEBRILE SEIZURES
ask about immunizations
-which organisms of concern?
Hib and strep pneumoniae
42
FEBRILE SEIZURES
investigations
none needed if simple seizure and normal neuro exam
43
viral meningitis
most common cause
transmission
enterovirus most common (85%)
initially mucosa (resp, GI) --> spread to CNS
44
PERTUSSIS
3 stages
1. catarrhal stage
- URTI
- fever UNCOMMON
- 1 to 2 weeks
2. Paroxysmal stage
- worsening paroxysmal cough
- watery rhinorrhea
- lasts 2-8 weeks
- sweating in between
3. Convalescent
weeks to months for cough to improve
45
PERTUSSIS
3 characteristics of cough associated with pertussis
```
cough lasting > 2 weeks
OR
-paroxysmal cough ANY duration
-inspiratory whoop
-associated with vomiting or apnea
```
46
PERTUSSIS
high risk contacts need chemoprophylaxis
- babies <1 year old
- pregnant women in 3rd trimester
- all household or daycare contacts if baby <1 year OR pregnant woman in 3rd trimester
47
MONO
organism
transmission
timeline
epstein barr virus
salivary transmission
oral shedding 6-18 months!
incubation 4-6 weeks
48
MONO
symptoms
characteristics of rash
```
tonsils with exudate
fever malaise etc
petechiae to palate
-posterior lymphadenopathy
-enlarged liver and spleen
```
RASH
-generalized maculopapular
trunk and arms --> face and forearms
-morbilliform, papular, scarletina, vesicular, purpuric, copper
49
MONO
complications
- splenic rupture
- glomerulonephritis
- arthritis
- hepatosplenomegaly
- meningitis
50
MONO
diagnosis
return to sports?
monospot 25% false neg in 1st week
-can be detected 2-9 weeks after exposure so often early false neg
avoid contact sports for 3 weeks (minimum 21 days)
51
DIAPER DERMATITIS
main organisms
candida albicans
| staph aureus
52
DIAPER DERMATITIS
characteristic and distribution of rash:
- candida:
- irritant:
- streptococcal
candida: scaly erythematous papules and plaques to FOLDS
irritant: BEEFY RED plaques with SATELLITE papules and pustules, CONVEX, spares intertriginous folds
strep: well demarcated bright red tender PERIANAL patch
53
DIAPER DERMATITIS
nonpharm counselling
```
• Skin care
• Clean and dry diaper area
• Change diaper frequently --> avoid cloth!
• Barrier creams
HYGIENE
```
54
DIAPER DERMATITIS
treatment
candida:
• Nystatin, miconazole, ketoconazole with every diaper change
Low potency corticosteroids (0.5-1% hydrocortisone)
secondary bacterial infection:
- mupirocin if local/mild
- keflex if worse
55
PITYRIASIS ROSEA
organism
common age group
herpesvirus 6/7
teens and young adults
56
PITYRIASIS ROSEA
onset of herald patch:
duration:
onset: herald patch 1-20 days before generalized rash
duration: 6-12 weeks
57
PITYRIASIS ROSEA
herald patch description
generalized rash description
oval pink or red plaque 2–5 cm in diameter, with a scale trailing just inside the edge of the lesion like a collaret.
generalized:
-SCALY circular or oval patch or plaques to chest or back in christmas tree pattern, itchy 25%
58
PITYRIASIS ROSEA
counselling
self-limiting
resolves in 1-2 months
moisturize dry skin
59
SCABIES
organism and lifespan
transmission
- female scabies mite burrows, lays 2-3 eggs/day, die after 4-6 weeks
- eggs hatch in 10-14 days
transmission: prolonged skin to skin contact
60
SCABIES
incubation
- primary episode
- subsequent
primary: 3-6 weeks after contact with infected person
if prior sensitization: within 1-3 days
61
SCABIES
symptoms
characteristics of rash
location
intense pruritis, worse at night
burrows, excoriated papules/pustules/vesicles
interdigital web spaces, flexor surfaces, axillae, genitals
babies: whole body including face, palms, soles
62
SCABIES
diagnostic tests
skin scraping not required (may have low number of mites)
63
SCABIES
nonpharm counselling
- all family members need to be treated
- wash towels, clothing etc in hot water
- tumble in hot dryer x 20 min
- if not able to wash: plastic bag x 1 week
64
SCABIES
pharm treatment
- dose
- contraindications
- peds consideration
permethrin 5%
-massage into skin from neck to soles of feet, leave on for 8-14 hours and shower off
contraindications: allergy to chrysanthemum/ragweed
Pediatric considerations: safe for infants as young as 2 months, need special application to scalp, temple, forehead, hands, feet. Babies: apply head to toe
REPEAT TREATMENT IN ONE WEEK
65
GUTTATE PSORIASIS
organism
timeline
beta-hemolytic strep
1-2 weeks after strep infection (tonsillitis or perianal dermatitis)
SUDDEN onset
resolves in 6-12 months
66
GUTTATE PSORIASIS
symptoms
SUDDEN onset
| small oval red papules and plaques on torso and extremities
67
SEBORRHEIC DERMATITIS
risk factors
- oily skin
- immunosuppression: transplant recipients, HIV infection, lymphoma
- neurological disorders (Parkinson’s, CVA, epilepsy)
- lack of sleep and stress
68
SEBORRHEIC DERMATITIS
organism
malassezia furfur
69
SEBORRHEIC DERMATITIS
characteristics of rash
location
yellow greasy adherent scale, minimally red
salmon pink patches or waxy
not itchy
scalp, armpit, groin, neck
folds
70
SEBORRHEIC DERMATITIS
nonpharm counselling
removal of scales:
- apply mineral/olive oil
- gently wash hours later
- do not vigorously remove hair --> permanent hair loss
71
name the atopy triad
atopic dermatitis
asthma
allergic rhinitis
72
IRRITANT DERMATITIS
-most common form?
ALLERGIC CONTACT DERMATITIS
-most common triggers
ATOPIC DERMATITIS
-most common triggers
IRRITANT
-diaper dermatitis
allergic triggers:
-poison ivy, nickel, fragrance
atopic triggers:
extreme temperatures, sweating, clothing with rough textures
exposure to skin irritants, topical medications, stress
Dust mites common aeroallergen
FOOD IS NOT COMMON
73
allergic dermatitis is what type of hypersensitivity?
delayed type (type IV)
74
ATOPIC DERMATITIS
location in infancy:
location in childhood
location in adults:
Distribution changes by age:
• Infancy: face, scalp, EXTENSOR surfaces. Diaper area spared
• Childhood and adult: FLEXURAL surfaces: neck, antecubital and popliteal fossae
Adults: greater extremity, head, neck involvement
75
PITYRIASIS ALBA
symptoms
description of rash
minimal or absent itch
| hypopigmented patch to face with fine scale
76
PITYRIASIS ALBA
treatment
counselling
no treatment if asymptomatic
- moisturize if dry
- clears after one year
77
ATOPIC DERMATITIS
nonpharm counselling
- avoid triggers
- air purifier
- NO food restriction needed
- limit baths and hot water
- emollients
- wet wraps
78
LICHEN PLANUS
- appearance
- location
- etiology
- prognosis
• Appearance:
○ Pruritic, polygonal, pink-purple flat-topped papules
○ Sometimes overlying delicate white lines (Wickham striae)
Pinpoint to >1 cm
• Location
○ Flexor surfaces
○ Rare in kids to involve mucous membranes and nails (50% of adults have oral lichen planus, 10% nails)
• Etiology
○ Unknown, ?virus ?medication
○ DermNet: T-cell mediated autoimmune disorder
• Prognosis
○ Resolves within 1-2 years, can have grey-brown post-inflammatory macules that will eventually fade
79
LICHEN STRIATUS
- appearance
- location
- etiology
appearance:
- flat topped papules, slightly hyperpigmented
- confluent red scaly linear bands
location
-blaschko lines
etiology unknown
80
LICE
organism and patho
transmission
allergic reaction to lice saliva during feeding
onset of itching delayed for 4-6 weeks
lifespan of louse is one month
-can survive 55 hours without host
transmission:
direct contact with head of infested patient
81
LICE
pharm counselling
- do not use conditioner before treatment
- rinse over sink instead of bath/shower
- rinse with warm water (instead of hot)
- keep treatment on for 10 minutes before rinsing
- REPEAT TREATMENT on day 9
82
Description of lesion morphology
SCALDA
```
size
colour
arrangement
lesion morphology
distribution
always check hair, nails, mucus membranes, between fingers and toes
```
83
MEASLES recovery
cough can persist for ____ weeks
fever beyond day ____ of rash suggests measles-related complication
two most common complications
cough can persist for 1-2 weeks
fever beyond day 3-4 of rash suggests complication
most common complication diarrhea and otitis media
84
MEASLES testing
NP swab: up to 8 days after rash onset
urine: up to 14 days after rash onset
IgM and IgG within 7 days of rash onset, repeat 10-14 days after first sample to determine if seroconversion
85
MEASLES
nonpharm counselling
- airborne for up to 2 hours
- isolation for 4 days after start of rash
- avoid pregnant, unvaccinated or immunocompromised people
86
MEASLES
when should contacts should receive vaccine?
incompletely immunized contacts:
| -within 72 hours of last exposure to infected person
87
VARICELLA ZOSTER
symptoms
characteristics of rash
fever and malaise x 2-3 days
generalized pruritic rash to torso, face, extremities
VESICULAR
various stages of resolution: macule --> papules --> vesicle
88
VARICELLA ZOSTER
complications
if in pregnancy: congenital varicella syndrome
- fetal demise
- secondary infection with staph
89
MONO
monospot detects _____ antibodies
______ weeks after infection
heterophil antibodies
detected 2-9 weeks after infection
90
MONO
splenic rupture symptoms
abdo pain
falling hematocrit
usually 14 days after symptom onset
91
complications of varicella
- superinfection
- pneumonia
- CNS involvement
- Reye syndrome
- glomerulonephritis
- arthritis
- congenital varicella syndrome (limb atrophy, CNS malformation, low birth weight, cataracts, learning disabilities)
- fetal demise
92
complications of HSV
conjunctivitis
- keratitis
- encephalitis
- secondary infection
93
varicella
symptoms
generalized pruritic rash
-torso, face, extremities with fever and malaise x 2-3 days
100s of vesicles in various changes
-rapidly changes from macular --> papular --> vesicle --> crusted
94
Hand foot mouth disease
- organism
- location of rash
-coxsackievirus
-vesicles and ulcers in buccal mucosa, tongue, palate, hands and feet
high fever
common in kids <5
